Citations

Background High-quality research studies on therapeutic approaches for migraine management in pediatrics are scarce. Therefore, we conducted a systematic review of current clinical practice guidelines for the diagnosis and management of migraine in children and adolescents to identify areas of consensus and disagreement, as well as critical gaps, paving the way for future updates and improvements. Methods We searched PubMed, WOS, and SCOPUS for guidelines published in the English language in the last 10 years focused on the diagnosis and management of migraine in children and adolescents. Results Following a systematic search, eight eligible guidelines were identified. These guidelines were authored by the American Academy of Neurology (AAN), the European Headache Federation/European Academy of Neurology (EHF/EAN), the International Headache Society (IHS), National Institute for Health and Care Excellence (NICE), the Danish Headache Society, and the German Migraine and Headache Society and the German Society of Neurology. There was a broad consensus on considering the International Classification of Headache Disorders-3rd edition as the diagnostic reference. As regards management, paracetamol and ibuprofen were considered first line in the acute management of migraine, with sumatriptan and zolmitriptan nasal sprays rated as second line. Injectable medications for acute management were overlooked in most guidelines. On the other hand, targeted age groups, dosing, and preventive treatment choices showed areas of variability. Various non-pharmacological measures gained attention in all guidelines. Notably, CGRP antagonists and non-invasive neuromodulation techniques were identified as major gaps. Conclusion The current systematic review highlights areas of agreement and disagreement between existing guidelines on the management of childhood and adolescent migraine and emphasizes the current gaps and opportunities, thus offering a solid foundation for future studies and guidelines.

Abstract Objective To estimate the incidence of de novo chronic rhinosinusitis and identify associated risk factors in kidney and liver transplant recipients without pre‐existing sinonasal complaints. Study design Retrospective cohort study. Setting Multisite study across Mayo Clinic Enterprise locations in Arizona, Florida, Minnesota, and Wisconsin. Methods Records of all patients who underwent kidney or liver transplantation between November 1, 2021, and November 1, 2022 were reviewed. Patients with documented sinonasal complaints prior to transplantation were excluded. Diagnoses were based on ICD‐10 codes assigned by board‐certified otolaryngologists, with follow‐up extending through November 2024. Demographic and clinical variables were collected, and multivariable logistic regression was used to identify predictors of de novo chronic rhinosinusitis. Results Among 1459 transplant recipients (mean age 55.1 years, 59.8% male), the cumulative 2‐year incidence of de novo chronic rhinosinusitis was 2.4% (24/986) in kidney and 2.3% (11/473) in liver transplant recipients ( P = .89). The overall incidence rate was 12.0 cases per 1000 person‐years, exceeding general population estimates. Transplant rejection (OR 3.2, 95% CI 2.5‐3.9, P < .001) and additional organ transplantation (OR 5.0, 95% CI 3.4‐6.5, P = .041) were independently associated with chronic rhinosinusitis development. Conclusion Kidney and liver transplant recipients experience a higher incidence of de novo chronic rhinosinusitis compared to the general population. Transplant rejection and additional organ transplantation significantly increase this risk. Early recognition and management of chronic rhinosinusitis in this population may support improved postoperative outcomes.

ABSTRACT Magnetic Resonance Spectroscopy Imaging (MRSI) offers spatially-resolved, neurometabolic information, acquired non-invasively at whole-brain scales from human subjects. Analysis of MRSI however, is extremely challenging. The metabolic information is highly convolved, and sparsely distributed across millions of spatial-spectral datapoints, allowing for little direct human interpretation. Conversely, the overall low signal-to-noise with high-intensity artifacts can confound unsupervised machine learning approaches. These technical barriers have left much of the potential of MRSI unrealized. We acquired MRSI data from 4 human subjects with a diagnosis of multiple sclerosis (MS), incorporating experimental design into an informed machine learning approach. MRSI acquisitions were registered to anatomical MRI to label 105k spectra from brain tissue and 162 spectra from white matter hyperintensities (WMHs), an imaging biomarker associated with MS lesions. Spectral labels were then used in contrastive principal component analysis (cPCA) to filter artifacts and background features in the MRSI data from lesion salient features and clustered into statistically significant states based on features that could be interpreted from the original data. Our approach renders MRSI data into testable representations of neurometabolism, enabling the method for fundamental and clinical research. Graphical Abstract Analysis workflow for neurometabolic profiling of MS lesions. MRSI and anatomical MRI is acquired and processed in parallel for spectral data and anatomical labels. Spectra are then labeled and separated into experimental vs background data for contrastive PCA. Spectra are clustered for similarity, further labeled, and projected onto a brain atlas for a neurometabolic view.

Background The optimal long-term antiplatelet monotherapy after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) remains uncertain, with limited data comparing aspirin and clopidogrel monotherapy. This meta-analysis aims to compare the safety and efficacy of clopidogrel versus aspirin in patients who have completed a standard duration (≥6 months) of event-free dual antiplatelet therapy (DAPT) following PCI with DES. Methods A comprehensive literature search was conducted across major electronic databases through May 2025 to identify relevant studies that compared clopidogrel monotherapy with aspirin monotherapy in adults who had undergone PCI with DES implantation. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE). Pooled estimates of relative risks (RRs) and adjusted hazard ratios (HRs) were calculated using a random-effects model. Results Five studies [two randomized controlled trials, three observational studies; n = 16, 289 patients] were included. Clopidogrel monotherapy was associated with a significant 31% reduction in MACCE compared with aspirin monotherapy [RR: 0.69; 95% confidence interval (CI) 0.60–0.79; P < 0.0001]. A pooled analysis of HRs demonstrated a similar benefit (HR: 0.67; 95% CI 0.58–0.77). Incidences of major bleeding and all-cause death were comparable between the two groups (RR: 0.93; 95% CI 0.57–1.51 and RR: 0.96; 95% CI 0.74–1.25, respectively). Notably, the analysis of HRs demonstrated that clopidogrel significantly reduced the risk of stroke (HR: 0.60; 95% CI 0.45–0.82; P = 0.001) and myocardial infarction (MI) (HR: 0.65; 95% CI 0.49–0.88; P = 0.005). Conclusion Clopidogrel monotherapy is more effective than aspirin for long-term prevention of MACCE, MI, and stroke, without increasing the major bleeding risk. Prospero ID CRD420251070685

Background The use of 3D imaging with navigation bronchoscopy has increased with the introduction of mobile cone-beam CT (mCBCT). Shape-sensing robotic-assisted bronchoscopy (ssRAB) integrated with mCBCT has been introduced to correct for CT to body divergence (CT-BD) during the biopsy of peripheral pulmonary nodules (PPNs). Methods Prospective observational multicentre study, enrolling patients with a PPN of ≤20 mm suspicious for malignancy, assessing tool-in-lesion (TIL), diagnostic yield, sensitivity for malignancy and incidence of pneumothorax or airway bleeding. Non-malignant index biopsies were followed for 12 months. Descriptive statistics are reported for all variables along with 95% CI for primary endpoints. Results 155 consecutive patients were enrolled at six centres. Median nodule size was 14.0 mm (IQR 11.0–17.0), with 54.8% of nodules (85/155) in the upper lobes, 25.8% (40/155) with CT bronchus sign present and median distance to the nearest pleural surface of 8.2 mm (IQR 1.8–20.0). TIL was achieved in 154/155 (99.4%, 95% CI 96.5 to 100.0) procedures. A median of two (IQR 1–3) mCBCT spins were performed, with median dose area product of 25.7 Gy · cm 2 (IQR 11.0–46.7). Diagnostic yield per the American Thoracic Society/American College of Chest Physicians (ATC/ACCP) definition was 89.0% (n=138/155; 95% CI 83.0 to 93.5) and sensitivity for malignancy was 91.5% (95% CI 86.4 to 96.5). No pneumothorax (0%, 95% CI 0.0 to 2.4) and two Nashville Grade three bleeding events were reported (1.3%, 95% CI 0.2 to 4.6). Interpretation The first prospective multicentre study of integrated ssRAB and mCBCT for small peripheral nodules resulted in diagnostic outcomes similar to those reported for transthoracic biopsy with a more favourable safety profile. Trial registration number ClinicalTrials.gov ID: NCT05562895 .

Over 53 million people in the United States provide unpaid care for individuals of all ages, including the elderly, chronically ill, and/or disabled. Additionally, 5.4 million caregivers are youth under the age of 18. Together, they deliver an estimated $600 billion in unpaid care annually, which is three times the amount Medicaid spends on professional long-term care. Few alternatives exist for families in the private and public sectors; even when options are available, they can often be unaffordable. The situation in the United States reflects a global crisis having business and economic implications. Unpaid adult caregiving frequently disrupts jobs and increases absenteeism, creating a trickle-down effect on caregiving youth who must act as adult substitutes and suffer comparable hardships. The United Kingdom enacted legislation addressing “youth carers,” but implementation has proven largely ineffective. This paper examines global service frameworks and policies addressing caregiving youth, employing a policy analysis research methodology, and proposes regulatory solutions based on insights from international experiences.

Non-muscle-invasive bladder cancer (NMIBC) comprises approximately 75% of new bladder cancer cases and generally carries a favorable prognosis, yet high rates of recurrence and progression necessitate close surveillance with frequent cystoscopies and repeated transurethral resections. Upfront treatment for high-risk disease is typically Bacillus Calmette-Guérin (BCG), although combinations with immune checkpoint inhibitors have reported results. Patients with BCG-unresponsive, intolerant, or refractory disease represent a subset of patients with high risk of progression, with early radical cystectomy being the standard approach for this setting. Global BCG shortages and the substantial impact of cystectomy on quality of life underscore the need for therapeutic alternatives. Over the past decade, investigational trials in immunotherapy have expanded treatment options for BCG-unresponsive NMIBC with CIS, leading to FDA approval of intravesical nadofaragene firadenovec, nogapendekin alfa-inbakicept, and systemic pembrolizumab. This narrative review summarizes developments in intravesical and systemic immunotherapies for NMIBC, highlights ongoing trials, and addresses controversies in trial design, treatment sequencing, comparative efficacy, and safety.