The venous excess ultrasound score (VExUS) is a promising method to assess venous congestion in adults, but evidence in children is scarce. This study aimed to evaluate the feasibility, reproducibility, and clinical usefulness of VExUS in pediatric patients. We also explored whether portal venous Doppler (PVD) alone could serve as a faster alternative and assessed the role of inferior vena cava (IVC) measurements. In this prospective single-center study, 35 pediatric patients were enrolled between 2022 and 2024. Associations between clinical variables and VExUS grades at admission (VExUS-0), 24 h (VExUS-24 h), and 48 h (VExUS-48 h), as well as PVD at corresponding time points, were analyzed. The relationship between IVC diameter and VExUS was also evaluated. VExUS demonstrated perfect reproducibility (κ coefficient and intraclass correlation coefficient = 1). Patients with VExUS-0 or VExUS-24 h grades 2–3 had longer aortic cross-clamp times (p = 0.03; 0.04) and higher vasoactive–inotropic scores (p = 0.01) than those graded 0–1. A higher incidence of acute kidney injury was observed in VExUS-24 h grades 2–3 (p = 0.04). Similar associations were found with PVD. Most patients with VExUS grades 2–3 had non-dilated IVCs according to pediatric reference values. Conclusion: VExUS is a feasible, reproducible, and clinically relevant bedside tool for detecting venous congestion in children. Its association with morbidity markers suggests prognostic potential, with optimal performance 24 h after PICU admission. PVD may provide comparable information in less time, while IVC diameter appears unreliable for this purpose.
Morton’s neuroma is one of the most common forefoot pathologies. In recent years, radiofrequency ablation has emerged as a minimally invasive alternative to surgical excision, aiming to relieve symptoms while reducing morbidity. To compare the efficacy and safety of radiofrequency neurolysis and surgical excision for the treatment of Morton’s neuroma at our institution. A single-center, observational, retrospective, and longitudinal study was conducted including patients treated between 2012 and 2022. Clinical data from patients who underwent either surgical excision or radiofrequency ablation were analyzed. Demographic characteristics, pain intensity assessed using the Visual Analog Scale (VAS), complication rates, and reintervention rates were recorded, with a minimum follow-up of two years. Statistical analysis was performed using SPSS version 25. A total of 192 procedures were identified (110 surgical excisions and 82 radiofrequency ablations). For analyses focused on demographic and baseline characteristics, repeated procedures performed in the same patient were grouped, resulting in 144 unique cases (92 excisions and 52 radiofrequency ablations). Both techniques resulted in significant pain reduction. Surgical excision achieved greater VAS improvement (− 5.57) compared with radiofrequency ablation (− 4.3). Complications were more frequent after surgical excision (13
BACKGROUND:Immunotherapy based on anti-PD1 inhibitors has significantly improved survival in advanced melanoma. However, a significant proportion of patients do not benefit, and predicting response to immunotherapy remains an area of unmet need. Our group previously defined an immune signature able to predict response to anti-PD1 inhibitors in this scenario. METHODS:In this study, we analyzed two cohorts of patients with advanced melanoma treated with anti-PD1 inhibitors: the GEM cohort, previously used to validate our immune signature, and Campbell's cohort, which contains data about different immunotherapy schemes. Using the 107 genes that compose our immune signature and consensus clustering, samples were classified as immune-low or immune-high. Then, CIBERSORTx and Ecotyper were used to estimate the proportion of each immune cell type and carcinoma ecotypes in both cohorts. RESULTS:We confirmed that the immune-low group includes mostly patients who do not response to anti-PD1 inhibitors. We also studied the distribution of carcinoma ecotypes in the immune-high and immune-low groups defined by our immune classification. Ecotypes CE9 and CE10 clustered in the immune-high group, with good response to treatment. The use of combination immunotherapy improved response rate both in immune-low and immune-high tumors. The immune-high group contained a higher number of CD8 T cells, B memory cells and T follicular helper cells. CONCLUSIONS:Our immune-based classification defines an immune-low group of tumors with poor response to anti-PD1 inhibitors. This immune classification is related to carcinoma ecotypes. Finally, a use of a combo scheme improves the rates of response both in immune-high and low groups but in the case of immune-low tumors, our results suggests that a combo treatment approach could be an adequate strategy and should be further explored in these patients. Altogether, our results support the utility of our immune signature in the prediction of response to anti-PD1 inhibitors in advanced melanoma.
This article presents a case study illustrating the contemporary integrative cognitive approach, a multidimensional model that weaves together cognitive, behavioral, affective, motivational, developmental, interpersonal, and sociocultural dimensions. The approach promotes dimensional and idiographic formulation to understand psychopathology as the expression of life trajectories. The case of Sofía, a 30-year-old outpatient with personality-spectrum difficulties, exemplifies how this model guides individualized intervention through collaborative meaning-making. Over two years of psychotherapy, work focused on affect regulation, schema modification, and the reconstruction of autobiographical narratives within a safe therapeutic relationship. Quantitative outcome monitoring and a qualitative first-person evaluation converged to show significant improvements in functioning, emotional awareness, and agency. The case underscores how integrative cognitive psychotherapy can support patients in becoming active protagonists of their own life stories.
BACKGROUND:Hepatitis C virus (HCV) has significantly impacted people with human immunodeficiency virus (HIV). Harm reduction programs, changing transmission patterns, and direct-acting antivirals (DAAs) have profoundly altered HIV/HCV coinfection trends. This study evaluates HCV prevalence among people with HIV in Spain over 2 decades. METHODS:We conducted 9 cross-sectional studies (2002-2023) in 39-43 centers. Sampled individuals were randomly sampled from people with HIV actively followed up at these centers, with proportional allocation. Main outcomes included the prevalence of anti-HCV antibody and active HCV infection (HCV RNA--positive result). RESULTS:The reference population ranged from 31 800 to 47 006, with sample sizes of 1260-1867. HIV transmission patterns shifted from 2002 to 2023, with injection drug use decreasing from 55% to 21% and the proportion of men who have sex with men increasing from 17% to 46%. HCV seroprevalence fell from 60.8% to 27.4%, and active infection from 46.3% to 0.9%. In the DAA era (2015-2023), active HCV infection dropped by 100% in heterosexuals, 94% in people who inject drugs, and 71% in men who have sex with men. Treatment uptake increased from 23% in 2002 to 99% by 2023 with all-oral DAAs. The prevalence of cirrhosis among active HCV cases peaked at 23.1% in 2015 but fell to 0% by 2021. Among those achieving sustained virologic response, cirrhosis prevalence was 20.4% in 2023. CONCLUSIONS:HIV/HCV coinfection has drastically declined in Spain, with active HCV infection prevalence <1% since 2021. DAAs were pivotal in this achievement. However, cirrhosis remains a concern among those with sustained virologic response. Ongoing surveillance and prevention efforts are essential to sustain these gains and address residual risks.
