Early identification of pulmonary congestion in acute coronary syndrome (ACS) remains challenging and is associated with adverse outcomes. Lung ultrasound (LUS) is a rapid bedside tool that may improve early clinical risk stratification. We conducted a prospective observational cohort study including 189 patients with type-1 ACS. LUS was performed within 24 h of admission; LUS positivity was defined as ≥ 3 B-lines in ≥ 2 zones per hemithorax. The number of lung segments with ≥ 3 B-lines was analyzed as a continuous variable. NT-proBNP and CA125 were also measured within 24 h of admission. The primary in-hospital outcome was acute heart failure (AHF), defined as the need for intravenous diuretics or mechanical ventilatory support. The long-term outcome was a 1-year composite of all-cause death, stroke, reinfarction, or hospitalization for heart failure. LUS positivity was present in 15.9
This study aims to evaluate evacuation performance in a high-acuity intensive care unit (ICU) by integrating building information modeling (BIM) and computational simulation and examine how different parametrizations affect the fidelity of predicted evacuation dynamics when compared with data from a real evacuation drill. A detailed BIM model of a tertiary hospital ICU was developed and imported into Pathfinder to simulate 3 protocol-based evacuation scenarios and 1 scenario calibrated with preparation times obtained from a 2024 evacuation drill. Simulations assessed occupant flow, bottlenecks, movement trajectories, and total evacuation times. Architectural constraints, behavioral rules, and patient dependency profiles were incorporated to reflect real operational conditions, including explicit geometric incompatibilities between door widths and ICU bed dimensions. Evacuation times produced with generic parameters showed a gap of up to 7 minutes 40 seconds less than the real drill duration, whereas the empirically calibrated simulation narrowed this difference to 2 minutes 30 seconds. Across all scenarios, bottlenecks consistently emerged at the main critical patient unit exit, primarily driven by architectural constraints such as insufficient door widths relative to bed size, which hindered bed maneuverability and intensified staff circulation conflicts. Flow rates peaked between 0.40 and 0.55 persons/s, with higher occupancy producing more sustained congestion. Preparatory actions for clinically complex patients significantly shaped overall evacuation performance. The integration of BIM and empirically informed simulation enhances the accuracy and operational relevance of evacuation analyses in complex clinical environments. Findings highlight the need for calibration based on real behavioral data and demonstrate how specific architectural mismatches, particularly between door geometry and bed dimensions, act as critical drivers of evacuation bottlenecks. This approach supports more robust risk assessment and emergency planning within critical socio-technical infrastructures.
BackgroundNovel treatments are needed to improve the poor prognosis of metastatic cancers. The ELEVATE Lung&UC study evaluated magrolimab plus docetaxel in patients with metastatic non-small cell lung cancer (mNSCLC), metastatic small cell lung cancer (mSCLC), and metastatic urothelial carcinoma (mUC).MethodsThis phase II, open-label, multi-arm study enrolled patients who had received 1–2 (mNSCLC, mSCLC) or 2–3 prior lines of therapy (mUC) in the locally advanced/metastatic setting. A safety run-in (SRI) cohort (mNSCLC/mSCLC/mUC) followed by a phase II cohort (three groups: mNSCLC, mSCLC, mUC) were planned. Primary endpoints were incidence of treatment-emergent adverse events (TEAEs; SRI and phase II) and objective response rate (ORR; phase II).ResultsThe SRI cohort (n = 9) had no dose-limiting toxicities. In phase II (mNSCLC, 29 patients; mSCLC, 42 patients; mUC, 26 patients), ORRs were 17.2% (mNSCLC), 4.8% (mSCLC), and 3.8% (mUC). Grade ≥3 magrolimab-related TEAE rates were 48.3% (mNSCLC), 47.6% (mSCLC), and 57.7% (mUC). A fatal TEAE suspected as magrolimab related (intracranial hemorrhage) occurred in one patient with mSCLC and brain metastasis (phase II). The study was closed early, which limited the interpretation of results due to short follow-up and limited endpoint maturity.DiscussionAdding magrolimab to docetaxel had manageable toxicity but no meaningful improvement in efficacy. These results provide insight into the safety and efficacy of anti-CD47–containing therapies and reinforce the need for treatments that address the unmet needs of patients with previously treated metastatic solid tumors.
Optimal glycemic control is essential to prevent complications in diabetes, and insulin administration practices play a key role. This study assessed insulin injection behaviors and related glycemic outcomes among individuals using multiple daily injections in Spain. A cross-sectional online survey was conducted via an independent patient platform (Canal Diabetes). Adults (18–65 years) with type 1, type 2, or other forms of diabetes (e.g., maturity-onset diabetes of the young (MODY) or secondary diabetes) requiring daily insulin injections were included. Demographic, clinical, and behavioral data were analyzed using SPSS Statistics, version 23 (IBM Corp., Armonk, NY, USA). Among 288 participants (mean age: 43.7 ± 14.7 years; 28.8
