The growing recognition of autonomic nervous system (ANS) dysfunction across a broad spectrum of neurological and systemic diseases calls for structured, multidisciplinary care. This position statement by the European Federation of Autonomic Societies aims to provide guidance on establishing an autonomic unit within a neurology department. A Task Force appointed by the European Federation of Autonomic Societies board in October 2022 proposed staffing and equipment requirements for autonomic units, based on a literature review, survey data from ANS laboratories, and existing diagnostic guidelines. These propositions were integrated into the initial 25 questions and refined using a modified Delphi method to achieve expert consensus. Consensus was predefined as ≥ 80
INTRODUCTION:Evidence suggests that the distal radioulnar joint injury associated with an operatively treated displaced fracture of the distal radius does not benefit from specific treatment after the radius is realigned. To better understand variation in treatment of the distal radioulnar joint we performed a scenario-based experiment presenting radiographs of displaced distal radial fractures accompanied by clinical scenarios with randomized aspects. METHODS:In a survey-based experiment, participants of the Science of Variation Group viewed a random subset of five of 10 sets of radiographs showing displaced fractures of the distal radius before and after anterior plate fixation. Each was accompanied by a clinical scenario with trauma energy level, age and gender randomized. Participants indicated their preferred distal radioulnar joint treatment: none, cast immobilization, operative reattachment of ligaments or ulnar styloid fixation, or distal radioulnar joint pinning. Factors associated with any treatment and with reattachment were sought in multivariable regression. RESULTS:Surgeons recommended distal radioulnar joint treatment in 67% (404 of 607) of the scenarios, most commonly cast immobilization in 41% (247 of 607). Recommendation for any distal radioulnar joint treatment was associated with younger patient age, and for reattachment specifically, was associated with younger patient age, high-energy trauma and fracture of the base of the ulnar styloid. CONCLUSIONS:The observation of frequent recommendation for distal radioulnar joint treatment, relatively more so for younger patients with higher energy injuries, and some tendency to repair an aligned ulnar styloid base fracture may diverge from existing evidence.
The R2 (lenalidomide-rituximab) and R2 with bendamustine (R2B) regimens are both feasible in relapsed/refractory follicular lymphoma (R/R FL), but prospective phase II data on R2B are lacking. In this multinational, prospective, randomised, non-comparative trial, patients with R/R FL were randomised 1:1 to R2 (arm A) or R2B (arm B). Patients achieving CT-based partial or complete remission (PR/CR) received rituximab maintenance every 3 months for 2 years. Co-primary endpoints were investigator-assessed CR rates at end-of-induction (EOI) and severe toxicity rates. Between December 2014 and July 2019, 92 patients were randomized. The trial was stopped prematurely due to slow accrual. CR rates at EOI were 11.4% (95% CI [3.8, 24.6%]) for R2 and 15.2% (CI [6.3, 28.9%]) for R2B. With a median follow-up of 74 months, predefined severe toxicities occurred in 3 (6.8%; CI [1.4, 18.7%]) and 6 pts (13.0%, CI [4.9, 26.3%]) in Arm A and Arm B respectively, with 2 pneumonia-related deaths in arm A and no treatment-related deaths in arm B; 43% and 66% experienced any grade 3-4 AE (2%/7% grade 4). At 60 months, in arms A and B event free survival (EFS) was 39.5% (CI [25.1, 53.6%]) and 56.4% (CI [40.1, 69.3%]). Overall survival (OS) was excellent at 72.1% and 86.3%, respectively. R2 and R2B are both effective treatment regimens for R/R FL. While CT-based CR rates were low, treatment with R2B resulted in numerically longer median EFS and OS, but this was associated with higher toxicity.
Scapular fractures are predominantly managed non-operatively. However, a subset of patients develops persistent pain, weakness, and functional impairment due to malunion, non-union, rotator cuff dysfunction, or scapulothoracic dyskinesia. Early identification of patients at risk for ongoing symptoms is essential, as timely surgical intervention may improve outcomes. Owing to the lack of randomized controlled trials comparing operative and non-operative management, surgical indications remain controversial. This article reviews the biomechanics of the scapula, mechanisms of injury, fracture types, and current operative indications. Two clinical cases are presented to illustrate decision-making in operative versus non-operative treatment. While selected patients benefit from surgical fixation with good long-term functional outcomes, evidence indicates that both treatment strategies can achieve high union rates when appropriately individualized.
