This update and revision of the international guideline for urticaria was developed in accordance with the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. It is an initiative of the Global Allergy and Asthma Excellence Network (GA(2)LEN) and its Urticaria and Angioedema Centers of Reference and Excellence (UCAREs and ACAREs), with the participation of 210 delegates from 107 national and international societies, from 59 countries. The consensus conference was held on December 6th, 2024. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell-driven disease, defined by a rapid appearance of wheals, angioedema, or both. The lifetime prevalence of acute urticaria is estimated to be approximately 20%. Chronic urticaria, categorized as either chronic spontaneous urticaria or chronic inducible urticaria, is disabling, impairs quality of life, and affects performance at work and school, however, novel therapies are available. This updated version of the international guideline for urticaria covers the definition and classification of urticaria and outlines expert-guided and evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria.
Lung resection for necrotizing pneumonia and lung abscess is often required to treat septic complications from refractory lung infections. All extents of parenchymal resection can be performed either by thoracotomy or thoracoscopic to successfully remove destroyed non-functional parenchyma while preserving viable tissue. Lobectomy is the commonest anatomic procedure while creation of pedicled muscular and pericardial flaps for stump reinforcement or space obliteration is common adjunct. As single lung ventilation is required for anatomic resections, treatment of any contralateral respiratory infection is mandatory. Respiratory support is not a contraindication but ventilated patients and those in ECMO are at higher risk. Early intervention and hemodynamic stabilization are important for improved outcomes.
Ulcerative colitis (UC) is driven by a dysregulated mucosal immune response. Interleukins (ILs) orchestrate both pro-inflammatory and regulatory pathways, but their systemic profiles before therapeutic intervention remain unclear. Identifying early cytokine signatures may help stratify disease and guide precision immunotherapy. This meta-analysis aimed to characterise the serum interleukin landscape of treatment-naïve adult UC. A systematic review and meta-analysis was conducted in accordance with PRISMA. PubMed, Scopus, Embase and Web of Science were searched from database January 1995 to September 2025 for studies assessing serum interleukins in untreated UC versus healthy controls. Inclusion criteria: adults ≥18 years; confirmed UC; treatment-naïve at sampling; extractable mean, SD and sample size for IL-17A, IL-8, IL-23 or IL-10; and healthy controls. Exclusion criteria: paediatric cohorts, tissue-only cytokine assays, interventional studies, unavailable quantitative data, and studies on IL-6, IL-1β or IL-33 due to predefined heterogeneity. Standardised mean differences (SMDs) with 95 % confidence intervals (CIs) were pooled using random-effects models (DerSimonian–Laird). Between-study heterogeneity (I²) and publication bias (Egger’s test) were assessed. Analyses were conducted in IBM SPSS Statistics v30.0. Eighteen studies met eligibility criteria (5 IL-17A, 5 IL-8, 4 IL-23, 4 IL-10). Compared with healthy controls, treatment-naïve UC showed: • IL-23: SMD 4.08 (95% CI 3.30–4.86; p<0.0001; I²=46%) • IL-17A: SMD 2.07 (1.48–2.66; p<0.0001; I²=60%) • IL-8: SMD 2.03 (1.27–2.79; p<0.0001; I²=0%) • IL-10: SMD −2.57 (−3.27—1.88; p<0.0001; I²=0%) These findings indicate a reproducible pattern of increased IL-23, IL-17A and IL-8, accompanied by reduced IL-10, in untreated UC across independent cohorts. Across available studies, treatment-naïve UC demonstrates consistent serum cytokine changes characterised by higher IL-23, IL-17A and IL-8 and lower IL-10 compared with healthy controls. This pattern may reflect upstream immune pathway activity in early disease and could support further evaluation of serum interleukins as potential non-invasive biomarkers in UC. References: 1. Liu X, Chen H, Shao L, et al. Updated cytokine profiling in ulcerative colitis. Front Immunol. 2023;14:1123456. 2. Lucaciu O, Copotoiu C, Copotoiu R, et al. Serum cytokine profiles in inflammatory bowel disease. J Immunol Res. 2021;2021:1-10. 3. Akpinar H, Yilmaz B, Dogruel N, et al. Serum IL-23 and IL-10 levels differentiate ulcerative colitis from controls. Eur J Gastroenterol Hepatol. 2020;32(8):1032-1040. 4. Zuo L, Li Y, Wang H, et al. Serum inflammatory cytokines in ulcerative colitis. World J Gastroenterol.2015;21(27):8271-8281. Conflict of interest: Dr. Martinos, Nikolaos: No conflict of interest Lazaris, Andreas C.: No conflict of interest Kroupis, Christos: No conflict of interest Kranidiotis, Georgios: No conflict of interest Stefanidis, Gerasimos: No conflict of interest Vasileiadis, Konstantinos: No conflict of interest Karakoidas, Christos Andreas: No conflict of interest Spyridon, Sgouros: No conflict of interest Thomopoulou, Georgia-Eleni: No conflict of interest
OBJECTIVE:There has been major controversy regarding the long term risk of death associated with the use of paclitaxel coated devices in the lower limbs. The authors performed a contemporary systematic review and meta-analysis. DATA SOURCES:Data sources included published literature and repositories of regulatory agencies. REVIEW METHODS:All cause mortality was analysed on the intention to treat principle. Because of violation of proportional hazards, reconstructed patient level survival data (R2 = 0.999) were fitted with piecewise Cox models and flexible generalised survival models with natural splines and shared frailty terms. Survival differences were summarised with the non-parametric statistical tests of the difference and the ratio of restricted mean survival time lost (RMTL). RESULTS:Thirty-four randomised studies with 7 486 subjects and 25 465 person years were included, more than twice the size of the latest industry sponsored meta-analysis for regulatory purposes. In the long term, there were 575 deaths amongst 4 231 patients in the paclitaxel arms (13.6% crude risk) vs. 367 deaths amongst 3 255 patients in the control arms (11.3% crude risk), with an average hazard ratio (HR) of 1.18 (95% confidence interval [CI] 1.03 - 1.35; p = .015). The RMTL ratio (non-parametric analogue of HR) was 1.21 times (95% CI 1.07 - 1.38; p = .003) at 5 years. The absolute RMTL difference was 0.08 years (95% CI 0.03 - 0.13; p = .004) at 5 years. The HR significantly varied over time, displaying a dynamic temporal pattern. Soon after treatment, HR progressively increased and became statistically significantly higher before the end of the first year and for most of the second year (HR 1.45, 95% CI 1.11 - 1.89; p = .007), before declining towards unity (neutral) again up to 5 years. There was modest between trial heterogeneity (θ = 0.083; p = .017) and level of certainty by Grading of Recommendations Assessment, Development and Evaluation was moderate. CONCLUSION:There is a significant, dynamic increase in all cause mortality following application of paclitaxel coated devices in the femoropopliteal artery.
Artificial intelligence has shown promise in assisting radiologists in imaging-based diagnosis across a wide range of diseases. Efficient training of large deep learning models is essential to cope with extremely large data sets or dynamically growing disease data, like in a pandemic like situation. In this retrospective study, we collected 300 CT scans from COVID-19 and non-COVID-19 pneumonia patients from three different centers in Germany. We investigated a hybrid CNN-DNN network model based on image decomposition and localization that naturally supports parallel and efficient training of deep learning models. In total, 156 models with three different architectures were trained to capture features at different levels resulting in 12 patient-level COVID-19 diagnosis models. Diagnostic performance as well as time saving were measured. The highest accuracy was obtained from DenseNet121 and 3D CNN models with a parallel CNN-DNN approach, resulting in 88.78% training, 76.67% validation and 76.03% test accuracy for the DenseNet121 with 4×4×1 subdomains and 87.72% training, 76.82% validation and 74.86% test accuracy, respectively, for the 3D CNN with 4×4×1 subdomains. The strongest reduction in parallel training time by a factor of 31 was observed for the 3D CNN model and 4×4×2 subdomains. Our parallel training approach improves efficiency as well as performance enabling rapid model development, among others crucial for pandemic preparedness.
