The approach outlined above for describing and reporting sonographic features of breast masses represents only the initial step in the development of a comprehensive system to enhance the accurate identification, reporting, and analysis of sonographic abnormalities of the breast. Future revisions, with validation of interobserver consistency in application of these descriptors across multiple centers, with feedback from potential users in the breast imaging community, will undoubtedly expand the utility of this effort.

Toward a standardized breast ultrasound lexicon, BI-RADS: ultrasound.

Seminars in Roentgenology

Waldenstr&#xf6;m macroglobulinemia (WM) is a lymphoplasmacytic lymphoma with immunoglobulin M (IgM) monoclonal protein. Clinical features include anemia, thrombocytopenia, hepatosplenomegaly, lymphadenopathy, and rarely hyperviscosity.

The presence of IgM monoclonal protein associated with &#x2265;&#x2009;10% clonal lymphoplasmacytic cells in bone marrow confirms the diagnosis. The L265P mutation in MYD88 is detectable in more than 90% of patients and is found in most IgM MGUS patients. MYD88 is not required for the diagnosis.

Age, albumin, hemoglobin level, platelet count, &#x3b2;2 microglobulin, Lactate dehydrogenase (LDH), and monoclonal IgM concentrations are characteristics that are predictive of outcomes.

Not all patients who fulfill WM criteria require therapy; these patients can be observed until symptoms develop. Rituximab-monotherapy is inferior to combination regimens. Recommended first-line therapy can be chemoimmunotherapy or a covalent Bruton tyrosine kinase inhibitor. The preferred Mayo Clinic induction is either rituximab and bendamustine (without rituximab maintenance) or zanubrutinib.

Bortezomib, cyclophosphamide, fludarabine, thalidomide, everolimus, pirtobrutinib, carfilzomib, lenalidomide, bendamustine, and venetoclax have all been shown to have activity in relapsed WM. Given WM's natural history, the reduction of therapy toxicity is an important part of treatment selection. Most patients succumb to causes unrelated to macroglobulinemia.

Waldenström Macroglobulinemia: 2025 Update on Diagnosis, Risk Stratification, and Management.

American Journal of Hematology

Postoperative pulmonary complications are common and associated with significant morbidity and mortality; however, the optimal intra-operative ventilation strategy to prevent postoperative pulmonary complications remains unclear. The aim of this study was to evaluate the effect of intra-operative ventilation strategy, including tidal volumes, positive end-expiratory pressure (PEEP) and use of recruitment manoeuvres on the incidence of postoperative pulmonary complications in adults having non-cardiothoracic surgery.

Relevant databases were searched to identify randomised controlled trials that directly compared intra-operative ventilation strategies among surgical patients who were followed up for &gt;&#x2009;24&#x2009;hours postoperatively and reported at least one outcome of interest.

A total of 51 randomised controlled trials were included. Compared with a high tidal volume/zero PEEP strategy, low tidal volume strategies likely reduced the risk of postoperative pulmonary complications when combined with: high PEEP (risk ratio (RR) 0.44, 95%CI 0.22-0.87); high PEEP with recruitment manoeuvres (RR 0.60, 95%CI 0.49-0.75); personalised PEEP with recruitment manoeuvres (RR 0.53, 95%CI 0.42-0.69); low PEEP (RR 0.63, 95%CI 0.50-0.78); and low PEEP with recruitment manoeuvres (RR 0.65, 95%CI 0.46-0.93) (all moderate certainty evidence). Compared with a low tidal volume/low PEEP strategy, a low tidal volume strategy with personalised PEEP likely reduces the risk of postoperative pulmonary complications (RR 0.85, 95%CI 0.73-0.99, moderate certainty).

Among patients undergoing non-cardiothoracic surgery, the use of intra-operative low tidal volume ventilation with a range of acceptable PEEP levels likely reduced the risk of postoperative pulmonary complications compared with high tidal volumes and zero PEEP. This study highlights the need for implementation research at both the provider and system levels to improve intra-operative adherence to lung protective ventilation strategies.

Intra-operative ventilation strategies and their impact on clinical outcomes: a systematic review and network meta-analysis of randomised trials.

Anaesthesia

Cardiac arrest is a serious condition frequently managed in the emergency department (ED). Medications are a component of cardiac arrest management.

This paper evaluates key evidence-based updates concerning medications used for patients in cardiac arrest.

Several medications have been evaluated for use in cardiac arrest. Routes of administration may include intravenous (IV) and intraosseous (IO). IV administration is recommended, though if an attempt at IV access is unsuccessful, IO access can be utilized. Epinephrine is a core component of guidelines, which recommend 1&#xa0;mg in those with shockable rhythms if initial CPR and defibrillation are unsuccessful, while in nonshockable rhythms, guidelines recommend that epinephrine 1&#xa0;mg be administered as soon as feasible. While epinephrine may improve rates of ROSC, it is not associated with improved survival with a favorable neurologic outcome. Evidence suggests the combination of vasopressin, steroids, and epinephrine may improve ROSC among those with in-hospital cardiac arrest, but there is no improvement in survival to discharge and survival with a favorable neurologic outcome. Antiarrhythmics (e.g., amiodarone, lidocaine, procainamide) likely do not improve short-term or long-term survival or neurologic outcomes, though guidelines state that amiodarone may be used in those with cardiac arrest and refractory pulseless ventricular tachycardia (pVT)/ventricular fibrillation (VF). Calcium and sodium bicarbonate should not be routinely administered in those with cardiac arrest. Beta-blockers may be considered in those with shock-resistant pVT/VF.

An understanding of literature updates concerning medication use in cardiac can improve the ED care of these patients.

Emergency medicine updates: Cardiac arrest medications.

American Journal of Emergency Medicine

Mineralocorticoid receptor antagonists (MRAs) are often underutilized in patients with heart failure (HF), particularly those with diabetes and/or chronic kidney disease (CKD). However, the impact of concurrent diabetes and CKD on the efficacy and safety of eplerenone in acute HF remains uncertain.

The EARLIER trial enrolled patients with acute HF, who were randomized to receive eplerenone or placebo for 6&#xa0;months. Patients were categorized based on the presence of diabetes and/or CKD (defined by eGFR&#x2009;&lt;&#x2009;45&#xa0;ml/min/1.73&#xa0;m2 or UACR&#x2009;&#x2265;&#x2009;30&#xa0;mg/g), and the associations between diabetes/CKD categories and cardiovascular outcomes were assessed. The effects of eplerenone on HF-related outcomes (i.e., cardiovascular death, HF hospitalization, worsening HF, or out-of-hospital diuretic intensification) and adverse events were also assessed across diabetes/CKD status.

Among 300 patients (mean age 67&#x2009;&#xb1;&#x2009;13&#xa0;years; 73% male), 39% had diabetes, mean estimated glomerular filtration rate was 63&#x2009;&#xb1;&#x2009;18&#xa0;ml/min/1.73&#xa0;m2 , median urine albumin-to-creatinine ratio was 34&#xa0;mg/g (13-84&#xa0;mg/g), and 58% had CKD. Patients with both diabetes and CKD (26%) had a higher risk of cardiovascular death and/or hospitalization compared to those without either disease (HR, 95% CI&#x2009;=&#x2009;2.57, 1.29-5.12; P&#x2009;=&#x2009;0.007, P-for-interaction&#x2009;=&#x2009;0.049), and poor prognosis persisted after adjusting for covariates (i.e., natriuretic peptide) (adjusted-HR, 95% CI&#x2009;=&#x2009;2.33, 1.12-4.84; P&#x2009;=&#x2009;0.02). Furthermore, the effects of eplerenone on HF-related outcomes and adverse events were consistent regardless of diabetes/CKD categories (all-P-for interaction&#x2009;&gt;&#x2009;0.05).

In patients with acute HF, the combination of diabetes and CKD was associated with an increased risk of cardiovascular events. However, the efficacy and safety of eplerenone were not influenced by diabetes and CKD status.

Eplerenone, diabetes, and chronic kidney disease in patients hospitalized for acute heart failure: findings from the EARLIER trial.

Cardiovascular Diabetology

Background : Antiphospholipid syndrome (APS) is a rare systemic autoimmune disease characterized by persistent antiphospholipid antibodies (aPL) in combination with recurrent thrombosis in the veins and/or arteries, obstetric morbidity, and various non-thrombotic associated complications. APS can be primary, as an isolated condition, or secondary in the context of another autoimmune disease, especially systemic lupus erythematosus. This comprehensive clinical review aims to summarize the current understanding of APS pathogenesis, diagnostic approaches, and treatment strategies for this unique clinical entity. Methods : A comprehensive review of the existing literature on APS was conducted, focusing on pathophysiological mechanisms, current diagnostic criteria, and therapeutic approaches. Results : APS pathogenesis involves complex interactions between aPL, phospholipid-binding proteins, and the coagulation cascade. Apart from the cardinal features of thrombosis and APS-related obstetric morbidity, APS is associated with a wide spectrum of clinical manifestations. Diagnosis remains challenging due to overlapping symptoms with other conditions, and clinicians should maintain a high index of suspicion in order to set the diagnosis. The recently published 2023 ACR/EULAR criteria although not definitive for clinical decision-making, these criteria offer clinicians a valuable tool to aid in determining whether further investigation for APS is warranted. Continued refinement of these criteria through ongoing feedback and updates is anticipated. Treatment strategies center on anticoagulation, but individualized approaches are necessary. Conclusions : Early diagnosis and multidisciplinary management of APS are critical to reducing morbidity and improving outcomes. Moreover, familiarization with the 2023 ACR/EULAR criteria is encouraged, recognizing that ongoing feedback and updates will contribute to their ongoing refinement and improvement. While VKAs remain the mainstay of treatment for most APS patients further research is needed to optimize treatment strategies and deepen our understanding of APS's underlying disease mechanisms.

Antiphospholipid Syndrome: A Comprehensive Clinical Review.

Journal of Clinical Medicine

Patients with return of spontaneous circulation (ROSC) following cardiac arrest are a critically important population requiring close monitoring and targeted interventions in the emergency department (ED). Therefore, it is important for emergency clinicians to be aware of the current evidence regarding the management of this condition.

This paper provides evidence-based updates concerning the management of the post-ROSC patient.

The patient with ROSC following cardiac arrest is critically ill, including a post-cardiac arrest syndrome which may include hypoxic brain injury, myocardial dysfunction, systemic ischemia and reperfusion injury, and persistent precipitating pathophysiology. Initial priorities in the ED setting in the post-ROSC patient include supporting cardiopulmonary function, addressing and managing the underlying cause of arrest, minimizing secondary cerebral injury, and correcting physiologic derangements. Testing including laboratory assessment, electrocardiogram (ECG), and imaging are necessary, aiming to evaluate for the precipitating cause and assess end-organ injury. Computed tomography head-to-pelvis may be helpful in the post-ROSC patient, particularly when the etiology of arrest is unclear. There are several important components of management, including targeting a mean arterial pressure of at least 65&#xa0;mmHg, preferably &gt;80&#xa0;mmHg, to improve end-organ and cerebral perfusion pressure. An oxygenation target of 92-98&#xa0;% is recommended using ARDSnet protocol, along with carbon dioxide partial pressure values of 35-55&#xa0;mmHg. Antibiotics should be reserved for those with evidence of infection but may be considered if the patient is comatose, intubated, and undergoing hypothermic targeted temperature management (TTM). Corticosteroids should not be routinely administered. While the majority of cardiac arrests in adults are associated with cardiovascular disease, not all post-ROSC patients require emergent coronary angiography. However, if the patient has ST-segment elevation on ECG following ROSC, emergent angiography and catheterization is recommended. This should also be considered if the patient had an initial history concerning for acute coronary syndrome or a presenting arrhythmia of ventricular fibrillation or pulseless ventricular tachycardia. TTM at 32-34&#xb0; C does not appear to demonstrate improved outcomes compared with targeted normothermia, but fever should be avoided.

An understanding of literature updates can improve the ED care of patients post-ROSC.

Emergency medicine updates: Managing the patient with return of spontaneous circulation.

Hypothyroidism is a relatively common condition that may affect as many as 10% of the population worldwide when its overt and subclinical presentations are considered. Important clinical comorbidities are highly prevalent in people with hypothyroidism and diminish quality of life and functional status in a manner that is proportional to the number of comorbidities present and their severity. This article reviews the common comorbidities of hypothyroidism, as reported in the literature. The comorbidities of hypothyroidism include clinical conditions commonly associated with hypothyroidism, such as dyslipidaemia, hypertension, fatigue or (possibly) cardiovascular disease, and can appear whether or not intervention with LT4 is applied appropriately to ensure biochemical euthyroidism. Other comorbidities may share some pathogenetic background with hypothyroidism, including depression or anxiety, or autoimmune conditions. Hypothyroidism may arise as a comorbidity of some other conditions, e.g. following the application of targeted cancer therapies or some disease-modfying treatments for multiple sclerosis. Other common treatments, including metformin, glucocorticoids or proton pump inhibitors, among others, may alter levels of thyrotropin, thus impacting on the monitoring of thyroid dysfunction and the diagnosis of thyroid dysfunction. Ensuring good control of hypothyroidism is a necessary first step in managing any patient with hypothyroidism. Then, physicians should be aware of the possibility of other comorbid conditions that must be addressed to achieve an optimal patient outcome.

Comorbidities of hypothyroidism.

Current Medical Research and Opinion

Pulmonary embolism is a common cause of cardiovascular-associated morbidity and mortality. Although pulmonary embolism affects individuals from all demographics, the incidence of pulmonary embolism is higher among people from certain racial groups, reproductive-age women compared with age-matched men, and transgender people taking estrogen hormones. Furthermore, disparities may exist in the diagnosis or management strategies of pulmonary embolism associated with race, ethnicity, sex, or socioeconomic status, which may correlate with poorer downstream outcomes, including recurrent pulmonary embolism, chronic thromboembolic pulmonary hypertension, or short- or long-term mortality. This scientific statement summarizes disparities in diagnosis, treatment strategies, and outcomes related to pulmonary embolism, and reviews approaches to create equitable pulmonary embolism care and address the knowledge gaps in the literature.

Toward a standardized breast ultrasound lexicon, BI-RADS: ultrasound.

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