The objective was to evaluate the pure-tone audiogram-based screening protocols in VS diagnostics.We retrospectively analyzed presenting symptoms,pure tone audiometry and MRI finding from 246 VS patients and 442 contr...The objective was to evaluate the pure-tone audiogram-based screening protocols in VS diagnostics.We retrospectively analyzed presenting symptoms,pure tone audiometry and MRI finding from 246 VS patients and 442 controls were collected to test screening protocols(AAO-HNS,AMCLASS-A/B,Charing Cross,Cueva,DOH,Nashville,Oxford,Rule3000,Schlauch,Seattle,Sunderland)for sensitivity and specificity.Results were pooled with data from five other studies,and analysis of sensitivity,specificity and positive likelihood ratio(LR+)for each protocol was performed.Our results show that protocols with significantly higher sensitivity(AMCLASS-A/B,Nashville)show also significantly lowest specificity,and tend to have low association(positive likelihood ratio,LR+)to the VS.The highest LR+was found for protocols AAO-HNS,Rule3000 and Seattle.In conclusions,knowing their properties,screening protocols are simple decision-making tools in VS diagnostic.To use the advantage of the highest sensitivity,protocols AMCLASS-A+B or Nashville can be of choice.For more reasonable approach,applying the protocols with high LR+(AAO-HNS,Rule3000,Seattle)may reduce the overall number of MRI scans at expense of only few primarily undiagnosed VS.展开更多
Cytomegalovirus (CMV) retinitis is a significant yet infrequent complication inpediatric hematopoietic stem cell transplant recipients, occurring in approximately4% of cases. Its presentation typically coincides with ...Cytomegalovirus (CMV) retinitis is a significant yet infrequent complication inpediatric hematopoietic stem cell transplant recipients, occurring in approximately4% of cases. Its presentation typically coincides with immune reconstitution,between 6 weeks to 6 months post-transplant, emphasizing the need fortimely detection. Symptoms often develop insidiously, underscoring the role offundus examinations during episodes of CMV viremia. However, the low incidencechallenges the necessity of routine screenings, as they may strain clinicalresources without clear benefits to patient outcomes. Management includes systemicand intravitreal antivirals, such as ganciclovir and foscarnet, and adoptiveT-cell therapy for refractory cases. Tailored follow-up strategies are crucial, withconsiderations for lesion activity and CMV viremia status to determine theduration of therapy. Baseline and post-transplant screenings remain a topic ofdebate, with evolving guidelines needed to balance patient safety and clinicalfeasibility. Future research is needed to address optimal screening intervals andinvestigate the role of pre-existing CMV serostatus in transplant eligibility andoutcomes.展开更多
文摘The objective was to evaluate the pure-tone audiogram-based screening protocols in VS diagnostics.We retrospectively analyzed presenting symptoms,pure tone audiometry and MRI finding from 246 VS patients and 442 controls were collected to test screening protocols(AAO-HNS,AMCLASS-A/B,Charing Cross,Cueva,DOH,Nashville,Oxford,Rule3000,Schlauch,Seattle,Sunderland)for sensitivity and specificity.Results were pooled with data from five other studies,and analysis of sensitivity,specificity and positive likelihood ratio(LR+)for each protocol was performed.Our results show that protocols with significantly higher sensitivity(AMCLASS-A/B,Nashville)show also significantly lowest specificity,and tend to have low association(positive likelihood ratio,LR+)to the VS.The highest LR+was found for protocols AAO-HNS,Rule3000 and Seattle.In conclusions,knowing their properties,screening protocols are simple decision-making tools in VS diagnostic.To use the advantage of the highest sensitivity,protocols AMCLASS-A+B or Nashville can be of choice.For more reasonable approach,applying the protocols with high LR+(AAO-HNS,Rule3000,Seattle)may reduce the overall number of MRI scans at expense of only few primarily undiagnosed VS.
文摘Cytomegalovirus (CMV) retinitis is a significant yet infrequent complication inpediatric hematopoietic stem cell transplant recipients, occurring in approximately4% of cases. Its presentation typically coincides with immune reconstitution,between 6 weeks to 6 months post-transplant, emphasizing the need fortimely detection. Symptoms often develop insidiously, underscoring the role offundus examinations during episodes of CMV viremia. However, the low incidencechallenges the necessity of routine screenings, as they may strain clinicalresources without clear benefits to patient outcomes. Management includes systemicand intravitreal antivirals, such as ganciclovir and foscarnet, and adoptiveT-cell therapy for refractory cases. Tailored follow-up strategies are crucial, withconsiderations for lesion activity and CMV viremia status to determine theduration of therapy. Baseline and post-transplant screenings remain a topic ofdebate, with evolving guidelines needed to balance patient safety and clinicalfeasibility. Future research is needed to address optimal screening intervals andinvestigate the role of pre-existing CMV serostatus in transplant eligibility andoutcomes.
