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Background: The role of prophylactic central compartment lymph node dissection in clinically node-negative papillary thyroid carcinoma is debated. This study presents the findings from a 10-year follow-up of a single-institution randomized controlled trial assessing the role of prophylactic central compartment lymph node dissection in clinically node-negative papillary thyroid carcinoma., Methods: Between 2008 and 2010, a total of 196 patients with clinically node-negative papillary thyroid carcinoma were randomly assigned to 2 groups in a 1:1 ratio to undergo total thyroidectomy (group A) or total thyroidectomy with prophylactic central compartment lymph node dissection (group B). Patients received low-dose radioactive iodine treatment (30 mCi) postoperatively, with additional doses as needed. Monitoring included serum thyroglobulin, thyroglobulin antibodies, and neck ultrasound imaging., Results: At the end of the follow-up, 151 patients were analyzed, after 28 from group A and 17 from group B were excluded. The 2 groups were similar in age at diagnosis (P = .643), sex distribution (P = .735), body mass index (P = .134), ultrasound-estimated thyroid volume (P = .650), and histologic tumor features. After >10 years (12.9 ± 2 years), no significant differences were observed in surgical and oncologic outcomes. The mean thyroglobulin levels were 0.1 ± 0.1 ng/mL in group A and 0.3 ± 1.3 ng/mL in group B (P = .146). Both groups showed similar findings in the need for further surgery (P = .917), for additional radioactive iodine (P = .979), and mean radioactive iodine dosage (P = .822). No difference was documented in permanent recurrent laryngeal nerve palsy (P = .640), permanent hypocalcemia (P = .238), and serum calcium level (P = .181). The only observed distinction was more parathyroid removal in prophylactic central compartment lymph node dissection cases based on histologic examination (P = .005)., Conclusion: Prophylactic central compartment lymph node dissection does not significantly affect surgical and oncologic outcomes in patients with clinically node-negative small papillary thyroid carcinoma after long-term follow-up., Competing Interests: Conflict of Interest/Disclosure The authors have no relevant financial disclosures., (Copyright © 2025. Published by Elsevier Inc.)

Purpose: Lemierre syndrome is a rare condition traditionally defined by bacterial infection of the head/neck region, local thrombophlebitis, and septic embolism. Although in most cases Fusobacterium necrophorum is isolated, it is questionable whether the presence of this microbe is mandatory for diagnosis. In this study, we investigated microorganisms isolated in cases of Lemierre syndrome and their association with demographical and clinical features., Methods: We conducted an analysis of individual patient data from 712 patients diagnosed with Lemierre syndrome. Demographics, clinical presentation, treatment strategies, and outcomes according to different pathogens were evaluated., Results: Among a total of 712 patients, in 574 cases bacterial growth was detected. In 415 patients Fusobacterium spp. was isolated, in 108 either Streptococcus spp. or Staphylococcus spp., and in 51 other bacteria. Patients with different bacteria differed markedly in age, site of preceding infections, clinical presentation, and treatment. Fusobacterium spp. was typically isolated in younger patients (69% of patients aged 16 to 30 years) while Streptococcus spp. and Staphylococcus spp. were more prevalent in older subjects (30% of patients aged over 45 years). Of all cases with Fusobacterium spp., 63% had a thrombosis of the internal jugular vein and 91% septic embolism, compared with 94% and 69%, respectively, in cases with Streptococcus spp. or Staphylococcus spp., Conclusion: In contrast to the available literature, our study suggests that Lemierre syndrome may be caused by multiple bacterial species, and that the clinical presentation and course may vary according to the specific bacterial species involved., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Epidemiological data on acute pulmonary embolism among children and adolescents are sparse and only date back to the 2000s. We aimed to establish annual estimates and age-stratified and sex-stratified indicators of acute pulmonary embolism among children and adolescents aged 0-19 years., Methods: We did a retrospective, nationwide, patient-level analysis of the Kids' Inpatient Database, including 5733 patients with acute pulmonary embolism aged 0-19 years admitted to hospital in the USA in 2016 and 2019. The database includes data of all children admitted to hospital during the 2 years available. We also accessed the US Multiple Cause of Death database and population data from the US Census Bureau for the same 2 years. We estimated the incidence, mortality, case fatality, and proportional mortality rates, provided data on the annual pulmonary embolism burden, and provided data on clinical events recorded during hospitalisation., Findings: In the years 2016 and 2019, 5733 patients (3353 [58.5%] female and 2380 [41.5%] male) were admitted to hospital with acute pulmonary embolism as the primary diagnosis or a concomitant diagnosis. The annual incidence of acute pulmonary embolism was 3·5 (95% CI 3·4-3·6) per 100 000 people. Two peaks in the incidence rate were observed-one in infants younger than 1 year and one in adolescents aged 15-19 years. The in-hospital case fatality rate was 4·5% (4·0-5·1). The crude odds ratio for in-hospital death among patients with (vs without) acute pulmonary embolism was 9·3 (7·9-10·9). The association between acute pulmonary embolism and death persisted across different multivariable models. Patients with acute pulmonary embolism with high-risk (vs no high-risk) features had the highest risk of death: 25·3% (20·6-30·5) among patients aged 0-9 years and 13·9% (11·9-16·2) among patients aged 10-19 years. In patients without high-risk features, risk of death was 4·9% (3·1-7·6) among patients aged 0-9 years and 0·7% (0·5-1·0) among patients aged 10-19 years. The risk of intracranial bleeding was also highest in the presence of pulmonary embolism with high-risk features: 8·1% (5·5-11·7) among patients aged 0-9 years and 3·6% (2·6-4·9) among patients aged 10-19 years. In patients without high-risk features, the risk of intracranial bleeding was 2·5% (1·3-4·6) among those aged 0-9 years and 0·5% (0·3-0·8) in those aged 10-19 years. Reperfusion treatments beyond systemic thrombolysis were rarely used among children and adolescents with acute pulmonary embolism., Interpretation: Acute pulmonary embolism is rare during childhood and adolescence. The high pulmonary embolism-related fatality among specific subgroups of patients can be interpreted in the context of severe comorbidities and pulmonary embolism events with high-risk features., Funding: None., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2025 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: Pulmonary embolism (PE) and its sequelae impact healthcare systems globally. Low-risk PE patients can be managed with early discharge strategies leading to cost savings, but post-discharge costs are undetermined., Purpose: To define healthcare resource utilisation and overall costs during follow-up of low-risk PE., Methods: We used an incidence-based, bottom-up approach and calculated direct and indirect costs over 3-month follow-up after low-risk PE, with data from the Home Treatment of Patients with Low-Risk Pulmonary Embolism (HoT-PE) cohort study., Results: Average 3-month costs per patient having suffered low-risk PE were 7029.62 €; of this amount, 4872.93 € were associated with PE, accounting to 69.3% of total costs. Specifically, direct costs totalled 3019.33 €, and of those, 862.64 € (28.6%) were associated with PE. Anticoagulation (279.00 €), rehospitalisations (296.83 €), and ambulatory visits (194.95 €) comprised the majority of the 3-month direct costs. The remaining costs amounting to 4010.29 € were indirect costs due to loss of productivity., Conclusion: In a patient cohort with acute low-risk PE followed over 3 months, the majority of costs were indirect costs related to productivity loss, whereas direct, PE-specific post-discharge costs were low. Effective interventions are needed to reduce the burden of PE and associated costs, especially those related to productivity loss., Competing Interests: Declarations. Conflict of interest: SB received lecture/consultant fees from Bayer HealthCare, Concept Medical, BTG Pharmaceuticals, INARI, Boston Scientific, and LeoPharma; institutional grants from Boston Scientific, Bentley, Bayer HealthCare, INARI, Medtronic, Concept Medical, Bard, and Sanofi; and economical support for travel/congress costs from Daiichi Sankyo, BTG Pharmaceuticals, and Bayer HealthCare, outside the submitted work. SVK reports institutional grants and personal lecture/advisory fees from Bayer AG, Daiichi Sankyo, and Boston Scientific; institutional grants from Inari Medical; and personal lecture/advisory fees from MSD and Bristol Myers Squibb/Pfizer. The remaining authors have nothing to declare., (© 2023. The Author(s).)

Competing Interests: L.H. received lecture/consultant fees from MSD and Janssen, outside the submitted work. S.K. reports institutional grants and personal lecture/advisory fees from Bayer AG, Daiichi Sankyo, Boston Scientific, and Penumbra Inc., and institutional grants from Inari Medical. Other authors have nothing to declare.

Introduction: Achieving an early diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) in pulmonary embolism (PE) survivors results in better quality of life and survival. Importantly, dedicated follow-up strategies to achieve an earlier CTEPH diagnosis involve costs that were not explicitly incorporated in the models assessing their cost-effectiveness. We performed an economic evaluation of 11 distinct PE follow-up algorithms to determine which should be preferred., Materials and Methods: 11 different PE follow-up algorithms and one hypothetical scenario without a dedicated CTEPH follow-up algorithm were included in a Markov model. Diagnostic accuracy of consecutive tests was estimated from patient-level data of the InShape II study (n=424). The lifelong costs per CTEPH patient were compared and related to quality-adjusted life-years (QALYs) for each scenario., Results: Compared to not performing dedicated follow-up, the integrated follow-up algorithms are associated with an estimated increase of 0.89-1.2 QALYs against an incremental cost-effectiveness ratio (ICER) of EUR 25 700-46 300 per QALY per CTEPH patient. When comparing different algorithms with each other, the maximum differences were 0.27 QALYs and EUR 27 600. The most cost-effective algorithm was the InShape IV algorithm, with an ICER of EUR 26 700 per QALY compared to the next best algorithm., Conclusion: Subjecting all PE survivors to any of the currently established dedicated follow-up algorithms to detect CTEPH is cost-effective and preferred above not performing a dedicated follow-up, evaluated against the Dutch acceptability threshold of EUR 50 000 per QALY. The model can be used to identify the locally preferred algorithm from an economical point-of-view within local logistical possibilities., Competing Interests: Conflict of interest: S. Barco received research support from Boston Scientific, Medtronic, Concept Medical, Sanofi and Novartis, all outside this manuscript. Conflict of interest: M. Delcroix received consulting fees from Actelion/Janssen/J&J, Acceleron/MSD, Gossamer and Ferrer, all outside the submitted work. Conflict of interest: L. Jara-Palomares reports grants from Daichii, Rovi, GlaxoSmithKline, BMS, Johnson and Johnson, Leo Pharma and MSD, all outside the submitted work. Conflict of interest: S.V. Konstantinides reports grants or contacts from Daiichi-Sankyo, and consulting fees from Boston Scientific, Inari Medical, Bayer AG, Penumbra Inc., Daiichi Sankyo, all outside this manuscript. Conflict of interest: F.A. Klok received research support from Bayer, BMS, BSCI, AstraZeneca, MSD, Leo Pharma, Actelion, Farm-X, The Netherlands Organisation for Health Research and Development, The Dutch Thrombosis Foundation, The Dutch Heart Foundation and the Horizon Europe Program, all outside this manuscript. Conflict of interest: All the other authors declare no competing interests., (Copyright ©The authors 2025.)

Background: Data on the epidemiologic burden of acute pulmonary embolism (PE) in Switzerland are unavailable. Knowledge gaps remain on trends in PE-related comorbidities, PE severity, and length of in-hospital stay (LOS) at a nationwide level., Objectives: To study the epidemiology of acute PE with a focus on overall trends, sex-stratified trends, and trends in patients with (vs without) hemodynamic instability., Methods: We used nationwide, patient-level data including all patients aged 15 years or older hospitalized for PE in Switzerland from 2003 to 2022, amounting to N = 180 600. Additionally, we analyzed the Swiss Death Registry for the same period. We estimated the disease-specific age-standardized incidence rates, mortality rates, in-hospital case fatality rates, proportional mortality rates, and LOS. Analyses were stratified by sex and the presence of features of high-risk PE., Results: During the study period, the PE-related incidence rate increased from 0.87 (95% CI: 0.82, 0.92) per 1000 population in 2003 to 1.19 (95% CI: 1.15, 1.24) in 2022. In contrast, a decreasing trend was found for mortality rates (18.7 [95% CI: 16.8, 20.6] per 100 000 population in 2003, 13 [95% CI: 11.7,14.2] in 2022), in-hospital case fatality rate (9.8 [95% CI: 9.1, 10.5] deaths per 100 hospitalized PE patients in 2003, 7.9 [95% CI: 7.4, 8.5] in 2019, subsequent increase during COVID-19 pandemic), and LOS (11 [Q1-Q3: 7-18] days in 2003, 8 [Q1-Q3: 4-16] in 2022). No major sex differences in trends were present. Except for LOS reduction, patients with high-risk features presented with similar trends., Conclusion: The incidence of acute PE in Switzerland increased over the last 20 years. Despite increasing trends in the median age at PE diagnosis, in-hospital case fatality and mortality rates decreased, particularly among patients with high-risk features, and the LOS progressively declined., Competing Interests: Declaration of competing interests There are no competing interests to disclose., (Copyright © 2025 The Author(s). Published by Elsevier Inc. All rights reserved.)