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MRI plays an important role in the evaluation of kidney allografts for vascular complications as well as parenchymal insults. Transplant renal artery stenosis, the most common vascular complication of kidney transplant, can be evaluated by MRA using gadolinium and nongadolinium contrast agents as well as by unenhanced MRA techniques. Parenchymal injury occurs through a variety of pathways, including graft rejection, acute tubular injury, BK polyomavirus infection, drug-induced interstitial nephritis, and pyelonephritis. Investigational MRI techniques have sought to differentiate among these causes of dysfunction as well as to assess the degree of interstitial fibrosis or tubular atrophy (IFTA)-the common end pathway for all of these processes-which is currently evaluated by invasively obtained core biopsies. Some of these MRI sequences have shown promise in not only assessing the cause of parenchymal injury but also assessing IFTA noninvasively. This review describes current clinically used MRI techniques and previews promising investigational MRI techniques for assessing complications of kidney grafts.

BackgroundOutcomes for children and adults with advanced soft tissue sarcoma are poor with traditional therapy. We investigated whether the addition of pazopanib to preoperative chemoradiotherapy would improve pathological near complete response rate compared with chemoradiotherapy alone.MethodsIn this joint Children's Oncology Group and NRG Oncology multicentre, randomised, open-label, phase 2 trial, we enrolled eligible adults (aged ≥18 years) and children (aged between 2 and 16 years) performance status score of at least 70. Patients received ifosfamide (2·5 g/m2 per dose intravenously on days 1-3 with mesna) and doxorubicin (37·5 mg/m2 per dose intravenously on days 1-2) with 45 Gy preoperative radiotherapy, followed by surgical resection at week 13. Patients were randomly assigned (1:1) using a web-based system, in an unmasked manner, to receive oral pazopanib (if patients

ObjectivesStandardization is an important milestone in the validation of DWI-based parameters as imaging biomarkers for renal disease. Here, we propose technical recommendations on three variants of renal DWI, monoexponential DWI, IVIM and DTI, as well as associated MRI biomarkers (ADC, D, D*, f, FA and MD) to aid ongoing international efforts on methodological harmonization.Materials and methodsReported DWI biomarkers from 194 prior renal DWI studies were extracted and Pearson correlations between diffusion biomarkers and protocol parameters were computed. Based on the literature review, surveys were designed for the consensus building. Survey data were collected via Delphi consensus process on renal DWI preparation, acquisition, analysis, and reporting. Consensus was defined as ≥ 75% agreement.ResultsCorrelations were observed between reported diffusion biomarkers and protocol parameters. Out of 87 survey questions, 57 achieved consensus resolution, while many of the remaining questions were resolved by preference (65-74% agreement). Summary of the literature and survey data as well as recommendations for the preparation, acquisition, processing and reporting of renal DWI were provided.DiscussionThe consensus-based technical recommendations for renal DWI aim to facilitate inter-site harmonization and increase clinical impact of the technique on a larger scale by setting a framework for acquisition protocols for future renal DWI studies. We anticipate an iterative process with continuous updating of the recommendations according to progress in the field.

The article Consensus-based technical recommendations for clinical translation of renal diffusion-weighted MRI.

This article presents the findings of a study conducted in Singapore that examined the use of oral antivirals (OAVs) among older adults with COVID-19 in primary care during the Omicron waves. The study revealed that a small percentage of older adults received OAVs, with nirmatrelvir-ritonavir being the most commonly prescribed medication. The study also identified factors such as primary care characteristics and socioeconomic status (SES) indicators that influenced the likelihood of receiving OAVs. The authors emphasize the importance of addressing disparities in OAV access among older adults and socioeconomically disadvantaged groups. They recommend targeted efforts to improve access for individuals with lower SES. [Extracted from the article]

Objective To quantify the impact of the change in definition of severe pneumonia on documented pneumonia burden. Methods We reviewed existing data acquired during observational hospitalized pneumonia studies, before the introduction of the pneumococcal conjugate vaccine, in infants aged 2-23 months from Fiji, Gambia, Lao People's Democratic Republic, Malawi, Mongolia and Viet Nam. We used clinical data to calculate the percentage of all-cause pneumonia hospitalizations with severe pneumonia, and with primary end-point consolidation, according to both the 2005 or 2013 World Health Organization (WHO) definitions. Where population data were available, we also calculated the incidence of severe pneumonia hospitalizations according to the different definitions. Findings At six of the seven sites, the percentages of all-cause pneumonia hospitalizations due to severe pneumonia were significantly less (P < 0.001) according to the 2013 WHO definition compared with the 2005 definition. However, the percentage of severe pneumonia hospitalizations, according to the two definitions of severe pneumonia, with primary end-point consolidation varied little within each site. The annual incidences of severe pneumonia hospitalizations per 100 000 infants were significantly less (all P < 0.001) according to the 2013 definition compared with the 2005 definition, ranging from a difference of -301.0 (95% confidence interval, CI: -405.2 to -196.8) in Fiji to -3242.6 (95% CI: -3695.2 to -2789.9) in the Gambia. Conclusion The revision of WHO's definition of severe pneumonia affects pneumonia epidemiology, and hence the interpretation of any pneumonia intervention impact evaluation. Objectif Quantifier l'impact de la modification de la definition de pneumonie severe sur le fardeau documente de la pneumonie. Methodes Nous avons examine les donnees existantes obtenues dans le cadre d'etudes d'observation de la pneumonie hospitaliere, avant l'introduction du vaccin antipneumococcique conjugue, chez des nourrissons ages de 2 a 23 mois aux Fidji, en Gambie, au Malawi, en Mongolie, en Republique democratique populaire lao et au Viet Nam. Nous avons utilise des donnees cliniques pour calculer le pourcentage d'hospitalisations pour une pneumonie toutes causes confondues avec une pneumonie severe, et avec une consolidation des criteres d'evaluation primaire, selon les definitions de l'Organisation mondiale de la Sante (OMS) de 2005 et 2013. Lorsque des donnees demographiques etaient disponibles, nous avons egalement calcule l'incidence des hospitalisations pour une pneumonie severe selon les differentes definitions. Resultats Dans six des sept sites, les pourcentages d'hospitalisations pour une pneumonie toutes causes confondues en raison d'une pneumonie severe etaient nettement plus faibles (P < 0,001) selon la definition de l'OMS de 2013 en comparaison avec la definition de 2005. Neanmoins, le pourcentage d'hospitalisations pour une pneumonie severe, selon les deux definitions de la pneumonie severe, avec une consolidation des criteres d'evaluation primaire variait peu dans chaque site. Les incidences annuelles d'hospitalisations pour une pneumonie severe pour 100 000 nourrissons etaient nettement plus faibles (total P < 0,001) selon la definition de 2013 en comparaison avec la definition de 2005, la difference allant de -301,0 (intervalle de confiance, IC, a 95%: de -405,2 a -196,8) aux Fidji a -3242,6 (IC a 95%I: -de 3695,2 a -2789,9) en Gambie. Conclusion La revision de la definition de l'OMS de la pneumonie severe affecte l'epidemiologie de la pneumonie et, par consequent, l'interpretation de toute evaluation de l'impact d'une intervention contre la pneumonie. Objetivo Cuantificar el impacto del cambio en la definicion de neumonia grave sobre la carga de neumonia documentada. Metodos Se revisaron los datos existentes adquiridos durante los estudios observacionales de neumonia hospitalizada, antes de la introduccion de la vacuna antineumococica conjugada, en lactantes de 2 a 23 meses de edad procedentes de Fiji, Gambia, Malawi, Mongolia, la Republica Democratica Popular Lao y Vietnam. Se utilizaron datos clinicos para calcular el porcentaje de hospitalizaciones por neumonia de cualquier causa con neumonia grave, y con consolidacion del punto final primario, de acuerdo con las definiciones de la Organizacion Mundial de la Salud (OMS) de 2005 o 2013. Cuando se dispuso de datos demograficos, tambien se calculo la incidencia de las hospitalizaciones por neumonia grave de acuerdo con las diferentes definiciones. Resultados En seis de los siete sitios, los porcentajes de hospitalizaciones por neumonia de cualquier causa con neumonia grave fueron significativamente menores (p < 0,001) segun la definicion de la OMS de 2013 en comparacion con la de 2005. Sin embargo, el porcentaje de hospitalizaciones por neumonia grave, segun las dos definiciones de neumonia grave, con consolidacion del punto final primario vario poco dentro de cada sitio. La incidencia anual de hospitalizaciones por neumonia grave por cada 100.000 lactantes fue significativamente menor (total p < 0,001) segun la definicion de 2013 en comparacion con la de 2005 y oscilo entre una diferencia de -301,0 (intervalo de confianza, IC, del 95%: -405,2 a -196,8) en Fiji y -3242,6 (IC del 95%: -3695,2 a -2789,9) en Gambia. Conclusion La revision de la definicion de neumonia grave de la OMS afecta a la epidemiologia de la neumonia y, por tanto, a la interpretacion de cualquier evaluacion del impacto de una intervencion para la neumonia., Introduction Pneumonia is the leading cause of post-neonatal deaths in children younger than 5 years, with many of the deaths occurring in low- and middle-income countries. (1,2) Several interventions exist [...]