Abdominal US in Pediatric Inflammatory Multisystem Syndrome Associated with SARS-CoV-2 (PIMS-TS).

Background Children with pediatric inflammatory syndrome temporally associated with SARS-CoV-2 (PIMS-TS), also known as multisystem inflammatory syndrome in children, present with abdominal pain among other nonspecific symptoms. Although initial imaging features of PIMS-TS have been reported, the duration of sonographic features remains unknown. Purpose To describe the abdominal US features of PIMS-TS at initial presentation and follow-up. Materials and Methods A retrospective review of children and young adults presenting with clinical features suspicious for PIMS-TS between April 2020 and June 2021 was carried out. US features were documented and reviewed at initial presentation and follow-up. Descriptive statistics were used and interobserver variability was calculated. Results Of 140 children and young adults presenting with suspected PIMS-TS, 120 had confirmed PIMS-TS (median age, 9 years; interquartile range, 7-12 years; 65 male patients) and 102 underwent abdominal US at presentation. PIMS-TS was present as a single abnormality in 109 of the 120 patients (91%) and abdominal symptoms were present in 104 of the 109 (95%). US examinations were abnormal in 86 of 102 patients (84%), with ascites being the most common abnormality in 65 (64%; 95% CI: 54, 73). Bowel wall thickening was present at US in 14 of the 102 patients (14%; 95% CI: 7, 20) and mesenteric inflammation was present in 16 (16%; 95% CI: 9, 23); all of these patients presented with abdominal symptoms. Among the patients with bowel wall thickening, the distal and terminal ileum were most involved (eight of 14 patients, 57%). Abdominal symptoms decreased to seven of 56 patients (13%) in those followed up at 6 months. Thirty-eight patients underwent follow-up US, and the presence of bowel inflammation had decreased to three of 27 patients (11%; 95% CI: -1, 23) in those followed up for less than 2 months and 0 of 17 (0%) in those followed up for more than 2 months. Conclusion Of 102 patients with pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 who underwent US at presentation, 14 (14%) had abdominal US findings of bowel inflammation and 16 (16%) had mesenteric edema. All US abnormalities resolved after 2 months. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by van Rijn and Pajkrt in this issue.

Adapting a Dialysis Service for Delivery of Percutaneous Arteriovenous Fistulas.

The percutaneous arteriovenous fistula (pAVF) is an exciting and novel addition to the vascular access options available to patients with end-stage kidney disease who require dialysis. Early clinical results have been promising, with high rates of maturation and low rates of reintervention. To successfully adapt an existing hemodialysis service to include the provision of pAVF formation, it is essential to identify and align the interests of key clinical and nonclinical stakeholders. Only through strong collaboration can the service be supported. The authors provide a comprehensive overview of the planning fundamentals required, including the referral pathway, screening and clinical assessment, and practical procedural elements and considerations, as well as follow-up requirements such as cannulation, fistula surveillance, and maintenance. Key staffing requirements are highlighted, including those pertaining to vascular US screening and dialysis nurse training. A broad and structured planning approach ensures that the entire network of key stakeholder interests is included and provides a strong foundation for a compelling business plan to attract the necessary funding and managerial support for the service. The authors present a systematic framework of the essential considerations necessary to facilitate the planning, funding, and ultimately delivery of a successful pAVF service. Online supplemental material is available for this article. ©RSNA, 2022.

Drugs in Alzheimer's disease Dementia: An overview of current pharmacological management and future directions.

BACKGROUND: Alzheimer's dementia is one of the most significant health burdens of the modern age in both industrialised and non-industrialised nations as it is a major cause of morbidity and functional impairment in the elderly. Currently there are no cures for progressive dementias, including Alzheimer's disease, and no treatments that would modify their progress. Intervention involves pharmacological treatment to temporarily relieve the symptoms, including three cholinesterase inhibitors and a noncompetitive NMDA antagonist, and the efficacy of these is widely debated. While our understanding of the underlying pathology of Alzheimer's continues to grow, we have yet to fully elucidate the mechanisms that drive neuronal loss in this condition. Any truly disease-modifying treatment must be developed to target these pathological pathways. METHODS: An extensive analysis of the available literature is presented here, including a number of trials, meta-analyses and reviews, with the aim of assessing current management, establishing best practice and summarising the future of dementia care. RESULTS: The efficacy of acetylcholinesterase inhibitors remains controversial due to uncertainty over what change is considered clinically significant. Any derived benefit seems to be independent of dementia severity and donepezil is the most cost-effective for Alzheimer's dementia. Memantine potentially influences the underlying pathological processes in Alzheimer's disease and may be more effective in moderate to severe Alzheimer's dementia. The role of combination therapy remains uncertain. Future therapies are aimed at modulating the disease process by using chemical agents to inhibit amyloid and tau deposition. None have been approved clinically. CONCLUSIONS: Current pharmacological therapy for Alzheimer's dementia is very limited and primarily aims at achieving symptom control. A major limitation is our lack of knowledge of the underlying pathology and it is only by better understanding the disease process that we can optimize therapeutic agents that modify disease progression.