Pulmonary veno-occlusive disease (PVOD) represents a rare and challenging form of pulmonary hypertension, characterized by preferential remodelling of the pulmonary venules. PVOD may be idiopathic as well as related to other conditions with environmental and genetic factors contributing to its development. Recently, bi-allelic mutations in the EIF2AK4-gene have been identified as a cause of heritable PVOD. PVOD shares an overlapping disease phenotype with pulmonary arterial hypertension (PAH) and is regularly misdiagnosed as such, although differentiation between these two conditions is important because of the different prognosis and therapeutic approach. The diagnosis of PVOD is frequently delayed because of the complex diagnostic process. The gold standard remains histology with widespread obliteration of small pulmonary veins by fibrous intimal thickening and patchy capillary proliferation as the pathological hallmark. At present, neither treatment guidelines nor curative medical therapies are available for PVOD. Because of the progressive nature of the disease, a quick referral for lung transplantation remains the only definitive therapy in subjects below the age of 65.
  The interstitial lung disease (ILD) multidisciplinary meetings (MDM) composing of pulmonologists, radiologists and pathologists, is integral to the rendering of an accurate ILD diagnosis. However, there is significant heterogeneity in the conduct of ILD MDMs and questions regarding its best practice remain unanswered.
 
  To achieve consensus among ILD experts on essential components of an ILD MDM.
 
  Using a Delphi methodology, semi structured interviews with ILD experts were used to identify key themes and features of ILD MDMs. These items informed two subsequent rounds of online questionnaires that were used to achieve consensus among a broader, international panel of ILD experts.  https://www.selleckchem.com/products/fx11.html  Experts were asked to rate their level of agreement on a five-point Likert scale. An a priori threshold for consensus was set at a median score 4 or 5 with an interquartile range of 0.
 
  We interviewed 15 ILD experts and 102 ILD experts participated in the online questionnaires. Five items and two exploratory statements achieved cternational expert guideline statement on ILD MDMs.
 
  This Delphi study showed consensus among international ILD experts on essential and desirable features of an ILD MDM. Our data represents a first step toward potential collaborative research into future standardisation of ILD MDMs.
 This Delphi study showed consensus among international ILD experts on essential and desirable features of an ILD MDM. Our data represents a first step toward potential collaborative research into future standardisation of ILD MDMs.Intermittent fasting (IF) is an emerging dietary trend that remains understudied. This study aimed to describe the implementation and eating disorder (ED) symptomatology, relevant to engagement in IF among both men and women. Intermittent fasters (N = 44 women, N = 20 men) recruited from Amazon Mechanical Turk, Reddit, and a Midwestern University were administered a demographic questionnaire, an assessment of ED symptomatology (Eating Disorder Examination Questionnaire; EDE-Q), and asked about their IF use. To assess the level of ED symptomatology among individuals using IF community and clinical norms were used for comparison. We hypothesized a) men and women engaging IF would score higher on the EDE-Q and b) more individuals engaging in IF would endorse ED behaviors (e.g., self-induced vomiting) than community norms. Intermittent fasters reported fasting for approximately 16 hours daily and for weight loss purposes. Men and women engaging in IF scored significantly higher than community norms on all subscales of the EDE-Q, with 31.25% of participants' EDE-Q scores being at or above the clinical EDE-Q cut-off. Men and women engaging in IF reported engaging in ED behaviors. Results suggest that IF is associated with ED symptomatology. Further research on psychological characteristics and temporal order of the association between IF and ED symptomatology is warranted.
  To present a case of metastatic struma ovarii, to review the literature on malignant struma ovarii and to discuss the management in locoregional and metastatic disease.
 
  We present a case of an 82-year-old patient with a malignant struma ovarii and liver metastasis. The patient was treated with pelvic surgery, total thyroidectomy, radioactive iodine therapy and TSH suppression therapy with levothyroxine. We performed a PubMed search for case reports of metastatic struma ovarii.
 
  43 cases of metastatic struma ovarii were identified. 53.5% of patients presented with metastatic disease at diagnosis. Mean time to development of metastasis was 6.9years in the group with initial locoregional disease. First-line treatment was pelvic surgery in all patients. Thyroidectomy was performed in 83.7% of patients, subsequent radioactive iodine therapy in 79.1%, followed by TSH suppression therapy in 46.5% of patients. Mean time of follow-up after diagnosis of metastases was 3.6years, ranging from 0.5 to 24years. At the end of the follow-up, 51.1% of patients were free of disease, 34.9% were alive with disease, 7.0% died of disease and 7.0% were lost to follow-up.
 
  The majority of patients with metastatic struma ovarii were treated with pelvic surgery, total thyroidectomy and radioactive iodine therapy. Suppression of TSH with levothyroxine was given in less than half of the patients. In non-metastatic setting, the same approach could be considered depending on the patient profile.
 The majority of patients with metastatic struma ovarii were treated with pelvic surgery, total thyroidectomy and radioactive iodine therapy. Suppression of TSH with levothyroxine was given in less than half of the patients. In non-metastatic setting, the same approach could be considered depending on the patient profile.Background Anoxic brain injury is a common mode of death following out-of-hospital cardiac arrest (OHCA). We assessed the course of regional cerebral oxygen saturation (rSO2) at the outset and during first responder resuscitation to understand its relationship with return of spontaneous circulation (ROSC) and functional survival. Methods We undertook a prospective observational investigation of adult OHCA patients treated by a first-responder EMS agency in King County, WA. Cerebral oximetry was performed using the SenSmart® Model X-100 Universal Oximetry System (Nonin Medical, Inc). We determined cerebral oximetry rSO2 overall and stratified according to ROSC and favorable survival status defined by Cerebral Performance Category (CPC) of 1-2. Results Among the 59 OHCA cases enrolled, 47% (n = 28) achieved ROSC and 14% (n = 8) survived with CPC 1-2. On average, initial rSO2 cerebral oximetry was 41% and was not different at the outset according to return of spontaneous circulation (ROSC) or survival status. Within 5 minutes of first responder resuscitation, those who would subsequently achieve ROSC had a higher rSO2 than those who would not achieve ROSC (51% vs.