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BACKGROUND: We sought consensus among practising respiratory physicians on the prediction, identification and monitoring of progression in patients with fibrosing interstitial lung disease (ILD) using a modified Delphi process. METHODS: Following a literature review, statements on the prediction, identification and monitoring of progression of ILD were developed by a panel of physicians with specialist expertise. Practising respiratory physicians were sent a survey asking them to indicate their level of agreement with these statements on a binary scale or 7-point Likert scale (- 3 to 3), or to select answers from a list. Consensus was considered to be achieved if ≥ 70% of respondents selected the same answer, or, for responses on a Likert scale, the median score was ≤ -2 (disagree/not important) or ≥ 2 (agree/important) with an interquartile range ≤ 1. There were three rounds of the survey. RESULTS: Surveys 1, 2 and 3 were completed by 207, 131 and 94 physicians, respectively, between March 2022 and July 2023. Decline in forced vital capacity (FVC), decline in diffusing capacity of the lungs for carbon monoxide, and increased fibrosis on high-resolution computed tomography (HRCT) were ranked as the most important endpoints for determining progression. Consensus was reached that progression on HRCT or a decline in FVC ≥ 10% from baseline is sufficient to determine progression, and that small declines in multiple endpoints indicates progression. Consensus was reached that a histological pattern of usual interstitial pneumonia (UIP) is a risk factor for progression of ILD, but that a biopsy to look for a UIP pattern should not be performed solely for prognostic reasons. Consensus was not reached on the time period over which progression should be defined. There was consensus that appropriate management of ILD depends on the type of ILD, and that despite adequate management or despite usual management should be included in the definition of progression. CONCLUSIONS: This modified Delphi process provided consensus statements on the identification of ILD progression that were supported by a broad group of clinicians and may help to inform clinical practice until robust evidence-based guidelines are available.

Abstract Background Advances in the field of genetics of interstitial lung diseases (ILDs) have led to the recent consensus statements made by expert groups. International standards for genetic testing in ILD have not yet been established. We aimed to examine current real-world strategies employed by pulmonologists working with familial ILD. Methods A panel of pulmonologists with expertise in ILD developed an international survey aimed at clinicians working with ILD. The survey consisted of 74 questions divided into eight topics: characteristics of respondents, diagnosis, screening of first-degree relatives, screening tools, genetic testing methods, lung transplantation, ethical concerns, and future needs. Results Overall, 237 pulmonologists from 50 countries participated. A family history of ILD was asked for by 91% of respondents while fewer asked for symptoms related to telomere disorders. Respondents stated that 59% had access to genetic testing, and 30% to a genetic multidisciplinary team (MDT). Many respondents were unaware of specific genetic testing methods. Pathogenic genetic variants were seen as a potential contraindication for lung transplantation in 6–8% of respondents. Genetic screening of relatives was supported by 80% of respondents who indicated insufficient evidence and a lack of formal guidelines for genetics and ILD. Only 16% had a standardized program. Conclusion Most pulmonologists ask for a family history of ILD and recommend genetic testing for ILD and screening in relatives but have limited knowledge of specific tests and access to genetic MDT. Evidence-based guidelines to inform patients, relatives, and physicians are still warranted.

Background: The latest guidelines on hypersensitivity pneumonitis (HP) categorise the disease as either fibrotic or non-fibrotic because of the greater clinical utility of this stratification. However, the prevalence and incidence of fibrotic and non-fibrotic HP are unknown. This study assessed the exact prevalence and incidence of fibrotic and non-fibrotic HP in Japan in 2021. Methods: For adults, the study hospitals were selected by stratified random sampling according to numbers of beds. The sampling rate was set at about 20%. The questionnaire survey was submitted to the target hospitals. For pediatric cases, a survey was distributed to all members of the Japanese Society of Pediatric Pulmonology and Japanese Society of Pediatric Allergy and Clinical Immunology. Results: Regarding adult cases, in total, 575 facilities responded to the survey, resulting in a response rate of 36.4%. The estimated prevalence and incidence of fibrotic HP were 6.3 and 2.5 per 100,000 population, respectively, versus 3.6 and 2.0 per 100,000 population, respectively, for non-fibrotic HP. Both fibrotic and non-fibrotic HP were more prevalent in southern Japan (Kyushu) and less prevalent in northern Japan (Hokkaido). The incidence of non-fibrotic HP was significantly lower in December than in the other months (relative risk ratio = 0.36, p

Intermediate α″ phase was constructed in as-printed Ti alloys by introducing interstitial carbon atoms to mitigate the detrimental effects of α′ martensite on ductility. The interstitials served as a lattice modulation limiter to achieve an incomplete atomic shuffle during martensitic transformation process to form metastable α″ phase, followed by stabilizing the α″ to inhibit the growth of α′ martensite. The resulting microstructure, characterized by a dominant α/α′ matrix decorated with fine α″ phase, enhanced twinning formation ability and induced dynamic Hall–Petch and grain refinement strengthening effects. This resulted in simultaneous improvements in both strength and ductility.

Background Acute exacerbations of fibrosing interstitial lung diseases (ILDs) are associated with high mortality. We used prospective data from the INBUILD trial to investigate risk factors for acute exacerbations and the impact of these events in patients with progressive pulmonary fibrosis. Methods Patients with progressive fibrosing ILDs other than idiopathic pulmonary fibrosis (IPF) were randomised to receive nintedanib or placebo. Associations between baseline characteristics and time to first acute exacerbation were assessed using pooled data from both treatment groups using Cox proportional hazard models, firstly univariable models and then a multivariable model using forward stepwise selection. The risk of death was estimated based on the Kaplan−Meier method. Results Over a median follow-up of approximately 19 months, acute exacerbations were reported in 58 (8.7%) of 663 patients. In the risk factor analysis, the final model included diffusing capacity of the lung for carbon monoxide (DLCO) % predicted, treatment and age. Lower DLCO % predicted was associated with an increased risk of acute exacerbation with a hazard ratio (HR) of 1.56 (95% CI 1.21–2.02) per 10 units lower (p

FeCoNiSi–Cu, FeCoNiSi–Mn, and FeCoNiSi–Ti equiatomic high entropy alloys (HEAs) were designed and produced via powder technology using spark plasma sintering (SPS). Metallurgical analysis tools, including SEM, XRD, EBSD, were used to investigate the crystal structure and the distribution of the formed phases for the prepared HEAs. The formation of a ductile FCC phase for all the prepared HEAs was observed, while the brittle BCC phase was formed only for FeCoNiSi–Mn HEA. By comparing the results with thermodynamic parameters, it is found that there is a strong agreement for the results with the valence electron concentration rule. FeCoNiSi–Cu and FeCoNiSi–Mn HEAs show 100% relative density, whereas FeCoNiSi–Ti HEA shows only 95%. All the prepared HEAs with Cu, Mn, and Ti additions show high hardness values of 507, 710, and 495 Hv, respectively. Both FeCoNiSi–Cu and FeCoNiSi–Mn HEAs have high compressive strength and yielding strength of 1854 MPa,1390 MPa for FeCoNiSi–Cu HEA and 1565 MPa, 1482 MPa) for FeCoNiSi–Mn HEA, respectively. Although having finer grains, FeCoNiSi–Ti HEA shows the lowest compressive strength and yield strength values. This is due to the tendency of the alloy to form intermetallic compounds and the presence of pores that act as nuclei for crack initiation and propagation. In addition, due to the presence of non-ferromagnetic elements in equiatomic ratio with other ferromagnetic elements (FeCoNi), FeCoNiSi–Cu HEA shows only 59.4 emu/gm for magnetization saturation, but the magnetic properties for both FeCoNiSi–Mn and FeCoNiSi–Ti HEAs nearly disappeared.The electrical resistivity for all the prepared HEAs is very high.

Transarterial embolization using Onyx (Medtronic, Irvine, CA, USA) results in a high cure rate for complete obliteration of dural arteriovenous fistulas. However, incomplete obliteration occurs in some cases. Reports on the use of bailout therapy in such cases are limited. A 79-year-old man was diagnosed with Borden type III tentorial dural arteriovenous fistulas during a check-up for a headache. We first performed transarterial embolization with Onyx from a tentorial artery, but the fistula was not completely obliterated. We then performed an additional transarterial embolization with n-butyl-2-cyanoacrylate from the same artery in a single session, and the fistula was successfully bailed out, resulting in complete obliteration. Combining different liquid embolic materials, Onyx and n-butyl-2-cyanoacrylate, is an effective strategy for achieving complete obliteration in incomplete transarterial embolization treatment of dural arteriovenous fistulas.

Internal carotid artery dissection is rare but can be a cause of stroke in young people. In a case of revascularization for stroke associated with internal carotid artery dissection, we initially used a stent retriever for thrombectomy. Since an appropriately-sized stent for permanent treatment was not available, we innovatively maintained temporary revascularization with the stent retriever for 90 minutes. Here we demonstrate the adaptability of the stent retriever for emergency care. A 49-year-old man suddenly developed severe right hemiplegia and aphasia. Magnetic resonance imaging showed occlusion of a left internal carotid artery with moderate ischemic changes in the left hemisphere cortex. Angiography showed dissection of the left internal carotid artery at the cervical level and secondary thrombus formation extending into the left middle cerebral artery. We initially attempted thrombectomy with a stent retriever and achieved successful reperfusion in the middle cerebral artery. An appropriately-sized stent was not available in the hospital at that time. During the 90-minute wait, the stent retriever was kept in place and temporary angioplasty was performed in the internal carotid artery dissection to maintain blood flow. Eventually, the stent was delivered and permanent revascularization was achieved. While there is no standard treatment for arterial dissection, endovascular strategies like stenting have been demonstrated to be beneficial. The innovative use of stent retrievers for temporary angioplasty of dissected lesions underscores their efficacy in swift deployment and maintenance of uninterrupted blood flow, particularly during emergency thrombectomy.

Abstract The concept of “indirect evolutionary rescue” refers to the evolutionary adaptation of an interacting species that can save a focal species from extinction in an unfavorable environment. Although theories suggest that indirect evolutionary rescue may have essential impacts on catchments in the context of fisheries where artificial selection pressure from fishing can drive evolution, its generality and conditions remain uncertain. In this study, by investigating how prey adaptation affects the persistence of a predator subjected to selective harvest with an eco‐evolutionary predator–prey model, we find that prey adaptation tends to deteriorate (facilitate) predator persistence when predator's evolvability is high (low). In the system where the predator possesses high evolvability, selection by fisheries inhibits a predator's adaptation to prey, allowing the prey to escape predation by adaptation. Prey adaptation will affect predator persistence negatively, leading to evolutionary murder. Conversely, in the system where the predator's evolvability is low, the removal of predator individuals by fisheries relaxes predation pressure on prey, making the prey less defensive. Vulnerable prey affects predator persistence positively, resulting in indirect evolutionary rescue. The context‐dependent response of natural resources to fisheries identified in this study suggests that the eco‐evolutionary interplay should be considered for better natural resource management.