Thrombus or tumor? a case of fibroelastoma as indicated during the submission process

We describe the case of a 50-year-old woman who was admitted to a pheriferal department for heart failure. The echocardiography revealed a small mass measuring about 1.3 × 1.0 cm adhering to the non-coronary cusp of the aortic valve, mild dilated cardiomiopathy and severe biventricular dysfunction. This mass had erroneously been considered a thrombotic lesion, so the patient was treated with thrombolysis and heparin e.v. Only after a transoesophageal echocardiography a tumour cardiac mass was suspected. The diagnosis of fibroelastoma was confirmed by MRI and then from the anatomic and histoligical definition after surgery

Advancing guideline quality through country-wide and regional quality assessment of CPGs using AGREE: a scoping review

Abstract Background and objective Clinical practice guidelines (CPGs) are evaluated for quality with the Appraisal of Guidelines for Research and Evaluation (AGREE) tool, and this is increasingly done for different countries and regional groupings. This scoping review aimed to describe, map, and compare these geographical synthesis studies, that assessed CPG quality using the AGREE tool. This allowed a global interpretation of the current landscape of these country-wide or regional synthesis studies, and a closer look at its methodology and results. Study design and methods A scoping review was conducted searching databases Medline, Embase, Epistemonikos, and grey literature on 5 October 2021 for synthesis studies using the later versions of AGREE (AGREE II, AGREE-REX and AGREE GRS) to evaluate country-wide or regional CPG quality. Country-wide or regional synthesis studies were the units of analysis, and simple descriptive statistics was used to conduct the analysis. AGREE scores were analysed across subgroups into one of the seven Sustainable Development Goal regions, to allow for meaningful interpretation. Results Fifty-seven studies fulfilled our eligibility criteria, which had included a total of 2918 CPGs. Regions of the Global North, and Eastern and South-Eastern Asia were most represented. Studies were consistent in reporting and presenting their AGREE domain and overall results, but only 18% (n = 10) reported development methods, and 19% (n = 11) reported use of Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Overall scores for domains Rigor of development and Editorial independence were low, notably in middle-income countries. Editorial Independence scores, especially, were low across all regions with a maximum domain score of 46%. There were no studies from low-income countries. Conclusion There is an increasing tendency to appraise country-wide and regionally grouped CPGs, using quality appraisal tools. The AGREE tool, evaluated in this scoping review, was used well and consistently across studies. Findings of low report rates of development of CPGs and of use of GRADE is concerning, as is low domain scores globally for Editorial Independence. Transparent reporting of funding and competing interests, as well as highlighting evidence-to-decision processes, should assist in further improving CPG quality as clinicians are in dire need of high-quality guidelines

Further VLBA observations of SiO masers toward Mira variable stars

We present the results of continued monitoring of the SiO masers at 7 mm wavelength in several of the Mira variable stars reported in Cotton et al. (2004, A&A, 414, 275) (o Ceti = Mira, U Orionis = U Ori, R Aquarii = R Aqr) over a period of 16 months, extending the observations to several pulsation cycles. The observed size of the maser rings varied by 3–14% with time but show no clear correlation with pulsation phase. In all cases, the SiO masers appear just outside the dense molecular layer indicated by near-IR observations. Rotation (or large scale motion) is possibly detected in o Ceti with a period of $89\times \sin(i)$ years. We find linear polarization up to ${\sim} 60\%$ and at several epochs predominantly tangentially ordered polarization vectors indicate a radial magnetic field direction. Jet-like features are examined in o Ceti and R Aqr and in both cases, the magnetic field appears elongated with the masing structure. This suggests that the dynamic feature in the envelope is dragging the magnetic field or that the gas is constrained to follow magnetic field