Forewarned Is Forearmed: What Do Editors Look for During Initial Manuscript Assessment?

Objetivo: dar a conocer a los participantes en el cuidado de la salud de la mujer embarazada, los más recientes avances y recomendaciones clínicas de un tema controversial que es causa importante de morbimortalidad perinatal en Colombia.Metodología: se revisaron las bases de datos Cochrane, Medline y Embase, además de la base latinoamericana SciELO, libros de la especialidad y consensos de otras sociedades científicas en búsqueda de estudios diagnósticos, revisiones sistemáticas, estudios aleatorizados y metaanálisis relativos a los términos: “restricción de crecimiento intrauterino” y “pequeño para la edad gestacional” en el período comprendido entre 1995-2009. A partir de esto, se realizó un manuscrito inicial, el cual fue sometido a discusión por medio de Internet. Posteriormente, el manuscrito final fue discutido y modificado en la ciudad de Medellín (Colombia), en el marco del congreso de Medicina Fetal S.A. en septiembre de 2008.Resultados: teniendo en cuenta la evidencia disponible, se presentó una guía para el manejo del feto PEG y con RCIU, la cual puede ser aplicada a Colombia.Conclusiones: este tema genera controversia debido a la falta de evidencia científica para la aplicación de algunas definiciones y pruebas diagnósticas en su manejo.

Vascular access dysfunction is one of the leading causes of morbidity and mortality among end-stage renal disease patients. Vascular access dysfunction exists in all three types of available accesses: arteriovenous fistulas, arteriovenous grafts, and tunneled catheters. To improve clinical research and outcomes in hemodialysis (HD) access dysfunction, the development of a multidisciplinary network of collaborative investigators with various areas of expertise, and common standards for terminology and classification in all vascular access types, is required. The North American Vascular Access Consortium (NAVAC) is a newly formed multidisciplinary and multicenter network of experts in the area of HD vascular access, who include nephrologists and interventional nephrologists from the United States and Canada with: (1) a primary clinical and research focus in HD vascular access dysfunction, (2) national and internationally recognized experts in vascular access, and (3) a history of productivity measured by peer-reviewed publications and funding among members of this consortium. The consortium's mission is to improve the quality and efficiency in vascular access research, and impact the research in the area of HD vascular access by conducting observational studies and randomized controlled trials. The purpose of the consortium's initial manuscript is to provide working and standard vascular access definitions relating to (1) epidemiology, (2) vascular access function, (3) vascular access patency, and (4) complications in vascular accesses relating to each of the vascular access types.

Editorial Policy

The Text of Sakrat al-Maut written by Abdurrauf Assingkili that was collected along with the text of Syar?b al-?syiq?n written by Syekh Hamzah Fansuri and the text of Hujjatus Shidd?q written by Syekh Nuruddin Arranir as well as other writings in the manuscript of Nagara strengthens the influence of the Islamic scholars on Islamic studies in Banjar. Philologically, this manuscript was regarded as a copy made in the 19th century, and it was not the initial manuscript written by Sheikh Abdurrauf in the 17th century. The circulation of Sakrat al-Maut manuscripts is not widespread. It is evident with the minimal number of manuscripts that were found / recorded in the catalog. In Banjar, the teachings contained in the manuscript text of Sakrat al-Maut is not fully adopted by next Banjar scholars.

Dear Editor,I read with great interest the recent article titled “Unlocking the Potential of VExUS in Assessing Venous Congestion: The Art of Doing it Right,” which critically examines the utility of venous excess ultrasound (VExUS) scores in assessing venous congestion. The article evaluates venous congestion across different clinical scenarios and patient populations, including those with heart failure and in critical illness [1]. While the article admirably underscores the importance of VExUS in guiding fluid management and predicting outcomes, I am particularly interested in delving deeper into certain caveats and limitations necessary to enhance its clinical applicability.The article rightly highlights the technical intricacies involved in performing VExUS assessments, particularly in interpreting inferior vena cava (IVC) and internal jugular vein ultrasound, along with Doppler evaluations. However, it is crucial to acknowledge the complexities associated with using IVC diameter alone to estimate right atrial pressure, especially in mechanically ventilated patients where such correlations may not hold uniformly. Factors such as anatomical variations, abdominal compliance, and intra-abdominal pressure dynamics can significantly influence IVC measurements, necessitating a nuanced approach that includes comprehensive visualization techniques and possibly integrating alternative modalities like internal jugular vein dynamics to mitigate potential inaccuracies [2].The article appropriately discusses how local structural changes in liver and kidney diseases can impact Doppler waveforms, thereby complicating the interpretation of VExUS findings. It is imperative to recognize that conditions such as liver cirrhosis or acute kidney injury can markedly alter venous hemodynamics, potentially confounding the reliability of traditional ultrasound parameters [3]. In such clinical scenarios, the integration of supplementary diagnostic tools and clinical judgment becomes indispensable to augment VExUS assessments and ensure judicious therapeutic decision-making [4].While acknowledging the established prognostic value of VExUS in cardiac surgery settings, the article rightly underscores the variability in its predictive accuracy across broader intensive care unit (ICU) populations. Discussions around the correlation between VExUS scores and clinical outcomes such as acute kidney injury or mortality highlight existing inconsistencies in the literature. For instance, while some studies report significant associations between higher VExUS grades and adverse outcomes, others suggest limited predictive utility in heterogeneous ICU cohorts [5]. This variability underscores the urgent need for methodologically rigorous multicenter studies with robust sample sizes to validate the prognostic efficacy of VExUS across diverse patient profiles and clinical contexts.The article’s introduction of the concept of “fluid tolerance” and emphasis on assessing hemodynamic congestion before administering fluids reflect a prudent approach aligned with contemporary patient-centered care principles. However, it is essential to underscore the complexity of fluid responsiveness assessment in critically ill patients, where individualized hemodynamic profiles and therapeutic goals necessitate a nuanced approach. Balancing the risks of fluid overload against the imperative to maintain adequate tissue perfusion underscores the critical role of integrating comprehensive clinical assessment with advanced diagnostic tools like VExUS to optimize fluid management strategies effectively [6].To enhance the clinical utility of VExUS, concerted efforts are warranted to standardize training protocols for clinicians and refine measurement techniques to mitigate interobserver variability. Moreover, expanding research initiatives should prioritize investigating the role of VExUS in specific patient cohorts, including those with complex hepatic or renal pathophysiology, to elucidate its utility beyond traditional ICU settings. Multicenter collaborations are essential to establish robust evidence supporting the broader applicability of VExUS in predicting clinical outcomes and guiding tailored therapeutic interventions.In conclusion, while recognizing the potential of VExUS as a valuable tool in assessing venous congestion and optimizing fluid management in critically ill patients, ongoing scientific rigor and methodological refinement are imperative to enhance its clinical validity and utility. As a practitioner committed to advancing nephrological care, I advocate for continued interdisciplinary collaboration and evidence-based research to maximize the impact of VExUS in improving patient outcomes.The authors have no conflicts of interest to declare.This study was not supported by any sponsor or funder.R.H.P. and P.G.Z.T. conceived and designed the study, drafted the initial manuscript, and performed critical revisions. C.M.P., V.B.G., R.S.A., T.D.M., and U.A.P.F. reviewed and edited the manuscript. All authors approved the final version.

Winning Tradeoffs in Space and Time for Environmentally Responsible Offshore Wind Energy Development Benjamin D. Best , Patrick N. Halpin

Uniform Format for Disclosure of Competing Interests in ICMJE Journals

e16518 Background: Endocervical adenocarcinoma (EA) is the 2nd most common uterine cervical malignancy (after squamous cell carcinoma). Early stage tumors are defined by depth of invasion (DOI); although used to guide nodal dissection, DOI not an entirely reliable criteria, and most patients have negative nodes. Thus, pathologic criteria that better predict risk of nodal metastases are needed. A prior study of 352 cases from 12 US and international institutions, with complete pathological and clinical follow-up averaging 52 months, found classifying EA by a newly proposed ‘Silva Pattern of Invasion’ (SPI) is the best predictor of nodal metastases. SPI are defined as A: no destructive stromal invasion or lymph-vascular invasion (LVI); B: small foci (<4 mm) of fragmented, angulated glands, solid aggregates or individual tumor cells associated with desmoplastia or LVI; and C: diffuse destructive invasion. Pattern A, 25% of cases, had no nodal metastases or recurrences. Approximately 25% were B, with 5% nodal metastases, 2% recurrence, and no tumor deaths. Pattern C cases: nodal metastases 23%, recurrences 21%, and death from tumor 9%. SPI appeared simple to diagnose, but a formal assessment of reproducibility is needed. Methods: Reproducibility for diagnosing SPI, and for the standard measurement of DOI is compared. Four Gynecological Pathologists, who have read the initial manuscript, but not involved in the original study nor from the participating institutions, and blinded to clinical information examine 1or 2 hematoxylin and eosin-stained glass slides from 90 cases from the original series. Results: 30 cases each of Pattern A, B, and C are reviewed. Kappa statistics will be estimated. With 90 samples, we will have >80% power to detect a true kappa of 0.7 in a test of the null hypothesis that kappa = 0.5 vs the alternative that kappa≠0.5 with equal frequencies in each SPI category. Conclusions: A good reproducibility outcome would indicate that the SPI could be applied in general practice. Accurate use of SPI requires examination of the entire lesion unless pattern B or C is found in the biopsy specimen. Use of the SPI system to guide nodal dissection will require validation in a large series.

Urban growth is a major threat to biodiversity conservation at the global scale. Its impacts are expected to be especially detrimental when it sprawls into the landscape and reaches sites of high conservation value due to the species and ecosystems they host, such as protected areas. I analyzed the degree of urbanization (i.e., urban cover and growth rate) from 2006 to 2015 in protected sites in the Natura 2000 network, which, according to the Habitats and Birds Directives, harbor species and habitats of high conservation concern in Europe. I used data on the degree of land imperviousness from COPERNICUS to calculate and compare urban covers and growth rates inside and outside Natura 2000. I also analyzed the relationships of urban cover and growth rates with a set of characteristics of Natura sites. Urban cover inside Natura 2000 was 10 times lower than outside (0.4% vs. 4%) throughout the European Union. However, the rates of urban growth were slightly higher inside than outside Natura 2000 (4.8% vs. 3.9%), which indicates an incipient urban sprawl inside the network. In general, Natura sites affected most by urbanization were those surrounded by densely populated areas (i.e., urban clusters) that had a low number of species or habitats of conservation concern, albeit some member states had high urban cover or growth rate or both in protected sites with a large number of species or habitats of high conservation value. Small Natura sites had more urban cover than large sites, but urban growth rates were highest in large Natura sites. Natura 2000 is protected against urbanization to some extent, but there is room for improvement. Member states must enact stricter legal protection and control law enforcement to halt urban sprawl into protected areas under the greatest pressure from urban sprawl (i.e., close to urban clusters). Such actions are particularly needed in Natura sites with high urban cover and growth rates and areas where urbanization is affecting small Natura sites of high conservation value, which are especially vulnerable and concentrated in the Mediterranean region.

The debate over myocarditis following COVID-19 vaccination is currently a trending topic in medicine. According to the US Centers for Disease Control and Prevention, the frequency of myocarditis/pericarditis following COVID-19 vaccination is low (12.6 per million doses), and the prognosis is considered good with rapid symptom recovery.1 Here we report the case of a 15-year-old adolescent male diagnosed with myocarditis after COVID-19 vaccination who subsequently underwent multiple cardiac magnetic resonance imaging (cMRI) studies, which showed positive late gadolinium enhancement (LGE) even after the acute phase. Three days after the second dose of a COVID-19 vaccine (BNT162b2) was administered, the patient complained of chest discomfort early in the morning. He visited a local clinic that morning where an electrocardiogram (ECG) was performed, which showed ST-segment elevation in the II, III, and V3-6 inductions. Although the chest discomfort resolved and his symptoms lessened over time, he was referred to our hospital the following day for further evaluation. Based on his clinical symptoms and course, a diagnosis of myocarditis caused by COVID-19 vaccination was made, and he was admitted to our hospital. At the time of admission, his height was 170.2 cm, weight 56.2 kg, blood pressure 112/68 mmHg, heart rate 64 beats per minute (bpm), respiratory rate 20/min, oxygen saturation (SpO2) 98% (room air), and body temperature 36.6 °C. Blood examination revealed markedly elevated troponin T (0.351 ng/mL) and mildly elevated N-terminal pro-B-type natriuretic peptide (NT-pro BNP, 127 pg/mL) and C-reactive protein (CRP, 0.92 mg/dL), white blood cell 3800/μL, eosinophil 1.7%, hemoglobin 13.8 g/dL, and platelets 152 000/μL. A standard 12-lead ECG showed ST-segment elevation at V4–5. Echocardiography showed normal left ventricular contraction with an ejection fraction of 62% and no clinically problematic atrioventricular valve insufficiency. Due to mild symptoms and good physical condition, a decision was made to observe the patient's clinical course without therapeutic intervention. On day 6 of hospitalization (6 days after onset), laboratory data normalized to troponin T at 0.008 ng/mL and NT-proBNP at 31.0 pg/mL. Cardiac MRI showed slight dyskinesis from the basal septum to the inferior wall. Increased signal from the basal to the middle and lateral inferior wall on black blood T2WI 2-lumen imaging and similarly increased signal in the apical region were also present (Fig. 1). Late gadolinium enhancement showed contrast effects mainly in the middle layer from the cardiac base to the center, from the lateral wall to the inferior wall, and in the inferior septal wall. The native T1 value of the LGE-positive area was within the normal range (T1 value: 1,246–1,274 ms). Although the findings confirmed by cMRI suggested myocardial edema, his physical condition was good, so he was discharged on the seventh day of hospitalization. We performed additional cMRI scans and exercise ECG 6 and 19 weeks after the onset of myocarditis. Cardiac MRI after 6 and 19 weeks showed the presence of LGE mainly in the middle layer of the inferior wall; however, the contrasted area was reduced (Fig. 1). As with the initial cMRI findings, the native T1 value was within the normal range in the area that was determined to be LGE positive. The area that was depicted in white in the T2-weighted image of the initial cMRI was also no longer observed. Cine MRI showed no dyskinesis and good left ventricle contraction with an ejection fraction of 65%. This case demonstrates that abnormal findings from cMRI can persist in post-COVID-19 vaccination myocarditis even after symptoms have abated. The patient's exercise ECG showed no abnormal findings. Previous reports have shown a high rate of abnormal MRI findings in post-COVID-19 vaccination myocarditis.2, 3 Recently, several reports have emerged showing residual abnormal findings on cMRI at mid-term follow up of post-COVID-19 vaccination myocarditis, including one report where seven of nine patients had residual abnormal findings at 6-month follow up.4 Positive LGE findings on cMRI in acute myocarditis have been reported to be useful in predicting major cardiovascular events and poor prognosis.5 Although post-COVID-19 vaccination myocarditis has a favorable prognosis and is considered curable, it may leave abnormalities in the myocardium, as observed in this case; it may therefore be premature to declare it as a complication with a good prognosis. In the future, the frequency of residual abnormal findings on cMRI and the timing of subsequent follow up should be re-examined. We would like to thank Dr. Atsuko Fujikawa and Dr. Atsushi Hiroishi of the Department of Radiology, St. Marianna University School of Medicine, for their careful interpretation of cardiac MRI. The authors declare no conflict of interest. Dr. Konno and Dr. Aso designed the study and drafted the initial manuscript. Dr. Sakurai, Dr. Masumori, Dr. Nakano, and Dr. Osada collected and analyzed the patient data. All the authors have reviewed and revised the manuscript and have approved the final manuscript for submission and agree to be accountable for all aspects of the work. The patient's family provided informed consent for the publication of this case report.

The British Journal of Haematology publishes original research papers in clinical, laboratory and experimental haematology. The Journal also features annotations, reviews, short reports, images in haematology and Letters to the Editor.

A novel coronavirus disease broke out in 2019 (COVID-19). This disease was found to be a result of infection from the 2019 novel coronavirus (2019-nCoV).1 The severity of COVID-19 disease ranges from asymptomatic to critically severe; clinical research reported that 10–15% of the patients were in the severe category and required a great deal of medical treatment and nursing care.2 Indicators are needed to evaluate and predict the severity of the disease. We conducted the present meta-analysis to clarify whether platelet count might be a potential indicator to evaluate and predict the severity of COVID-19 in patients. Relevant studies published in English up to 30 April 2020 were searched through PubMed Scopus, EMBASE, Web of Science and Cochrane Library. Keywords included "COVID-19", "platelet count", "severe" and "thrombocytopenia". To be included in the analysis, the studies had to report the mean and (±standard deviation, SD) of the platelet count in both severe and non-severe COVID-19 patients, or report the median and interquartile range (IQR) or median and range of platelet count, from which we could extract information about the mean (±SD).3, 4 The studies that reported the proportions of patients with thrombocytopenia in both severe and non-severe COVID-19 were also included. Studies were excluded when the participants might have a large overlap with other included studies. Study quality was evaluated by a checklist from the Agency for Healthcare Research and Quality. The pooled standardized mean difference (SMD) and odds ratio (OR) with 95% confidence interval (CI) were worked out by STATA 12.0 software (StataCorp LCC, College Station Texas, USA), and shown in the forms of forest plots figures. The detailed statement of materials and methods is shown in Data S1. After a comprehensive search and review (Figure S1), 31 studies with 7613 participants were included. Twenty-five of the included studies reported the platelet count of both severe and non-severe COVID-19 patients and 15 of the included studies reported the proportion of thrombocytopenia in both severe and non-severe COVID-19 patients. Detailed information and the reference list of included studies are shown in Tables SI and SII. For the 25 studies that reported the platelet count of both severe and non-severe COVID-19 patients, the pooled SMD revealed a lower platelet count in severe patients than non-severe patients (SMD = −0·36, 95% CI −0·48 to − 0·23, I2 = 56·9%; shown in Fig 1A). The results of a sensitivity analysis and test of publication bias are shown in Figures S2 and S3. Six of the 25 studies defined death as the severe state. The pooled SMD revealed a much lower platelet count in non-survivor COVID-19 patients than survivor patients (SMD = −0·60, 95% CI −0·72 to − 0·47, I2 < 0·1%; shown in Fig 1B). Fifteen of the 31 included studies reported the proportion of thrombocytopenia in both severe and non-severe COVID-19 patients. The pooled OR of thrombocytopenia for severe COVID-19 patients indicated a significant association between thrombocytopenia and severe COVID-19 (OR = 3·46, 95% CI 1·72–6·94, I2 = 91·8%; shown in Fig 2A). The results of a sensitivity analysis and test of publication bias are shown in Figures S4 and S5. Three of the 15 studies defined death as the severe state. The pooled OR suggested a stronger association between thrombocytopenia and death caused by COVID-19 (OR = 11·75, 95% CI 3·51–39·31, I2 = 88·9%; shown in Fig 2B). Abnormal platelet count, especially thrombocytopenia, is quite common in patients in the intensive care unit (ICU).5 The decreasing platelet count usually indicates the dysfunction of organs or systems and leads to a disorder of homeostasis. Studies found that thrombocytopenia in the ICU tended to increase the risk of death.6 It has also been reported that 2019-nCoV infection might affect the blood coagulation mechanism resulting in a disorder of blood coagulation.7 The mechanism by which 2019-nCoV affects blood coagulation might be similar to that of severe acute respiratory syndrome (SARS) which broke out in 2002 to 2003. The possible mechanism of thrombocytopenia in the SARS disease might be due to damage to the lung. The damage to the lung caused by the SARS corona virus, or mechanical ventilation, might lead platelet activation and aggregation, resulting in platelet consumption and thrombocytopenia.8 The lung has also been found to be a site of platelet biogenesis.9 Fibrosis and other lung damage might affect the formation and releasing of platelets. Collins10 reported that infection of the human coronavirus strain 229E could cause apoptosis in human monocytes/macrophages, which suggested that 2019-nCoV might damage the hematopoietic cells or platelet directly. However, the exact mechanism of how 2019-nCoV affects platelet count still needs to be explored. In conclusion, when compared to the non-severe COVID-19 patients, the patients with severe COVID-19 had a lower platelet count. The non-survivors had a much lower platelet count than the survivors. Thrombocytopenia might be a risk factor for COVID-19 progressing into a more severe state. More studies about platelet count in COVID-19 are needed. We wish to express our appreciation to all the authors whose publications could be included in our meta-analysis. This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. The authors declare no conflict of interest. Shi-Qin Jiang, Qiu-Fen Huang and Wei-Ming Xie are joint first authors and contributed equally to the present meta-analysis; Shi-Qin Jiang, Wei-Ming Xie and Xiao-Qing Quan conceived the analysis; data was extracted by Qiu-Fen Huang and Wei-Ming Xie independently; Shi-Qin Jiang, Qiu-Fen Huang and Wei-Ming Xie analysed and interpreted the data; Shi-Qin Jiang and Chao Lv drafted the initial manuscript; the manuscript was critically revised by Xiao-Qing Quan for important intellectual content. All authors read and approved the final manuscript. All authors accept full responsibility for the content of the present article. Fig S1. Flow diagram of literature search and study selection. Fig S2. Result of sensitivity analysis for standardized mean difference (SMD) of platelet count between severe and non-severe COVID-19 patients. The middle vertical line indicates the pooled SMD of 25 studies, and the two side vertical lines represent the 95% confidence interval (CI) values. Every hollow round indicates the pooled SMD when the left study was omitted in a meta-analysis with a random-effect model. Fig S3. Begg's funnel plot of the 25 studies reported the platelet count of both severe and non-severe COVID-19 patients. The horizontal line indicates the pooled standardized mean difference (SMD). The asymmetry of two oblique lines was tested by Egger's linear regression test (P = 0·328). Fig S4. Result of sensitivity analysis on odds ratios (OR) of thrombocytopenia for severe COVID-19 patients. The middle vertical line indicates the pooled OR of 15 studies, and the two side vertical lines represent the 95% confidence interval (CI) values. Every hollow round indicates the pooled OR when the left study was omitted in a meta-analysis with a random-effect model. Fig S5. Begg's funnel plot of the 15 studies reported the proportion of thrombocytopenia in both severe and non-severe COVID-19 patients. The horizontal line indicates the pooled odds ratio (OR). The asymmetry of two oblique lines was tested by Egger's linear regression test (P = 0·735). Table SI. Characteristics of studies reported the platelet count in both severe and non-severe COVID-19 patients. Table SII. Characteristics of studies reported the proportion of thrombocytopenia in both severe and non-severe COVID-19 patients. Data S1. Materials and methods. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Biomarkers to predict infection and infection-related complications during chemotherapy-induced neutropenia in acute myeloid leukaemia: a pilot study.

Primary sternal osteomyelitis is a rare infection of the bones, but its fundamental characteristics mirror those of long bone osteomyelitis: increased incidence at a younger age, male preponderance, nonspecific presentation, and unreliability of plain radiographs for diagnosis. Also, the spectrum of reported pathogens roughly agrees with that reported for osteomyelitis at other sites.1 Osteomyelitis complicated by abscesses or sequestra typically requires surgical intervention, such as abscess drainage or necrotic bone removal.2 The patient completed 4 weeks of intravenous antibiotic therapy, which was switched to oral cefalexin and then he was discharged. Regular outpatient ultrasonography confirmed the disappearance of the detached sternal segments and new bone formation in the original sternal position (Figure 1d,e). Subsequent CT also confirmed the resolution of the abscess and bone fragments as well as new bone formation in the original sternal location (Figure 1f). Oral antibiotics were continued for 5 months. The patient was evaluated for immunodeficiency at the previous hospital through immunoglobulin level and lymphocyte subset testing. Aside from a low IgG2 level of 61.2 mg/dL, no other apparent abnormalities were detected. Upon re-evaluation at our hospital, the IgG2 level had recovered to 111 mg/dL, and it was not actively considered a contributing factor to susceptibility to infection. Although this case involved both sequestra and abscess formation, we opted for antibiotic therapy without surgical intervention for the reasons mentioned above. A case series of 74 pediatric primary sternal osteomyelitis cases reported that five out of six cases of abscess formation recovered without surgical intervention.1 Our approach was further justified by our ability to closely monitor treatment progress through frequent ultrasonography examinations and our readiness to promptly implement surgical treatment if needed. In this case, the sternal segments detached, subsequently disappeared, and new bone formation was observed in the original sternal location. At birth, the sternum typically has 4–5 ossification centers, from which ossification spreads. By 1 year of age, ossification extends to the lower part of the sternal body, while ossification of the xiphoid process is further delayed, taking over 3 years. Complete bony fusion of the sternal body occurs around age 30.3 These characteristics may explain why multiple segments detached in this case. Detailed reports of sternal segment detachment and subsequent new bone formation in patients with sternal osteomyelitis are rare, making this case a valuable contribution to the literature. We were able to closely and repeatedly monitor the progression of sternal osteomyelitis and surrounding structural changes using ultrasound. One key factor enabling such detailed observation was the sternum's anatomical characteristics as a flat bone located near the surface, which facilitated clear imaging. Additionally, given the patient's age and the early stage of ossification, ultrasound proved particularly useful, as progressive ossification can lead to acoustic shadowing, limiting sonographic visibility in older patients. All the authors meet the ICMJE authorship criteria. Hiroki Shimono drafted the initial manuscript. Akiko Kinumaki supervised writing the case report and critically reviewed the manuscript. Natsuho Adachi, Hiroyuki Tanaka, Yuko Kajiho, and Shoichiro Kanda critically reviewed and revised the manuscript. All the authors have read and approved the final manuscript. The authors declare no conflict of interest. Informed consent was obtained from the parents of the patient to publish the data in this report.

7 - Publishing in Scientific Journals