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\"The Anthropocene is the current geological age, in which human activity has profoundly shaped the planet and its biodiversity. In this remarkable symphony of essays adapted and expanded from his groundbreaking podcast, John Green reviews different facets of the human-centered planet - from the QWERTY keyboard and Staphylococcus aureus to the Taco Bell breakfast menu - on a five-star scale. John Green's gift for storytelling shines throughout this artfully curated collection that includes both beloved essays and all-new pieces exclusive to the book.\"-- Provided by publisher

We aimed to provide an overview on research path in nuclear medicine climbing the steps of the Evidence-Based Medicine (EBM) pyramid using review of 14 subjectively selected papers out of 111 published in the Annals of Nuclear Medicine during January–December 2019. Following the structure of the EBM hierarchy, we chose at least one study for each step of the pyramid from the basis (pre-clinical research, expert opinion, case report and case series), to the middle (case-control and cohort studies, randomised controlled trials), towards the top (meta-analyses and systematic reviews). Additionally, we collected information on the promoter of each included study: investigator-initiated trials (IITs) vs industry-sponsored trials (ISTs). We found that pre-clinical studies are primarily focused on the development of novel molecular targets in cancer, with promising results. At the same time, clinical investigations deal with cardiological, neurological, infectious and oncological applications using both SPECT and PET modalities. Additionally, radionuclide therapy gained interest and is experiencing comprehensive clinical implementation. Our overview confirms the current central role of IITs as compared with ISTs. Challenges and future directions in Nuclear Medicine research are discussed.

Although single-photon-emitting radiotracers have long been the standard for renal functional molecular imaging, recent years have seen the development of positron emission tomography (PET) agents for this application. We provide an overview of renal radionuclide PET radiotracers, in particular focusing on novel 18F-labelled and 68Ga-labelled agents. Several reported PET imaging probes allow assessment of glomerular filtration rate, such as [68Ga]ethylenediaminetetraacetic acid ([68Ga]EDTA), [68Ga]IRDye800-tilmanocept and 2-deoxy-2-[18F]fluorosorbitol ([18F]FDS)). The diagnostic performance of [68Ga]EDTA has already been demonstrated in a clinical trial. [68Ga]IRDye800-tilmanocept shows receptor-mediated binding to glomerular mesangial cells, which in turn may allow the monitoring of progression of diabetic nephropathy. [18F]FDS shows excellent kidney extraction and excretion in rats and, as has been shown in the first study in humans. Further, due to its simple one-step radiosynthesis via the most frequently used PET radiotracer 2-deoxy-2-[18F]fluoro-d-glucose, [18F]FDS could be available at nearly every PET centre. A new PET radiotracer has also been introduced for the effective assessment of plasma flow in the kidneys: Re(CO)3-N-([18F]fluoroethyl)iminodiacetic acid (Re(CO)3([18F]FEDA)). This compound demonstrates similar pharmacokinetic properties to its 99mTc-labelled analogue [99mTc](CO)3(FEDA). Thus, if there is a shortage of molybdenum-99, Re(CO)3([18F]FEDA would allow direct comparison with previous studies with 99mTc. The PET radiotracers for renal imaging reviewed here allow thorough evaluation of kidney function, with the tremendous advantage of precise anatomical coregistration with simultaneously acquired CT images and rapid three-dimensional imaging capability.

How often do you advise parents to alternate paracetamol with ibuprofen to manage a young child with a fever? First, The Archivist would question why you were doing that: the concern about bringing a fever down only adds to the development fever phobia in parents. After a good discussion about the value of fever and a search for the cause, one might want to give an antipyretic/analgesic to make the child more comfortable and less ‘irritable’. What do you suggest? Time for a network meta-analysis. So, before you read the following systematic review, The Archivist suggests you read the accompanying paper by Wade and Mathis [Pediatrics. 2024;154(4):e2024067408. DOI: https://doi.org/10.1542/peds.2024-067408]. This paper puts things in perspective regarding the main objective to manage a child with fever, safely with no adverse events. They pose many questions. Is the simple reduction of a fever enough to justify dual antipyretic therapy? When should caregivers move to a dual regimen? What is the role of parent counselling? De la Cruz-Mena et al [Pediatrics (2024) 154 (4): e2023065390. DOI: https://doi.org/10.1542/peds.2023-065390] have assessed the comparative efficacy of paracetamol or ibuprofen alone, alternating or combined through a systematic review and network meta-analysis, examining randomised trials. The study demonstrates very neatly how to complete a pairwise and network meta-analysis using the random-effects model. There were 31 trials including 5009 children. They calculated that combined (OR 0.19; CI 0.09 to 0.42) and alternating therapies (OR 0.20; CI 0.06 to 0.63) may be superior to paracetamol, whereas ibuprofen at a high dose may be comparable (OR 0.98; CI 0.63 to 1.59) when the proportion of afebrile children at the fourth hour and at the sixth hour is the primary outcome. There were no differences between ibuprofen (low or high dose), or alternating, or combined with paracetamol in terms of adverse events. So, it appears that dual therapy short term is more effective than monotherapy in bringing the fever down by 4 and 6 hours. The authors claim that a combined regimen was superior to alternating medications but the ORs do not support that conclusion. This is all well and good but there are limitations in the meta-analysis. Outcomes such as child discomfort were only reported in 6 of the 31 studies and adverse events were only reported for the first 6 hours. There are no data on multiple dosing, which happens in real life. The accompanying editorial also highlights that these medications are often the cause of medication errors and overdosing and there are some data that suggest if parents have fever phobia and are anxious, there is an increase likelihood of unintentional overdose. The Archivist thinks it makes sense to start off with monotherapy and then if it is still deemed that the fever needs further treatment, then combine or alternate. Future studies need to have standardised defined outcome measurements for child comfort, hydration and safety biomarkers.

A healthy boy aged 4 months, born at 35 weeks of gestation with a normal postnatal history was brought to our emergency department with severely reduced oral intake and irritability for 48 hours. Intraoral examination showed an enlarged unilateral cystic mass with a bluish hue, without any inflammation or pain, which was arising from the anterior part of the mouth floor (figure 1).