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The Chiropractic Educators Research Forum (CERF) convened a conference on December 6, 2025. During the meeting, presenters and panelists took an in-depth look at concepts and research related to educators and chiropractic programs engaging stakeholders.
Despite the exponential growth of artificial intelligence (AI) solutions designed to assist radiologists in clinical practice, their actual impact on radiology departments remains below initial expectations. Daily workflows have not been profoundly transformed. The actual clinical benefit of these tools is often limited to single, modality-specific "narrow AI" tasks, and their return on investment is unclear. The purpose of this article was to analyze: (i), the human and perceptual challenges that shape attitudes toward AI among radiologists, referring clinicians, and patients; (ii), the technical and clinical limitations of current AI models, including the mismatches between target tasks and real-world needs, and between published versus real-life performances; (iii), the lack of objective return on investment quantification and the paucity of medicoeconomic studies in a context of constrained hospital budgets; (iv), the limitations of the current "assistive models" of human-AI interaction in radiology; (v), the technical and organizational difficulties that information and technology departments face in integrating, maintaining, and securing a growing number of AI applications across specialties within complex hospital information systems; (vi), the ethical and patient safety concerns related to bias, transparency, data protection, and regulatory compliance with respect to data protection officers and the European General Data Protection Regulation; and (vii), the underexplored environmental and energy implications of large-scale AI deployment. Finally, potential solutions relating to AI governance, national data infrastructures, user education, and the design of randomized clinical trials and cost-effectiveness studies, are discussed to promote the responsible, evidence-based integration of AI into radiology practice.
The Chiropractic Educators Research Forum (CERF) convened a conference on December 7, 2024. During the meeting, presenters and panelists took an in-depth look at concepts and research related to what educators and chiropractic programs are doing for collaboration.
The Chiropractic Educators Research Forum (CERF) convened a conference on June 28, 2025. During the meeting, presenters and panelists took an in-depth look at concepts and research related to the continuous quality improvement efforts of educators and chiropractic programs.
Pelvic congestion syndrome (PCS) is a major cause of chronic pelvic pain in women of reproductive age. It is often associated with pelvic venous insufficiency and venous dilatation of the ovarian and uterine veins, resulting in a variety of symptoms exacerbated by venous hypertension. Despite its prevalence, PCS lacks standardized diagnostic and management protocols, making effective treatment challenging. The purpose of this expert consensus statement was to summarize the opinions of French radiologists and gynecologists regarding the diagnosis, imaging, treatment, and management of PCS. A working group of 14 expert radiologists and gynecologists from various French medical centers used a Delphi panel approach with several rounds of remote and face-to-face meetings to formulate and refine expert opinions based on the current literature and clinical expertise. These opinions were categorized according to diagnostic criteria, imaging techniques, therapeutic options, and follow-up protocols. The group formulated 72 initial opinions, and 65 were retained after rigorous evaluation for consensus. Key diagnostic tools include Doppler ultrasound for detection of venous reflux and magnetic resonance imaging for detailed assessment of venous anatomy. Endovascular embolization was highlighted as the primary treatment approach and recommended after thorough imaging evaluation. Noninvasive treatments and multidisciplinary care were also emphasized for comprehensive management. The expert opinion also included post-treatment follow-up to assess quality of life and symptom resolution. This structured consensus approach helped develop standardized expert opinions on management of, providing clear guidelines for diagnosis, treatment, and follow-up. These guidelines should improve clinical practice and patient care in the management of PCS.
Cryptosporidium spp. are important zoonotic parasites that can cause moderate to severe diarrhea in humans and animals. However, the epidemiological data of Cryptosporidium in sika deer in China need to be updated. In this study, a total of 466 fecal samples were collected from sika deer in Shandong, Jilin, Liaoning, and Heilongjiang provinces. Nested PCR was used to amplify the SSU rRNA gene to detect Cryptosporidium spp. The results showed that the overall infection rate of Cryptosporidium spp. was 14.81%, with no significant differences among regions (p = 0.05). The highest infection rate was found in Heilongjiang Province (23.60%) and the lowest in Jilin Province (10.71%). The infection rate in summer (23.61%) seemed higher than that in autumn (13.20%), but the difference was not statistically significant (p = 0.30). Notably, young sika deer showed a significantly higher infection rate (28.21%) compared to adults (10.32%) (p < 0.0001). Sequence analysis identified two Cryptosporidium species/genotypes: Cryptosporidium deer genotype (98.55%) and Cryptosporidium ubiquitum (1.45%). Subtyping revealed that the C. ubiquitum isolate belonged to the zoonotic XIIa subtype. These findings provide new insights into the prevalence and genetic diversity of Cryptosporidium in sika deer and suggest that sika deer may act as a potential reservoir for zoonotic Cryptosporidium transmission. Prévalence et caractérisation de Cryptosporidium chez le cerf sika du nord de la Chine. Les Cryptosporidium spp. sont d’importants parasites zoonotiques pouvant provoquer des diarrhées modérées à sévères chez l’homme et l’animal. Cependant, les données épidémiologiques concernant Cryptosporidium chez le cerf sika en Chine doivent être mises à jour. Dans cette étude, 466 échantillons fécaux ont été prélevés sur des cerfs sika dans les provinces du Shandong, du Jilin, du Liaoning et du Heilongjiang. La PCR nichée a été utilisée pour amplifier le gène de l’ARNr SSU afin de détecter les Cryptosporidium spp. Les résultats ont montré que le taux d’infection global par Cryptosporidium spp. était de 14,81 %, sans différence significative entre les régions (p = 0,05). Le taux d’infection le plus élevé a été observé dans la province du Heilongjiang (23,60 %) et le plus faible dans la province du Jilin (10,71 %). Le taux d’infection en été (23,61 %) semblait plus élevé qu’en automne (13,20 %), mais la différence n’était pas statistiquement significative (p = 0,30). De manière notable, les jeunes cerfs sika ont montré un taux d’infection significativement plus élevé (28,21 %) que les adultes (10,32 %) (p < 0,0001). L’analyse de séquence a identifié deux espèces/génotypes de Cryptosporidium : Cryptosporidium génotype « deer » (98,55 %) et Cryptosporidium ubiquitum (1,45 %). Le sous-typage a révélé que l’isolat de C. ubiquitum appartenait au sous-type zoonotique XIIa. Ces résultats apportent de nouvelles perspectives sur la prévalence et la diversité génétique de Cryptosporidium chez le cerf sika et suggèrent que le cerf sika pourrait agir comme un réservoir potentiel pour la transmission zoonotique de Cryptosporidium.
Unmeasured confounding bias threatens the validity of observational studies. Although sensitivity analyses and study designs have been proposed to address this problem, they often overlook the growing availability of auxiliary data. Using negative controls from these data is a promising new approach to reduce unmeasured confounding bias. In this article, we develop a Bayesian nonparametric method to estimate a causal exposureresponse function (CERF) using information from negative controls to adjust for unmeasured confounding for continuous exposures. We model the CERF as a mixture of linear models. This strategy captures the potential nonlinear shape of CERFs while maintaining computational efficiency, and it leverages closed-form results that hold under the linear model assumption. We assess the performance of our method through simulation studies. We find that the proposed method can recover the true shape of the CERF in the presence of unmeasured confounding under assumptions. To show the practical utility of our approach, we apply it to adjust for a possible unmeasured confounder when evaluating the relationship between long-term exposure to ambient PM2.5 and cardiovascular hospitalization rates among the elderly in the continental US. We implement our estimation procedure in open source software and have made the code publicly available to ensure reproducibility.
This article presents a simple regression model to inform decisions on the allocation amount from the United Nations' Central Emergency Response Fund (CERF) in response to new or deteriorating humanitarian emergencies. The model offers a quick and user-friendly way to summarise historical (2016-24) CERF allocations and to estimate amounts for new allocations. It includes four elements: type of emergency; total funding required for a short-term humanitarian response; overall humanitarian needs and risks in the country; and the number of people who would receive humanitarian assistance or protection services with a CERF allocation. The model is integrated into CERF's decision-making process, which considers other factors as well. It provides a check by generating an analytical comparison with almost 380 past allocations. In an external review, the model has been found 'fit for purpose'. The article concludes with a discussion of other potential uses of the model and how it could be developed.
Dried chilies, although widely used as food ingredients such as paprika, present food safety risks across the production chain due to bacterial contamination, including Salmonella. This study assesses the fate of Salmonella Montevideo on red peppers during microwave drying and compares predictive models incorporating the effects of dynamic temperature and water activity (aw). Fresh red chilies (aw = 0.98) were sliced lengthwise, inoculated with Salmonella Montevideo, then dried at two power levels in a microwave oven for 45 min (120W) and 18 min (240W) to achieve aw<0.60. Temperature dynamics (24.5-87.6°C) were captured using an infrared camera, then the aw and Salmonella counts were measured at each sampling point. Salmonella survival parameters were estimated with four primary models (Weibull, log-linear, Geeraerd, and Cerf models), and then the Bigelow-type model was incorporated into the selected primary model to characterize the effects of temperature and aw on Salmonella inactivation. All models were assessed using the corrected Akaike information criterion (AICc). Higher microwave power resulted in lower Salmonella survival over time (p < 0.05) with a reduction range of 2.3-3.2 log. The log-linear/Bigelow (zT) yielded the lowest AICc value (11.94), which was the best-fitted model with D77°C-value of 4.24 min and a zT-value of 9.15°C. Temperature changes are determinant to describe Salmonella survival during chili drying, as the log-linear/Bigelow (zT) model better described the nonlinear reduction of Salmonella during the process. These findings serve as a basis to develop and refine spice drying conditions to improve Salmonella control while maintaining quality.
Material-intensive infrastructure systems, such as flexible pavements, offer significant opportunities for reducing resource consumption and associated life-cycle environmental impacts through design-level interventions. This study integrates structural performance metrics, specifically modulus improvement factor (MIF), into life cycle assessment (LCA) decision-making for pavements. The life cycle carbon emissions of conventional and sustainably reinforced pavements were evaluated. Besides, the inclusion of acidification potential and abiotic fossil resource depletion was evaluated for pavement at the material stage. Further, sensitivity analysis and field verification were performed. Results reveal that material production and manufacturing contribute more than half of total emissions, while transportation contributes to one-third, with the least at the construction stage. A carbon emission reduction factor (CERF) was formulated to compare reinforced and unreinforced materials, demonstrating that geogrid inclusion reduces embodied carbon across all subgrade conditions. The proposed LCA framework demonstrates a practical pathway for structural benefits along with sustainability evaluation into pavement design.
To report the prevalence of potentially surgical digestive complications in critically ill patients with status epilepticus (SE), identify the associated factors, and study the association between digestive complications and mortality at hospital discharge. Retrospective analysis of prospectively collected data. Twenty-three ICUs. Adults prospectively included in the ICTAL Registry between February 2018 and July 2025. Inclusion criteria were age 18 years or older and ICU admission for SE. Digestive complications were defined by severe clinical and/or radiologic findings suggestive of a need for surgical intervention, including bowel ileus, colonic dilatation, and/or gut ischemia. A propensity score identified factors associated with digestive complications. Logistic multivariable regression assessed predictors of hospital mortality. None. Among 1007 patients, 16 patients (1.6%) developed digestive complications (median age, 58 yr; 37.5% male) at a median of 5 days (interquartile range, 3-9 d) after SE onset. Surgery was required in six patients (37.5%). Paralytic ileus or colonic dilatation occurred in 13 patients (81.3%), and bowel or colonic ischemia in 7 (43.8%). Refractory SE (RSE) and its treatment (propofol, midazolam, thiopental, and ketamine) were significantly associated with digestive complications. In-hospital mortality was higher in patients with digestive complications (50.0% vs. 18.4%; p = 0.005). Digestive complications independently predicted mortality (odds ratio, 3.43; 95% CI, 1.13-10.21; p = 0.03). Potentially surgical digestive complications in SE were rare but strongly associated with RSE and its treatment. These complications independently predicted hospital mortality.
The aim of this study was to demonstrate that foveal lesions of the triangular fibrocartilage complex (TFCC) are underreported on wrist arthro-CT and to compare imaging review data with clinical and surgical findings to assess their impact on patient management. One hundred forty-nine wrist arthro-CTs were reviewed by two musculoskeletal radiologists, who were blinded to the surgical data and initial reports. Discrepancies between TFCC lesions and the initial reports were analysed and compared with the clinical and surgical data. TFCC lesions were identified in 59% of patients, including 43% ulnar, 33% central, and 3% radial lesions. A comparison with the initial reports revealed 45 underreported lesions, 89% of which involved ulnar lesions, including 69% affecting the foveal bundle. Patients with complete ulnar TFCC lesions reported significantly more ulnar-sided pain and radioulnar instability than those without TFCC lesions (p < 0.0001). Isolated foveal lesions were significantly associated with ulnar-sided pain (p = 0.0201), but not with radioulnar instability (p > 0.99). Among the 149 patients, 12 underwent TFCC surgery. In 8 patients, the lesions were identified in the initial radiological reports and confirmed intraoperatively. In 4 patients, surgery was performed despite negative initial reports. A retrospective imaging review confirmed the lesions, which were in agreement with the surgical findings. The application of new classifications and recent knowledge enabled the identification of previously unreported lesions in 28% of cases, including 69% involving the foveal attachment, highlighting the diagnostic challenges of this type of injury. This study shows that foveal TFCC lesions are frequently underreported on wrist arthro-CT and that a structured review, incorporating recent classifications and multiplanar reconstructions, significantly improves lesion detection, particularly for foveal involvement. Foveal TFCC lesions are difficult to identify on wrist arthro-CT because of their subtle and variable imaging appearance. Re-evaluation of arthro-CT scans and comparison with initial reports, which used recent classifications and multiplanar reconstructions, revealed that 28% of the lesions were underreported. Improved detection of foveal involvement may lead to more accurate management of ulnar-sided wrist pain.
Submucosal injection is essential during endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) to create a protective cushion and enable safe lesion removal. However, commonly used solutions such as normal saline diffuse rapidly and provide only transient mucosal elevation. This study aimed to develop and characterize a thermosensitive hydrogel based on poloxamer 407 (P407) to achieve a more sustained submucosal lift. A design of experiments approach identified an optimized formulation containing 20% (w/v) P407 in water for injection, exhibiting suitable gelation temperature, gelation time, osmolality, and pH. Rheological analyses demonstrated low viscosity at room temperature, rapid sol-gel transition near 30°C, and the formation of a stable elastic network at 37°C. In vitro degradation showed progressive erosion, with complete dissolution within 24 h. Sterile filtration and needle passage produced only minor changes in viscoelastic moduli and did not alter gelation kinetics. Ex vivo studies using porcine gastrointestinal tissues confirmed that the hydrogel generated an initial mucosal lift comparable to 0.9% NaCl but maintained the elevation significantly longer. These findings demonstrate that P407-based thermosensitive hydrogel displayed favorable physicochemical, rheological, and functional properties for submucosal injection, supporting its potential as a next-generation lifting agent for EMR and ESD. Further in vivo studies are warranted to assess performance, safety, and clinical applicability.
The benefits of non-invasive respiratory support strategies (NIRS), such as high-flow nasal oxygen therapy, in delaying intubation remain uncertain. We used an emulated target trial approach to evaluate outcomes associated with late intubation in patients with severe acute respiratory failure due to COVID-19. We conducted a retrospective multicentre cohort study using the French prospective OUTCOMEREA database. Adult patients admitted to intensive care units (ICUs) for severe SARS-CoV-2 pneumonia with an ICU length of stay of at least seven days were included in the study. Descriptive analyses were used to compare patients who were intubated after day 6 with those who remained under NIRS. In the emulated target trial, patients who were eligible between ICU days 7 and 12 were assigned to undergo late intubation or to remain under NIRS. Weighted Cox proportional hazards models were used. The primary outcome was 60-day mortality. Of the 1206 ICU patients with SARS-CoV-2 pneumonia, 288 were still in the ICU on day 7. Of these, 65 (22.6%) subsequently underwent late intubation and had a 60-day mortality rate of 78.5%. In the emulated target trial, which included 234 patients at risk of intubation, 57 underwent late intubation. Late intubation was associated with a higher risk of death (adjusted hazard ratio: 2.89; 95% confidence interval: 1.50-3.92). The estimated absolute difference in 60-day survival was - 0.34 (95% CI - 0.62 to 0.30). The restricted mean survival time was 17.8 days shorter in the late intubation group (95% CI - 30.6 to 10.8). In this multicentre cohort, patients requiring late intubation had a very high mortality rate. In the emulated target trial analysis, late intubation was associated with poorer survival compared to continued NIRS, suggesting a subgroup of patients with progressive respiratory failure rather than a direct effect of intubation timing.
Transbronchial interventions are rapidly evolving for diagnosis and treatment of peripheral lung nodules. Despite recent advances and lower risk of pleural-related complications, the diagnostic yield of bronchoscopic approaches remains lower than that of image-guided percutaneous approaches. Standardized transbronchial methods use engineered, robotic, and navigation approaches; however, a possible alternative approach familiar to interventional radiology (IR) could use image guidance, image fusion, and IR devices like guidewires and steerable sheaths for transbronchial navigation without the use of a bronchoscope. IR tools, training, and workforce might be applied to transbronchial approaches via minimally invasive image guidance. This review article summarizes current innovations and opportunities in transbronchial procedures that might be addressed using familiar IR technologies.
Brain death after hanging-induced cardiac arrest is a fatal complication about which few data are available. We aimed at identifying the early predictors of progression to brain death in patients with hanging-induced cardiac arrest. Retrospective study including adults with return of spontaneous circulation from hanging-induced cardiac arrest admitted to 34 ICUs in France and Belgium between 2000 and 2024. Logistic multivariate regression was performed to identify factors associated with progression to brain death. Of the 554 patients with hanging-induced cardiac arrest, brain imaging was performed on admission in 443 (80.0%) patients. Overall, 169/554 (30.5%) and 142/443 (32.1%) patients progressed to brain death within a median time of 3 days, and up to 12 days, after the hanging-induced cardiac arrest. In 443 patients with brain imaging, five factors were independently associated with a higher risk of progression to brain death: female (OR, 1.76; 95% CI, 1.06-2.90; p = 0.03), asystole as first recorded rhythm (OR, 2.03; 95% CI, 1.27-3.29; p = 0.004), low-flow time > 30 min (OR, 1.84; 95% CI, 1.07-3.17; p = 0.03), total Logistic Organ Dysfunction System Score at day 1 (OR, 1.93/per point; 95% CI, 1.14-3.29; p = 0.02), and cerebral oedema and/or ischemic complication on brain CT scan at ICU admission (OR, 1.62; 95% CI, 1.01-2.61, p = 0.04). Conversely, age > 50 years (OR, 0.59; 95%CI, 0.35-0.98, p = 0.04) and status myoclonus ≤ day 2 (OR, 0.24; 95%CI, 0.09-0.54, p = 0.001) were associated with a lower risk of progression to brain death after hanging-induced cardiac arrest. Our findings emphasise the very high rate of brain death after hanging-induced cardiac arrest. In our population, factors associated with brain death after hanging induced cardiac arrest predominantly reflect initial injury severity.
Supraclavicular fossa (SCF) irradiation is integral to adjuvant radiotherapy (RT) for node-positive breast cancer. Due to anatomical proximity, the thyroid gland is frequently exposed, leading to hypothyroidism in approximately 20-40% of long-term survivors. Despite robust dose-response evidence, thyroid management remains inconsistent and breast cancer-specific dose guidance is lacking. This nationwide survey evaluated current practice patterns regarding thyroid delineation, SCF contouring, and thyroid dose guidance during elective SCF irradiation in Switzerland. A structured electronic questionnaire was distributed between May and November 2025 to all 30 Swiss radiation oncology centers treating breast cancer. Institutional characteristics, thyroid contouring practices, SCF target delineation, and applied thyroid dose guidance were assessed. Analyses were descriptive only. Thirty-three responses from 25 of 30 centers (83%), including all university hospitals, were analyzed. Modern RT techniques were widely implemented (VMAT 79%, IMRT 15%). Routine thyroid contouring was reported by 91% of respondents, of which 94% used AI-assisted tools. However, only 55% applied explicit thyroid dose guidance. Reported mean thyroid dose (Dmean) thresholds ranged from 12 to 35 Gy and clustered at 13.5-15 Gy, 20-21 Gy, and 30-32 Gy. Excluding ALARA ("as low as reasonably achievable") responses, the median Dmean guidance was 21 Gy (IQR 16-30 Gy). SCF delineation varied substantially, particularly regarding superior and medial margins, and 64% reported CTV/PTV cropping to reduce thyroid dose. Despite strong dose-response evidence and widespread availability of advanced RT techniques, thyroid protection during elective SCF irradiation remains inconsistently implemented. These findings reveal a gap between evidence and practice and support the development of harmonized, breast cancer-specific recommendations, including routine thyroid delineation, anatomy-based SCF contouring, and explicit, oncologically safe dose guidance-particularly Dmean targets of ≤ 13.5 Gy, with ≤20-21 Gy as a pragmatic upper limit-to reduce radiation-induced hypothyroidism without compromising cancer control.
Cell migration and strategic positioning within tissues is critical for the rapid mobilization of a T cell response. T cells must remain motile in both lymphoid and nonlymphoid tissues, which vary widely in mechanical properties such as stiffness. Here we showed that activated T cells sensed mechanical cues and responded with changes in cell morphology, nuclear envelope composition and initiation of DNA repair to protect their genomic material from force-mediated damage. Increased mechanical input also drove the transcriptional reprogramming of activated T cells, including changes in many of the core genes shared by tissue-resident memory T cells across diverse tissues, by modulating the expression of the tissue-resident memory T cell-associated transcription factors Klf2, Runx3 and Hic1. Thus, mechanosensing by activated T cells impacted T cell fate, promoting a transcriptional program associated with tissue residency.
Lung transplantation (LT) remains the only viable therapeutic option for many patients with end-stage lung disease. Over the past decades, the landscape of LT has undergone significant changes. This report presents the first detailed analysis of lung donation and transplantation activity in France. All single and double LTs performed in France in 2024 were included in this analysis. Data were obtained from the national registry of the French organ procurement organisation, encompassing donor, candidate, and recipient characteristics, as well as post-transplant outcomes. In 2024, a total of 323 LTs were performed, including 273 from donation after brain death (DBD) and 50 from donation after circulatory death (DCD). This represents an increase from the 288 LTs performed in 2023 but remains below the 2019 level of 384 LTs. The number of DCD procedures doubled compared to 2023, reaching 50, with a lung utilization rate of 90.7%, up from 72.7% in 2023. The primary indications for LT were COPD/emphysema (45.5%) and interstitial lung disease (ILD, 37.6%), while cystic fibrosis (CF)/bronchiectasis accounted for only 4.1% of cases. The median waiting time for candidates was 2.5 months, with a cumulative incidence of transplantation reaching 53% at 3 months, 67% at 6 months, and 81% at 12 months. One-year post-transplant survival was 83.7%, with variations by indication: 89.3% for CF/bronchiectasis recipients, 87.4% for COPD/emphysema, and 80% for ILD. Only 13.7% of candidates were listed under high-urgency status, a decrease from 17% in 2023 and 24.6% in 2022. Over the past five years, the number of CF and bronchiectasis candidates declined from 112 (24%) to 14 (4.1%), while ILD candidates increased from 117 (25%) to 129 (38%). France's LT activity shows gradual recovery, primarily driven by increased DCD procedures, which need to be further developed. LT centers must adapt their surgical and medical strategies to address the evolving distribution of underlying diseases leading to transplantation.
Eradication of infection after total hip arthroplasty (THA) is particularly challenging. The aim was to evaluate whether cerclage wires, used to stabilize an extended trochanteric osteotomy (ETO) in patients undergoing two-stage revision THA for infection, become colonized with bacteria. The findings could help discern whether cerclage wires should be systematically exchanged during the second surgery to reduce the risk of persistent infection. Patients were included in the study if they had undergone two-stage revision THA for infection, that required stem removal using an ETO, and the cerclage wires had been exchanged during the second-stage procedure. The cohort comprised a consecutive series of 28 patients, 14 females and 14 males, aged 67.9 ± 13.1 years with a body mass index of 29.8 ± 6.6 kg/m2. Following the second-stage procedure, sonication of the explanted spacer and cerclage wires was performed separately to check for bacteria. Twenty-six of the 28 patients were available for bacterial testing following the second-stage procedure. Sonication of the cerclage hardware revealed one case of bacterial contamination and no cases of bacterial colonization. Furthermore, sonication of the spacer revealed one case of bacterial contamination and no cases of bacterial colonization. Cerclage wires used for fixation of ETO during two-stage revision THA for infection are not colonized by bacteria, suggesting that it may not be necessary to systematically exchange them during the second-stage procedure. Further studies with larger cohort sizes are necessary to confirm these findings.