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Contrast fluoroscopy of the upper gastrointestinal (GI) tract has become less common in the last decades, mainly due to the development of endoscopy and cross-sectional imaging methods. However, it remains an important imaging technique offering real-time dynamic acquisitions of the upper GI tract with a high temporal and spatial resolution and the ability to adjust the position of the child appropriately, thus being valuable and irreplaceable for addressing specific clinical queries such as tracheoesophageal fistula, aspiration, strictures, oesophageal injuries, hernias, achalasia, post-operative leaks, and duodenal anatomy. Therefore, junior radiologists should continue to seek and maintain expertise in performing and interpreting contrast fluoroscopy studies. The aim of this paper is to present a practical approach to contrast fluoroscopy of the upper GI tract in children, focused on its normal radiological anatomy and physiology. It lists current indications for the upper GI series and provides a list of indications where alternative imaging techniques have replaced fluoroscopy. Finally, basic hands-on procedural recommendations are presented.
To explore the status of low-dose CT lung cancer screening (LCS) training practices, identify existing gaps, and define key competencies to be included in LCS educational curricula. As part of the European SOLACE project, a structured cross-sectional survey consisting of 11 closed- and open-ended items, developed based on relevant literature, international guidelines, and expert input to assess LCS current practices and training needs, was administered to a panel of European LCS experts. Participants were invited to individual Zoom interviews (May-November 2025). Data were analyzed using descriptive statistics. Twenty-five LCS experts were interviewed from 14 European countries, including 10 radiologists (40%), 8 pulmonologists (32%), 4 thoracic surgeons (16%), 1 project manager (4%), 1 smoking cessation specialist (4%), and 1 general practitioner (GP) (4%). Reported training activities ranged from established programmes (4/14 countries), to learning initiatives (6/14) and/or planned programmes (4/14). Radiologists (96%), pulmonologists (80%), and GPs (60%) were identified as the main target groups for training. On a 6-point Likert scale (0 = not important, 5 = extremely important), experts indicated limited awareness of training needs as the most relevant gap (mean 2.8 ± 2.2). Key educational areas to be strengthened included management of incidental findings (4.5 ± 0.6) and confident use of guidelines for nodule management (3.8 ± 1.8). Among essential competencies for professionals involved in LCS, the highest-rated were competence in managing incidental findings (4.7 ± 0.6), familiarity with guideline-based nodule management (4.7 ± 0.6), basic knowledge of AI tools (4.5 ± 0.8), and communication with LCS participants (4.5 ± 1.1). The findings suggest a heterogeneous LCS training landscape across European countries and underscore the importance of developing shared European curricula. Key priorities may include strengthening technical skills alongside structured communication training. Education and training of all stakeholders are essential for the successful implementation of LCS programmes. This survey assesses the current status of LCS training practices across Europe, identifies existing gaps, and defines key competencies to inform future curricula for health professionals involved in LCS. The European LCS training landscape is highly heterogeneous, with substantial variability in training activities, target professionals, and delivery modalities.
Heart failure and chronic liver disease account for substantial morbidity and mortality worldwide. Both conditions share common risk factors and a bidirectional pathophysiology, and the coexistence of both conditions is expected to increase over time. Management of coexisting heart failure and liver disease is challenged by the under-representation of participants with liver disease in landmark heart failure clinical trials, impaired hemodynamics at advanced stages of liver disease, altered drug metabolism, and higher risk of adverse events than portended by either condition alone. Moreover, diagnostic pitfalls might be encountered in relation to assessing the primary etiologies driving the disease process, estimating the degree of liver fibrosis, and differentiating primary liver disease from heart failure-related liver congestion particularly, given the complex interplay between sinusoidal pressure, congestion, and structural fibrosis. Cardiovascular-hepatic cross-thematic research, clinical education, and health care services could optimize management and patient outcomes. The purpose of the current review is to (i) highlight the growing epidemiology of concurrent heart failure-liver disease; (ii) provide diagnostic clues for liver disease and an approach for interpreting liver marker abnormalities amongst heart failure patients; (iii) describe the main therapeutic strategies in real-world clinical settings; and (iv) discuss current gaps in knowledge and future directions. This update on the framework of the heart failure-liver disease overlap phenomenon can inform clinical care policies and facilitate novel research in the field.
Pediatric differentiated thyroid carcinoma (DTC) is a rare disease, creating challenges for standardized care across Europe. The Netherlands published its first national pediatric DTC guideline in 2020. The 2022 European Thyroid Association (ETA) guideline introduced differences that required reconciliation with national practice. This article presents the 2026 update of the Dutch guideline, harmonized with European recommendations while retaining context-specific adaptations. The 2020 Dutch guideline was systematically compared with the ETA 2022 guideline. Differences were discussed by the national pediatric DTC working group and addressed in a structured consensus meeting to agree on revisions and adaptations relevant to the Dutch context. Most European recommendations were adopted. Key national adaptations include performing total thyroidectomy without prior histology in Bethesda V-VI nodules with a proven BRAF mutation, expanded use of molecular diagnostics in selected nodules, and referral for genetic counseling in confirmed cases. In addition, less extensive surgery and selective omission of radioactive iodine therapy in low-risk patients were recommended, based on shared decision-making. Follow-up with neck ultrasound was limited to an initial 3-month assessment, with subsequent imaging only in case of rising thyroglobulin or anti-thyroglobulin concentrations. The 2026 Dutch guideline aligns with European recommendations while preserving context-specific adaptations. It provides a framework for consistent, patient-centered care and supports standardized clinical practice in the Netherlands, offering a model for harmonized pediatric DTC management across Europe.
Polygenic risk scores (PRSs), which quantify inherited susceptibility to complex traits and diseases, have emerged as valuable tools for risk stratification and precision medicine. Despite their promise, PRS developed on European cohorts often demonstrate substantially reduced predictive accuracy in non-European populations, due to differences in genetic architecture. The disproportionate representation of European ancestry cohorts in genome-wide association studies (GWAS) leads to inequitable deployment of PRS technologies across diverse populations. Here, we introduce PRANA (Polygenic Risk Adaptation via Neural-network Architecture), a deep learning framework that adapts an existing PRS developed on one population to other ancestries. Unlike methods that require large-scale GWAS in the target population, PRANA leverages pre-trained PRS models derived from European cohorts and adapts them using modestly sized cohorts from the target population. We evaluated PRANA on seven complex traits in South Asian, East Asian and Ashkenazi Jewish populations, as well as in selected smaller East Asian subpopulations where the scarcity of training data poses a particular challenge. PRANA mostly improved predictive performance of the baseline PRS models by 5%-20% in terms of effect size (β) and Nagelkerke's R2, and, in most cases, outperformed existing cross-ancestry multi-PRS approaches. These results highlight PRANA as a scalable and practical strategy to reduce disparities in genomic risk prediction and advance the equitable application of PRS in diverse populations.
Artificial intelligence (AI) shows promise for improving cancer management, but clinical adoption is limited by the absence of standardized validation tools. As an important step toward bridging the AI chasm, the European CHAIMELEON project addresses this gap by developing a platform for in silico validation of AI models in oncology, aligned with the EUCAIM project. We designed a web-based platform using Kubernetes microservices architecture, integrating imaging, clinical, and AI components. The backend combines a REST API, an ORTHANC-PACS, and a Keycloak/OAuth2 security layer. The frontend includes a customized OHIF DICOM viewer for oncological case review. Clinicians evaluated cases across three sequential stages: (1) Standard clinical assessment, (2) Assessment with AI predictions, and (3) Final review against clinical endpoint ground truth. The platform also collects clinicians' perceptions of AI utility, trust, workflow integration, and usability through a Likert-scale questionnaire. The platform provided efficient access to multimodal data for five cancer types. Clinicians completed structured validations, and survey responses indicated favorable perceptions: 93% found the platform intuitive, over 80% would recommend it, and agreement on AI utility exceeded 40% across most endpoints, indicating a positive reception of the AI as a supportive "second reader" tool that prompts clinical re-evaluation rather than simple consensus. Workflow impact was rated positively, underlining the potential to support clinical decision-making. This platform offers a reproducible, scalable, and user-friendly environment for clinical validation of AI models in oncology. Its modular architecture allows integration of additional AI models and is designed to ensure sustainability and interoperability, fostering evidence-based AI adoption in European radiology practice. ClinicalTrials.gov, NCT06950996. How can the medical community standardize the in silico clinical validation of oncology AI models to safely bridge the gap before real-world deployment? We successfully implemented a web-based microservices platform, demonstrating high clinical usability and defining human-AI trust dynamics across five distinct cancer types. This standardized validation framework directly enhances diagnostic confidence and interdisciplinary medical collaboration, bridging technical performance with clinical trust to ensure that innovative artificial intelligence technologies safely optimize daily treatment decisions and ultimately maximize therapeutic success and safety for oncology patients.
MR enterography (MRE) and intestinal ultrasound (IUS) are used to assess therapeutic response in Crohn's disease (CD) follow-up. There is, however, no clear guidance regarding which modality should be used for individual patients or if they are interchangeable. Therefore, clinical practice varies. We will compare the accuracy of MRE and IUS to classify treatment response in CD. Multicentre, non-randomised, multiple arm, prospective cohort study of luminal CD patients aged 16 years or older being treated with steroids, immunomodulators, biologics/biosimilars or small molecules with baseline MRE or IUS. The study will be based in three tertiary referral centres, UK (n=2) and Belgium (n=1), with a target sample size of 155 patients. Patients will undergo both MRE and IUS for response assessment within 20 months of baseline scanning, performed within 6 weeks of each other. One scan will be standard care, the other a research intervention. Interpreting radiologists will be masked to the alternative response assessment test. The primary outcome is the comparative accuracy of MRE and IUS for European Crohn's and Colitis Organisation-European Society of Gastrointestinal and Abdominal Radiology treatment response group categorisation compared with multidisciplinary consensus panel reference standard, using all available clinical information. Secondary outcomes include the influence of baseline scanning (MRE or IUS) on response characterisation accuracy, response accuracy of MRE and IUS disease activity scoring systems, management impact for each follow-up imaging modality and patient reported preferences. This protocol has been approved by the National Health Service Research Ethics Committee and West of Scotland Research Ethics Committee 1 (24/WS/0121). Participant informed written consent will be obtained. Findings will be disseminated by peer-reviewed publications, conference presentations and patient and public involvement collaborators. NCT06800326.
Objective The objective of this study was to compare the diagnostic performance of the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) and the European Thyroid Imaging Reporting and Data System (EU-TI-RADS) in differentiating benign from malignant thyroid nodules using guideline-based fine-needle aspiration recommendation as the test-positive criterion, and to evaluate demographic and sonographic predictors of thyroid malignancy in a real-world clinical cohort. Materials and methods This retrospective diagnostic accuracy study included thyroid nodules assessed by ultrasound followed by ultrasound-guided fine-needle aspiration cytology (FNAC), with histopathology used as the reference standard for surgically excised nodules. Ultrasound images were independently reviewed by three experienced consultant radiologists blinded to cytological and histopathological outcomes, with consensus used for disagreements. The definitive cohort comprised 809 nodules: 652 benign and 157 malignant. Nodules without a definitive outcome, including nonoperated Bethesda III/IV cases, were excluded from the primary analysis. Bethesda I nodules remained excluded because they were nondiagnostic. Diagnostic performance was calculated using 2 × 2 contingency tables, including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, likelihood ratios, and diagnostic OR (DOR). Paired comparisons were performed using McNemar testing. Multivariable logistic regression was performed to identify independent predictors of malignancy. Sensitivity analyses were performed by classifying excluded nonoperated Bethesda III/IV nodules as benign and malignant in separate scenarios. Results The definitive cohort comprised 809 nodules, including 652 benign nodules and 157 malignant nodules. ACR TI-RADS correctly identified 135 of 157 malignant nodules (sensitivity 85.99%) and correctly excluded 481 of 652 benign nodules (specificity 73.77%). EU-TI-RADS correctly identified 142 of 157 malignant nodules (sensitivity 90.45%) but correctly excluded only 233 of 652 benign nodules (specificity 35.74%). ACR TI-RADS demonstrated higher PPV (44.12% vs 25.31%), NPV (95.63% vs 93.95%), overall accuracy (76.14% vs 46.35%), and DOR (17.26 vs 5.26). EU-TI-RADS had slightly higher sensitivity than ACR TI-RADS (McNemar p = 0.046), whereas ACR TI-RADS had significantly higher specificity (McNemar p < 0.001). Sensitivity analyses including nonoperated Bethesda III/IV nodules yielded similar results. Multivariable logistic regression identified hypoechogenicity, solid or almost entirely solid composition, and taller-than-wide orientation as independent predictors of malignancy, while irregular or lobulated margins and microcalcifications showed quasi-complete separation because of their strong association with malignant nodules. Conclusions Both systems demonstrated high sensitivity and high NPV. In this primary healthcare cohort, ACR TI-RADS provided substantially higher specificity and overall accuracy, suggesting greater potential to reduce unnecessary FNAC, whereas EU-TI-RADS offered marginally higher sensitivity. Hypoechogenicity, solid or almost entirely solid composition, and taller-than-wide orientation were independent predictors of malignancy. Irregular or lobulated margins and microcalcifications were also strongly associated with malignancy but showed quasi-complete separation.
Artificial intelligence (AI), first defined in 1955 by John McCarthy, has transformed daily life across industries through applications such as chatbots, autonomous vehicles, and navigation systems. The 2022 release of ChatGPT marked a pivotal moment, highlighting AI's rapidly expanding potential. The health care industry is increasingly embracing AI-enabled tools across oncology, pathology, and radiology to augment disease screening and clinical workflows. Ambient listening technologies support clinical documentation, reduce administrative burden, and improve patient-physician interactions. Large language models combined with natural language processing are being evaluated for generating clinical summaries managing patient portal messaging and converting freehand notes to electronic health records, while also uncovering patterns in patient data to support more personalized treatments. Forward-thinking health systems are establishing informatics departments to optimize these models. Notably, with 1 in 6 adults sourcing health information from AI, rising to nearly one-quarter among individuals younger than 30 years, there is a growing need to ensure that these technologies provide accurate and reliable information to safeguard patient safety and support appropriate clinical use. PRACTALL, a collaboration between the American Academy of Allergy, Asthma & Immunology and the European Academy of Allergy & Clinical Immunology, aims to equip allergist-immunologists with essential AI insights highlighting tools for clinical practice, education, and research. By addressing potential pitfalls and biases, PRACTALL illustrates how AI can enhance efficiency, improve patient care, and alleviate administrative burdens in health care.
Genome-wide association studies (GWAS) have identified 80+ genetic loci associated with Alzheimer's disease (AD), enabling the development of polygenic risk scores (PRS). However, the predictive accuracy of PRS in diverse populations remains low. Here, we evaluated the predictive accuracy of single-, multi-, and cross-ancestry AD-PRS models across multi-ancestral populations. We used AD GWAS summary statistics from European, African, Admixed American, and East Asian populations to construct AD-PRS for each target population. Model performance was assessed by estimating odds ratios, R2, and area under the curve. The cross-ancestry Bayesian PRS model demonstrated the highest predictive performance in non-European populations. It was significantly associated with poorer cognitive function, lower Aβ42 cerebrospinal fluid levels, and the most severe category of Aβ and tau neuropathological burden. Inclusive genetic datasets and cross-ancestry PRS models are needed to enhance the transportability of AD-PRS across multi-ancestral populations.
Background and Objectives: Coronary computed tomography angiography (CCTA) has become a central non-invasive imaging modality for the evaluation of suspected chronic coronary syndromes. Nevertheless, referral patterns and sex-related differences in real-world CCTA utilization may vary according to demographic structure, healthcare accessibility, and regional clinical practice. The present study aimed to evaluate age- and sex-related patterns in CCTA referrals and coronary atherosclerotic burden within a real-world Eastern European single-center CCTA referral cohort. Materials and Methods: We performed a retrospective analysis of 2742 consecutive CCTA examinations at a tertiary center in Sibiu, Romania, between March 2019 and January 2025. The demographic profile of the referral cohort was compared with the adult population structure of Sibiu County. Subsequently, an age- and sex-stratified proportional subsample of 397 cases was selected from the CCTA cohort for detailed analysis of sex-related differences regarding coronary artery calcium score (CACS), significant coronary stenoses, and significant cardiovascular event risk. Results: The age distribution of the CCTA referral cohort differed significantly from that of the adult county population (p < 0.01), with referrals concentrated predominantly between 55 and 79 years of age. Female patients were overall more frequently represented within the referral cohort compared with the underlying county population; however, males demonstrated significantly higher coronary artery calcium scores, a greater prevalence of significant coronary stenoses, and higher revascularization risk compared with females-particularly between 50 and 79 years of age-within the stratified proportional subsample. In contrast, patients younger than 40 years demonstrated very low rates of significant coronary disease regardless of sex. Conclusions: This study provides a real-world perspective on age- and sex-related patterns in CCTA utilization and coronary atherosclerotic burden within an Eastern European imaging center. The findings highlight the interaction between demographic structure, guideline-directed diagnostic strategies, and coronary imaging utilization in routine clinical practice.
(1) Objectives: In acute pulmonary embolism (PE), detailed thrombus burden scores are often complex and time-consuming, limiting their integration into urgent radiology reports. We evaluated a simplified modified Ghanima score (GmScore and GmS) designed to provide a structured estimate of thrombus burden and assessed its clinical correlation and reproducibility. (2) Methods: In this retrospective single-center study, 132 consecutive patients with confirmed acute PE were classified according to the modified GmScore: GmS1 (segmental), GmS2 (lobar), and GmS3 (main pulmonary arteries), considering luminal obstruction ≥ 50%. European Society of Cardiology (ESC) risk category, simplified Pulmonary Embolism Severity Index (sPESI), CT right-to-left ventricular (RV/LV) ratio, echocardiographic right ventricular dysfunction, and 30-day mortality were recorded. Inter- and intraobserver agreement were assessed using weighted kappa. (3) Results: In 132 patients (mean age 64.8 ± 16.5 years; 77 men), a significant clinical gradient was observed across GmScore categories. ESC intermediate-high/high risk occurred in 0% of GmS1 and 95.6% of GmS2-3 patients (p < 0.001). The median RV/LV ratio increased progressively (0.76, 1.58, and 1.79 for GmS1-3; p < 0.001), with a strong correlation between the GmScore and RV/LV (Spearman ρ = 0.75). GmS2 and GmS3 showed no significant difference in ventricular repercussion (p = 0.938), whereas GmS1 differed markedly. Using GmS ≥ 2 to identify ESC intermediate-high/high risk yielded 100% sensitivity and negative predictive value. Interobserver agreement was excellent (κ = 0.92). Thirty-day mortality was 0% in GmS1, 2.0% in GmS2, and 14.6% in GmS3 (p = 0.005). (4) Conclusions: The modified GmScore is a simple, reproducible CT-based descriptor that aligns closely with right ventricular repercussion and ESC risk stratification.
Anti-Ku antibodies (Abs) are rare and detected in various autoimmune diseases (AIDs), presenting in various phenotypes, potentially affecting different organs including the lungs. This study aimed to describe the characteristics and evolution of interstitial lung disease (ILD) in anti-Ku-positive patients. An observational, multicentre, retrospective study was conducted across 10 French University Hospitals between January 2010 and June 2025, including patients with anti-Ku Abs with ILD. Clinical data and all pulmonary function tests and chest CT scans available were reviewed for this study. ILD progression was defined using criteria inspired by the American Thoracic Society/European Respiratory Society/Japenese Respiratory Society/Asociación Latinoamericana de Tórax Clinical Practice Guidelines, applied across the entire follow-up period rather than within the 12-month timeframe, to capture all clinically meaningful progression events. To account for event timing, time to ILD progression was analysed as a time-to-event outcome using Cox proportional hazards models. Among 154 anti-Ku-positive patients (51 with idiopathic inflammatory myopathy, 46 with systemic lupus erythematosus, 30 with Sjögren's disease, 27 with systemic sclerosis), 60 (39%) had ILD (68% women, median age 56 years). The predominant ILD pattern was fibrotic non-specific interstitial pneumonia (27%, n=16). ILD was already present at AID diagnosis in 48 patients (80%). Forty-five (75%) patients progressed after a median time of 4 (2-11) years. Male sex (adjusted HR (aHR) 2.7; 95% CI 1.4 to 5.2) was associated with ILD progression. When the 12-month cut-off was strictly applied, only six patients fulfilled the progressive fibrosing ILD definition. Baseline pulmonary fibrosis was present in 34 (57%) patients and was associated with a reduced survival when adjusting for age at ILD diagnosis and cardiac involvement (aHR 6.5, 95% CI 1.5 to 28.2). ILD occurred in 39% of anti-Ku-positive patients and progressed in 75% of them, underscoring the importance of systematic ILD screening and monitoring in these patients.
The recent approval of disease-modifying therapies (DMTs) for early Alzheimer's disease (AD) marks a major shift in clinical practice. Biomarker confirmation of amyloid pathology is now required alongside clinical assessment, and blood-based tests are improving accessibility. This creates increased demand for timely and accurate diagnosis while avoiding overdiagnosis in low-probability cases. This Belgian consensus aims to guide biomarker-based diagnosis of AD in the era of DMTs and to highlight the system adaptations required for safe and equitable implementation. Belgium, with universal healthcare but regionally organised dementia care, provides a relevant case to illustrate both opportunities and challenges. This consensus was developed by 31 experts in cognitive neurology, geriatrics, neuropsychology, neuroimaging, neurochemistry, and primary care, coordinated by the Belgian Dementia Council (BeDeCo). Recommendations were based on multidisciplinary discussion, current evidence, and the organisation of dementia care in Belgium. The consensus outlines a stepwise diagnostic approach that integrates clinical assessment with biomarker confirmation using cerebrospinal fluid, amyloid-PET, and emerging blood-based tests. We review the strengths and limitations of each modality and provide guidance for use across clinical scenarios. Using Belgium as a case example, we illustrate challenges that are shared across European healthcare systems, such as limited reimbursement, unequal access to expertise, and insufficient diagnostic capacity, and formulate pragmatic recommendations to address these issues. This consensus offers practical guidance for embedding biomarker-based diagnostic strategies into clinical care. By outlining structured pathways and system-level priorities, it facilitates safe, feasible, and equitable implementation of DMTs for AD.
Neurological disorders are a leading cause of disability, morbidity, and mortality globally, imposing a substantial and growing economic burden. In Europe, several factors including demographic aging and improved diagnostics have increased the prevalence of these conditions. Despite their significant societal impact, comprehensive and comparable estimates of the economic burden of neurological disorders across Europe remain limited. Existing studies are mostly outdated, disease-specific, or geographically narrow. The Cost Of Illness in Neurology in EUrope (COIN-Eu) study addresses this gap by developing a standardized framework to assess the disease- and country-specific economic burden of major neurological disorders across all 47 member countries of the European Academy of Neurology (EAN). This burden-of-disease study employs a prevalence-based approach to estimate three key economic measures per disorder and country: (1) annual per-patient costs by cost type, (2) total annual costs on a national level, and (3) relative total costs as a percentage of GDP. The study includes twelve major neurological disorder groups affecting adults (≥ 20 years). Epidemiological data are primarily sourced from the Global Burden of Disease Study 2021, supplemented by systematic literature reviews where necessary. Cost data are extracted from systematic reviews of peer-reviewed publications and converted to 2019 Euros using standardized procedures. Data gaps are addressed through structured imputations based on income group stratification. Final estimates are validated by an expert panel from the EAN. The framework enables the generation of harmonized cost estimates across countries and disorders, accounting for direct and informal care costs and indirect costs. Expert review ensured plausibility and consistency of the results. The COIN-Eu study framework provides a comprehensive and transparent methodology to estimate the economic burden of neurological disorders in Europe. It facilitates evidence-based health policy planning, highlights data gaps, and supports future cross-national burden-of-disease assessments in neurology and beyond.
Vestibular schwannoma (VS) is a rare, benign tumor of the vestibulocochlear nerve. Diagnosis relies on MRI, but nonspecific clinical symptoms make early identification challenging. To evaluate the prevalence of VS among MRI referrals and assess the clinical symptoms and referral criteria leading to imaging. This retrospective observational study was conducted at a tertiary university hospital from July 2023 to August 2024. Data were extracted from institutional radiological imaging archive system. The total number of MRI referrals, confirmed VS cases, and associated clinical symptoms were recorded. Referral patterns were analysed using the European Academy of Otology and Neuro-Otology (EAONO) criteria. Of 600 MRI scans analyzed, 11 cases (1.8%) confirmed VS. Referrals were primarily made by private ENT specialists (68.5%). Tumor sizes ranged from 6-23 mm, with two tumors exceeding 20 mm, requiring consideration for surgery. Asymmetrical hearing loss was the most frequently mentioned symptom (80.8%), but no single symptom or combination reliably predicted VS. VS was an uncommon finding among MRI referrals. Asymmetric hearing loss was the predominant symptom but did not reliably predict tumor presence. The findings highlight the need to refine referral criteria to improve diagnostic efficiency and reduce unnecessary imaging.
Progress in artificial intelligence (AI)-based analysis of surgical videos has been constrained by reliance on manual frame-level annotations rather than patient-level outcomes. In addition, concerns about data privacy restrict the exchange of laparoscopic video data and, thereby, multicenter collaboration. To address these limitations, we developed a pipeline that integrates weakly supervised deep learning with Swarm Learning, a decentralized machine learning approach that enables collaborative model training without data centralization. We evaluated our pipeline using a dataset of 397 laparoscopic appendectomy recordings from six international centers for two patient-level staging tasks: (1) laparoscopic grading of appendicitis and appendiceal perforation detection; and (2) histopathologic inflammation grading. We identified optimal modeling configurations (frame sampling rates and model architectures) using the binary perforation detection task, then compared Swarm Learning with single-center and centralized learning across the laparoscopic and histopathologic disease staging tasks. In addition, we surveyed participating centers to identify barriers to clinical implementation of our learning pipeline for surgical video analysis. For binary perforation detection, frame sampling at one frame per second and use of the SurgTempoNet architecture resulted in reliable classification performance, outperforming SurgFrameNet and Multiple Instance Learning. For both laparoscopic (area under the receiver operating curve [AUROC]: 0.818±0.092) and histopathologic disease staging (AUROC: 0.626±0.029), Swarm Learning consistently outperformed single-center training and achieved performance comparable to centralized learning on external validation (AUROC: 0.795±0.092 for laparoscopic grading; AUROC: 0.610±0.018 for histopathologic grading). The user survey identified hardware failure and limited integration of the decentralized learning pipeline with electronic patient records as key barriers to clinical implementation. Weakly supervised deep learning enables the prediction of patient-level labels directly from surgical video data. Swarm Learning facilitates privacy-preserving multicenter collaboration and achieves performance on par with centralized learning, highlighting its potential for advancing clinically relevant, collaborative AI development in surgical video analysis. (Funded by the European Union and others.).
Anterior cruciate ligament reconstruction (ACLR) is complicated by high failure rates in young, active individuals, which is associated with worse outcomes and higher rates of osteoarthritis (OA). Failure of ACLR limits activity, reduces quality of life and substantially increases socio-economic costs. Thus, strategies to reduce ACLR failure are imperative. In the STABILITY 1 trial, we showed that adding a lateral extra-articular tenodesis (LET) to ACLR with a hamstring tendon (HT) graft provided greater stability than HT alone (Relative Risk Reduction (RRR)=0.38; 95% CI 0.21 to 0.52; p<0001). Recent meta-analyses suggest patellar tendon (bone patellar tendon bone (BPTB)) grafts provide better stability than HT although with greater donor site morbidity. Recently, the quadriceps tendon (QT) graft has become popular, claiming similar stability to BPTB without donor site morbidity. However, no high-quality studies have shown it to be better and no study has determined if the reduced rate of ACLR failure seen with the addition of a LET to a HT graft is still present when using stronger, stiffer BPTB or QT grafts. Therefore, this study will evaluate whether in patients at high risk of rerupture, graft type (QT, BPTB, HT) with or without a LET offers a greater reduction in rate of clinical failure, better performance-based function and patient-reported symptoms, function and quality of life or higher rates of return to sport 2 years after ACLR. And does graft type±LET affect muscle strength recovery or increase the risk of donor site morbidity or lateral compartment articular cartilage degeneration? Do females, who are more often quadriceps dominant in their landing biomechanics, experience better outcomes if their ACLR uses a BPTB and/or QT autograft compared with a HT+LET autograft? Finally, is a particular graft type±LET a more cost-effective approach to ACLR? Across 31 centres (9 Canadian, 8 European, 14 USA), we will randomly assign 1292 patients with an ACL rupture who are at high risk of failure to either QT (±LET) or BPTB (±LET). Eligible participants will be 14-25 years of age, with at least two of the following: (1) Grade 2 pivot shift or greater; (2) returning to high-risk pivoting sport; (3) generalised ligamentous laxity; or (4) knee recurvatum of 10 degrees or more. Surgeons with similar expertise and no preference for either graft type will use traditional randomisation; two centres will use an expertise-based approach. Outcomes include ACLR clinical failure, patient-reported outcomes that assess symptoms, activity, participation and quality of life, measures of impaired range of motion and muscle function (quadriceps and hamstring strength), performance-based measures of physical function (hop tests, drop vertical jump), return to preinjury sports, adverse outcomes, intervention-related donor site morbidity and complications. Clinical failure and performance-based outcomes will be assessed by blinded evaluators over 2 years following ACLR. Analyses will combine STABILITY 2 and STABILITY 1 data in a mixed effects model where fixed effects include study, graft type, meniscal repair status and sex, while time, patient and surgeon are random effects variables. Ethics approval was granted for each centre prior to beginning recruitment. If successful, the results of this study will inform the optimal treatment of ACL rupture in young athletes, and women specifically, who are at risk for persistent rotational laxity/instability and graft rerupture. Reducing the risk of ACLR clinical failure will reduce the need for revision ACLR and the associated decreased quality of life and socio-economic burden that occurs because of ongoing knee instability and the increased risk for OA. https://clinicaltrials.gov/study/NCT03935750.
Background: Antimicrobial resistance (AMR) threatens empirical therapy for invasive pediatric infections, but contemporary data from Serbia and the Western Balkans remain limited for blood and cerebrospinal fluid isolates. Methods: We performed a retrospective CAESAR-linked multicenter microbiological surveillance analysis of first eligible invasive bacterial isolates from hospitalized children in Serbia from 1 January 2020 to 31 December 2024. Organism distribution, ESBL production, carbapenemase marker results, and selected resistance outcomes were analyzed descriptively and with temporal trend and multivariable models. Results: Among 907 isolates, 879 (96.9%) were recovered from blood and 28 (3.1%) from cerebrospinal fluid; neonates and infants accounted for 57.9% of isolates. K. pneumoniae was the predominant organism (318/907, 35.1%), followed by E. coli (172/907, 19.0%), S. aureus (137/907, 15.1%), and Acinetobacter spp. (96/907, 10.6%). Among K. pneumoniae and E. coli isolates with available ESBL results, ESBL production was frequent, whereas carbapenemase testing was restricted to a selected subset and the carbapenemase type was not recorded in the national surveillance extract. In K. pneumoniae, meropenem resistance increased from 19.7% in 2020 to 48.6% in 2024, and later study years remained independently associated with meropenem resistance after adjustment. Conclusions: This microbiological surveillance study identifies K. pneumoniae predominance, neonatal concentration, frequent ESBL production, and a rising carbapenem-resistance signal as the principal findings among invasive pediatric isolates in Serbia. Resistance estimates, particularly carbapenemase production, should be interpreted as surveillance indicators rather than clinical prevalence estimates. These data support strengthened pediatric invasive-isolate surveillance, center- and age-specific antibiograms, molecular characterization, and coordinated antimicrobial stewardship and infection prevention and control efforts within the wider European AMR context.
Poly ADP-ribose polymerase (PARP) inhibitors (PARPi) have revolutionized cancer care across multiple solid tumor types for patients with BRCA-mutations and homologous recombination deficient malignancies. Sentinel trials for PARPi, however, have had limited participation from non-European populations, limiting interpretation of results, dosing strategies, and quality-of-life implications in these patients. Our objective was to review participation by race and ethnicity in sentinel PARPi trials across disease sites. A literature search was conducted using PubMed/MEDLINE. Core search terms included "PARP inhibitor" and the disease sites of interest (breast, ovary, prostate, pancreas). A review of each sentinel trial was conducted utilizing data from ClinicalTrials.gov to obtain and/or confirm demographic information. Sentinel PARPi trials across all disease sites included populations that were predominantly White. TRITON2 (prostate) had the highest proportion of Black participants (5.8%), while Black participation in breast and ovarian cancer trials was almost always <3%. Missing data on race and ethnicity was common, and highest in TRITON2 and TRITON3 (∼20%, prostate) and ARIEL3 (13.3%, ovary). Aggregation into an "other" category was highest in EMBRACA (17.2%). Hispanic ethnicity was reported in only 5 of the 14 trials. There is overwhelming underrepresentation of racial and ethnic minorities in sentinel PARPi trials. Systemic issues in accepted clinical trial infrastructure, including reporting practices, site selection, protocol biases, and access challenges are all likely etiologies. Addressing the complexity of inclusion in global oncology research is still a crucial need to ensure cancer care equity.