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Background: Although diagnostic reference levels (DRLs) based on anatomical regions are widely used in computed tomography (CT) imaging, a clinical-indication-based approach provides a more accurate representation of daily practice and protocol variation. This study aimed to establish typical radiation doses for common CT clinical indications among adult patients at King Abdulaziz University Hospital (KAUH) in Saudi Arabia. Methods: This retrospective cross-sectional study included 298 adult patients who underwent CT examinations between 2020 and 2025 using two dual-source scanners operating in single- and dual-source modes. Demographic data, acquisition parameters, and radiation dose metrics, including CT dose index (CTDIvol) and the dose-length product (DLP), were extracted from scanner consoles. Six clinical indications were analyzed: brain trauma, sinusitis, chest metastases (chest Mets), interstitial lung disease (ILD), abdominopelvic metastases (AbdPel Mets), and hernia. Results: Typical median CTDIvol values in mGy were 36.4 for brain trauma, 3.4 for sinusitis, 4.9 for chest Mets, 5.6 for ILD, 7.2 for AbdPel Mets and hernia. Corresponding DLP values in mGy·cm were 654, 50, 173, 188, 344, and 369, respectively. Brain trauma demonstrated the highest radiation exposure, whereas sinusitis CT showed the lowest. Most values were comparable to or lower than international DRLs. Conclusions: This study provides the first comprehensive clinical-indication-based DRL data in Saudi Arabia beyond anatomical benchmarks, supporting ongoing dose optimization and future national DRL development.

Physical activity is a key lifestyle factor for mental health prevention, yet the influence of accelerometer placement on mood prediction remains unclear. We merged high-resolution acceleration data and Ecological Momentary Assessment (EMA) mood reports from 259 healthy participants across three ambulatory studies (SedMood, 24 hrCog, HO). Additionally, 15 min pre-assessment movement windows consisting of raw triaxial acceleration (64 Hz) from hip, thigh, chest, and wrist sensors were paired with six-item mood EMA queries. Features (e.g., mean, entropy, spectral power) were extracted and fed into gradient-boosted decision tree models (XGBoost), trained separately for energetic arousal, valence, and calmness. Performance was measured using the metrics MAE, RMSE and R2. Within individual studies, chest and hip sensors achieved the highest performance, followed by wrist and thigh. In the combined dataset, hip sensors again outperformed thigh (R2 0.38 vs. 0.20). Multi-sensor models rarely surpassed the best single-sensor configuration and sometimes reduced accuracy. These results suggest that sensor location modestly impacts mood-prediction performance, with hip and chest offering the most reliable signals, while adding sensors does not reliably enhance predictive power. Future work should explore larger, homogenous datasets and location-specific feature engineering to refine wearable-based mental health monitoring.

Background: Systematic infectious screening is recommended before initiation of biologic therapies in chronic inflammatory rheumatic diseases (CIRDs), yet the clinical impact of this strategy in low-prevalence settings remains insufficiently characterized. This study aimed to evaluate the proportion of abnormal findings and their impact on treatment management. Methods: We conducted a retrospective single-center study including adult patients with CIRDs who underwent systematic pre-biologic infectious screening between January 2019 and June 2025. Screening included HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), interferon-γ release assay (IGRA), and chest radiography. The primary outcome was the proportion of abnormal results and their impact on biologic initiation. Results: A total of 418 patients was included (mean age 48.2 ± 14.6 years; 69.1% female). No active HIV, HBV, or HCV infections were detected. Past HBV infection markers were identified in 2.6% of patients, and anti-HCV antibodies in 0.7%, all without detectable viremia. None of these findings required modification of biologic therapy. IGRA positivity was observed in 4.3% of patients and indeterminate results were seen in 3.1%. Preventive antituberculous therapy was initiated in most newly identified IGRA-positive cases, leading to delayed biologic initiation in several patients. Chest radiography yielded limited additional diagnostic value. Conclusions: In this population, systematic pre-biologic infectious screening identified few clinically actionable viral infections, whereas latent tuberculosis screening represented the main determinant of therapeutic modification. These findings support continued emphasis on tuberculosis risk assessment and warrant further prospective studies to evaluate optimized and potentially targeted screening strategies incorporating cost-effectiveness analyses.

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) can improve outcomes following refractory out-of-hospital cardiac arrest (OHCA); however, access is constrained by geography and resources. This study compared two strategies against the current system in Nara Prefecture, Japan: a two-stage hospital model using chest-pain network hospitals as ECPR-initiation sites, and a prehospital ECPR model using physician-staffed ambulances from two extracorporeal membrane oxygenation (ECMO)-ready hospitals. Methods: A geographic information system (GIS)-based simulation was conducted using emergency medical service (EMS) records of witnessed cardiac-origin OHCA cases (2017-2022). Isochrone analyses estimated areas reachable within a 60 min arrest-to-ECMO target. In the two-stage hospital model, patients located within a 15 min transport radius from chest-pain network hospitals were considered geographically covered. In the prehospital ECPR model, a physician-staffed ambulance was assumed to reach arrest sites within a 25 min travel-time radius from ECMO-ready hospitals. The study outcome was geographic coverage, defined as the proportion of cases within each service area; the two strategies were compared using McNemar's test for paired proportions. Results: Among 1476 included cases, the coverage rate was as follows: current system, 28.7%; two-stage hospital model, 65.2%; prehospital model, 70.4% (p < 0.001). Certain eastern and southern mountainous regions remained outside both coverage areas. Conclusions: Using real-world EMS data, a mobility-focused prehospital ECPR strategy provided broader potential geographic access without requiring additional fixed hospital infrastructure than expanding hospital-based initiation sites. Optimization of prehospital deployment may represent a geographically feasible approach to expanding ECPR access in mixed urban-rural regions, though operational feasibility and cost-effectiveness require further evaluation.

Inflammation in epicardial adipose tissue (EAT) contributes to cardiovascular disease through the local production of pro-inflammatory cytokines affecting the adjacent myocardium. Selenium (Se) is essential for selenoprotein-mediated antioxidant and anti-inflammatory functions. We investigated associations between Se status and inflammatory markers in EAT and in the circulation in patients with coronary artery disease (CAD). Patients with CAD undergoing coronary artery bypass grafting (n = 52) and valve disease patients receiving valve replacement serving as controls (n = 22) were included from the ATICH study. EAT biopsies were obtained during open-chest chest surgery. Serum Se was measured by inductively coupled plasma mass spectrometry. Associations between Se and EAT mRNA expression of Nod-like receptor family pyrin domain-containing protein 3 (NLRP3) inflammasome components and cytokines, as well as circulating inflammatory markers, were assessed using Spearman's rho and group comparisons based on median Se levels. Se concentrations were lower in CAD patients than controls (0.9 vs. 1.1 &#xb5;mol/L, p = 0.025). In CAD patients, Se levels correlated with EAT expression of CASP1 and IL18, and with circulating IL-6. Se levels above the median were associated with lower EAT expression of CASP1 and NLRP3 and reduced IL-6 levels (p < 0.05, all). Our analysis of publicly available RNA seq data demonstrated selenoprotein's presence in EAT. Lower Se status in CAD was associated with increased systemic and EAT inflammation, suggesting a role for selenoprotein-dependent antioxidant mechanisms in regulating cardiac adipose tissue inflammation.

This study evaluated variations in phenotypic and physiological traits of Snowy White chickens reared under high-altitude conditions in Lhasa, China, at 3650 m and low-altitude conditions in Ya'an, China, at 600 m. Chickens reared at high altitude showed delayed sexual maturity and peak laying, as well as lower laying rate and hatchability. In contrast, egg weight at first laying was higher in chickens reared at high altitude. Organ index analysis showed that high-altitude chickens had a higher heart index but lower liver, stomach, and spleen indices than low-altitude chickens (p < 0.05). High-altitude chickens also had greater chest depth and chest circumference but shorter shank length and smaller shank circumference (p < 0.05). Multivariate analyses further indicated liver and spleen indices as major contributors to the separation between altitude groups. These results show that high-altitude rearing is associated with altered reproductive performance, organ development, and body conformation in Snowy White chickens. These findings may inform the evaluation, breeding, and management of layer chickens in plateau production systems.

Background/Objectives: Hip arthroscopy is a minimally invasive procedure with rare complications that can occur due to air entry outside the joint space. Case Presentation: A 19-year-old patient underwent right hip arthroscopy with attempted joint venting. The next morning, she had pain in her right leg, neck, and chest with paresthesias over her hands and feet. A subsequent emergency department physical exam revealed crepitation of the lower extremities, abdomen, chest, and neck caused by air entrance during arthroscopy. The patient also reported blurred near vision. Additionally, the pupils were fixed, did not accommodate, and were dilated at 7 mm. Computed tomography scans revealed subcutaneous emphysema, pneumoperitoneum, pneumomediastinum, and cervicofacial emphysema. Magnetic resonance imaging of the brain revealed a Chiari I malformation. The patient received four hyperbaric oxygen treatments. By the fourth treatment, near visual acuity had improved, but far visual acuity had worsened. Vision had returned to normal eight days after discharge. Conclusions: It is proposed that the patient's reduced near vision, accommodation paralysis, and fixed and dilated pupils were brought about by pneumomediastinum and cervicofacial emphysema, inhibiting the ability of the pupils to constrict, causing bilateral mydriasis and accommodation paralysis for near targets. Additionally, the subsequent transient myopic shift is a known complication of hyperbaric oxygen therapy, which increases the refractive index of the crystalline lens.

Precise respiration assessment is crucial for heart rate variability (HRV) interpretation as respiratory components-particularly respiratory sinus arrhythmia (RSA)-provide essential information on vagally mediated regulation. Conventional single-lead electrocardiogram-derived respiration (EDR) methods measure the amplitude modulation of the QRS-waveform caused by respiratory chest movements. This causes a displacement of the electrical heart axis in relation to the ECG lead axis, typically within the 2D frontal plane of the Einthoven electrode montage. Another approach is based on heartbeat acceleration and deceleration during respective inspiration and expiration causing RR interval modulation. However, interval-based methods depend on the complexity of sympathovagal factors that affect RSA. The present feasibility study accounts for the 3D rotational movement of the electrical heart axis during the respiratory cycle and avoids non-respiratory neuromodulatory confounds. The beat-to-beat cardiac rotation was extracted from Frank-XYZ coordinates reconstructed via a four-electrode EASI device. In a pilot study with data from 19 healthy adults performing acoustically paced breathing (6-18 bpm), three surrogates (RR-IntervalEDR, R-AmplitudeEDR, HeartmovementEDR) were compared using a unified Python 3.11.13 pipeline (3D VCG R-peak detection, multivariate Mahalanobis artifact correction, wavelet-based analysis) against a synthetic reference derived from the instructed breathing schedule. The results demonstrated a consistently lower estimation error and higher reference-based signal-to-noise ratio (refSNR), measuring spectral alignment with the paced-breathing trajectory for HeartmovementEDR and achieving a mean refSNR of 6.01 dB (vs. 4.62 dB for RR-IntervalEDR and 3.20 dB for R-AmplitudeEDR) and a mean absolute estimation error of 0.016 Hz (vs. 0.050 Hz and 0.032 Hz, respectively). Notably, HeartmovementEDR and R-AmplitudeEDR performance slightly improved at higher heart rates, consistent with the interpretation that higher cardiac sampling density benefits spectral resolution for chest movement-based methods, whereas RR-IntervalEDR showed no significant heart rate dependence. Furthermore, HeartmovementEDR was compared with the EDR results obtained by applying the Kubios-HRV Premium software (version 3.5.0). Kubios-EDR yielded higher precision at elevated breathing frequencies, whereas HeartmovementEDR outperformed Kubios-EDR at breathing rates below 10 bpm-a range that is particularly relevant for vagally activating slow breathing protocols or treatments. Future work should validate this method using a direct respiration measurement under spontaneous natural breathing conditions.

Background/Objectives: Triple-rule-out CT angiography (TRO-CTA) enables simultaneous evaluation of coronary, pulmonary, and aortic causes of acute chest pain, but conventional single-acquisition protocols may compromise vascular enhancement because of conflicting contrast timing requirements. This study evaluated whether a physiology-based sequential helical-axial-helical acquisition strategy could provide consistent tri-territory enhancement in emergency settings. Methods: In this retrospective single-center study, 71 consecutive evaluable emergency department patients (mean age, 66.6 &#xb1; 17.0 years; 33 women) with undifferentiated acute chest pain underwent TRO-CTA using a structured sequential protocol (pulmonary, coronary, and aortic phases) guided by individualized test-bolus timing. Objective image quality was assessed using vascular attenuation, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR); subjective image quality was independently graded by two radiologists. Results: Mean vascular attenuation exceeded predefined diagnostic thresholds in all territories (pulmonary 546.7 &#xb1; 237.8 HU [95% CI, 490.4-603.0]; coronary 438.8 &#xb1; 113.9 HU [95% CI, 411.9-465.8]; aortic 604.3 &#xb1; 190.9 HU [95% CI, 559.2-649.5]). Diagnostic interpretability was achieved in all three territories in every technically analyzable examination without repeat contrast-enhanced imaging. Median subjective image-quality scores were 5 (IQR, 4-5) for pulmonary, 4.5 (IQR, 4-5) for coronary, and 4 (IQR, 4-5) for aortic phases; interobserver agreement was good to excellent. Mean total DLP was 461.5 &#xb1; 122.5 mGy&#xb7;cm. Conclusions: A sequential physiology-based TRO-CTA strategy is technically feasible in a tertiary emergency setting and provides consistent tri-territory enhancement. Because this was a single-arm technical validation study, prospective comparative and outcome-based studies are required to confirm its clinical impact.

Anti-granulocyte macrophage colony stimulating factor (anti-GM-CSF) antibodies, classically associated with pulmonary alveolar proteinosis (PAP), are increasingly recognised as a cause of adult-onset immunodeficiency predisposing to opportunistic infections. Coinfections with multiple opportunistic pathogens in this context are uncommon. We describe a rare case of disseminated Nocardia paucivorans, pulmonary Cryptococcus gattii, pulmonary Mycobacterium chelonae, and subsequent PAP in a patient with high-level anti-GM-CSF antibodies. A 64-year-old man presented with subacute bilateral shoulder pain and was diagnosed with acromioclavicular septic arthritis. N. paucivorans was isolated, and subsequent evaluation demonstrated disseminated infection with numerous brain abscesses, left eye endophthalmitis and pulmonary involvement. Interval computed tomography of the chest revealed new right lower lobe consolidation, a biopsy of which identified C. gattii and M. chelonae. Immunological testing confirmed high-level anti-GM-CSF antibodies. The patient received prolonged combination antimicrobial therapy, including meropenem, ceftriaxone, linezolid, trimethoprim-sulfamethoxazole, moxifloxacin, fluconazole, tigecycline and clofazimine, with clinical and radiological improvement of infectious lesions. Despite microbiological clearance, progressive bilateral ground-glass opacities developed on serial chest imaging consistent with PAP, with no pathogens identified on bronchoscopic sampling. Given minimal respiratory symptoms, PAP-directed therapy was deferred. The patient remains clinically stable on trimethoprim-sulfamethoxazole prophylaxis with ongoing clinical and radiological surveillance. This case illustrates the expanding clinical spectrum of anti-GM-CSF antibody-associated disease and underscores the importance of considering this diagnosis in patients presenting with opportunistic infections, in particular, disseminated nocardiosis or C. gattii infection. It also highlights the need for vigilance in evaluating for coinfections, recognition of PAP as a noninfectious codiagnosis, and the importance of long-term follow-up in affected patients.

Background: Skeletal myopathy is a common complication of heart failure (HF), contributing to exercise intolerance and impaired physical function. This study explores the relationship between practical skeletal muscle measurements and key biomarkers in HF patients undergoing cardiac rehabilitation. Methods: Sixty-nine stable chronic HF patients participated in a 3-month phase II cardiac rehabilitation program. Physical examinations, including the 6-Minute Walk Test (6MWT), chest expansion, inspiratory diaphragm thickness, and handgrip strength, were conducted. Blood samples were analyzed for myostatin and miRNA-133a. Data were analyzed using paired t-tests, Wilcoxon tests, Chi-square/Fisher's exact tests, and correlation analyses. Results: Significant improvements were observed in 6MWT distance, chest expansion, and inspiratory diaphragm thickness following rehabilitation (p < 0.001). Handgrip strength also significantly improved post-rehabilitation. Myostatin and miRNA-133a levels did not change significantly post-rehabilitation. However, exploratory cross-sectional analysis revealed trends suggesting that lower myostatin levels correlated with better endurance (p = 0.036), while higher myostatin levels were also observed in patients with better 6MWT performance (p = 0.014). Higher miRNA-133a levels were potentially associated with better overall fitness, including endurance and respiratory function (p < 0.05). Conclusions: Readily performed physical assessments can serve as clinical indicators of the systemic impact of HF on skeletal muscle. The study highlights the importance of evaluating extracardiac function in HF patients, demonstrating potential exploratory associations between physical function and key biomarkers.

Background/Objectives: Cardiopulmonary resuscitation (CPR) skill assessments are susceptible to evaluator subjectivity, cognitive fatigue, and observational limitations. Although recent advances in multimodal artificial intelligence have increased the possibility of automated video-based assessment, its validity for clinical skill evaluation remains insufficiently examined. Methods: In this cross-sectional study, we enrolled 130 laypersons who underwent Basic Life Support training and skill testing. Twenty recordings were used for prompt development and 110 recordings were analyzed. Expert evaluators and GPT-4o independently assessed participants' skills using a 12-item checklist. The manikin sensor data were the reference standard for the four chest compression metrics. Agreement was evaluated using Gwet's agreement coefficient 1 (AC1) and intraclass correlation coefficient (2,1). Diagnostic accuracy, sensitivity, and specificity were compared using McNemar's test. Results: Procedural items such as confirming cardiac arrest, calling 119, and requesting an automated external defibrillator showed a near-perfect agreement between experts and GPT-4o (AC1 > 0.8). However, the agreement was poor for the compression depth (AC1 = 0.374) and full chest recoil (AC1 = 0.355). Experts demonstrated high sensitivity (77.8-84.3%) but low specificity (24.6-47.8%), whereas GPT-4o showed low sensitivity (35.6-40.6%) but high specificity (69.2-76.1%). Conclusions: GPT-4o cannot serve as a standalone evaluator because of its inherent limitations in inferring three-dimensional spatial information from two-dimensional videos. However, its high agreement on procedural items and complementary error patterns with that of human evaluators on compression metrics suggests its potential as a decision support tool to mitigate expert leniency bias in CPR education.

Amiodarone is a widely used antiarrhythmic agent. Pulmonary toxicity is its most feared non-cardiac complication and is classically associated with high doses and prolonged duration of therapy. We report a case of early-onset amiodarone pulmonary toxicity (APT) developing after approximately one month of standard-dose amiodarone therapy (400 mg/day) in the setting of concurrent decompensated heart failure with preserved ejection fraction (HFpEF), which substantially complicated the diagnostic evaluation. A 71-year-old male with paroxysmal atrial fibrillation, nonischemic cardiomyopathy, and multiple comorbidities was initiated on amiodarone 400 mg/day in April. Within one month, he developed progressive dyspnea on exertion and productive cough. He presented to the emergency department in September with acute hypoxic respiratory failure (SpO&#x2082; 86% on room air), weight gain, and bilateral lower extremity edema approximately five months after symptom onset. CT of the chest demonstrated bilateral ground-glass and consolidative opacities with upper lobe predominance and interlobular septal thickening. The initial working diagnosis of decompensated HFpEF was supported by elevated BNP and peripheral edema; intravenous furosemide led to the resolution of edema but no improvement in oxygenation. APT was subsequently suspected, and intravenous methylprednisolone was initiated, resulting in marked clinical improvement. The patient was discharged on room air on a prolonged prednisone taper. At the three-month follow-up, he demonstrated complete symptomatic resolution, marked radiological improvement, and normalization of BNP. This case adds to the existing evidence that clinically significant APT may occur at standard maintenance doses and within a shorter timeframe than traditionally recognized. Coexistent HFpEF poses a major diagnostic challenge given the substantial overlap in clinical and radiological features. The possibility of concurrent rather than competing pathology should always be considered. Clinicians should maintain a high index of suspicion for APT in any patient on amiodarone with progressive respiratory symptoms, irrespective of dose or duration of exposure.

As integral members of pulmonary nodule (PN) programs, advanced practice providers (APPs) routinely evaluate PN cancer risk and make management recommendations. It is unknown whether an artificial intelligence (AI) tool impacts APP PN assessment and decision-making. What is the theoretical effect of APP use of a commercially available AI radiomics-based computer-aided diagnosis tool on PN diagnostic accuracy and management decision-making? In this retrospective multi-reader multi-case study performed from May 2024 to June 2024, 6 APP "readers" (4 in pulmonology, 2 in thoracic surgery) independently evaluated 300 chest CT scan "cases", each with an indeterminate PN 5-30 mm in maximal diameter (50% cancer prevalence). Using solely CT imaging data, APPs provided an estimate of cancer risk and management recommendation for each case without and then with AI tool assistance. The effect of the AI tool on readers' diagnostic performance and management decisions was assessed using descriptive statistics, area under the receiver operating characteristic curve (AUC), and reclassification plots and tables. With AI tool assistance, APP readers' average PN diagnostic accuracy increased by 9 percentage points (AUC: 0.79 vs 0.88; P<0.001). A higher proportion of malignant PNs were classified as high (>65%) risk (63% vs 46%; P<0.001) and recommended for a lung biopsy or surgical resection (72% vs 55%; P<0.001) with AI tool assistance. While benign PNs were more often classified as low (<5%) risk (39% vs 34%; P<0.001) with AI tool assistance, there was no statistically significant difference in the proportion recommended for an invasive procedure (18% vs 17%; P=0.3). APP use of a commercially available AI radiomics-based tool for PN evaluation was associated with increased diagnostic accuracy and invasive diagnostic procedure recommendation for malignant PNs. Future prospective, randomized clinical trials are required to assess its use in routine clinical practice.

Primary pulmonary inflammatory myofibroblastic tumor (IMT) associated with paraneoplastic pemphigus (PNP) is extremely rare. IMT is an intermediate (rarely metastasizing) mesenchymal neoplasm rather than a conventional sarcoma. We report a case of a 68-year-old female patient who initially presented with generalized skin rash, oral mucosal ulceration, and fever. Chest CT revealed a thoracic mass (initially difficult to determine whether mediastinal or pulmonary in origin). Subsequent thoracotomy and surgical resection with pathological examination confirmed an ALK-rearranged inflammatory myofibroblastic tumor (SQSTM1: ALK fusion) of pulmonary origin. Oral mucosal pathology, combined with clinical findings, supported a diagnosis of PNP. This case aims to provide reference for the diagnosis and treatment of patients with primary pulmonary IMT complicated by PNP. However, the follow-up period was short and systemic immunosuppressive therapy was not administered; this should be regarded as a cautionary note rather than a therapeutic recommendation.

Acne is an inflammatory dermatological disorder largely caused by Cutibacterium acnes (C. acnes), which primarily affects the face, neck, chest, and back, leading to skin impairment. This condition is often associated with post-inflammatory erythema, hyperpigmentation, and scarring, as well as psychosocial and emotional distress. Based on the major pathological characteristics of acne with microbiome colonization, and multiple immune responses, we selected doxycycline, a common clinically used antibiotic and anti-inflammatory drug, and epigallocatechin gallate (EGCG), a polyphenol, to construct topically applicable nanoparticles (NPs). The resulting doxycycline-EGCG (DE) NPs significantly reduced the proportion of dead cells in C. acnes-induced HaCaT cells and demonstrated excellent anti-inflammatory effects through inhibition of NF-&#x3ba;B and STAT3 pathways compared to doxycycline alone. Moreover, the DE NPs exhibited better antibacterial efficacy against C. acnes along with improved antioxidant capacity than doxycycline. In an acne-like mouse model, the DE NPs also effectively suppressed skin inflammation and reduced inflammatory cytokine expression. Overall, this work presents a co-assembly strategy driven by covalent and non-covalent interactions, affording polyphenol-based doxycycline NPs with potent anti-inflammatory, antioxidant and antibacterial properties, and offering new opportunities for safe and effective acne local therapy.