Society 5.0 envisions a future where technology and humanity integrate to address societal concerns. In an era marked by significant technological advancements, particularly in artificial intelligence, it is vital to uphold the core values of compassionate care and human connection. While the healthcare sector is central to this transformation, the prevailing research ethics frameworks remain dominated by Western individualism and positivism. This conceptual paper aims to establish a case for integrating African research canons-ujamaa, utulivu, kujitoa, uhaki, and ukweli-into bioethical discourse to create a more inclusive, culturally relevant framework. As a conceptual review, this paper analyses existing Afrocentric paradigms and uses the Bachelor of Clinical Medical Practice (BCMP) curriculum as an illustrative case study of decolonised ethics in practice. Incorporating Ubuntu and specific African research canons challenges the Western-centric status quo, fostering a research environment that prioritises communal well-being and harmony. We can contribute to humanising healthcare by integrating these Afrocentric values, working towards creating a society that is more inclusive and compassionate. The inclusion of African research canons may lead to inclusive and culturally relevant research ethics by shifting the emphasis from Western individualism to a more holistic and human-centred approach.
To evaluate an in-house newly fabricated patient-specific pediatric head CT phantom developed for trauma-oriented emergency imaging, with emphasis on multiplanar visual realism, cross-platform interpretability, and expert-reader assessment of diagnostic acceptability. A heterogeneous phantom was generated from an anonymized retrospective head CT dataset of a 5-year-old child and designed to preserve emergency-relevant osseous, aerated, orbital, and intracranial anatomy. A complex orbito-nasal midface trauma was incorporated as a trauma-mimicking feature. CT was performed on two clinical multidetector systems from different vendors: a 64-row GE Discovery CT750 HD and an 80-row Canon Aquilion RXL, each using routine pediatric head CT protocols. Ten radiologists independently reviewed axial, coronal, and sagittal reformations in bone and soft-tissue windows using a structured 20-item, 4-domain scoring framework. Representative multiplanar images showed preserved calvarial contour, skull-base and orbital anatomy, aerated sinonasal spaces, intracranial contour, falcine/midline anatomy, ventricular depiction, posterior fossa appearance, and visualization of the complex orbito-nasal midface trauma. Expert ratings were favorable on both scanners, with higher scores on Canon across all domains. Domain means on Canon versus GE were 4.38 versus 4.02 for osseous realism, 4.32 versus 4.00 for soft-tissue realism, 4.36 versus 4.18 for multiplanar interpretability, and 4.57 versus 4.10 for clinical utility. Overall composite scores were 4.38 on Canon and 4.07 on GE, paired domain-level differences showed higher mean scores for the Canon dataset in all domains, with the largest difference in clinical utility (+ 0.47). The phantom provided clinically recognizable, trauma-relevant pediatric emergency head CT appearances across multiplanar bone and soft-tissue review and was rated as realistic and diagnostically acceptable by expert readers, supporting its use in protocol evaluation, training, and observer-based emergency radiology research.
This commentary advances a reframing of science as a dialectical process that moves from local lifeworld to provisional universals and back to locally situated renewal. We term this movement Indigenized Science. Building on two decades of cultural praxis work, we propose that universalization has broadened inclusion yet often stalls before reembedding knowledge into the geographic, linguistic, and sociopolitical contexts where athletes live and practitioners work with coaches, teammates, staff, and administrative leadership. Herein, we (a) synthesize how cultural sport psychology has progressed from early calls for awareness to contextualized inquiry, (b) identify limits of prevailing Anglophone methodological canons when transported across geographic settings, and (c) propose a culturally relevant and safe actionable framework for indigenizing research and practice. We offer an actionable framework specifying six intervention points: literature (multilingual and cross-regional canons), philosophies of science (context-congruent epistemologies), development of cooperation (international cooperation), situating of authors/participants/contexts (explicit "place" and positionality), modes of inquiry (community-compatible designs and elicitation), and analytic strategies (coanalysis and coauthorship to preserve local meaning). We exemplify how these choices cohere to enhance ecological validity, ethical reciprocity, and knowledge translation across diverse systems. This contribution reveals a methodological and ethical orientation, but it is not a replacement for scientific generalization. Rather, it is a disciplined return to contexts renewing and reinforcing science. We conclude with implications for scientist-practitioner training, positioning indigenization as a rigor-enhancing route to globally relevant, locally resonant sport psychology.
This data article presents an image dataset compiled for the purpose of machine learning-based identification and prediction of adulteration levels in Teff (Eragrostis tef (Zucc.) Trotter) flour. The dataset includes images of pure white, mixed, and red Teff flour varieties, as well as these flours adulterated with wood flour (sawdust) and gypsum (calcium sulfate) powder. Adulteration levels range from 10% to 40% in 5% increments. The data collection process involved preparing Teff flour from naturally dried and milled Teff grains. Samples of 100 grams of each Teff flour variety were then mixed with the adulterants at the specified concentrations. A total of 5000 raw images were captured using an 18-megapixel Canon EOS 7D camera under controlled studio lighting (300 W incandescent lamps), with the samples placed 30 cm from the camera lens in a 10 cm x 10 cm plastic box. To enhance the dataset's diversity and quantity, 25,000 augmented images were generated by shuffling image pixels' locations with various block sizes (1 × 1, 2 × 2, 4 × 4, 8 × 8, and 16 × 16). This dataset is a valuable resource for researchers and students in Teff adulteration using image processing and feature extraction. It also holds potential for use by Food and Drug Administration Authorities and law enforcement to develop automated methods for detecting Teff flour adulteration, offering an alternative to time-consuming physio-chemical laboratory tests. The dataset's structure and augmentation methods are detailed to ensure reproducibility and encourage further research into robust machine learning models for food quality control.
A super-resolution deep learning (DL) image reconstruction algorithm (Precise Image Quality Engine (PIQE)) was originally designed for cardiac CT, but is now available for abdominal CT. To examine objective and subjective image quality (IQ) improvements PIQE compared to Advanced Intelligent Clear-IQ Engine (AiCE) in abdominal CT. A retrospective analysis was conducted on 69 adult patient routine contrast enhanced abdominopelvic CT exams on a single Aquilion ONE/INSIGHT CT system (Canon Medical Systems, Otawara Japan). Images were reconstructed using PIQE (strength level L1 and L2) and AiCE (L1- the institutional standard). Four blinded radiologists assessed image noise, image contrast, small structure visibility, image sharpness, artifacts, and overall image preference with Likert scales. Reader agreement was assessed with Krippendorff's alpha. Circular regions of interest were placed on five slices on the left and right liver, portal vein, aorta, subcutaneous fat, and bilateral psoas muscles. CT number, noise, signal-to-noise ratios (SNRs), and contrast-to-noise ratios (CNRs) were determined. All significant differences between reconstructions were assessed via the Friedman test with post-hoc Dunn-Sidak corrections. Reader agreement was fair ( α ¯ = 0.20 $\bar{\alpha}=0.20$ ). PIQE L2 was preferred for image contrast and image noise and PIQE L1 was preferred for image sharpness (p < 0.05). CT numbers were significantly different between AiCE L1 and PIQE (p < 0.05) and noise was statistically lowest in PIQE L2 compared to AiCE L1 (p < 0.05). SNR and CNR differences were statistically significant (p < 0.003), with PIQE L2 demonstrating the highest SNR and CNR. The best subjective IQ metrics for image contrast, image noise, and image sharpness were obtained with PIQE. The best objective IQ metrics (SNR and CNR) were obtained with PIQE L2. This work supports improved image contrast and decreased noise when using PIQE as compared to AiCE.
Academic nursing does not simply have a diversity problem; it has a knowledge problem. The discipline's credentialing systems, editorial norms, accreditation frameworks, and theoretical canon function as gatekeeping mechanisms that shape whose scholarship is recognized as legitimate, whose methods are considered rigorous, and whose expertise is institutionally validated. Although critical theoretical frameworks have increasingly entered nursing discourse, their structural implications are frequently diluted or neutralized within institutional practice. The purpose of this paper is to examine academic nursing as an epistemological gatekeeper and to analyze how nursing's knowledge infrastructure sustains racial hierarchy while simultaneously performing commitment to equity. Drawing on Critical Race Theory (CRT), and specifically Cheryl Harris's concept of whiteness as property, this conceptual analysis examines the structural and epistemic mechanisms through which academic nursing regulates legitimacy, knowledge production, and disciplinary authority. The paper also considers common diversity, equity, and inclusion (DEI) counterarguments within nursing institutions. The analysis argues that epistemic gatekeeping within academic nursing is neither accidental nor benign. Critical frameworks such as CRT are often incorporated into nursing discourse only after being stripped of structural force and rendered institutionally safe. These dynamics influence who teaches nursing, what nurses are taught, and the profession's capacity to fulfill its stated commitments to health equity. The paper identifies mechanisms of epistemic exclusion and examines how institutional norms reproduce racialized hierarchies of knowledge and authority. Academic nursing must confront not only issues of representation, but also the epistemological structures that govern legitimacy and authority within the discipline. Structural reform is necessary to address entrenched forms of epistemic gatekeeping and to advance meaningful institutional accountability in nursing education and scholarship.
Metal artifacts in computed tomography (CT) significantly compromise image quality and CT number (CTN) accuracy, which may influence downstream applications such as radiation therapy workflows. Although commercial metal artifact reduction (MAR) algorithms are widely used, their performance varies across vendors and clinical scenarios, and standardized methods for quantitative comparison remain limited. This study quantitatively compares four commercial MAR algorithms using standardized metrics and a novel analytical approach. A custom-designed resin phantom with interchangeable inserts (solid water, aluminum, titanium, and stainless steel) was scanned using four CT systems: Canon, GE, Philips, and Siemens. Each system's proprietary MAR algorithm was applied to obtain artifact-reduced image sets. Quantitative analysis employed complementary methods: (1) circular profile analysis measuring mean CTN deviations at concentric distances from metal objects; (2) geometric accuracy assessment of metal objects; and (3) volumetric artifact characterization using analysis of severe artifact voxels and composite error metric (M-error index) that integrates both artifact extent and intensity. Color maps and accumulated histograms of ΔCTN values between pre- and post-MAR images were used to characterized artifact patterns and MAR performance. All four MAR methods showed minimal |ΔCTN| at mid (2.80 cm) and far (3.80 cm) distances but showed pronounced increases in |ΔCTN| near the metal interface at the closest radius (1.27 cm). Smart-MAR exhibited the highest CTN deviation for aluminum (16.83 HU), while O-MAR showed the largest deviations for titanium and stainless steel (42.40 and 42.60 HU). Quantitative evaluation showed that single-energy metal artifact reduction (SEMAR) and iterative metal artifact reduction (iMAR) achieved the most consistent geometric accuracy (<5%) across all metals. O-MAR showed the highest accuracy for titanium (approximately 0.36%) but larger deviations for aluminum (approximately 9%), while Smart-MAR exhibited the greatest errors exceeding 19% for both titanium and stainless steel. SEMAR, Smart-MAR, and iMAR showed lower M Error values (0.00-0.83) than O-MAR, which showed significantly higher values (1.15-2.45). SEMAR and iMAR achieved the most consistent geometric accuracy (<5% error) and artifact suppression across all metals, while O-MAR demonstrated material-dependent performance with substantial residual artifacts near metal interfaces. These phantom-based benchmarks provide vendor-neutral performance data on MAR performance under controlled settings.
Diffusion tensor image analysis along the perivascular space (DTI-ALPS) was originally developed and defined as a noninvasive diffusion MRI method intended to evaluate glymphatic function and is now widely used in neuroimaging research. However, accumulating evidence suggests that the biological meaning of the ALPS index is more complex than initially assumed as a simple marker of glymphatic function. The ALPS index does not directly measure whole-brain fluid transport but rather reflects localized directional diffusivity based on the Brownian motion of water molecules. Its value is strongly influenced by white matter microstructure, including fiber orientation, crossing fibers, extracellular geometry, and age-related diffusivity changes. In addition, because the ALPS index is a ratio-based measure derived from directional diffusivity components, its alterations may arise from different combinations of numerator and denominator diffusivity changes, indicating that similar ALPS index reductions may reflect distinct underlying microstructural mechanisms. White matter microstructure may represent not merely a confounding factor, but a structural substrate guiding interstitial fluid transport itself. White matter hydraulic permeability exhibits strong anisotropy, and brain fluid transport may occur preferentially along white matter tracts. Thus, the structure dependence of the ALPS index may reflect physiologically relevant interactions between white matter architecture and interstitial fluid dynamics rather than simple measurement bias. In this review, we propose redefining the ALPS index not as a direct marker of glymphatic function, but as a "spatially fixed-point biomarker" evaluating directional diffusivity within anatomically defined regions. Within this framework, the ALPS index can be understood as a composite biomarker reflecting interactions among white matter microstructure, extracellular environment, vascular geometry, and neurofluid-related tissue environment. Because the ALPS index has been associated with aging, sleep, and various diseases, it may function less as a disease-specific marker and more as an adjunctive imaging marker relevant to brain health assessment and the brain tissue environment.
This work evaluated the safety and efficacy of histotripsy treatments with metal in the therapeutic beam path or directly in the treatment zone. Histotripsy treatments were performed on 66 agar phantoms with metal nearfield, adjacent to and within the treatment zone. Two endovascular coil sizes, a surgical clip and three gold fiducials were tested. The energy required to treat, treatment size and Dice coefficient were compared with control treatments without metal. In vivo histotripsy treatments were performed on four healthy swine (two treatments per animal). Treatments were performed centered on a metallic fiducial (n = 3) or deep to the endovascular coils (n = 3), as well as without metal in the beam path (control, n = 2). The control treatments were performed in independent areas of the liver. Imaging and gross necropsy were used to assess safety. Additionally, imaging and histology were used to assess efficacy. The phantom treatment energy levels, diameters and Dice coefficients, as well as in vivo treatment diameters, failed to show any significant differences between the experimental and control groups. No off-target damage was observed. Histologically, the treatment zones beneath a coil and over a metal fiducial were both complete, with acellular debris surrounded by a transition zone of hepatocytes with pyknotic nuclei and atrophic sinusoidal plates. Histotripsy with endovascular coils in the ultrasound beam path or with a metal fiducial directly in the treatment zone was safe and effective in this small, acute in vivo swine study.
Photon-counting detector computed tomography (PCD-CT) offers several image reconstruction options, e.g. virtual monoenergetic images (VMIs) and relative electron density (RED) images. This study investigated these PCD-CT reconstructions for dose calculation in head-and-neck cancer (HNC) patients. 10 HNC patients referred to radiotherapy were scanned with PCD-CT. The same contouring and therapy strategy was followed as in the patients' clinical treatment, optimized on an energy-integrated-detector CT (EID-CT). 18 volumetric arc therapy treatment plans (6 MV photons) were optimized on RED images and recalculated on 70 keV VMI (VMI70), using the same amount of monitor units. While RED images did not require scanner-specific calibration, the conversion from CT number to RED for VMI70 was calibrated using a phantom with tissue-equivalent inserts with known RED. To assess the clinical impact of using RED maps with vendor-provided calibration, one plan per patient was recalculated using bulk material overrides. Plan quality was evaluated by evaluating dose-volume metrics, such as the dose to 98% of planning target volume, and compared between RED, VMI70, and EID-CT. All plans optimized on RED images fulfilled the clinical goals. Dose-volume metrics differed by <3% between RED and VMI70 and <5% between RED and EID-CT. RED differed by differed by <4% from bulk density override (<1% when the target did not overlap with air volumes). Treatment planning can be accurately performed on PCD-CT images of HNC cases, using either VMI (after CT-number-to-RED conversion) or RED images (without scanner-specific calibration).
With the expanding clinical application of cardiac computed tomography (CT) for myocardial tissue characterization, the accuracy of extracellular volume fraction (ECV) quantification is critically dependent on image quality. This study aimed to compare the performance of deep learning reconstruction (DLR), hybrid iterative reconstruction (HIR), and model-based iterative reconstruction (MBIR) in terms of image quality and the accuracy of ECV quantification in cardiac CT. Fifty patients with suspected cardiac disease who underwent both cardiac CT and magnetic resonance imaging (MRI) were prospectively enrolled. Non-contrast and delayed-phase CT images were reconstructed using HIR, MBIR, and DLR algorithms, respectively. Visual image noise, beam-hardening artifacts, and display of myocardium and blood pool were evaluated using a four-point scale. CT value, image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) of six segments of myocardium were measured and calculated. CT-ECV of six segments of myocardium was calculated in subtraction images. Pearson or Spearman correlation and Bland-Altman analysis were used to evaluate the correlation and consistency between CT-ECV and MRI-ECV in six segments of myocardium. DLR significantly decreased image noise and beam-hardening artifacts, increasing SNR and CNR, providing superior visualization of the myocardium and blood pool compared to HIR and MBIR (P<0.001). In ECV quantification, DLR demonstrated a significantly lower mean absolute difference between CT-ECV and MRI-ECV across all six segments of myocardium (P<0.05). Compared with HIR and MBIR, DLR improved the correlation between CT-ECV and MRI-ECV (P<0.001). DLR showed the highest consistency in assessing ECV in all segments of myocardium (bias: -0.183) compared to HIR (bias: 0.390) and MBIR (bias: 0.540). Cardiac CT combined with DLR enhances the myocardial image quality and improves the accuracy of CT-ECV quantification.
Cerebrospinal fluid (CSF) transport along meningeal pathways contributes to brain fluid homeostasis and is thought to change with aging, yet quantitative, region-resolved measurements across lifespan remain limited. We hypothesized that meningeal CSF transport dynamics exhibit region-specific age associations rather than uniform decline. We applied non-contrast time-spatial labeling inversion pulse (Time-SLIP) MRI combined with a bi-component analytical model to characterize CSF transport dynamics in a healthy, activity-controlled cohort of 64 adults aged 19-86 years. Signal increase ratio time courses were decomposed into a fast Gaussian bulk-displacement and a slower Γ-variate perfusion-like component. Linear mixed-effects models were used to assess regional and age-related effects. Model fits were robust across all participants (R2 = 0.97). CSF transport metrics differed significantly across parasagittal dura subregions and the superior sagittal sinus. Age associations were heterogeneous: the perfusion-like component declined with age in upper parasagittal dura, increased in lower parasagittal regions, and remained relatively stable within the superior sagittal sinus. Additional timing and amplitude parameters exhibited region-specific age trajectories. These findings demonstrate regionally heterogeneous aging effects on meningeal CSF transport dynamics and suggest age-related redistribution rather than uniform decline, providing a noninvasive framework for assessing physiological remodeling of CSF transport with aging.
This prospective observational study evaluated short-term intraocular pressure (IOP) changes and safety following intravitreal injection of aflibercept 8 mg versus 2 mg in diabetic macular edema (DME). We included 40 eyes from 36 patients with center-involving DME, with 18 patients and 20 eyes in each group. IOP was measured at baseline (sitting and supine), 30 s post-injection (supine, T1), and at 5, 15, and 30 min (sitting, T2-T4). Vitreous reflux (VR), paracentesis, and baseline data were also assessed. Both groups showed a marked but transient IOP rise, peaking at T1 (59.0 ± 17.4 mmHg and 60.1 ± 20.8 mmHg) and returning to near baseline by T4 (14.6 ± 4.6 mmHg and 16.6 ± 6.7 mmHg), without significant between-group differences. No eyes required paracentesis, and VR severity was comparable. At T1, greater VR or prior vitrectomy was associated with lower IOP, but this effect was not sustained, and other baseline factors did not significantly affect IOP. These findings suggest that aflibercept 8 mg induces a transient IOP elevation comparable to that with aflibercept 2 mg, with IOP returning to baseline levels by 30 min. Additionally, aflibercept 8 mg demonstrated an acceptable short-term safety profile in eyes with DME.
Lung cancer remains a critical global health concern, with a substantial fraction arising in never-smokers. Air pollution-including particulate matter (PM2.5, PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2), and ozone (O3)-has been implicated in lung carcinogenesis; however, studies linking these exposures to molecular biomarkers in Hispanic populations remain scarce. This study aimed to evaluate the association between exposure to air pollutants and oncogenic mutations in non-small cell lung cancer (NSCLC) in Hispanic patients in Bogotá. A retrospective cohort study was conducted on 205 Hispanic patients diagnosed with NSCLC between 2015 and 2022 at a quaternary care hospital in Bogotá, Colombia. Lung cancer driver mutations [epidermal growth factor receptor mutations (EGFRm), anaplastic lymphoma kinase (ALK) rearrangement, and programmed death-ligand 1 (PD-L1) expression] were assessed by reverse transcription polymerase chain reaction and immunohistochemistry. The estimated individual-level exposure to air pollutants (PM2.5, PM10, NO2, SO2, O3, and CO) was assessed from Bogotá's Air Monitoring Stations using an inverse distance weighted regression model. Adjusted logistic regression analyses evaluated associations between biomarkers and pollutants. Kaplan-Meier and Cox proportional hazards models examined survival outcomes. Mean annual exposure to PM2.5 (15.9 µg/m3), PM10 (32.6 µg/m3), and NO2 (28.3 µg/m3) exceeded the thresholds recommended by the World Health Organization. EGFRm were identified in 24.9% of patients, ALK rearrangements in 12.2%, and PD-L1 expression ≥1% in 41.5% (≥50% in 5.4%). EGFRm was associated with increased exposure to PM2.5 and PM10 levels [PM2.5: odds ratio (OR) 2.49, 95% confidence interval (CI): 1.11-6.41; PM10: OR 1.54, 95% CI: 1.05-2.34]. NO2 was associated with increased PD-L1 expression (OR 1.83, 95% CI: 1.33-2.65). The 5-year overall survival (OS) rate was 29.0%. Increased exposure to PM2.5 [hazard ratio (HR) 1.72; 95% CI: 1.04-2.84] and SO2 (HR 1.69, 95% CI: 1.07-2.68) were associated with mortality. These results underscore the potential impact of air pollution on the molecular landscape and clinical outcomes of patients diagnosed with NSCLC, and they open new avenues for research in genetically admixed populations.
To determine the prevalence of MRI-confirmed ischiofemoral impingement (IFI) in young patients with nonarthritic hip pain, and to evaluate the associations of femoral, acetabular, pelvic, and spinopelvic parameters with IFI. We included 250 patients with nonarthritic hip pain who underwent standardized imaging (MRI and CT, lateral standing and deep-seated spinopelvic radiographs). IFI was diagnosed by quadratus femoris oedema/atrophy. IFI-positive/negative hips were compared for morphological and spinopelvic parameters. Underlying pathologies (e.g. femoroacetabular impingement, dysplasia) were documented. Multivariate regression identified independent predictors of IFI and determinants of quadratus femoris space (QFS). IFI was identified in 14/250 patients (5.6%), all female. IFI cases had significantly reduced ischiofemoral space (24.8 mm (SD 6.7) vs 34.9 mm (SD 10.2); p < 0.001) and QFS (9.2 mm (SD 3.4) vs 20.7 mm (SD 7.0); p < 0.001). IFI cases demonstrated larger ischial angle (135.7° (SD 3.0°) vs 132.2° (SD 4.0°); p = 0.002), higher femoral version (16.5° (SD 10.3°) vs 10.4° (SD 12.3°); p = 0.031), and reduced femoral (34.2 mm (SD 5.6) vs 37.7 mm (SD 5.9); p = 0.016) and acetabular offset (29.4 mm (SD 3.5) vs 32.0 mm (SD 4.8); p = 0.036). In standing, IFI cases tended to have lower lumbar lordosis (LL) (55.31° (SD 7.95°) vs 59.91° (SD 10.50°); p = 0.077), higher pelvic tilt (15.68° (SD 4.73°) vs 12.39° (SD 6.20°); p = 0.047), and smaller mismatch between pelvic incidence and LL (-2.39° (SD 7.18°) vs -7.82° (SD 10.00°); p = 0.034). The change in LL across standing to deep-flexed sitting transition (ΔLL) was lower in IFI cases (50.31° (SD 10.89°) vs 56.89° (SD 10.64°); p = 0.020). Multivariate regression identified reduced QFS (odds ratio (OR) 1.92, 95% CI 1.30 to 2.89; p < 0.001) and greater LL (OR 1.16, 95% CI 1.00 to 1.33; p = 0.047) as independent predictors of IFI. Size of QFS was associated positively with femoral offset (β = 0.35; p < 0.001) and mismatch between pelvic incidence and LL (β = 0.18; p = 0.028), and negatively with ischial angle (β = -0.34; p < 0.001), femoral version (β = -0.14; p = 0.016), and standing pelvic tilt (β = -0.16; p = 0.026). IFI occurred in 5.6% of patients and was characterized by a distinct morphometric and sagittal alignment profile, including increased femoral version, reduced offset, greater ischial angle, reduced LL, increased pelvic tilt, and diminished spinal motion. These findings support a multifactorial model in which hip morphology and spinopelvic alignment jointly influence posterior hip clearance in IFI.
Assessing subtle compositional changes in cranial and sensory organ fluids-including cerebrospinal fluid (CSF), ocular humors, and inner ear lymph fluid-is vital for neuroimaging. Heavily T2-weighted Fluid-attenuated Inversion Recovery (FLAIR) is sensitive to T1 changes induced by solutes, but conventional magnitude reconstruction (e.g., HYDROPS subtraction) suffers from artifacts like signal cancellation, paradoxical gadolinium-based contrast agent (GBCA) effects, and motion misregistration. This review summarizes the technical characteristics and diverse applications of PRISM (Polarity-preserving Real Inversion Solute Mapping), a robust 3D-real Inversion Recovery (IR) sequence developed to overcome these limitations. PRISM achieves high T1-sensitivity using phase-sensitive (real) reconstruction with an ultra-long repetition time (TR), allowing whole-brain coverage and simultaneous assessment of CSF, the eyeball, and the inner ear within a clinically feasible time. Critically, its polarity-preserving display depicts fluids lacking T1-shortening solutes with a negative signal (black), clearly differentiating them from bone and air. Clinically, PRISM's utility spans both non-contrast and contrast-enhanced applications. Non-contrast PRISM is useful for assessing CSF protein concentration variations, meningeal lymphatic stasis, or compositional changes indicating inner ear pathologies. When combined with GBCA, time-course PRISM (pre-contrast up to 24 h delayed) uniquely visualizes solute dynamics, providing profound insights into blood-barrier integrity (e.g., blood-labyrinth barrier) and glymphatic waste clearance (e.g., CSF washout, perivascular space enhancement). Moreover, PRISM is a reliable, single-acquisition method for visualizing delayed contrast-enhanced endolymphatic hydrops, bypassing prior subtraction pitfalls. PRISM's ability to detect subtle compositional markers with high resolution positions it as a highly promising MRI advancement. However, to facilitate its routine widespread clinical adoption, further standardization, broader validation, and multi-platform reproducibility are essential. Continued efforts to establish robust protocols will be necessary to realize its potential as a non-invasive tool for screening and monitoring glymphatic function.
Reviving extinct animals offers a crucial opportunity to recover lost or unknown genetic resources, yet cloning methods are unsuitable because they depend on intact donor nuclei and abundant oocytes or recipients from closely related species. To overcome these constraints, we explored a chromosome level revival strategy. Blood cells from rat carcasses stored at - 30 °C for over one year were introduced into enucleated mouse oocytes, where the rat nuclei underwent premature chromosome condensation. Microtubule polymerization inhibition enabled dispersion of rat chromosomes within the ooplasm, allowing isolation of individual chromosomes by micromanipulation. Each chromosome was subsequently transferred into an intact mouse oocyte, followed by intracytoplasmic sperm injection using GFP-transgenic mouse sperm. Embryos were cultured to the blastocyst stage, yielding 17 ES cell lines, two of which carried 41 chromosomes. Spectral karyotyping confirmed the presence of rat chromosome 9 alongside a full set of normal mouse chromosomes. These ES cells generated chimeric mice exhibiting GFP based chimerism across multiple organs. Histological analyses further demonstrated expression of numerous genes located on rat chromosome 9 within chimera mouse. This study demonstrated that a single chromosome from a frozen extinct species can be functionally revived and its transcriptional activity assessed within an interspecies oocyte.
Large language models (LLMs) can generate structured educational content at scale, yet their role in postgraduate radiology training remains untested. This pilot study evaluated the feasibility of deploying LLM-generated radiology board preparation materials, the psychometric properties of adapted survey instruments, and exploratory effect-size estimates for sample-size planning of a future multicentre trial. We conducted a prospective observational pilot among 41 radiology residents preparing for the 2026 Korean Radiology Board Examination. A governed seven-stage LLM pipeline generated 6,000 Anki flashcards, 833 infographic summaries, and presentation slides. Materials were distributed freely, and 24 completers self-selected into users (n = 15) and non-users (n = 9). Outcomes included enrollment yield, retention rate, voluntary adoption rate, internal consistency (Cronbach's alpha) of adapted cognitive load and satisfaction scales, and change scores in extraneous cognitive load (ECL) and self-efficacy (SE), compared using Mann-Whitney U tests with Cohen's d and 95% confidence intervals. Of 114 registered candidates, 44 were recruited (38.6%); 41 were enrolled (yield 93.2%); retention was 58.5% (24 of 41), below the prespecified 80% threshold; and voluntary adoption was 62.5%. The ECL scale showed acceptable reliability (alpha = 0.87 baseline, 0.80 post-examination). After reverse-coding one reverse-worded item (E3), the corrected three-item trust-in-AI alpha was 0.583 (bootstrap 95% CI 0.151 to 0.746), below the conventional 0.70 threshold. Between-group differences were non-significant for ECL (d = - 0.28; 95% CI - 1.50 to 0.59) and SE (d = 0.26; - 0.62 to 1.24). Among users, educational quality was rated 3.33 of 5.00, and 86.7% reported encountering no factual inaccuracies. A medium-effect scenario (d = 0.50) would require 160 participants. Retention (58.5%), the trust-scale alpha of 0.583, and the - 40 Net Promoter Score together indicate that the data-collection protocol, the AI-trust instrumentation, and the user-experience design all require modification before an efficacy trial is justified. Operational deployment was feasible at the levels of enrollment yield and voluntary adoption, but not retention. Adapted cognitive load and satisfaction scales reached acceptable reliability; the trust-in-AI and single-item self-efficacy outcomes did not meet conventional thresholds. Exploratory between-group point estimates were small and unstable across sensitivity strata; they are reported as inputs for sample-size planning and should not be interpreted as evidence for or against educational benefit.
Acute pancreatitis (AP) is a major cause of gastrointestinal hospitalizations worldwide. Although typically self-limiting, up to one-third of cases develop complications associated with increased morbidity and mortality. Despite recent advances that have improved outcomes, clinical heterogeneity necessitates updated, evidence-based guidance. In addition, there remains a need to improve the implementation of evidence-based recommendations across Ibero-Latin American countries by bringing together diverse scientific societies and regional experts to enhance applicability and the dissemination of best practices. This guideline offers comprehensive recommendations for both mild and complicated AP diagnosis and management. Questions on AP management were addressed by expert teams comprising one coordinator and four pancreatology specialists from the Iberian Peninsula and Latin America. For each question, a systematic review was conducted using PubMed, Embase, and the Cochrane Library, focusing on randomized controlled trials and systematic reviews published between January 1979 and March 2024 in English, Spanish, or Portuguese. In the absence of high-quality evidence, the search was expanded to include observational studies. Recommendations were formulated using the GRADE system and submitted to an expert panel for consensus; unresolved questions were revised and resubmitted until consensus was reached. Twenty evidence-based recommendations were developed, addressing key aspects of AP management, including definitions, diagnostic criteria, etiological assessment, initial management, management of local complications, splanchnic vein thrombosis, abdominal compartment syndrome, indications for intensive care admission, antibiotic use, early endoscopic retrograde cholangiopancreatography, timing of cholecystectomy, strategies for detecting choledocholithiasis, and the management of pancreatic function insufficiency. Each recommendation included a statement, the level of evidence, the strength of the recommendation, and a summary of the supporting evidence. The iLATAM guidelines are the first Ibero-Latin American clinical practice guidelines for AP. They provide evidence-based recommendations integrating medical, endoscopic, and surgical approaches, with the aim of promoting consistent, high-quality care across diverse healthcare settings. In alignment with international standards for transparency and methodological rigor, the methodological protocol for this guideline was registered in PROSPERO (International Prospective Register of Systematic Reviews) on July 23, 2022 (Registration ID: CRD42022345788).
We evaluated the safety and effectiveness of transcarotid artery revascularization with integrated embolic protection (TCAR-IEP) among patients at high risk for adverse events during carotid endarterectomy. TCAR-IEP provides dual neuroprotection and streamlines the procedure by using a novel flow reversal system together with the Neuroguard IEP Direct, incorporating a closed-cell nitinol stent, semicompliant postdilation balloon, and an integrated 40-μm embolic protection filter mounted on a 70-cm delivery catheter. PERFORMANCE III (Direct Access Carotid Artery Stenting Using the Neuroguard IEP System) was a prospective, multicenter, multinational, open-label, nonrandomized study. All patients had either de novo or post-carotid endarterectomy restenotic lesions of the internal carotid artery or carotid bifurcation with ≥50% stenosis if symptomatic or ≥70% stenosis if asymptomatic. The study primary end point was a composite 30-day rate of major adverse events, defined as the cumulative incidence of all strokes, myocardial infarctions, and deaths within 30 days of the index procedure. Secondary end points included ipsilateral, major, and minor strokes; acute, procedural, and technical success; cranial nerve injury; cardiac death; neurological death; access site complications; and number of patients requiring blood transfusion. We enrolled 146 patients in the pivotal cohort. The intention-to-treat analysis included all 146 evaluable patients (mean age, 70.5 years; 21.2% symptomatic; 39.7% diabetic), with one patient lost to follow-up at 30 days. Lesions were predominantly de novo, with a mean diameter of stenosis of 82.6%; 98.6% were moderately to severely calcified. The 30-day rate of major adverse events was 0.7% (1/145), composed of one unrelated cardiac death 18 days after the index procedure. There were no strokes or neurological deaths. The upper bound of the 95% confidence interval (3.8%) for the primary end point was significantly less than the prespecified performance goal of 11.0% (P < .001), thereby meeting the study's objective. Technical success was achieved in 99.3% of patients, with no cranial nerve injuries, stent thromboses, or blood transfusions. The mean flow reversal time was 7.4 ± 3.5 minutes. PERFORMANCE III results demonstrate high technical success and zero strokes, neurological deaths, or cranial nerve injuries. These outcomes highlight the potential of dual neuroprotection, utilizing TCAR-IEP, to enhance patient safety with carotid stenting.