共找到 20 条结果
In the original publication [...].
Invasive fungal diseases (IFD) pose a major health challenge in Latin America and the Caribbean (LAC), particularly in vulnerable populations. A cross-sectional, survey is distributed between April 2023 and May 2025 to institutions involved in IFD diagnosis or care across LAC. The questionnaire evaluates diagnostic tools, antifungal availability, and therapeutic drug monitoring (TDM). A total of 619 institutions from 23 countries across LAC participate. Candida spp. (92%) and Aspergillus spp. (54%) are most frequently reported as major fungal threats. Culture (90%) is widely available, whereas access to galactomannan (41%), β-D-glucan (29%), and molecular testing (23%) is considerably lower. Availability of antifungals, including liposomal amphotericin B (38%), echinocandins (51%), voriconazole (57%) or posaconazole (33%) is significantly higher in countries with GDP per capita >US$ 10,000, in transplant centres, and in institutions managing people living with HIV. Therapeutic drug monitoring is available in only 36% of centres. Major diagnostic and treatment gaps persist in low-income countries, particularly in access to tools for identifying endemic mycoses. Substantial disparities exist in IFD diagnostic and treatment capacity across LAC, primarily driven by national income and institutional complexity. Strengthening laboratory infrastructure, antifungal access, and integration of fungal disease management into public health systems is urgently needed.
Repeated evidence demonstrates limited reproducibility and accuracy of the visual quantification (VQ) of the tumor cell content (TCC) by clinical pathologists for downstream molecular testing. Artificial intelligence (AI)-based digital quantification (DQ) of TCC represents a promising alternative, yet real-world evidence from routine molecular diagnostic workflows remain limited. In this study, we evaluated the analytical performance and practical aspects of analytical validation process of an AI-based DQ tool in routine molecular diagnostics. The clinical-grade AIM-TumorCellularity (AIM-TC; PathAI©) workflow was tested in molecular diagnostics for samples analyzed by comprehensive genomic profiling (FoundationOne®CDx (F1CDx), Foundation medicine Inc.). The cohort included 300 non-paired resection, biopsy, and cytology/cell block) specimens from primary and metastatic breast (n = 66), lung (n = 117), colorectal (n = 40), pancreatic (n = 38), and prostate (n = 39) cancers, reflecting real-world diagnostic sample heterogeneity of a tertiary care center. We compared TCC estimates generated by pathologists' VQ, AI-based DQ, and molecular quantification (MQ) by bioinformatic deconvolution. Agreement was lowest between VQ and MQ (Spearman Rs = 0.38) and between VQ and DQ (Rs = 0.44), while DQ showed stronger concordance with MQ (Rs = 0.63). Single-cell validation against expert ground truth demonstrated high performance of DQ in tumor cell detection, with sensitivity of 0.98.5, specificity of 0.99, and accuracy of 0.99, based on 27,958 annotated cells across 60 regions of interest comparable to microscopic high-power fields. Analysis of pre-analytical and analytical factors identified specimen type and cautery/crush artifacts as the main pre-analytical contributors to DQ-VQ discrepancies, while overall variations in specimen cellularity was the dominant analytical factor. In summary, this study provides the first comprehensive real-world evaluation of AI-based TCC quantification in routine molecular pathology workflow, highlighting its robustness, accuracy, and the critical role of pre-analytical standardization, as well as pathologists` oversight for successful clinical implementation.
Training and body composition requirements in elite sports may elevate eating disorder (ED) risk. Current estimates suggest a range of 1-28% prevalence of ED in elite athletes, reflecting methodological heterogeneity, underreporting, and limited research focus. EDs adversely affect physical health (e.g., osteoporosis, fatigue, injury), psychological well-being, and athletic performance, often persisting beyond athletic careers. Sport-specific demands may obscure ED symptoms, making underdiagnoses likely. This longitudinal study's objective is to furnish proof for the theoretical model of disordered eating in elite athletes by examining the role of sport-specific indicators, to improve early identification and psychological diagnostics. Three-hundred elite athletes from weight-sensitive (ballet, bodybuilding) and less weight-sensitive (soccer, racket sports, basketball) sports will complete assessments at four time points. A subgroup of 90 athletes will participate in clinical interviews. Logistic and hierarchical regressions will identify ED risk indicators and estimate the prevalence of EDs in athletes. Receiver Operating Characteristic (ROC) analyses will assess diagnostic accuracy of single and combined indicators with reporting of sensitivity, specificity, and the Area Under the Curve (AUC). Group differences and measurement invariance of ED instruments will be tested between the athlete group and 300 non-athlete controls. Identifying reliable ED indicators in elite sports may support early intervention. This theory-based approach aims to enhance diagnostic accuracy and athletes' care. Prospective registration of the study in the German Clinical Trials Register (DRKS00035100) on 03 February 2025.
Multiple endocrine neoplasia (MEN) syndromes are rare hereditary disorders characterized by the development of multiple endocrine and non-endocrine tumours with variable penetrance and age-dependent expression. Although uncommon, these syndromes are highly relevant from both biological and clinical perspectives, as they exemplify the direct link between germline genetic alterations and tumorigenesis. Early tumour detection is critical in MEN syndromes because many associated neoplasms-such as medullary thyroid carcinoma (MTC), pancreatic neuroendocrine tumours (NETs), pheochromocytomas, and parathyroid disease-may remain clinically silent for prolonged periods while retaining malignant potential. Delayed diagnosis is associated with advanced disease and worse outcomes, whereas early identification enables curative or organ-preserving interventions. This clinical challenge has driven the development of integrated diagnostic strategies combining genetic testing, biochemical markers, and imaging. Among these, genetic testing plays a pivotal role, providing definitive diagnosis, enabling family screening, and guiding risk-adapted surveillance. The aim of this review is to provide a comprehensive synthesis of genetically driven diagnostics in MEN syndromes, outlining the current state of the art and future directions in precision medicine.
Background: Artificial intelligence (AI) is increasingly being integrated into modern dental practice, particularly in diagnostics, radiographic analysis, treatment planning, and practice management. Despite the rapid advancement of AI-based technologies, evidence regarding dentists' attitudes toward AI in Central and Eastern Europe remains limited. This study aimed to evaluate Polish dentists' attitudes toward artificial intelligence in contemporary dental practice and to investigate differences in AI acceptance according to sex, age group, and dental specialty. Materials and Methods: A cross-sectional online questionnaire-based study was conducted among licensed dentists practicing in Poland. An anonymous questionnaire comprising 15 attitude statements rated on a five-point Likert scale was distributed through professional social media groups. The survey assessed attitudes toward the use of AI in clinical, diagnostic, and administrative aspects of dentistry. Statistical analyses were performed using Statistica 16.0. Group comparisons were conducted using the Mann-Whitney U test and Kruskal-Wallis test with Benjamini-Hochberg false discovery rate correction. Internal consistency of the questionnaire was assessed using Cronbach's alpha coefficient. Results: A total of 183 completed questionnaires were included in the analysis. The internal consistency of the questionnaire was high (Cronbach's α = 0.900). The overall acceptance of AI was moderate (mean score: 3.18 ± 0.73). The highest levels of agreement were observed for the perceived potential of AI to improve dental practice management (mean = 4.05) and for general openness toward AI implementation in dentistry (mean = 4.05). Respondents also expressed a high willingness to use AI for generating clinical documentation (mean = 3.69). In contrast, the lowest acceptance was observed for statements suggesting that AI could replace dentists (mean: 1.36). Within the study sample, men demonstrated significantly higher overall AI acceptance than women (p < 0.001). Significant differences were also observed between age groups and dental specialties. Orthodontists demonstrated the highest AI acceptance among the surveyed specialties; however, these findings should be interpreted as exploratory because of unequal subgroup sizes. After FDR correction, significant differences between age groups remained only for selected questionnaire items. Conclusions: Within the limitations of this convenience sample, the findings suggest that Polish dentists generally perceive artificial intelligence as a supportive tool rather than a replacement for clinicians. Acceptance was greatest for administrative and organizational applications of AI, whereas autonomous clinical decision-making received substantially lower support. These findings suggest that the successful implementation of AI in dentistry should prioritize assistive technologies that enhance clinical workflows while preserving the central role of the dentist in patient care.
Background/Objectives: Accurate estimation of augmentation volume is essential for successful maxillary sinus augmentation planning. Manual CBCT-derived volumetric calculations remain time-consuming and operator-dependent. Artificial intelligence (AI)-assisted volumetric estimation may provide a standardized and reproducible alternative. This study evaluated the agreement and reliability of an AI-assisted volumetric estimation tool compared with CBCT-derived manually calculated augmentation volumes for sinus augmentation planning. Methods: A retrospective comparative study was conducted on 60 CBCT scans obtained from patients undergoing implant treatment planning. Radiographic measurements included bone width (A), residual alveolar bone height (B), sinus lift height (C), sinus lift width (D), and sinus lift depth (E). Manual augmentation volume was calculated using a geometric ellipsoid approximation formula derived from standardized linear measurements. AI-assisted volumetric estimation was performed using the volumetric analysis tool integrated within Planmeca Romexis 6.3 software. Two calibrated periodontists repeated both manual and AI-assisted measurements twice with a two-week interval. Reliability was assessed using intraclass correlation coefficients (ICC), while agreement between methods was evaluated using ICC and Bland-Altman analysis. Results: The mean manually calculated planned augmentation volume per implant site was 0.47 ± 0.11 cm3, whereas the mean AI-assisted planned augmentation volume was 0.52 ± 0.10 cm3. AI-assisted measurements were significantly greater than manual measurements (p < 0.001). Manual measurements demonstrated moderate intra- and inter-examiner reliability (ICC = 0.722, 0.701, and 0.649), whereas AI-assisted measurements demonstrated excellent reliability (ICC = 0.917, 0.924, and 0.903). Agreement between AI-assisted and manual volumetric estimation was good (ICC = 0.847). Bland-Altman analysis demonstrated a mean bias of 0.061 cm3 with limits of agreement ranging from 0.028 to 0.094 cm3. No significant associations were observed between augmentation volume and age, sex, or number of missing teeth after normalization per implant site (p > 0.05). Conclusions: AI-assisted volumetric estimation demonstrated excellent reproducibility and good agreement with manually calculated augmentation volumes while producing slightly higher volume estimates. AI-assisted volumetric estimation may serve as a reliable adjunctive tool for sinus augmentation planning by improving standardization and reducing operator-dependent variability.
Large-bore mechanical thrombectomy (LBMT) is a catheter-directed therapy for acute pulmonary embolism (PE). The relationship between aspirated thrombus weight and volume with outcomes remains unclear. The aim was to evaluate the impact of aspirated thrombus weight and volume on outcomes after LBMT. This prospective, open-label, single-arm, single-center registry study included 48 patients undergoing LBMT using the FlowTriever system (Inari Medical/Stryker, Irvine, CA, USA). Thrombus weight and volume were quantified, and clot composition assessed. Associations between thrombus characteristics and clinical, invasive hemodynamics, echocardiographic parameters, and biomarkers were evaluated immediately after the procedure, at hospital discharge, and at 3-month follow-up. Thrombus material was available in 48 patients (31% women), of which 41 presented with intermediate-risk and 7 with high-risk PE. LBMT resulted in significant reductions in systolic pulmonary artery pressures (sPAP) intraprocedurally (- 12.8 ± 8.3 mmHg, p < 0.001), with a further invasively measured decrease through 3 months (- 9.6 ± 10.6 mmHg, p < 0.001). From baseline to discharge, right ventricular coupling improved (+ 0.24, p < 0.001) and right ventricle (RV)/left ventricle (LV) ratio decreased (- 0.23, p < 0.001). NT-proBNP and high-sensitivity cardiac troponin T declined significantly. Neither thrombus weight nor volume correlated with acute changes in sPAP (ρvolume = 0.06; ρweight = 0.10), RV-uncoupling (ρvolume = 0.47; ρweight = 0.46), and RV/LV ratio (ρvolume = - 0.02; ρweight = - 0.005) (p for all > 0.05), nor with outcomes at 3 months. Aspirated thrombus weight and volume were not associated with improvements after LBMT, suggesting that, beyond mechanical obstruction, additional mechanisms potentially including paracrine and endocrine effects of thrombus material may contribute to acute and chronic PE-related cardiopulmonary dysfunction.
Objectives: Demographic features of subjects, such as body mass index, height, weight, age, or sex, may affect diameters of vessels such as the splenic artery (SA) and splenic vein (SV). Some studies use alternative anatomical indicators, including the body of the first lumbar vertebra (L1), to improve standardization in the assessment of vascular pathologies. This study aimed to evaluate the relationship between splenic vessel diameters (SA and SV) and L1 using abdominopelvic computed tomography images obtained from individuals aged 1-80 years. Methods: Radiologic images of 800 subjects were included in the examination. Proximal (SA1 and SV1), middle (SA2 and SV2) and distal (SA3 and SV3) calibers of SA and SV were measured. Ratios of vessel calibers to the transverse diameter of the body of L1 (L1TD) were calculated. Results: Age had a clear influence on the diameters of SA and SV. SV1 showed a steady increase until the early fifties, followed by a decline beginning in the seventies. Both SV2 and SV3 enlarged until the early twenties, after which no significant variation was observed. SA1, SA2, and SA3 gradually increased from 1 year of age through the early fifties, but demonstrated a statistically significant reduction at older ages. The ratios of SA and SV diameters to L1TD were highest during the first decade of life and dropped markedly in the second decade. Following this period, these ratios generally tended to rise initially and then decline with further aging. Conclusions: This study provides age-specific CT-based reference values for SA and SV diameters and their ratios to the L1 vertebral body. Since L1 is readily identifiable on routine computed tomography, these ratios may provide a practical complementary anatomical reference. Further studies are warranted to validate their clinical applicability.
Background/Objectives: This exploratory, randomized, patient-masked, intra-individual pilot study evaluated the feasibility of intraoperative swept-source optical coherence tomography (SS-OCT) for quantifying capsular-bag dynamics during cataract surgery and explored potential differences between an adaptive fluidics system (AFS) and a gravity-based fluidics system (GFS). Methods: Twenty-seven myopic cataract patients (54 eyes) underwent bilateral phacoemulsification, with one eye randomly assigned to AFS and the fellow eye to GFS using the same phacoemulsification platform (Stellaris/Stellaris Elite, Bausch & Lomb, Rochester, NY, USA). Intraoperative SS-OCT scans were acquired at six predefined surgical stages (M1-M6) to measure anterior and posterior capsule distances relative to the corneal endothelium. Intraoperative discomfort was assessed using a visual analog scale. Results: Of 648 attempted scans, 392 (60.5%) were analyzable, confirming partial feasibility of the prototype system. At the onset of phacoemulsification with irrigation on (M2), the predefined primary endpoint, anterior-capsule distance was greater with GFS than with AFS (4.23 ± 0.58 mm vs. 3.72 ± 0.73 mm), corresponding to greater mean deepening from baseline under GFS (1.19 mm) than under AFS (0.63 mm). However, this difference was not statistically significant after adjustment for multiple comparisons. No significant inter-system differences were found at other timepoints, and overall discomfort scores were similar (p = 0.70). Conclusions: Intraoperative SS-OCT enabled real-time visualization and partial quantitative assessment of capsular-bag dynamics during cataract surgery. The observed difference at the initiation of phacoemulsification may suggest reduced anterior-capsule deepening with adaptive fluidics, but this comparison was not statistically significant after multiplicity adjustment. The 39.5% measurement failure rate underscores the need for technical refinement before routine clinical implementation.
Objectives: Temporomandibular disorder (TMD) is a multifactorial condition that significantly affects patients' quality of life. This study investigated the association between clinical, biopsychosocial, and genetic factors, including the MMP3 rs679620 polymorphism, and TMD in women from southern Brazil. Methods: A cross-sectional case-control study was conducted including 305 women, comprising 138 patients with TMD (disc displacement with or without reduction and arthralgia) and 167 controls without TMD symptoms. TMD was diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Clinical and biopsychosocial characteristics were evaluated, and the MMP3 rs679620 polymorphism was genotyped using real-time polymerase chain reaction (RT-PCR). Univariate and multivariate analyses were performed, with statistical significance established at p < 0.05. Results: Univariate analysis demonstrated significant associations between TMD and chronic pain (p = 0.002), somatic symptoms (p < 0.001), and depression (p = 0.007). Multivariate analysis identified pain preventing leisure activities, headache, ear ringing (tinnitus), and age as factors significantly associated with the presence of TMD. No significant association was observed between the MMP3 rs679620 polymorphism and TMD in the study population. Conclusions: Clinical and biopsychosocial factors were associated with the presence of TMD in this female population, whereas the MMP3 rs679620 polymorphism was not. These findings support the multifactorial nature of TMD and suggest that biopsychosocial factors may play a greater role than the genetic variant investigated in this population. Due to the cross-sectional case-control design, the observed associations should not be interpreted as evidence of causal relationships.
Background/Objectives: Bloodstream infections (BSIs) carry high mortality, and any delay in initiating optimal antimicrobial therapy worsens outcomes. Syndromic multiplex-PCR panels applied to signal-positive blood cultures markedly shorten time-to-identification but are expensive and report results in a strictly qualitative format. We describe twenty-two months of real-world BioFire FilmArray Blood Culture Identification 2 (BCID2) testing in a southern Italian hospital, focusing on pathogen epidemiology, resistance-gene detection, and the economic and interpretive trade-offs of the assay. Methods: We retrospectively reviewed all BCID2 runs performed on signal-positive blood-culture bottles at P.O. "Vito Fazzi" (ASL Lecce) from July 2024 to April 2026. Each run was classified as single-pathogen-positive, polymicrobial (co-infection)-positive, or negative (no on-panel target). Resistance determinants were tabulated by year and by presumptive carrier. A direct-cost analysis was performed at a reagent cost of €250 per test. Results: Of 498 runs, 401 (80.5%) yielded at least one on-panel target (330 single-pathogen, 71 polymicrobial), whereas 97 (19.5%) were negative. Among 526 organism detections, Gram-positive (48.9%) and Gram-negative (45.8%) bacteria predominated; Staphylococcus spp., Escherichia coli and the Klebsiella pneumoniae group were most frequent. Resistance determinants (n = 244) were dominated by mecA/C, CTX-M and KPC. Co-infections (17.7% of positives) frequently prevented unambiguous attribution of a resistance gene to a specific co-detected organism. Total reagent expenditure was €124,500, of which €24,250 (19.5%) was spent on negative results. Conclusions: BCID2 delivered rapid, broad pathogen and resistance-gene detection in a high-resistance setting. Its qualitative-only output, the difficulty of attributing a resistance gene to a specific organism in polymicrobial samples, and the cost of negative results nonetheless argue for diagnostic-stewardship gating, semiquantitative reporting, and local validation of complementary and lower-cost assays.
Background/Objectives: T-cell receptor gamma (TCRγ) clonality testing by multiplex polymerase chain reaction (PCR) is an important ancillary method in the diagnostic evaluation of T-cell lymphoproliferative disorders. Interpretation is particularly challenging in HTLV-1 infection, in which persistent antigenic stimulation may produce clonal or oligoclonal T-cell expansions overlapping with non-neoplastic patterns. This study aimed to assess the diagnostic performance and interpretative contribution of two EuroClonality/BIOMED-2 assays (TCRγ-A and TCRγ-B), considered complementary components of the same analytical panel, and a single-tube multiplex PCR assay (TCRγ-O), and to develop an integrated workflow for TCRγ clonality interpretation. Methods: A total of 107 peripheral blood samples were analyzed, including 19 healthy donors, 75 HTLV-1 carriers, and 13 patients with adult T-cell leukemia/lymphoma (ATLL). TCRγ clonality was evaluated using three multiplex PCR assays followed by capillary electrophoresis. Profiles were classified as polyclonal, oligoclonal, or monoclonal. Diagnostic performance analysis was performed using healthy donors as the reference negative group and ATLL patients as the reference positive group. Results: The combined EuroClonality approach (TCRγ-A+B) showed the highest sensitivity (100%), whereas TCRγ-O showed the highest specificity (94.7%). TCRγ-A and TCRγ-B each showed a sensitivity of 76.9%, with specificities of 84.2% and 78.9%, respectively. Classification was highly concordant in healthy donors and ATLL patients employing both assays. However, among HTLV-1 carriers, classification varied across the assays. The integrated workflow was associated with a significant change in the distribution of molecular classification patterns in the HTLV-1 group compared with EuroClonality-based interpretation alone. (Stuart-Maxwell, p < 0.001). Conclusions: The EuroClonality/BIOMED-2 strategy provided greater sensitivity, whereas TCRγ-O showed greater specificity. Their integration supported a complementary and hierarchical approach to TCRγ clonality assessment, particularly in HTLV-1 infection. These findings support an exploratory integrated framework for TCRγ clonality interpretation in HTLV-1 infection and ATLL, requiring validation in larger independent cohorts.
Radiomics has produced tens of thousands of publications yet almost no handcrafted radiomic signatures in routine clinical use, and the reasons are increasingly understood to be problems of reproducibility and clinical translation rather than of algorithms. This critical narrative review argues that the field systematically generates paper-grade evidence-findings sufficient to publish-far faster than decision-grade evidence-findings sufficient to change clinical practice. Drawing on meta-scientific research, we describe seven fragility mechanisms (publication bias, analytical flexibility, underpowering, HARKing [hypothesizing after the results are known], citation distortion, cognitive bias, and misaligned incentives) and show why radiomics is structurally exposed to all of them simultaneously: high-dimensional feature spaces, acquisition-dependent measurement instability, segmentation variability, retrospective single-centre data, small samples, and leakage-prone validation. We then summarise empirical evidence on the radiomics literature, which remains pervaded by suboptimal methodological quality, near-absent negative results, limited external validation, sparse calibration and clinical-utility assessment, low data and code sharing, and a measurable retraction signal. We interpret these patterns as the output of a self-reinforcing system rather than isolated errors, and argue that better algorithms alone cannot resolve them. Finally, we argue that closing this gap requires not better models but evidentiary discipline: the consistent, enforceable application of standards the field already has, and the calibration of published claims to the strength of the underlying evidence.
Background/Objectives: Pulmonary arterial hypertension (PAH) occurs in >12% of systemic sclerosis (SSc) patients and has a high mortality. Annual screening for all SSc patients is the standard of care and can include spirometry (RFT), serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) and echocardiography (TTE). We sought to evaluate the accuracy of NT-proBNP alone to screen for SSc-PAH. Methods: We defined groups as low, intermediate and high risk of PAH according to RFT, TTE and RHC (right heart catheter) parameters. NT-proBNP thresholds predictive of risk group were defined, and ROC curves were used to evaluate the predictive accuracy of the calculated cut-points to diagnose SSc-PAH within the following 12 months. Results: A total of 820 SSc patients had NT-proBNP recorded 12 months prior to RHC, or if no RHC had been performed, within 12 months of the most recently recorded annual visit. The majority (335, 40.85%) were assigned to low risk of PAH, 189 (23.05%) to intermediate risk and 176 (21.46%) to high risk. NT-proBNP level < 122.9 ng/L defined the low-risk group, 122.9-186.6 ng/L defined the intermediate risk and >186.6 ng/L defined the high risk. NT-proBNP ≥210 ng/L with RFT (the 'ASIG algorithm') had the highest predictive accuracy, with sensitivity of 86.75% (77.52-93.19%), specificity of 60.71% (58.52-62.87%), PPV of 8.47% (6.69-10.55%), NPV of 99.09% (98.38-99.55%) and AUC of 0.74 (0.70-0.78). NT-proBNP ≥ 210 ng/L alone had sensitivity of 67.05% (56.21-76.70), specificity of 71.91% (70.03-73.72), PPV of 8.25% (6.34-10.52), NPV of 98.30% (97.57-98.86) and AUC of 0.69 (0.64-0.74). NT-proBNP thresholds associated with the three defined risk groups performed similarly overall. Conclusions: NT-proBNP alone, compared to the ASIG algorithm, had a slight reduction in NPV and AUC to predict PAH within 12 months. When NT-proBNP is ≥210 ng/L, the NPV remains high (98.0%).
Background/Objectives: The clinical profile of serum Maresin-1 (MaR1) in relation to diabetic retinopathy phenotypes and proteinuria in type 2 diabetes mellitus (T2DM) remains unclear. We evaluated serum MaR1 across healthy controls and patients with T2DM without diabetic retinopathy (DR), non-proliferative DR (NPDR), or proliferative DR (PDR), and examined the relationship between MaR1 and the urine protein-to-creatinine ratio (UPCR). Methods: This single-center cross-sectional study included 93 participants. Serum MaR1 was measured by ELISA. Group differences were assessed with the Kruskal-Wallis test and Holm-adjusted post hoc tests. DR phenotypes were analyzed among patients with T2DM. The MaR1-UPCR relationship was examined using correlation and adjusted regression models. Results: MaR1 differed across groups (H = 49.36, p < 0.001, epsilon2 = 0.521). The median MaR1 was 89.8 (82.8-97.2) pg/mL in controls and 34.3 (33.0-36.0), 35.8 (34.4-36.7), and 34.0 (33.1-35.7) pg/mL in T2DM without DR, NPDR, and PDR, respectively. MaR1 was higher in controls than in all T2DM groups, whereas T2DM groups did not differ. Within T2DM, MaR1 was not associated with DR stage (H = 4.44, p = 0.109; rho = -0.001, p = 0.996). MaR1 was inversely related to the UPCR overall (rho = -0.272, p = 0.008), but not within T2DM (rho = -0.057, p = 0.634) or in adjusted models. Conclusions: MaR1 was markedly lower in T2DM than in controls. This reduction was not explained by DR stage or proteinuria. These findings indicate that MaR1 should be interpreted as a T2DM-associated systemic alteration rather than as a marker of retinopathy stage or proteinuria.
Background/Objectives: Hybrid operating rooms combine advanced intraoperative imaging, endovascular capabilities, and multidisciplinary resources within a single procedural environment. However, their use in otolaryngology remains insufficiently characterized. This study evaluated institutional patterns of hybrid operating room use, principal clinical indications, multidisciplinary involvement, and perioperative resource utilization in otolaryngology. Methods: We conducted a retrospective single-center study of eligible otolaryngologic procedures performed between 1 October 2018 and 31 December 2025. Patient characteristics, operative sites, hybrid operating room applications, multidisciplinary involvement, intraoperative blood loss, postoperative intensive care unit admission, and length of hospital stay were analyzed. Results: A total of 55 unique procedures were included. The median age was 46.0 years (interquartile range, 33.0-58.5 years; range, 5-76 years), and 33 patients (60.0%) were male. Computed tomography-based localization and navigation represented the predominant application, accounting for nearly three-quarters of procedures. The sinonasal cavity, nasopharynx, and skull base were the most frequently treated anatomical regions, comprising approximately 60% of operative sites. Angiography and endovascular intervention constituted the second most common application. Multidisciplinary collaboration, most frequently involving cardiovascular surgery and interventional radiology, was required in nearly one-quarter of procedures. Procedures relying primarily on intraoperative imaging were associated with a median estimated blood loss of 20 mL and a median hospital stay of 3 days. Cases requiring vascular, cardiopulmonary, or other advanced hybrid capabilities showed greater postoperative resource utilization, including more frequent intensive care admission and longer hospitalization. Conclusions: The hybrid operating room served as a versatile platform for image-guided, vascular, and multidisciplinary procedures in otolaryngology. Its capabilities were used during the management of anatomically complex and high-acuity cases, while differences in postoperative resource utilization appeared to reflect procedural complexity and baseline clinical risk.
Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis, and early diagnosis is essential for improving patient outcomes. Conventional imaging modalities such as ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) have limitations in detecting small PDAC. Endoscopic ultrasonography (EUS) is useful for identifying small lesions; however, even small PDAC can be invasive and may metastasize, resulting in Stage IV disease. The most effective way to improve the prognosis of PDAC is to diagnose lesions confined to the ductal epithelium, such as high-grade pancreatic intraepithelial neoplasia (HG-PanIN) or carcinoma in situ (CIS). Identifying focal pancreatic parenchymal atrophy (FPPA) on CT or MRI may suggest the presence of HG-PanIN/CIS and prompt further evaluation using serial pancreatic juice aspiration cytologic examination (SPACE). Recognizing FPPA and performing SPACE enables the diagnosis of PDAC at Stage 0 (HG-PanIN/CIS), which can lead to improved prognosis.
Background/Objectives: Psoriatic disease (PsD) is a chronic cutaneous and systemic inflammatory condition associated with an increased risk of metabolic-dysfunction-associated steatotic liver disease (MASLD) and its complications. Our objective was to determine the prevalence of MASLD in our overall cohort and to analyze it across PsO, PsA, and healthy control groups. The secondary objective was to describe hepatic steatosis and fibrosis using transient elastography (FibroScan®) and to characterize hepatic scores within each study group. The third objective was to assess whether specific cardiovascular risk factors were associated with the development of hepatic steatosis or fibrosis in individuals with PsD and healthy controls. Methods: A cross-sectional study was conducted at a single tertiary care center, enrolling consecutive patients from the Dermatology and Rheumatology Departments. Individuals with pre-existing liver disorders were excluded. The control cohort comprised 102 healthy volunteers without chronic inflammatory or hepatic conditions. All participants underwent comprehensive clinical assessments, serum biomarker analysis, and FibroScan®. Results: A total of 330 participants were included, 228 with PsD (101 with psoriasis (PsO) and 127 with psoriatic arthritis (PsA)) and 102 healthy controls. MASLD was present in 39% of the overall cohort, with a prevalence of 47.5% in PsO, 32.2% in PsA, and 8.8% in healthy controls (p < 0.001). FibroScan® measurements indicated a tendency toward increased liver stiffness and higher controlled attenuation parameter (CAP) values in patients with PsD. Both PsO and PsA groups showed a higher prevalence of cardiometabolic risk factors compared with controls (p < 0.05). Non-invasive fibrosis indices were also significantly altered in both patient groups. Conclusions: Patients with PsD demonstrated a higher prevalence of MASLD, hepatic fibrosis, and cardiometabolic abnormalities compared with healthy controls in our cohort.
Background/Objectives: Early mortality risk stratification after CT-confirmed cervical spine fractures remains clinically challenging in patients with major trauma. Imaging establishes a structural diagnosis, but it does not fully capture early physiological deterioration. This study aimed to develop and internally validate a prognostic model for in-hospital mortality and evaluate whether a MAP-derived Shock Index provides incremental prognostic information beyond routinely available clinical variables and the Injury Severity Score (ISS). Methods: This retrospective single-center cohort study included 131 adults with CT-confirmed cervical spine fractures and ISS ≥ 15 who were admitted to a tertiary trauma center between 2013 and 2023. The MAP-derived Shock Index was calculated as heart rate divided by estimated systolic blood pressure, where estimated systolic blood pressure was defined a priori as 1.5 × MAP. Four prespecified logistic regression models were evaluated: a base clinical model, base plus MAP-derived Shock Index, base plus ISS, and base plus MAP-derived Shock Index plus ISS. Discrimination, Brier score, calibration, bootstrap internal validation, and decision curve analyses were performed. Results: The in-hospital mortality rate was 22.9% (30/131). The base plus MAP-derived Shock Index model achieved an apparent AUC of 0.93 and an optimism-corrected AUC of 0.91. The MAP-derived Shock Index provided incremental prognostic information beyond the ISS; as an individual predictor, its AUC was 0.82 compared with 0.74 for the ISS. With each 0.1-unit increase, the MAP-derived Shock Index was associated with higher odds of in-hospital mortality. Decision curve analysis suggested a higher apparent net benefit across clinically relevant thresholds. Conclusions: In this internally validated retrospective cohort, the MAP-derived Shock Index complemented clinical and ISS-based assessments for early in-hospital mortality risk stratification after CT-confirmed cervical spine fracture. The index is not the conventional SBP-based Shock Index, and the model requires external multicenter validation before clinical use.