India accounts for one-third of the global incidence and mortality of oral cancer. The national oral cancer screening program uses Conventional Oral Examination by Primary Healthcare (PHC) workers. This subjective assessment leads to unnecessary referrals to higher centers for biopsy and false negatives due to inappropriate biopsy site selection. Angiogenesis is one of the steps in early carcinogenesis, as solid tumors, such as oral cancers, cannot grow beyond 2-3 mm in diameter without inducing their own blood supply. The increased vascular supply and metabolic rate in malignant cells lead to a rise in temperature, which can be detected by sensitive digital infrared (IR) cameras. An Artificial Intelligence-enabled automatic analysis of intraoral IR images of oral lesions can be used for screening, early detection of Stage I and II oral cancers, and biopsy site selection as an objective Point-of-Care (POC) adjunct. A standardized protocol for passive and active IR imaging of intraoral lesions (index test) with a smartphone-based IR camera will be prepared to train a Medical Scientist and Technician. IR images of already diagnosed normal, Inflammatory, potentially malignant disorders, and malignant oral lesions (N = 100 each) will be used in Phase I to train an AI model to classify images as malignant or non-malignant. A second set of IR images of these oral lesions will be used in Phase II (N = 100 each) for evaluating the performance of the AI model. The reference test for malignancy will be histopathology (Gold standard). The intra/inter observer reliability will be assessed using the kappa statistics A clinical trial and validation of the proof of concept are proposed for IR imaging of intraoral lesions as a noninvasive POC adjunct for early detection and screening of oral cancer by PHC workers, and for the selection of biopsy sites by surgeons. © 2026 Wiley Periodicals LLC.
It remains unclear whether vascular characteristics or hemodynamics of the vertebrobasilar artery (VBA) among patients with left- and right-sided hemifacial spasm (HFS) lesions correlate with the risk of HFS occurrence and disease severity. This study aims to investigate the correlation of VBA characteristics with the incidence risk and severity of HFS. A total of 60 patients with HFS who were admitted to Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, between January and October 2024 were retrospectively enrolled in the HFS group. Another 59 healthy individuals who underwent physical examinations were assigned to the control group. Data on the characteristics of the VBA were collected for both groups, and the correlation between these characteristics and the occurrence risk of HFS was analyzed. In addition, patients in the HFS group were further stratified according to the lesion side (left vs right) and HFS severity grade (mild vs moderate vs severe) for subgroup analysis and comparison of VBA imaging features. The diameters of the left vertebral artery (VA), right VA, and basilar artery in the HFS group were all found to be larger than those in the control group, and the difference in the diameter of the left VA between the two groups was more significant (p < 0.05). Multivariate logistic regression analysis demonstrated that the diameter of the left VA (odds ratio [OR] = 4.014, 95% confidence interval [CI]: 1.997-8.070), the diameter of the right VA (OR = 3.890, 95% CI: 2.217-6.825), and the diameter of the basilar artery (OR = 2.022, 95% CI: 1.008-4.058) were independent influencing factors for the occurrence of HFS (p < 0.05). There were no statistically significant differences in the diameters of the VA and basilar artery among patients with severe, moderate, and mild HFS (p > 0.05). The diameters of the left VA, right VA, and basilar artery are significantly correlated with the occurrence of HFS, while the severity of the disease shows no correlation with the diameter of the ipsilateral VA. This suggests that the morphological changes of the VBA system may play an important role in the pathogenesis of HFS.
Increases in cytoplasmic free Ca2+ ions ([Ca2+]) are a critical signal in pancreatic islet beta-cells and are usually required for insulin secretion in response to glucose or other secretagogues. Changes in Ca2+, monitored using high-speed imaging across individual or multiple planes of the islet, can be used to explore the functional networks of beta-cells required for the precise regulation of insulin secretion. These networks are composed of functionally distinct beta-cell subpopulations: first-responders, highly connected hubs, and leader beta-cells, which initiate, connect, and dictate the pattern of spatially organized Ca2+ oscillations, respectively. Alterations in Ca2+ coordination among beta-cells contribute to defective insulin secretion, which underlies all forms of diabetes mellitus. Here, we provide a detailed protocol to perform Ca2+ imaging in isolated rodent islets, focusing on mouse islets expressing the genetic Ca2+ sensor, GCaMP6. We provide a step-by-step guide to evaluate general parameters of islet Ca2+dynamics, coordination, connectivity, and identification of specific functional subpopulations. This approach can be applied to investigate the role of Ca2+ dynamics and coordination in tissues where coordination is critical for normal function.
Low back pain (LBP) is the leading cause of disability worldwide. Unhelpful beliefs, low pain resilience, and overreliance on imaging contribute to chronicity and poor outcomes. Despite growing recognition of psychosocial influences, culturally adapted assessment tools for Urdu-speaking populations are lacking. This study aimed to translate and cross-culturally adapt Urdu versions of the back pain attitudes questionnaire (BackPAQ), pain resilience scale (PRS), and medical scans beliefs questionnaire (MSBQ), and to conduct an initial evaluation of their structural validity and internal consistency. Following Beaton's six-step protocol and COSMIN guidelines, the BackPAQ, PRS, and MSBQ were translated and culturally adapted into Urdu. A cross-sectional sample of 461 adults with LBP (mean age=38.5 ± 12.3 years; 66.6 % female) completed the translated instruments. Item distributions, internal consistency, and exploratory factor analyses (EFA) were examined. Reliability was evaluated using Cronbach's α and standard error of measurement (SEM). Associations with established Urdu versions of the oswestry disability index and pain catastrophizing scale, were visually examined using scatter plots. EFA supported a four-factor structure for the Urdu BackPAQ (14 items, 46.0 % variance explained, α=0.69). The PRS retained its original two-factor structure (51.5 % variance explained, α=0.88), and the MSBQ demonstrated a unidimensional structure (46.2 % variance explained, α=0.71). Scatter plots indicated small, directionally consistent associations between the Urdu instruments with disability and catastrophizing. The Urdu versions of the BackPAQ, PRS, and MSBQ demonstrated acceptable structural validity and internal consistency, with the PRS showing excellent content validity. Test-retest reliability, responsiveness, and predictive validity should be evaluated in future clinical and longitudinal studies before broader clinical application.
Quality control (QC) is essential for ensuring the diagnostic reliability of Single-Photon Emission Computed Tomography (SPECT) systems. However, the reliance on third-party software for analyzing QC metrics introduces a potential source of variability that is not yet standardized. Variability in QC results due to the use of different image analysis software may compromise both equipment evaluation and interinstitutional comparability. This technical note assessed the variability in QC test results generated by different SPECT image analysis software packages to underscore the need for improved standardization. Five representative commercial SPECT QC software packages (A-E) were used to analyze identical DICOM image sets acquired from four SPECT/CT systems in accordance with the WS 523-2019 standard. Evaluated metrics included file reading success rates, key performance indicators (intrinsic uniformity, resolution, linearity), and compliance rates. Statistical analysis employed ANOVA or Welch's tests, followed by LSD post hoc testing, with effect sizes (η2) reported. File reading success varied significantly (61.8%-100%), with Softwares B and D exhibiting higher failure rates. Compliance rates for identical devices varied considerably (68.8%-100%). Statistically significant intersoftware differences were found for intrinsic integral uniformity (F = 10.17, p < 0.05, η2 = 0.092), intrinsic spatial resolution (Welch F = 79.7, p < 0.05, η2 = 0.477), and intrinsic differential linearity (F = 2.65, p < 0.05, η2 = 0.137). The effect sizes for spatial resolution and differential linearity indicated large effects (η2 > 0.14). Significant differences (p < 0.05) in key indicators were also observed across analyses for UFOV/CFOV fields of view and X/Y directions. Pairwise comparisons indicated that the primary differences existed between Softwares B, D, and E compared to the other packages. We found significant disparities between software packages in both file reading capability and the analysis of key QC performance indicators. These differences directly impact the accuracy of equipment performance evaluations and interinstitutional comparability, potentially leading to divergent conclusions regarding the same device's compliance status.
The 5-year survival rate of early-stage hepatocellular carcinoma (HCC) patients remains only 60%, largely due to the inability to achieve ultra-early detection and safe, minimally invasive intervention of its premalignant precursor-high-grade dysplastic nodules (HGDN). Current clinical practice faces an unresolved dilemma: conventional imaging has limited sensitivity for HGDN, no standardized minimally invasive intervention exists, and no integrated platform enables synchronous detection, boundary localization and on-demand intervention, despite HGDN 80.8% 5-year HCC progression rate. To address these core challenges, we developed a multifunctional dual-hairpin DNA polydopamine nano-system (H/R@PDA-GC) targeting miRNA-224, a biomarker consistently upregulated during HGDN malignant transformation.This system enables specific detection of miRNA-224 with an ultra-low limit of detection (LOD) of 0.068 pM. Clinically, there is a 3-5-year natural history window from HGDN formation to clinically diagnosable early HCC; thus, this system provides a potential technical tool for the ultra-early warning of HCC at the precancerous stage. It simultaneously activates near-infrared fluorescence for targeted imaging of HGDN to precisely delineate lesion boundaries, and leverages its efficient photothermal conversion capability to achieve effective ablation of HGDN in validated murine models. Both cellular and animal studies confirmed its good in vitro and short-term in vivo biocompatibility, significant anti-inflammatory and antioxidant effects, and therapeutic efficacy, addressing the dual clinical needs of ultra-early detection and safe intervention of premalignant lesions. Consequently, H/R@PDA-GC provides an integrated theranostic strategy, which has potential clinical value for reducing the risk of HCC progression, and lays a foundation for ultra-early intervention of HCC precancerous lesions.Clinical trial number. Not applicable.
Oligometastatic cancer is characterised by a low volume of metastases to a small number of anatomical sites. However, evaluating the impact of metastases-directed therapies (MDTs) on overall survival or quality of life is often challenging. Current clinical trials use a wide range of primary endpoints that might not be validated or suited to MDT. To address this issue, we did a systematic review of international trial registries, alongside a Delphi consensus process involving 30 experts and five patient representatives. The aim was to identify preferred primary endpoints for MDT trials in oligometastatic disease, regardless of tumour type. Overall survival and progression-free survival were the most frequently used endpoints across the 121 comparative trials reviewed. Over four Delphi consensus rounds, overall survival had the highest level of agreement, although its limitations as a sole endpoint were emphasised. In addition to the widely used progression-free survival endpoint, polymetastatic progression-free survival and start-or-switch of systemic therapy-free survival also reached consensus, particularly for trials integrating systemic therapies. Both polymetastatic progression-free survival and systemic therapy-free survival permit repeat MDT without classifying it as treatment failure. Patient representatives highlighted the importance of time-to-deterioration of quality of life. This consensus supports overall survival as a primary endpoint and, in addition to progression-free survival, recommends polymetastatic progression-free survival and systemic therapy-free survival, especially in combination with systemic therapies. Adopting these endpoints will make MDT trials more relevant, comparable, and patient-centred, thereby empowering future clinical and policy decisions.
Acute heart failure (AHF) is a common but underrecognized cause of dyspnea. Chest computed tomography (CT) can accurately assess pulmonary congestion, but radiologist reporting capacity may limit clinical utility. We hypothesized that an artificial intelligence (AI) model could automatically detect imaging signs of AHF and aimed to prospectively validate an AI model in an independent emergency department cohort, benchmarking its performance against radiologists and cardiologists. We prospectively validated a supervised machine-learning model in a single-center study of dyspneic patients undergoing low-dose, non-contrast chest CT and echocardiography. The primary analysis assessed diagnostic performance for CT-detected pulmonary congestion compatible with AHF, using radiologist-reported AHF as the reference and the area under the curve at receiver operating characteristic analysis (AUROC). Secondary analyses compared the AI model with blinded research radiologists and expert cardiologists. Of 234 patients (56% males), aged 74 ± 10 years (mean ± standard deviation), 61 (26%) had radiologist-reported AHF. The AI model achieved high diagnostic performance (AUROC 0.95 [95% confidence interval 0.93-0.98]), with 89% sensitivity [78-95] and 89% specificity [83-93]. At prespecified thresholds, rule-out maximized sensitivity (97% [89-100]) at the expense of specificity (74% [67-81]), whereas rule-in yielded high specificity (96% [92-98]) but lower sensitivity (66% [52-77]). In secondary analyses, the AI model achieved a median AUROC of 0.94 (range 0.91-0.96). The AI model demonstrated high diagnostic performance for detecting AHF on chest CT in dyspneic patients. Integration into emergency workflows may support more consistent diagnosis, independent of clinician experience or time constraints. AI-based analysis of chest CT may enable earlier and more consistent detection of AHF, supporting timely triage and management, especially when specialist radiological expertise is limited or delayed. An AI model prospectively detected AHF on chest CT in dyspneic emergency department patients. In a prospective single-center cohort, AI achieved high diagnostic performance (AUROC 0.91-0.96), comparable to that of radiologists and cardiologists. AI-based chest CT interpretation may improve diagnostic consistency in the absence of standardized CT criteria for AHF.
Coronal shear fractures of the distal humerus are rare but severe injuries. Reconstruction is often challenging, especially in comminuted cases, which is why many surgeons opt for an elbow arthroplasty in those cases. However, total elbow arthroplasty is associated with a variety of potential problems itself. Therefore, the aim of this study was to present the functional and clinical outcome of coronal shear fractures treated by osteosynthetic reconstruction in a short- to mid-term follow-up, and to identify possible risk factors for an inferior outcome. We performed a retrospective follow-up assessment of 51 consecutive patients (30 women; median age 56 years, (IQR 39-62)) who underwent osteosynthetic reconstruction for coronal shear fractures between 2012 and 2022 after a minimum follow-up period of two years. The Mayo Elbow Performance Score, Oxford Elbow Score, and Disabilities of the Arm, Shoulder and Hand score were evaluated, and all available radiographs were analyzed. All complications and revision procedures were assessed. Univariable and multivariate regression analyses were performed to identify potential risk factors for a poor outcome following osteosynthetic reconstruction. After a median follow-up period of 43 (IQR 28-78) months, the median Mayo Elbow Performance Score was 100 (IQR 85-100), the median Oxford Elbow Score was 42 (IQR 34-46), and median Disabilities of the Arm, Shoulder and Hand score was 6 (IQR 2-28). The median ROM was 148° (IQR 126-155) for flexion, 0° (IQR 0-0) for extension, 90° (IQR 85-90) for pronation, and 90° (IQR 85-90) for supination. There was no extension deficit on the injured site. The overall complication and reoperation rates were 35.3% and 27.4%, respectively, with severe elbow stiffness being the most common reason for revision. Increasing Dubberley classification and posterior comminution were significantly associated with a poor outcome and higher rates of complications and revision. This short- to mid-term follow-up shows good functional results after osteosynthetic reconstruction in coronal shear fractures despite high complication and revision rates. However, increasing Dubberley classification, posterior comminution and the presence of complications show inferior outcome scores. This study shows that osteosynthetic reconstruction can be an option even in comminuted coronal shear fractures. Nevertheless, patient factors need to be considered and an individual decision concerning the surgical treatment is necessary. Patients should be counseled about the high complication rates and inferior outcome with increasing Dubberley classification. Level III.
Persistent pelvic pain (PPP) is often regarded as multifactorial and complex. There is limited knowledge on how patients with PPP resemble and differ from those with persistent non-pelvic pain (PNPP). The specific aims of this study were to compare self-reported background and pain characteristics, affective symptoms, and quality of life at baseline between patients with PPP and those with PNPP at three multidisciplinary pain clinics in Norway, and to explore differences between men and women with PPP. This is a cross-sectional study, using registry data from three tertiary, multidisciplinary pain clinics. Patients ≥17 years answered web-based questionnaires on background, baseline pain symptoms, mental health, and quality of life. We used t-tests, chi square, and multivariable logistic regression. Of 934 consenting patients (71 % of those attending), 30 had missing diagnoses, and 127 (13.6 %) were diagnosed with PPP. PPP patients less often reported widespread pain than PNPP patients (adjusted odds ratio (AOR) 0.2, 95 % confidence interval (CI) 0.2-0.4). We found high prevalence of fatigue, insomnia, and anxiety among all the pain patients, but PPP patients were more likely to report depression (AOR 1.6, 95 % CI 1.0-2.6) and pain catastrophizing (AOR 1.8, 95 % CI 1.2-2.8). All the pain patients had a low health-related quality of life. Women with PPP had higher prevalence of severe fatigue than men with PPP. This study confirms that pain clinic patients generally experience high levels of emotional distress and poor health-related quality of life. PPP patients tend to exhibit higher rates of pain catastrophizing, yet less widespread pain. Understanding the specific symptom profile of PPP patients is crucial for effective treatment in pain clinics. The potential underutilization of pain clinics in the treatment of PPP patients warrants further investigation.
Development of a new ultrasound (US) synovitis score (SONography in Arthritis and Rheumatism (SONAR)-7) with evaluation of its diagnostic performance in a cohort of patients with psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA), in comparison with healthy controls (HC). We included 121 participants: 41 patients with PsA and 39 patients with axSpA, from six Swiss hospitals and 41 HC. All participants underwent a clinical examination of joints (68/66 tender joint count/swollen joint count (SJC)), followed by a detailed musculoskeletal US examination of 22 joints to assess for greyscale (GS) and power Doppler (PD) synovitis in adherence with the definitions established by the Outcome Measures in Rheumatology US working group. The 'SONAR-7' score incorporated GS and PD lesions across 14 joints, including four metacarpophalangeal joints, four distal interphalangeal joints of the hands, two metatarsophalangeal joints, knees and wrists. It demonstrated an area under the receiver operating characteristic curve of 0.831 (95% CI 0.76 to 0.90), with an excellent specificity (95.1%) and moderate sensitivity (44%), comparable to existing US scores. The inflammatory components of the SONAR-7 correlated significantly with clinical measures of inflammation and disease activity (correlation: 0.37 for SJC-28, 0.33 for Disease Activity in Psoriatic Arthritis and 0.48 for US enthesitis). New bone formation in the same joints was associated with the Health Assessment Questionnaire (p=0.035) and Bath Ankylosing Spondylitis Metrology Index (p=0.016). The SONAR-7 score represents a fast and effective US-based tool for the evaluation of inflammatory and structural joint involvement in patients with PsA and axSpA, with high specificity and meaningful associations with clinical and quality-of-life outcomes.
Late-life depression (LLD) is a heterogeneous psychiatric condition characterized by a wide range of psychopathological symptoms and associated with functional and structural abnormalities in brain networks implicated in mood and cognitive regulation. This cross-sectional study investigated the relationship between specific depressive symptom dimensions and cortical brain measures, as assessed by magnetic resonance imaging, in a sample of 87 community-dwelling older adults with depression. Significant associations were identified between the severity of sad mood and reduced cortical volume in the right medial orbitofrontal cortex (OFC) (p [FDR] = 0.047), as well as reduced cortical thickness in the left OFC (p [FDR] = 0.008), left ventrolateral prefrontal cortex (VLPFC) (p [FDR] = 0.02), and right dorsolateral prefrontal cortex (DLPFC) (p [FDR] = 0.054). Apathy/lassitude was also significantly associated with reduced thickness in the left OFC (p [FDR] = 0.016) and left VLPFC (p [FDR] = 0.046). Moreover, overall depression severity correlated with reduced thickness in the right middle temporal cortex (MTC) (p [FDR] = 0.035). Our results suggest that feelings of low mood and lassitude in LLD are linked to structural changes in brain regions involved in emotion regulation, motivational drive, self-referential thinking, executive control, and decision-making. The findings contribute to the understanding of the neurobiological underpinnings of LLD and support the hypothesis that symptom-specific disruptions within mood and cognitive processing circuits are integral to its pathophysiology.
Falls are a leading cause of emergency department (ED) visits among older adults, often resulting in fractures. Point-of-care ultrasound (POCUS) has emerged as a valuable diagnostic tool for emergency nurse practitioners (ENPs), offering rapid, radiation-free evaluation of musculoskeletal injuries. This article examines the effectiveness of POCUS in detecting fractures, with evidence demonstrating high sensitivity and specificity, particularly for long-bone injuries. A case study of a patient with a humeral fracture highlights the utility of POCUS in diagnosis and expedited orthopedic referral. The article also discusses ultrasound physics, bone imaging techniques, and transducer selection for musculoskeletal assessments. Beyond clinical accuracy, POCUS use is associated with reduced ED length of stay and healthcare costs. While operator-dependent, structured training models are expanding ENP proficiency in POCUS. Integrating this modality into ED practice enhances timely triage and improves patient outcomes, particularly in resource-limited or high volume settings.
This randomised controlled trial aimed to compare the efficacy of Alexandrite picosecond laser therapy combined with dermal polyrevitalisation (NCTF® 135 HA) with laser therapy alone for reducing the severity of melasma. The outcomes were assessed using 3D imaging and the Dermatology Life Quality Index (DLQI). The secondary objectives were to evaluate the safety and tolerability of the combined treatment, and its impact on patients' quality of life. The study was conducted in a clinical dermatological setting in Moscow, Russia, in 2023. It was designed as a randomised controlled trial comparing two melasma treatment protocols: picosecond Alexandrite laser therapy alone versus the laser combined with the injectable polyrevitalising agent NCTF® 135 HA. A total of 31 patients participated in the study, including 27 women and four men aged between 32 and 61 years. The patients were divided into two groups: 12 patients in Group 1 received laser treatment only, while 19 patients in Group 2 received laser treatment and NCTF® 135 HA. 89.5% of patients in Group 2 reported an improvement in their skin condition compared to 66.7% in Group 1, and the mean reduction in pigmentation was 75% versus 40% respectively (p < 0.01). Erythema severity decreased by 70% in Group 2 and by 35% in Group 1 (p < 0.01). The recurrence rate was 5.3% in Group 2 and 25% in Group 1 (p < 0.05). The application of the combined treatment protocol for melasma over a period of two months resulted in the reduction, fragmentation, and lightening of pigmented lesions. However, further long-term studies with more extensive and diverse populations are needed to confirm these findings due to the small sample size and short follow-up period.
To evaluate the clinical utility of "multi-echo recombined gradient echo" (MERGE)-based bone-like MRI for delineating acetabular osseous morphology in developmental dysplasia of the hip (DDH), and to determine whether this technique provides quantitative measurements with agreement to CT. This retrospective study included 32 patients with DDH (2 men, 30 women; aged 33 ± 13 years, mean ± standard deviation) who underwent both hip MRI and CT between August 2020 and September 2023. One clinically affected hip per patient was analyzed. The MRI protocol included T1-weighted imaging, short tau inversion-recovery (STIR), and a MERGE sequence with a negative look-up table to enhance bone-like contrast. Joint space width (JSW) and center-edge (CE) angles were measured on all modalities. Mean JSW was 4.2 ± 1.4 mm (T1-weighted), 3.0 ± 1.3 mm (STIR), 3.3 ± 0.9 mm (MERGE), and 3.4 ± 1.1 mm (CT), without a significant difference between MERGE and CT (p = 0.776). Mean CE angles were 29.7 ± 9.5°, 30.9 ± 9.9°, 31.4 ± 10.1°, and 31.4 ± 10.1°, respectively, without significant difference between MERGE and CT (p = 0.908). As an exploratory feasibility study, our findings suggest that MERGE-based bone-like MRI may allow reliable visualization of acetabular morphology and provide quantitative measurements with good agreement to CT. The ability to simultaneously evaluate osseous and soft-tissue structures supports its potential as a radiation-free and comprehensive imaging method for DDH, warranting further validation in larger cohorts. MERGE-based bone-like MRI enables simultaneous visualization of the hip bone and soft tissues without radiation exposure. This method provides a clinically feasible, MRI-based alternative to CT for evaluating acetabular morphology in DDH. MERGE-based MR bone-like imaging visualized acetabular morphology and provided CE angle and joint space measurements comparable to CT. MERGE showed the closest agreement with CT for CE angle and joint space, outperforming T1WI and STIR in accuracy. This technique offers radiation-free, comprehensive hip evaluation, serving as a potential MRI-based alternative to CT in DDH assessment.
The incidence of esophageal cancer resections is rising, and survivorship improving. Consequently, more patients are living longer with gastric conduits and enduring the associated morbidity. Gastric conduit shape and peristalsis are believed to mediate conduit function, gastrointestinal symptoms, and quality of life (QoL). However, the relationship between anatomical variations, peristaltic function, and conduit emptying remains largely undefined. This prospective observational study recruited patients with gastric conduits at least 2 years post-esophagectomy and controls with normal gastric anatomy. Dynamic and static MRI sequences were obtained following porridge ingestion. Nuclear scintigraphy conduit emptying studies were available for 17 out of 18 (94%) patients. QoL questionnaire data were collected. Eighteen patients with conduits and 12 controls were recruited. Peristalsis was measurable in 15 conduits. There was no difference in peristaltic wave frequency between conduits and controls (5 waves per 90 seconds in each group) or median Gastric Motility Index Interquartile Range (IQR) 35.45 mm2/second (17.3-47.5) vs 36.5 mm2/second (9.8-99.4) p = 0.61. Gastric emptying was significantly reduced in conduit patients (0.10% vs 15% p = 0.01). Acute angulation and conduits wider than 4 cm were associated with slower emptying (444 minutes vs 127 minutes, p = 0.025) and (286 minutes vs 76 minutes, p = 0.02), respectively. Delayed emptying demonstrated a significant positive correlation with reflux (rs0.614, p = 0.009) and increased gastrointestinal symptoms (rs0.553, p = 0.021). Peristalsis is present in most conduits, but it does not correlate with improved emptying. Anatomical features, particularly conduit angulation and width influence conduit function. These findings may guide further research into optimizing conduit formation and treating dysfunction.
BACKGROUND Ankle arthritis is a chronic degenerative disease; its typical symptom is pain in the ankle joint. This retrospective study of 65 patients with mid-stage ankle osteoarthritis aimed to compare clinical outcomes from supramalleolar osteotomy (SMOT) and supramalleolar osteotomy combined with fibular osteotomy (SMOT+FO). MATERIAL AND METHODS Based on whether fibular osteotomy was performed during the procedure, the patients were categorized into the SMOT group (n=34) or the SMOT+FO group (n=31). Surgical outcomes were systematically assessed using the Visual Analogue Scale (VAS) for pain, American Orthopaedic Foot and Ankle Society (AOFAS) score, range of motion (ROM), and complication rates. Radiographic parameters were compared between the 2 groups, including the distal tibial articular surface angle, talar tilt angle, tibiocrural angle, and tibial lateral surface angle. RESULTS The AOFAS scores, VAS scores, and imaging indicators in both patient groups showed significant improvement compared with preoperative levels (P<0.001). However, no statistically significant improvement was observed in the ROM. Compared to SMOT, the addition of fibular osteotomy demonstrated superior outcomes in terms of AOFAS scores and greater improvement in both the talar tilt and tibiocrural angles (P<0.001). The overall incidence of postoperative complications in the SMOT group was lower than that in the SMOT+FO group (2.9% vs 6.4%; OR, 0.44; 95% CI, 0.04 to 5.10). However, the difference did not reach statistical significance (P=0.500). CONCLUSIONS Combining fibular osteotomy with SMOT not only significantly enhances ankle joint function but also exhibits notable advantages in improving radiological parameters, so as to provide long-term clinical benefits for patients.
Clinical utility and dynamics of plasma biomarkers in early-onset dementia remain underexplored. To investigate plasma biomarker trajectories and their associations with clinical outcomes in early-onset Alzheimer disease (EOAD) and frontotemporal dementia (FTD). This multicenter, prospective cohort study analyzed participants in phase 1 of the Longitudinal Study of Early-onset Dementia and Family Members (LEAF), which was conducted from April 2021 through December 2023 in 34 centers across South Korea. Patients with β-amyloid-positive EOAD and FTD were included and underwent annual blood sampling and clinical assessment, within a follow-up period of approximately 2 years. Data were analyzed between June 2025 and March 2026. Levels of plasma phosphorylated tau 217 (p-tau217), glial fibrillary acidic protein (GFAP), and neurofilament light chain (NfL) biomarkers were analyzed using assays. (1) Associations of baseline biomarkers with clinical outcomes (assessed with the Mini-Mental State Examination [MMSE] and the Clinical Dementia Rating-Sum of Boxes [CDR-SB] for the EOAD group, or the frontotemporal lobar degeneration [FTLD]-modified CDR-SB for the FTD group), (2) biomarker trajectories, and (3) association of biomarker level changes and clinical outcomes. A total of 322 participants with p-tau217, GFAP, and NfL analyses were stratified into the EOAD or FTD group based on their diagnosis. The EOAD group (n = 245) had a mean (SD) age of 61.8 (5.4) years and included 163 females (66.5%), while the FTD group (n = 77) had a mean (SD) age of 65.1 (7.3) years and included 45 females (62.3%). In the EOAD group, higher log2-transformed baseline p-tau217, GFAP, and NfL were each associated with faster decline in the MMSE score (association estimate [SE], -0.390 [0.127], P = .002; -0.775 [0.164], P < .001; and -0.679 [0.182], P < .001, respectively) and the CDR-SB score (estimate [SE], 0.401 [0.099], P < .001; 0.535 [0.126], P < .001; and 0.693 [0.122], P < .001, respectively). In the FTD group, GFAP and NfL were associated with MMSE decline (estimate [SE], -2.118 [0.566], P < .001 and -2.360 [0.428], P < .001, respectively), whereas p-tau217 was not (estimate [SE], 0.071 [0.418], P = .87). No biomarker was associated with FTLD-modified CDR-SB score change. Longitudinally, all mean (SD) biomarker levels increased in the EOAD group (p-tau217: 0.253 [0.077] pg/mL, P = .001; GFAP: 0.173 [0.040] pg/mL, P < .001; NfL: 0.149 [0.045] pg/mL, P = .001), whereas in the FTD group, only NfL level showed an upward pattern (0.251 [0.127] pg/mL, P = .05). Annualized biomarker changes were associated with worsening clinical outcomes in the EOAD group, but not in the FTD group. GFAP and NfL level increases were associated with MMSE score decline (estimate [SE], -0.005 [0.002], P = .007 and -0.010 [0.003], P = .001, respectively), while p-tau217 level increases were associated with CDR-SB score worsening (estimate [SE], 0.072 [0.024], P = .003) in the EOAD group. In this cohort study of patients with EOAD and FTD, baseline p-tau217, GFAP, and NfL were consistently associated with clinical outcomes in the EOAD group, whereas GFAP and NfL were associated with cognition only in the FTD group. These findings demonstrate distinct characteristics of plasma biomarkers in EOAD and FTD, supporting their potential utility for risk stratification.
This study aims to evaluate the implementation of the uterine sliding sign in routine pelvic ultrasound examinations for improving the diagnosis of deep endometriosis. A retrospective analysis was conducted at Mayo Clinic's Florida and Arizona campuses, including 200 premenopausal and perimenopausal women with chronic pelvic pain, infertility, or suspected endometriosis. Sonographers performed a uterine sliding maneuver during transvaginal ultrasound, and the acquisition times were recorded. Sonographer experience and the time required to perform the sliding sign were analyzed using Microsoft Excel. The median acquisition time for the uterine sliding sign was 26 seconds, with no statistically significant difference based on sonographer experience. The addition of this maneuver extended the ultrasound examination by <1 minute on average, regardless of sonographer experience level. Incorporating the uterine sliding sign into routine pelvic ultrasound protocols is a quick and efficient method that enhances the detection of deep endometriosis, potentially reducing the significant diagnostic delay associated with endometriosis. This study supports the feasibility and minimal time impact of implementing the Society of Radiologists in Ultrasound (SRU) recommendations for augmented pelvic ultrasound in clinical practice.
Pulmonary aspiration of gastric contents is a serious clinical complication, particularly in patients receiving enteral nutrition or undergoing anesthesia. Gastric residual volume (GRV) is a commonly used surrogate marker that can identify delayed gastric emptying and enteral nutrition intolerance, both of which may increase the risk of aspiration. Traditional methods for measuring GRV are invasive and lack standardization. Point-of-care ultrasound (PoCUS) has emerged as a promising, noninvasive bedside alternative. Despite its growing clinical use, there is still no consolidated guidance on PoCUS procedures for GRV assessment in adult patients. This scoping review aims to map and synthesize the available evidence on procedural techniques, interpretation criteria, and decision-making applications related to PoCUS for GRV assessment. This scoping review will follow the JBI Collaboration methodology and will be reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols extension for Scoping Reviews) guidelines. The PCC (population, concept, and context) mnemonic guided the formulation of the research question. Systematic searches will be conducted in MEDLINE, CINAHL, Embase, Scopus, Cochrane Library, and LILACS, as well as in gray literature sources. Eligible sources will include primary studies, reviews, and clinical guidelines focused on PoCUS for GRV assessment in adults (aged ≥18 years). Two independent reviewers will perform study screening and data extraction. The synthesis will be structured using the I-AIM (indication, acquisition, interpretation, and medical decision-making) framework. Results will be summarized narratively, in tables, and through visual representations such as flowcharts and conceptual diagrams. This protocol was registered on the Open Science Framework registry on August 21, 2025. The literature search began on April 3, 2026, with study selection and data extraction planned for May 2026. The final results are expected to be submitted for publication in July 2026. As this is a protocol study, no results are available yet. This review will identify and categorize the procedures, technical parameters, and clinical applications of PoCUS for GRV assessment in adult patients. By mapping the existing evidence, the findings may inform future research, educational curricula, and the development of clinical guidelines for nurses. In addition, the review will highlight methodological gaps and variations in practice that may affect the safe and effective use of PoCUS across diverse health care settings.