搜索结果：Radiologic

Tularemia is a rare zoonotic disease caused by Francisella tularensis, whose pulmonary manifestations occur only sporadically in Central Europe and can be particularly challenging to diagnose. We report on a 58-year-old patient presenting with B-symptoms in whom a thoracic mass was detected on computed tomography. Further imaging studies revealed a metabolically active mediastinal mass with lymphadenopathy, suggestive of bronchial carcinoma. Only surgical mediastinoscopy with evidence of granulomatous-histiocytic inflammation, as well as further infectious disease diagnostics, led to the diagnosis of pulmonary tularemia. Following a 20-day course of doxycycline, there was rapid clinical improvement and complete laboratory and radiological regression of the lymphadenopathy. This case underscores that pulmonary tularemia can resemble malignant processes morphologically and metabolically. Early consideration of infectious disease differential diagnoses, as well as the combination of histology, serology, and molecular biological methods, are crucial to avoid misdiagnoses and unnecessary invasive procedures. Die Tularämie ist eine seltene Zoonose, verursacht durch Francisella tularensis, deren pulmonale Manifestation in Mitteleuropa nur sporadisch auftritt und diagnostisch besonders herausfordernd sein kann.Wir berichten über einen 58-jährigen Patienten mit B-symptomatik bei welchem computertomografisch eine thorakale Raumforderung detektiert wurde.Die weiterführende bildgebende Diagnostik zeigte eine metabolisch aktive mediastinale Raumforderung mit Lymphadenopathie, verdächtig auf ein Bronchialkarzinom. Erst die chirurgische Mediastinoskopie mit Nachweis granulomatös-histiozytärer Entzündungen sowie die weiterführende infektiologische Diagnostik führten zur Diagnose einer pulmonalen Tularämie.Unter einer 20-tägigen Therapie mit Doxycyclin kam es zu einer raschen klinischen Besserung und vollständigen laborchemischen sowie radiologischen Regression der Lymphadenopathie.Der Fall unterstreicht, dass die pulmonale Tularämie malignen Prozessen morphologisch und metabolisch ähneln kann. Eine frühzeitige Einbeziehung infektiologischer Differenzialdiagnosen sowie die Kombination aus Histologie, Serologie und molekularbiologischen Verfahren sind entscheidend, um Fehldiagnosen und unnötige invasive Maßnahmen zu vermeiden.

As the endolymphatic (ES) undergoes normal postnatal maturation, the surrounding vestibular aqueduct (VA) undergoes a corresponding change in morphology, quantified by its angular trajectory (ATVA). In adult temporal bones with Meniere's disease (MD), a fetal orientation ATVA (≥140°) indicates underlying ES hypoplasia and defines the so called hypoplastic disease endotype (MD-hp). However, ES hypoplasia has also been described histologically in other inner ear syndromes and congenital conditions, independent of MD. We aimed to investigate whether ATVA ≥140° occurs in mature temporal bones beyond its established association with the MD-hp endotype. Retrospective retrieval of CT scans performed on patients over age 12 years at Massachusetts Eye and Ear between January 2016 and December 2024 was conducted, with search terms encompassing diseases previously described to be associated with temporal bone anomalies. CT studies that did not allow adequate assessment of the VA were excluded. Two neuroradiologists blinded to clinical information independently performed ATVA measurements, with consensus interpretation rendered for disagreements in ATVA categories (adult, intermediate, or fetal orientation). 103 patients with congenital temporal bone anomalies were identified. 98 patients (190 ears) met inclusion criteria. Fetal VA orientation (ATVA ≥140°) was identified in 8 ears from 6 patients. Intermediate VA orientation (ATVA 121°-139°) was identified in 19 ears from 15 patients. Among 8 patients with branchio-oto-renal (BOR) syndrome, 2 patients had bilateral fetal orientation ATVA and 2 patients had mixed fetal/intermediate orientation ATVA. Among 11 patients with trisomy 21, 5 demonstrated unilateral abnormal ATVA. Higher than 120° ATVA values were also observed in CHARGE syndrome, Apert syndrome, and Chiari I malformation. Review of clinical records did not show a diagnosis of MD within our cohort. Fetal and intermediate ATVA orientations were observed in several congenital temporal bone anomalies without documented MD. These findings further support that abnormal ATVA reflects altered VA/ES developmental morphology and is not exclusive to the MD-hp endotype. Accordingly, fetal orientation ATVA should be interpreted within the broader clinical and radiologic context, particularly in the presence of additional congenital abnormalities.

Accurate survival prediction in non-small cell lung cancer (NSCLC) requires integrating clinical, radiological, and histopathological data. Multimodal deep learning (MDL) can improve precision prognosis, but small cohorts and missing modalities limit its clinical applicability, as conventional approaches enforce complete-case filtering or imputation. We present a missing-aware multimodal survival framework that combines computed tomography (CT), whole-slide histopathology images (WSI), and structured clinical variables for overall survival modeling in unresectable stage II-III NSCLC. The framework uses foundation models (FMs) for modality-specific feature extraction and a missing-aware encoding strategy that enables intermediate multimodal fusion under naturally incomplete modality profiles. By design, the architecture processes all available data without dropping patients during training or inference. Intermediate fusion outperforms unimodal baselines and both early and late fusion strategies, with the trimodal configuration reaching a C-index of 74.42. Modality-importance analyses show that the fusion model adapts its reliance on each data stream according to representation informativeness, shaped by the alignment between FM pretraining objectives and the survival task. The learned risk scores produce clinically meaningful stratification of disease progression and metastatic risk, with statistically significant log-rank tests across all modality combinations, supporting the translational relevance of the proposed framework.

To assess the risks posed by space radiation, the dose equivalent, defined as the integral of the measured absorbed dose and the radiation quality factor (Q), is currently employed. The Q is closely related to cancer risk estimation, as it reflects the relative biological effectiveness of radiation. These relationships have been investigated using several biological endpoints in anticipation of future space missions. The International Commission on Radiological Protection (ICRP) addressed radiation exposure in space using Q, as detailed in ICRP Publication 123. Currently, the Q-LET relationship established in ICRP Publication 60 for general dose assessment on the ground is applied in space dosimetry. However, a Q value that takes track structure into account has been developed to evaluate radiation risks associated with specific biological effects. For future deep space missions, a more practical Q value specifically adapted to the characteristics of space radiation may be required for accurate dose assessment. This special issue explores new frontiers in space radiation risk assessment by integrating recent advances in physical and biological research, including microdosimetry and studies of inter- and intra-cellular responses.

To describe the clinical effectiveness and safety of dalbavancin (DAL) for the treatment of Vascular Graft and Endograft Infections (VGEI). A retrospective, single-center observational study was conducted at a tertiary-care university hospital in Rome from January 2020 to December 2024, including all consecutive patients diagnosed with VGEI who received at least one dose of DAL. Cases were identified through the hospital electronic medical record database. VGEIs were diagnosed using MAGIC criteria. Primary outcomes were clinical and radiological response at the end of treatment (EOT) and at six-month follow-up. Thirteen patients were included (median age: 76 years; 92% of males; median Charlson Comorbidity Index 5). Aortic vessels were involved in 61.5% of cases, peripheral vessel in 38.5%. Microbiological identification was achieved in 84.6% of cases, with Staphylococcus aureus (MSSA and MRSA) being the most frequent pathogen. Surgical explant was performed in 53.8% of patients, predominantly for peripheral VGEIs. DAL was used to facilitate early discharge (69.2%) or as suppressive antibiotic therapy (30.8%). No adverse events related to DAL were reported. Clinical success was achieved in 84.6% of patients at EOT and maintained in 61.5% at six-month follow-up. DAL appears to be an effective and well-tolerated option for the management of VGEI, particularly in frail patients or those not eligible for surgery, both to facilitate early discharge and as long-term SAT. Further prospective studies are needed to confirm these findings.

Separation surgery has emerged as a key surgical strategy for metastatic spinal cord compression (MSCC), aiming to create a circumferential decompressive margin that allows safe delivery of postoperative radiotherapy. However, despite its widespread adoption, the clinical value of objectively confirming separation on early postoperative magnetic resonance imaging (MRI) remains unclear. To evaluate whether separation success confirmed by MRI at 2-3 weeks postoperatively is associated with improved neurological recovery, functional outcomes, and survival in patients with MSCC. Retrospective cohort study. Fifty-nine patients who underwent posterior separation surgery for MSCC between 2020 and 2023 were included. All patients underwent metal artifact-reduced MRI at three weeks postoperatively and were classified into a separation group (Group S; n = 26, 44.1%) or a non-separation group (Group NS; n = 33, 55.9%) based on MRI findings. Primary outcomes included neurological recovery (motor grade and ambulation status), overall survival, and length of hospital stay. Secondary outcomes included radiologic parameters (Bilsky grade and Spinal Instability Neoplastic Score), postoperative complications, and radiotherapy administration. Successful separation was defined as a cerebrospinal fluid margin ≥2 mm between the tumor and spinal cord. Baseline characteristics were compared using appropriate parametric and nonparametric tests. Logistic regression was used to identify predictors of separation success. Survival outcomes were analyzed using the Kaplan-Meier method with log-rank testing and Cox proportional hazards regression. Baseline characteristics were comparable between groups except for Bilsky grade distribution. Group NS had a significantly higher proportion of Bilsky grade 3 lesions (28/33 vs. 16/26, p = 0.041). Compared with Group NS, Group S demonstrated significantly higher postoperative motor grades (4.54 vs. 3.67, p = 0.015), higher ambulation rates (92.3% vs. 69.7%, p = 0.032), and shorter hospital stays (15.81 vs. 23.94 days, p = 0.042). Overall survival was significantly longer in Group S (13.31 vs. 6.02 months, p = 0.001). Logistic regression identified preoperative Bilsky grade as the only independent predictor of separation failure (OR = 0.248, 95% CI: 0.069-0.888, p = 0.032). Cox regression demonstrated that separation failure was associated with a 2.63-fold increased risk of mortality (p = 0.006). Separation success confirmed on early postoperative MRI obtained 2-3 weeks after surgery was associated with early neurological recovery, higher postoperative ambulation rates, and prolonged survival in patients with MSCC. Despite technical limitations, early postoperative MRI provides a practical and objective means of assessing decompression adequacy and may support postoperative evaluation and treatment planning following separation surgery for MSCC.

Pneumoconiosis, a common occupational lung illness, arises from inhaling dust, with silicosis specifically caused by fine crystalline silica dust, leading to lung scarring and inflammation. The diagnosis of silicosis relies on routine monitoring, which includes physical examinations, medical history reviews, and imaging. Chest radiography is a common form of medical screening due to its affordability, efficiency, and suitability for routine use. Recent success in deep learning (DL) for medical image classification has demonstrated that DL algorithms can identify silicosis with high precision by classifying CT images. DL models, specifically convolutional neural networks, have become an effective approach due to their ability to analyse medical images. Therefore, this study presents a novel Multimodal Deep Learning Framework for Early Identification of Silicosis Diagnosis (MDLF-EISD) using radiological images, focused on enabling timely clinical intervention and improving patient outcomes. The proposed framework applies feature fusion (EfficientNet-B3, a capsule network, and ConvNext V2) for integrating complementary radiographic representation, enhancing the ability of the model in capturing disease-specific patterns over different levels of silicosis. Moreover, a convolutional bidirectional attention model is utilised to classify silicosis into corresponding categories effectively. An extensive simulation studies were carried out to evaluate the enhanced performance of the MDLF-EISD method under Silicodata. The comparative analysis of the MDLF-EISD method illustrated a superior accuracy value of 98.73% over other models. These results demonstrate that the feature fusion improves discriminative capabilities for silicosis-related radiographic findings. The proposed system has the ability to support as a computer-aided screening tool for early silicosis diagnosis, particularly in resource-limited clinical and occupational health settings where access to expert radiologists is limited.

Subcutaneous natalizumab offers greater convenience than intravenous administration, but pharmacokinetic differences have raised concerns about potential subclinical disease activity. Serum neurofilament light chain (sNfL) and glial fibrillary acidic protein (GFAP) are sensitive biomarkers of neuroaxonal damage and astroglial activation. In this prospective, single-center cohort study, consecutive patients with relapsing-remitting multiple sclerosis who transitioned from intravenous to subcutaneous natalizumab were followed for 12 months. Serum sNfL and GFAP were measured at baseline (prior to switch), and at 6 and 12 months using SIMOA technology. Additional clinical outcomes included annualized relapse rate (ARR), EDSS, and MRI activity. 23 patients were included (mean age 43.7 years; 91% female). Median disease duration was 14 years (IQR 8.1-22), median time on natalizumab was 5 years (IQR 3.3-7.9), baseline 2-year ARR was 0.09 ± 0.2, and median EDSS was 2.0 (IQR 2.0-3.5). Median sNfL Z-scores were 0.2 (IQR - 0.3-0.6) at baseline, 0.1 (IQR - 0.4-1.0) at 6 months, and 0.5 (IQR - 0.4-1.1) at 12 months, with no significant change over time (p = 0.401). GFAP levels were similarly stable (87.7, 86.8, and 90.2 pg/mL; p = 0.957). ARR remained low and unchanged (0.09 pre- and post-switch; p = 1.0), with no radiological activity observed. EDSS remained stable over follow-up. In this small real-world cohort, switching from intravenous to subcutaneous natalizumab was associated with stable sNfL and GFAP levels over 12 months, alongside stable conventional clinical and MRI outcomes. These findings provide supplementary biomarker evidence broadly consistent with existing clinical trial and real-world data, but should be interpreted cautiously given the small sample size.

With the rapid development of image-guided minimally invasive therapeutic techniques, percutaneous cryoablation has become increasingly important in the comprehensive management system of pulmonary tumors due to its advantages such as good repeatability and minimal damage to surrounding structures. This consensus was developed by a working group consisting of multidisciplinary experts from respiratory and critical care medicine, interventional radiology, thoracic surgery, oncology, and ultrasound. Based on a systematic search of relevant domestic and international literature, synthesis of the latest guidelines and consensus statements, and combined with clinical practice experience in China, the group formulated 10 consensus recommendations through multiple rounds of expert discussion and voting. The contents cover the indications and contraindications of percutaneous cryoablation for lung tumors, pre-procedural biopsy strategies, application scenarios and timing of intervention in advanced lung cancer, key technical points of cryoablation, management principles for lesions of different numbers and sizes, as well as key practical aspects such as post-operative follow-up and evaluation processes and prevention and treatment strategies for complications. This consensus clarifies the role of percutaneous cryoablation in the comprehensive management of lung tumors and emphasizes that it should be performed in a standardized manner under the evaluation of a multidisciplinary team (MDT) to optimize the whole-course management pathway for patients with lung cancer. High-quality clinical research is still needed in the future to further refine standardized operating procedures and evidence-base, thereby providing references for clinical practice. 随着影像引导微创治疗技术的快速发展，经皮冷冻消融因其可重复性好、对周围结构损伤小等优点，在肺部肿瘤综合管理体系中的重要性日益凸显。共识由呼吸与危重症医学科、介入放射科、胸外科、肿瘤科、超声科等多学科专家组成工作组，在系统检索国内外相关文献、综合最新指南与共识的基础上，结合中国临床实践经验，经多轮专家研讨与投票表决，形成了10条共识建议。内容涵盖经皮肺部肿瘤冷冻消融的适应证与禁忌证、术前活检策略、晚期肺癌中的应用场景及介入时机、冷冻消融的关键技术要点、不同病灶数量与大小的处理原则，以及术后随访评估流程和并发症防治策略等关键实践环节。共识明确了经皮冷冻消融在肺部肿瘤综合管理中的定位，强调应在多学科诊疗团队评估下规范开展，以优化肺癌患者的全程管理路径。未来仍需进一步开展高质量临床研究，以完善标准化操作流程和循证依据，为临床实践提供参考。.

Orthotopic liver transplantation (OLT) offers curative treatment for hepatocellular carcinoma (HCC) and underlying cirrhosis. However, the benefit of this limited resource in early-stage HCC with preserved liver function is unclear. This study evaluates whether older adults with early-stage HCC and Child-Pugh class A cirrhosis derive additional survival benefit from OLT following complete percutaneous thermal ablation (TA). This study reviewed 98 patients aged 60-80 years with very early or early-stage HCC (BCLC 0/A) and Child-Pugh class A cirrhosis, treated between 2011 and 2020, who had complete response to TA at 6 months. Patients were stratified by whether or not they underwent subsequent OLT. Primary outcomes were overall survival (OS) and cancer-specific survival (CSS) at 5 and 10 years. Intention-to-treat, subgroup, and multivariate and time-varying Cox regression analyses were performed. No statistically significant differences in OS (p=0.075) or CSS (p=0.49) were observed between OLT and non-OLT groups. Five-year OS was 92.0% (OLT) vs. 81.2% (non-OLT), and 10-year OS was 81.2% vs. 61.9%. Five-year CSS was 100.0% (OLT) vs. 92.3% (non-OLT), and 10-year CSS was 89.1% vs. 86.3%. Intention-to-treat analysis showed no difference between groups (p=0.76), with 5-year OS of 85.1% (OLT waitlisted) vs. 83.5% (non-waitlisted), and 10-year OS of 71.0% vs. 66.6%. In time-varying Cox regression analysis, transplantation was not significantly associated with overall survival (p=0.24). For older adults with early-stage HCC and well-compensated cirrhosis who undergo successful TA, no statistically significant survival advantage was detected for those who received subsequent OLT compared to active surveillance.

Accurate interpretation of pediatric elbow imaging depends on understanding the developmental relationship between the radial head and the capitellum. While the traditional sequence of pediatric elbow ossification centers provides a useful framework, it does not capture morphologic variability, asynchronous maturation, and eccentric ossification patterns that may mimic pathology. This review synthesizes current evidence on pediatric elbow ossification with particular emphasis on normal and variant radial head development. The following key questions are addressed: (1) How frequently does eccentric radial head ossification occur on MRI? (2) What is its magnitude and relationship to age and sex? (3) How should normal variants be distinguished from pathology? Recent findings reveal that the capitellum commonly ossifies eccentrically before centralizing with growth. In our cohort of 66 children, radial head ossification was eccentric in 68-71% of cases in both sagittal and coronal planes. Offsets were small (average magnitude&#x2009;<&#x2009;3%), predominantly posterior and radial, and generally did not correlate with age except for progressive centralization in the coronal plane among males. The radiocapitellar line remained reliable on the lateral view but demonstrated expected lateral offset on AP views. Eccentric radial head ossification represents a common physiologic pattern that does not reliably centralize with age. Recognition of this variant can reduce misdiagnosis and unnecessary intervention, and has implications for fracture assessment, surgical planning, and longitudinal research. Future studies should include prospective MRI tracking across diverse populations to establish normative ranges and develop quantitative tools for clinical applications.

暂无摘要（点击查看详情）

We compared performance across 3 breast cancer risk domains-clinical, polygenic, and mammography artificial intelligence-alone and in combination over a 10-year time horizon among women with a negative screening mammogram within a Kaiser Permanente Research Bank (KPRB) prospective cohort. The study included 82&#x2009;957 women (61&#x2009;962 non-Hispanic White, 7256 Asian, 3414 Black, and 5466 Latina) who enrolled in KPRB between 2003 to 2020. Women with a prior history of breast cancer or high/moderate-penetrant gene mutation were excluded. The negative screening mammogram (no clinically visible cancer) closest to enrollment was used to generate the Mirai mammography AI risk score. KPRB survey and electronic health record data were used to generate the Breast Cancer Surveillance Consortium version 3 (BCSCv3) clinical risk score. Genome-wide genotypes were used to compute the 313-SNP polygenic risk score, adjusted for genetic ancestry (PRS313adj). Risks of breast cancer (invasive or ductal carcinoma in situ) at 0 to 10&#x2009;years after the mammogram were estimated using Cox models, with 5-fold cross-validation used to estimate the C-index. During 10&#x2009;years of follow-up, 2471 women developed breast cancer. The C-index (95% CI) for the combined model with all 3 risk scores (0.70; 95% CI&#x2009;=&#x2009;0.69 to 0.71) was significantly higher than for univariate models with only the BCSCv3 (0.62; 95% CI = 0.61 to 0.63), PRS313adj (0.61; 95% CI = 0.60 to 0.62), or Mirai (0.66; 95% CI = 0.65 to 0.67) risk score. Integrating mammographic AI and polygenic risk scores with clinical risk models significantly improved breast cancer risk discrimination, supporting use of combined models for personalized screening and prevention.

Neurofibromatosis type 1 (NF1) is a heterogeneous neurodevelopmental disorder where motor deficits and attention-deficit/hyperactivity disorder (ADHD) occur at higher rates than typical populations. To characterize network-level changes associated with these impairments, we compared functional connectivity in youth with NF1 to typically developing controls. In the NF1 cohort, we analyzed relationships between functional connectivity, motor impairment, and ADHD severity. Thirty-two participants (16 NF1, 16 typically developing; 8-16 years) underwent resting-state functional magnetic resonance imaging. Seed-to-voxel analyses were conducted for network seeds (sensorimotor, default mode, salience, and dorsal attention). Group differences were tested across brain voxels, and we examined brain-behavior associations within the NF1 group by correlating functional connectivity with motor scores from the Physical and Neurological Examination of Subtle Signs and ADHD severity from the parent-reported ADHD rating scale. Youth with NF1 displayed cortico-cortical hyperconnectivity and cortico-subcortical hypoconnectivity within the sensorimotor network, and hyperconnectivity within and between default mode, dorsal attention, frontoparietal, and visuospatial networks. In youth with NF1, poorer motor performance was associated with reduced cortico-cortical intrasensorimotor and sensorimotor-visuospatial connectivity. Greater inattentive symptoms were linked to decreased default mode-sensorimotor connectivity, increased default mode-visuospatial connectivity, and increased dorsal attention-frontoparietal connectivity. Default mode-sensorimotor/visuospatial hyperconnectivity correlated with worse total ADHD symptoms. Ineffective integration across default mode, sensorimotor, and visuospatial networks may be linked to motor and attentional phenotypes in NF1 and may serve as a candidate biomarker, pending replication in larger, more heterogeneous samples. We also demonstrate preliminary evidence of compensatory hyperconnectivity in youth with NF1 presenting with co-occurring neurodevelopmental difficulties.

The reliable deployment of artificial intelligence systems in medical imaging requires high diagnostic performance, robustness and interpretability. In this study, we developed and evaluated two automated frameworks for binary classification of shoulder radiographs (XRs) using deep learning (DL) and hybrid DL-machine learning (ML) approaches. A convolutional neural network (CNN) based on a fine-tuned VGG19 architecture was trained end-to-end on a large, balanced dataset of 4,268 shoulder XRs. In parallel, hybrid models were constructed by extracting deep feature representations from the trained network and combining them with traditional ML classifiers. Model performance was evaluated on independent internal (n = 480) and external (n = 308) validation sets. Both approaches achieved high discriminative performance. Paired comparison of Receiver Operating Characteristic (ROC) curves using the DeLong test revealed no statistically significant differences between the end-to-end CNN and the hybrid CNN-ML pipeline for either internal validation (AUC 0.956 vs. 0.961) or external generalization (AUC 0.940 vs. 0.942). Model interpretability was assessed using Grad-CAM and SHAP values. Our results suggest that while both frameworks are robust, the end-to-end DL approach offers a more streamlined workflow and more direct visual explainability via saliency maps. These findings support the potential of AI-based tools for shoulder XR analysis; however, prospective real-world validation, assessment under routine prevalence conditions, and direct comparison with human readers are still needed before clinical integration can be established.

Response to anti-programmed cell death protein-1 (anti-PD-1) immunotherapy remains limited in patients with metastatic non-small cell lung cancer (NSCLC), whose tumors exhibit low or absent programmed death-ligand 1 (PD-L1) expression, and subsequent second-line therapy has poor efficacy. To address this limitation, we evaluated the efficacy and safety of combined ipilimumab and nivolumab (IPI/NIVO) with subablative radiotherapy (RT) in patients with metastatic NSCLC with negative or low PD-L1 expression, who had progressed on prior anti-PD-1 therapy. This single-arm, prospective phase II trial aimed to enroll 30 evaluable patients with metastatic NSCLC exhibiting low (1-49%)&#x2009;or negative (<1%) PD-L1 tumor expression who had progressed after first-line anti-PD-1 therapy. Primary endpoints were safety, disease control rate (DCR), and objective response rate (ORR) at 6 and 12 weeks, assessed in non-irradiated tumor lesions. Treatment consisted of IPI 1&#x2009;mg/kg every 6 weeks (Q6W) and NIVO 240&#x2009;mg every 2 weeks for 6 weeks combined with subablative RT (3&#xd7;8&#x2009;Gy to 1-4 lesions). Thereafter, IPI 1&#x2009;mg/kg Q6W and NIVO 360&#x2009;mg every 3 weeks were continued. In 31 patients of the intention-to-treat population, ORR was 7% and 10% at 6 and 12 weeks, and reached 29% as the best response. DCR was 58% and 39% at 6 and 12 weeks. Overall survival (OS) differed significantly by best response, with a median OS of 3.1, 13.5 and 22.5 months for progressive disease, stable disease and partial/complete response (p<0.001). Baseline sum of longest diameters, together with age, blood inflammatory markers and albumin levels, were prognostic of treatment response. All patients experienced treatment-related adverse events (AEs), with grade 3 as the highest severity in eight patients (26%). Immune-related AEs led to treatment discontinuation in five patients (16%). Early T-cell activation in peripheral blood samples (day 8) was detectable and more pronounced in responders than in progressors. In patients with metastatic NSCLC and low or negative tumor PD-L1 expression, IPI/NIVO/RT was able to induce objective clinical responses in a subset of patients who had progressed after first-line anti-PD1 therapy. Treatment was associated with a strong T-cell activation, improved OS and an acceptable safety profile. 2020-001097-29.

Few studies have described long-term respiratory sequelae of adolescent (people aged 10-19&#xa0;years) tuberculosis (TB) survivors. We hypothesized that compared with healthy adolescents with no history of TB, survivors of adolescent pulmonary TB have greater respiratory impairment (reduced lung function) and disability (symptoms and activity limitations). In this prospective cohort study in Lima, Peru, we used spirometry, oscillometry, and the St George's Respiratory Questionnaire (SGRQ) to evaluate, on 2 separate occasions, the lung health of adolescents successfully treated for pulmonary TB and matched healthy controls. TB survivors with abnormal lung function underwent chest computed tomography (CT). Using mixed-effects regression with an interaction term for time since treatment completion and random effects for individual and matched pairs, we modeled changes in lung function and disability over 24&#xa0;months from treatment completion, comparing findings between TB survivors and controls. Compared with 101 controls (median age 17&#xa0;years, 56% male), 101 TB survivors (median age 18&#xa0;years, 56% male) had less favorable forced expiratory volume in 1 second, forced vital capacity, total airway resistance (R5), small airway resistance (R5-20), and reactance area (AX). Over the study period, AX, R5, and R5-20 improved for TB survivors but remained worse than controls. TB survivors had persistently greater respiratory disability (measured by SGRQ). Chest CTs of TB survivors demonstrated architectural distortion, reticular patterns, nodules, and bronchiectasis. Adolescent TB survivors experience persistent, symptomatic chronic lung disease despite bacteriological cure. Our findings highlight the need for respiratory assessments beyond treatment completion.

To evaluate the influence of ultrasound probe type on ultrasonographic morphometric measurements of the mental foramen (MF) and to assess their agreement with cone-beam computed tomography (CBCT). The findings may have clinical implications for dental implant safety in the mandibular premolar region. This cross-sectional study included 44 adults with bilaterally visible MF on CBCT. Ultrasonographic measurements of horizontal and vertical MF diameters were obtained bilaterally using linear (3-12 MHz) and hockey-stick (8-18 MHz) probes and compared with CBCT measurements. Two observers performed all measurements independently. Reliability was assessed using intraclass correlation coefficients (ICC), and agreement between modalities was evaluated using paired-samples t-tests and Bland-Altman analysis. Repeated-measures ANOVA revealed no significant within-observer differences among imaging modalities (all p > 0.05). Interobserver agreement was moderate to good across all modalities (ICC: 0.727-0.846; all p < 0.001). Before correction for multiple comparisons, ultrasonography performed with the linear probe showed statistically significant differences from CBCT for the right horizontal (p < 0.001), right vertical (p&#x202f;=&#x202f;0.015), and left vertical diameters (p&#x202f;=&#x202f;0.047), whereas no statistically significant differences were observed between hockey-stick probe measurements and CBCT for any side or measurement orientation (all p > 0.05). After Benjamini-Hochberg correction, only the right horizontal linear probe measurement remained statistically significant. Probe type may influence ultrasonographic morphometric measurements of the MF, and high-frequency small-footprint probes demonstrated closer agreement with CBCT measurements. Ultrasonographic assessment of the MF may assist in the preoperative identification of the mental neurovascular bundle and serve as a supportive adjunct during implant planning and related surgical procedures.

Superior hypophyseal artery (SHA) aneurysms are occasionally associated with infraoptic anterior cerebral artery (ACA) variants, characterized by the A1 segment coursing beneath the optic nerve.1,2 A 69-year-old female presented with an 8 mm right SHA aneurysm, and subsequent angiography demonstrated a Wong Type I infraoptic ACA, resulting in a dual arterial supply to the aneurysm.3 Due to this anatomy, dual overlapping Pipeline Shield flow diverters were deployed. However, one-year follow-up demonstrated persistent aneurysm flowing from continued infraoptic ACA inflow. Microsurgical clipping via supraorbital eyebrow craniotomy was performed, placing two mini-clips at the aneurysm-infraoptic ACA junction to eliminate anterograde filling while preserving retrograde perfusion. Complete exclusion with normal A1 patency was confirmed with intraoperative ICG angiography, fluorescein angiography, and formal cerebral angiography. Six-month imaging demonstrated persistent occlusion. Infraoptic ACA variants resulting in dual blood supply may necessitate combined embolization and flow diversion or microsurgical approaches when flow diversion alone proves inadequate. Institutional review board (IRB) approval was obtained and written informed consent was obtained from the patient for publication of this case video and accompanying images.