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Triple-negative breast cancer (TNBC) is an aggressive breast cancer subtype with a high risk of early central nervous system dissemination and poor outcomes after brain metastasis (BM). This systematic review summarizes current evidence on incidence, treatment strategies, outcomes, guidelines, and ongoing trials in TNBC-associated BM. The review followed PRISMA guidance and was registered in the Open Science Framework (OSF.IO/6TDRF). MEDLINE, Scopus, Web of Science, DOAJ, and ClinicalTrials.gov were searched through January 17, 2026. Eligible records comprised randomized trials, prospective, retrospective, and ambispective cohorts, registry analyses, case series, guideline or consensus documents, and registered clinical trials reporting TNBC-specific CNS data. Data were extracted independently and synthesized descriptively because clinical and methodological heterogeneity precluded quantitative meta-analysis. Forty-three records met the inclusion criteria: 27 clinical studies (25 addressing parenchymal brain metastases and two addressing leptomeningeal metastases), seven guideline or consensus documents, and nine ongoing clinical trials. Across clinical studies, 67,290 patients were included; 2,555 patients had TNBC and developed CNS involvement. SRS achieved 1-year local control rates of 90-99% in selected patients with limited intracranial disease, but distant intracranial relapse remained frequent. Whole-brain radiotherapy was commonly used for extensive disease and was associated with poorer survival in observational cohorts. Among systemic options, sacituzumab govitecan had the most consistently reported TNBC-specific intracranial signal, although current evidence did not establish comparative superiority. TNBC-associated BM remains linked to substantial morbidity, mortality, and limited prospective evidence. SRS is preferred for appropriately selected patients with limited disease. Sacituzumab govitecan has the most consistently reported TNBC-specific CNS activity, but no systemic agent has established superiority in prospective TNBC-specific CNS trials. Not applicable.

Obsessive-compulsive disorder (OCD) is characterized by its symptomatology heterogeneity, which poses challenges for its assessment and treatment. Ecological momentary assessment (EMA) has been proposed as a promising method for gathering information and may offer advantages over retrospective methods. The present study aims to conduct a systematic review of the use of EMA in OCD, examining the main variables assessed, methodological considerations, and the advantages of EMA compared with retrospective measures to assess OCD. The systematic search was conducted using databases including Scopus, Pubmed, Web of Science, PsycNET, and Cochrane Library. Of the identified studies, 28 met the inclusion criteria. These studies focused on the assessment of obsessions, compulsions, experiential avoidance, and sleep, with compulsions being the most studied variable. The studies reveal diverse EMA methods, with traditional paper recordings and smartphones differing in frequency and duration of the records. Some studies reported that EMA may serve as a valid and sensitive tool for detecting changes in OCD and overcome some limitations of retrospective assessments. Despite the potential of EMA, their validity is still questionable, and their application during intervention processes is limited, particularly given the heterogeneity of the available evidence and the limited application of EMA during intervention processes. Further research is essential to enhance their integration in clinical settings.

Pseudohypoaldosteronism type 1 (PHA1) is a rare hereditary disorder characterised by aldosterone resistance leading to salt wasting, hyperkalaemia, and metabolic acidosis. Two forms are recognised: a milder renal form (PHA1A) due to NR3C2 mutations and a severe systemic form (PHA1B) caused by biallelic mutations in epithelial sodium channel (ENaC) subunit genes. Data on Indian patients are scarce. This study describes the clinical, biochemical, and molecular characteristics and treatment outcomes of children with PHA1 from South India. This multicentric retrospective series included nine children diagnosed with PHA1 across six tertiary care centres between 2022 and 2025. Clinical and biochemical data were extracted from hospital records. Plasma renin, aldosterone, cortisol, and 17-hydroxyprogesterone were measured at presentation. Genetic testing was performed using clinical exome sequencing, and variants were classified according to American College of Medical Genetics and Genomics (ACMG) guidelines. All nine patients had the systemic form (PHA1B). The median age at presentation was 14 days (interquartile range 5.5-42.5), and parental consanguinity was present in seven (78%). All presented with hyponatraemia and hyperkalaemia (median serum sodium 124 mEq/L; potassium 8.0 mEq/L). Eight (pathogenic/likely-pathogenic: 4, supporting: 4) homozygous variants were identified in SCNN1A (n = 2), SCNN1B (n = 3), and SCNN1G (n = 3); all were novel. Six patients (67%) died, mainly due to sepsis (n = 2) or treatment discontinuation (n = 4), while three remain stable on oral sodium supplementation. This first multicentric South Indian series highlights exclusive reporting of PHA1B, high early mortality, and major treatment challenges. Eight novel ENaC variants expand the genetic spectrum of PHA1B in India.

Despite elevated risk for epilepsy following traumatic brain injury (TBI), there are limited tools to assess epilepsy risk following TBI using routine clinical data. The objective of this study was to develop and validate a machine learning approach to predict the onset of posttraumatic epilepsy (PTE) over varying time horizons following TBI, using only routine clinical data collected up to the month of TBI documentation. This retrospective longitudinal cohort study included post-9/11 US veterans with a TBI diagnosis between 2008 and 2017 in US Department of War and Veterans Health Administration records. Machine learning models predicted PTE onset at 2, 5, and 10 years after the date of first TBI documentation. Only preinjury information was used for prediction. Model performance was evaluated on held-out test data (30%). Shapley additive explanations (SHAP) were used to quantify the contribution of predictive features. The cohort of 107 987 US veterans with TBI included 4930 (4.6%) incident epilepsy cases. Predicting epilepsy status, an optimized random forest model achieved area under curve [95% confidence interval] scores from receiver operating characteristic curves of .75 [.73-.77], .74 [.72-.75], and .73 [.72-.74] for 2-, 5-, and 10-year forecast windows postinjury, respectively. High-risk stratification identified 17.5% of all 5-year epilepsy cases at a false positive rate of just 2.3% in the TBI population. SHAP analysis identified TBI severity and a cumulative preinjury comorbidity index as important predictors of PTE risk. Machine learning algorithms applied to routinely collected administrative health data can effectively stratify long-term risk for epilepsy following TBI over a wide range of time horizons. These models open the possibility for enrichment of PTE cases in future preventative clinical trials using widely available routine clinical data.

 Early Hearing Detection and Intervention programmes support early identification and management of hearing loss. However, limited data exist on post-diagnostic pathways, amplification uptake, and continuity of care within public-sector paediatric services.  To describe management pathways and outcomes of children diagnosed with hearing loss following newborn and infant hearing screening (NIHS) at a tertiary paediatric hospital in the Western Cape.  A retrospective descriptive cohort study was conducted at the Red Cross War Memorial Children's Hospital. Records of children under 6 years (August 2019 - August 2024) with documented NIHS results and confirmed hearing loss were reviewed using departmental databases and a self-developed data extraction tool. Data included demographics, risk factors, diagnostic outcomes, amplification, referrals, and follow-up attendance.  Of 7871 children seen, 511 (6.5%) had NIHS results. Eighty-three underwent diagnostic testing, of whom 72 (86.7%) were diagnosed with hearing loss. The mean age at diagnosis was 17.3 months. Infectious (32.5%) and neurological (28.9%) risk factors predominated. Mild (31.3%) and moderate (33.7%) conductive loss was most frequent. Only 15.3% received amplification, predominantly bilateral behind-the-ear devices. Most children (78.3%) were referred to additional services, primarily otolaryngology (81.5%). Follow-up attendance remained high (85.5%).  High follow-up rates contrast with low uptake of amplification, likely reflecting conductive pathology and systemic constraints. Greater integration across audiology, otolaryngology, and early intervention services is needed.Contribution: This study provides contextually relevant evidence on post-diagnostic paediatric hearing care, including amplification uptake, referral patterns, and continuity to follow-up in the South African public sector.

Primary hyperparathyroidism (PHPT) is a rare but notable metabolic cause of acute pancreatitis (AP). Early diagnosis and surgical intervention are crucial to prevent recurrence and improve prognosis. We retrospectively analyzed the clinical data of a 61-year-old male presenting with AP and severe hypercalcemia (3.54 mmol/L) as the initial manifestation of PHPT. Additionally, a systematic review of 83 studies published between 1958 and May 2026 was performed in accordance with PRISMA guidelines. Individual patient data (IPD) on demographics, total serum calcium levels, treatment modalities, and clinical outcomes were extracted. The patient's total serum calcium was 3.54 mmol/L (14.16 mg/dL) with a parathyroid hormone (PTH) of 640.5 pg/mL. Unenhanced abdominal computed tomography (CT) confirmed acute pancreatitis (AP; moderately severe acute pancreatitis according to the Revised Atlanta 2012 classification), and a left inferior parathyroid adenoma was identified via cervical ultrasonography and 99mTc-MIBI scintigraphy. Total serum calcium normalized following parathyroidectomy (PTX), with resolution of symptoms. A systematic review of 107 patients with primary hyperparathyroidism-associated pancreatitis (PHPT-AP) showed the median age was 38 years (IQR 26-56, range 11-88), 41.1% male, and the median peak total calcium was 3.25 mmol/L (IQR 2.98-3.82, range 2.55-5.36). PTX was performed in 88.8% of the cases. PHPT is a treatable cause of acute pancreatitis and should be considered in cases of idiopathic or recurrent pancreatitis. Routine screening of total serum calcium and PTH levels is recommended for idiopathic or recurrent AP. For PHPT-AP patients with hypercalcemic crisis (>3.75 mmol/L or >15 mg/dL), early parathyroidectomy after medical stabilization (traditionally recommended within 72 hours, although modern evidence supports optimization over 48 hours up to 1 week) is safe and curative. For severe but non-crisis PHPT-AP (such as our index case with peak calcium 3.54 mmol/L), definitive parathyroidectomy should be scheduled during the same hospitalization or within 2-4 weeks after pancreatitis resolution. Among 99 survivors, 75 had explicit follow-up records with no pancreatitis recurrence reported; quantifiable follow-up duration was available for 36 of these patients (median 18 months, IQR 6-36).

Sarcoidosis disproportionately affects U.S. military Veterans. Its rising incidence and prevalence among Veterans are higher than in civilians and vary by branch of service, suggesting a role for prior military exposures. To investigate whether estimated service-related exposure to inorganic dust is associated with increased risk of sarcoidosis. In a retrospective nested case-control study of Veterans enrolled in the Veterans Health Administration (VHA) who received VHA- or Medicare-covered care, sarcoidosis cases identified in electronic health records between 2002 and 2022 were each matched to five controls by propensity scores and incidence density sampling by calendar year. To estimate inorganic dust exposure, military occupational codes (MOCs) were linked to a job exposure matrix (JEM). Multivariable conditional logistic regression analyses were adjusted for demographics, geography, rurality, and service branch. The attributable fraction among the exposed was calculated. In secondary analyses, latency from service separation to diagnosis was assessed. In sensitivity analyses, exposure misclassification was assessed by using a modified JEM weighted for MOC coding precision and by examining only post-9/11 Veterans; service duration was also analyzed. Among >16 million individuals evaluated, 3,019,636 Veterans had at least one MOC; 5,855 incident cases and 29,275 controls were analyzed. Inorganic dust exposure was associated with increased risk of sarcoidosis (conditional odds ratio [cOR]: 1.08; 95% confidence interval [CI], 1.003-1.170); the attributable fraction was 7.6%. Associations were stronger with a modified JEM score (cOR: 1.15; 95% CI 1.05-1.27) and when restricted to post-9/11 Veterans (cOR: 1.25; 95% CI 1.07-1.47). In latency analysis, sarcoidosis risk peaked 2-5 years post-service (cOR: 2.10; 95% CI: 1.20-3.58). Occupational and environmental exposure to inorganic dust during military service was associated with increased risk of sarcoidosis among Veterans, carrying potential implications for prevention and surveillance.

Hyperkalemia (HyperK) is a potentially life-threatening complication in advanced chronic kidney disease (CKD), yet its prediction in real-world outpatient settings remains challenging. In a retrospective cohort study including 395 patients with CKD stages 4-5, all with baseline serum potassium levels within the normal range, followed for up to 2.2 years. Clinical, biochemical, and pharmacological variables were obtained from electronic health records, and logistic regression with LASSO selection was applied to identify independent predictors of HyperK. Sex-stratified nomograms were developed to facilitate individualized risk estimation, and model performance was assessed using AUROC, calibration plots, and internal validation with 1,000 bootstrap resamples. During follow-up, 303 patients (76%) developed HyperK. Independent predictors included higher serum creatinine, calcium, and age, while higher sodium levels, hemoglobin, obesity, and thiazide use were associated with lower risk. In adjusted models, men had a 49% lower risk of HyperK (OR 0.51, 95% CI 0.28-0.92). Sex-specific nomograms demonstrated good discrimination, with AUROC of 0.78 in men and 0.81 in women, and calibration analyses confirmed adequate model fit. Importantly, both models showed a high negative predictive value (>95%), supporting their use in safely identifying low-risk patients who may require less intensive monitoring. Secondary analyses showed that higher phosphate was independently associated with mortality (OR 1.74, 95% CI 1.04-2.93), while increased creatinine predicted the need for kidney replacement therapy (OR 1.29, 95% CI 1.08-1.56). These findings provide validated, sex-specific nomograms that enable individualized risk prediction of HyperK in advanced CKD, supporting personalized management in outpatient nephrology care.

Pelvic organ prolapse (POP) is increasingly recognized as a disorder of pelvic connective tissue mechanobiology. Fibroblasts maintain extracellular matrix (ECM) homeostasis, but their dysfunction is a hallmark of POP. However, their role as mechanosensitive regulators remains incompletely understood. This narrative review summarizes current evidence on fibroblast mechanobiology and ECM remodeling in POP and synthesizes these findings into a potential multiscale framework linking mechanical loading to maladaptive tissue remodeling and prolapse progression. We conducted a narrative review on fibroblast mechanobiology and ECM failure in POP. A PubMed search up to February 2026 identified 882 records; 877 were screened after duplicate removal, and 64 PubMed-indexed articles were included, supplemented by reference-list screening. No formal systematic review protocol or PRISMA flow diagram was applied. Accumulating evidence indicates that POP is not merely an age-related degenerative condition but may involve impaired force transmission within pelvic connective tissues. Sustained mechanical overload disrupts the actin cytoskeleton and focal adhesion stability in fibroblasts, aberrantly activating mechanosensitive pathways such as TGF-β/Smad and RhoA/ROCK signaling. These signaling alterations promote fibroblast apoptosis, cellular senescence, or pathological myofibroblast differentiation, contributing to collagen type I/III imbalance, increased matrix degradation, and impaired collagen cross-linking. Based on these findings, we propose a multiscale mechanobiological framework linking abnormal mechanical loading, fibroblast dysfunction, ECM disorganization, and progressive pelvic support failure. Dysregulated fibroblast mechanobiology may contribute to POP pathogenesis. Integrating tissue biomechanics, cellular mechanotransduction, and ECM remodeling may inform early intervention strategies and biomechanically targeted therapies.

 Despite advances in the prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV), challenges persist in retention in care, antiretroviral therapy (ART) adherence and follow-up of HIV-exposed infants, particularly postpartum. In Angola, qualitative evidence on women's lived experiences remains limited.  To explore the experiences of HIV-positive postpartum women and identify opportunities to strengthen PMTCT services in Angola.  The study was conducted at Lucrécia Paim Maternity Hospital, a major maternal and child health referral centre in Luanda, Angola.  A qualitative study with an experiential orientation informed by phenomenological sensitivity was conducted between April 2025 and July 2025. Semi-structured interviews were conducted with 20 women up to 6 months postpartum, recruited through purposeful sampling from institutional records. Interviews were transcribed verbatim and analysed using reflexive thematic analysis following Braun and Clarke, supported by qualitative data analysis (MAXQDA) software.  Four themes emerged: discovery and acceptance of diagnosis, marked by emotional distress and gradual adaptation; pregnancy and childbirth, characterised by supportive care and episodes of stigmatisation; postpartum and baby care, involving heightened responsibility and challenges with medication and infant feeding; and infant testing, experienced with anxiety until confirmation of serological status. Post hoc comparisons by age group and partner status suggested variations in psychosocial needs and care experiences.  Postpartum PMTCT is influenced by emotional, relational and institutional determinants affecting continuity of care. Strengthening integrated, woman-centred models with psychosocial support, consistent communication and stigma reduction is essential.Contribution: This study provides context-specific qualitative evidence to improve postpartum PMTCT services in Angola and similar settings.

Model-informed precision dosing is often constrained by the limited generalizability of traditional population pharmacokinetic models, especially in critically ill patients. A hybrid machine learning-population pharmacokinetic framework is proposed to improve a priori pharmacokinetic predictions by integrating real-world clinical data. This approach was applied to vancomycin trough concentration prediction. Two widely used two-compartment population pharmacokinetic models provided individual pharmacokinetic parameter estimates. Maximum a posteriori Bayesian estimation was used to adjust population parameters for individual patients based on drug administration records, therapeutic drug monitoring values, and patient-specific covariates from the MIMIC-IV database. The resulting clearance and central volume of distribution estimates served as training targets for XGBoost and symbolic regression models. Machine learning-predicted parameters were reinserted into the original pharmacokinetic equations to generate a priori vancomycin trough concentrations without reliance on therapeutic drug monitoring input. The hybrid models demonstrated improved prediction accuracy over traditional population pharmacokinetic covariate models and reduced vancomycin trough concentration prediction error by up to ~20%. XGBoost generally provided the highest predictive performance, while symbolic regression produced interpretable mathematical expressions revealing associations between non-traditional clinical predictors and pharmacokinetic parameters, highlighting a trade-off between accuracy and interpretability. This framework illustrates the potential of combining machine learning with population pharmacokinetic modeling to refine pharmacokinetic parameter estimation and support more precise, individualized dosing. The workflow is adaptable to other drugs and patient populations, offering a generalizable methodological strategy to identify non-traditional predictors and enhance existing pharmacometric model performance in real-world clinical settings.

This study aimed to assess the short-term 3-dimensional (3D) stereophotogrammetric soft-tissue, cephalometric, and airway effects of corticotomy-assisted rapid maxillary expansion (RME) and facemask (FM) therapy in late-adolescent patients with Class III malocclusion. This prospective controlled clinical trial included 16 late-adolescent patients with Class III malocclusion (mean age, 14.90 &#xb1; 0.64 years) treated with corticotomy-assisted RME and Petit-type FM therapy and 16 untreated Class III controls (mean age, 14.03 &#xb1; 0.90 years). Lateral cephalograms and 3D stereophotogrammetric records were obtained at pretreatment and posttretment or at corresponding time points during the observation period. Paired t tests or Wilcoxon signed rank tests were used for within-group comparisons, and independent t tests or Mann-Whitney U tests were used for between-group comparisons (P <0.05). In the corticotomy group, SNA (2.36&#xb0;), A-Na perp (2.67 mm), ANB (4.08&#xb0;), SN-GoGn (3.41&#xb0;), and overjet (5.97 mm) increased, whereas SNB (-1.71&#xb0;), Pg-Na perp (-2.61 mm), and IMPA (-4.32&#xb0;) decreased. A 3D soft-tissue analysis revealed increases in ANB angle (2.50&#xb0;), maxillary length (1.16 mm), mandibular height (2.94 mm), and nasal ala and alar base width (1.57 and 1.97 mm), whereas mandibular corpus length (-2.58 mm), facial convexity (-4.84&#xb0;), and bigonial width (-3.94 mm) decreased. After treatment, bilateral Al showed lateral displacement along the horizontal (x) axis, whereas bilateral alare curvature and subnasale showed anterior displacement along the sagittal (z) axis, with nonsignificant 2.5 mm between-group difference observed at Pg. An approximately 1-mm increase in nasopharyngeal airway length was observed, but no significant between-group differences were found. Despite reduced growth potential, corticotomy-assisted RME and FM therapy produced measurable short-term skeletal and 3D soft-tissue improvements in patients with true skeletal Class III malocclusion in late adolescence and may serve as an intermediate adjunctive option; however, long-term stability and randomized comparative data are required.

Off-the-ball behaviors are central to tactical and technical performance in professional football, shaping individual and collective movements supporting coordinated play. Although spatiotemporal tracking data has made these dynamics observable, the literature remains fragmented, with inconsistent definitions and narrow analytical approaches. This scoping review summarizes how off-the-ball behaviors have been examined through tracking data and highlights computational methods and limitations.Following PRISMA-ScR, a systematic search was conducted in PubMed, Scopus, Web of Science and SportDiscus up to January 2026. Eligible studies involved elite players, tracking data, and analyzed off-the-ball behaviors while providing technical, tactical or kinematic insights. Peer-reviewed empirical studies in English were included. Search identified 4283 records, of which 32&#x2009;met the criteria. Publications increased after 2020, covering European leagues such as Germany, Spain and the other major competitions. Across studies, 7705 matches were analyzed, with sample sizes ranging from single matches to over 4,000 matches. Tracking systems sampled at various frequencies, with 25&#x2009;Hz being the most common, and all studies combined positional and event data. Off-the-ball behaviors were assessed at player, subgroup and team levels across phases of play, revealing methodological heterogeneity.Research on off-the-ball behaviors employs diverse spatiotemporal metrics and modeling techniques but remains dispersed across disconnected frameworks. Defensive phases are examined more frequently than attacking ones, and common limitations include context-specific samples, simplified outcomes and limited integration of opponents and situational constraints. Future work would benefit from shared conceptual frameworks, richer contextual modeling and methods that balance sophistication with interpretability for football analytics.

&#xa0;The separation of humans and dogs in a domestic setting may be impossible due to their long history of domestication. This close interaction can lead to conflicts and dog bites, which can cause injuries, trauma or even death. Dog bites are often underestimated, posing a significant public health risk. This study examined dog bite incidents involving humans in the Khakhu Madala area of the Thulamela sub-district in Limpopo Province, conducted within primary healthcare (PHC) facilities. &#xa0;A qualitative, exploratory and descriptive approach was used to investigate dog bite incidents in the Khakhu Madala local area. The study focused on registered dog-bite victims from PHC records between January 2020 and December 2021. Participants were selected through non-probability purposive sampling. Unstructured interviews conducted with 25 participants provided rich insights. Data analysis followed Tech's eight-step criterion, ensuring trustworthiness through transferability, reliability, confirmability and credibility. &#xa0;Key themes included a lack of owner responsibility in controlling dogs, increased dog aggression contributed to the consumption of indigenous plants and other variations and structural environmental factors. &#xa0;The study found that improving safety requires collaboration among health professionals, community engagement and evaluation of legislation. Further research on dog bite incidents is necessary.Contribution:&#xa0;The article highlights the prevalence of dog bites. This will assist in raising public health awareness and in informing policies and legislation to better equip them to put measures in place regarding dog bite incidents. The article also contributes to bringing education on safe dog interactions, improving treatment protocols and informing stricter enforcement of dog control laws.

The contribution of dietary sodium to asthma development remains unclear, particularly for adult-onset disease. We examined associations between estimated 24-h urinary sodium excretion, table salt use and incident asthma in a large prospective cohort. We analysed 420&#x2009;041 adults aged 40-69&#x2005;years without prior asthma. Incident asthma was ascertained through linked health records. Urinary sodium was estimated using the INTERSALT equation from spot urine samples. Frequency of adding salt at the table was self-reported. Associations were evaluated using multivariable Cox proportional hazards models with adjustment for sociodemographic, lifestyle and clinical factors. Over a median 10.9-year follow-up, 11&#x2009;927 participants developed asthma. Compared with the lowest quintile, the highest quintile of estimated urinary sodium was associated with increased asthma incidence (hazard ratio (HR) 1.50, 95% CI 1.41-1.59). Associations were stronger in females (HR 1.55, 95% CI 1.44-1.68) than males (HR 1.28, 95% CI 1.17-1.39; p-heterogeneity=0.0011) and in individuals with low eosinophil counts <300&#x2005;cells&#xb7;&#xb5;L-1 (HR 1.55, 95% CI 1.43-1.66) compared with those &#x2265;300&#x2005;cells&#xb7;&#xb5;L-1 (HR 1.24, 95% CI 1.10-1.40; p-heterogeneity=0.0017). Associations were also stronger in never-smokers (HR 1.64, 95% CI 1.51-1.79) than former (HR 1.46, 95% CI 1.33-1.60) or current smokers (HR 1.16, 95% CI 1.00-1.36; p-heterogeneity=0.0008). Frequent table salt use ("always" versus "never/rarely") was associated with higher asthma incidence (HR 1.28, 95% CI 1.19-1.37), with no meaningful subgroup differences. Higher estimated urinary sodium excretion and frequent table salt use were associated with greater asthma incidence. Stronger associations in women and individuals with low eosinophil counts suggest potential phenotype-specific susceptibility. Randomised studies are warranted to test whether sodium reduction lowers asthma risk in these subgroups.

Background Clinical histories accompanying imaging orders guide protocol selection and diagnostic focus. However, they are often incomplete, potentially compromising diagnostic accuracy and workflow efficiency. Purpose To evaluate whether large language models (LLMs) can improve the clinical utility of provided imaging indications by leveraging clinical notes. Materials and Methods This retrospective study curated a dataset from deidentified electronic health records at the University of California San Francisco (January 2012 to August 2024), consisting of radiology reports with paired referring clinician-provided and radiologist-curated indications linked to clinical notes. The dataset was stratified across five body systems and five pathophysiologic categories to derive LLM selection and reader study internal test sets. For the reader study, 20 radiologists with 2-25 years of experience compared indications from the referring clinician, radiologist, and best-performing LLMs. Readers scored comprehensiveness, factuality, and conciseness and ranked indications for usefulness in protocoling, usefulness in interpretation, and overall ranking. Models and clinicians were compared using cumulative link mixed models with Tukey-adjusted post hoc comparisons. Results From 28&#x2009;313 patients (mean age, 59 years &#xb1; 20.6 [SD]; 14&#x2009;912 women), 250 examinations from 247 patients were sampled for the reader study. After nine exclusions, 241 examinations were analyzed, yielding 482 reader-examination evaluations. Indications from the best-performing proprietary (Claude 3.5 Sonnet; Anthropic) and open-source (Qwen 2.5-7B Instruct; Alibaba) LLM were rated as more comprehensive (Likert rating of 5: 37.14% and 28.42%, respectively; both P < .001) and factual (68.05% and 59.75%; both P < .001) than referring clinician indications. The proprietary LLM ranked most useful in protocoling (rank 1: 40.87%; all P < .001), useful in interpretation (44.61%; all P < .001), and overall ranking (44.19%, all P < .001). Comprehensiveness (65.77% of ratings; both P < .001) most strongly influenced overall rankings. Conclusion LLMs generated radiology-relevant indications from clinical notes that were more comprehensive and factual than clinician indications, and when generated by the proprietary LLM, were ranked most useful in protocoling and imaging interpretation. &#xa9; RSNA, 2026 Supplemental material is available for this article. See also the editorial by Yilmaz and Cardoza-Ochoa in this issue.

To characterize age- and sex-specific patterns of microcytic anemia during adolescence and to estimate the potential yield of screening across age groups.&#xa0;We performed a retrospective Electronic Health Record (EHR)-based study using data from Clalit Health Services (CHS), the largest health maintenance organization in Israel. Adolescents aged 12-18&#xa0;years with at least one hemoglobin and mean corpuscular volume (MCV) measurement between 2003 and 2023 were included. Individuals with hereditary, hemolytic, or chronic inflammatory causes of anemia were excluded. Microcytic anemia was defined as hemoglobin&#x2009;<&#x2009;12&#xa0;g/dL for females and&#x2009;<&#x2009;13&#xa0;g/dL for males with MCV&#x2009;<&#x2009;78 fL. Age- and sex-specific prevalence was calculated among tested adolescents and in the total CHS-insured population. Screening efficiency was assessed using the number needed to test (NNT).&#xa0;A total of 1,306,623 test records were analyzed. Among females, the prevalence of microcytic anemia increased with age, from 7.8% at ages 12-13 to 12.5% at ages 17-18. Among males, prevalence declined from 18.9% at age 12-13 to 2.1% at ages 17-18. This resulted in a reversal of the sex distribution of microcytic anemia prevalence during mid-adolescence, with females exceeding males from approximately age 15 onward. The NNT increased with age among males and remained relatively stable during mid- to late adolescence among females. &#xa0;Microcytic anemia demonstrates distinct age- and sex-specific patterns during adolescence. The increasing prevalence among females and declining prevalence among males suggest that targeted screening of adolescent girls during mid-adolescence may be an efficient strategy for identifying microcytic anemia, a condition commonly associated with iron deficiency in this age group. &#x2022; Iron deficiency anemia remains common in adolescents, particularly among females in high-income countries. &#x2022; Prevalence estimates vary widely due to differences in definitions, populations, and study designs. &#x2022; There are no universally accepted guidelines for routine anemia screening in adolescents, and current practices are inconsistent. &#x2022; A reversal in sex-specific prevalence of microcytic anemia occurs during mid-adolescence, with higher rates in females from approximately age 15 onward. &#x2022; Screening efficiency, quantified by number needed to test, varies substantially by age and sex, supporting targeted screening of adolescent girls at age 14.

Latent tuberculosis infection (LTBI) screening plays a vital role in global efforts to eliminate tuberculosis (TB). While LTBI treatment has been associated with lower rates of reactivation of TB and all military branches screening programs for LTBI screening, there is limited military data on factors associated with screening positivity and treatment completion. This retrospective study examined positive Quantiferon-Plus (QFT-Plus) assays in the San Antonio Military Health System between January 2022 and June 2024. Electronic medical records were reviewed for information, including demographics, indications for testing, TB risk factors, deployment and travel history, quantitative QFT-Plus results, final diagnosis, and treatment course. QFT-Plus assays were considered false positive in patients with repeat tests that were negative. A total of 6,321 QFT-Plus assays were performed in the study period with 192 (3%) unique patients identified to have positive QFT-Plus assays. Ninety-seven (51%) patients were ultimately diagnosed with LTBI with most patients being active-duty military. The most common indication for testing was occupational screening, such as for health care workers. Patients with an initial greater TB-nil value were more likely to have true disease rather than a false positive (0.968 [0.52-3.5] vs. 0.435 [0.38-0.62], P&#x2009;=&#x2009;.0007). Of patients diagnosed with LTBI, a total of 58 (60%) initiated treatment and 41 (42%) had documented completion of treatment. Factors associated with incomplete treatment were use of an isoniazid-only regimen (n&#x2009;=&#x2009;6, 60% non-completion rate) and reassignment to a new duty station after LTBI diagnosis (n&#x2009;=&#x2009;11, 79% non-completion rate). This study offers a modern evaluation of LTBI screening in a military setting and provides targets for future interventions including those who change duty stations or use an isoniazid-based regimen. Military clinicians should be aware that patients with a low positive TB-nil on QFT-Plus assays are frequently false positive and require repeat testing.

This study aimed to evaluate blood pressure profiles in children with isolated renal ectopia by using ambulatory blood pressure monitoring (ABPM) to determine the prevalence and patterns of hypertension, and to explore the relationships between ectopy subtype and kidney function. Clinical and ABPM data from 24 children with isolated renal ectopia followed between January 2024 and January 2025 at &#xc7;ukurova University Department of Pediatric Nephrology were evaluated. Type of ectopia, presence of decreased renal parenchymal uptake on dimercaptosuccinic acid (DMSA) scintigraphy, estimated glomerular filtration rate (eGFR) and presence of end organ damage were also&#xa0;assessed. On the day of ABPM, standard deviation scores (SDS) were recorded for anthropometric measurements and office and 24-hour BP values. Of 24 patients (66.7% male), 75% had simple ectopia and 25% had crossed-fused ectopia. Mean age was 11.3 &#xb1; 3.7 years. Masked hypertension was identified in 45.8%. eGFR negatively correlated with 24-hour systolic BP SDS (r = -0.456, P = .02), nighttime diastolic BP SDS (r = -0.417, P = .04), and nighttime systolic BP SDS (r = -0.487, P = .01). Decreased parenchymal uptake was present in 50% of patients and was associated with lower height SDS (P = .03), higher nighttime systolic BP SDS (P = .01) and increased frequency of systolic non-dipping (91.7% vs. 45.5%; P = .02). The crossed-fused renal ectopia group had a higher prevalence of vesicoureteral reflux (P = .009) and lower eGFR (P = .01). Children with isolated renal ectopia show a high prevalence of ABPM abnormalities, particularly masked hypertension and altered nocturnal blood pressure patterns. Regular monitoring of growth, kidney function, and blood pressure is essential to detect both early and late complications.