International braz j urol : official journal of the Brazilian Society of UrologyMarcos Tobias-Machado, Ricardo C Brianson, John Eder Gamarra Bravo, Alcedir Raiser, Eliney Faria
INTRODUCTION: Horseshoe kidney is an uncommon congenital fusion anomaly that can make renal tumor surgery especially challenging because of altered rotation, limited mobility, variable vascular supply, and an unpredictable collecting system (1-7). This video presents a robot-assisted partial nephrectomy for a high-complexity renal tumor in this setting. CASE PRESENTATION: A 33-year-old man, with ECOG 0 and no relevant comorbidities, was diagnosed with a 7.5-cm solid renal mass in the central posterior portion of the left moiety of a horseshoe kidney. The lesion had a RENAL score of 10p. Contrast-enhanced computed tomography and three-dimensional reconstruction were used to understand the relationship between the tumor, aberrant vessels, renal hilum, and collecting system, supporting the decision to attempt nephron-sparing surgery (5, 8). Surgical technique and results: The procedure was performed through a transperitoneal robotic approach with the patient in right lateral decubitus using the Da Vinci Si platform. Port placement followed a standard renal robotic configuration, with a paramedian supraumbilical camera port, three robotic working ports along a craniocaudal lateral axis, a caudal fourth-arm port, and two medial assistant ports for suction, exposure, and support during renorrhaphy. After exposure of the horseshoe kidney and left hilar dissection, two arterial branches and one renal vein were identified. Tumor excision was performed under vascular control, with 20 minutes of warm ischemia and no collecting system opening, followed by two-layer absorbable renorrhaphy with adjunctive hemostatic agents. The operative time was 150 minutes. No transfusion, conversion, drain placement, or relevant immediate complication occurred. The urinary catheter was removed after 24 hours, and the patient was discharged 72 hours after surgery. Pathology showed clear cell renal cell carcinoma, Fuhrman grade 3, pT2N0M0, with negative surgical margins. During 12 months of oncologic follow-up, renal function remained stable and semiannual imaging showed no evidence of recurrence. Contemporary video reports have also emphasized the feasibility of advanced robotic renal surgery and complex partial nephrectomy strategies in selected patients (9, 10). CONCLUSION: In a carefully selected patient, robot-assisted partial nephrectomy supported by three-dimensional planning was feasible for a complex renal tumor in a horseshoe kidney, with negative surgical margins, preserved renal function, and no recurrence during 12 months of follow-up.
The Journal of dermatological treatmentMaria Elisabetta Greco, Francesca Feresin, Alberto di Caro, Francesca Paola Sasso, Ilaria Proietti, Luigi Angelo Fiorito, Nicola Perrotta, Giovanni Pellacani, …
INTRODUCTION: Vitiligo is an acquired depigmenting disorder characterized by white macules resulting from the loss of functional melanocytes. MATERIAL AND METHODS: This multicenter, real-life observational study evaluated the efficacy of topical Ruxolitinib (15 mg/g) in 100 patients with non-segmental facial vitiligo treated twice daily for three months, combining clinical scales and noninvasive imaging techniques. Assessments at baseline, 30 days, and 90 days included Facial Vitiligo Area Scoring Index (F-VASI), Facial Vitiligo Extent Score - Body Surface Area (F-VES BSA), Vitiligo Extent Score (VES) grade, Physician's and Patient's Global Vitiligo Assessments, and Dermatology Life Quality Index. RESULTS: Significant improvements were observed across most clinical indices, with marked reductions in disease extent and severity scores (p < 0.0001). Quality of life also improved substantially, as reflected by DLQI reduction. Although F-VASI showed a smaller mean change, it remained statistically significant. DISCUSSION: Instrumental evaluation, including VISIA imaging, Wood's lamp examination, reflectance confocal microscopy, and LC-OCT, confirmed clinical findings by demonstrating repigmentation and a reduction in affected areas. Overall, topical Ruxolitinib proved effective in reducing facial vitiligo lesions and improving patient-reported outcomes. CONCLUSIONS: These findings support the therapeutic potential of JAK inhibitors, although further controlled studies are warranted to confirm long-term efficacy and safety.
Dialogues in clinical neuroscienceNatalia G Docteur, Hayley G P Huston, Avery A Krupa, Brandy L Callahan
Attention-deficit/hyperactivity disorder (ADHD) affects 2.5% of adults and is associated with cognitive decline and dementia. The neurobiological mechanisms contributing to adverse outcomes in ADHD are poorly understood. ADHD-related brain alterations may persist into later life and interact with ageing-related processes, potentially increasing susceptibility to neuropathology. This preregistered systematic review synthesised neuroimaging findings in adults aged 35 years and older with clinical, symptomatic, or genetic risk for ADHD, and summarised cognitive and clinical correlates. A search of five databases produced 13 included studies. Risk of bias was assessed using the Newcastle-Ottawa Scale. Most studies (11/13) had low risk of bias. Compared to controls, ADHD groups exhibited alterations in fronto-striatal, fronto-parietal, and limbic systems implicated in executive control and attention. Middle-aged adults with clinical ADHD showed more widespread cortical structural differences, whereas older adults demonstrated abnormalities primarily in frontal regions, possibly reflecting attenuation of differences through ageing. Two functional studies in those with clinical ADHD reported frontal hypoactivation alongside parietal hyperactivation, consistent with compensatory recruitment. Among undiagnosed samples, there were interactions between genetic risk for ADHD and Alzheimer's disease-related pathology affecting brain and cognitive outcomes. Overall, ADHD-associated neurobiological alterations appear to persist into older age. Longitudinal investigations are needed to clarify these relationships.
BACKGROUND: Cognitive impairment is a relatively prevalent comorbidity in chronic obstructive pulmonary disease (COPD), yet its neuropathological mechanism remains poorly understood. METHODS: We enrolled 48 stable COPD patients, categorized into cognitively normal (CogN, n = 22) and impaired (Cog, n = 26) groups based on Montreal Cognitive Assessment (MoCA) scores, along with 34 matched healthy controls. All participants underwent 3T MRI with quantitative susceptibility mapping (QSM) to quantify regional brain iron content. Group comparisons of whole-brain and region-of-interest susceptibility were performed. Mediation analysis was then used to test whether specific brain iron deposition mediates the relationship of both COPD status and peripheral inflammatory markers with cognitive performance. RESULTS: Cog patients showed increased total iron in the right cerebellum crus I, while CogN patients exhibited higher paramagnetic susceptibility (χpara) in the left orbitofrontal cortex (OFC), right precentral gyrus, and right brainstem. χpara in the left OFC and right brainstem were positively correlated with total MoCA, abstraction, and orientation scores. Mediation analysis demonstrated that χpara of the left OFC mediated the effects of both COPD status and systemic neutrophil counts on impaired abstraction. Additionally, right brainstem χpara mediated the relationship between COPD and deficits in orientation. CONCLUSIONS: COPD patients with cognitive impairment exhibited distinct patterns of brain iron deposition. Importantly, deposition in several key regions served as a potential mediator, linking both COPD and systemic inflammation to specific cognitive deficits. These preliminary findings suggest a possible association between brain iron accumulation and cognitive impairment in COPD, offering candidate neuroimaging markers for early identification. .
The Journal of dermatological treatmentNazila Poostiyan, Zahra Nikyar, Reza Makhmali, Mohsen Hosseini, Zabihollah Shahmoradi
BACKGROUND: Androgenetic alopecia (AGA) is the most common type of hair loss in men. Finasteride and dutasteride are oral 5-alpha-reductase inhibitors. This study compared their efficacy and safety in Iranian men with moderate to severe AGA. METHODS: This randomized single-blind clinical trial included 46 men aged 20-50 years. Patients received finasteride 1 mg daily or dutasteride 0.5 mg daily for 24 weeks. Hair density and thickness were measured by trichoscopy and photographs. Satisfaction was recorded with a visual analog scale (VAS). Adverse effects were documented. RESULTS: Both groups improved in hair growth after 24 weeks with no significant difference. Serum PSA fell in the dutasteride group from 0.63 ± 0.18 to 0.42 ± 0.22 (p < 0.001). No significant change appeared in the finasteride group. Dutasteride produced greater PSA reduction than finasteride (B = 0.17, p < 0.01). Age had no effect on PSA (p = 0.58). VAS scores showed no difference. Safety profiles were similar. Sexual side effects were most common, with erectile dysfunction more frequent in the finasteride group. No serious events occurred. CONCLUSION: Finasteride and dutasteride improved hair density with similar safety. Dutasteride caused stronger PSA reduction, suggesting more potent 5-alpha-reductase inhibition.
Journal of medical economicsPatrik Zamecnik, Jürgen Feuerstein, Michael Berghahn, Jelle Barentsz
BACKGROUND AND OBJECTIVE: Accurate nodal staging in intermediate- to high-risk prostate cancer (PCa) is crucial for treatment decisions. While extended pelvic lymph node dissection (ePLND) is the standard, it is invasive and has a low diagnostic yield. A 2019 analysis suggested that non-invasive imaging such as PSMA-PET/CT and ferumoxtran-enhanced macrophage-MRI (m-MRI) is cost-effective, but at the possible expense of a small QALY loss compared to ePLND, based on limited evidence. Recent Phase 3 trials have provided new data, prompting a reevaluation. Therefore, the aim of this article is to update a model with recent trial data to assess the cost-effectiveness of m-MRI and PSMA-PET/CT versus ePLND in Germany. MATERIAL AND METHODS: We adapted a Markov model to simulate lifetime outcomes for men with intermediate- to high-risk PCa from a German insurer's perspective, with costs updated to 2025 level. Diagnostic accuracy data were derived from recent multicenter trials. Costs and QALYs were calculated using a 3% discount rate. Sensitivity analyses tested uncertainties. A practical interactive online-tool is provided for clinical decision-making and research purposes, which can incorporate various input data (https://macrophage-mri.app). RESULTS: Both imaging options were dominant over ePLND (€37,855; 18.11 QALYs). PSMA-PET/CT was €7,869 cheaper and gained 0.800 QALYs; m-MRI was €9,985 cheaper and gained 0.990 QALYs. m-MRI was superior, saving €2,116 and gaining 0.19 QALYs over PSMA-PET/CT. The probabilistic analysis showed that m-MRI was optimal over 95% of the time at an €80,000/QALY threshold; the probability of PSMA-PET/CT being optimal was less than 5%. CONCLUSIONS: An imaging-first approach outperforms routine ePLND, with m-MRI as a cost-effective option. PSMA-PET/CT's low sensitivity limits its usefulness, though it is still cheaper than ePLND. These results support including m-MRI in guidelines for initial staging.
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal ObstetriciansMaría De la Calle, Eva Manuela Pena-Burgos, Sara Ruiz Martínez, Ana Gallardo Navarro, Jose Luis Bartha
INTRODUCTION: Fetal presentation of the first twin plays a key role in delivery planning. While vertex presentation is considered favorable for vaginal delivery, presentation changes may occur during the third trimester. However, the factors influencing these changes-particularly in relation to chorionicity-remain poorly defined. MATERIAL AND METHODS: This was a retrospective cohort study including 263 twin pregnancies (166 dichorionic diamniotic (DCDA), 97 monochorionic diamniotic (MCDA)) followed at a tertiary center between 2000 and 2025. Third-trimester ultrasounds were performed at 32 weeks and prior to delivery. We evaluated changes in the presentation of the first twin and analyzed variables that may be associated with fetal dynamics or stability, including parity, amniotic fluid volume, placental location, estimated fetal weight, and second twin presentation. RESULTS: The first twin maintained the same presentation in 53.6% of DCDA and 57.7% of MCDA pregnancies. Among those initially non-vertex, a spontaneous change to vertex presentation occurred in 53.4% of DCDA and 71.4% of MCDA cases. No statistically significant associations were found between presentation changes and the maternal or ultrasound-related variables studied. When vertex presentation was observed in the third trimester, it remained stable in over 95% of cases. CONCLUSIONS: The presentation of the first twin remains dynamic throughout until delivery, especially in non-vertex cases. However, a vertex presentation after 32 weeks is highly predictive of stability until delivery. Serial third-trimester ultrasound are essential for accurate delivery planning and should guide shared decision-making with expectant parents.
Journal of investigative surgery : the official journal of the Academy of Surgical ResearchXiaoyin Tang, Bingwei Lu, Min Ding, Yan Lin, Ping Li
PURPOSE: To evaluate the reduction in ablated lesion volume after ultrasound-guided percutaneous radiofrequency ablation (RFA) for benign breast tumors and identify factors associated with shrinkage. METHODS: This retrospective study included 64 patients (244 benign breast tumors) treated with RFA from December 2014 to February 2021. All tumors were biopsy confirmed before ablation. Follow-up at 1, 3, 6, and 12 months measured nodule volume changes and recorded complications, with analyses at the individual nodule level. RESULTS: All patients were discharged within 24h without major events. Grade I pain occurred in two patients (3.13%), with no higher-grade complications observed. The complete ablation rate at 1 month was 98.77% (241/244). At 12 months, lesion volume decreased significantly (p < 0.001), with a mean volume reduction ratio (VRR) of 97.14% and a complete sonographic disappearance rate of 81.97% (200/244). Multiple mixed-effect linear regression showed that lesions with a maximum diameter > 20 mm and an absence of blood vessels within 5 mm of the nodule were significantly associated with a lower 12-month VRR. CONCLUSIONS: Ultrasound-guided RFA is safe and effective for benign breast tumors. Ablated lesions effectively shrink, with nodule size and the presence of blood vessels around the nodules being associated with the 12-month VRR.
BACKGROUND: Left ventricular thrombus (LVT) is a significant complication in ischemic cardiomyopathy (ICM). However, factors associated with LVT have mainly been reported in patients with recent myocardial infarction (MI), while data in chronic ICM remain limited. This study aimed to identify factors associated with CMR-detected LVT in patients with chronic ICM (left ventricular ejection fraction [LVEF] < 50% of ischemic etiology, >40 days post-MI), develop a CMR-based risk score, and evaluate the prognostic implications of LVT on major adverse cardiovascular events (MACE). METHODS: This study included 790 patients with ICM who underwent CMR at an academic hospital in Thailand between 2016 and 2023. Factors associated with LVT were identified using logistic regression analyses. A CMR-based risk score was developed and validated, with discriminative performance assessed by the area under the receiver operating characteristic curve (AUC-ROC). MACE, defined as a composite of cardiovascular death, ischemic stroke, transient ischemic attack, systemic embolism, nonfatal MI, or heart failure hospitalization, was also evaluated. Factors associated with MACE were assessed using Cox regression analysis. RESULTS: The mean age was 66.9 ± 11.3 years, and 75.3% were male. LVT was detected in 116 patients. Independent factors associated with LVT included apical aneurysm, apical late gadolinium enhancement (LGE), and the number of LGE segments. The CMR-LVT Score, incorporating these variables, demonstrated an AUC of 0.73 (95%CI, 0.68-0.77;p < 0.001) in the derivation cohort and 0.79 (95%CI, 0.69-0.90;p < 0.001) in the validation cohort. During a median follow-up of 3.2 years (IQR, 1.6-5.5), 150 MACE occurred. Baseline LVT was independently associated with MACE (adjusted HR 2.38, 95%CI 1.31-4.30;p = 0.004). CONCLUSIONS: In patients with ICM undergoing CMR, apical aneurysm, apical LGE, and LGE extent were independently associated with LVT. The CMR-LVT Score demonstrated acceptable discriminative performance for identifying higher-risk patients who may benefit from more intensive follow-up. LVT was also independently associated with MACE.
The veterinary quarterlyElisabeth Maria Burgers, Samantha Miles, Ruben van den Broek, Chloé Najac, Beatrice Lena, Thomas O'Reilly, Andrew Webb, Stefanie Veraa
Prohibitive costs associated with high-field MRI systems have resulted in reduced access in resource-limited areas with consequential healthcare inequities. This has renewed interest in purposefully designed low-field (LF) systems that, despite inherently lower signal-to-noise ratios, have advantages in terms of cost, portability, and accessibility. This pilot study successfully translated a previously developed LF (0.05 T) MRI canine cadaver brain protocol for in vivo application and compared the acquired images with paired 1.5 T images from 21 different canine patients. The visibility of 15 anatomic features was ordinarily scored (scale 1-3) on transverse T1-weighted post-contrast (21/21 patients) and T2-weighted (17/21 patients) sequences. Lateral ventricles were easily visualized (89.3%-100% scored 3/3) across all sequence‒system combinations, with T2-weighted sequences also providing good identification of the mesencephalic aqueduct (56.3%-100%), fourth ventricle (77.1%-100%), and thalamus (68.8%-100%). Absolute visual grading characteristics (VGC) analysis confirmed comparable performance of the LF system to the 1.5 T MRI for these features, a particularly relevant finding given the system's originally intended application for pediatric hydrocephalus neuroimaging in resource-limited areas. This study represents the first in vivo usage and evaluation of a 0.05 T MRI in a clinical veterinary context.
International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia GroupYezhao Li, Tianquan Cai, Zhengfeng Huang, Hongzhi Yang
OBJECTIVE: Microwave ablation (MWA) is a minimally invasive therapy for liver metastases. Image guidance, primarily ultrasound (US) and computed tomography (CT), is critical for precision, but their comparative safety profiles remain debated. This study aims to compare the incidence and severity of complications between US-guided and CT-guided MWA in patients with liver metastases. METHODS: After propensity score matching (PSM), retrospective analysis of 120 patients (2022-2024) undergoing US-guided (n = 60) or CT-guided (n = 60) MWA at a single tertiary referral center. Complications were classified using the Clavien-Dindo system. Statistical analysis included Student's t test, χ2 tests, and logistic regression. RESULTS: Major complications (Clavien-Dindo ≥ III) occurred in 5% of US-guided vs. 13.3% of CT-guided cases (p = 0.04). US guidance correlated with fewer pneumothoraxes (0% vs. 8.3%, p = 0.02) and reduced radiation exposure (p < 0.001). There was no statistically significant difference in the 12-month local tumor progression (LTP) rate between the two groups (p = 0.79). CONCLUSION: US-guided MWA demonstrates comparable tumor control to CT guidance with fewer complications and avoids radiation exposure, supporting its preferential use for high-risk patients.
Annals of medicineKo Eun Kim, Yerin Lee, Hyunyoung Kang, Dai Hyun Kim, Hwan Kyu Roh, Sejung Yang, Beom Suk Kim
BACKGROUND: Chronic venous insufficiency (CVI) produces heterogeneous lower-extremity skin changes that often mimic inflammatory dermatoses, complicating the differentiation between venous etiologies and conditions requiring dermatologic care. Coexisting venous signs further confound visual interpretation, leading to diagnostic variability. To address this unmet clinical need, we developed and externally validated a pose-guided, high-resolution deep learning pipeline to classify CVI-related skin lesions from routine clinical photographs. MATERIALS AND METHODS: A deep learning framework was developed using a multicentre dataset (8672 images) from Korea University Guro Hospital, Chung-Ang University Gwangmyeong Hospital and Heartwell Vein Clinic. The pipeline integrated Sapiens-based pose estimation for limb localization and a U-Net model refined with Segment Anything Model 2 (SAM2) for skin segmentation. Multiple backbone architectures were evaluated, and ResNet-34 was selected based on optimal performance, taking refined masks and RGB images as input. Performance was evaluated on an internal test set, an independent clinical dataset (n = 183), and the Fitzpatrick17k dataset. RESULTS: ResNet-34 emerged as the optimal architecture, achieving an internal AUROC of 0.922 with balanced sensitivity (0.679) and specificity (0.943) at 1024 × 1024 resolution. Pose-guided skin segmentation improved discrimination compared to using raw images (AUROC 0.920) or skin masking alone (AUROC 0.905). Multicentre training enhanced generalizability, yielding an external AUROC of 0.877 and maintaining high performance on the Fitzpatrick17k dataset (sensitivity 0.918). CONCLUSIONS: Our pose-guided, high-resolution pipeline enables robust, objective detection of CVI-related skin lesions. By demonstrating high generalizability across multicentre and public datasets, this framework serves as a reliable decision-support tool to standardize clinical phenotyping and facilitate consistent triage and management of chronic venous disease across diverse care settings.
Although cardiovascular complications are the most common cause of morbidity and mortality in chronic kidney disease (CKD), the detection of subclinical cardiorenal remodeling is still limited. This is a single-center, exploratory observational study of 127 patients with CKD of various etiologies (hypertensive nephropathy, diabetic nephropathy and chronic glomerulonephritis) and 30 healthy controls. In addition to transthoracic echocardiography at rest and after exercise, biomarkers of podocyte injury (urinary nephrin), fibrosis (urinary type IV collagen and serum galectin-3), cardiac wall stress (serum NT-proBNP) and renal filtration/cardiovascular risk integration (serum cystatin C) were assessed. Biomarker abnormalities were consistent across all CKD groups, even in the absence of overt heart-failure symptoms and preserved ejection fraction. Urinary nephrin and type IV collagen were significantly increased, as were galectin-3 and NT-proBNP concentrations. All CKD groups had resting E/e' values above the normal range and these values were further elevated following exercise. Nephrin showed a strong positive correlation with E/e' and post-exercise echocardiography was associated with greater discrimination of an operationally defined subclinical cardiorenal phenotype than resting imaging. These exploratory findings indicate that a combined biomarker and echocardiographic profile is associated with an early cardiorenal phenotype and may assist in risk stratification of patients with CKD exhibiting early cardiorenal remodeling prior to the development of overt heart failure; they are hypothesis-generating and not intended to set diagnostic criteria. Prior to implementing this multimarker strategy clinically, larger, multicenter prospective studies with multivariable adjustment and external validation should be performed.
BACKGROUND: Patients undergoing dialysis are at an elevated risk of cardiovascular events. This study aimed to develop machine learning (ML) prediction models to identify risk factors for major adverse cardiovascular events (MACE) in dialysis patients. MATERIALS AND METHODS: This retrospective study included 203 patients undergoing dialysis with a median age of 45.0 years and 64.0% male. The participants were divided into training and test sets in a 7:3 ratio. LASSO regression selected characteristic variables from patients'general information, laboratory tests, and echocardiographic parameters (including global longitudinal strain [GLS]). Eight ML models were constructed,and SHAP analysis evaluated feature importance. RESULTS: The incidence of MACE (including myocardial infarction, unstable angina, heart failure, and cardiovascular death) in dialysis patients was 38.92%. The average follow-up period was 18 months. LASSO regression identified eight feature variables. Among the ML models, AdaBoost demonstrated superior performance, with an AUC of 0.883 (95% CI: 0.830-0.937), accuracy of 0.804, sensitivity of 0.864 and specificity of 0.762 in the training set, and an AUC of 0.809 (95% CI: 0.706-0.912), accuracy of 0.750, sensitivity of 0.90 and specificity of 0.675 in the test set. The SHAP analysis identified N-terminal pro-brain natriuretic peptide (NT-proBNP) level, estimated glomerular filtration rate (eGFR), GLS and age as the four most important features for predicting MACE in patients undergoing dialysis (mean absolute SHAP values: 0.199, 0.176, 0.096 and 0.091, respectively). CONCLUSION: Elevated NT-proBNP, advanced age, reduced eGFR and impaired GLS were independently associated with an increased risk of MACE in patients undergoing dialysis.
Scandinavian cardiovascular journal : SCJJunwen Zhang, Yuan Yuan, Ke Wei, Chunrong Bao
AIMS: Transthoracic echocardiography is widely used to assess the volume status of patients with coronary heart disease combined with heart failure (CHD-HF) because of its noninvasive and convenient nature. Inferior vena cava (IVC) measurement is a commonly used alternative method for evaluating central venous pressure. This study analyzed the specific clinical applications of IVC diameter (IVCD) and collapse index (IVCCI) in assessing the cardiac dysfunction severity and prognosis of CHD-HF patients. METHODS: A retrospective analysis was conducted on 340 CHD patients treated at our hospital between January 2021 and March 2023. Patients were categorized into CHD (n = 123) and CHD-HF (n = 217) groups. Ultrasound measurements of IVCD and IVCCI were performed, and 2-year follow-up data were compiled to record cardiovascular re-hospitalization and all-cause death. Spearman or Pearson was utilized for correlation analysis. ROC analysis was used for performance analysis, and Kaplan-Meier and Cox regression were harnessed for survival analysis. RESULTS: CHD-HF patients showed increased IVCD and decreased IVCCI. CHD-HF patients experiencing cardiovascular re-hospitalization or all-cause death exhibited elevated IVCD and reduced IVCCI. IVCD (AUC = 0.715, 95%CI = 0.638-0.792, cut-off = 14.15 mm; AUC = 0.795, 95%CI = 0.732-0.858, cut-off = 13.04 mm) and IVCCI (AUC = 0.790, 95%CI = 0.726-0.853, cut-off = 51.47%; AUC = 0.731, 95%CI = 0.661-0.801, cut-off = 50.00%) demonstrated high predictive values for cardiovascular re-hospitalization and all-cause death in CHD-HF patients. IVCD (HR = 1.124, 95%CI = 1.056-1.196; HR = 1.139, 95%CI = 1.078-1.203) and IVCCI (HR = 0.959, 95%CI = 0.921-0.999; HR = 0.956, 95%CI = 0.921-0.992) were both independently associated with cardiovascular re-hospitalization and all-cause death in CHD-HF patients. CONCLUSION: IVCD and IVCCI effectively predict cardiovascular re-hospitalization and all-cause death in CHD-HF patients.
Annals of medicineJin Wang, Junjun Wang, Yingying Peng, Fei Hou, Xinche Zhang, Hua Jin
OBJECTIVE: To develop and evaluate a multimodal deep learning model that integrates first- and second-trimester ultrasound images with first-trimester maternal serum biomarkers for early prediction of severe fetal growth restriction (FGR). MATERIALS AND METHODS: In this prospective study, 13,991 pregnant women were initially recruited, and after applying inclusion and exclusion criteria, 598 singleton pregnancies (299 with severe FGR and 299 controls) were analyzed. Severe FGR was diagnosed at or after 24 weeks' gestation and defined as an estimated fetal weight (EFW) or abdominal circumference (AC) below the 3rd percentile. Seven ultrasound views were collected (first-trimester crown-rump length, nuchal translucency; second-trimester head and abdominal circumference, femur length, umbilical artery S/D ratio, and amniotic fluid depth), along with maternal age and first-trimester serum markers (PAPP-A and free β-hCG, expressed as MoM). A convolutional neural network (CNN) with multi-level attention and dynamic convolution modules was trained end-to-end using stochastic gradient descent with cross-entropy loss. Model performance was evaluated with five-fold cross-validation. RESULTS: The integrated model achieved high predictive accuracy for severe FGR, with an AUC of approximately 0.96, accuracy of 91%, and F1-score of 0.912. Matthews correlation coefficient (MCC) was 0.798. The model outperformed single-modality baselines, such as a ResNet-50 CNN trained on images alone. Ablation experiments showed that adding maternal serum biomarkers and advanced CNN modules significantly improved performance. The model demonstrated excellent discrimination between severe FGR and control cases, with high sensitivity and precision in classification. CONCLUSIONS: A deep learning model combining routine ultrasound and first-trimester serum biomarkers can accurately predict severe FGR before clinical signs appear. This model significantly enhances early severe FGR risk stratification and suggests potential for AI-based prediction tools in prenatal care to guide earlier surveillance and intervention.
International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia GroupJianguang Gan, Jiemei Gan, Yuanxia Jiang, Jian Li, Xuequn Yang, Zhaoyan Deng, Ling Pan
OBJECTIVE: To observe the effects of ultrasound-guided percutaneous thermal ablation of the parathyroid glands on the left ventricular structure and function in patients with end-stage renal disease (ESRD) and secondary hyperparathyroidism (SHPT). METHODS: Retrospective cohort study (May 2019-March 2025). Patients: thermal ablation (n = 64) vs. medical therapy (n = 115). Propensity score matching (1:1, caliper 0.2) based on gender, age, baseline PTH, serum calcium, left ventricular mass index (LVMI) yielded 108 patients (54/group). Multivariable regression adjusted for residual confounding. Measurements at baseline and 6 months. Changes in LVMI, LVEF, PTH, phosphorus, serum calcium, blood pressure compared. RESULTS: After matching, in the thermal ablation group, LVMI, PTH, serum phosphorus, serum calcium, and systolic blood pressure (SBP) at 6 months decreased compared with baseline (all p < 0.05). In the medical therapy group, serum calcium decreased compared with baseline (p < 0.05). Inter-group comparisons showed that the reductions in LVMI, PTH, serum phosphorus, serum calcium, and SBP were greater in the thermal ablation group than in the medical therapy group (all p < 0.05). Multivariable regression analysis showed that thermal ablation was independently associated with a greater percentage reduction in LVMI (95% CI: 7.49-24.44, p < 0.001). In the thermal ablation subgroup with baseline left ventricular systolic dysfunction, LVEF increased from baseline to 6 months (p = 0.017). CONCLUSION: Ultrasound-guided percutaneous thermal ablation of the parathyroid glands was associated with greater reductions in PTH, serum phosphorus, serum calcium, SBP and LVMI than medical therapy. In the pilot subgroup of patients with baseline left ventricular systolic dysfunction, LVEF showed an increase after thermal ablation.
Journal of the International Society of Sports NutritionCarlos Abraham Herrera-Amante, Israel Ríos-Limas, Wiliam Carvajal-Veitía, Rodrigo Yáñez-Sepúlveda, Citlalli Daniela Morón-López, Karla Jessica Mendoza-Sánchez,…
BACKGROUND: Precise assessment of body composition is fundamental for monitoring training adaptations, guiding nutritional strategies, and informing performance-related decision-making in elite female soccer. Dual-energy X-ray absorptiometry (DXA) is considered a reference method; however, its limited accessibility restricts routine use in high-performance settings. Existing anthropometric equations often lack population-specific validation, particularly for elite Mexican female soccer players. This study aimed to derive and internally validate an anthropometric equation for estimating body fat percentage (%BF) and to evaluate its agreement with DXA. METHODS: Twenty-seven elite players from the Mexican Women's National Team underwent DXA assessment and International Society for the Advancement of Kinanthropometry (ISAK)-standardized anthropometry during a training camp. Sample-size adequacy was assessed a posteriori. A multiple linear regression model was derived using the sum of eight skinfolds (Σ8SF) and waist girth (WG) as predictors. Regression assumptions were verified through residual diagnostics, and multicollinearity was assessed using variance inflation factors. Predictive performance was evaluated using mean absolute error (MAE), root mean square error (RMSE), and standard error of estimate (SEE). Agreement with DXA was assessed using the intraclass correlation coefficient (ICC) and Bland-Altman analysis. Internal validation was performed using leave-one-out cross-validation (LOOCV). The six historical anthropometric equations were additionally refitted to the present sample to enable a like-for-like comparison of predictor structures. RESULTS: The Mexican Footbal Federation equation (%BF = 0.12 × Σ8SF +0.39 × WG - 17.0) demonstrated moderate agreement with DXA (ICC = 0.71; mean bias: -0.05%; 95% LOA: -4.61% to +4.70%). The model explained 54% of the variance in DXA %BF (R² = 0.54; R²-adjusted = 0.50) and showed acceptable predictive performance (LOOCV Q² = 0.50; RMSE = 2.33%; MAE = 1.86%; SEE = 2.47%). After refitting each of the six historical anthropometric equations to the present sample, the Mexican Footbal Federation predictor combination retained the lowest RMSE (2.33% vs. 2.55-2.93%) and the highest ICC (0.71 vs. 0.44-0.63), supporting that the model's advantage stems from its predictor structure rather than calibration on the test data. CONCLUSIONS: The Mexican Football Federation equation provides a population-specific, field-applicable tool for estimating %BF in elite Mexican female soccer players. External validation in larger and more diverse cohorts is required before its widespread application.
Gynecological endocrinology : the official journal of the International Society of Gynecological EndocrinologyKatalin Widmann, Marlene Hager, Lisa-Maria Windischbauer, Robert Krysiak, Johannes Ott
OBJECTIVE: Women with Turner syndrome (TS) are at increased risk of reduced bone mineral density (BMD) due to primary ovarian insufficiency. This study aimed to assess longitudinal changes in BMD in TS patients receiving oral or transdermal hormone replacement therapy (HRT) and to identify factors associated with bone density decline. METHODS: This retrospective pilot study included 40 TS patients treated with oral or transdermal estradiol. The median age was 22 years in both the transdermal (20-30) and oral (20-27) groups. Median BMI was 23.1 (21.1-25.5) and 25.4 (22.1-29.1), respectively. Dual-energy X-ray absorptiometry (DEXA) of the lumbar spine and femoral neck was performed at baseline and follow-up. The primary outcome was the t-score at both sites. Univariable and multivariable logistic regression analyses were used to identify factors associated with declining t-scores. RESULTS: At baseline, 38.3% of patients had osteopenia, and 3.3% had osteoporosis. During follow-up, a decline in t-scores at at-least one skeletal site was observed in 47.5% of patients. No significant differences were found between oral and transdermal estradiol therapy regarding absolute t-scores, t-score changes, or the proportion of patients with declining t-scores (all p > 0.05). In multivariable analysis, lower vitamin D levels at follow-up were independently associated with declining t-scores. CONCLUSIONS: In TS patients, the route of estradiol administration did not significantly affect long-term BMD outcomes. Despite HRT, a substantial proportion of patients experienced bone loss. Vitamin D status has emerged as the most relevant modifiable factor associated with declining BMD, highlighting the need for bone health management beyond HRT.
Plant signaling & behaviorMakoto T Fujiwara, Ryuuichi D Itoh
Chloroplast division is a complex process influenced by various proteins, among which bacteria-derived MinE plays a vital role in correctly placing the FtsZ-based division apparatus and initiating the division. This study aimed to elucidate the intrachloroplastic localization of MinE in the living mesophyll cells of Arabidopsis thaliana using the MinE-yellow fluorescent protein (YFP) fusion. Fluorescence microscopy of the complemented A. thaliana minE mutant, expressing MinE-YFP under the native MinE promoter, showed normal chloroplast division and revealed a mid-chloroplast MinE ring composed of array-of-dots and filaments, as well as other distinct localization patterns of MinE during chloroplast division. The MinE ring relatively maintained its configuration during chloroplast constriction, as does the FtsZ ring, suggesting a dynamic protein dissociation correlating with division progression. We also observed a unique "twin dot" structure and one-sided distribution of MinE in chloroplasts with slight over-accumulation of MinE-YFP in transgenic tissues. These observations deviate from the well-accepted model of the MinE behavior during Escherichia coli cytokinesis, suggesting fundamental differences in the division mechanisms between chloroplasts and bacteria. The present findings deepen our understanding of the protein organization at the chloroplast division site and highlight the distinctive nature of the MinE protein's behavior in plants.