Prognostic significance of cardiovascular magnetic resonance advanced atrial parameters in chronic significant aortic regurgitation.

BackgroundPost-pull chest X-rays (ppCXR) are routinely performed after chest tube (CT) removal despite questionable utility. Prior studies suggest that ppCXR rarely alter management, but the impact of timing remains unknown. This study compares early vs delayed ppCXR on radiographic changes and clinical management in asymptomatic trauma patients. We hypothesized ppCXR timing may influence radiographic findings, but not reintervention rates.MethodsA retrospective study of trauma patients undergoing CT placement and removal at a level 1 trauma center from 2019 to 2022. Each ppCXR was classified as early (≤4h) or delayed (>4h). Primary outcome was reintervention after CT removal (CT replacement, VATS, or thoracotomy). Secondary outcomes included radiographic changes, unplanned ICU transfer, hospital and ICU LOS, and total CXRs.Results318 patients were included with a mean age of 47.2years, 25.2% female, and 77.4% with blunt mechanism. Most had delayed ppCXR (78.3%) with mean delay of 7.2h (2.3 vs 9.5h, P < .001). No differences were found in radiographic changes (26.1 vs 29.3%, P = .708) or reintervention (4.3 vs 5.6%, P = .999) between groups. Radiographic changes occurred in 28.6% of ppCXR, but these findings display poor sensitivity (65.0%) and specificity (73.4%) for reintervention. Delayed ppCXR had more ICU transfers (0 vs 5.6%, P = .046), but no differences in hospital LOS, ICU LOS, or total CXRs.DiscussionThe timing of ppCXR did not affect detection of radiographic changes or reintervention rates. Our findings support growing evidence questioning routine ppCXR in asymptomatic trauma patients. Future multicenter studies are warranted to establish standardized protocols and reduce unnecessary imaging in trauma care.

Is there histological evidence supporting capsulectomy in patients with breast implant illness: A case-control study.

Is routine Doppler sonography needed to detect deep vein thrombosis after total knee arthroplasty? A real-world comparison of two clinical pathways.

Transaldolase deficiency is a rare autosomal recessive disease caused by biallelic mutations in the TALDO1 gene. This disorder is characterized by multisystem involvement, including liver disease. Here, we present 2 siblings with transaldolase deficiency and a novel homozygous mutation in the TALDO1 gene. The index case was presented with hepatosplenomegaly and elevated transaminases in infancy. The 11-year-old sibling, who was diagnosed through family screening, also had chronic liver disease with fibrotic changes, despite initially normal liver function tests. Both patients exhibited additional findings, including dysmorphic facial features, hypergonadotropic hypogonadism, proteinuria, and skeletal anomalies such as scoliosis. Liver biopsies revealed periportal and bridging fibrosis without necroinflammatory activity or malignant transformation. In the second case, a 6 mm T2-hyperintense nodular lesion detected on MRI prompted close monitoring for hepatocellular carcinoma. This report highlights the phenotypic variability of TALDO deficiency, the potential for progressive liver damage in asymptomatic patients, and the importance of liver biopsy and imaging in surveillance. Early diagnosis using genetic testing and family screening facilitates the timely management of complications. Given the multisystem nature of the disorder, multidisciplinary follow-up is essential.

Abstract Aims To assess whether traditional aortic stenosis (AS) classification correlates with myocardial fibrosis as evaluated by cardiac magnetic resonance (CMR) in asymptomatic severe AS and to identify echocardiographic parameters associated with myocardial fibrosis. Methods and results A prospective observational study on asymptomatic patients with severe AS (aortic valve area &amp;lt;1.0 cm², LVEF ≥50%) who underwent transthoracic echocardiography (TTE) and CMR was conducted. Patients were classified into high-gradient (HG), low-flow low-gradient (LFLG), and normal-flow low-gradient (NFLG) AS subtypes. Myocardial fibrosis was assessed by CMR using late gadolinium enhancement (LGE), native T1 mapping, and extracellular volume (ECV). Among 76 patients, LGE was present in 40 (53%), with a median extent of 1.24% (0.41–3.75%;) and a median ECV of 26.9%. No significant differences in myocardial fibrosis were found across all AS subtypes. Patients with LGE exhibited higher left ventricular mass (114.2 vs. 98.5 g/m², P=0.033) and greater wall thickness (13.5 vs 12.0 mm, P=0.026), as well as an increased left atrial volume index (LAVI, 45.4 vs. 35.2 mL/m², P=0.011) on TTE. A significant non-linear association between LAVI and LGE presence was observed. Myocardial fibrosis correlated with extravalvular cardiac damage. Conclusion Myocardial fibrosis, as assessed by LGE, was observed in half of the patients with asymptomatic severe AS and preserved LVEF and did not differ across all AS subtypes. Left ventricular hypertrophy and left atrial remodelling by TTE were associated with myocardial fibrosis and could serve as surrogate markers of extravalvular cardiac damage. This finding highlights the limitations of traditional classification alone in predicting myocardial impairment.

Abstract Background Severe pulmonary regurgitation is a frequent long-term complication in patients with congenital heart disease, such as tetralogy of Fallot, pulmonary atresia, and pulmonary stenosis. While symptomatic individuals are generally treated with pulmonary valve replacement (PVR), the optimal timing of intervention in asymptomatic patients remains a topic of active investigation. Cardiovascular magnetic resonance (CMR) imaging, with its capacity for volumetric assessment and quantification of ejection fractions, serves as a cornerstone of diagnostic evaluation, guiding the timing of PVR. Purpose This study aimed to investigate whether the right ventricular end-diastolic volume index (RVEDVi) and pulmonary regurgitation (PR) fraction, used as criteria for PVR, are constant parameters or vary depending on heart rate and/or adrenergic stimulation. Methods We prospectively investigated 17 patients with chronic severe pulmonary regurgitation (PR fraction 40.8% +/- 6.2) due to tetralogy of Fallot (70%), pulmonary atresia with intact ventricular septum (12%), and pulmonary valve stenosis (18%). CMR imaging included flow measurements of the main pulmonary artery and ascending aorta acquired during free breathing, as well as steady-state free precession (SSFP) cine images in axial orientation obtained during breath-hold for volumetric assessment. All examinations were performed on a 1.5 Tesla MR scanner at rest and during submaximal exercise, which increased heart rate by an average of 24%—equivalent to a workload of approximately 25% of peak VO2. Exercise was conducted using a custom-built, MRI-conditional leg paddle ergometer, without interruptions during imaging. Results The results showed a reduction in PR fraction (from 40.8% +/- 6.2 to 35.3%+/-7.6, Δ -13.2%, p &amp;lt;0.0001) and RVEDVi (from 139.8ml/m2 +/-19.9 to 128.4ml/m2 +/- 20.7, Δ -8%, p 0.0002) during exercise. Left ventricular ejection fraction (LVEF) remained within the normal range and increased appropriately with exercise. In contrast, right ventricular ejection fraction (RVEF), although normal at rest (57.2% +/- 4.3), demonstrated a blunted response to exercise, with only a modest, non-significant increase (Δ 3.5%, p = 0.14), suggesting impaired contractile reserve of the right ventricle. Conclusions In the presence of severe pulmonary regurgitation, we observed a decrease in RVEDVi during exercise, accompanied by a concurrent reduction in pulmonary regurgitation fraction. Notably, this effect was evident even with modest elevations in heart rate. These findings highlight heart rate as a significant determinant of CMR-derived volumetric measurements and suggest it should be carefully considered in the clinical decision-making process for pulmonary valve replacementResults General Parameters

This study was aimed at identifying MRI findings related to total hip arthroplasty (THAs) infection using coronal STIR with metal artifact reduction sequences (MARS) at 1.5T. This retrospective multicenter study included all patients with THAs who underwent 1.5T MRI with MARS from December 2015 to April 2020. Two groups are as follows: an infected group and a non-infected group (including asymptomatic THAs and symptomatic non-infected THAs). MARS were either multi-acquisition with variable-resonance image combination (MAVRIC) or slice encoding for metal artifact correction (SEMAC). Imaging features were evaluated to assess their association with THA infection (including both symptomatic and asymptomatic patients). Sensitivity, specificity, and accuracy of these imaging findings were assessed, and inter-reader agreement (kappa, K) was determined. Sixteen patients with THAs had periprosthetic infection, compared with 46 THAs in the non-infected group. Bone edema extending to adjacent soft tissues, defined as a combination of femoral bone marrow edema, hyperintense cortical signal, periostitis, and overall soft tissue edema, had the greatest diagnostic performance for infection: 15/16(94%) infected THAs and 0/46(0%) non-infected THAs (accuracy = 0.98, sensitivity = 0.94, specificity = 1, p < 0.001 Chi-Square test). This combination, predominant in the infected group (p < 0.001 for all), also demonstrated separately high accuracy (acc = 0.94-1), sensitivity (se = 0.94-1), and specificity (0.94-1). Fistula and fluid collection were highly specific (spe = 1) and accurate (acc = 0.81-0.82), although less sensitive (se = 0.25-0.31, p < 0.001). The combination of femoral bone marrow edema, hyperintense cortical signal, periostitis, and soft tissue edema is accurate in the diagnosis of periprosthetic hip joint infection using coronal STIR with MARs at 1.5T.

Lipoprotein(a) [Lp(a)] is an inherited cardiovascular risk factor. However, its association with coronary plaque characteristics beyond traditional risk enhancers remains unclear. We aimed to evaluate the association between Lp(a) levels and coronary plaque characteristics in asymptomatic primary prevention patients, and to compare its predictive value against other risk enhancers, including LDL particle concentration (LDL-P), high-sensitivity C-reactive protein (hsCRP), and coronary artery calcium (CAC) score. We retrospectively analyzed 547 asymptomatic patients undergoing coronary computed tomography angiography (CCTA) between 2018-2024. Plaque characteristics were assessed using artificial intelligence-based quantitative CCTA. Associations between Lp(a), LDL-P, hsCRP, CAC score, and plaque features were evaluated using multivariable regression adjusted for age and sex. Median age was 56 years, 69.8% were male. Higher Lp(a) was associated with greater total plaque volume (β=23.1 mm³, p=0.006), calcified plaque (β=11.1 mm³, p=0.014), non-calcified plaque (β=12.0 mm³, p=0.027), and low-density non-calcified plaque (LDNCP; β=0.4 mm³, p<0.001) volumes, as well as increased area stenosis (β=1.9%, p=0.031) and remodeling index (β=0.02, p=0.017). In multivariable models, CAC score was the strongest predictor of overall plaque burden including calcified and non-calcified plaque (p<0.000) but was not associated with LDNCP. Lp(a) remained independently associated with LDNCP (β=0.45 mm³, p=0.013), while LDL-P and hsCRP showed no significant associations. In asymptomatic primary prevention patients, Lp(a) was independently associated with high-risk coronary plaque features, specifically LDNCP, beyond traditional risk enhancers. These findings highlight the unique role of Lp(a) in identifying coronary plaque vulnerability and suggest complementary roles for Lp(a) and CAC in refining cardiovascular risk stratification.

Ovarian cancer is a highly lethal gynecological malignancy with poor prognosis. Early diagnosis of ovarian cancer is crucial for improving patient survival rates. Ultrasound is currently the most used imaging modality for the detection of ovarian cancer. However, its diagnostic accuracy is limited, particularly in the early stages of the disease. Circulating tumor DNA (ctDNA) has emerged as a promising noninvasive biomarker for cancer diagnosis. In this study, we aimed to investigate the clinical value of ultrasound combined with ctDNA (mutations in: TP53, KRAS, and PIK3CA) in the early diagnosis of ovarian cancer. A total of 686 participants were enrolled, comprising 186 advanced symptomatic ovarian cancer patients, 16 histologically confirmed asymptomatic ovarian cancer patients, and 484 patients with benign ovarian lesions. Of the 202 ovarian cancer cases, 57.4% were high-grade serous carcinomas, followed by endometrioid (15.8%), clear cell (9.9%), mucinous (7.9%), and low-grade serous carcinomas (6.9%). All participants underwent standardized ultrasound examination and ctDNA analysis. Ultrasound characteristics were evaluated for morphological features including mass composition, border definition, and presence of ascites. Circulating tumor DNA was analyzed for mutations in TP53, KRAS, and PIK3CA genes. Diagnostic performance was assessed through sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) calculations for individual and combined detection methods. In asymptomatic ovarian cancer patients, ultrasonography revealed complex solid-cystic masses in 50.0% of cases and ascites in 43.75%, with 87.50% sensitivity and 94.33% specificity. Molecular analysis detected ctDNA mutations in 81.25% of asymptomatic cases, predominantly in TP53 (31.25%), KRAS (25.00%), and PIK3CA (25.00%). This analysis, which focused exclusively on these three genes, demonstrated 81.25% sensitivity and 97.46% specificity. The combined diagnostic approach significantly improved detection parameters (p < 0.001), with sensitivity increasing to 93.75%, specificity to 99.25%, PPV to 75.00%, and NPV to 99.85%. False-positive results decreased from 38 (ultrasound alone) and 17 (ctDNA alone) to 5 cases with the combined approach. Distinct mutation profiles were observed between cancer and benign groups, with only 15.91% of benign cases showing detectable ctDNA mutations. Our results suggest that ctDNA is a promising biomarker for the early detection of ovarian cancer, with higher sensitivity and specificity than ultrasound. The combination of ultrasound and ctDNA may provide a more accurate diagnostic strategy for the early detection of ovarian cancer. These findings may contribute to the development of novel noninvasive biomarkers for the early diagnosis of ovarian cancer.

Femoroacetabular Impingement (FAI) occurs secondary to morphologic abnormalities of the hip joint resulting in abnormal bony contact during functional hip range of motion. It is hypothesized this predisposes the hip joint surface to experience increased stress, load, and increased risk of early osteoarthritis. Longitudinal studies have observed that a significant number of patients with radiographic signs of FAI went on to develop end-stage osteoarthritis or require total hip arthroplasty. There are studies investigating the presence of radiographic features of FAI in asymptomatic patients. However, there is less published literature investigating the presence of radiographic features of FAI in symptomatic patients. The primary objective of this retrospective review is to evaluate the presence of radiographic features of FAI in symptomatic patients and its relationship with global acetabular retroversion (AR) measured on Computed Topography (CT) scan Institutional research ethics board approval was obtained prior to study commencement. A retrospective cohort study was conducted using clinical practice data of a single academic surgeon. Patients who underwent hip arthroscopy for symptomatic FAI between August 2017- August 2024 were screened. Patients with AR, defined as &gt;/= 5 degrees relative to normal published parameters at the 1 o'clock, 2 o'clock and 3 o'clock positions were included. Standard pelvic radiographs were analyzed for radiographic signs of FAI: crossover sign (including crossover percentage), ischial spine sign and empty posterior wall sign. Statistical analysis was performed to determine the sensitivity and specificity of each sign and if there is a relationship between the number of radiographic signs observed on standard pelvic radiographs and acetabular retroversion (AR) measured on CT. Continuous variables were compared using univariate analysis of variance (ANOVA) and linear regression analyses. A total of 200 patients were reviewed and 156 patients were included for analysis. Patients were categorized into globally retroverted (n=48), regionally retroverted (n=64) and normal version (n=44). The presence of 2 radiographic signs in globally retroverted patients were significant for greater acetabular retroversion at the 1- and 2 o'clock positions (p &gt; 0.05), but not at the 3 o'clock position (p = 0.059). A positive crossover sign in isolation was most sensitive at detecting acetabular retroversion at 91.6%. A positive crossover sign percentage greater than 30% was most specific at 86.7%. The presence of three radiographic signs with a crossover percentage greater than 30% increased specificity to 93.3%. Linear regression analysis observed a correlation between crossover percentage and degree of acetabular retroversion at the 1 and 3 o'clock positions (p &lt; 0.05). In this limited retrospective review of patients with symptomatic FAI, radiographic signs of FAI can detect global AR with significant sensitivity and specificity. Our results are comparable to previously described studies investigating their utility in detecting focal retroversion at the 3 o'clock position. Crossover percentage was observed to have a positive association with the extent of AR and may be valuable as a predictive tool. The results of this retrospective review may provide guidance in when to pursue CT imaging in select cases where AR is suspected to inform operative management.

Hereditary multiple osteochondromas (HMO) is a common paediatric condition defined by the presence of multiple cartilage-capped bony lesions. Spinal osteochondromas affect up to 68% of HMO patients.1 Although most are asymptomatic, cord-encroaching osteochondromas can lead to significant neurological symptoms and morbidity.2 Limited guidelines exist regarding the use of advanced imaging as a screening modality for spinal osteochondromas. This study aims to evaluate the incidence of spinal osteochondromas detected via advanced imaging in the paediatric HMO population. A systematic review and meta-analysis was conducted following the Cochrane Handbook for Systematic Reviews of Interventions. A search was performed across MEDLINE, Embase, CENTRAL, and CINAHL databases for articles published between May 1, 1946 and May 31, 2024. Included studies reported on the use of advanced imaging, computer tomography (CT) or magnetic resonance imaging (MRI), in HMO patients under the age of 21. The primary outcome was spinal osteochondroma incidence determined by advanced imaging. Secondary outcomes included type of imaging, indication for imaging, symptoms on presentation, incidence of spinal encroaching lesions, incidence of patients requiring surgical intervention, and postoperative outcomes. A meta-analysis of single proportions was conducted to determine the pooled incidence of spinal osteochondromas, incidence of spinal canal-encroaching lesions, and incidence of spinal surgery in HMO patients. Of 415 eligible articles, seven met inclusion criteria. These studies included 198 HMO patients with a weighted mean age of 12 ± 1.0 years, and 47% were female. MRI was the primary imaging modality (99%) with 69% imaged secondary to institutional screening protocols. Approximately 21% had neurological symptoms at the time of imaging. Overall, the pooled incidence of spinal osteochondromas was 36% (Figure 1, 95% CI, 24–51%). Of these, 43% were located in the cervical spine, 38% in the thoracic spine, and 19% in the lumbar spine. Among HMO patients with spinal osteochondromas, 49% (95% CI, 37–61%) had canal-encroaching lesions and 21% (95% CI, 13–33%) underwent spinal surgery. Postoperatively, 47% of individuals had resolution of their symptoms, and no long-term complications were reported across six of the studies. Figure 1. Forest plot of incidence of spinal osteochondromas in HMO patients, demonstrating a rate of 36%. While spinal osteochondromas are prevalent amongst HMO patients, standardised screening protocols remain limited. Despite favourable surgical outcomes for symptomatic canal-encroaching lesions, initial and serial screening is needed to prevent irreversible neurological damage. Early baseline screening may also be warranted for asymptomatic HMO patients once sedation is no longer indicated. As global guidelines evolve, large multicentre prospective studies are needed to identify optimal timing for spinal osteochondroma screening in HMO patients. For any figures or tables, please contact the authors directly.

Background: Follicular lymphoma (FL) is the second most common B-cell lymphoma in Western countries, typically presenting as an indolent disease with prolonged overall survival. Despite favorable initial responses to therapy, most patients experience relapse, and early progression is associated with poor outcomes. Methods: This guideline provides evidence-based recommendations from the Spanish GELTAMO group on the diagnosis, staging, treatment, and follow-up of FL. A systematic literature review was conducted, and recommendations were graded according to the GRADE system. Results: Histopathological diagnosis should be based on excisional biopsy. PET-CT is recommended for staging and response evaluation. For localized disease, involved-site radiotherapy (ISRT) remains the treatment of choice. In asymptomatic patients with advanced-stage disease and low tumor burden, a watch-and-wait approach is appropriate, although rituximab monotherapy is also acceptable. For advanced-stage disease with high tumor burden, immunochemotherapy with anti-CD20 antibodies (rituximab or obinutuzumab) combined with CHOP, CVP, or bendamustine is recommended, followed by maintenance therapy. Management of relapsed disease is tailored based on tumor burden, treatment history, and timing of relapse. Although novel immunotherapies (CAR-T therapy and bispecific antibodies) are emerging as promising options, autologous stem cell therapies may still be a valid option in young patients with early relapse who are sensitive to immunochemotherapy. Conclusions: FL is a heterogeneous disease requiring individualized management strategies. Recent advances in immunotherapy and molecular diagnostics are reshaping the therapeutic landscape. These updated GELTAMO recommendations aim to provide practical guidance for optimal FL management in clinical practice.

Accurate prediction of asymptomatic small abdominal aortic aneurysm (AAA) growth is crucial for risk stratification and personalized surveillance. This study developed an end-to-end deep learning framework to predict rapid expansion (≥0.5 cm/6 months) using computed tomography angiography (CTA) images from 81 asymptomatic patients with small AAA (30 rapid-growth and 51 stable patients). The pipeline integrated three core components: a ResNet50 classifier for identifying aortic images (99.86% accuracy, 99.91% F1-score), a YOLOv11 detector for localizing aneurysms (precision–recall: 0.902), and a MedMamba-based feature fusion model that combined imaging features with clinical metadata via multi-head self-attention. Model robustness was ensured through stratified 5-fold cross-validation and comprehensive data augmentation. The fusion model achieved a predictive accuracy of 98.75% and an F1-score of 97.78, outperforming seven classical deep learning backbones. Furthermore, explainability analyses confirmed the model’s reliance on established clinical risk factors and highlighted biologically plausible imaging regions for prediction. The proposed ResNet50–YOLOv11–MedMamba framework demonstrates the feasibility of automating AAA growth prediction directly from CTA and shows promising potential to enhance clinical decision-making.

Background/Objectives: Iron-deficiency anemia (IDA) is a common condition in children and is frequently attributed to nutritional causes. However, gastrointestinal (GI) pathology may be present even in the absence of overt GI symptoms. The diagnostic value of endoscopic evaluation in asymptomatic pediatric patients with IDA remains debated. This systematic review aimed to synthesize available evidence on endoscopic and histologic findings in asymptomatic children with IDA and to assess their clinical implications. Methods: A systematic review was conducted in accordance with the PRISMA 2020 guidelines, and the protocol was registered in PROSPERO. MEDLINE (via PubMed) and Scopus were searched for studies involving children and adolescents (0–18 years) with confirmed iron-deficiency anemia and no gastrointestinal symptoms who underwent endoscopic evaluation. Results: Six studies met the inclusion criteria, comprising a total of 455 pediatric patients. Upper GI endoscopy was the most commonly performed procedure. Clinically significant findings were frequently identified, including histologic features consistent with celiac disease, Helicobacter pylori-associated gastritis, and chronic inflammatory gastric changes. Histologic abnormalities were often present despite minimal or absent macroscopic endoscopic findings. The diagnostic yield of endoscopy was particularly high in older children and adolescents and in those with severe or refractory IDA. Conclusions: This systematic review demonstrates that asymptomatic children with IDA may harbor significant GI pathology detectable by endoscopic and histologic evaluation. These findings support the consideration of targeted endoscopic assessments in selected pediatric patients with unexplained or persistent IDA, even in the absence of GI symptoms.

Professional quality of life influences patient care, staff well-being, and organizational efficacy. The COVID-19 pandemic placed pressure on healthcare professionals, disrupting their professional quality of life and imposing a psychological burden. In Greece, these issues were intensified by a decade of economic crisis, marked by constrained healthcare budget, personnel shortages, and insufficient resources. This study investigates the pandemic's impact on the professional quality of life of Greek healthcare professionals to support targeted interventions. A cross-sectional study was conducted using descriptive statistics. The participants were a convenience sample of 246 healthcare professionals from a Greek regional university hospital with at least one year of experience and who had worked with COVID-19-positive or potentially exposed but asymptomatic patients. Data were collected between March and June 2021 using the Professional Quality of Life Scale (version 5). Of the 246 participants, 81.3% were women and 33.8% were aged 50 or older. Moderate concern and fear regarding COVID-19 were reported, with 34.6% extremely afraid of transmitting the virus to family or friends and 22.8% to patients or their families. Overall professional quality of life was moderate: compassion satisfaction was moderate to high, while burnout and secondary traumatic stress were moderate to low. Higher compassion satisfaction was linked to holding a position of responsibility. Burnout was associated with having children, permanent employment, years of experience, and increased pandemic-related fear. Higher secondary traumatic stress was associated with older age, more years of experience, and greater pandemic-related fear. These findings support international research and highlight that the moderate levels observed indicate intrinsic motivation based on professionalism in patient care, providing evidence of resilience and coping mechanisms that reduce psychological consequences on well-being due to the pandemic.

With the increase in Japan's aging population, the number of total colonoscopies (TCS) performed in individuals aged over 80 years is rising. However, TCS carries an increased risk of complications in older individuals, raising concerns about its utility in this population. This study aimed to evaluate the clinical value of TCS in older individuals diagnosed with advanced colorectal cancer (CRC) at our institution. We conducted a retrospective review of patients aged ≥80 years who underwent TCS between January 2010 and December 2021. Patients diagnosed with advanced CRC were categorized into symptomatic and asymptomatic groups based on the presence or absence of symptoms. The groups were compared in terms of clinical characteristics, pathological features, and long-term outcomes. Among 4,130 older patients who underwent TCS, 297 (7.2%) were diagnosed with advanced CRC. Of these, 221 (74%) were symptomatic, and 76 (26%) were asymptomatic. Compared with symptomatic patients, asymptomatic patients had significantly higher body mass index (23.6 vs. 21.5 kg/m²), serum albumin levels (3.7 vs. 3.5 g/dL), and lower carcinoembryonic antigen (CEA; 3.9 vs. 5.6 ng/mL) and carbohydrate antigen 19-9 (CA19-9; 13.4 vs. 19.7 U/mL) levels (all p<0.05). The asymptomatic group also had a higher rate of early-stage disease (68.4% vs. 36.2%) and a greater history of prior TCS (21.1% vs. 5.4%, p<0.001). Five-year overall and disease-specific survival rates were significantly higher in the asymptomatic group (68.3% and 88.3%, respectively) compared to the symptomatic group (38.7% and 65.5%) (p<0.001). No severe complications, such as perforation, were observed. TCS facilitates early detection and improves prognosis in older patients with advanced CRC, supporting its use in appropriately selected individuals.

The increased use of CT in emergency departments (ED) has led to a rise in incidental detection of pneumomediastinum (PNM). As this finding can be associated with oesophageal perforation (OP), clinicians face a diagnostic dilemma on whether further invasive investigation (such as endoscopy) is required. This study aimed to identify clinical, biochemical and radiological predictors of OP in patients with PNM, to develop a non-invasive diagnostic approach. A retrospective analysis of adult patients with CT-confirmed PNM was conducted from January 2016 to December 2022 at a tertiary hospital in Queensland, Australia. Data were collected from electronic medical records on demographics, presenting features, vital signs at presentation and 6-24 hours, laboratory results and specific CT findings. Univariable analyses identified candidate predictors of OP, and multivariable logistic regression was used to determine independent predictors. Among 336 patients with PNM, 22 (6.5%) had confirmed OP. Dysphagia (p<0.001) and vomiting (p=0.002) on presentation were significant univariable predictors of OP. No asymptomatic patients were found to have OP. None of the measured laboratory markers (including white cell count, C-reactive protein and lactate) were predictive of OP. Key CT findings associated with OP were mediastinal free fluid, pleural effusion and oesophageal wall disruption (all p<0.001). Multivariable analysis identified that the combination of mediastinal free fluid plus oesophageal wall disruption was the strongest predictor of OP with a sensitivity of 86.4% and specificity of 98.4%. Clinical features such as dysphagia and vomiting, together with specific CT signs (mediastinal fluid, pleural effusion and oesophageal wall disruption), strongly predict OP in patients with PNM. Patients who are asymptomatic and lack these high-risk features are unlikely to have an OP and can probably be managed conservatively without invasive testing. These findings may help clinicians risk-stratify patients with PNM and avoid unnecessary admissions and invasive procedures.

Spontaneous isolated celiac artery dissection (SICAD) is a rare vascular disorder involving a dissecting lesion confined to the celiac trunk, often detected incidentally due to advances in computed tomography (CT). We report the case of a 60-year-old asymptomatic woman in oncologic follow-up, in whom contrast-enhanced CT revealed a chronic isolated celiac artery dissection with a double lumen and preserved distal flow. No ischemic or aneurysmal complications were observed. Conservative management with antiplatelet therapy and strict blood pressure control was initiated, with stable CT findings at 6- and 12-month follow-up. This case highlights the central role of CT in diagnosing, characterizing, and monitoring SICAD. Current evidence supports a conservative approach in asymptomatic patients, reserving endovascular intervention for complicated or progressive cases. Integration of advanced imaging protocols and updated vascular guidelines enables precise risk stratification and reduces unnecessary invasive procedures, improving patient outcomes.

Vascular atherosclerotic calcification is a pathological process marked by the abnormal deposition of calcium minerals in the intima. Asporin (ASPN) is a small leucine-rich proteoglycan which interacts with collagen and calcium. Due to its role in matrix mineralization, we hypothesized that ASPN might act as a regulator of vascular calcification, thereby promoting atherosclerotic plaque stability. ASPN protein, analyzed by ELISA, was quantified in 176 carotid endarterectomy plaques (Carotid Plaque Imaging Project cohort, including 98 patients with cerebrovascular symptoms and 78 asymptomatic patients). Plaque composition was assessed by histological, biochemical and immunological assays, along with bulk RNA sequencing, to investigate the role of ASPN in atherosclerosis. Patients donating plaques were followed up for postoperative cardiovascular events, median follow-up 6.58 years. The effect of ASPN on smooth muscle cell differentiation and matrix mineralization was investigated in vitro using human vascular smooth muscle cells overexpressing ASPN. Increased ASPN protein levels were observed in plaques from asymptomatic patients compared to patients with cerebrovascular symptoms. ASPN protein levels were positively associated with markers of plaque stability and regulation of extracellular matrix remodelling while showing an inverse relationship with calcification. Patients with high intraplaque ASPN had a lower risk for future cardiovascular events. Mechanistically, ASPN overexpression in vascular smooth muscle cells reduced matrix mineralization in vitro, supporting its potential role in plaque stabilization. ASPN is a regulator of vascular calcification in atherosclerosis, promoting a plaque phenotype that is less prone to rupture. Additionally, high ASPN levels are associated with fewer future cardiovascular events.