Clinical Features Research Articles

Migraine and ergot use increase plasma pentraxin 3 levels: an Egyptian study

ABSTRACT Background Endothelial dysfunction and inflammation are linked to migraine, which may contribute to atherogenesis and increase the risk of ischemia. In migraineurs, preclinical vascular involvement manifested as compromised structural characteristics of vessel wall has not received enough attention or evaluation. Objectives To measure plasma pentraxin 3 as an indicator of endothelial dysfunction in migraine in comparison to controls and to examine its correlation with clinical characteristics, headache severity, and brain magnetic resonance imaging findings. Subjects and methods This study was conducted on 40 migraineurs and 40 healthy matched control subjects. The severity and intensity of headaches were quantified using the Headache Impact Test and the translated Arabic version of Migraine Disability assessment questionnaires. Both patients and controls underwent routine laboratory assessment, brain MR imaging, and measurement of plasma pentraxin 3 level. Results Patients with migraine had a significantly higher mean plasma pentraxin 3 when compared to controls. Patients with chronic migraine and those taking ergots also had significantly higher plasma pentraxin 3 levels. Additionally, there were statistically significant positive correlation between frequency of headaches and duration of the disease with plasma pentraxin 3 level. For diagnosing endothelial dysfunction in migraine patients, the sensitivity and specificity of pentraxin 3 levels were 85% and 95%, respectively, with cut-off value of 3.100 ng/ml. Conclusion Pentraxin 3 levels could be used as a chemical biomarker for endothelial dysfunction in migraines with high sensitivity and specificity. Higher plasma levels of pentraxin 3 in patients receiving ergots may influence the selection of treatment for migraine patients.

Clinical features of pediatric spinal tuberculosis at tertiary general hospital

Spinal Tuberculosis is a secondary tuberculosis due to hematogenous spread from the primary infection site (lungs) caused by the bacteria Mycobacterium tuberculosis and is chronic-destructive in nature which attacks the spine. Manifestations in the form of deformity can also be cosmetically disturbing and will certainly reduce the sufferer's quality of life. The diagnosis of Spinal Tuberculosis is difficult and it commonly presents at an advanced stage. This retrospective study was performed at tertiary general hospital to identify the demographic and presenting clinical features of pediatric Spinal Tuberculosis population. Based on demographic characteristics, it was found that majority patients were female (59.34%) and in the range of 13-18 years old (52.75%). Based on diagnostic characteristics, it was found that majority of the lesions involved the thoracic spine (72.52%), majority of Kyphotic Angle in the range of 0-40 degrees (32.97%), more patients with vertebral collapse damage levels, types of deformity changes, complications of spinal stenosis, the main complaint is back pain and usually followed by weakness in the legs, and the most common patient laboratory results are increased WBC (White Blood Cells), decreased Hgb (Hemoglobin), and increased ESR (Erythrocyte Sedimentation Rate).

Construction of an Artificially Intelligent Model for Accurate Detection of HCC by Integrating Clinical, Radiological, and Peripheral Immunological Features.

Integrating comprehensive information on hepatocellular carcinoma (HCC) is essential to improve its early detection. We aimed to develop a model with multi-modal features (MMF) using artificial intelligence (AI) approaches to enhance the performance of HCC detection. A total of 1,092 participants were enrolled from 16 centers. These participants were allocated into the training, internal validation, and external validation cohorts. Peripheral blood specimens were collected prospectively and subjected to mass cytometry analysis. Clinical and radiological data were obtained from electrical medical records. Various AI methods were employed to identify pertinent features and construct single-modal models with optimal performance. The XGBoost algorithm was utilized to amalgamate these models, integrating multi-modal information and facilitating the development of a fusion model. Model evaluation and interpretability were demonstrated using the SHapley Additive exPlanations method. We constructed the electronic health record, BioScore, RadiomicScore, and DLScore models based on clinical, radiological, and peripheral immunological features, respectively. Subsequently, these single-modal models were amalgamated to develop an all-in-one MMF model. The MMF model exhibited enhanced performance compared to models comprising only single-modal features in detecting HCC. This superiority in performance was confirmed through the internal and external validation cohorts, yielding area under the curve (AUC) values of 0.985 and 0.915, respectively. Additionally, the MMF model improved the detection ability in subpopulations of HCCs that were negative for alpha-fetoprotein and those with small size, with AUC values of 0.974 and 0.996, respectively. Integrating multi-modal features improved the performance of the model for HCC detection.

Radiogenomic explainable AI with neural ordinary differential equation for identifying post-SRS brain metastasis radionecrosis.

Stereotactic radiosurgery (SRS) is widely used for managing brain metastases (BMs), but an adverse effect, radionecrosis, complicates post-SRS management. Differentiating radionecrosis from tumor recurrence non-invasively remains a major clinical challenge, as conventional imaging techniques often necessitate surgical biopsy for accurate diagnosis. Machine learning and deep learning models have shown potential in distinguishing radionecrosis from tumor recurrence. However, their clinical adoption is hindered by a lack of explainability, limiting understanding and trust in their diagnostic decisions. To utilize a novel neural ordinary differential equation (NODE) model for discerning BM post-SRS radionecrosis from recurrence. This approach integrates image-deep features, genomic biomarkers, and non-image clinical parameters within a synthesized latent feature space. The trajectory of each data sample towards the diagnosis decision can be visualized within this feature space, offering a new angle on radiogenomic data analysis foundational for AI explainability. By hypothesizing that deep feature extraction can be modeled as a spatiotemporally continuous process, we designed a novel model based on heavy ball NODE (HBNODE) in which deep feature extraction was governed by a second-order ODE. This approach enabled tracking of deep neural network (DNN) behavior by solving the HBNODE and observing the stepwise derivative evolution. Consequently, the trajectory of each sample within the Image-Genomic-Clinical (I-G-C) space became traceable. A decision-making field (F) was reconstructed within the feature space, with its gradient vectors directing the data samples' trajectories and intensities showing the potential. The evolution of F reflected the cumulative feature contributions at intermediate states to the final diagnosis, enabling quantitative and dynamic comparisons of the relative contribution of each feature category over time. A velocity curve was designed to determine key intermediate states (locoregional ∇F=0) that are most predictive. Subsequently, a non-parametric model aggregated the optimal solutions from these key states to predict outcomes. Our dataset included 90 BMs from 62 NSCLC patients, and 3-month post-SRS T1+c MR image features, seven NSCLC genomic features, and seven clinical features were analyzed. An 8:2 train/test assignment was employed, and five independent models were trained to ensure robustness. Performance was benchmarked in sensitivity, specificity, accuracy, and ROCAUC, and results were compared against (1) a DNN using only image-based features, and (2) a combined "I+G+C" features without the HBNODE model. The temporal evolution of gradient vectors and potential fields in F suggested that clinical features contribute the most during the initial stages of the HBNODE implementation, followed by imagery features taking dominance in the latter ones, while genomic features contribute the least throughout the process. The HBNODE model successfully identified and assembled key intermediate states, exhibiting competitive performance with an ROCAUC of 0.88±0.04, sensitivity of 0.79±0.02, specificity of 0.86±0.01, and accuracy of 0.84±0.01, where the uncertainties represent standard deviations. For comparison, the image-only DNN model achieved an ROCAUC of 0.71±0.05 and sensitivity of 0.66±0.32 (p=0.086), while the "I+G+C" model without HBNODE reported an ROCAUC of 0.81±0.02 and sensitivity of 0.58±0.11 (p=0.091). The HBNODE model effectively identifies BM radionecrosis from recurrence, enhancing explainability within XAI frameworks. Its performance encourages further exploration in clinical settings and suggests potential applicability across various XAI domains.

Accuracy of nursing diagnoses identified at admission and discharge of patients with decompensated heart failure.

To determine the accuracy of nursing diagnoses at hospital admission and discharge for patients with heart failure (HF). This comparative study examined the documentation in 155 medical records of patients with an admitting diagnosis of HF during August 2018 and July 2019. An audit tool was used to record the diagnoses made by nurses during routine care at the time of admission and discharge. Two researchers (L.S. and A.C.) examined the records and evaluated the documented nursing diagnoses using the Nursing Diagnosis Accuracy Scale version 2. Kappa was used for agreement between them. Patient social and clinical characteristics were described using percentages, absolute frequencies, means, and standard deviations. A total of 18 unique nursing diagnoses were identified across the 155 patients. Among the 754 nursing diagnoses recorded, 85% of those identified at admission (n=644) were deemed highly accurate. At discharge, of the 527 diagnoses recorded, 66% (n=349) were rated as highly accurate. Excess fluid volume was the most common diagnosis (85% at admission, 49% at discharge). Three risk diagnoses were frequent at both points: risk for infection, risk for falls, and risk for decreased cardiac output. Agreement between evaluators ranged from Κ=0.234 to 1.00. Greater agreement in nursing diagnoses at discharge likely reflects ongoing patient monitoring. Persistent diagnoses at discharge highlight the need for continued nursing care post-discharge. This study encourages nurses to improve clinical evaluation for HF patients from admission to discharge. As key clinical indicators are identified, nurses can improve the accuracy of their diagnoses and plan more effective interventions to achieve positive health outcomes and reduce unnecessary hospitalization.

Evaluation of the utility of the sFlt-1/PlGF ratio in pregnancy complicated by pre-eclampsia - single-center study. Preliminary analysis.

To evaluate relationship between sFlt-1/PlGF ratio, clinical characteristics and outcomes of pre-eclampsia. Retrospective analysis of 29 pregnant women with pre-eclampsia who had measured sFlt-1/PlGF ratio was conducted using electronic medical records from Obstetrics and Perinatology ward of University Hospital in Cracow. Women median age: 33.5 years, number of pregnancies: one 52%, two 15%, three 18%,more than three 15%, number of deliveries: one 59.3%, two 37%, three 3.7%, median body mass index during hospitalization: 29.4 kg/m². Chronic diseases apart from hypertension: 67% of women (diabetes 37%, hypothyroidism 26%, obesity 11%). Median newborns birth weight: 1640 g, median Apgar score at 5 minutes: 8, median umbilical cord blood pH: 7.32. Fetal growth restriction: 28.6% of cases. All deliveries were by c-section. Median gestational age at delivery: 32 weeks. sFlt-1/PlGF ratio was inversely correlated with gestational age at delivery (r = -0.42, p = 0.02). The median sFlt-1/PlGF ratio was higher in women with severe pre-eclampsia (n = 15) than in those with mild pre-eclampsia (n = 14) (211 vs. 57, p < 0.001). sFlt-1/PlGF ratio of > 85 had a sensitivity of 80% and a specificity of 71% for predicting severe pre-eclampsia. sFlt-1/PlGF ratio is useful in assessing the severity and prognosis of pre-eclampsia. sFlt-1/PlGF ratio should not be used as a sole criterion for making clinical decisions, but as an adjunct to other clinical and laboratory parameters.

Pentraxin-3 as a novel prognostic biomarker in non-neutropenic invasive pulmonary aspergillosis patients.

The incidence of invasive pulmonary aspergillosis (IPA) in non-neutropenic patients is increasing. This study aimed to evaluate the clinical outcomes and risk factors for mortality in non-neutropenic IPA patients. We conducted a prospective, multicenter study from August 2020 to February 2024, enrolling 565 patients with suspected IPA. The study cohort comprised 195 IPA (non-neutropenic) cases and 370 non-IPA cases. Peripheral blood and bronchoalveolar lavage fluid (BALF) specimens were collected to measure pentraxin-3 (PTX3) levels. Additionally, demographic data, clinical characteristics, and antifungal therapy of each patient were recorded. We analyzed factors associated with 30- and 90-day mortality. IPA patients exhibited higher mortality rates compared to non-IPA patients, with 30-day rates of 26.15% versus 8.38% (P < 0.001) and 90-day rates of 34.36% versus 13.24% (P < 0.001). Higher plasma and BALF PTX3 levels were associated with poor prognosis in IPA patients. ROC curve analysis identified optimal PTX3 thresholds of 4.29 ng/mL in BALF (sensitivity, 67.1%; specificity, 81.4%) and 7.11 ng/mL in plasma (sensitivity, 73.4%; specificity, 82.8%) for predicting mortality. Multivariate Cox regression analysis confirmed PTX3 levels in plasma (hazard ratio [HR] 3.87, 95%CI [1.87-8.00], P＜0.001) and BALF (HR 2.40 [1.19-4.84], P = 0.014) were independent prognostic factors for IPA mortality. Additionally, positive galactomannan test results in both BALF and plasma were initially correlated with increased mortality in IPA patients. However, after adjusting for potential confounding factors, this correlation no longer remained statistically significant. In conclusion, PTX3 is a promising prognostic biomarker of mortality in IPA patients.IMPORTANCEStudies have confirmed the value of pentraxin-3 (PTX3) in the diagnosis of invasive pulmonary aspergillosis (IPA), yet its prognostic significance in IPA remains unclear. This study found that in non-neutropenic IPA patients, plasma and bronchoalveolar lavage fluid (BALF) levels of PTX3 are independently associated with poor outcomes. Furthermore, the optimal cutoff values of PTX3 for predicting a poor prognosis of IPA are 4.29 ng/mL in BALF and 7.11 ng/mL in plasma. These findings could help us better manage IPA in non-neutropenic patients, potentially enhancing the prognosis of patients with this condition.

Clinicopathological Features of Mixed Connective Tissue Disease-Related Myositis: A Case Series.

Mixed connective tissue disease (MCTD) patients often have myositis, however, myopathological and clinical data for MCTD are limited. Recent reports have shown that the pathology of MCTD myositis resembles that of immune-mediated necrotizing myopathy (IMNM), whereas earlier reports described perifascicular atrophy or inflammatory infiltrates predominantly in the perivascular region in MCTD myositis. We aim to describe the clinical and myopathological features of MCTD myositis. We analyzed the clinical and myopathological findings of nine myositis patients with U1-RNP antibodies who fulfilled the diagnostic criteria for MCTD. Eight patients had muscle weakness in the proximal extremities, and overall, six patients had atypical weakness in the face, neck, wrist, or fingers. Four of those patients required additional intensive treatment (intravenous immunoglobulin or methylprednisolone). Therapeutic responses were consistently favorable overall, and there were no deaths during the observation period. In biopsied muscle specimens, common findings were mild myogenic change, increased necrotic and regenerating fibers, and inflammatory infiltrates predominating in the perivascular region. Two specimens were classified into the spectrum of dermatomyositis (DM); the remaining seven specimens, which had a smaller number of necrotic fibers and nonspecific infiltration, were unclassifiable. Patients with MCTD myositis often exhibit an axial or atypical distribution of muscle weakness, which may require intensive therapy. Histological study demonstrates the heterogeneity of myopathology of MCTD myositis and suggests that DM and underlying vasculopathy might be present in these patients.

Biochemical markers in hand osteoarthritis: a path to precision medicine.

Hand osteoarthritis (HOA) is a heterogeneous joint disease with high radiographic and symptomatic prevalence. The diagnosis of HOA is based on clinical and radiographic features. The identification of potential biomarkers for diagnosis, prognosis, disease severity assessment, and therapeutic efficacy evaluation of НОА remains an active area of research. To summarize the eligible biomarker data, a comprehensive narrative review was performed using the PubMed and Scopus databases covering publications from inception to December 2024. Our search uncovered five distinct groups of biomarkers associated with HOA, categorized based on their origin and involvement in distinct biological processes: (1) cartilage synthesis and catabolism, (2) bone remodeling, (3) inflammation, (4) adipokines, and (5) others classified separately. Each biomarker was evaluated in accordance with the Burden of disease, Investigative, Prognostic, Efficacy of intervention, and Diagnostic (BIPED) criteria. In conclusion, no biomarker has yet demonstrated sufficient sensitivity, specificity, or reproducibility to meet the BIPED criteria for classification. The early diagnosis and treatment of HOA require the development of more sensitive assays, advanced platforms, and rigorous bio-clinical trials to stratify previously studied biomarkers and identify novel ones. Precision medicine in HOA demands reliable biomarkers, cost-effective assays, and standardized, reproducible methodologies for global applicability.

Psychosocial burden and sociodemographic characteristics of cancer survivors seeking support for work-related issues in outpatient cancer counseling centers

ABSTRACT Introduction Outpatient cancer counseling centers (OCCs) are important social work facilities that provide support for cancer survivors who have psychosocial and sociolegal challenges. This paper explores clinical and sociodemographic characteristics, psychosocial burden as well as access routes of clients in OCCs seeking work-related counseling. Methods Between May 2022 and December 2023, data were collected in 19 OCCs, using questionnaires and documentation by counselors. Results The 719 cancer survivors surveyed had a mean age of 50 and were predominantly female (78%); 46% had been diagnosed with breast cancer. Most respondents had university entrance certificates (42%). The respondents rated their overall life and job satisfaction at a mean of 5 and distress at a mean of 7. The majority of respondents had received information about the OCC from the hospital. Discussion The results show that especially women with breast cancer and high socioeconomic status made use of counseling in the CARES study. The respondents also had a high sense of burden and dissatisfaction and access routes to the OCCs were mainly through recommendations of the treating hospitals or physicians. These findings can be used to ensure need-based counseling in the OCC, as well as to address additional target groups that are currently underrepresented.

Avascular necrosis in pediatric rheumatic diseases: an Italian retrospective multicentre study

BackgroundAtraumatic avascular necrosis (AVN) is a severe condition that may complicate the course of rheumatic diseases and contribute to long-term damage. However, there is a lack of evidence on this rare event in pediatric rheumatology. The aim of our study was to evaluate the occurrence of avascular necrosis in the context of rheumatologic diseases in Italy and to describe the main demographic and clinical features of AVN patients, with a particular focus on treatment background.MethodsAll centres part of the Italian Society of Pediatric Rheumatology were invited to participate in a retrospective case collection of children with rheumatic diseases complicated by a pediatric-onset AVN. Demographic, clinical, laboratory and imaging data were recorded, together with outcome and treatment background, particularly steroid exposure. Population collected was further evaluated according to the different underlying rheumatologic disease and to the time of AVN onset.ResultsFourteen patients (SLE = 7; JIA = 4; others = 3) were collected from 7 centres. Females were predominantly affected (71%) with a median age at AVN diagnosis of 14.3 years. Multifocal involvement was mostly reported (93%), mainly involving femoral heads (44%) and knees (28%). All patients had a severe rheumatologic background and received systemic glucocorticoids with a median cumulative prednisone equivalent dose of 457.5 mg/kg. In all patients but one imaging showed persistence of abnormalities, despite the complete resolution of symptoms in 6 of them. Bisphosphonates were the most used therapeutic approach; orthopedic surgery was required in 2 cases.ConclusionsDespite its rarity, AVN may be a severe complication of pediatric rheumatic diseases. Active monitoring is crucial to promptly identify patients and to prevent long-term damage. Prospective large sample studies are required to better understand the impact of steroid exposure and its complex interplay with other potential contributing factors.

Multiple system atrophy related neurogenic bladder: mechanism and treatment.

Multiple system atrophy (MSA) is a progressive neurodegenerative disease characterized by its aggressive nature. Its main clinical features include autonomic dysfunction, Parkinson's disease, and cerebellar ataxia. We conducted a comprehensive review of the existing literature, exploring studies and reports related to the mechanisms and treatment of multiple system atrophy related neurogenic bladder. Our aim is to provide a detailed and up-to-date overview of its underlying pathophysiology and current therapeutic strategies. Neurogenic bladder, a common manifestation of MSA, often goes untreated or mistreated, significantly affecting patients' quality of life. Early-stage bladder dysfunction is frequent in MSA patients and correlates with disease severity. The mechanisms of MSA related neurogenic bladder are related to the autonomic nervous system, somatic nerves, frontal cortex, brainstem, and sacral medulla center. Currently, treatment for MSA related neurogenic bladder is mainly symptomatic, and specific drugs are lacking. Further in-depth research is needed to develop more effective therapeutic options that improve patients' quality of life and reduce the risk of complications.

Predictive ability of systemic coagulation-inflammation index on early fistula failure after radiocephalic arteriovenous fistula creation.

To the best of our knowledge, a possible predictive relationship between the systemic coagulation-inflammation index (SCI) and arteriovenous fistula (AVF) failure following AVF creation has not yet been examined. We therefore designed this study to examine the predictive ability of SCI on postoperative early AVF failure in patients undergoing primary radiocephalic AVF operation. A total of 189 patients who underwent primary radiocephalic AVF operation for hemodialysis access were included in this retrospective observational cohort study, and then divided into two groups according to whether AVF failure occurred within the first 3 months after the operation; as failed AVF group (n = 44) and non-failed AVF group (n = 145). The patients' baseline clinical characteristics and laboratory parameters were recorded and then compared between the groups. Patients in failed AVF group were significantly older and had higher smoking rate than those in non-failed AF group. The median values of fibrinogen, platelet-to-lymphocyte ratio and SCI were significantly higher in failed AVF group than in non-failed AVF group. With regards to other clinical characteristics and laboratory parameters, no significant differences were detected between the groups in the univariate analyses. Only age and SCI maintained their significances in the multivariate logistic regression analysis, and were therefore considered as the independent predictors of AVF failure. ROC curve analysis revealed that SCI of 37.9 constituted the optimum cut-off value with 97.7% sensitivity and 94.5% specificity rates for predicting AVF failure. The present study demonstrated for the first time in the literature that SCI significantly and independently predicted early AVF failure following radiocephalic AVF creation.

Factors Influencing Daily Living and Ostomy Self-Care Management in Ostomates: A Mixed Methods Study.

To examine the factors affecting the ability of ostomates to perform activities of daily living and manage ostomy self-care. Mix method design. This study was undertaken through survey (descriptive and clinical characteristics form and Katz Activities of Daily Living (ADL)) for collecting the quantitative data (n = 60) and semi-structured interviews were conducted with patients unable to perform ostomy self-care for collecting qualitative data (n = 12) between January 2023 and December 2023. Factors hindering the ability to perform ostomy self-care were physical reasons (68.3%) and psychological reasons (66.7%). Multiple linear regression analysis revealed that individuals with a chronic disease have a Katz ADL score 12.6 times higher than those without a chronic disease (p = 0.004, OR = 12.665, 95% CI: 2.304-69.614). Qualitative analysis identified three themes as challenges, taking over ostomy care and factors improving the quality of life with ostomy. The findings indicate that having an ostomy impairs individuals' ability to perform daily activities independently and manage their ostomy. Additionally, the presence of a chronic disease in ostomates predicts greater dependence in daily activities. In this regard, support mechanisms should be identified and activated based on the needs of ostomates and chronic diseases, with nursing interventions tailored to address those needs. A dedicated team of specialised ostomy nurses can offer valuable support by focusing on ostomy management and assessing factors that affect both self-care and daily activities. This study highlights the impact of coping with an ostomy on daily life and self-care, underscoring the need for targeted support for vulnerable groups and guiding ostomy care nurses in post-discharge follow-up and support group organisation. STROBE and GRAMMS checklists. Patients contributed to the study by sharing their experiences through face-to-face interviews during data collection process.

Combining clinical and radiological features improves prediction of bowel ischemia in patients with CT findings of pneumatosis intestinalis.

Pneumatosis intestinalis on CT presents a diagnostic dilemma, because it could reflect bowel ischemia or benign finding. To determine radiological and clinical features that can predict bowel ischemia in patients with pneumatosis intestinalis on CT. Patients with "pneumatosis" in abdominal CT reports performed between 1/1/2002 and 12/31/2018 were retrospectively included. Pneumatosis intestinalis was confirmed by review of images. Radiological features of pneumatosis, laboratory data, clinical signs and symptoms were collected. Pathologic pneumatosis intestinalis (PPI) was defined as presence of ischemic (viable or dead) bowel on surgery or death during admission or within 30 days of discharge due to ischemia. Univariate statistical analysis was used to identify features associated with PPI, followed by multivariate logistic regression models. A total of 313 consecutive patients with pneumatosis intestinalis (162 (52%) men, median age 67 years, IQR 55-78 years) were included. Pathologic pneumatosis intestinalis was present in 114/313 (36%) patients. Presence of arterial or venous thrombosis, porto-mesenteric gas, fat stranding, and location in the small bowel were significantly associated with PPI. A combined clinical and radiological model, which included age, WBC, creatinine, abdominal distention, rebound or guarding, shock, presence of porto-mesenteric gas and fat stranding showed an AUC of 0.85 for prediction of PPI, higher than models using clinical (AUC = 0.80, p = 0.005) or radiological factors (AUC = 0.80, p < 0.0001) alone. Improved prediction of pathological pneumatosis intestinalis can be achieved by a model incorporating both clinical and radiological features (AUC = 0.85)rather than by either clinical (AUC = 0.80) or radiological (AUC = 0.80) features alone.

Preoperative MRI to Predict Upstaging of DCIS to Invasive Cancer at Surgery.

Ductal carcinoma in situ (DCIS) is overtreated, in part because of inability to predict which DCIS cases diagnosed at core needle biopsy (CNB) will be upstaged at excision. This study aimed to determine whether quantitative magnetic resonance imaging (MRI) features can identify DCIS at risk of upstaging to invasive cancer. This prospective observational clinical trial analyzed women with a diagnosis of DCIS on CNB. All the participantsunderwent preoperative 3T MRI. Quantitative MRI features from routine dynamic contrast-enhanced (DCE) MR images (e.g., peak percent enhancement [PE]) and from advanced high temporal-resolution DCE MR images (e.g., Ktrans) were measured. Clinical, pathologic, and mammographic features were reviewed. Associations with upstaging were summarized using the area under the receiver operating characteristic curve (AUC). Of 58 DCIS lesions at CNB, 15 (26%) were upstaged to invasive cancer at surgery. Of the 58 lesions, 46 (79%) enhanced on MRI, although enhancement alone was not significantly associated with upstaging (p = 0.71). Among the DCIS lesions that enhanced, higher PE was most strongly associated with upstaging (AUC, 0.81; adjusted p = 0.009) and outperformed MRI features acquired via high temporal resolution DCE-MRI (AUC, 0.50-0.73). Lesion span on MRI was not significantly associated with upstaging risk (AUC, 0.55; adjusted p = 0.61), nor were any clinical, pathologic, or mammographic features (p > 0.24). Quantitative features acquired from routine clinical breast MRI and advanced DCE-MRI demonstrated good performance in identifying which DCIS lesions were upstaged to invasive cancer at excision. These features may prove valuable for appropriate selection of active surveillance in future DCIS de-escalation trials.

Development and validation of a nomogram combining clinical and 18F-FDG PET/CT parameters for prediction of high-grade patterns in invasive lung adenocarcinoma

Objective: To establish and validate a nomogram based on clinical characteristics and metabolic parameters derived from 18F-fluorodeoxyglucose positron emission tomography and computed tomography (18F-FDG PET/CT) for prediction of high-grade patterns (HGP) in invasive lung adenocarcinoma. Methods: The clinical and PET/CT image data of 311 patients who were confirmed invasive lung adenocarcinoma and underwent pre-treatment 18F-FDG PET/CT scan in Beijing Hospital between October 2017 and March 2022 were retrospectively collected. The enrolled patients were divided into HGP group (196 patients) and non-HGP group (115 patients) according to the presence and absence of HGP. The data were divided into training set and validation set at 7∶3 ratio using R statistical software and simple random allocation. A nomogram prediction model was constructed in training set. The area under the curve (AUC) of receiver operating characteristic (ROC) was depicted in the training and validation set respectively for assessing the prediction efficacy. The goodness of fit, consistency between predicted and observed probability and clinical usefulness of the model were evaluated by Hosmer-Lemeshow test, calibration curve and decision curve analysis (DCA). Results: The age of 311 patients were (65.6±10.9) years and included 148 males (47.6%). In training set of 217 patients, 141 (65.0%) contained HGP while in validation set of 94 patients, 55 (58.5%) contained HGP. Gender in training set, serum carcino-embryonic antigen (CEA) in validation set, smoking history, clinical stage, cytokeratin fragments (CYFRA21-1), maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), metabolic tumor volume (MTV), total lesion glycolysis (TLG) and maximum diameter (Dmax) in both sets showed significant differences between HGP and non-HGP groups (all P<0.05). The variables integrated in the model were gender, clinical stage, CYFRA21-1, SUVmean and TLG. The AUC (95%CI) of the ROC curve in training and validation set were 0.888 (0.844-0.932) and 0.925 (0.872-0.977), the sensitivity and specificity were 85.1%, 79.0% and 83.6%, 89.7%, respectively. The model showed good goodness of fit (training set: χ2=8.247, P=0.410, validation set: χ2=1.636, P=0.990). Calibration curve and DCA also indicated good consistency and clinical net benefit of the nomogram model. Conclusion: The nomogram model based on clinical features and metabolic parameters derived from 18F-FDG PET/CT could effectively predict the presence of HGP in invasive lung adenocarcinoma and be beneficial to treatment planning.

Research progress in diagnosis and treatment of psychogenic pseudosyncope in children.

Psychogenic pseudosyncope is one of the primary causes of transient loss of consciousness in children and adolescents, essentially classified as a conversion disorder that significantly impacts patients' quality of life. Clinically, psychogenic pseudosyncope shares certain similarities with vasovagal syncope in terms of pre-syncope symptoms and triggers, making it sometimes difficult to differentiate and easily misdiagnosed. Therefore, placing emphasis upon the characteristics of psychogenic pseudosyncope is crucial for early identification and treatment, which holds significant importance for the mental and psychological health of children and adolescents. In the present review, we aimed to address psychogenic pseudosyncope with clinical features, diagnosis, and treatment.

Altered Intra- and Inter-Network Resting-State Functional Connectivity is Associated with Neuropsychological Functioning and Clinical Symptoms in Patients with Isolated Rapid Eye Movement Sleep Behavior Disorder.

Isolated rapid-eye movement (REM) sleep behavior disorder (iRBD) is characterized by abnormal behaviors in REM sleep and is considered as a prodromal symptom of alpha-synucleinopathies. Resting-state functional magnetic resonance imaging (rsfMRI) studies have unveiled altered functional connectivity (rsFC) in patients with iRBD. However, the associations between intra- and inter-network rsFC with clinical symptoms and neuropsychological functioning in iRBD remain unclear. To characterize intra- and inter-network rsFC in iRBD patients using a data-driven approach and to assess its associations with clinical features and cognitive functioning. Forty-two patients with iRBD and 45 healthy controls (HC) underwent rsfMRI and comprehensive neuropsychological testing. Resting-state networks were characterized using independent component analyses. Group differences in intra- and inter-network rsFC and their associations with clinical and neuropsychological data were studied. A threshold of corrected P < 0.05 was used in all the analyses. iRBD patients displayed lower intra-network rsFC within basal ganglia, visual, sensorimotor, and cerebellar networks, relative to HC. Mean rsFC strength within the basal ganglia network positively correlated with processing speed and negatively with the non-motor symptoms in iRBD patients. Reduced inter-network rsFC between sensorimotor and visual medial networks was observed in iRBD patients, which was associated with global cognitive status. iRBD is characterized by both reductions in intra-network rsFC in cortical and subcortical networks and inter-network dysconnectivity between sensorimotor and visual networks. Abnormalities in intra- and inter-network rsFC are associated with cognitive performance and non-motor symptoms, suggesting the utility of both rsFC measures as imaging markers in prodromal alpha-synucleinopathies. © 2025 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Near-universal prevalence of central adiposity in heart failure with preserved ejection fraction: the PARAGON-HF trial.

An expansion of fat mass is an integral feature of patients with heart failure and preserved ejection fraction (HFpEF). While body mass index (BMI) is the most common anthropometric measure, a measure of central adiposity-the waist-to-height ratio (WHtR)-focuses on body fat content and distribution; is not distorted by bone or muscle mass, sex, or ethnicity; and may be particularly relevant in HFpEF. The PARAGON-HF trial randomized 4796 patients with heart failure and ejection fraction ≥45% to valsartan or sacubitril/valsartan. The current work characterizes the association of BMI and WHtR with clinical features, outcomes, and the response to neprilysin inhibition. About half (49%) of the participants were considered obese by BMI (≥30 kg/m2), but nearly every patient (96%) had central adiposity (WHtR ≥0.5). Among patients who were not obese (BMI <30 kg/m2), 860 (37%) had marked central adiposity (WHtR ≥0.6). Higher BMI and WHtR were both associated with higher risk of total heart failure hospitalizations, but as compared with BMI, WHtR was linearly associated with heart failure outcomes and identified a higher proportion of patients who had a particularly elevated risk (i.e., 30% or greater). An obesity-survival paradox (i.e., improved outcomes in those with greater adiposity) was apparent with BMI in unadjusted analyses, but it was not observed with WHtR. Although neprilysin inhibition appeared to have greater effects on heart failure outcomes in patients with higher BMI and WHtR, analyses of interaction with obesity metrics did not show significant heterogeneity across the range of values for adiposity. In PARAGON-HF, in contrast with BMI, nearly every patient with HFpEF had central adiposity (as assessed by WHtR), and the risks of adverse heart failure events were more robustly related to WHtR. These data challenge the current reliance on BMI as an appropriate metric of adiposity, and they suggest that-rather than obesity-related HFpEF being regarded as a select HFpEF subgroup-central adiposity is a ubiquitous feature of HFpEF.