Zero-electron-mass limit for a two-fluid Euler–Poisson system for general initial data

Reflection Spectroscopy-Assessed Skin Carotenoids Are Positively Associated With Diet Quality and Inversely Associated With Food Security Among Participants in a Community-Based Nutrition Intervention.

Abstract Aim of study To assess MRI features of invasive breast cancer in relation to lymphovascular invasion (LVI) and its clinicopathological associations. Methods This retrospective study included 103 cases of pathologically proven breast cancer who had undergone preoperative MRI including conventional study, dynamic contrast-enhanced study (DCE) and diffusion-weighted imaging (DWI). Lesions were reviewed and described according to Breast Imaging Reporting and Data System (BIRADS) lexicon 2013 edition in addition to other MRI findings including: peritumoral edema, intratumoral high T2 signal intensity, tumor apparent diffusion coefficient (ADC) value, peritumoral ADC value, and peritumor–tumor ADC ratio. Histopathological and immunohistochemical analysis was done. Presence or absence of lymphovascular invasion (LVI) on postoperative histopathology was assessed. Statistical analyses were performed to identify significant MRI findings found with LVI as well as its clinicopathological associations. Results Higher T-stage of the tumor ( p < 0.0001), tumor histologic grade ( p < 0.0001), molecular subtype (negative hormonal and positive HER2 status), high Ki-67 proliferation index ( p < 0.0001), peritumoral edema ( p < 0.001), intratumoral high T2 signal intensity ( p < 0.001) were significantly associated with LVI. The tumor ADC value ( p = 0.034), peritumoral ADC value ( p < 0.001), and peritumor–tumor ADC ratio ( p < 0.001) had significant correlation with LVI. Prediction of LVI can be made using cutoff value for peritumoral ADC (> 1.5) and peritumor/tumor ADC ratio (> 1.9) ( p < 0.001). Conclusions We found that lymphovascular invasion was more common in HER2-positive molecular subtypes and high-grade invasive tumors. T2-weighted imaging was helpful in detecting peritumoral edema and intratumoral high T2 signal which is strongly associated with lymphovascular invasion. Peritumoral ADC value and peritumor–tumor ADC ratio can be predictive MRI findings for LVI. This can impact management plans and patient prognosis especially in node-negative invasive breast cancer cases.

Distinguishing preoperative criteria and postoperative histological features of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) from those of other thyroid tumors with follicular architecture and papillary nuclear features (non-NIFTP) is crucial to prevent overtreatment. In this study, we aim to identify the predictive factors of NIFTP. We conducted a retrospective study in which we collected cases of thyroid tumors with follicular architecture and papillary nuclear features diagnosed between 2012 and 2022. Clinicopathological characteristics, therapeutic modalities, and follow-up were compared between NIFTP and non-NIFTP tumors. Forty cases of NIFTP and 44 cases of non-NIFTP were identified. NIFTP accounted for 8.83% of all PTCs and 33.6% of all thyroid tumors with follicular architecture and papillary nuclear features. NIFTP was associated with younger age (p=0.005), isoechoic nodules on ultrasound (US) (p=0.004), regular contours (p=0.028), absence of microcalcifications (p=0.005), and predominance in European Thyroid Imaging Reporting and Data System 2 and 3 scores (p<0.001). They predominantly exhibited a nuclear score of 2 (p<0.001), focal nuclear abnormalities (p=0.015), and a thin capsule (p=0.004). No case of NIFTP showed distant or lymph node metastases. Multivariate analysis identified a nuclear score of 2, focal nuclear abnormalities, and a thin tumor capsule as independently associated with NIFTP. Our findings demonstrated the indolent nature of NIFTP and the utility of cervical US in raising preoperative suspicion for this entity. Because findings regarding the Bethesda classification were not available in our study, a prospective multicenter study with a larger sample size and a longer follow-up period is warranted to address this limitation.

Artificial intelligence for marine oil spill management: Recent advances and future directions.

The Gail and Tyrer–Cuzick models draw on different input variables and can assign the same woman to different risk categories, yet whether this discordance alters clinical risk stratification in populations with high mammographic density prevalence has not been formally assessed. This study aimed to compare clinical concordance and density-driven risk reclassification between the 2 models in a Turkish screening cohort. In this prospective cross-sectional study, lifetime breast cancer risk was calculated using both models in 1365 women aged 35 to 75 undergoing routine screening at Ordu University Training and Research Hospital from June 2025 to January 2026. Mammographic density was assessed by independent radiologists blinded to clinical data. Concordance at the ≥20% lifetime risk threshold was evaluated using Cohen kappa and the prevalence-adjusted bias-adjusted kappa. The mean age was 50.6 ± 7.8 years; 77.2% had dense breasts (Breast Imaging Reporting and Data System Type C/D). The Gail model classified 40 women (2.9%) as high risk (≥20% lifetime risk); the Tyrer–Cuzick model classified 232 (17.0%; P < .001). Cohen κ was 0.22 (95% confidence interval: 0.15–0.29), deflated by marginal asymmetry; the prevalence-adjusted bias-adjusted κ was 0.70, corresponding to substantial agreement (Prevalence Index, 0.80; Bias Index, 0.14; observed agreement, 85.2%). A total of 182 women (13.3%; 95% confidence interval: 11.6–15.3%) classified as low or average risk by Gail were reclassified as high risk by the Tyrer–Cuzick model. The reclassification rates were 14.5% for dense breasts (Type C/D) and 24.1% for extremely dense breasts (Type D). The sensitivity analyses confirmed that mammographic density was the primary driver of inter-model discordance (κ = 0.19; upstaging rate = 10.8%). In this Turkish screening cohort, the Gail and Tyrer–Cuzick models showed only fair concordance at the ≥20% threshold for supplemental magnetic resonance imaging, with mammographic density as the principal driver of disagreement. Outcome-linked validation in populations with high breast density prevalence is needed before either model can be recommended as the reference.

While Janus kinase inhibitors (JAKi) have been associated with an increased risk of serious infections compared with biologics in patients with ulcerative colitis (UC), data comparing the risk of infection across individual JAKi remain limited. We aimed to compare the risk of serious infections among patients with UC treated with tofacitinib, upadacitinib, or filgotinib. We conducted a nationwide cohort study using the French National Health Data System, including UC patients aged >15 years who initiated tofacitinib, upadacitinib, or filgotinib between 2019 and 2025. We assessed the risk of serious infection (defined as requiring hospitalization) according to treatment exposure. Propensity score weighting accounted for indication bias. Overall, 237 serious infections occurred among 6449 JAKi initiations: 2735 used upadacitinib, 2825 tofacitinib, and 889 filgotinib. Median age was 39 years, 49.5% were women, and median time since UC diagnosis was 7.1 years. Incidence rates per 1000 patient-years were 38.8 for upadacitinib, 30.6 for tofacitinib, and 28.4 for filgotinib. Compared with upadacitinib, adjusted hazard ratios for serious infection were 0.93 (95% CI: 0.70-1.24) for tofacitinib and 0.88 (95% CI: 0.56-1.39) for filgotinib. No differences were observed across infection sites or pathogen types. Higher doses of upadacitinib and tofacitinib were associated with increased infection risk. The risk of non-severe infections, particularly against herpes simplex virus and varicella zoster virus, was highest with upadacitinib and lowest with filgotinib. Tofacitinib, upadacitinib, and filgotinib were associated with similar risks of serious infection in patients with UC. Infection risk appeared to be driven primarily by dose rather than by type of JAKi.

Biological aging (BA) may influence chronic kidney disease (CKD) development. We evaluated the association of accelerated BA-quantified using Klemera-Doubal method biological age (KDM-BA) and phenotypic age (PhenoAge)-with incident CKD, and assessed its predictive value beyond conventional risk factors (CKD Prediction Consortium [CKD-PC] model) in participants with diabetes. This two-country cohort study included 14,274 participants with diabetes from the UK Biobank and 7,900 from the China Renal Data System (CRDS). KDM-BA and PhenoAge were calculated from clinical biomarkers, and their acceleration (deviation from chronological age) was evaluated. Cox regression assessed associations with incident CKD, while C-index, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) evaluated predictive performance. Over median follow-ups of 13.3 (UK Biobank) and 3.3 (CRDS) years, 1,676 and 709 incident CKD cases were documented. Each standard deviation increase in KDM-BA acceleration was associated with 31% (95%CI: 23-39%) (UK) and 68% (95%CI: 58-80%) (China) higher CKD hazard. PhenoAge acceleration similarly increased CKD risk (29% and 28%, respectively). In the UK Biobank, adding KDM-BA or PhenoAge acceleration to the CKD-PC model (C-index = 0.770) led to modest but statistically significant improvements in prediction (C-index increase = 0.004 [95%CI: 0.002-0.006] and 0.003 [0.001-0.005], respectively), while leukocyte telomere length (LTL) provided no benefit (0.0001 [-0.0004, 0.0005]). Both BA measures enhanced reclassification (NRI: 0.034-0.076; IDI: 0.002-0.003). CRDS analyses yielded consistent results. Accelerated BA is consistently associated with higher CKD hazard in diabetes across European and Asian populations. KDM-BA and PhenoAge offer practical tools for refining CKD risk stratification.

PI-RADS v2 and Adverse Prostate Cancer Outcomes: A Cross-cohort Replication Study Across Three Centers.

The purpose was to evaluate the concordance of prostate cancer therapeutic decisions based on in-bore MRI-targeted biopsies (MRI-TB) alone, with decisions based on combined in-bore MRI-TB and systematic US-guided biopsies. We included male biopsy-naïve patients, aged between 50 and ≤ 75 years, with PSA greater than 4 and/or a pathological digital rectal examination in this single-centre, exploratory, prospective, interventional study. All patients received T2-weighted MRI between November 2022 and May 2024, presenting a single lesion with a positive Prostate Imaging Reporting and Data System (PI-RADS) score ≥ 3. In-bore MRI-TB were carried out with the assistance of a Remote-Controlled Manipulator. A second operator (radiologist), blind to in-bore MRI-TB results, carried out systematic 12-core TRUS-guided biopsies.We evaluated concordance of therapeutic decisions decided in a multidisciplinary team meeting (MDT1) based on in-bore MRI-TB only, with decisions based on the combined biopsies (MDT2, blind to MDT1 decision). ISUP score and cancer detection concordance, and tolerance and acceptability of the procedures were evaluated. Fifty patients were included, with average age 63.4 years (SD 6.9). Therapeutic strategies were aligned for 43 patients, with a weighted Cohen's Kappa of 0.81 [95%CI 0.67;0.95], within the very good range. ISUP score concordance was very good (0.82 [0.68;0.97]) and cancer detection concordance was strong (0.63 [0.38;0.89]). Pain was higher after TRUS-guided biopsies. Fourteen (28%) patients preferred in-bore MRI-TB and 7 (14%) preferred TRUS-guided and 29 (58.0%) had no preference. No infections were recorded. MRI-targeted biopsies reduce pain for patients. However, while there was excellent concordance between the two methods for therapeutic decisions and ISUP scores, the lower concordance for cancer detection means that systematic biopsies cannot yet be omitted for prostate cancer diagnosis.

IntroductionBreast density is a risk factor for breast cancer and reduces the sensitivity of mammography. Manual breast imaging reporting and data system (BI-RADS) classification remains the clinical standard, but automated methods have been developed to improve reproducibility and efficiency. This review evaluated the concordance between automated/semi-automated measurements and manual assessments of mammographic breast density.MethodsWe systematically searched MEDLINE, Embase, Cochrane Database of Systematic Reviews, CENTRAL, Scopus, and Web of Science (2014 onwards) for studies comparing automated or semi-automated measurement with manual BI-RADS classification on 2D digital mammography. Eligible studies included ≥60% of participants from routine screening populations. Data extraction and risk of bias assessment followed a registered protocol (PROSPERO: CRD42024550250).ResultsThere is good concordance between automated/semi-automated measurement and manual assessment of breast density in the 26 included studies. Meta-analysis of 13 Volpara studies showed a tendency to classify mammograms as dense compared with manual assessment, but the difference was not statistically significant and statistical heterogeneity was very high (pooled difference 0.03, 95% CI -0.03 to 0.10; I2 = 98%). Studies of Quantra and other software showed broadly similar findings, but variability in software versions and BI-RADS editions limited comparability. Reporting of participant demographics was poor, thus generalisability is unclear.ConclusionsAutomated breast density software, such as Volpara and Quantra, shows promising concordance with manual BI-RADS assessment and may enhance consistency in screening programmes. Heterogeneity across studies and limited information on representativeness preclude firm conclusions. Large-scale, standardised, and inclusive evaluations are needed to establish clinical utility.FundingNational Institute for Health and Care Research.

To quantify the relative contribution of radiologists and urologists to variability in clinically significant prostate cancer (CSPC) detection across multiparametric magnetic resonance imaging (mpMRI)-guided prostate fusion biopsies and to determine whether this differed across Prostate Imaging-Reporting And Data System (PI-RADS) categories. We analysed biopsy-naïve men within the Michigan Urological Surgery Improvement Collaborative (MUSIC) who underwent fusion biopsy between August 2017 and November 2021. The primary outcome was the proportion of variance in CSPC detection (Gleason score ≥3 + 4) at targeted regions of interest that was explained by individual urologists and radiologists. We used generalised linear mixed-effects models to partition variance and estimate intraclass correlation coefficients (ICCs) for radiologist- and urologist-level effects for PI-RADS score 3-5 lesions. We calculated the median odds ratio (MOR) to quantify the expected difference in odds of CSPC detection when comparing a randomly selected higher- vs lower-detecting provider from the same distribution. Among 1544 men with 2045 targeted lesions, mpMRIs were interpreted by 115 radiologists and biopsies performed by 86 urologists. For PI-RADS score 3 lesions, urologists (ICC = 0.15, MOR = 2.07) accounted for greater variance in CSPC detection than radiologists (ICC = 0.07, MOR = 1.61). For PI-RADS score 4, both urologist (ICC = 0.05, MOR = 1.49) and radiologist (ICC = 0.07, MOR = 1.61) contributed modestly. For PI-RADS score 5, radiologists (ICC = 0.17, MOR = 2.19) explained a larger proportion of variance than urologists (ICC = 0.01, MOR = 1.19), suggesting individual radiologists meaningfully impact CSPC detection of high-risk lesions. For PI-RADS score 3 lesions, the specific urologist performing the biopsy was a strong source of variation, while for PI-RADS score 5 lesions, the radiologist had greater influence on CSPC detection rates. Optimising MRI acquisition and interpretation, ensuring accurate fusion registration, and improving biopsy accuracy are critical to improving diagnostic consistency.

Purpose This study aims to examine the conditions under which blockchain-enabled supply chain carbon transparency (SCCT) generates credible and interpretable signals of decarbonization performance. It explores how blockchain reshapes the signaling environment in supply chains and examines the moderating role of technology uncertainty (TU) in influencing these signaling mechanisms. Design/methodology/approach A quasi-natural experiment was used at the focal firm–customer interface as an observable slice of multi-tier supply chain signaling. Multi-year data were collected from Bloomberg ESG, SPLC and Factiva, covering blockchain adoption events, carbon transparency indicators and dyadic operational carbon footprints across industries. The analysis combined propensity score matching with difference-in-differences estimation to isolate the causal effect of blockchain-enabled transparency, supported by robustness checks and post hoc qualitative triangulation. Findings Blockchain adoption alone is associated with a short-term increase in operational carbon intensity. However, when integrated with SCCT, it reduces emissions by enhancing the verification and interpretability of carbon information. The effect diminishes under high TU, where instability in data interoperability and system reliability weakens the credibility and observability of the signal. Research limitations/implications The study focuses on partner-verifiable operational emissions (Scopes 1 and 2) at the focal firm–primary customer interface, thereby limiting visibility into full supply chain carbon dynamics. Future research should extend to multi-tier networks and examine long-term behavioral changes induced by blockchain-driven transparency. Practical implications Managers should view blockchain not as an automatic solution but as an infrastructure that enhances verifiable, interpretable transparency. Effective decarbonization requires stable technological environments, consistent data protocols and coordinated verification across partners to prevent signal distortion. Originality/value The study refines signaling theory by shifting the focus of credibility from cost and visibility to verifiability and interpretability. It introduces TU as a boundary condition and shows that blockchain serves as a signaling infrastructure that enables verifiable, collectively responsible supply chain decarbonization.

End stage renal disease (ESRD) is characterized by irreversible loss of kidney function requiring dialysis or kidney transplant to maintain fluid homeostasis. The integumentary system is known to be affected, and nail changes such as Terry's nails and half-and-half nails are frequently observed. However, the prognostic significance of nail manifestations in this population remains poorly defined. Using the United States Renal Data System, which contains medical claims of all ESRD patients in the US, a retrospective cohort analysis was performed using patients enrolled between 2005 and 2018, allowing for at least a one-year follow-up. A nail change diagnosis was determined using ICD-9 and ICD-10 codes and mortality risk was evaluated using Cox Proportional Hazards (CPH) models. Of the 1,028,817 ESRD subjects included in this analysis, 66,704 (6.5%) subjects had a nail change diagnosis. In the final CPH model, a nail change diagnosis was independently associated with an increased risk of all-cause mortality (HR=1.22; 95% CI 1.20-1.23) after controlling for demographic and clinical risk factors. Despite this association, nail changes are likely underdiagnosed in the ESRD population. Our findings underscore the importance of a comprehensive dermatological evaluation of ESRD patients and recognition of nail changes as a possible prognostic indicator.

Effectiveness of nirsevimab immunisation after birth versus RSVpreF maternal vaccination in preventing RSV-related hospitalisations in infants: a population-based retrospective cohort study.

This research explored how systemic and institutional constraints impede the transition of urban NEET youth. Framed by empowerment, systems, and social exclusion theories, the study adopts a qualitative comparative case study design complemented by critical realism. Using purposive and snowball sampling techniques, semi-structured in-depth interviews were conducted with 38 NEET youth, eight staff of the Youth Employment Agency, and eight social workers in Kumasi, Accra, Tamale, and Ho. Findings reveal systemic fragmentation and policy incoherence. The study recommends institutionalizing social work roles, integrated NEET data systems, cash-plus models, and participatory governance within Ghana’s youth protection architecture by the relevant stakeholders.

To examine the role of multiparametric magnetic resonance imaging (mpMRI) in enhancing prostate cancer (PCa) detection and selecting candidates for active surveillance (AS), given that its utility in monitoring disease progression remains unclear. The Miami Active Surveillance Trial (MAST) is a prospective trial of men undergoing serial mpMRI and biopsies on AS for PCa. Participants had annual mpMRI with MRI-targeted and systematic biopsies at confirmatory (12-18 months) and subsequent intervals (12, 24, and 36 months). Grade progression was defined as an upgrade from Grade Group (GG) 1 to GG ≥2 or GG 2 to GG ≥3. The performance of MRI was evaluated at baseline (prior to confirmatory biopsy) and on subsequent biopsies for association with grade progression. Fine and Gray competing-risk models evaluated MRI for predicting grade progression after controlling for risk factors. Among 205 men, 79 (38.5%) had grade progression at the conclusion of the trial (36 months), with 40 (19.5%) men having grade progression at confirmatory biopsy, and the remaining 39 (2.0-9.8%/year) progressing on subsequent biopsies. A Prostate Imaging-Reporting And Data System (PI-RADS) score of 4 or 5 (vs no suspicious lesions or PI-RADS 1 and 2) on baseline MRI (prior to confirmatory biopsy) was an independent predictor of grade progression on confirmatory biopsy (Gray's test P < 0.001), with volume progression treated as a competing risk. At 36 months, MRI-only surveillance would have avoided 45% of biopsies but missed 32% of progression events. Pre-confirmatory biopsy MRI independently predicted grade progression on confirmatory and subsequent biopsies during AS; however, false positives and negatives still occur highlighting the need for periodic biopsy of the prostate.

Rural residents with end-stage kidney disease have lower access to kidney transplantation, especially in later stages. We examined the impact of rurality on initiation of transplant evaluation and whether this varies by region. We conducted a retrospective cohort study of 86,839 adults (18-80 years) referred for kidney transplantation between 2015 and 2023 in the Early Steps to Transplant Access Registry, linked to United States Renal Data System (USRDS). Rurality was defined using the USRDS variable based on ZIP code using Rural-Urban Commuting Area codes. The primary outcome was evaluation initiation within six months of referral. Fine and Gray competing risks models estimated time to evaluation start, accounting for death as a competing event, with multivariable adjustment and interaction by geographic region; sub-analyses were stratified by ESRD Network. Median time to evaluation was longer for rural patients (166 days) than urban patients (106 days), a pattern consistent across all ESRD Networks. The largest rural-urban time gaps were observed in New York and the Ohio River Valley. Rural residence was associated with an 11% lower likelihood of evaluation initiation (aSHR[95% CI], 0.89[0.86,0.92]). The strongest disparities were in New York (aSHR[95% CI], 0.56[0.50,0.62]) and New England (aSHR[95% CI], 0.76[0.69,0.83]). The Southeast (aSHR[95% CI], 0.90[0.87,0.94]) and Ohio River Valley (aSHR[95% CI], 0.92[0.85,0.99]) showed similar associations. Rural residents were less likely to initiate transplant evaluation compared to urban residents. These findings suggest that rural disparities exist in the early steps of the transplant process, highlighting the need for targeted interventions, especially in regions with lowest access.

Diagnostic accuracy of sonomammography in the evaluation of palpable breast masses: Correlation with histopathology.

Abstract Vesical Imaging–Reporting and Data System (VI-RADS) has been recently proposed for standardizing magnetic resonance imaging (MRI) reporting in bladder cancer. In this single-center prospective observational study, we sought to compare the diagnostic accuracy of biparametric MRI (BP-MRI) and multiparametric MRI (MP-MRI) in detection of detrusor muscle invasion by bladder cancer using VI-RADS. Patients with bladder cancer underwent MRI on a 3 Tesla scanner. Tumors were scored on T2-weighted images (T2WI), diffusion-weighted imaging (DWI), and dynamic contrast enhanced (DCE) imaging according to VI-RADS. Results of BP-MRI and MP-MRI were compared taking histopathology as the gold standard. Receiver operating characteristic (ROC) curve analysis was used to find out the cut-off point of VI-RADS for predicting detrusor muscle invasion by bladder cancer. Diagnostic tests were used to calculate sensitivity and specificity of BP-MRI and MP-MRI for detecting muscle-invasive bladder cancer (MIBC) for each VI-RADS cutoff. A total of 30 patients with bladder cancer were evaluated using MRI. Using the ROC curve, the cut-off for both BP-MRI and MP-MRI VI-RADS for predicting MIBC was determined to be ≥3. Area under the ROC curves (AUROC) of BP-MRI and MP-MRI were 0.866 and 0.861, respectively, the difference being statistically insignificant (DeLong's test p = 0.900). BP-MRI and MP-MRI also had equal sensitivity (95.5%) and specificity (75.0%) at the cut-off of VI-RADS score ≥3. On account of their similar diagnostic accuracy, BP-MRI appears to be a feasible alternative to MP-MRI in detection of detrusor muscle invasion by bladder cancer.