Nonthrombotic pulmonary artery embolism (NTPE) involves occlusion of pulmonary arteries by nonthrombotic material, such as septic emboli, tumor cells, fat, air, or foreign substances. NTPE is less common than thrombotic pulmonary embolism (PE) and may be misdiagnosed as PE. Although the clinical manifestation mimics that of PE, NTPE has distinct pathophysiologic mechanisms that necessitate different management. Diagnosis requires a high index of clinical suspicion and knowledge of imaging findings. The authors provide an overview of the various causes of NTPE, including infectious, neoplastic, iatrogenic or exogenous, and miscellaneous entities, and highlight their key imaging findings. Early and accurate diagnosis is essential for appropriate management. ©RSNA, 2026.

Introduction: Classical clinical prediction rules (Wells and Geneva) are widely used to assess the risk of Pulmonary Embolism (PE). Still, their performance in Coronavirus Disease 2019 (COVID-19) is uncertain, given frequent D-Dimer (DD) elevations unrelated to thrombosis. Aim: To compare the diagnostic performance of an optimised DD cut-off against Wells and Geneva scores in Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) confirmed COVID-19 patients with suspected PE. Materials and Methods: A retrospective, single-centre cohort study was conducted at Department of Internal Medicine, Consorci Sanitari de Terrassa, Barcelona, Spain, from Consorci Sanitari de Terrassa (Barcelona, Spain) from January 2021 to June 2021. Adult COVID-19 patients undergoing Computed Tomography Pulmonary Angiography (CTPA) for suspected PE were analysed. Receiver Operating Characteristic (ROC) analysis was used to assess DD, Wells, and Geneva; the optimal DD threshold was identified by Youden’s index. Group comparisons used t-test or Mann-Whitney U for continuous variables and Chi-square or Fisher’s-exact test for categorical variables; p-value <0.05 was considered significant. Results: CTPA was performed in 586 patients, of whom 148 had confirmed COVID-19 infection. PE was diagnosed in 13.5% (20/148) of cases. Patients with PE had significantly higher DD levels than those without PE (p-value <0.05). A DD threshold of 3126 ng/mL yielded 80% sensitivity and 68.5% specificity, potentially avoiding 87 CTPAs while missing 4 PE diagnoses. In comparison, the Wells score showed poor performance {Area Under Curve (AUC) 0.60, 95% Confidence Interval (CI) 0.48-0.72; sensitivity 55%, specificity 56%}, whereas the revised Geneva score was even less accurate (AUC 0.41, 95% CI 0.26-0.55; sensitivity 45%, specificity 55%). Conclusion: In the present cohort of COVID-19 patients with suspected PE, an optimised DD cut-off demonstrated superior discriminatory performance compared to conventional clinical prediction rules. Therefore, in COVID-19 settings with suspected PE, a DD threshold of approximately 3,126 ng/mL may help reduce unnecessary Computed Tomography (CT) pulmonary angiographies when interpreted in conjunction with clinical probability and physician judgment.

Effectiveness and Safety of Apixaban Versus Warfarin in Atrial Fibrillation Patients With Malignancy: A Propensity-Matched Analysis.

Association of body mass index and length of stay in patients undergoing minimally invasive surgery for uterine cancer: a National Surgical Quality Improvement Program (NSQIP) study.

A Comparative Analysis of Fatal Outcomes in 5,370 Geriatric Versus 12,254 Nongeriatric Adult Patients: A Clozapine Study in VigiBase.

Evaluating posterior column osteotomy in single-level transforaminal lumbar interbody fusion: A retrospective study.

MicroRNAs (miRNAs) are small regulatory molecules that control protein synthesis, presenting promising opportunities for novel, mechanism-based therapies. Their roles are essential in the biological processes underlying thrombosis, including vascular function, coagulation, and platelet activity. Specific miRNAs, such as miR-126 and miR-223, that influence platelet activation and adhesion are particularly relevant to thrombotic disorders, including deep vein thrombosis (DVT) and pulmonary embolism (PE). This positions them as intriguing targets for new therapeutic strategies. miRNA-based treatments, using synthetic mimics or inhibitors (antagomirs), offer a potential avenue for precisely modulated anticoagulant therapy. However, these approaches remain in early-stage development. Significant challenges must be overcome before miRNA therapies can achieve widespread clinical adoption. Further research is essential to elucidate miRNA function in venous thromboembolism (VTE) fully and to translate these insights into safe and effective treatments. This review summarizes current knowledge of the role of miRNAs in VTE, underscores their substantial therapeutic potential, and addresses the critical obstacles and practical limitations that must be resolved to realize their full promise in treating thrombotic diseases.

The optimal dietary pattern of brain age and related diseases remains unclear, and the relationship between dietary metabolomic signature and these conditions is still poorly understood. This cohort study included 13,691 participants from the UK Biobank (53.67% female, mean age 54.9 ± 7.5 years), we investigated the relationship between five healthy dietary patterns and brain age gap (BAG). Metabolomic signatures were constructed using a LASSO model, and multivariable linear regression was applied to examine the relationship between metabolomic signatures and brain age. Higher AHEI-2010 and DASH scores were associated with reduced BAG. Specifically, higher DASH scores reduced BAG in obese populations. Metabolomic signatures accounted for 30.43% and 35.47% of the associations between dietary patterns and BAG, respectively, and were themselves significantly correlated with BAG. AHEI-2010/DASH diets and plasma metabolites are associated with brain aging, offering a metabolomic basis for personalized dietary interventions.

Therapeutic venesection is a cornerstone in the management of polycythaemia to reduce hyperviscosity and thrombotic risk. However, its application in patients receiving anticoagulation, particularly heparin, is complex due to the potential for bleeding complications. The current case report describes a 40-year-old male who presented with progressive breathlessness, fatigue, and pedal oedema. Laboratory investigations revealed polycythaemia with elevated haemoglobin and haematocrit levels. The patient was diagnosed with acute pulmonary thromboembolism and severe pulmonary artery hypertension. He was initiated on unfractionated heparin therapy. Due to persistent symptoms and hyperviscosity, therapeutic venesection was performed after temporarily withholding heparin. A total volume of 450 mL of blood was removed. The procedure was well tolerated, with stable vital signs, and the patient showed symptomatic improvement following venesection. The present case highlights the therapeutic benefit and safety of venesection in a patient with polycythaemia and pulmonary thromboembolism receiving anticoagulation. Meticulous risk assessment, temporary cessation of anticoagulation at the time of venesection, and strict procedural monitoring were critical in preventing complications. A multidisciplinary approach ensured optimal patient outcomes. The novelty of the current case lies in the successful integration of therapeutic venesection in a high-risk anticoagulated patient, guided by an individualized risk-benefit assessment and coordinated multidisciplinary management to optimise safety and outcomes in complex thrombotic scenarios.

The combination of paeoniflorin and hydroxysafflor yellow A alleviated pulmonary thrombosis by inhibiting platelet-neutrophil interaction via the P-selectin-PSGL-1 signaling axis.

Right ventricular dysfunction is a critical predictor of mortality, often progressing to right heart failure, contributing to 3%-9% of heart failure admissions. Acute right heart failure is the primary cause of death in conditions such as right ventricular myocardial infarction and massive pulmonary embolism. Mechanical circulatory support with right ventricular assist devices (RVADs) has become essential in managing both acute and chronic right heart failure. Such devices provide hemodynamic support by assisting the failing right ventricle. This review outlines the mechanisms, clinical indications, and complications of these RVADs. Chest radiography and echocardiography are the primary modalities used for confirming the correct positioning of these devices, and CT is useful for evaluating intra- and extracardiac complications. These imaging modalities are vital for identifying complications and ensuring optimal device performance. As the use of RVADs grows, radiology's role in optimizing outcomes will continue to expand. Keywords: Right Ventricle, Cardiac Assist Devices, Conventional Radiography, CT, Echocardiography Supplemental material is available for this article. © RSNA, 2026.

Introduction: Ovarian cancer is one of the most common gynecological cancers in the United States. Common sites of distant metastasis from ovarian cancers and other cancers of Mullerian origin include the liver, pleura and lungs. However, metastasis to the brain remains exceptionally rare, ranging from 0.49 to 6.1%. Hence, the scarcity of such cases poses significant diagnostic and management challenges. Case Presentation: We present a case of an 80-year-old female who at the time of initial diagnosis presented with complaints of right leg pain, shortness of breath and cough. Imaging studies were remarkable for a pulmonary embolism, 2.5 cm mediastinal mass, pleural effusions, omental caking and an occlusive thrombus in the right greater saphenous vein. Malignancy was suspected in the setting of hypercoagulability. Biopsy of the omentum and pleural cytology revealed a high grade ovarian serous carcinoma. The patient received neoadjuvant chemotherapy followed by cytoreductive surgery and additional chemotherapy afterwards. She demonstrated good response to treatment with follow up PET without evidence of disease. Over the next four years, the patient was intermittently placed on chemotherapy when found to have elevated CA125 levels and PET scan showing small volume disease mostly in the pelvis. Six-years later, the patient presented to the oncology clinic with complaints of dizziness and imbalance for the past month. MRI brain showed a new left cerebellar mass with vasogenic edema and obstructive hydrocephalus. However, restaging CT chest, abdomen and pelvis showed minimal to no disease, with the only possible foci being a 1.2 cm paraaortic lymph node. The patient underwent left suboccipital craniotomy and cerebellar tumor resection with pathology showing metastatic carcinoma consistent with spread from a Mullerian primary. Conclusion: This case emphasizes the diagnostic complexity and evolving clinical course of Müllerian tumors. In a patient with a history of Mullerian tumor and new onset neurological symptoms, differential diagnosis should include metastasis to the brain, even with minimal to no active pelvic and systemic disease burden.

Hip fractures are a major cause of morbidity and mortality among older individuals. Accurate prediction of 30-day mortality after hip fracture surgery is crucial for effective resource allocation and patient management. To compare the Nottingham Hip Fracture Score (NHFS) and Acute Physiology and Chronic Health Evaluation (APACHE)-II score in predicting 30-day mortality among 182 geriatric patients (≥ 60 years) undergoing elective hip fracture surgery at Tata Main Hospital, Jamshedpur, India. NHFS and APACHE-II scores were calculated preoperatively. Patients were followed up for 30 days post-surgery to determine mortality outcomes. Statistical analysis, including receiver operating characteristic curve analysis, was performed to assess the predictive accuracy of both scores. Results indicated that APACHE-II demonstrated superior predictive ability compared to NHFS. The study also assessed secondary outcomes such as ventilator and inotropic support, acute kidney injury (AKI), cardiac morbidity, pulmonary embolism, deep vein thrombosis, and length of hospital stay (LOS). APACHE-II showed superior performance in predicting the need for ventilator support and AKI. Both scores showed significant discrimination for ventilator and inotropic support and LOS but not for AKI. The findings highlight the importance of comprehensive risk stratification for managing geriatric patients with hip fracture.

Osteonecrosis of the femoral head (ONFH) is a progressive condition that often requires surgical intervention. Although treatment strategies have traditionally emphasized joint-preserving procedures in younger patients, advances in implant technology and perioperative management may have altered contemporary surgical decision-making. However, large-scale evidence describing temporal changes in surgical treatment patterns for ONFH is limited. Using the Japanese Diagnosis Procedure Combination (DPC) database, we conducted a nationwide retrospective cohort study of patients who underwent surgical treatment for ONFH between December 2012 and March 2023. Surgical procedures were categorized as total hip arthroplasty (THA), bipolar hemiarthroplasty (BHA), proximal femoral osteotomy, pelvic osteotomy, or hip arthroscopy. Temporal trends in procedure selection were evaluated overall and by age group. Postoperative complications, including infection, deep vein thrombosis (DVT), pulmonary embolism, periprosthetic fracture, and in-hospital mortality, were compared between THA and BHA using univariate and multivariable logistic regression analyses. A total of 36,109 patients were included. THA was the most frequently performed procedure throughout the study period, with its proportion increasing from 72.6% in 2012 to 90.6% in 2022, while the use of BHA and joint-preserving osteotomy steadily declined. Among patients aged ≤ 20years, proximal femoral osteotomy predominated until 2020; thereafter, arthroplasty procedures accounted for more than half of all surgeries in this age group. Similar shifts toward THA were observed in patients aged 21-40years. In adjusted analyses, BHA was associated with a higher risk of postoperative infection and DVT, whereas THA was associated with a higher risk of periprosthetic fracture and in-hospital mortality. No significant differences were observed in dislocation or pulmonary embolism rates. Nationwide data demonstrate a substantial shift in surgical management of ONFH in Japan, with increasing use of THA and declining reliance on joint-preserving procedures, even among younger patients. While arthroplasty has become the dominant treatment modality, careful consideration of long-term outcomes, complication profiles, and patient age remains essential. Integration of large-scale administrative data with detailed clinical and imaging information may further refine optimal treatment strategies for ONFH.

The global aging trend highlights the need for effective strategies to prevent cognitive impairment and depression. This study aimed to examine the mediating role of DASH diet quality in the association between sustainable dietary behaviors, cognitive function, and depressive symptoms among older adults. A cross-sectional study was conducted at Firat University Hospital, involving 773 older adults. Data collection included structured questionnaires assessing demographic characteristics, DASH diet adherence (DASH Diet Quality Scale), sustainable nutritional behavior (Sustainable Consumption Behavior-Nutrition Scale, SCBN), depressive symptoms (Geriatric Depression Scale-15, GDS-15), and cognitive performance (Standardized Mini-Mental State Examination, SMMSE). Anthropometric measurements were also obtained. Statistical methods involved hierarchical regression analyses, and structural equation modeling (SEM) to examine direct and indirect relationships among study variables. Correlation analyses indicated negative associations between depression and both DASH diet (r= -0.378, p < 0.001) and sustainable nutritional behaviors (SCBN; r= -0.277, p < 0.001). Cognitive function positively correlated with DASH (r = 0.277, p < 0.001) and SCBN scores (r = 0.295, p < 0.001). Hierarchical regression revealed that better adherence to DASH diet (β=-0.13, p < 0.001) and higher SCBN scores (β=-0.12, p < 0.001) predicted lower depression scores, whereas SCBN positively predicted cognitive function (β = 0.03, p < 0.001). Structural equation modeling confirmed that the DASH diet partly explained the association between sustainable nutrition and both depression (indirect β=-0.02, p < 0.001) and cognitive function (indirect β = 0.01, p < 0.001). The study highlighted the beneficial role of DASH diet adherence and sustainable nutritional practices in mitigating depressive symptoms and supporting cognitive function in older adults. These dietary patterns could represent crucial components of preventive strategies for healthy aging. Further longitudinal research using objective dietary assessments is needed to clarify causal relationships.

Late Venous Thromboembolism Chemoprophylaxis and Increased Risk of Deep Venous Thrombosis, Pulmonary Embolism, and Mortality in Patients with Traumatic Spinal Injury.

The prognostic implications of atrial fibrillation (AF) burden in pulmonary embolism (PE) remains unclear. This study aimed to investigate the relationship between AF burden and prognosis in PE patients. In this retrospective cohort study using the Medical Information Mart for Intensive Care IV (MIMIC-IV v2.0) database, patients with confirmed PE diagnosis were included. AF burden was calculated as the percentage of total AF duration relative to total records duration using nurse-documented continuous electronic monitoring (CEM) records. Patients with AF were dichotomized into low-burden and high-burden groups using an optimal cut-off value of 12.0%. Multivariable Cox proportional hazards models were employed to evaluate the 1-year all-cause mortality risk across sinus rhythm (SR), low-burden, and high-burden AF groups. Among 1,175 patients, 246 (20.9%) had AF, comprising 84 cases of low-burden AF and 162 cases of high-burden AF. The 1-year all-cause mortality rates were 22.1% (SR), 26.2% (low-burden AF), and 40.7% (high-burden AF), respectively. After full adjustment, high-burden AF demonstrated a significant association with 1-year all-cause mortality (HRadjusted: 1.67, 95% CI: 1.22-2.29, p = 0.001), whereas low-burden AF showed no statistically significant association (HRadjusted: 0.97, 95% CI: 0.62-1.53, p = 0.906). The robustness of these associations was maintained in subgroup and sensitivity analyses. Restricted cubic spline (RCS) analysis identified a nonlinear relationship between AF burden and 1-year all-cause mortality risk, demonstrating an inverted U-shaped dose-response pattern (P for non-linearity = 0.022). High AF burden independently predicted 1-year all-cause mortality in PE patients, suggesting its clinical utility for risk stratification.

Pulmonary embolism and cement leakage in cement-augmented spinal instrumentation: incidence, associated factors, and clinical impact.

Exercise testing in chronic thromboembolic pulmonary hypertension and chronic thromboembolic pulmonary disease without pulmonary hypertension: a comprehensive systematic review and meta-analysis.

Capitolunate fusion (CLF) has been proposed as a viable alternative to other motion-preserving techniques such as three-corner fusion (3CF) and four-corner fusion (4CF) for scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC). This study systematically reviewed the literature comparing clinical outcomes and complication profiles of CLF versus 4CF; a small number of three-corner fusion cases were included. The PubMed, EMBASE, and Web of Science databases were systematically searched for articles published between 1990 and 2025. Two independent authors performed blinded screening of titles and abstracts, followed by blinded full-text review. Outcomes of interest included the visual analog scale (VAS) score, Patient-Rated Wrist Evaluation (PRWE), grip strength, Disabilities of the Arm, Shoulder and Hand (DASH) score, reoperation rate, adverse events, and range of motion. Seven studies were included, consisting of six retrospective cohort studies and one randomized controlled trial, encompassing a total of 320 patients. The VAS score demonstrated a borderline non-significant standardized mean difference of 0.34 (95% confidence interval: - 0.004 to 0.69; p = 0.053) in favor of four corner fusion. No statistically significant differences were observed between CLF and 4CF for PRWE, DASH score, range of motion, overall complication rate, reoperation rate, or nonunion rate. Only seven patients underwent three-corner fusion, precluding subgroup-specific analysis. Compared with four-corner fusion, capitolunate fusion yields comparable patient-rated outcome measures, strength, motion, and complication profiles. Higher-quality prospective studies are required to further validate these findings. Therapeutic study.