Combined left and right atrial reservoir strain identifies a high-risk phenotype in patients with chronic heart failure.

Preoperative frailty for predicting in-hospital mortality in patients after cardiac surgery: an interpretable Machine learning model based on a retrospective multicenter cohort study.

GOLD BioAge and depression: Associations with mortality among depressed NHANES participants (2005-2018).

Objective: To investigate the predictive value of baseline serum KL-6 levels for acute exacerbation (AE) in patients with fibrotic interstitial lung disease (F-ILD). Methods: A single-center retrospective cohort study was conducted, enrolling 265 patients with fibrotic ILD diagnosed by multidisciplinary team (MDT) at Sichuan Provincial People's Hospital from July 2022 to November 2024, including 118 patients with idiopathic pulmonary fibrosis (IPF) and 147 patients with fibrotic connective tissue disease-associated ILD (CTD-ILD). Baseline data were collected, and the primary endpoint was the occurrence of AE during follow-up. Cox regression analysis was used to identify independent risk factors for AE, and ROC curve analysis was performed to evaluate predictive performance. Results: After a median follow-up of 20 months, 77 patients (29.1%) developed AE. Multivariate Cox regression showed that KL-6≥1 363.5 U/ml (HR=3.928, P<0.001) was an independent risk factor for AE. Baseline KL-6 predicted AE in F-ILD with an AUC of 0.795, and the optimal cutoff value was 1 363.5 U/ml. The combined model (KL-6+CA15-3+CYFRA21-1+DLCO%) achieved an AUC of 0.853. Subgroup analysis revealed that KL-6 had the highest predictive value in IPF patients (AUC=0.820), followed by CTD-ILD patients (AUC=0.774). Conclusion: Baseline serum KL-6 is an independent predictor of AE in patients with F-ILD, demonstrating good risk stratification capability, particularly with optimal performance in IPF.

Premature ventricular contractions (PVCs) are common arrhythmia encountered in patients with and without structural heart disease. Although often benign and asymptomatic, they may also cause palpitations, exercise intolerance, presyncope, and reduced quality of life, and in some patients can contribute to PVC-induced cardiomyopathy or trigger malignant ventricular arrhythmias. Their clinical significance depends on symptom burden, PVC frequency, ventricular function, and the presence of underlying myocardial disease. Diagnostic evaluation includes electrocardiography, ambulatory rhythm monitoring, echocardiography, exercise testing, and cardiac magnetic resonance imaging for tissue characterization and risk stratification. Management ranges from reassurance and lifestyle modification to pharmacologic therapy and catheter ablation. Beta-blockers and nondihydropyridine calcium channel blockers remain common first-line options, whereas antiarrhythmic drugs may be considered in carefully selected patients. Catheter ablation is an effective treatment for symptomatic PVCs, high PVC burden, and PVC-induced cardiomyopathy, with high procedural success rates and favorable effects on arrhythmic burden and ventricular function. Novel approaches, including electrocardiographic imaging-guided planning, pulsed field ablation, stereotactic radioablation, neuromodulation, and renal denervation, may further expand future therapeutic options. This review summarizes the pathophysiology, clinical implications, diagnostic evaluation, and contemporary management of PVCs, with emphasis on medical therapy, catheter ablation, and emerging treatments.

Reliable biomarkers may allow early risk stratification for mortality in older adults. Post-translational modification-derived products (PTMDPs), such as homocitrulline, and the tissue accumulation of advanced glycation end products (AGEs), measured by skin autofluorescence, have been suggested as potential biomarkers of adverse outcomes in older and frail individuals. The aim of this study was to assess their association with 3-year mortality following hospitalisation. We followed a cohort of 250 hospitalised patients over 3years. Serum PTMDPs (homocitrulline, carboxymethyllysine, pentosidine, and MG-H1) were measured using liquid chromatography coupled with tandem mass spectrometry, and AGEs were quantified by skin autofluorescence. We examined associations with mortality using bivariable analyses and a multivariable Cox regression model. An exploratory cut-off for homocitrulline was established at the third quartile of its distribution within the study population. During follow-up, 92 deaths occurred. In bivariable analyses, all biomarkers were associated with mortality. In the multivariable model, homocitrulline levels of >400 μmol/mol Lys were significantly associated with mortality (hazard ratio 1.73, 95 % confidence interval 1.06-2.82), after adjustment for age, frailty, and comorbidities. The model's predictive performance, with an area under the curve (AUC) of 0.76, was only slightly affected by the exclusion of homocitrulline (AUC=0.755). These results indicate that although elevated homocitrulline was independently associated with mortality, its incremental value for risk prediction was modest. Larger studies are needed to further evaluate the clinical utility of PTMDPs, especially homocitrulline, for risk prediction and clinical decision-making.

Subcentimeter thyroid nodules: Diagnostic challenges, risk stratification and management in contemporary surgical oncology practice.

Artificial intelligence in rare pediatric solid tumor research and clinical care: A scoping review.

Diabetic ankle fractures present significant clinical challenges, with higher rates of complications including infection, non-union, Charcot neuroarthropathy, and amputation compared to non-diabetic patients. Despite this burden, no universally accepted guidelines exist for risk stratification and management. The Adelaide Fracture in the Diabetic Ankle (AFDA) score was proposed in 2014 but has limitations including uniform weighting of risk factors and exclusion of local injury characteristics. This systematic review of reviews aimed to synthesise current evidence and develop an updated, evidence-based risk stratification tool. A comprehensive search of Embase, PubMed, and Web of Science was conducted. Eligible studies included systematic and narrative reviews examining outcomes, risk factors, or interventions for diabetic ankle fractures. Risk of bias was assessed using the ROBIS tool. Data were synthesised narratively, and an evidence-informed, consensus-based scoring system was developed by translating observed effect sizes from the included reviews into weighted risk scores. Thirteen reviews were included. Complicated diabetes, particularly peripheral neuropathy, peripheral arterial disease, and prior Charcot neuroarthropathy, emerged as the strongest predictors of adverse outcomes. Non-operative management of unstable fractures was associated with significantly higher complication rates. Based on these findings, we propose the Manchester Ankle Fracture Diabetic Risk Assessment Score (MADRAS), incorporating weighted systemic host factors, local injury characteristics, and modifiable patient factors across a 17-point scale stratifying patients into four management tiers: low risk (0-2), moderate risk (3-5), high risk (6), and very high risk (≥ 7). MADRAS addresses limitations of existing frameworks by incorporating evidence-based weightings and local injury factors. Prospective external validation is required before widespread clinical adoption; until then, MADRAS should be regarded as a decision-support tool. This tool may assist clinicians in systematic risk stratification and surgical decision-making for diabetic ankle fractures.

Accurate identification of individuals at high risk of gastric cancer (GC) remains a major challenge for effective screening. We aimed to identify plasma proteomic signatures and develop a risk prediction model for GC risk stratification. Plasma proteomic profiling was performed using liquid chromatography-tandem mass spectrometry in a case-control discovery set (100 GC cases and 94 controls). Candidate proteins were evaluated in 52,552 UK Biobank participants with a median follow-up of 13.63 years, during which 92 incident GC cases were identified. Risk models integrating clinical, genetic, and proteomic factors were developed using LASSO-penalized Cox regression with stability selection and internally validated using bootstrap resampling. Among 2306 differentially expressed proteins in discovery, 25 were replicated in validation at nominal significance (P < 0.05) with consistent directions. Two proteins (CTSD and GGH) remained significant after false discovery rate correction. A primary proteomic model (clinical factors plus five proteins) improved discrimination versus clinical model (optimism-corrected C-index: 0.745 vs. 0.732, P = 0.046). Risk stratification revealed a clear GC risk gradient: hazard ratios were 6.08 (95% CI 2.15-17.20) for moderate-risk and 23.88 (95% CI 8.66-65.87) for high-risk groups. The risk score was also associated with GC risk as continuous variable (HR per standard deviation: 1.09, 95% CI 1.08-1.11). The 15-year cumulative incidence ranged from 0.02 to 0.56% across risk groups. Decision curve analysis indicated improved clinical utility. Plasma proteomic signatures may improve GC risk stratification beyond traditional clinical factors and could support more targeted screening strategies. Further validation is warranted.

The rising incidence of thyroid cancer presents a growing diagnostic and therapeutic challenge. Various risk stratification systems have sought to integrate clinical, ultrasonographic, and, in some cases, cytological features to aid malignancy prognostication. This systematic review aims to critically evaluate risk stratification tools (RSTs) for patients with thyroid nodules, which incorporate multimodal inputs to assess their diagnostic performance and clinical utility in supporting surgical decision-making. PubMed, Embase, and Cochrane databases were searched from inception to 04/13/2026, identifying studies evaluating multivariable risk prediction models for adult patients undergoing assessment of thyroid nodules. Studies were excluded if the proposed tool failed to incorporate clinical features, ultrasound findings, and cytology results or was not validated with histology. Data extraction encompassed methodology of model development, performance metrics, and approaches to validation. Risk of bias was assessed using the PROBAST+AI tool. Seven studies describing five distinct RSTs met inclusion criteria Thyroid Nodule App (TNAPP), the McGill Thyroid Nodule Score (MTNS), CUT Score, Memorial Sloan Kettering Cancer Centre (MSKCC) nomogram, and Thyroid Prediction Score (TiPS). TiPS demonstrated the highest sensitivity (96.2%) and specificity (97.5%) with area under the curve (AUC) >0.9. The CUT score also showed strong performance (AUC >0.9), particularly in low-to-intermediate risk nodules. TNAPP underperformed (accuracy 50.5%; specificity 27.5%) despite broad clinical inputs. The MTNS and MSKCC, although promising for indeterminate cytology, lacked robust validation. Most models were derived from single-center, retrospective cohorts, limiting generalizability. RSTs integrating multimodal data may improve thyroid nodule risk stratification, particularly in cases of indeterminate cytology. However, methodological limitations and lack of external validation currently restrict clinical utility. Prospective evaluation in diverse populations is required to identify the most effective and generalizable tools. Until then, RSTs should be used as adjuncts to, not replacements for, clinical judgment and shared decision-making in thyroid nodule assessment.

AS-OCT parameters, especially ACD and nasal angle parameters, demonstrate persistent structural differences across the PACD disease spectrum even after LPI and may serve as a useful adjunctive tool for structural assessment and risk stratification in treated eyes. Although laser peripheral iridotomy (LPI) alleviates pupillary block in primary angle closure disease (PACD), structural differences across the disease spectrum may persist after treatment. This study aimed to evaluate anterior segment optical coherence tomography (AS-OCT) parameters in treated primary angle closure disease (PACD) and identify features associated with severity. Retrospective analysis was performed on 160 eyes from 91 patients. AS-OCT was conducted using Tomey CASIA2 Angle Protocol. Disease severity was established before laser peripheral iridotomy (LPI) based on clinical gonioscopy and standard diagnostic criteria. All eyes underwent AS-OCT after LPI. One-way ANOVA with post hoc Tukey HSD and ROC curve analysis evaluated intergroup differences and diagnostic cutoffs. Significant differences in AS-OCT parameters were observed for ACD ( P =0.020), AOD ( P <0.001), TISA ( P <0.001), ARA ( P <0.001), ITC Index ( P =0.001), and ITC Area ( P =0.013). Acute angle closure glaucoma (AACG) had the most narrowing and the highest ITC values. ROC analysis demonstrated modest discriminative performance for individual AS-OCT parameters. ACD ≤1.82mm demonstrated high sensitivity (100%) but low specificity (21.4%), while AOD 250/500 nasal cutoffs demonstrated high specificity (100%/96.4%) with low sensitivity. AS-OCT demonstrates persistent structural differences across the PACD spectrum after LPI and may serve as an adjunct for structural assessment and risk stratification in treated eyes.

To investigate MRI-based breast edema patterns as biomarkers of tumor aggressiveness and their predictive value for pathological response to neoadjuvant chemotherapy (NAC) in invasive breast cancer. This retrospective study evaluated 235 female patients (mean age, 52 ± 12 years) with biopsy-proven invasive breast cancer who underwent pre-NAC breast MRI. After excluding 19 patients (10 for inadequate image quality, 9 for post-biopsy imaging), 216 patients were analyzed. Breast edema score (BES) was independently assessed by two radiology residents to evaluate interobserver agreement. Subsequently, a breast radiologist reviewed all cases to establish the definitive dataset. The differences in clinicopathological characteristics between the two groups and between different BES were compared. Interobserver agreement for BES classification was very high (92.6% concordance). Edema presence correlated significantly with larger tumor size (p = 0.001), higher histological grade (p = 0.001), axillary lymph node metastasis (p = 0.015), hormone receptor negativity (p < 0.001), lymphovascular invasion (p = 0.031), and elevated Ki-67 (p = 0.001). Higher BES groups (BES 2-4) showed stronger associations with aggressive features: tumor size (p < 0.001), grade (p = 0.022), hormone receptor negativity (p = 0.001), non-luminal subtypes (p = 0.001), and intratumoral necrosis (p = 0.002). Neither edema nor BES predicted pathological response to NAC (p = 0.999, p = 0.299). BES and edema are robust imaging biomarkers of tumor aggressiveness but demonstrate no predictive value for NAC response. MRI-based edema scoring holds clinical relevance for noninvasive tumor phenotyping and risk stratification in breast cancer management. Question Can MRI-based breast edema patterns predict tumor aggressiveness and pathological response to neoadjuvant chemotherapy in invasive breast cancer patients, aiding noninvasive risk stratification? Findings BES correlates with aggressive tumor features (larger size, higher grade, hormone negativity; all p < 0.050 but shows no predictive value for NAC response (p = 0.299). Clinical relevance BES serves as a practical imaging biomarker for risk stratification and tumor phenotyping, guiding individualized therapy. However, it shows no utility in predicting NAC response, emphasizing the need for complementary predictive tools in treatment planning.

Machine Learning Prediction of Hospital Stay in Pediatric Typhoid Intestinal Perforation: Pilot Study.

Major adverse cardiovascular events (MACE) are a leading cause of morbidity and mortality in patients with end-stage renal disease (ESRD). However, risk stratification and prognostic prediction remain limited. To assess the incremental prognostic value of combined left atrial (LA) and left ventricular (LV) strain in predicting MACE among ESRD patients receiving renal replacement therapy. Prospective. Three hundred thirteen ESRD patients (mean age: 53.8 ± 14.0 years; 202 males) undergoing maintenance dialysis. Balanced steady-state free precession (bSSFP) cine sequence at 3.0 T. Myocardial strain was analyzed from bSSFP cine images using feature-tracking software (CVI42). LA strain components were reservoir (LARS), conduit (LAScd), and contractile (LASct) strain, and LV strain included global longitudinal (GLS), radial (GRS), and circumferential (GCS) strain. Patients were followed up via clinical records and MACE were documented. Prognostic models were constructed using multivariable Cox proportional hazards regression. The baseline prediction model of conventional cardiovascular risk factors was then compared with models incorporating LARS and GLS to assess incremental prognostic value. Cox proportional hazards regression identified predictors of MACE, and model performance was evaluated using C-index, Akaike and Bayesian information criteria (AIC/BIC), and Kaplan-Meier analysis. p < 0.05 was considered significant. During a median follow-up of 16.93 months, 61 patients developed MACE. LARS (hazard ratio (HR) 0.90, 95% confidence interval (CI) 0.87-0.94) and LV GLS (HR 1.21, 95% CI 1.08-1.36) were independent predictors. The Cox model incorporating both LARS and LV GLS showed improved discrimination compared with the clinical risk factor model (C-index 0.79 vs. 0.70). Stratification by both LA and LV strain markers significantly improved MACE prediction (log-rank: p < 0.001). The integration of LA and LV strain offered superior prognostic value for MACE prediction in ESRD patients, enabling refined risk stratification beyond traditional measures. 2. Stage 3.

Genetic architecture of multiple myeloma: From somatic alterations to germline susceptibility and clinical implications.

Subamniotic or subchorionic hematoma (SAH/SCH) is associated with diverse pregnancy outcomes. The clinical implications of accompanying oligohydramnios and hemorrhagic amniotic fluid on MRI remain unclear. To investigate the importance of oligohydramnios and hemorrhagic amniotic fluid on placental MRI for SAH/SCH in risk stratification. Retrospective. Seventy-one singleton pregnancies with SAH/SCH identified on placental MRI performed during the second or third trimesters, from 2016 to 2023. 1.5 T, Fat-saturated T1-weighted gradient echo and half-Fourier-acquired single-shot turbo spin echo sequences. Cases were classified into three groups: Groups A (oligohydramnios and hemorrhagic amniotic fluid), B (either oligohydramnios or hemorrhagic amniotic fluid), and C (SAH or SCH only). Groups B and C were subclassified as B-1 (oligohydramnios), B-2 (hemorrhagic amniotic fluid), C-1 (detected hematoma on ultrasound before MRI), and C-2 (incidentally detected hematoma on MRI). Unfavorable obstetric outcome (abortion or birth before 34 gestational weeks) and neonatal outcome (duration of neonatal intensive care unit [NICU] stay) were compared. Fisher's exact test, Kruskal-Wallis test, Mann-Whitney U test, and Kaplan-Meier analysis with Log-rank test. Significance was determined at p < 0.05. Unfavorable obstetric outcomes were significantly higher in Group A (11/12, 91.7%) than groups B (6/17, 35.3%) and C (9/42, 21.4%). Significant differences were found among the five subclassified groups, most notably between B-1 and B-2. The median duration of NICU stay was 87, 30.5, 0, 25, and 8 days in Groups A (n = 12), B-1 (n = 5), B-2 (n = 12), C-1 (n = 11), and C-2 (n = 31), respectively. Group A showed the worst neonatal outcomes. MRI findings of oligohydramnios and/or hemorrhagic amniotic fluid in pregnancies with SAH/SCH are associated with adverse obstetric and neonatal outcomes, supporting risk stratification. 4. Stage 5.

Recognition and management of metabolic dysfunction-associated steatohepatitis (MASH) are hindered by variability in diagnostic practices and limited real-world data on disease progression. This study assessed the use of non-invasive testing (NIT) in MASH identification and estimated incidence rates and time-to-disease progression. Adults in the TARGET-NASH cohort (enrolled 2016-2023) were included. MASH was confirmed via medical records, NITs, pathology reports, and imaging. Patients with MASH and significant/advanced fibrosis/cirrhosis (F2/F3/F4) were included. Outcomes included progression to cirrhosis, liver-related complications, and all-cause mortality. Among 1964 patients (median age 59, median BMI 34), 79% had data to calculate Fibrosis-4 score (FIB-4), 36% had FibroScan, and 29% had biopsy. Among the 776 F2-F3 patients, 17% progressed to cirrhosis over a median follow-up (mFU) time of 64.6 months. In F2-F3 patients, one unit increase in FIB-4 was associated with 14% increased hazard of cirrhosis; similarly, incidence rates for cirrhosis in patients with liver stiffness measurements (LSMs) 10-15kPa were 60.8/1000PY (per 1000 person-years; 3.5× higher than those with LSM <10kPa). Among the 794 patients with compensated cirrhosis (cF4), 46% experienced progression events, 13% died, and 1.3% had a liver transplant (mFU=66.0 months). Among the 394 patients with decompensated cirrhosis (dF4), 29.4% died, and 9.6% had a liver transplant (mFU=62.0 months). Higher FIB-4 was associated with increased risk of decompensation and mortality in cF4 patients. Similarly, patients with LSM ≥15kPa had a greater incidence rate of mortality (9.1/1000PY vs. 4.3/1000PY and 3.8/1000PY for LSM 10-15kPa and <10kPa, respectively). The burden of MASH underscores the urgency of standardizing NIT use and diagnosis. Expanding FibroScan use, automating FIB-4 calculation, and increasing awareness of NITs can improve early detection and risk stratification, thereby improving patient outcomes.

Early predictors of fatal leptospirosis and the role of pathogen lineages remain poorly defined, limiting clinical risk stratification, genomic surveillance, and public health response in leptospirosis-endemic settings. We conducted a multicenter prospective cohort study of hospitalized patients with suspected leptospirosis in Thailand during 2015-2024. Among 459 patients with laboratory-confirmed cases, 25 (5.4%) died during hospitalization. Older age, higher total bilirubin, and higher leptospiremia were independently associated with in-hospital death, and a combined model demonstrated good discriminatory performance. We performed targeted amplicon sequencing analysis directly on clinical samples and whole-genome sequencing on available isolates. Genomic analysis identified Leptospira interrogans as the predominant species; clonal group 272 sequence type 34 was the predominant lineage and was observed in all patients with fatal cases for whom genomic data were available. Our findings support integration of clinical predictors and pathogen load for early risk stratification and highlight the potential value of genomic surveillance in leptospirosis-endemic settings.

Artificial intelligence model predicts malignant transformation of oral leukoplakia and optimizes interventions.