Category: Nevin Manimala

Eur Radiol. 2025 Apr 13. doi: 10.1007/s00330-025-11567-4. Online ahead of print.

ABSTRACT

PURPOSE: This multicenter trial was conducted to evaluate MRI for the longitudinal management of incidental pulmonary nodules in heavy smokers.

MATERIALS AND METHODS: 239 participants (63.9 ± 8.4 years, 43-82 years) at risk of or with COPD GOLDI-IV from 16 centers prospectively underwent two rounds of same-day low-dose computed tomography (LDCT1&2) and MRI1&2 at an interval of three years in the nationwide COSYCONET trial. All exams were independently assessed for incidental pulmonary nodules in a standardized fashion by two blinded readers, incl. axis measurements and Lung-RADS categorization, with consensual LDCT results serving as the standard of reference. A change in diameter ≥ 2 mm was rated as progress. 11 patients underwent surgery for suspicious nodules after the first round.

RESULTS: Two hundred twenty-four of two hundred forty nodules (93.3%) persisted from LDCT1 to LDCT2, with a sensitivity of MRI2 of 82.8% and 81.5% for readers 1 and 2, respectively. Agreement in Lung-RADS categories between LDCT2 and MRI2 was substantial in per-nodule (κ = 0.62-0.70) and excellent in a per-patient (κ = 0.86-0.88) approach for both readers, respectively. Concordance between LDCT2 and MRI2 for growth was excellent to almost perfect (κ = 0.88-1.0). The accuracy of LDCT1 and MRI1 for lung cancer was 87.5%. Lung-RADS ≥ 3 category on MRI1 had higher accuracy for predicting progress (23.1% and 21.4%, respectively) than LDCT1 (15.8%).

CONCLUSION: Compared to LDCT, MRI shows similar capabilities for the longitudinal evaluation of incidental nodules in heavy smokers. Decision-making for nodule management guided by Lung-RADS seems feasible based on longitudinal MRI.

KEY POINTS: Question Can MRI serve as an alternative to low-dose CT (LDCT) for the longitudinal management of pulmonary nodules in heavy smokers, addressing concerns over radiation exposure? Findings MRI demonstrated substantial agreement with LDCT in detecting nodule growth, accurately categorizing Lung-RADS, and comparable accuracy in identifying malignancy over a three-year follow-up. Clinical relevance Longitudinal MRI demonstrates high consistency with LDCT in assessing the growth of incidental pulmonary nodules and categorizing per-patient Lung-RADS, offering a reliable, radiation-free alternative for monitoring and early malignancy detection in high-risk populations.

PMID:40221941 | DOI:10.1007/s00330-025-11567-4

Eur Radiol. 2025 Apr 13. doi: 10.1007/s00330-025-11574-5. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to assess diagnostic performance of high-resolution dynamic contrast-enhanced (DCE) MRI with deep learning-based compressed sensing and super-resolution (DLCS-SR) reconstruction for identifying microadenomas.

MATERIALS AND METHODS: This prospective study included 126 participants with suspected pituitary microadenomas who underwent DCE MRI between June 2023 and January 2024. Four image groups were derived from single-scan DCE MRI, which included 1.5-mm slice thickness images using DLCS-SR (1.5-mm DLCS-SR images), 1.5-mm slice thickness images with deep learning-based compressed sensing reconstruction (1.5-mm DLCS images), 1.5-mm routine images, and 3-mm slice thickness images using DLCS-SR (3-mm DLCS-SR images). Diagnostic criteria were established by incorporating laboratory findings, clinical symptoms, medical histories, previous imaging, and certain pathologic reports. Two readers assessed the diagnostic performance in identifying pituitary abnormalities and microadenomas. Diagnostic agreements were assessed using κ statistics, and intergroup comparisons for microadenoma detection were performed using the DeLong and McNemar tests.

RESULTS: The 1.5-mm DLCS-SR images (κ = 0.746-0.848) exhibited superior diagnostic agreement, outperforming 1.5-mm DLCS (κ = 0.585-0.687), 1.5-mm routine (κ = 0.449-0.487), and 3-mm DLCS-SR images (κ = 0.347-0.369) (p < 0.001 for all). Additionally, the performance of 1.5-mm DLCS-SR images in identifying microadenomas [area under the receiver operating characteristic curve (AUC), 0.89-0.94] surpassed that of 1.5-mm DLCS (AUC, 0.83-0.87; p = 0.042 and 0.011, respectively), 1.5-mm routine (AUC, 0.76-0.78; p < 0.001), and 3-mm DLCS-SR images (AUC, 0.72-0.74; p < 0.001).

CONCLUSION: The findings revealed superior diagnostic performance of 1.5-mm DLCS-SR images in identifying pituitary abnormalities and microadenomas, indicating the clinical-potential of high-resolution DCE MRI.

KEY POINTS: Question What strategies can overcome the resolution limitations of conventional dynamic contrast-enhanced (DCE) MRI, and which contribute to a high false-negative rate in diagnosing pituitary microadenomas? Findings Deep learning-based compressed sensing and super-resolution reconstruction applied to DCE MRI achieved high resolution while improving image quality and diagnostic efficacy. Clinical relevance DCE MRI with a 1.5-mm slice thickness and high in-plane resolution, utilizing deep learning-based compressed sensing and super-resolution reconstruction, significantly enhances diagnostic accuracy for pituitary abnormalities and microadenomas, enabling timely and effective patient management.

PMID:40221940 | DOI:10.1007/s00330-025-11574-5

Eur Radiol. 2025 Apr 13. doi: 10.1007/s00330-025-11566-5. Online ahead of print.

ABSTRACT

OBJECTIVE: Radiation safety concerns have spurred the development of real-time dosimetry systems. This study investigated the occupational dose exposure of interventional radiologists during lower extremity and abdominal procedures.

MATERIALS AND METHODS: Real-time dosimetry was performed during 102 consecutive interventions (51 lower extremity, 51 abdominal). Radiation protection measures included protective glasses (lead equivalent 0.5 mm), thyroid shielding (0.5 mm), vests (0.35 mm), aprons (0.25 mm), as well as movable acrylic and table shields (both 0.5 mm) during all procedures. Dosimeters were attached to the interventionalist’s glasses on the side of the x-ray tube, to the back of the supporting hand, and under the vest. Using standardized values over time to account for exposure time differences between interventions, dose-area products and the dose equivalent H_P(10) were recorded in all three positions.

RESULTS: Lower extremity angiographies were associated with a substantially lower median dose-area product (5.3 vs. 51.4 Gy × cm²) and exposure time (462 vs. 762 s) than abdominal interventions (both p < 0.001). For lower extremity procedures, H_P(10) per minute recorded by the hand, cranium/eye lens, and body trunk dosimeters was 2.45, 0.01, and < 0.01 µSv/min, respectively. Markedly higher dose equivalents were documented for the hand (7.54 µSv/min), cranium/eye lens (0.26 µSv/min), and body trunk (0.04 µSv/min) during abdominal interventions (all p < 0.001).

CONCLUSION: Real-time dosimetry confirmed sufficient radiation protection with the application of dedicated safety measures, even in dose-intensive abdominal procedures. Interventionalists’ supporting hands are subjected to the highest radiation exposure, followed by the cranium/eye lens and the body trunk.

KEY POINTS: Question Active dosimetry facilitates real-time assessment of radiation exposure in different measurement sites, but a multi-dosimeter setup has not been explored for interventional radiology so far. Findings Occupational radiation exposure is considerably higher in abdominal than in lower extremity procedures. Interventionalists’ supporting hands receive the highest dose equivalents regardless of procedure type. Clinical relevance Dose monitoring in real time is key to understanding the radiation burden of different anatomical features during image-guided interventions. Especially in dose-intensive abdominal procedures, protective measures are essential to minimize the occupational radiation exposure of the interventionalist.

PMID:40221939 | DOI:10.1007/s00330-025-11566-5

Microbiol Immunol. 2025 Apr 13. doi: 10.1111/1348-0421.13220. Online ahead of print.

ABSTRACT

Oral squamous cell carcinoma (OSCC) is one of the most common head and neck cancers, and immunotherapy targeting programmed cell death 1 (PD-1) has become a treatment option for recurrent OSCC after surgery and radiation therapy. However, few studies have identified definitive biomarkers for predicting patient response to anti-PD1 therapy in OSCC. In the present study, biopsy specimens were obtained from 23 patients with recurrent OSCC who were subsequently treated with anti-PD1 therapy. Immunohistochemical examinations of CD3, CD8, FOXP3, CD103, CD163, programmed cell death ligand 1 (PD-L1), HLA-A/B/C, HLA-DR, and β2 microglobulin were performed, and their correlation with clinical response was statistically analyzed. We found that an increased density of CD8-positive lymphocytes and increased PD-L1 expression predicted a favorable response to anti-PD1 therapy in recurrent OSCC. In contrast, clinical factors such as age and sex, and immune-related factors such as HLA-Classes I and II, were not associated with the response to anti-PD1 therapy. Taken together, our results suggest that immunohistochemical analysis of CD8 and PD-L1 may be useful for predicting the efficacy of anti-PD1 therapy in recurrent OSCC.

PMID:40221937 | DOI:10.1111/1348-0421.13220

J Hosp Med. 2025 Apr 13. doi: 10.1002/jhm.70054. Online ahead of print.

ABSTRACT

BACKGROUND: Pediatric Hospital Medicine (PHM) has a rapidly changing landscape following subspecialty certification in 2016. As the field continues to evolve, so does the role of fellowship training.

OBJECTIVES: The goal of this study was to characterize postgraduate expectations of current PHM fellows to contribute to the understanding of PHM workforce dynamics.

METHODS: Using a constructivist approach, we employed a cross-sectional survey method with both multiple-choice and free-text questions to study PHM fellows’ perspectives regarding posttraining employment and motivations for pursuing fellowship. We used multiple listservs to recruit current PHM fellows for participation. We analyzed survey data using descriptive statistics and free-text responses using conventional inductive content analysis.

RESULTS: A total of 119 PHM fellows (response rate 61%) completed the survey. Most participants anticipated higher starting salaries, more protected time and leadership opportunities, and more efficient career advancement because of PHM fellowship training. Additionally, participants noted several modifiable factors influencing their postgraduate employment considerations which included workplace culture and lifestyle considerations. Participants reported various motivations for pursuing PHM fellowship training, including future job security and career flexibility.

CONCLUSIONS: Despite different reasons for pursuing additional training, the majority of PHM fellows in our study believe that fellowship training should result in increased compensation, resources, and career opportunities than if they had not completed fellowship training. These findings have implications for counseling trainees interested in PHM and for the PHM workforce.

PMID:40221932 | DOI:10.1002/jhm.70054

Knee Surg Sports Traumatol Arthrosc. 2025 Apr 13. doi: 10.1002/ksa.12675. Online ahead of print.

ABSTRACT

PURPOSE: Wearable technologies, like the Apple Watch, offer new possibilities for collecting objective data on physical activity post-operatively following total knee arthroplasty (TKA). This study aims to describe changes in daily physical activity levels using objective metrics over different time points following TKA.

METHODS: This study analyzed data from a prospective cohort of 152 patients undergoing a unilateral TKA. Patients wore an Apple Watch and used a digital care management application for data collection. Step count, steadiness, standing duration, gait speed and performance on a 6-min walk test were collected from Apple HealthKit at multiple time points: pre-operative, 6 weeks post-operatively, 6 months post-operatively and 12 months post-operatively. Statistical analyses were performed using R software, including descriptive statistics and paired t tests to compare outcomes at different time points post-operatively.

RESULTS: Participants demonstrated significant improvements in daily physical activity levels over the course of 12 months post-operative. At 6 months post-operative, participants showed the highest average daily step count (mean ± SD: 5293 ± 236 steps; p < 0.001), with improvements persisting at 12 months post-operative (5180 ± 260 steps; p < 0.001) compared to preoperative values. Gait speed increased from 0.88 ± 0.01 m/s preoperatively to 1.01 ± 0.01 m/s (p = 0.006) at 12 months post-operative. Standing hours increased from 9.99 ± 0.30 to 11.47 ± 0.31 h at 6 months post-operative and persisted. Steadiness and the estimated 6-minute walk test showed recovery trends, though variability remained at 12 months post-operative, suggesting the need for additional longitudinal assessment CONCLUSION: This study provides one of the first longitudinal analyses of post-operative functional recovery using Apple HealthKit, offering continuous real-world gait and activity tracking beyond traditional patient-reported measures. These findings highlight the value of wearable technology in monitoring post-operative activity and offering insights into TKA recovery patterns. The study suggests a critical recovery window at 6 months post-operative and emphasizes the need for ongoing support to maintain improvements. The integration of wearable technology in post-operative monitoring offers a promising approach to tracking patient progress and optimizing functional outcomes following TKA.

LEVEL OF EVIDENCE: Level II.

PMID:40221914 | DOI:10.1002/ksa.12675

West Afr J Med. 2024 Nov 29;41(11):1091-1096.

ABSTRACT

BACKGROUND: Chlamydia Trachomatis infection often runs an asymptomatic course with long-term sequelae. It commonly affects the fallopian tubes and could result in tubal blockage. A study of antichlamydial antibodies, a marker of the disease’s presence, could help understand the disease burden in a given population.

OBJECTIVE: To determine the prevalence of anti-chlamydial antibodies, and its association with tubal infertility among female partners of infertile couples in Enugu, South-eastern Nigeria.

METHODOLOGY: It was a cross-sectional analytical study involving two groups of infertile women attending gynaecology clinics of two tertiary institutions in Enugu, south-eastern Nigeria. Group A (Study group) had tubal factor infertility (n = 143) while Group B (Control) had non-tubal factor infertility (n = 143). Data were obtained using a structured, interviewer-administered questionnaire. Peripheral blood samples were collected and analyzed for anti-chlamydial antibodies using Human chlamydial trachomatis ELISA kits. Statistical package for social science (SPSS) version 25.0 was used for analysis. P-value of <0.05 was statistically significant.

RESULT: The overall prevalence of chlamydial seropositivity was 28.0%. Women with tubal factor infertility were almost twice more likely to have chlamydial seropositivity than those with non-tubal factor infertility (33.6% vs 22.4%; OR = 1.75; 95% C.I = 1.03 – 2.96; p = 0.036). Bilateral tubal occlusion (66.4%) was the commonest tubal pathology identified in the hysterosalpingogram.

CONCLUSION: Anti-chlamydial antibodies were significantly associated with tubal factor infertility in Enugu, South-eastern Nigeria. It is recommended that serum anti-chlamydial antibody testing could be adopted as a screening test for tubal infertility in the study population.

PMID:40221906

Percept Mot Skills. 2025 Apr 13:315125251334155. doi: 10.1177/00315125251334155. Online ahead of print.

ABSTRACT

This study aimed to explore athletes’ perceptions of referees’ judgements in taekwondo competitions using text mining analysis. Participants comprised 100 taekwondo athletes taking part in the World Taekwondo Championships. A total of 898 pieces of identified keywords data were collected on the perceptions of refereeing judgments. The stability and reliability of the referees’ judgments were also examined quantitatively. SPSS, KrKwic, and Netminer 4.0 were used to process the data, and descriptive statistics, covariance matrix, and centrality analysis were performed. The study revealed that the overall perception of the referees’ judgments, including the head referee’s gam-jeom declarations and the assistant referee’s punch points, centered on “unfairness” and “inconsistency,” confirming that taekwondo competitors perceived referees’ judgments as unfair. In particular, ‘gam-jeom_declared’ was perceived as unfair, and other situations such as ‘punch_points,’ ‘clinch_position,’ and ‘video_replay’. The overall fairness confidence level was 37.23%, indicating that the players perceived the referees as unfair. The results of this study can be used as a basis for further research on refereeing fairness.

PMID:40221890 | DOI:10.1177/00315125251334155

Microsc Res Tech. 2025 Apr 13. doi: 10.1002/jemt.24868. Online ahead of print.

ABSTRACT

This study evaluated the effectiveness of conventional rotary instruments (CRI), atraumatic restorative treatment (ART), and the BRIX-3000 chemomechanical caries removal gel by measuring bone mineral density (BMD) and mineral composition in vitro. The carious dentin of 50 extracted human primary molar teeth was removed by using three different methods and restored with high-viscosity glass ionomer cement FUJİ-IX. The BMD values measured from all sections of the cavity floor in the BRIX-3000, ART, and CRI groups are 1.72, 1.79, and 1.66 g/cm³, respectively. SEM-EDX measurements were performed on five randomly selected teeth from the groups. In the BRIX-3000 group, the mean wt Ca% was 65.6, wt P% was 25.34, and the Ca/P ratio was 2.57. In the ART group, 65.75, 23.79, and 2.58 were found, respectively. In the CRI group, 65.73, 26.03, and 2.53 were found, respectively. While there was no difference between the wt Ca% values in all groups in the comparison of the cavity floor and adjacent sound dentin of the samples, the wt P% values were statistically significantly higher on the sound dentin surface.

PMID:40221886 | DOI:10.1002/jemt.24868

Am J Ind Med. 2025 Apr 13. doi: 10.1002/ajim.23722. Online ahead of print.

ABSTRACT

BACKGROUND: Prior work has linked work stressors to asthma. However, research related to gender-specific associations remains sparse and yielded mixed results. We aimed to address this gap.

METHODS: We drew on cross-sectional data from the 2015 National Health Interview Survey (individual-level response rate = 79.7%). Included were participants in employment who were aged 18-70 (n = 18,701). Work-to-family conflict, workplace bullying, and job insecurity were assessed as work stressors. Asthma was defined based on self-reports of a lifetime diagnosis by a doctor or other health professional. To account for the complex sampling design, variance estimation was used to compute weighted descriptive statistics and odds ratios (ORs) as well as corresponding 95% confidence intervals (CIs) using multivariable logistic regression. To test for interaction, interaction terms for work stressors and gender were included in additional models.

RESULTS: In the full sample, work-to-family conflict, workplace bullying and job insecurity showed positive associations with asthma (OR = 1.20, 95%CI = 1.03-1.40; OR = 1.45, 95%CI = 1.17-1.80; and OR = 1.20, 95%CI = 0.99-1.45, respectively). We did not observe meaningful gender differences in the magnitudes of the ORs. All interaction terms were not statistically significant.

CONCLUSIONS: Work stressors were positively associated with asthma, but there was no evidence of gender differences. Prospective studies are needed to determine the potential temporal relation of these associations.

PMID:40221872 | DOI:10.1002/ajim.23722