Category: Nevin Manimala

Virchows Arch. 2025 Aug 23. doi: 10.1007/s00428-025-04230-2. Online ahead of print.

ABSTRACT

Malignant histiocytoses are rare histiocytic neoplasms that exhibit aggressive clinical and histopathological features. One of these entities, Langerhans cell sarcomas (LCS), shares some histopathological features with Langerhans cell histiocytosis but is distinguished by its overtly malignant cytologic features. The literature on LCS is mostly limited to short reports and a few reviews, while a complete revision of its nosology is lacking. This study aims to fill this gap in the knowledge on LCS, explore potential prognostic factors, and propose a clinical subclassification for better patient stratification, which could guide future treatment investigations. A systematic review of the literature was conducted following PRISMA guidelines. From each included patient, a complete set of clinical and pathological features was collected. Descriptive and association statistics, as well as survival analysis, were performed using R Studio. A cohort of 88 patients was analyzed, the majority being adult males with multisystem pictures often involving skin and lymph nodes. pERK pathway gene mutations were reported in around half. Overall prognosis was poor, even though the association with another hematological neoplasm displayed a significant negative prognostic impact (p = 0.0017). Moreover, in primary cases, a significant difference was observed dividing patients into single system vs multisystem (p = 0.012). Despite treatment modalities being highly heterogeneous, statistical analyses provided insights into the relevance of treating patients according to disease spread (e.g., treating localized masses with surgery alone leads to frequent complete remission, p = 0.0002). This study provides an extensive analysis of LCS nosology and prognostic factors, underscoring the importance of distinguishing LCS from LCH and other histiocytoses, as well as adopting a unified system to define disease spread and guide therapeutic management.

PMID:40848146 | DOI:10.1007/s00428-025-04230-2

Int Urogynecol J. 2025 Aug 23. doi: 10.1007/s00192-025-06282-z. Online ahead of print.

ABSTRACT

INTRODUCTION AND HYPOTHESIS: Diabetic bladder dysfunction (DBD) is a prevalent but underrecognized complication of type 2 diabetes mellitus (T2DM), affecting 25 to 87% of patients and significantly impairing quality of life. The specific risk factors for DBD remain poorly understood due to inconsistent findings in prior studies. This study aims to systematically identify the risk factors associated with DBD among Chinese T2DM patients.

METHODS: A case-control study was conducted in Shenzhen, China, spanning from March 2019 to January 2024, involving T2DM patients from two tertiary comprehensive hospitals. Patients were categorized into DBD and non-DBD groups based on DBD presence or absence. Comparative analysis utilized the Mann-Whitney U test and χ² test, with significant variables subsequently subjected to logistic regression analysis.

RESULTS: In this study, 35.5% of patients with T2DM experienced the outcome of DBD. Comparative analysis between DBD and non-DBD groups revealed that 11 of 60 candidate variables demonstrated significant associations with DBD development (P < 0.05). Significant predictors identified in logistic regression included age (OR 1.03, 95% CI 1.01-1.04), gender (OR 0.47, 95% CI 0.31-0.72), duration of T2DM (OR 1.08, 95% CI 1.04-1.11), urine microalbumin/creatinine ratio (UA/CR) (OR 1.01, 95% CI 1.01-1.01), and insulin use (OR 2.27, 95% CI 1.30-3.96).

CONCLUSIONS: This study identified a total of five significant risk factors, offering robust evidence for DBD intervention and providing critical insights for reducing its incidence and enhancing patient quality of life.

PMID:40848143 | DOI:10.1007/s00192-025-06282-z

Eur Radiol. 2025 Aug 23. doi: 10.1007/s00330-025-11972-9. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of this study was to develop machine learning (ML) models to explore the relationship between chronic pulmonary embolism (PE) burden and severe pulmonary hypertension (PH) in surgical chronic thromboembolic pulmonary hypertension (CTEPH).

MATERIALS AND METHODS: CTEPH patients with a preoperative CT pulmonary angiogram and pulmonary endarterectomy between 01/2017 and 06/2022 were included. A mean pulmonary artery pressure of > 50 mmHg was classified as severe. CTs were scored by a blinded radiologist who recorded chronic pulmonary embolism extent in detail, and measured the right ventricle (RV), left ventricle (LV), main pulmonary artery (PA) and ascending aorta (Ao) diameters. XGBoost models were developed to identify CTEPH feature importance and compared to a logistic regression model.

RESULTS: There were 184 patients included; 54.9% were female, and 21.7% had severe PH. The average age was 57 ± 15 years. PE burden alone was not helpful in identifying severe PH. The RV/LV ratio logistic regression model performed well (AUC 0.76) with a cutoff of 1.4. A baseline ML model (Model 1) including only the RV, LV, Pa and Ao measures and their ratios yielded an average AUC of 0.66 ± 0.10. The addition of demographics and statistics summarizing the CT findings raised the AUC to 0.75 ± 0.08 (F1 score 0.41).

CONCLUSIONS: While measures of PE burden had little bearing on PH severity independently, the RV/LV ratio, extent of disease in various segments, total webs observed, and patient demographics improved performance of machine learning models in identifying severe PH.

KEY POINTS: Question Can machine learning methods applied to CT-based cardiac measurements and detailed maps of chronic thromboembolism type and distribution predict pulmonary hypertension (PH) severity? Findings The right-to-left ventricle (RV/LV) ratio was predictive of PH severity with an optimal cutoff of 1.4, and detailed accounts of chronic thromboembolic burden improved model performance. Clinical relevance The identification of a CT-based RV/LV ratio cutoff of 1.4 gives radiologists, clinicians, and patients a point of reference for chronic thromboembolic PH severity. Detailed chronic thromboembolic burden data are useful but cannot be used alone to predict PH severity.

PMID:40848142 | DOI:10.1007/s00330-025-11972-9

Eur Radiol. 2025 Aug 23. doi: 10.1007/s00330-025-11941-2. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate deep-learning (DL) based real-time cardiac cine sequences acquired in free breathing (FB) vs breath hold (BH).

MATERIALS AND METHODS: In this prospective single-centre cohort study, 56 healthy adult volunteers were investigated on a 1.5-T MRI scanner. A set of real-time cine sequences, including a short-axis stack, 2-, 3-, and 4-chamber views, was acquired in FB and with BH. A validated DL-based cine sequence acquired over three cardiac cycles served as the reference standard for volumetric results. Subjective image quality (sIQ) was rated by two blinded readers. Volumetric analysis of both ventricles was performed.

RESULTS: sIQ was rated as good to excellent for FB real-time cine images, slightly inferior to BH real-time cine images (p < 0.0001). Overall acquisition time for one set of cine sequences was 50% shorter with FB (median 90 vs 180 s, p < 0.0001). There were significant differences between the real-time sequences and the reference in left ventricular (LV) end-diastolic volume, LV end-systolic volume, LV stroke volume and LV mass. Nevertheless, BH cine imaging showed excellent correlation with the reference standard, with an intra-class correlation coefficient (ICC) > 0.90 for all parameters except right ventricular ejection fraction (RV EF, ICC = 0.887). With FB cine imaging, correlation with the reference standard was good for LV ejection fraction (LV EF, ICC = 0.825) and RV EF (ICC = 0.824) and excellent (ICC > 0.90) for all other parameters.

CONCLUSION: DL-based real-time cine imaging is feasible even in FB with good to excellent image quality and acceptable volumetric results in healthy volunteers.

KEY POINTS: Question Conventional cardiac MR (CMR) cine imaging is challenged by arrhythmias and patients unable to hold their breath, since data is acquired over several heartbeats. Findings DL-based real-time cine imaging is feasible in FB with acceptable volumetric results and reduced acquisition time by 50% compared to real-time breath-hold sequences. Clinical relevance This study fits into the wider goal of increasing the availability of CMR by reducing the complexity, duration of the examination and improving patient comfort and making CMR available even for patients who are unable to hold their breath.

PMID:40848141 | DOI:10.1007/s00330-025-11941-2

Eur Radiol. 2025 Aug 23. doi: 10.1007/s00330-025-11947-w. Online ahead of print.

ABSTRACT

OBJECTIVES: Fractures in children are common in emergency care, and accurate diagnosis is crucial to avoid complications affecting skeletal development. Limited access to pediatric radiology specialists emphasizes the potential of artificial intelligence (AI)-based diagnostic tools. This study evaluates the performance of the AI software BoneView® for detecting fractures of the upper extremity in children aged 2-18 years.

MATERIALS AND METHODS: A retrospective analysis was conducted using radiographic data from 826 pediatric patients presenting to the university’s pediatric emergency department. Independent assessments by two experienced pediatric radiologists served as reference standard. The diagnostic accuracy of the AI tool compared to the reference standard was evaluated and performance parameters, e.g., sensitivity, specificity, positive and negative predictive values were calculated.

RESULTS: The AI tool achieved an overall sensitivity of 89% and specificity of 91% for detecting fractures of the upper extremities. Significantly poorer performance compared to the reference standard was observed for the shoulder, elbow, hand, and fingers, while no significant difference was found for the wrist, clavicle, upper arm, and forearm. The software performed best for wrist fractures (sensitivity: 96%; specificity: 94%) and worst for elbow fractures (sensitivity: 87%; specificity: 65%).

CONCLUSION: The software assessed provides diagnostic support in pediatric emergency radiology. While its overall performance is robust, limitations in specific anatomical regions underscore the need for further training of the underlying algorithms. The results suggest that AI can complement clinical expertise but should not replace radiological assessment.

KEY POINTS: Question There is no comprehensive analysis of an AI-based tool for the diagnosis of pediatric fractures focusing on the upper extremities. Findings The AI-based software demonstrated solid overall diagnostic accuracy in the detection of upper limb fractures in children, with performance differing by anatomical region. Clinical relevance AI-based fracture detection can support pediatric emergency radiology, especially where expert interpretation is limited. However, further algorithm training is needed for certain anatomical regions and for detecting associated findings such as joint effusions to maximize clinical benefit.

PMID:40848140 | DOI:10.1007/s00330-025-11947-w

Eur Radiol. 2025 Aug 23. doi: 10.1007/s00330-025-11910-9. Online ahead of print.

ABSTRACT

Low-dose CT screening for lung cancer reduces the risk of death from lung cancer by at least 21% in high-risk participants and should be offered to people aged between 50 and 75 with at least 20 pack-years of smoking. Iterative reconstruction or deep learning algorithms should be used to keep the effective dose below 1 mSv. Deep learning algorithms are required to facilitate the detection of nodules and the measurement of their volumetric growth. Only large solid nodules larger than 500 mm³ or those with spiculations, bubble-like lucencies, or pleural indentation and complex cysts should be investigated further. Short-term follow-up at 3 or 6 months is required for solid nodules of 100 to 500 mm³. A watchful waiting approach is recommended for most subsolid nodules, to limit the risk of overtreatment. Finally, the description of additional findings must be limited if LCS is to be cost-effective. KEY POINTS: Low-dose CT screening reduces the risk of death from lung cancer by at least 21% in high-risk individuals, with a greater benefit in women. Quality assurance of screening is essential to control radiation dose and the number of false positives. Screening with low-dose CT scans detects incidental findings of variable clinical relevance, only those of importance should be reported.

PMID:40848139 | DOI:10.1007/s00330-025-11910-9

Abdom Radiol (NY). 2025 Aug 23. doi: 10.1007/s00261-025-05156-8. Online ahead of print.

ABSTRACT

OBJECTIVE: Primary liver carcinosarcoma (CS) and sarcomatoid carcinoma (SC) are rare malignant tumors of the liver. Although the two tumors often overlap in clinical and imaging manifestations, there are currently no reports comparing the imaging features of these two tumors. Our study aims to compare the clinical characteristics and imaging features of these two tumors to further describe their distinct features, thereby enhancing understanding and diagnostic accuracy.

METHODS: A retrospective analysis was conducted on the clinical and imaging data of 17 patients with CS and 27 patients with SC diagnosed by surgical or needle biopsy between September 2010 and December 2024 at our hospital. The data were summarized and statistically analyzed.

RESULTS: Both groups were predominantly male, with a lower mean age (56.65 ± 11.82) in the CS group compared to the SC group (64.93 ± 8.15) (P = 0.01). Compared to the SC group, the CS group more commonly presented with hepatitis B, cirrhosis, and elevated AFP levels. Both groups were more commonly located in the right hepatic lobe, with larger tumors that were often solitary, irregularly shaped, and lobulated. Most tumors exhibited necrosis and hemorrhage. Calcification was observed in two cases in the CS group on CT scans. The tumor margins were predominantly indistinct, and the majority of tumors did not show a capsule. Approximately half of the patients in the SC group had lymph node involvement, which was significantly higher than in the CS group (P = 0.023). After contrast enhancement, all cases in both groups showed heterogeneous enhancement in the arterial phase. Regarding enhancement distribution, the CS group more commonly exhibited enhancement at the margins and in the solid components, while most cases in the SC group showed enhancement at the margins and in the septa. In terms of dynamic enhancement patterns, the CS group more commonly exhibited partial or complete regression in the delayed phase, while the SC group more commonly exhibited progressive or persistent enhancement in the delayed phase, with statistical significance (P = 0.042).

CONCLUSION: Patients in the SC group had significantly higher age and lymph node involvement than those in the CS group. In terms of tumor enhancement patterns, the CS group primarily exhibited delayed-phase regression or partial regression, while the SC group primarily exhibited delayed-phase persistent or progressive enhancement.

PMID:40848125 | DOI:10.1007/s00261-025-05156-8

Int J Clin Pharm. 2025 Aug 23. doi: 10.1007/s11096-025-01993-1. Online ahead of print.

ABSTRACT

INTRODUCTION: Initiation of direct oral anticoagulants (DOAC) for the management of venous thromboembolism (VTE) typically includes a lead-in dosing phase. However, some patients may receive a shortened course due to comorbid conditions and/or numerous days of parenteral therapy. Limited data exist on the outcomes of an abbreviated lead-in therapy regimen.

AIM: To investigate the clinical outcomes of patients receiving abbreviated versus standard/non-abbreviated DOAC lead-in regimens following parenteral anticoagulation therapy for VTE.

METHOD: We conducted a retrospective cohort study including adults (≥ 18 years of age) who were admitted for acute VTE between 04/01/2019 and 12/31/2023 and received ≥ 24 h of parenteral anticoagulation before being transitioned to a DOAC with abbreviated versus non-abbreviated DOAC lead-in dose. The primary outcome was death or readmission from a thrombotic event within 30 days of discharge. Data were presented using descriptive statistics, logistic regression, and time-to-event analysis.

RESULTS: Across 590 patients, the median (IQR) age was 67 (58-76) years and 280 (47.5%) were female. Over half had a pulmonary embolism (54.9%; N = 324), 21.0% (N = 124) had a deep vein thrombosis, and the remainder experienced a combination. Most patients received the non-abbreviated lead-in dose (83.2%; N = 491). When compared to the non-abbreviated cohort, a higher proportion of those who received an abbreviated lead-in therapy had prior VTE and heart failure. There were no significant associations between an abbreviated lead-in dose and the primary outcome (aOR 0.44; 95% CI 0.13-1.52; P = 0.20). Bleeding events were also similar between the abbreviated and non-abbreviated dose cohorts at the longest follow-up (3.0%, N = 3 vs. 2.9%, N = 14; P = 0.92; aOR 0.82; 95% CI 0.22-3.1; P = 0.77) and within 30 days of DOAC initiation (HR 1.24; 95% CI 0.26-5.82; P = 0.79).

CONCLUSION: An abbreviated DOAC lead-in therapy was not associated with short-term mortality, readmission due to recurrent thrombosis, or bleeding. Further prospective studies are needed to confirm these findings and provide insights into more personalized regimens.

PMID:40848117 | DOI:10.1007/s11096-025-01993-1

Int J Clin Pharm. 2025 Aug 23. doi: 10.1007/s11096-025-01990-4. Online ahead of print.

ABSTRACT

INTRODUCTION: Polypharmacy is a growing public health concern, yet its association with area-level socioeconomic deprivation in England has been under-explored.

AIM: To investigate whether socioeconomic deprivation, measured by the Index of Multiple Deprivation (IMD), is associated with polypharmacy among adults.

METHOD: We analysed cross-sectional data from the 2021 Health Survey for England, including 1705 adults aged 16+ who completed nurse visits and reported prescribed medication use in the past week. Polypharmacy was defined as the use of five or more prescribed medications. IMD scores were categorised into quintiles (least to most deprived). Multivariable logistic regression estimated adjusted odds ratios (ORs) with 95% confidence intervals (CIs), controlling for age, sex, ethnicity, multimorbidity, obesity, smoking, alcohol use, and GP visit frequency. A polynomial contrast test assessed linear trends, and adjusted predicted probabilities were calculated to illustrate the deprivation-polypharmacy gradient.

RESULTS: In the fully adjusted model, adults residing in the most deprived IMD quintile had significantly higher odds of polypharmacy (OR 1.82; 95% CI 1.09-3.04; p = 0.022) compared to those living in the least deprived areas. No statistically significant associations were observed for intermediate quintiles. A polynomial contrast test confirmed a significant linear trend across IMD levels (p = 0.010), indicating that the odds of polypharmacy increased progressively with greater area-level deprivation. This gradient was further illustrated by adjusted predicted probabilities, which rose from 18.3% (95% CI 15.3-21.3%) in the least deprived quintile to 24.6% (95% CI 20.1-29.2%) in the most deprived (p < 0.001).

CONCLUSION: Socioeconomic deprivation is independently associated with polypharmacy, even after adjusting for multimorbidity and other confounders, highlighting persistent health inequalities within England’s healthcare system. Targeted strategies, including regular medication reviews and enhanced access to care in deprived communities, may help mitigate risks and promote equity in prescribing practices.

PMID:40848116 | DOI:10.1007/s11096-025-01990-4

Surg Today. 2025 Aug 23. doi: 10.1007/s00595-025-03122-x. Online ahead of print.

ABSTRACT

PURPOSE: We investigated the surgical outcomes of completion lobectomy after primary segmentectomy for lung malignancies.

METHODS: A review of 1139 patients who underwent pulmonary segmentectomy for lung malignancies, identified 17 (1.5%) who underwent completion lobectomy. We analyzed the clinicopathological outcomes of completion lobectomy in these 17 patients, statistically, and evaluated the degree of surgical difficulty, using logistic regression models.

RESULTS: The primary segmentectomy was performed on the right-side in six patients, centrally in seven, in the upper lobe in nine, and as a complex segmentectomy in ten. Lung cancer was diagnosed in 13 patients. Completion lobectomy required an intrapericardial procedure in five patients, main pulmonary artery (PA) clamping in seven, bronchial plasty in five, and PA-plasty in five. The mean operative time was 219 min, and the mean blood loss was 193 ml. Cut-end recurrence was confirmed in nine (56%) patients, and Grade III or higher morbidity occurred in six patients (38%) with no short-term mortality. Logistic regression analysis revealed that upper lobe completion lobectomy was a significant predictor of surgical difficulty (OR 23.8, 95%CI 1.742-333.3, p = 0.018).

CONCLUSION: Completion lobectomy is technically challenging, especially in the upper lobe, but the oncological and surgical results are acceptable. This procedure is a promising and important strategy for treating secondary lesions in the residual lobe after segmentectomy.

PMID:40848109 | DOI:10.1007/s00595-025-03122-x