Nevin Manimala

Eur Radiol. 2025 Mar 27. doi: 10.1007/s00330-025-11489-1. Online ahead of print.

ABSTRACT

OBJECTIVES: Contrast-enhanced ultrasound (CEUS) assesses omental lesion nature, but CEUS-guided biopsy feasibility, effectiveness, and safety are uncertain.

METHODS: From January 2020 to January 2024, patients scheduled for ultrasound-guided omental biopsy at the First Hospital of China Medical University were enrolled. They were divided into CEUS-guided and conventional ultrasound-guided groups, balanced using propensity score matching (PSM). Success rate, diagnostic accuracy, and complication rate were compared. Subgroup analyses considered sonographic features, with significance at p < 0.05.

RESULTS: After PSM, 310 CEUS-guided and 160 conventional ultrasound-guided patients were analyzed. Groups were similar in demographics and omental characteristics (p > 0.05). CEUS-guided biopsy had higher sample acquisition (97.42% vs. 93.13%, p = 0.029) and diagnostic accuracy (96.03% vs. 87.92%, p = 0.002). Overall complication rate was 9.36% (44/470), with distant metastasis in 0.43% (2/470). Complication rates did not differ significantly between groups. In hyperechoic group, dense group, and non-nodule group, CEUS-guided biopsy had higher success (97.99% vs. 92.55%, p = 0.042) and accuracy (96.48% vs. 86.17%, p = 0.002). In non-nodule group, CEUS-guided accuracy was superior (93.41% vs. 84.11%, p = 0.015).

CONCLUSION: Ultrasound-guided omental biopsy is a safe and effective method for obtaining samples. CEUS-guided omental biopsy enhances sample acquisition and diagnostic accuracy, especially in hyperechoic group, dense group, and non-nodule group, suggesting it is a more accurate and effective diagnostic method.

KEY POINTS: Question Selecting a puncture site for diffuse lesions of the greater omentum presents challenges, as conventional ultrasound-guided biopsy often encounters difficulties in avoiding local necrotic tissue. Findings Ultrasound-guided biopsy of the greater omentum is a safe and effective diagnostic method, especially when augmented with CEUS, which can significantly enhance diagnostic accuracy. Clinical relevance CEUS can markedly enhance diagnostic accuracy by providing a robust foundation for selecting the biopsy site and pathway. Therefore, it is advisable to routinely employ CEUS-guided puncture pathways for atypical omental lesions.

PMID:40146426 | DOI:10.1007/s00330-025-11489-1

Eur Radiol. 2025 Mar 27. doi: 10.1007/s00330-025-11524-1. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to assess whether pharmacokinetic parameters derived from DCE-MRI can stratify Programmed Death-Ligand 1 (PD-L1) expression in NSCLC. The secondary aim was to identify a suitable pharmacokinetic model configuration for anisotropic temporally-spaced DCE-MRI sequences, considering Tofts variants, population-averaged arterial input functions (AIF), and bolus arrival time (BAT) estimation methods.

MATERIALS AND METHODS: From April 2021 to May 2023, patients with locally advanced non-small cell lung cancer (NSCLC) were prospectively enrolled. Tumors were categorized based on: PD-L1 absence/presence (threshold 1%) and hyperexpression/hypoexpression (threshold 50%). Pharmacokinetic parameters were extracted using several candidate configurations; fit quality was evaluated using coefficient of determination (R²). Mann-Whitney U-test and ROC-AUC were used to assess correlation with PD-L1 for the best-fit configuration.

RESULTS: Thirty-eight patients (mean age 68 ± 9 years, 28 men) were included. PD-L1 expression was present in 25 patients (66%) and absent in 13 (34%). PD-L1 was hyperexpressed in 13 (34%) patients and hypoexpressed in 25 (66%). Voxel-wise pharmacokinetic parameters were extracted using the best-fit configuration-extended Tofts model (ETM) with Georgiou AIF and Peak-Gradient (PG) BAT estimation (R² = 0.79). K^trans median (0.25 vs. 0.12 min^–¹, p = 0.02), K^trans standard deviation (0.32 vs. 0.23 min^–¹, p = 0.01) and K_ep median (1.09 vs. 0.59 min^–¹, p = 0.02) were significantly higher in PD-L1 < 50% group (ROC-AUC 0.71-0.76).

CONCLUSION: DCE-MRI pharmacokinetic parameters could stratify PD-L1 hypo/hyperexpression in NSCLC. The ETM with PG BAT estimation method and Georgiou AIF was the best-performing pharmacokinetic configuration.

KEY POINTS: Question Could Dynamic Contrast-Enhanced (DCE) MRI offer a safe and non-invasive way to assess Programmed Death-Ligand 1 (PD-L1) expression? Findings Quantitative DCE-MRI parameters K^trans (the volume transfer rate) and K_ep (the efflux rate constant) show potential for distinguishing PD-L1 hyperexpression from hypoexpression. Clinical relevance Preliminary results suggest that DCE-MRI could be a safe method to stratify PD-L1 hypo/hyperexpression in non-small cell lung cancer, potentially optimizing treatment decisions, given the high cost of immunotherapy.

PMID:40146425 | DOI:10.1007/s00330-025-11524-1

Eur Radiol. 2025 Mar 27. doi: 10.1007/s00330-025-11516-1. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the association between plaque characteristics and burden by coronary computed tomography angiography (CCTA) and ischemia determined by invasively measured fractional flow reserve (FFR), and whether the addition of plaque characteristics improves ischemia discrimination beyond coronary stenosis alone.

METHODS: A systematic literature review and meta-analysis of studies from PubMed, EMBASE, and the Cochrane Library databases, published between January 2005 and October 2024 were conducted to assess the relationship between quantitative and qualitative coronary plaque characteristics and invasive FFR. Pooled analyses were performed using weighted mean difference for plaque volumes with 95% confidence intervals and odds ratios for qualitative plaque findings.

RESULTS: A total of 29 studies involving 4416 patients (mean age 63 ± 9 years and 71% male) with predominantly stable coronary artery disease were included. Data on 3923 lesions and 3520 vessels were pooled. Total plaque, non-calcified plaque, and percent aggregate plaque volumes, as well as percent plaque burden, were inversely associated with FFR at both per-lesion and per-vessel levels (all, p-values < 0.05). The presence of high-risk plaque characteristics, including low-attenuation plaque, napkin-ring sign, and spotty calcification, were more frequently observed in lesions and vessels with FFR ≤ 0.80 (all, p-values < 0.05). Among plaque volumes, the percent aggregate plaque volume consistently improved ischemia discrimination independently of stenosis.

CONCLUSION: CCTA-derived quantification of plaque volumes and identification of high-risk plaque characteristics are associated with ischemia and significantly enhance discrimination of ischemia-causing lesions independently of coronary stenosis severity.

KEY POINTS: Question Plaque characteristics have been suggested as the missing link between coronary artery stenosis severity and ischemia. Findings High-risk plaque characteristics and larger coronary plaque volumes are associated with ischemia (FFR ≤ 0.80). Clinical relevance The addition of CCTA-derived plaque assessment improved the discrimination of ischemia compared with stenosis evaluation alone. Combining coronary stenosis and plaque assessment may improve the non-invasive assessment of patients with coronary artery disease and gatekeeping to the catheterization laboratory.

PMID:40146424 | DOI:10.1007/s00330-025-11516-1

Eur Radiol. 2025 Mar 27. doi: 10.1007/s00330-025-11527-y. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare the therapeutic effect, adverse events, and hepatic artery injury (HAI) between gelatin spheres (GS) and nonspherical gelatin sponge particles (GP) in conventional transcatheter arterial chemoembolization (C-TACE).

MATERIALS AND METHODS: A total of 368 consecutive patients with hepatocellular carcinoma (HCC) who underwent C-TACE between September 2019 and May 2021 were included in this single center retrospective study. Adverse events, radiologic tumor response, local tumor recurrence, and HAI were evaluated.

RESULTS: Subsegmental C-TACE was performed using biodegradable GS in 165 patients and nonspherical biodegradable GP in 203 patients. No significant differences in patient background existed between the groups, and there was no significant difference in adverse event rate (p = 0.231). The CR and overall tumor response in the GS and GP groups were 73.3% vs 70.9%, and 99.4% vs 98.5%, respectively, with no significant between-group differences (p = 0.642 and p = 0.631). No significant difference in cumulative local tumor recurrence rate existed between the groups (p = 0.558). HAI was observed in 16% (20 of 125 patients) in the GS group and 37.4% (49 of 131 patients) in the GP group. The incidence of HAI was significantly higher in the GP group than in the GS group (p < 0.001). In multiple logistic regression analysis, risk factors for HAI were index tumor size ≥ 3 cm (p = 0.001) and use of GP (p < 0.001).

CONCLUSION: C-TACE with GS resulted in the same therapeutic and adverse effects as C-TACE with nonspherical GP while causing significantly less HAI.

KEY POINTS: Question Comparisons between GS and nonspherical GP are lacking, and the potential advantages of GS over nonspherical GP are not well studied. Findings HAI incidence was higher in the GP than the GS group, and risk factors of HAI were index tumor size ≥ 3 cm and GP use. Clinical relevance C-TACE with GS resulted in the same therapeutic and adverse effects as C-TACE with nonspherical GP while causing significantly less HAI.

PMID:40146423 | DOI:10.1007/s00330-025-11527-y

J Cancer Educ. 2025 Mar 27. doi: 10.1007/s13187-025-02617-y. Online ahead of print.

ABSTRACT

Effective cancer prevention requires early interventions to enhance health literacy, particularly for Opisthorchis viverrini (OV) and cholangiocarcinoma (CCA) in the Greater Mekong Subregion. This study developed and evaluated the Muk-KAMSComD Model, a structured learning management approach, to improve health literacy and preventive behaviors among primary school students in Mukdahan Province, a high-risk area in Thailand. A four-step research and development (R&D) framework was implemented: (1) situation and needs assessment, (2) model development, (3) implementation, and (4) refinement and presentation. Thirty-six Grade 6 students were selected through multi-stage sampling, and a one-group pretest-posttest design assessed health literacy using validated questionnaires. The 12-week intervention integrated the HALO Model (Healthy School, Active Learning, Lesson Study, and Open Class) with six key health literacy skills. Data were analyzed using qualitative content analysis, descriptive statistics, and paired t-tests. The Muk-KAMSComD Model consists of Knowledge provision, Awareness and belief creation, Motivation enhancement, Self-management practice, Communication, and Decision-making and forwarding. Post-intervention, students significantly improved (p < 0.001) in knowledge, communication, self-management, media literacy, information access, and decision-making skills. Information access showed the highest improvement, while self-management remained the lowest. The model was refined to strengthen parental engagement and instructional materials for enhanced effectiveness. The Muk-KAMSComD Model effectively strengthens health literacy and preventive behaviors for OV and CCA among primary school students. Its integration into school curricula and public health programs could contribute to sustainable CCA prevention in endemic regions.

PMID:40146421 | DOI:10.1007/s13187-025-02617-y

Eur J Orthop Surg Traumatol. 2025 Mar 27;35(1):136. doi: 10.1007/s00590-025-04253-0.

ABSTRACT

PURPOSE: The rising demand for primary total shoulder arthroplasty (TSA) has spurred interest in comparing the safety and cost-effectiveness of outpatient TSA in ambulatory surgical centers (ASCs) versus hospital-based centers (HSCs). This study evaluates ASCs and HSCs for medical complications, readmission rates, implant complications, and costs.

METHODS: This retrospective cohort study used the PearlDiver Mariner Database to identify patients undergoing primary TSA in ASCs or HSCs, assessing medical complications, readmissions, implant issues, and costs. ASC patients were matched in a 1:5 ratio to HSC patients by age, sex, region, and Elixhauser Comorbidity Index (ECI). Logistic regression analyzed the impact of ASC versus HSC settings on complications and readmissions, while Welch’s t-tests compared costs. Statistical significance was determined by a P value less than or equal to 0.05.

RESULTS: ASCs showed lower odds of pulmonary embolism (OR = 0.69; P = 0.04), total medical complications (OR = 0.89; P = 0.01), prosthetic joint dislocation (OR = 0.43; P = 0.05), and total implant-related complications (OR = 0.85; P = 0.03), but a higher 90-day readmission rate (OR = 1.22; P < 0.01). ASCs also offered significant cost savings on the day of surgery ($4600 vs. $11,100; P < 0.01) and for 90-day total costs ($6600 vs. $13,500; P < 0.01) compared to HSCs.

CONCLUSION: Outpatient primary TSA in ASCs offers comparable safety with substantially lower costs than HSCs. Despite higher readmission rates, ASCs represent a viable, cost-effective alternative.

PMID:40146416 | DOI:10.1007/s00590-025-04253-0

J Gastrointest Cancer. 2025 Mar 27;56(1):89. doi: 10.1007/s12029-025-01209-9.

ABSTRACT

BACKGROUND AND AIMS: Currently, there are no biomarkers with high accuracy in the detection of pancreatic cancer. This article aims to evaluate the performance of a novel diagnostic model based on a combination of biomarkers in the washing fluid obtained by EUS-FNA with imaging examination in pancreatic cancer.

METHODS: This study included 59 patients with pancreatic lesions who underwent EUS-FNA and were categorized into malignant and benign groups on the basis of pathology diagnosis. The levels of CEA, CA19-9, CA125, CA724, CYFRA 21-1, IMP3, SMAD4, and S100P in EUS-FNA washing fluid were detected by ELISA. We attempted to construct a new diagnostic method by combining the above biomarkers with EUS, CT, MRI, and PET-CT.

RESULTS: CEA, CA19-9, CA724, CA125, and CYFRA 21-1 showed statistical significance in the diagnosis of pancreatic cancer (AUC > 0.7, p < 0.05). CA724 had a specificity of up to 100% in the group with positive EUS diagnosis. If at least two positive imaging results (EUS/CT/MRI/PET-CT) combined with at least one tumor marker (CEA/CA199/CA724) in series, the sensitivity was 88.57% and the specificity was 91.67%.

CONCLUSIONS: Combining the tumor markers CEA, CA19-9, CA724, CA125, and CYFRA 21-1 in the washing fluid of EUS-FNA with commonly used imaging methods can help distinguish benign and malignant pancreatic lesions.

PMID:40146407 | DOI:10.1007/s12029-025-01209-9

Metabolomics. 2025 Mar 27;21(2):45. doi: 10.1007/s11306-025-02244-0.

ABSTRACT

BACKGROUND: Research gaps persist in understanding the interactions between serum 25 (OH)D levels, intestinal fungi, and their metabolites in postmenopausal women.

METHODS: This study, approved by the Ethics Committee of Zhongshan Hospital, Xiamen University, recruited postmenopausal women from Xiamen. Clinical assessments included Body Mass Index (BMI) calculations and blood tests for various bone-related markers using Roche’s electrochemiluminescence system. Bone density was measured via dual-energy X-ray absorptiometry. Fecal DNA was extracted for Internal Transcribed Spacer (ITS) sequencing with a two-stage PCR process and analyzed using high-throughput Illumina sequencing. Metabolites were extracted from fecal samples and analyzed by ultra-high-performance liquid chromatography combined with mass spectrometry. Statistical analyses and data visualization were performed using R, focusing on fungal community structure and correlations with metabolites.

RESULTS: The study analyzed 81 postmenopausal women, categorized into vitamin D deficient (VDD), insufficient (VDI), and sufficient (VDS) groups based on serum 25 (OH)D levels. Other health markers, including age and BMI, were consistent across groups. Notably, Linear discriminant analysis identified distinct fungal communities across VDD, VDI, and VDS groups. In the VDD group, notable fungi included Hanseniaspora occidentalis and Pichia. The VDI group showed enrichment of Candida, while the VDS group had higher abundances Such as Phanerochaete, and Nectriaceae. Alpha diversity metrics, such as the Chao1 index, differed significantly among the groups (p < 0.05). Correlation analysis (Spearman) revealed that fungi like Trichosporon and Penicillium positively associated with 25 (OH)D3, whereas fungi such as Cystofilobasidium were negatively correlated with bone mineral density (BMD). Metabolites like Glutaric acid positively correlated with 25 (OH)D3, while L-Citrulline and Deoxycholic acid were negatively correlated. Additionally, Argininosuccinic acid correlated positively with BMD, whereas Acamprosate and p-Hydroxyphenylacetic acid were negatively associated.

CONCLUSION: In postmenopausal women, fungal community composition varies significantly with vitamin D status, potentially correlating with serum 25 (OH)D levels and BMD, indicating that specific fungal species may be relevant for therapeutic strategies with osteoporosis and offering insights into the broader bone health effects of vitamin D.

PMID:40146404 | DOI:10.1007/s11306-025-02244-0

Neurosurg Rev. 2025 Mar 27;48(1):331. doi: 10.1007/s10143-025-03466-5.

ABSTRACT

There are limited data on the impact of light sedation (LS) on changes in intraoperative hypotension related to carotid artery stenting (CAS). We aimed to investigate intraoperative hypotension and perioperative complications in CAS under LS with intravenous dexmedetomidine (Dex). A retrospective analysis of 140 consecutive patients who underwent CAS at our centre from September 2018 to March 2021 was performed. The primary endpoint was the incidence of intraoperative hypotension associated with CAS, defined as continuous systolic blood pressure < 90 mmHg. The secondary outcomes were perioperative complications, including dysphoria, transient ischaemic attacks (TIA), stroke, myocardial infarction (MI), reperfusion syndrome, and 24-h haemodynamic events after CAS. Eighty-nine patients were treated under LS, and 51 patients were treated under local anaesthesia (LA). Intraoperative haemodynamic instability was observed in 13 of 140 (9.3%) patients; hypotension occurred in 2.2% (2/89) of patients in the LS group, which was significantly lower than the rate in the LA group (2.2% vs. 11.8%, P = 0.027). Dysphoria occurred in 1.1% of the LS cohort and 15.7% of the LA cohort (P < 0.05). TIA was observed in 2.2% of the LS cohort and 15.7% of the LA cohort (P < 0.05), respectively. There were no statistically significant differences in periprocedural stroke, reperfusion syndrome, or 24-h haemodynamic events after CAS between the two groups, and none of the patients exhibited MI. Performing CAS under LS with intravenous Dex was a safe and effective anaesthesia option in terms of inhibiting intraoperative hypotension and could markedly decrease the incidence of dysphoria and TIA.

PMID:40146394 | DOI:10.1007/s10143-025-03466-5

Bull Environ Contam Toxicol. 2025 Mar 27;114(4):54. doi: 10.1007/s00128-025-04033-w.

ABSTRACT

Per- and polyfluoroalkyl substances (PFAS) are persistent environmental contaminants widely detected in water and sediment worldwide. Despite growing concerns about their ecological and health risks, their distribution in African aquatic environments remains understudied. This study addresses the knowledge gap in PFAS contamination by analysing the spatial and temporal distribution of 18 PFAS in Apies River water and sediment in Pretoria, South Africa. Surface water and sediment samples were collected upstream and downstream of the Apies River during dry seasons. The analysis of PFAS concentrations was conducted using liquid chromatography-tandem mass spectrometry. Statistical analysis, including paired t-tests, non-metric multidimensional scaling, and hierarchical cluster analysis, were applied to determine spatial and temporal trends. The study revealed significant spatial variations in PFAS contamination, with upstream locations consistently exhibiting higher concentrations than downstream. In surface water samples, L_PFBS, 4:2 FTS, 6:2 FTS, and L_PFHpS showed statistically significant differences (p < 0.05) between sites. Perfluorocarboxylic acids were the dominant PFAS class in surface water (50.47-57.15%), whereas perfluorosulfonic acids were more prevalent in sediments. Upstream sediment had higher L_PFHpS (43.00 ng/g), L_PFDS (38.89 ng/g), and L_PFHxS (23.91 ng/g) than downstream (31.96, 27.84, and 18.02 ng/g, respectively). The findings reveal contamination sources and partitioning between surface water and sediments, aiding in water quality management and pollution mitigation strategies.

PMID:40146386 | DOI:10.1007/s00128-025-04033-w