Nevin Manimala

Eur Radiol. 2025 Aug 9. doi: 10.1007/s00330-025-11778-9. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the discriminative power of coronary artery calcium (CAC) score-based Cox models for predicting cardiovascular disease (CVD) in older adults with longstanding diabetes, a population at elevated CVD risk. We also aimed to determine whether adding computed tomography (CT)-derived costal cartilage calcification (CCC) improves risk prediction, given the potential limitation of CAC due to widespread soft tissue calcification.

MATERIALS AND METHODS: We analyzed adults ≥ 65 years from the multi-ethnic study of atherosclerosis with longstanding diabetes mellitus (DM, ≥ 5 years, n = 231) and compared them to non-DM participants (n = 1148). We evaluated CAC-based risk models (adjusted for Framingham Risk Score, race/ethnicity, and statin use) and assessed the impact of adding CCC on model performance using Cox proportional-hazards regression and Harrell’s C-statistic to predict CVD and coronary heart disease (CHD) incidence. CHD events included fatal coronary events, resuscitated cardiac arrest, myocardial infarction, adjudicated angina, and revascularization with angina. CVD events encompassed CHD, stroke (excluding transient ischemic attack), cardiovascular death, or other atherosclerotic deaths.

RESULTS: Over 8.7 years, CVD and CHD events occurred in 17% and 10% of DM participants and 11% and 5% of non-DM participants, respectively. In longstanding DM participants, doubling of CAC was associated with higher CVD risk (HR: 1.13; 95% CI: 1.01-1.26), with model discrimination improving from C-statistic 0.66 to 0.69 (p = 0.02) after adding CCC. For CHD, the corresponding HR was 1.05 (95% CI: 0.98-1.13), and the C-statistic rose from 0.65 to 0.69 (p = 0.04). In non-DM participants, CCC did not enhance model performance for either CVD or CHD (p > 0.5).

CONCLUSION: CCC, a measurable biomarker of non-cardiovascular calcification from any conventional CT, improves CVD and CHD risk prediction models’ performance in older adults with longstanding DM.

KEY POINTS: Question Coronary artery calcium (CAC) may have limited discriminative power for predicting cardiovascular outcomes in older adults with longstanding diabetes. Findings Costal cartilage calcification (CCC), a biomarker of non-cardiovascular calcification from CT, improves the prediction of cardiovascular disease and coronary heart disease risks in this population. Clinical relevance Incorporating CCC, which can be easily measured using existing CAC assessment tools on CT scans, into cardiovascular risk assessment could refine clinical decision-making and improve individualized risk stratification in older adults with longstanding diabetes.

PMID:40782222 | DOI:10.1007/s00330-025-11778-9

Eur Radiol. 2025 Aug 9. doi: 10.1007/s00330-025-11813-9. Online ahead of print.

ABSTRACT

OBJECTIVES: Cholesteatomas (CSs) are locally aggressive and can infiltrate adjacent structures as they expand. This study aimed to establish a straightforward scoring system using dual-layer detector dual-energy CT (DL-DECT) to improve the identification of cholesteatomas in patients.

MATERIALS AND METHODS: Between August 2023 and July 2024, 871 patients with soft tissue density shadows in the ear region who underwent DL-DECT examination were retrospectively enrolled at our institute. Surgical treatments followed by pathological examinations were performed. Based on pathological findings, the lesions were classified into cholesteatoma (CS) and non-cholesteatoma (non-CS) groups. The diagnostic performance of anatomical and quantitative parameters derived from DL-DECT was evaluated using receiver operating characteristic (ROC) curve analysis. Logistic regression was applied to develop a diagnostic scoring system.

RESULTS: A total of 87 patients (median age, 51 years; 45 men and 42 women) with suspected temporal bone CS were included, comprising 44 CS cases and 43 non-CS cases. The effective atomic number (Zeff) demonstrated the highest diagnostic accuracy (area under the curve [AUC] = 0.786), followed by the slope of the energy spectral curve (AUC = 0.784), scutum destruction (AUC = 0.759), and CT40 keV (AUC = 0.724). Logistic regression identified two significant predictors, which were incorporated into the scoring system. When the system score reached 2 points (Zeff ≤ 7.12 accompanied by scutum destruction), the AUC in the ROC analysis reached 0.868 (95% confidence interval: 0.778-0.931), significantly outperforming each individual parameter (all p < 0.05).

CONCLUSION: The DL-DECT-derived scoring system serves as an innovative imaging marker for detecting CSs.

KEY POINTS: Question Accurate differentiation between CSs and non-CSs is critical for selecting surgical approaches. However, high-resolution CT demonstrates limited discriminatory power. Findings A straightforward diagnostic scoring system incorporating Zeff ≤ 7.12 and scutum destruction was developed to efficiently identify patients with CS. Clinical relevance This scoring system may facilitate the early identification of CS, potentially improving patient outcomes through timely intervention.

PMID:40782221 | DOI:10.1007/s00330-025-11813-9

Support Care Cancer. 2025 Aug 9;33(9):773. doi: 10.1007/s00520-025-09775-1.

ABSTRACT

PURPOSE: This study aimed to develop and validate a Chinese version of the Frailty Risk Perception Questionnaire (FRPQ) for older adults with colorectal cancer.

METHODS: The study was conducted in two phases. In phase 1, a preliminary questionnaire was developed based on theoretical framework analysis, literature review, and qualitative interviews conducted in Chinese with 25 older adults with colorectal cancer. In phase 2, the reliability and validity of the Chinese FRPQ were evaluated through a cross-sectional survey of 350 older adults with colorectal cancer aged 65-85 years across different treatment stages.

RESULTS: Exploratory factor analysis identified a four-factor structure explaining 63.25% of the total variance: perceived susceptibility (17 items), perceived severity (8 items), cognitive risk (5 items), and emotional risk (6 items). The Chinese FRPQ demonstrated good construct validity, with satisfactory convergent validity (correlation coefficients with Fried Frailty Scale: r = 0.683, p < 0.001; with TFI: r = 0.715, p < 0.001) and known-group validity (significant differences among robust, pre-frail, and frail groups, p < 0.001). The Cronbach’s alpha coefficient for the total scale was 0.942, with subscale coefficients ranging from 0.867 to 0.923. Test-retest reliability over two weeks showed an intraclass correlation coefficient of 0.875.

CONCLUSION: The 33-item FRPQ is a valid and reliable instrument for assessing frailty risk perception among older adults with colorectal cancer. This tool may help healthcare providers better understand patients’ perceptions of frailty risk and develop targeted interventions.

PMID:40782220 | DOI:10.1007/s00520-025-09775-1

Neuroradiology. 2025 Aug 9. doi: 10.1007/s00234-025-03728-5. Online ahead of print.

ABSTRACT

PURPOSE: Guillain-Barré Syndrome (GBS) is an autoimmune disorder causing acute inflammatory polyneuropathy, resulting in muscle weakness. Timely diagnosis is critical to prevent complications such as respiratory failure and long-term disability. Ultrasound imaging of peripheral nerves, specifically assessing nerve cross-sectional area (CSA), has been suggested as a diagnostic tool for GBS. This systematic review aims to evaluate the utility of nerve ultrasound in diagnosing and monitoring GBS.

METHODS: A systematic review was conducted following PRISMA guidelines, searching databases including PubMed, Scopus, Web of Science, and Cochrane Library up to December 2024. Studies that used ultrasound to assess peripheral nerve size in GBS patients compared to healthy controls or other neuropathy patients were included. Statistical analysis was conducted using Review Manager 5.4 software.

RESULTS: Out of 848 studies, 25 met the inclusion criteria, with 12 included in the meta-analysis. A total of 528 patients with GBS were included. Ultrasound revealed significant increases in the CSA of cervical, peroneal, median, ulnar, and tibial nerves in GBS patients. Specifically, cervical nerve enlargement (MD: 1.45, P = 0.0008) and peroneal nerve enlargement (Mean Difference (MD): 2.09, P < 0.00001) were notable. Subgroup analysis revealed significant enlargement of the ulnar and tibial nerves across different anatomical regions.

CONCLUSION: Ultrasound imaging of peripheral nerves, particularly changes in CSA, provides valuable diagnostic insight for GBS, may be helpful in early recognition and intervention. Further studies are needed to establish consistent CSA patterns and improve diagnostic accuracy across various GBS subtypes.

PMID:40782205 | DOI:10.1007/s00234-025-03728-5

Eur Spine J. 2025 Aug 9. doi: 10.1007/s00586-025-09225-w. Online ahead of print.

ABSTRACT

PURPOSE: Anterior lumbar interbody fusion (ALIF) is commonly performed via a left-sided retroperitoneal approach, often in collaboration with access surgeons. However, the dominance of this laterality lacks clear evidence-based rationale. This study reports a standardized right-sided retroperitoneal approach for stand-alone ALIF performed solely by a spine surgeon, evaluates its feasibility and safety, and highlights its potential advantages.

METHODS: We conducted a retrospective, monocentric case series of all patients who underwent stand-alone ALIF via a primary right-sided approach between January 2017 and August 2024 by a single right-handed spine surgeon. A detailed surgical technique is described. Perioperative and demographic data were collected, including operative time, hospital stay, implant configuration, and complications. Descriptive statistics were computed using R and Python.

RESULTS: Fifty-nine patients (mean age 55.88 years, 64.41% female) underwent surgery, with most procedures at the L5-S1 level (89.83%). The mean operative time was 115.59 minutes (excluding complex and proctorship cases), and the adjusted mean hospital stay was 3.81 days. The complication rate was low (3.39%), with no severe adverse events or reoperations. All patients received stand-alone polyetheretherketone (PEEK) cages, predominantly 36 mm wide. No vascular injuries or mortality occurred.

CONCLUSION: The right-sided retroperitoneal approach for ALIF is feasible, safe, and efficient when performed by a trained spine surgeon. This approach offers potential strategic benefits as a primary alternative to the conventional left-sided route, especially in stand-alone L5-S1 procedures.

PMID:40782201 | DOI:10.1007/s00586-025-09225-w

Eur Spine J. 2025 Aug 9. doi: 10.1007/s00586-025-09261-6. Online ahead of print.

ABSTRACT

We appreciate the efforts of Maheshwari et al. in exploring CALM1 polymorphisms in degenerative cervical myelopathy (DCM) within an Indian cohort. While the study offers valuable insights, we respectfully highlight certain methodological concerns-particularly regarding statistical interpretation, control group heterogeneity, and age differences between groups. Furthermore, interpretations suggesting pathogenicity for a computationally benign variant may benefit from additional functional validation. We believe that addressing these aspects in future studies will enhance the robustness and translational relevance of genetic research in DCM.

PMID:40782200 | DOI:10.1007/s00586-025-09261-6

Eur Spine J. 2025 Aug 9. doi: 10.1007/s00586-025-09147-7. Online ahead of print.

ABSTRACT

Brain tumor occurs due to the abnormal development of cells in the brain. It has adversely affected human health, and early diagnosis is required to improve the survival rate of the patient. Hence, various brain tumor detection models have been developed to detect brain tumors. However, the existing methods often suffer from limited accuracy and inefficient learning architecture. The traditional approaches cannot effectively detect the small and subtle changes in the brain cells. To overcome these limitations, a SpinalNet-Quantum Dilated Convolutional Neural Network (Spinal-QDCNN) model is proposed for detecting brain tumors using MRI images. The Spinal-QDCNN method is developed by the combination of QDCNN and SpinalNet for brain tumor detection using MRI. At first, the input brain image is pre-processed using RoI extraction. Then, image enhancement is done by using the thresholding transformation, which is followed by segmentation using Projective Adversarial Networks (PAN). Then, different processes, like random erasing, flipping, and resizing, are applied in the image augmentation phase. This is followed by feature extraction, where statistical features such as average contrast, kurtosis and skewness, and mean, Gabor wavelet features, Discrete Wavelet Transform (DWT) with Gradient Binary Pattern (GBP) are extracted, and finally detection is done using Spinal-QDCNN. Moreover, the proposed method attained a maximum accuracy of 86.356%, sensitivity of 87.37%, and specificity of 88.357%.

PMID:40782198 | DOI:10.1007/s00586-025-09147-7

Vet Parasitol. 2025 Aug 6;339:110571. doi: 10.1016/j.vetpar.2025.110571. Online ahead of print.

ABSTRACT

Dermanyssus gallinae is a haematophagous mite species of major concern in the egg industry across the world and there has been a recent surge in studies to find new control methods for this parasite. To provide mites for these experiments, D. gallinae is often raised on hens with the attendant welfare and ethical issues that this entails. Alternatively, mites are collected from infested farm buildings which can lead to variability in mite provenance and quality as well as biosecurity issues. To attempt to overcome these issues in mite supply, we describe a method for maintenance of an in vitro colony of D. gallinae. Mites were maintained, in vitro, for up to 12 weeks and were fed several times per week with goose blood as a food source. The expansion of the colony was monitored weekly and the biomass of mites increased linearly during the initial 8 weeks of culture. To determine the ability of such in vitro-raised mites to feed and thrive if they were exposed to a hen host, mites that had been maintained in this way were used in an “on-hen mite feeding assay” to establish any differences in mite feeding rates, fecundity and mortality between in vitro-raised mites and mites freshly collected from a poultry farm. Feeding rate comparisons were significantly-different between experimental repetitions (p < 0.001), demonstrating the repeatability issues associated with different batches of farm-caught mites. Significantly higher feeding rates on hens were observed for one comparison of farm-caught, compared to in vitro-raised, deutonymphs (p = 0.012) and for adult females (p = 0.002); but no significant difference between the mite sources was demonstrated in feeding rates for protonymphs (p = 0.608) or adult females (p = 0.715) in another experiment. Following on-hen feeding, there were no statistically significant differences between experiments, or between in vitro-raised or farm-caught fed mites, for mite mortality in any life stage or for egg laying.

PMID:40779827 | DOI:10.1016/j.vetpar.2025.110571

J Neurosurg Pediatr. 2025 Aug 8:1-9. doi: 10.3171/2025.5.PEDS24548. Online ahead of print.

ABSTRACT

OBJECTIVE: Myelomeningocele (MMC) is a severe neural tube defect frequently associated with vertebral anomalies, including scoliosis and kyphosis, which can significantly impact mobility and quality of life. This study aimed to evaluate the incidence and clinical correlations of scoliosis and other vertebral anomalies in children with MMC.

METHODS: A retrospective analysis of the hospital records of 422 pediatric MMC patients diagnosed between 2013 and 2020 at two tertiary care centers was conducted. Patients were evaluated for scoliosis, kyphosis, hemivertebra, butterfly vertebra, block vertebra, and diastematomyelia using radiographic and MRI findings. The severity of scoliosis was assessed using Cobb angles, and statistical analyses were performed to determine associations between vertebral anomalies.

RESULTS: Scoliosis was identified in 55.9% of patients (mean Cobb angle 35.65°), while kyphosis was present in 41.2%. The presence of hemivertebra and butterfly vertebra was strongly associated with scoliosis progression. Additionally, patients with split cord malformations exhibited a higher incidence of scoliosis and kyphosis. Age was found to be a key factor in scoliosis severity, with curve progression observed over time.

CONCLUSIONS: Scoliosis and other vertebral anomalies are highly prevalent in MMC patients, necessitating early diagnosis and multidisciplinary management. These findings underscore the importance of long-term monitoring and individualized treatment approaches to optimize spinal health and functional outcomes.

PMID:40779802 | DOI:10.3171/2025.5.PEDS24548

J Neurosurg Spine. 2025 Aug 8:1-10. doi: 10.3171/2025.5.SPINE25303. Online ahead of print.

ABSTRACT

OBJECTIVE: Proximal junctional kyphosis (PJK) affects 5%-61% of patients following thoracolumbar fusion. Many patients are asymptomatic, but a plurality require surgical revision at a cost of $75,000 per case. This analysis sought to analyze the degree to which bone quality and paraspinal muscle sarcopenia influence PJK failure mode.

METHODS: Patients undergoing thoracolumbar instrumented fusion with an upper instrumented vertebra (UIV) at the thoracolumbar junction (T10-L2) were identified and data were gathered on surgery, bone quality, pre- and postoperative sagittal alignment, and paraspinal muscle cross-sectional area (CSA). PJK was defined as a ≥ 10° increase in proximal junctional angle from the first postoperative radiograph. PJK was classified as discoligamentous failure (type 1), bone failure (type 2), or screw-bone interface failure (type 3) according to the Yagi-Boachie system. Bone quality was assessed by Hounsfield units (HUs) and the vertebral bone quality (VBQ) score at the UIV.

RESULTS: One hundred fifty patients were identified (median age 67 years, 53.3% female), 46 of whom experienced PJK (22 type 1, 13 type 2, 11 type 3). The median time to onset was most rapid for type 2 events (2.6 months). There were no differences between patients experiencing PJK versus controls regarding bone quality (HUs or VBQ score) or paraspinal muscle CSA on univariate comparison. However, subdivision by PJK type showed patients experiencing bone failure (type 2) PJK had significantly lower HUs at the UIV and UIV+1 relative to those experiencing type 1 PJK or no PJK (all p < 0.05). The VBQ score trended toward being significant, with a higher VBQ score (worse bone quality) in those suffering type 2 PJK, but did not reach statistical significance (p = 0.07). Patients experiencing discoligamentous failure PJK (type 1) had small multifidus CSA (390 mm2) relative to patients experiencing type 2 (516 mm2) or type 3 (440 mm2) PJK and patients who did not experience PJK (481 mm2), although the difference did not reach statistical significance. On time-to-event analysis, low HUs of the UIV/UIV+1 predicted type 2 (hazard ratio [HR] 0.81, 95% CI 0.70-0.93; p = 0.002) and type 2/3 PJK (HR 0.87, 95% CI 0.78-0.96; p = 0.006) but not type 1 PJK. Low UIV multifidus CSA trended toward being a significant predictor of type 1 PJK (HR 0.85, 95% CI 0.69-1.05; p < 0.10).

CONCLUSIONS: The combination of underlying bone quality and paraspinal musculature CSA at the UIV appeared to influence failure mode among patients who underwent lumbosacral instrumented fusion terminating at the thoracolumbar junction.

PMID:40779797 | DOI:10.3171/2025.5.SPINE25303