Tag: pubmed

Eur Radiol. 2025 Jun 25. doi: 10.1007/s00330-025-11774-z. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the performance of the ultrasound hepatorenal index (US-HRI) for the diagnosis of hepatic steatosis in patients with type 2 diabetes and metabolic dysfunction-associated steatotic liver disease (MASLD), using MRI proton density fat fraction (MRI-PDFF) as reference.

MATERIALS AND METHODS: This two-center prospective study included 129 and 263 patients in the training and validation cohorts, respectively, between 2019 and 2022. Hepatic steatosis was classified according to MRI-PDFF as S0 (≤ 6.5%), S1 (6.5-16.5%), S2 (16.5-22%), and S3 (> 22%). Obuchowski measurement (OB) was performed to assess the diagnostic performance of US-HRI in the whole cohort. Optimal cut-offs of US-HRI for diagnosing ≥ S1 and ≥ S2 were identified in the training cohort by maximizing the Youden index and were applied in the validation cohort.

RESULTS: Overall, 392 patients were included (mean age, 59 years ± 9.5; 235 men). The OB (four class problem S0 to S3) was 0.79 ± 0.01. Pairwise accuracy was good for S0 vs S1, S2 or S3 (0.78 to 0.89) but decreased for distinguishing among higher grades (0.54 to 0.62). Optimal US-HRI threshold for diagnosing ≥ S1 was 1.16, with a sensitivity of 82.7% (95% CI: 77.4-87.3), specificity of 80.0% (95% CI: 56.3-94.3), and AUC of 0.81 (95% CI: 0.76-0.86). The threshold for diagnosing ≥ S2 was 1.47, with a sensitivity of 49.0% (95% CI: 39.1-59.0), specificity of 73.0% (95% CI: 65.3-79.7), and AUC of 0.61 (95% CI: 0.55-0.67).

CONCLUSION: US-HRI was a reliable tool for diagnosing steatosis in type 2 diabetic patients with MASLD. However, its performance in assessing more severe grades of steatosis was inadequate.

KEY POINTS: Question Ultrasound hepatorenal index (US-HRI) performance for the diagnosis of steatosis in type 2 diabetic patients with metabolic dysfunction-associated steatotic liver disease (MASLD) is not well defined. Findings US-HRI demonstrated good diagnostic performance for steatosis (S0 vs S1-S3), but this decreased for diagnosing S2-S3. Clinical relevance US-HRI provides a quantitative approach for detecting hepatic steatosis in patients with MASLD and type 2 diabetes, but has shown limited effectiveness in grading higher grades.

PMID:40560415 | DOI:10.1007/s00330-025-11774-z

Eur Radiol. 2025 Jun 25. doi: 10.1007/s00330-025-11772-1. Online ahead of print.

ABSTRACT

OBJECTIVES: Rejection is the leading cause of graft failure, and its diagnosis remains a challenge. Elastography and dynamic contrast-enhanced ultrasound (DCE-US) are novel non-invasive techniques for quantifying tissue elasticity and perfusion. Their role in pancreas graft rejection has not yet been defined.

MATERIALS AND METHODS: From October 16 to January 20, all pancreas transplantations performed at our institution were prospectively studied with elastography and DCE-US at 1 week, 3 weeks, and 12 months post-transplantation. Surveillance biopsies were performed at 3 weeks and 12 months. Elastography and DCE-US were also conducted in all requested biopsies during this period (regardless of the date of transplantation). Patients were categorized according to the biopsy result: normal/rejection. Grafts with other complications were excluded. Cut-off values were established.

RESULTS: One hundred twenty-one elastography and 127 DCE-US in 56 patients were included. All parameters showed a high dispersion during the first 90 days post-transplantation. After this period, the rejection group presented higher stiffness (0.97 vs 1.46 m/s, p < 0.001) and lower perfusion. The optimal cut-off value for elastography was 1.27 m/s (AUC 0.80), and for DCE-US were: peak enhancement 601 a.u. (AUC 0.67), wash-in AUC 2748 a.u. (AUC 0.70), wash-in rate 118 a.u. (AUC 0.65), wash-in perfusion index 369 a.u. (AUC 0.67), wash-out AUC 5181 a.u. (AUC 0.69) and total AUC 6388 a.u. (AUC 0.68). A combined predictive score showed that alteration of elastography and DCE-US was associated with a 23.2-fold probability of rejection.

CONCLUSION: After the first 90 days post-transplantation, pancreas graft rejection is associated with higher stiffness and lower graft perfusion.

KEY POINTS: Question Pancreas graft rejection remains a clinical challenge, as there are currently no reliable non-invasive tests for its diagnosis. Findings After the first 90 days post-transplantation, elastography and DCE-US show higher stiffness and lower pancreas graft perfusion in the presence of rejection. Clinical relevance These non-invasive tools, which can be easily integrated into daily routine practice, may be useful in identifying grafts at higher risk of rejection, allowing closer follow-up or early biopsy to establish early rejection treatment, improving graft and patient survival.

PMID:40560414 | DOI:10.1007/s00330-025-11772-1

Eur Radiol. 2025 Jun 25. doi: 10.1007/s00330-025-11775-y. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate LI-RADS major and ancillary features for MRI-based diagnosis of pediatric malignant liver tumors.

MATERIALS AND METHODS: This single-center retrospective study enrolled pediatric patients who underwent contrast-enhanced liver MRI for focal liver lesions from January 2010-February 2023. Three readers independently performed imaging analysis based on LI-RADS v2018. The reference standard was a pathological diagnosis or stability/regression for over one year on follow-up. Estimation of diagnostic accuracy and multivariable logistic regression were conducted to identify LI-RADS features associated with malignant hepatocellular tumors and hepatic malignancy in general.

RESULTS: Of the 102 patients (median age [interquartile range], 4.5 [0.6-14.0] years; boys:girls, 54:48), 58.8% (60/102) had malignant liver tumors and 49.0% (50/102) had malignant hepatocellular tumors. The sensitivity and specificity of major features for diagnosis of malignant hepatocellular tumors were as follows: nonrim arterial enhancement, 73.4% and 39.6%; enhancing capsule, 56.7% and 92.0%; nonperipheral washout, 70.1% and 94.2%. Nonperipheral washout (sensitivity, 70.1%; specificity, 94.2%; adjusted OR, 34.5; p < 0.001), restricted diffusion (sensitivity, 97.9%; specificity, 53.8%; adjusted OR, 72.3; p = 0.001), and fat-in-mass (sensitivity, 29.0%; specificity, 93.0%; adjusted OR, 4.3; p = 0.01) were associated with malignant hepatocellular tumors, while nonperipheral washout (sensitivity, 58.7%; specificity, 94.5%; adjusted OR, 12.5; p < 0.001), restricted diffusion (sensitivity, 97.1%; specificity, 65.8%; adjusted OR, 31.1; p < 0.001), and mosaic architecture (sensitivity, 79.5%; specificity, 90.0%; adjusted OR, 20.4; p < 0.001) were associated with hepatic malignancy in general.

CONCLUSION: Restricted diffusion was a sensitive MRI LI-RADS feature, while nonperipheral washout and mosaic architecture were specific features for diagnosing pediatric malignant liver tumors.

KEY POINTS: Questions MRI is the recommended modality for pediatric focal liver lesions, but only a few studies have examined the diagnostic accuracy of MRI LI-RADS features in children. Findings Restricted diffusion was sensitive for malignant liver tumors, while mosaic architectures were specific for malignant liver tumors. Nonperipheral washout was specific for diagnosing malignant hepatocellular tumors. Clinical relevance Nonperipheral washout, restricted diffusion, and mosaic architecture were reliable MRI LI-RADS features for diagnosing pediatric malignant liver tumors.

PMID:40560413 | DOI:10.1007/s00330-025-11775-y

Evid Policy. 2023 Jun 12;20(2):184-204. doi: 10.1332/174426421X16843219978173.

ABSTRACT

BACKGROUND: Primary care professions practicing traditional medicine systems, such as naturopathy, may have an increased need to use critical thinking to integrated diverse knowledge sources in response to the complex ‘messiness’ of clinical practice. The degree to which the varied knowledge types used by naturopathic practitioners align with evidence-based practice principles remains unexplored.

AIMS AND OBJECTIVES: To investigate naturopathic practitioners’ behaviours, perceptions and attitudes towards their use of knowledge and information sources.

METHODS: An online cross-sectional survey study administered in five languages to the international naturopathic profession. Descriptive statistics were prepared using Stata 16.1.

FINDINGS: Survey respondents (n=453) represented all world regions. The most common type of knowledge used to inform clinical practice was developed through clinical experience (86.2%) or during initial clinical training (81.2%). The most used information sources were scientific journals (80.4%), conferences or other professional events (78.2%), modern naturopathic clinical textbooks (74.6%), laboratory, pathology or radiology tests (74.0%), or professional journals for clinicians (73.5%). The greatest trust in knowledge acquired from information sources was attributed to information from laboratory, pathology or radiology tests. The greatest importance was placed on information based on the patient’s perspective of living with their health condition.

DISCUSSION AND CONCLUSIONS: Naturopathic practitioners do not appear to have a strong level of trust for any particular information source, despite variations in trust between sources. Further, their philosophies and principles may promote the importance naturopathic practitioners place on non-research information sources such as patient experience and add further complexity to clinical decision-making processes for naturopathic practitioners.

PMID:40557648 | DOI:10.1332/174426421X16843219978173

Int J Epidemiol. 2025 Jun 11;54(4):dyaf096. doi: 10.1093/ije/dyaf096.

NO ABSTRACT

PMID:40557612 | DOI:10.1093/ije/dyaf096

Ann Behav Med. 2025 Jan 4;59(1):kaaf050. doi: 10.1093/abm/kaaf050.

ABSTRACT

BACKGROUND: Emerging statistical methods addressing the multilevel compositional nature of sleep architecture can offer insights into how daily time reallocations between sleep stages (total wake time in bed [TWT], light sleep [Non rapid eye movement stage 1 and 2], slow wave sleep [SWS], and rapid eye movement [REM] sleep) are associated with post-sleep affect.

PURPOSE: This study investigated the daily, prospective association between sleep architecture and affect.

METHODS: In 96 healthy, young adults across 15 consecutive days, sleep architecture was measured at night using electroencephalography (Z-Machine Insight+) and affect was self-reported using the PANAS-X at awakening. Bayesian multilevel compositional data analysis examined how reallocating time between sleep stages was associated with affect.

RESULTS: Various reallocations of sleep stages predicted affect, at both within- and between-person levels. Between-person reallocation of 30 min/night from light or REM sleep to SWS was associated with ≥0.38 points higher high and low arousal positive affect, and from SWS to any other sleep stages was associated with ≥0.21 points higher high arousal negative affect. Within-person reallocation of 30 min/night from REM to any other stages predicted ≥0.05 points higher high arousal negative affect, and 30 min/night from TWT to SWS or REM predicted ≤-0.07 lower low arousal negative affect.

CONCLUSIONS: Findings highlight the distinct constellations of sleep architecture associated with affect in everyday life. Extension of SWS and REM for improving affect, while considering other off-set sleep stages, should be confirmed in experimental research in daily settings, to inform diagnostic and intervention strategies for sleep and affective disorders.

PMID:40557584 | DOI:10.1093/abm/kaaf050

Pharm Stat. 2025 Jul-Aug;24(4):e70021. doi: 10.1002/pst.70021.

ABSTRACT

Covariate-adjusted estimators of average treatment effects in clinical trials are typically more efficient than unadjusted estimators. Recent guidance from the FDA is highly detailed regarding the appropriate use of covariate adjustment for point estimation. Less direction is provided, however, on how to estimate the variance of such estimators. In this paper, we demonstrate that a precise description of the estimand is necessary to avoid ambiguity when comparing variance estimators for average treatment effects involving binary endpoints. When considering the suitability of a proposed estimand, together with a corresponding variance estimator, it is important to consider that the patients enrolled in clinical trials are typically a convenience sample. Since there is no unique way to map this process into formal statistical assumptions, it follows that a range of estimands, and therefore a range of variance estimators, may be acceptable. We aim to highlight through simulation results how the properties of proposed variance estimators differ, as well as the underlying reasons.

PMID:40557557 | DOI:10.1002/pst.70021

Int J Surg. 2025 Jun 25. doi: 10.1097/JS9.0000000000002673. Online ahead of print.

ABSTRACT

BACKGROUND: The 2015 American Thyroid Association guidelines recommend total thyroidectomy (TT) followed by radioactive iodine (RAI) therapy as the primary treatment modality for intermediate-risk papillary thyroid carcinoma (PTC) patients with lateral lymph node metastasis (LLNM). However, the supporting evidence remains insufficient. The clinical superiority of TT versus lobectomy (LT) in this patient population remains unclear, and the optimal surgical approach for intermediate-risk PTC with LLNM continues to be debated.

AIM: This meta-analysis examined the clinical superiority of TT versus LT for intermediate-risk PTC with unilateral LLNM.

METHODS: This PRISMA/AMSTAR-compliant meta-analysis (PROSPERO: CRDXXX) evaluated recurrence-free survival (RFS) in intermediate-risk PTC with unilateral LLNM. Systematic searches of PubMed, Web of Science, and Cochrane Library (2004-2024) combined MeSH terms and title/abstract: (“papillary thyroid carcinoma” OR “papillary thyroid cancer” OR “PTC”) AND (“lateral cervical lymph node metastasis” OR “lateral neck lymph node metastasis” OR “lateral lymph node metastasis” OR “lateral cervical nodal metastasis” OR “N1b”) AND (“thyroidectomy” OR “total thyroidectomy” OR “lobectomy”). Two investigators independently extracted data on surgical outcomes, adjuvant RAI therapy, and RFS metrics, with quality assessed via Newcastle-Ottawa Scale. Prespecified subgroup analyses examined RAI utilization and surgical extent impacts. Pooled hazard ratios (HR) with 95% confidence intervals (CI) were calculated using Review Manager 5.3, prioritizing adjusted HR. Heterogeneity was assessed via I2 statistics.

RESULTS: Among 609 initially identified references, 8 studies met the inclusion and exclusion criteria, comprising 2,462 intermediate-risk PTC patients with unilateral LLNM. Of these, 53.3% (1,313/2,462) underwent TT, and 46.7% (1,149/2,462) underwent LT. Compared with the TT group, LT showed no statistically significant difference on RFS (HR = 1.08, 95% CI 0.83-1.40, p = 0.56). In subgroup analyses: Compared with TT + RAI, LT showed no significant difference in RFS (HR = 0.66, 95% CI 0.40-1.08, p = 0.10); Compared with TT + RAI, LT or TT alone showed no significant difference in RFS (HR = 0.65, 95% CI 0.41-1.03, p = 0.07); Compared with TT alone, LT showed no significant difference in RFS (HR = 1.16, 95% CI 0.63-2.12, p = 0.64); Compared with TT + RAI, TT alone showed no significant difference in RFS (HR = 0.87, 95% CI 0.42-1.81, p = 0.37).

CONCLUSION: For intermediate-risk PTC patients with isolated unilateral LLNM, TT and LT demonstrate comparable oncological outcomes in terms of RFS. Unilateral LLNM alone should not constitute an absolute indication for TT. When no additional high-risk features are present, LT may serve as a preferable alternative to optimize quality of life while maintaining oncological safety.

PMID:40557546 | DOI:10.1097/JS9.0000000000002673

Eur J Emerg Med. 2025 Aug 1;32(4):278-287. doi: 10.1097/MEJ.0000000000001229. Epub 2025 Jun 24.

ABSTRACT

BACKGROUND: Undiagnosed HIV-infected patients are mainly responsible for viral transmission in Western countries. Emergency departments (EDs) could represent a strategic point in healthcare systems to uncover HIV infection.

OBJECTIVE: This study aimed to analyze the time trends of HIV testing in EDs in Barcelona (Spain) and investigate if EDs have changed HIV screening patterns after the implementation of a targeted opt-in strategy for HIV testing.

DESIGN: This is a quasiexperimental (pre/post) study.

SETTING AND PARTICIPANTS: Monthly HIV tests performed by Microbiology Departments of four hospitals in Barcelona were recorded over 78 months, classified as ordered by ED or at other healthcare levels. Monthly ED attendances were compiled, along with new HIV diagnoses.

INTERVENTION: Implementation of an opt-in strategy to test every ED patient with targeted conditions (community-acquired pneumonia, herpes zoster, mononucleosis syndrome, chemsex, postexposure prophylaxis, sexually transmitted diseases) in addition to other classical reasons for HIV testing.

OUTCOME MEASURES AND ANALYSIS: Determination of trends over time in HIV screening and new diagnoses in EDs during the 60-month preintervention and 18-month postimplementation periods, and estimation of the impact of intervention using interrupted time series analyses.

MAIN RESULTS: A total of 659 885 HIV tests were performed, with 11 442 (1.7%) being ordered by EDs (0.29% of ED comers were tested), and 287 new HIV diagnoses made (positivity rate: 2.8%). During the preintervention period, HIV testing increased over time (overall and in EDs), new HIV diagnoses in EDs remained stable, and the rate of positive HIV tests decreased. The intervention increased the monthly average of HIV tests ordered in the ED by 106 (95% CI = 86-125), proportion of ED comers screened by 0.075% (95% CI = 0.032-0.118), and proportion of HIV tests made in Barcelona performed by EDs by 0.728% (95% CI = 0.424-1.032), but had no impact on new HIV diagnoses and rate of positive HIV tests in the EDs.

CONCLUSION: In the last years, HIV screening in Barcelona increased, with EDs having a significant and increasing role in the overall HIV testing in Barcelona. The implementation of a targeted opt-in strategy for HIV screening in EDs increased the number of HIV tests performed, but not the number of HIV diagnoses made in EDs.

PMID:40557507 | DOI:10.1097/MEJ.0000000000001229

Pest Manag Sci. 2025 Jun 25. doi: 10.1002/ps.70017. Online ahead of print.

ABSTRACT

BACKGROUND: Plant Protection Products (PPPs) consist not solely of active ingredients. Some of the other ingredients of the finished formulations are intended to enhance the efficacy of the main active ingredient. The PPPs’ effects impact honeybees that pollinate crops by exposing them to a complex of numerous chemical compounds. Depending on their composition, PPPs affect these insects in various ways. The present study estimated the effect of sublethal doses of insecticide (Active Ingredient (AI): indoxacarb) and commercial adjuvant (AI: alkylbenzene sulphonic acid sodium salt) applied individually and as a combination of these two formulations, on thermal preference and CO₂ emission rate of bees, and expression of the genes CYP9Q1, CYP9Q2, and CYP9Q3 involved in detoxification processes of these insects.

RESULTS: Aqueous solutions of adjuvant and a mixture of both formulations statistically significantly altered honeybee thermal preferences (a decrease in the selected ambient temperature by 1.4 and 0.9°C, respectively). CO₂ emissions levels also changed (a drop of 1.7% for the insecticide-treated group, 10% for those treated with adjuvant and 15.4% for those treated with both formulations applied together). The levels of the transcripts of the genes CYP9Q1, CYP9Q2, and CYP9Q3 were significantly elevated only in the head of the honeybee, but not in its abdomen.

CONCLUSION: Our results indicate that ready-made PPP formulations, their adjuvants, and their mixtures determine the physiological status of honeybees, although the direction of changes might vary depending on the analyzed parameter. © 2025 Society of Chemical Industry.

PMID:40557483 | DOI:10.1002/ps.70017