Citations

Artificial intelligence (AI)-based object detection in radiology can assist in clinical diagnosis and treatment planning. This article examines the AI-based object detection models currently used in many imaging modalities, including X-ray Magnetic Resonance Imaging (MRI), Computed Tomography (CT), and Ultrasound (US). The key models from the convolutional neural network (CNN) as well as the contemporary transformer and hybrid models are analyzed based on their ability to detect pathological features, such as tumors, lesions, and tissue abnormalities. In addition, this review offers a closer look at the strengths and weaknesses of these models in terms of accuracy, robustness, and speed in real clinical settings. The common issues related to these models, including limited data, annotation quality, and interpretability of AI decisions, are discussed in detail. Moreover, the need for strong applicable models across different populations and imaging modalities are addressed. The importance of privacy and ethics in general data use as well as safety and regulations for healthcare data are emphasized. The future potential of these models lies in their accessibility in low resource settings, usability in shared learning spaces while maintaining privacy, and improvement in diagnostic accuracy through multimodal learning. This review also highlights the importance of interdisciplinary collaboration among artificial intelligence researchers, radiologists, and policymakers. Such cooperation is essential to address current challenges and to fully realize the potential of AI-based object detection in radiology.

Over the past decade, stress echocardiography has evolved from a test for assessing epicardial artery stenosis to a comprehensive functional test, targeting multiple cardiovascular parameters. The new approach includes several structured steps: (a) evaluating regional wall motion abnormalities to detect epicardial artery stenosis or vasospasm; (b) assessing pulmonary congestion and diastolic function via B-lines with lung ultrasound; (c) gauging preload and contractile reserve with volumetric echocardiography; (d) measuring coronary microvascular reserve using Doppler-based coronary flow velocity in the middistal left anterior descending artery; and (e) determining cardiac sympathetic reserve by tracking heart rate reserve on an ECG. This evolution was supported extensively by the Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI), which played a key role in five areas: (1) developing the initial, curiosity-driven project; (2) disseminating protocols and results at national and international conferences, supporting logistic infrastructure and publication expenses; (3) establishing a digital platform (customized Redcap) for data entry and storage; (4) facilitating patient recruitment across 19 Italian centers; and (5) offering formal endorsement through six presidencies, adding credibility and reach beyond any single institution. The protocol quickly advanced from concept to high-impact publications, earning inclusion in 2024 specialty guidelines. Initially Italian-led, the study now includes 50 centers across 20 countries (e.g. USA and China). Beyond the 50 peer-reviewed papers published in 2016–2024, this study offers a novel, sustainable approach to cardiac stress testing, providing more information at lower costs, with zero radiation and minimal environmental impact. SIECVI’s endorsement was instrumental in amplifying the study’s rigor and outreach.

AimsPrevious studies have highlighted differences in the risk of periprosthetic fractures (PPFs) in patients undergoing total hip arthroplasty with either a cemented taper slip (TS) stem or a composite beam (CB) stem. This biomechanical study explored the occurrence of PPF around these stems, and the protective effect of adding a 16-gauge prophylactic calcar or diaphyseal wire to the TS stems to increase the resistance to torque as a potential way to prevent these fractures.MethodsA total of 21 TS stems (eight alone, six with calcar wiring, and seven with diaphyseal wiring placed 2 cm distal to the lesser trochanter) and seven CB stems were cemented into standard sawbones. The peak torque at failure was measured using a servohydraulic test machine, and the fracture location was recorded. An a priori power analysis determined that seven specimens per group were needed to detect a 30 Nm difference with 90% power, assuming a 14.8 Nm SD in peak torque between groups. Comparisons were performed using paired t-tests.ResultsCB stems exhibited a significantly higher mean peak torque at failure (205.3 Nm (SD 26.9)) than TS stems (159.5 Nm (SD 17.4); p = 0.012), calcar-wired TS (148.2 Nm (SD 38.6); p = 0.031), and diaphyseal-wired TS (164.9 Nm (SD 21.5); p = 0.027). This study did not demonstrate that wired-TS stems had a higher peak torque at failure than non-wired TS stems. Additionally, calcar wiring was not found to be stronger than diaphyseal wiring (p = 0.400). Four CB fractures occurred distal to the stem, whereas all TS fractures occurred at the mid-stem, simulating a Vancouver type B fracture. Interestingly, adding the diaphyseal wire shifted the fracture location more distally in four of the seven stems (p = 0.070).ConclusionIn this model, CB stems had greater resistance to torque than TS stems, which may explain the lower risk of PPF. Adding calcar or diaphyseal wires to the TS stems resulted in no significant change in peak torque to fracture. CB cemented stems should be considered in patients at high risk of PPF.Cite this article: Bone Joint J 2025;107-B(5 Supple A):32–37.

Abstract Firework injuries remain a significant public health concern, with an estimated 9700 injuries reported in 2023. This study examines trends in pediatric facial injuries from fireworks over the past decade using the National Electronic Injury Surveillance System. Pediatric cases from 2014 to 2023 were identified using the fireworks consumer code (1313) and filtered for facial injuries (body part code 76). Data was analyzed using chi-square tests to assess significance and logistic regression to evaluate trends. An estimated 4625 pediatric facial injuries from fireworks presented to emergency departments nationwide from 2014 to 2023. Among cases (n = 177), 68.4% were male and 31.6% were female. Thermal burns (60.5%), lacerations (15.3%), and contusions/abrasions (11.9%) were the most common injuries. Males were more likely to be injured than females (P-value: < .001). Overall, 17.5% of injuries required hospitalization or transfer. Older children were significantly more likely to sustain injuries requiring hospitalization (Odds Ratio [OR]: 1.13, 95% CI, 1.04-1.23, P = .005). Younger children had higher odds of sparkler-related injuries, although the risk rapidly decreased with age (OR: 0.76, 95% CI, 0.68-0.86, P < .001). Our results show fireworks continue to cause significant pediatric facial injuries, with thermal burns being the most common diagnosis, and nearly one in 5 facial injuries from fireworks requiring hospitalization. Efforts to reduce facial injuries from fireworks should focus on minimizing the risk of injury in younger children while ensuring safety protocols are in place to address more significant injuries in older children.

Abstract This study explores parallels between systemic hypoxia adaptation in high-altitude populations and tumorigenesis. We identified EPAS1, a gene critical for hypoxia adaptation in populations such as Tibetans and Sherpas, as playing a similar adaptive role in tumors arising under hypoxic conditions. Tumors from patients with chronic hypoxia displayed impaired DNA repair and frequent emergence of EPAS1 variants, with frequencies reaching up to 90%, echoing the positive selection seen in high-altitude dwellers. Mechanistically, EPAS1 gain-of-function mutations promote COX4I2 expression, reducing cellular oxygen consumption and supporting tumor proliferation in hypoxia. Analysis of clinical data from patients with hypoxia revealed tissue-specific and time-sensitive tumorigenic effects, particularly impacting oxygen-sensitive cells in the postnatal period. Our findings suggest that EPAS1-driven adaptation mechanisms in high-altitude populations provide a model for understanding tumor evolution under hypoxic stress, highlighting how genetic adaptations to diverse stressors in natural populations may yield insights into tumorigenesis and cancer progression. Significance: This study reveals a broad convergence in genetic adaptation to hypoxia between natural populations and tumors, suggesting that insights from natural populations could enhance our understanding of cancer biology and identify novel therapeutic targets. See related commentary by Lee, p. 875

Objectives/Goals: Undergraduate Medical Education (UME) may apply Just-in-Time training (JITT) to provide medical students with learning experiences closely aligned with real-time clinical needs. The purpose of this scoping review is to offer an overview of the implementation of JITT training in UME. Methods/Study Population: Following the five-stage framework by Arksey and O’Malley to methodically collect and analyze studies on JITT in UME, five electronic databases were searched, and a supplemental search for grey literature was conducted. Studies exploring the integration of JITT principles into UME clinical training and their time to follow-up after training were included. Bloom’s Taxonomy was used to assess educational goals of JITT interventions. Results/Anticipated Results: The review yielded 21 studies across 4 countries. The majority were cohort studies (13) and randomized control trials (5). Assessment definitions and use of JITT varied widely. Most studies focused on short-term outcomes, defined by being measured immediately after JITT session (15) or at the end of JITT-based rotation or clerkship (3). Three studies evaluated outcomes at a period longer than 2 weeks after completion of session or clerkship. Attitudes (9), followed by skills (8) were the most common educational goals of intervention. The efficacy and utility of JITT in improving educational goal acquisition was demonstrated in 90% (17/19) of the studies with reported outcomes. Discussion/Significance of Impact: The introduction of JITT in UME has been shown to meet the immediate needs of healthcare environments; however, evidence is limited in the evaluation of longer-term outcomes. Further research to determine the impact of JITT on long-term learning retention and education goal acquisition in UME is merited.

In this review, we discuss the risks and adverse effects reported for the current Food and Drug Association (FDA)-approved biologics used in the management of asthma, including omalizumab, benralizumab, dupilumab, mepolizumab, reslizumab, and tezepelumab. Our review focuses on the risk of hypersensitivity reactions, infection, and malignancy. Where relevant, we have included information regarding the risk of cardiovascular disease and eosinophilia, and we have included specific information regarding vaccine use among patients receiving the above biologics. We also review currently available data regarding the use of biologics in the context of pregnancy. Our goal is to provide a comprehensive resource for providers utilizing these agents, so that they may adequately counsel patients about the risks of therapy and identify adverse events if they occur.

ABSTRACT Background: Neutrophil extracellular traps (NETs), and its formation and release, known as NETosis, may play a role in the initiation of thrombin generation (TG) in trauma. The objective of this study was to assess whether trauma patients, who develop symptomatic venous thromboembolism (VTE), have increased levels of plasma citrullinated histone H3 (CitH3) and accelerated TG kinetics. Methods: Patients presenting to a level I trauma center as trauma activations had samples collected within 12 h of time of injury, alongside healthy volunteers (HV). CitH3 was measured by enzyme-linked immunosorbent assay, and TG data were measured using a TG analyzer, comparing results between patients developing symptomatic VTE versus those who did not, within 90 days of injury. Data were expressed as median and quartiles (Q1, Q3), and tested using Wilcoxon rank-sum or Fisher’s exact test, or 1-sample test of Spearman’s correlation, P < 0.05 considered significant. Results: 39 trauma patient samples were analyzed (10 with and 29 without VTE), and compared to 15 HV samples. CitH3 levels in patients who developed VTE were significantly greater as compared to those who did not (12.8 ng/mL [7.1, 30.8]; 3.0 ng/mL [1.8,6.8], P = 0.024), with levels in both groups greater compared to HV (1.2 [0.3, 4.1], P = 0.003, P = 0.012), respectively. TG profiles were accelerated in patients developing VTE, with differences in peak height (337.6 nM [304.4, 356.0]; 231.8 nM [180.2, 281.8], P = 0.008), endogenous thrombin potential (1718.5 nM*min [1,500, 1794]; 1208.5 nM*min [1,072, 1,417], P = 0.003) and velocity index (213.2 nM/min [162.3, 260.5]; 124.3 nM/min [93.2, 223.1], P = 0.03), respectively. Conclusion: Trauma patients developing VTE exhibit increased NETosis, measured by increased CitH3 levels and accelerated TG early after injury, outlining an area for further understanding VTE after trauma.

Giant cell arteritis (GCA) is a relapsing large vessel vasculitis with risk of serious ischemic manifestations, including vision loss and vascular damage in the form of large artery stenosis, aneurysms, and dissections. Approximately 50% of patients treated with glucocorticoid (GC) monotherapy and 30% of patients receiving adjunctive therapy with tocilizumab experience disease relapses, often during the first 2 years after diagnosis. Although most relapses in GCA do not involve life‐ or organ‐threatening presentations and can be controlled successfully, frequent relapses may lead to increased prescription of GC and consequent treatment‐related morbidity, in addition to risk of further vascular damage. Emerging data suggest that persistent disease activity may lead to increased vascular morbidity. Additionally, although tocilizumab decreases the frequency of relapses, more than 50% of patients relapse after discontinuation of therapy. Therefore, although interleukin‐6 blockade suppresses disease activity, it does not restore tolerance. In this article, we discuss the practical diagnosis and management of GCA relapses from an expert perspective. Current treatment options for GCA relapses, including those recommended by international guidelines, and novel potential therapies are reviewed.