Citations

Cancer-associated thrombosis (CAT) is a leading cause of morbidity and mortality in patients with malignancy, yet its imaging manifestations extend far beyond the conventional diagnosis of deep vein thrombosis and pulmonary embolism. This comprehensive review examines the full spectrum of CAT as encountered by radiologists, from routine venous thromboembolism to unusual-site thromboses, arterial thromboembolic events, catheter-related complications, and endovascular management strategies. Patients with cancer face a four- to seven-fold increased risk of venous thromboembolism compared with the general population, and arterial thromboembolism occurs at more than twice the expected rate, particularly within the first six months following cancer diagnosis. The radiologist’s role spans detection, characterization, and therapeutic guidance across multiple vascular territories. Key diagnostic challenges addressed include the distinction between bland and tumor thrombus—a determination with direct implications for TNM staging, surgical planning, and systemic therapy selection—and the recognition of incidental thromboembolism, which carries prognostic weight equivalent to symptomatic events and warrants similar clinical management. Emerging applications of diffusion-weighted MRI, contrast-enhanced ultrasound, and FDG-PET/CT provide a multiparametric toolkit for thrombus characterization, while artificial intelligence and machine learning show promise for improving patient selection and reducing unnecessary imaging. The expanding recognition of cancer-associated arterial disease, including cerebrovascular, coronary, and peripheral arterial events, requires that cardiovascular structures receive systematic attention on routine oncologic imaging. Interventional radiology contributes actively to CAT management through inferior vena cava filtration, catheter-directed thrombolysis, and thrombolytic-sparing mechanical thrombectomy, the latter being particularly relevant in oncology patients with elevated bleeding risk. Conclusions: Realizing the full potential of imaging in CAT requires not only technical proficiency with individual modalities but a synthesized, oncology-informed interpretive approach that incorporates the patient’s treatment history, biomarker status, and thrombotic risk profile at the time of image interpretation, positioning the radiologist as a central rather than peripheral figure in oncologic care.

Introduction Obesity and related cardiometabolic comorbidities, including hypertension, dyslipidaemia, diabetes, metabolic dysfunction-associated steatotic liver disease and atherosclerotic cardiovascular disease, are increasingly prevalent among individuals with inflammatory bowel disease (IBD). These conditions influence disease activity, therapeutic response, surgical outcomes and overall quality of life, yet evidence remains fragmented. The M odulate O besity and relate D metabolic compl I cations F or Y ielding improvements in IBD outcomes (MODIFY-IBD) initiative aims to synthesise evidence and generate consensus recommendations to guide practice and future research in this area. This study describes a protocol for a structured evidence synthesis and Research ANd Development/University of California, Los Angeles (RAND/UCLA) Appropriateness Method (RUAM) consensus process. Methods and analysis We will conduct three systematic reviews and a structured evidence synthesis organised into three domains: (1) the impact of obesity on IBD outcomes, (2) the burden of cardiometabolic complications in IBD and (3) the management of overweight, obesity and cardiometabolic comorbidities in IBD. A multidisciplinary international panel of gastroenterologists, surgeons, endocrinologists, hepatologists, cardiologists and dietitians will assess each statement using the RAND/UCLA appropriateness method. Panellists will rate the appropriateness of each statement (only those that fall within their area of expertise) on a 1–9 scale (1–3=inappropriate, 4–6=uncertain and 7–9=appropriate), with medians rounded up (eg, 6.5=appropriate). Agreement will be assessed using the RAND Disagreement Index (DI<1.0=agreement). Ethics and dissemination This study will not involve direct patient participation, as it is based on evidence synthesis and expert consensus; therefore, formal research ethics committee approval will not be required. Patient representatives will contribute to the consensus process to provide contextual perspectives but no identifiable data will be collected. Findings will be disseminated through publication in peer-reviewed journals, presentation at major gastroenterology and IBD conferences and communication with professional societies. A lay summary and patient-friendly infographic will also be developed to facilitate translation of recommendations into clinical practice. PROSPERO registration numbers CRD420251178843: a systematic review of the impact of obesity on inflammatory bowel disease outcomes. CRD420251178799: a systematic review of cardiometabolic complications in inflammatory bowel disease. CRD420251174653: management of overweight, obesity and cardiometabolic comorbidities in inflammatory bowel disease: a systematic review.

Introduction Geriatric distal femur fractures are associated with mortality rates exceeding 20%, comparable to hip fractures. Traditional single implant fixation often requires weight-bearing restrictions that delay recovery. This pilot study aims to assess the feasibility of conducting a multicentre randomised controlled trial comparing dual vs single implant fixation for geriatric distal femur fractures. Methods and analysis This multicentre, prospective, randomised controlled pilot trial will enrol 80 participants aged 60 years or older with displaced distal femur fractures at five US level 1 trauma centres. Patients will be randomly allocated 1:1 to receive either single implant (lateral plate or retrograde nail) or dual implant (nail-plate or dual plate) fixation. All patients will be permitted immediate weight-bearing. The primary outcome is feasibility assessed through enrolment rate (80 patients in 12 months), protocol adherence (≥90%) and follow-up retention (≥85% at 12 months). Secondary outcomes include post-surgical mobility (AM-PAC, TUG), patient-reported outcomes (PROMIS-PF, PROMIS-29), mortality (90-day and 1 year) and complication rates. Analyses will be on an intention-to-treat basis. Ethics and dissemination The protocol was approved by the University of Utah Institutional Review Board (IRB_00149119) and IRBs at all participating centres. Written informed consent will be obtained from participants or legally authorised representatives. Findings will be disseminated through peer-reviewed publications and conference presentations. Trial registration number NCT05292313 .

ABSTRACT Background/Objectives Prospective applicants for pediatric dermatology fellowships often use program websites as a source of information. This study evaluated the content of pediatric dermatology fellowship websites to identify potential areas of improvement including website accessibility and information found on websites. In addition, this study also surveyed current pediatric dermatology fellows and program directors (PDs) to determine priorities in website content across different stakeholders. Methods Using the Society for Pediatric Dermatology's (SPD) list of fellowship programs, two independent evaluators assessed the same 40 total programs, with 29 of the same websites included for analysis, against 27 criteria across four domains. In addition, an electronic survey was disseminated via the SPD's mailing list to current pediatric dermatology fellows and fellowship PDs. Results On average between both evaluators, of the 29 included fellowship websites, 9 educational criteria were included 47.8% of the time across the websites, compared to 46.0% of 10 recruitment criteria, 30.7% of 5 social criteria, and 31.6% of 3 other criteria. Fellows were significantly more likely than PDs to consider several website components as highly valuable. Conclusions These findings reveal variable and incomplete content across pediatric dermatology fellowship websites, as well as differing expectations for fellowship websites between pediatric dermatology fellowship applicants and PDs, which may help provide suggestions to optimize future website development to enhance applicant engagement.

Objectives: We evaluated agreement between human papillomavirus (HPV) tests performed on self-collected vaginal and clinician-collected cervical specimens to advance HPV self-collection as a cervical cancer screening option in our health care system. Methods: This diagnostic accuracy study was conducted at an academic medical center. Participants were 25–65 years old with upcoming colposcopy appointments. One cohort (n = 79) self-collected a vaginal specimen in the clinic immediately before a clinician-collected cervical specimen. The second cohort (n = 115) self-collected a vaginal specimen at home, mailed it in, and had a clinician-collected cervical specimen in the clinic. Paired specimens were evaluated for total (TPA), positive (PPA), and negative (NPA) percentage agreement. Extreme temperature stability studies were also conducted. Results: Compared with clinician-collected cervical specimens, in-clinic self-collected vaginal specimens showed a TPA, PPA, and NPA of 98%, 100%, and 97% for HPV16; 99%, 100%, and 99% for HPV18; 86%, 94%, and 79% for high-risk other (HRO) HPV. The TPA, PPA, and NPA for at-home self-collected vaginal specimens compared with clinician-collected cervical specimens were 94%, 79%, and 96% for HPV16; 95%, 43%, and 98% for HPV18; 89%, 80%, and 93% for HRO. Vaginal specimens showed prolonged stability and were unaffected by extreme temperatures. Conclusions: In general, in-clinic and at-home self-collected vaginal HPV specimens for HPV screening demonstrate high agreement with clinician-collected cervical specimens, with the exception of low PPA in the at-home self-collected vaginal HPV18 subgroup. Our findings support the use of HPV self-collection as a practical option to expand access to cervical cancer screening.

ABSTRACT Background Polypharmacy is common in autoimmune rheumatic diseases (ARDs) and increases adverse drug events (ADEs), but comparative evidence across diseases is limited. We aimed to quantify ADE burden and identify medications associated with ADE risk across six ARDs, and to examine shared and disease-specific patterns across diseases. Methods We conducted a retrospective cohort study at a tertiary medical center (2010–2024). Adults with ankylosing spondylitis (AS), psoriatic arthritis (PsA), rheumatoid arthritis (RA), Sjögren’s disease (SjD), systemic lupus erythematosus (SLE), or systemic sclerosis (SSc) were identified using diagnostic codes. ADEs were ascertained using validated case definitions. Medications were mapped to Anatomical Therapeutic Chemical classes; active exposure was defined within 30 days before the index date. Polypharmacy was defined as ≥5 concurrent medications (minor 5–10; major >10). Within each ARD, nested case–control analyses matched on encounter type (1:4) were performed, and adjusted odds ratios (aORs) were estimated using conditional logistic regression. Findings Among 10,578 patients, 3,154 (29.8%) experienced at least one ADE. ADE burden varied across diseases, with the highest prevalence observed in SSc (35.9%). Polypharmacy was common (57.3% minor, 39.4% major) and medication burden was consistently higher in ADE cases across encounter types (eg, SLE outpatient median 12 vs 6; inpatient 20 vs 10; emergency 17 vs 8). Across ARDs, the strongest associations with ADEs were observed for supportive and symptom-directed therapies (acid suppressors, pain adjuncts, and sedative-hypnotic/psychotropic medications), whereas conventional disease-modifying antirheumatic drugs (DMARDs) showed weaker associations. Disease-specific signatures included gastrointestinal agents in SSc (metoclopramide aOR 12.32), antibiotics and respiratory agents in AS (ciprofloxacin aOR 13.71, fluticasone aOR 8.88). Interpretation ADEs affect nearly one-third of ARD patients and increase with medication burden. Risk concentrates in supportive and symptom-directed therapies rather than DMARDs, with both shared and disease-specific patterns. Optimizing prescribing, particularly for pain management and corticosteroid use, can reduce medication-related harm.

Abstract The optimal management of diverticulitis in young and immunocompromised patients remains controversial, particularly regarding whether these groups warrant a lower threshold for surgery. Historically, young patients were often offered elective colectomy after the first episode of diverticulitis because of concerns regarding recurrence and more aggressive disease. However, contemporary evidence shows that although younger patients may experience higher recurrence rates, they are not at increased risk for complicated recurrence, emergency surgery, or mortality compared with older adults. Nonoperative management is successful in most cases, supporting an individualized rather than age-based surgical approach. Immunocompromised patients, including those with solid organ transplantation, malignancy, chemotherapy exposure, chronic steroid use, or autoimmune disease requiring immunosuppression, represent a higher-risk population. These patients more commonly present with complicated diverticulitis, perforation, sepsis, and atypical symptoms that may delay diagnosis. Although uncomplicated disease can often be managed nonoperatively, immunocompromised patients experience higher rates of emergent surgery, stoma creation, postoperative complications, and mortality, particularly when surgery is performed in a non-elective setting. Current evidence does not support lowering the surgical threshold solely on the basis of young age or immunosuppression status. Instead, management should remain individualized, incorporating disease severity, recurrence pattern, comorbidities, operative risk, and patient preferences. Further research is needed to better define optimal surgical timing and patient selection in these two populations.

Abstract Background Stroke is a time-sensitive neurological emergency in which early EMS activation and presentation to definitive care are cornerstones of effective therapy. Large language models (LLMs) are increasingly consulted by the public for medical advice, but the veracity of the guidance provided by commercially available models responding to potential stroke symptoms is not well understood. Methods We performed a cross-model benchmarking study comparing the triage choices of three frontier LLMs (Claude Sonnet 4.6, GPT-4o, and Llama 3.3-70b-versatile) on first-person vignettes describing a unilateral arm symptom on waking, across 10 symptom descriptors, and two clinical phases (before and after a partially reassuring self-examination), with or without a clinical distractor (n=50 per condition). Results Claude sought emergency care most often, Llama least, and GPT-4o in between, diverging most sharply in the post-examination phase where Claude called 911 in 100% of runs, Llama called for non-emergency help in 100%, and GPT-4o was symptom-dependent. A distractor shifted behavior away from emergency care in almost all conditions: calling 911 fell from 37.9% to 14.6% and waiting rose from 0% to 45.9% in the post-examination vignette. Responses were also sensitive to symptom word: weak, limp, heavy, and clumsy generated higher alarm, whereas numb, tingly, odd, strange, and weird generated less urgent responses. Conclusions The increasing use of LLMs for medical advice has significant public health implications. Commercially available LLMs show significant model-to-model variability and framing sensitivity when confronted with potential stroke symptoms, including under-recognition of canonical CDC warning descriptors, underscoring the need for systematic benchmarking as these tools become de facto first points of contact for patients experiencing neurological emergencies.

Objective: To evaluate magnetic resonance (MR) imaging artifact and image distortion associated with the Oticon Medical Sentio Ti bone conduction implant (BCI) and identify optimized imaging techniques. Study design: Cadaveric study. Intervention: One cadaveric head specimen was unilaterally implanted with Sentio Ti BCI according to the manufacturer's instructions. Main outcome measures: Imaging was performed with a Siemens 1.5 Tesla MR machine on XA60 software before and after implantation. Imaging was performed with both standard and metal mitigation techniques. Image scoring (diagnostic vs. nondiagnostic) and qualitative assessment of anatomic subsites were performed by 2 experienced neuroradiologists. Results: Image distortion and artifact were noted in all postimplant sequences. For all sequences, imaging of the ipsilateral middle ear, mastoid, and internal auditory canal (IAC) was nondiagnostic. The axial T1 turbo spin echo high bandwidth sequence had the best artifact reduction; however, the ipsilateral temporal bone remained nondiagnostic. Notably, nonecho planar diffusion-weighted imaging (non-EPI DWI) was nondiagnostic for both the ipsilateral temporal bone and the contralateral IAC and middle ear. Conclusions: After implantation of the Sentio Ti BCI, imaging of the ipsilateral temporal bone is rendered nondiagnostic on all MR sequences due to artifact despite the use of metal mitigation techniques. Importantly, the non-EPI DWI HASTE sequence, which is used for cholesteatoma surveillance, is nondiagnostic for all ipsilateral and most contralateral temporal bone subsites, making cholesteatoma surveillance challenging with an implant in place. This finding is critical for clinical decision-making, as rehabilitation of conductive hearing loss in the setting of chronic otitis media is among the most common indications for use of a BCI.