Citations

Objectives: Metastasis to the thyroid gland (MTT) is uncommon, and its presentation, diagnosis, and management remain incompletely characterized. We described a contemporary institutional cohort and examined detection, diagnostic evaluation, treatment, and survival after MTT diagnosis. Methods: We conducted a retrospective descriptive cohort study of patients with pathologically confirmed MTT who were evaluated at the Mayo Clinic in Rochester, Minnesota, from 2010 through 2025. Clinical, imaging, cytologic, pathologic, treatment, and outcome data were abstracted from the electronic health record. Survival was estimated using the Kaplan-Meier method. Results: Among 42 patients, the most common primary malignancies were kidney (40.5%) and lung (23.8%). MTT was detected incidentally on staging or surveillance imaging in 66.7% and was symptomatic in 23.8%. The median interval from primary cancer diagnosis to MTT was 3.67 years and was longer for kidney cancer (8.7 y) than lung cancer (0.94 y). Most lesions were unifocal (81.0%); common ultrasound features were solid composition (50.0%) and hypoechogenicity (47.6%), but findings were nonspecific. Among 23 patients evaluated with a single fine-needle aspiration (FNA) before diagnosis, metastasis was confirmed on the first procedure in 56.5% of cases. Eighteen patients underwent surgery. The median overall survival after MTT diagnosis was ∼1.75 years; outcomes differed by surgical status, although treatment selection and disease extent preclude causal interpretation. Conclusions: MTT should be considered in patients with a new thyroid lesion and a history of malignancy. Tissue diagnosis may require repeat FNA, core-needle biopsy, and immunohistochemistry. Management should be individualized based on symptoms, primary tumor biology, extent of systemic disease, and goals of care.

Introduction: Microtia is a complex congenital auricular deformity, with research spanning operative technique, epidemiology/genetics, biomaterials, and complications. Despite this breadth, there is limited work characterizing which studies have been most influential in shaping the field. This study aimed to identify and analyze the top 100 most-cited articles on microtia using a bibliometric approach. Methods: A comprehensive search using the Web of Science (WoS) was conducted to identify studies on microtia, and the top 100 articles were selected by citation count. Bibliometric data, study type (clinical, review, and basic science), clinical focus category, materials discussed, and sample sizes for clinical studies were extracted. Spearman correlation tests and Kruskal-Wallis tests were used to analyze citation patterns. Results: The top 100 microtia studies, published between 1957 and 2022, accumulated 12,692 total citations, with a mean of 127±84 citations per article, and were published across 49 journals. Clinical studies predominated (n=58), followed by reviews (n=28) and basic science studies (n=14). Publication year significantly differed by article type ( P =0.02), with basic science studies tending to be more recent. Newer publication year was associated with higher citations per year ( P <0.001) but fewer total citations overall ( P =0.002). Among clinical studies, technique-focused papers were most common (n=27) and were largely centered on autologous costal cartilage reconstruction (n=25). Clinical studies examining alternative materials were less represented but tended to be more recent publications. Conclusion: These findings suggest that the most-cited microtia literature has primarily included landmark clinical technique papers, but newer, rapidly cited work increasingly reflects emerging biomaterials and tissue engineering.

Abstract Context. Thyroid nodule ultrasound findings are crucial in guiding management decisions for patients with thyroid nodules. However, the frequency with which ultrasound images are discussed and reviewed with patients during clinical visits is not well understood. Objective. To assess how often thyroid ultrasound images are shown and discussed with patients during consultations, and to identify predictors of image review during clinical visits. Design and setting. Secondary analysis of a multicenter pilot randomized clinical trial conducted at two academic medical centers in the United States. Participants. Adults undergoing evaluation for thyroid nodules. Intervention. Participants were randomized to receive either usual care or care enhanced with a conversation aid. Main Outcome Measures. The primary outcome was the frequency of thyroid nodule imaging review evaluated as a binary outcome. Secondary outcomes included evaluation of predictors of image discussion. Results. Eighty-five patients were evaluated. Most participants were women (80%), mean age (60 years, SD 16), and White (86%), undergoing new patient visits (84%). Thyroid nodule ultrasound images were reviewed with patients in 53% of visits (45/85), and in all cases, clinicians initiated the imaging discussion. Predictors of image review included type of consultation (new patient visit) (OR 10.6, 95% CI: 1.79, 62.3). Age, sex, study arm, thyroid nodule size or cancer risk and plan of care (e.g., completing a biopsy) were not statistically associated with review of clinical images. Conclusions. Review of thyroid ultrasound images during clinical visits is relatively common, with consultation type serving as significant predictor.

Importance Thirty-day hospital readmission is used to guide postdischarge care; however, a single binary 30-day estimate does not distinguish when risk occurs from when intervention is most actionable, with implications for allocation of postdischarge resources. Objective To evaluate time-structured hospital readmission risk within 30 days after discharge and implications for clinical utility. Design, Setting, and Participants Retrospective prognostic study of adults with hospital discharges from 2017 to 2024 (from 19 hospitals within a US health system for the development cohort) and 2008 to 2019 (from Medical Information Mart for Intensive Care IV for the external cohort) with 30-day follow-up. Analyses were conducted from November 2025 through June 2026. Exposure Postdischarge prediction window, including landmark intervals of 0 to 7, 8 to 14, 15 to 21, and 22 to 30 days and cumulative horizons through days 7, 14, 21, and 30 after discharge. Main Outcomes and Measures First all-cause hospital readmission before death during each landmark interval and by each cumulative horizon. Risk estimates were derived using clinical information available at hospital discharge. Performance was assessed using discrimination, calibration, decision curves, and capacity-constrained analyses. Results Among 617 841 discharges in the development cohort, the median (IQR) patient age was 65 (50-76) years, and 315 220 discharges (51.0%) occurred among female patients. The 30-day readmission rate was 16.3% (95% CI, 16.2%-16.5%), with 68 797 readmissions (68.2%) occurring within 14 days. Cumulative-horizon analyses characterized readmission risk through days 7, 14, 21, and 30, whereas landmark interval-specific analyses showed lower positive predictive values (PPVs) beyond day 7. At 5% intervention capacity, landmark PPVs were 58.3% (95% CI, 57.4%-59.1%) for days 0 to 7, 16.0% (95% CI, 15.5%-16.6%) for days 8 to 14, 14.5% (95% CI, 13.9%-15.0%) for days 15 to 21, and 12.9% (95% CI, 12.4% to 13.5%) for days 22 to 30; numbers needed to prevent 1 readmission were 8.6, 31.3, 34.6, and 38.6, respectively. Conclusions and Relevance In this prognostic study of adult hospital discharges, hospital readmission risk varied over time and was not captured by a single binary 30-day estimate. These findings suggest that time-structured readmission modeling can characterize when readmission risk occurs, but additional work is needed before such models can reliably guide interventions during specific postdischarge intervals.

Background: Noninvasive tests are well validated in metabolic dysfunction–associated steatotic liver disease, but evidence in metabolic dysfunction and alcohol-associated liver disease (MetALD) and alcohol-associated liver disease (ALD) is limited. We evaluated noninvasive test–based clinical care pathways for fibrosis risk stratification in MetALD and ALD. Methods: This is a multinational, multicenter, cross-sectional study across 35 centers in 16 countries (2013–2025), including adults with MetALD or ALD. Fibrosis was assessed by liver biopsy and/or vibration-controlled transient elastography (VCTE). In biopsy-proven participants, we analyzed the sequential pathway (Fibrosis-4 [FIB-4] first, followed by VCTE for indeterminate FIB-4) to identify advanced fibrosis (≥F3). Diagnostic accuracy was assessed using the AUC. Results: Among 893 participants (41.3% MetALD and 58.7% ALD), the median age was 52 [43.0–61.0] years, and 79.4% were male. The estimated prevalence of advanced fibrosis was 45% (32.2% in MetALD and 54.0% in ALD). Participants with MetALD had a more dysmetabolic profile but lower fibrosis stages than ALD. Among biopsy-proven participants, FIB-4 AUC was 0.720, and VCTE AUC was 0.833. FIB-4 performed better in MetALD than ALD (AUC 0.773 vs. 0.540), while VCTE accuracy was similar across groups. In the sequential pathways, the false-negative rate for advanced fibrosis (misclassified as low risk) was 6.8% (4.9% MetALD and 11.3% ALD). Conclusions: In biopsy-proven patients, FIB-4 performance was acceptable in MetALD but substantially weaker in ALD. The standard 2-step pathway performed adequately in MetALD but missed a clinically meaningful proportion of advanced fibrosis in ALD.

BACKGROUND: Primary aldosteronism (PA) is a common and treatable cause of hypertension, yet data on the durability of medical treatment response beyond the first year are limited. Using the PA medical treatment outcomes framework, we evaluated long-term biochemical and clinical outcomes and factors associated with treatment response. METHODS: We conducted an international, multicenter, observational cohort study across 27 centers on 4 continents. Adults with PA treated with mineralocorticoid receptor antagonists and/or epithelial sodium channel blockers between 2016 and 2021 were included if follow-up data were available at ≥12 months. Biochemical and clinical responses were classified as complete, partial, or absent using PA medical treatment outcomes criteria. Ordinal logistic regression identified determinants of a favorable treatment response. RESULTS: The cohort included 1292 patients (47.5% women, mean age 52 years) with a median follow-up of 34 months (interquartile range, 21–51). At ≥12 months, 58.3% achieved a complete biochemical response, and 20.8% achieved a complete clinical response, with only 5% showing no response. Determinants of a favorable biochemical response included lower aldosterone and lateralization index, and higher renin and potassium levels at baseline. In those taking spironolactone, a higher daily dose was also associated with a favorable biochemical response. Determinants of a favorable clinical response included female sex, lower body mass index, shorter duration of hypertension, and absence of hypertension-mediated organ damage. CONCLUSIONS: Targeted medical therapy for PA can deliver sustained biochemical and clinical benefits. Early disease detection and adequate dose titration are highly actionable determinants of long-term treatment success.

Abstract Rationale Chronic bronchitis (CB), a common phenotype of chronic obstructive pulmonary disease (COPD), is characterized by pathologic mucus hypersecretion and is associated with substantial morbidity, impaired quality of life, and progressive functional decline, with prior studies demonstrating an average worsening of approximately one point/year on the COPD Assessment Test (CAT). Bronchial rheoplasty (BR) with RheOx® combines mechanical mucous plug disimpaction with pulsed electric field (PEF) energy to ablate and restore the airway mucosa. The RheSolve study was designed to provide evidence of safety and efficacy versus mechanical disimpaction alone. Primary endpoint results have been previously reported; final 2-year outcomes are reported here. Methods RheSolve was a prospective, randomized, double-blind study enrolling 273 patients with COPD and moderate-to-severe CB across 37 centers in the United States and Europe. Participants were randomized 2:1 to BR (n = 185) or a mechanical control procedure (n = 88). Following unblinding at 12 months, 75% of control patients crossed over to BR, precluding valid randomized comparisons beyond that time point; therefore, longer-term outcomes were evaluated using within-patient changes from baseline in the BR cohort. Outcomes included CAT, St George’s Respiratory Questionnaire (SGRQ), Cough and Sputum Assessment Questionnaire (CASA-Q), and pulmonary function tests (PFTs). Results Patients in the BR group represented a moderate to severe COPD CB phenotype at baseline (FEV1 60.9% predicted, emphysema (-950 HU) 11.0%, CAT 27.2 points, SGRQ 64.4) with most patients (93%) receiving a combination of ≥ 2 long-acting medications (LABA, LAMA, inhaled corticosteroids). The BR procedure was well-tolerated with no SAEs related to the device or procedure beyond 12 months. Both groups demonstrated clinically meaningful improvements in CAT, SGRQ, and CASA-Q at 12 months (P &lt; 0.001), which were sustained in the BR group through 24 months. Follow-up was limited to 1 year in the mechanical control group, with outcomes demonstrating a modest regression towards baseline at 12 months (Figure). PFTs were also stable to improved in the BR group (changes from baseline to 24 months: FEV1 % Predicted 0.9 (±10.8) P = 0.319, FVC % Predicted 2.8% (±14.0) P = 0.02, FEV1/FVC -0.5% (±7.2) P = 0.449). Conclusions BR with RheOx® (e.g.,mechanical mucous plug disimpaction and PEF delivery) demonstrated clinically meaningful symptom improvement that was sustained through 24 months supporting BR as a therapeutic option for patients with persistent symptoms despite appropriate medical therapy. This abstract is funded by: Galvanize Therapeutics

A structured approach for interpreting postoperative imaging of the anterolateral abdominal wall integrates anatomic knowledge with surgical techniques and their associated complication patterns.

Stroke is the second leading cause of death globally and a major contributor to lower-limb disability, affecting gait, balance, and functional independence in elderly populations. While robot-assisted rehabilitation has demonstrated effectiveness in motor recovery, access remains limited due to high costs and geographic barriers, particularly in Latin America. This study presents ExoKnee, a low-cost knee exoskeleton designed through biomimetic principles and 3D-printed fabrication as a proof-of-concept device targeting gait rehabilitation in elderly adults. The system integrates a single-degree-of-freedom pneumatic actuator controlled by electromyography (EMG) signals from the quadriceps muscle, enabling knee flexion and extension (90° to 180°). The design was evaluated through finite element analysis and dynamic simulations in MATLAB/Simulink R2024a under constant, stepwise, and sinusoidal reference inputs in a digital-twin environment. Expert validation using the Content Validity Coefficient yielded a mean score of 0.8747, reflecting preliminary expert agreement on the conceptual design’s coherence and relevance. The prototype demonstrated controlled movements through a 6-bar pneumatic system with EMG-triggered relay activation, validated at the proof-of-concept level through simulation and single-subject threshold calibration. ExoKnee addresses critical gaps by offering an anthropometrically informed, biosignal-driven, and locally manufacturable rehabilitation platform for low- and middle-income countries, pending clinical validation. Future work will focus on clinical trials and adaptive EMG control strategies.