Publications by Year: 2026

OBJECTIVES: This study aimed to evaluate the association of iodine nutritional status with TNs, and papillary thyroid carcinoma (PTC) in women attending an outpatient clinic at a university hospital in an iodine-sufficient region of Brazil. Additionally, the urinary iodine status was evaluated in patients with PTC and BRAF mutation.

METHODS: Cross-sectional study including 133 women who underwent thyroid ultrasound and urinary iodine concentration (UIC) measurement. The diagnosis of PTC was confirmed by histopathology, and the BRAF V600E mutation was assessed through immunohistochemistry in patients with classical PTC.

RESULTS: A UIC > 300 µg/L was an independent risk factor for the presence of TNs (odds ratio [OR] 3.42, 95 % confidence interval [CI] 1.10-10.66 p = 0.033) and for the occurrence of PTC (OR 3.90, 95 % CI 1.00-15.42, p = 0.05). The BRAF V600E mutation was present in 50 % of the analyzed PTCs, with frequencies of 33.3 %, 50.0 %, and 75.0 % among participants with insufficient, adequate, and more than adequate iodine levels, respectively. The median UIC was higher in patients with the follicular subtype of PTC compared with those with the classical subtype (318.1 µg/L vs. 207.1 µg/L, respectively; p = 0.048). A high frequency of UIC values ≥ 300 µg/L also was found in patients with the follicular subtype of PTC (83.3 %).

CONCLUSION: In an iodine-sufficient area, UIC values ≥ 300 µg/L suggested an association with the presence of TNs and PTC. A high frequency of iodine excessive status was observed in patients with follicular subtype. However, none of the patients with presence of the BRAFV 600E mutation presented excessive iodine status.

OBJECTIVES: Patient-centered communication together with evidence-based practice is seen as the underlying pillars of shared decision making (SDM). However, the application of patient-centered communication in physiotherapy practice has not yet been studied from an observer-based point of view. The purpose was to determine to what extent physiotherapists use patient-centered communication in the first physiotherapy consultations of people with shoulder problems, and to what extent patient-centered communication is related to the level of SDM.

METHODS: In this secondary analysis, 100 audio-recorded initial physiotherapy consultations with people with shoulder problems, obtained through convenience sampling, were analyzed for the level of patient-centered communication using the Four Habit Coding Scheme (4HCS) (0-100, higher 4HCS scores indicate higher level of patient-centered communication). The relation between the level of patient-centered communication and the SDM was analysed in multiple steps.

RESULTS: A total of 100 initial physical therapy consultations of 41 participating physical therapists were included. The mean 4HCS score was 45(range 18-90). The correlation between the 4HCS and the OPTION-5 scores was 0.610(CI95 % 0.470 - 0.720). The four categories in the relation between patient-centered communication and SDM show that the most consultations are in the group of low patient-centered communication and low SDM and that there are only two consultations in the low patient-centered communication and high SDM.

CONCLUSION: Our results show that there is room for improvement in the application of patient-centered communication in physiotherapy practice although physiotherapists do apply patient-centered communication more than SDM. Patient-centered communication does not guarantee the application of SDM, although a higher level of SDM does indicate a higher degree of patient-centered communication. Practice implications This study offers clinical guidance on how to improve the integration of patient's perspective, values, and preferences in the decision making.

BACKGROUND: Lung cancer remains the leading cause of cancer-related death worldwide. Low-dose computed tomography (LDCT) is the current gold standard for screening, but radiation exposure remains a concern. Cone-Beam Computed Tomography (CBCT) offers ultra-low-dose acquisition but has not yet been tested for thoracic screening.

PURPOSE: To evaluate the feasibility of using a latest-generation CBCT system for thoracic imaging in a lung cancer screening context.

MATERIALS AND METHODS: 88 patients, current or former smokers, were retrospectively included. They underwent thoracic CBCT (7 G Dual Energy system, NewTom, Italy) between July 2024 and April 2025 at a preventive health center, with either a standard-dose protocol (n = 48) or a low-dose protocol (n = 40). Two board-certified radiologists independently assessed pulmonary findings and image quality. Radiation doses were compared. Statistical analysis included mixed-effects models and interobserver agreement.

RESULTS: The radiation exposure was significantly lower in the low-dose group, with a median cumulative DLP of 42.8 mGy·cm, compared to 107.7 mGy·cm, representing a 2.5-fold reduction in radiation (p<0.001). Nodule detection occurred in 41% of patients overall. Overall image quality was rated good/excellent in 85% (low-dose) vs 83% (standard-dose); Risk Difference (RD) = +2% [IC95% -12; +16], Risk Ratio (RR) = 1.03. Diagnostic confidence was high in 82% vs 83%; RD = -1% [-14; +12], RR = 0.99. Spatial resolution was slightly lower in the low-dose group (OR = 0.51, p = 0.04). Interobserver agreement for nodule detection was substantial across both groups (κ = 0.73-0.83).

CONCLUSION: Low-dose CBCT offers substantial radiation dose reduction without compromising diagnostic confidence or interobserver reliability. CBCT may represent a promising, cost-effective alternative or complement to low-dose CT in preventive lung imaging programs, but prospective studies comparing CBCT to LDCT are warranted.

OBJECTIVE: The objective of this video is to describe a case of disseminated peritoneal leiomyomatosis (DPL) mimicking deeply infiltrating endometriosis and discuss the preoperative workup, intraoperative approach, and postoperative considerations. We also illustrate key surgical techniques to optimize safe and complete resection, including use of indocyanine green (ICG) for ureteral identification and strategic use of retractors for improved visualization and mobilization of lesions.

SETTING: Tertiary care, academic center with expertise in complex gynecologic surgery.

PARTICIPANTS: A 48-year-old patient with a remote history of laparoscopic hysterectomy for uterine fibroids that required morcellation, although it was unknown if this was performed in a contained fashion. She presented with chronic cyclical pelvic pain, urinary urgency, and tenesmus. She was started on progestin therapy for presumed endometriosis, with incomplete symptom relief.

INTERVENTION: Pelvic MRI revealed nodular thickening of bilateral round ligament remnants, a spiculated fibrotic lesion with hemorrhagic foci involving the right ovary and terminal ileum, and a lobulated mass abutting the bladder and vaginal cuff. Laparoscopic surgical excision was planned during which leiomyomatous lesions noted at the umbilicus, vaginal cuff, bladder, and round ligament remnants. Cystoscopy-guided ureteral instillation of ICG was used to aid ureteral identification, and rectal and vaginal retractors were used to delineate anatomy.

CONCLUSION: DPL is an uncommon and often misdiagnosed condition that may mimic deep endometriosis. Recognition of its iatrogenic association highlights the importance of contained morcellation during gynecologic surgery. Preoperative imaging and intraoperative identification of critical structures, such as the ureters, bladder and rectal borders, enable safe, complete excision with low risk of recurrence.

INTRODUCTION: Reducing meat intake could improve planetary and human health, but high sodium in commercially prepared meat-free foods may undermine some health benefits of reducing meat intake. This study characterized trends in sodium content of meat-based versus meat-free foods in large chain U.S. restaurants and examined mean sodium differences and portions of items qualifying for a high-in-sodium warning label.

METHODS: Data came from MenuStat.org, a longitudinal database of menu items from U.S. restaurants collected annually from 2013 to 2021. The analytic sample included 24,147 items from 75 restaurants. Linear regression for panel data assessed trends in mean per-item sodium overall and by meat category (meat based/meat free), adjusted for restaurant type, menu category, children's item, and energy. Postestimation margins estimated mean sodium. Analyses were conducted in 2025.

RESULTS: From 2013 to 2021, mean sodium content was high, with no significant changes among meat-based or meat-free items. Meat-free items accounted for 22.1% of items and had lower mean sodium than meat-based items (-301 mg; 95% CI= -365, -238), consistent over time, across restaurant types and nearly all menu categories. Across all years, 13.4%-17.2% meat-based and 3.7%-5.9% of meat-free items would qualify for a high-in-sodium warning label by exceeding 100% of the sodium Daily Value.

CONCLUSIONS: Across 75 large chain restaurants, the sodium content of menu items did not change from 2013 to 2021. Meat-free items were lower in mean sodium than meat-based items but were still high in sodium. Efforts to shift toward plant-forward diets should be paired with stronger sodium reduction policies.

INTRODUCTION: Bronchodilator responsiveness (BDR) is associated with progression to COPD. Genetic risk for COPD, summarized by polygenic risk scores (PRS), predicts low lung function and COPD. However, it remains unclear whether genetic predisposition to COPD is related to BDR and whether PRS and BDR together influence lung function decline in individuals at risk for the disease.

METHODS: We analyzed data from COPDGene participants with a smoking history and normal spirometry at study enrollment. We cross-sectionally examined the association of a PRS with 2005-BDR-FEV1 % (change relative to pre-bronchodilator) and 2021-BDR-FEV1 % (change relative to predicted). We also examined the association of PRS, 2005-BDR-FEV1 %, and 2021-BDR-FEV1 % with progression to COPD and longitudinal FEV1 decline between enrollment and follow-up adjusted for demographics, smoking history, and FEV1 at enrollment.

RESULTS: PRS did not correlate with 2005-BDR-FEV1 % in 1446 African Americans (AA) but PRS correlates with BDR in both unadjusted (rho = 0.01, P < 0.001) and adjusted analysis in 3378 non-Hispanic Whites (NHW). NHW participants with BDR had higher PRS than those without. Models including 2005-BDR-FEV1 % demonstrated better accuracy than those including PRS (Area under the curve: 0.762 vs 0.743 in NHW; 0.693 vs 0.653 in AA). BDR models also outperformed PRS models for longitudinal FEV1 decline. Mediation analysis showed that about one third of the PRS effect on FEV1 decline in NHW was explained through BDR.

CONCLUSIONS: BDR is more strongly associated with progression to COPD and FEV1 decline than PRS, and part of the PRS effect is mediated through BDR.

PURPOSE: We investigated whether transamniotic fetal mRNA vaccination could be a viable strategy for perinatal immunization against Zika virus (ZIKV) infection in a rodent model.

METHODS: Twenty pregnant Sprague Dawley dams underwent volume-matched intra-amniotic injections in all their fetuses (n = 280) of either a suspension of a custom-made mRNA encoding for the ZIKV pre-membrane (ZIVK-prM) and envelope (ZIKV-E) structural proteins encapsulated in a semi-synthetic composite lipopolyplex (vaccinated, n = 153), or of the same lipopolyplex without mRNA (control, n = 127) on gestational day 17-18 (E17-18; term = E21-22). Pup serum levels of ZIKV-E antigen-specific IgG antibodies were measured by ELISA at term up to 3 months of age. Splenocyte and lymph node cell suspensions were incubated either with or without ZIKVE challenge, followed by flow cytometry to assess T-cell response.

RESULTS: When controlled by mRNA-free injections, ZIKV-E-specific IgG was not detected in the serum of term fetuses; however, levels were significantly elevated in vaccinated pups from postnatal day 5-16 (p = 0.005-0.002). Splenocytes from vaccinated pups showed significant increases in IL-6 and IFN- γ productions after the antigen-specific challenge at 2 and 3 months (p = 0.049 to 0.003 vs. nonchallenged cells), along with a significant decrease in IL-13 production at 3 months (p = 0.006). Lymph node cells also demonstrated increased production of IFN-γ (p < 0.001 vs. non-challenged cells), along with a significant decrease in IL-13 production, both at 3 months (p = 0.014).

CONCLUSIONS: Transamniotic fetal mRNA vaccination with a Zika virus antigen can induce adaptive humoral and cellular immune responses extending into the neonatal period in a healthy rat model.

LEVEL OF EVIDENCE: N/A (animal and laboratory study).

TYPE OF STUDY: Animal and laboratory study.

OBJECTIVE: Compromises to the integrity of articular cartilage, whether genetic, post-traumatic or age-related, lead to debilitating chronic degenerative diseases including osteoarthritis. In this study, our objective was to leverage multiomic and spatial transcriptomic datasets to identify gene regulatory networks that drive human articular cartilage cell fate, and build a foundation from which novel therapeutics to overcome degenerative disease could be developed.

DESIGN: We jointly profiled the transcriptome and open chromatin regions in individual nuclei recovered from distal femora at 2 fetal timepoints and performed high-definition spatial transcriptomics at an additional timepoint. We established a human pluripotent stem cell platform to interrogate the function of computationally predicted transcription factors during human chondrocyte differentiation.

RESULTS: We computationally predicted gene regulatory networks governing chondrocyte subsets comprising the human distal femur during development. Following functional analysis of two transcription factors predicted to function in the superficial zone, CREB5 and NFATC2, using our in vitro experimental platform, we found both have the potential to reprogram growth plate cartilage and induce features of articular cartilage. We further identified new biological roles for CREB5 related to ECM organization and taxis.

CONCLUSIONS: We expect new regulatory networks we uncovered to be important for promoting cartilage health and treating disease, and our platform to be a useful tool for studying cartilage development and homeostasis in vitro. The ability to reprogram chondrocytes toward an articular-like fate has significant therapeutic potential to treat degenerative joint diseases.

AIM: This study aimed to evaluate the CT and MRI features of ovarian mucinous tumors associated with mature teratomas.

MATERIALS AND METHODS: The present study enrolled a total of 34 patients with histopathologically proven ovarian mucinous tumors associated with mature teratomas, including collision tumors composed of mucinous tumors and mature teratomas and mucinous tumors arising from mature teratomas. All patients underwent preoperative pelvic CT and/or MRI. Imaging findings were retrospectively reviewed.

RESULTS: Histopathological diagnosis of mucinous tumors included mucinous cystadenoma in 22 patients, mucinous borderline tumor (MBT) in 10 patients, and mucinous carcinoma in two patients. The mean maximum tumor diameter was 168 mm (range, 39-314 mm). All tumors were unilateral, well-defined, predominantly cystic, and multilocular. A total of 14 tumors (41 %) had fewer than 10 loculi, while 12 tumors (35 %) had 30 or more. Fatty components were observed in 30 tumors (88 %), and 20 of 30 tumors (67 %) had multiple fatty components. On MRI, stained glass appearance was observed in 20 of 29 tumors (69 %). On CT, nodular calcifications within fatty components were observed in 12 of 21 tumors (57 %), whereas flattened calcifications within the septa of non-fatty components were observed in 7 of 21 tumors (33 %). Pseudomyxoma peritonei (PMP) was observed in three patients (9 %) with MBT.

CONCLUSIONS: Ovarian mucinous tumors associated with mature teratomas typically presented as large, multilocular cystic lesions with fatty components and teratoma/mucinous tumor-associated calcifications. Although PMP was uncommon, it was rarely observed in patients with MBT.

PURPOSE: Biochemical recurrence (BCR) following radical prostatectomy (RP) remains a significant concern in prostate cancer (PCa) management, as it is associated with an increased risk of metastasis and disease progression. While conventional clinical and pathological prognostic factors are helpful in determining the prognosis, their accuracy remains suboptimal. Radiomics has been shown to be a promising tool for improving risk stratification and outcome prediction in PCa patients post-RP. This systematic review and meta-analysis aims to evaluate the prognostic value of radiomics-based models in predicting BCR after RP.

METHODS: This study was conducted following PRISMA guidelines. A comprehensive literature search was performed across PubMed, Scopus, Web of Science, and Embase up to April 2025. Eligible studies included original research articles that evaluated radiomics models for predicting BCR in PCa patients post-RP. Data extraction and quality assessment were conducted independently by two reviewers using the METhodological RadiomICs Score (METRICS).

RESULTS: A total of 16 studies encompassing 3,634 patients met the inclusion criteria. The pooled sensitivity and specificity for radiomics-based models in predicting BCR in the validation subgroup were 0.82 (95% CI: 0.74-0.88) and 0.80 (95% CI: 0.67-0.88), respectively. The overall hazard ratio (HR) for BCR prediction in the radiomics models was 4.61 (95% CI: 3.06-6.96). Subgroup analyses indicated that models integrating radiomics with clinical variables outperformed those relying solely on imaging-derived features.

CONCLUSION: Radiomics-based models show strong potential in predicting BCR after RP, with potential clinical utility in personalizing patient management. Moving forward, future research should focus on integrating radiomics with other omics data to develop more informative models.