Publications

BACKGROUND/OBJECTIVE: Following a verbal command marks the bedside transition from unresponsiveness to overt recovery of consciousness after acute brain injury. Its timing across phenotypes, stability once present, and dependence on sedation are uncharacterized at scale.

METHODS: Retrospective cohort of adults with acute brain injury, first intensive care unit stay, in the Medical Information Mart for Intensive Care IV (MIMIC-IV). Command-following was the Glasgow Coma Scale motor response "Obeys Commands." Among patients not following commands at admission, cumulative incidence was estimated with death or hospice and discharge without recovery as competing events. Instability was quantified as transient first recovery and threshold crossings; examinations were tagged for concurrent sedation. Principal findings were externally validated in the multicenter eICU Collaborative Research Database.

RESULTS: Of 13,900 brain-injured patients with three or more motor examinations, 5498 (39.6%) were not following commands at admission. The cumulative incidence of first command-following was 43.5% by 24 h and 65.0% by 14 days, ranging at 14 days from 36.9% in anoxic injury to 77.2% in ischemic stroke (anoxic versus ischemic stroke at 72 h, difference 0.41; adjusted P = .002). Among 3573 patients who recovered, the first recovery was transient in 22.2%, and 62.4% crossed the threshold repeatedly. Nonfollowing was strongly associated with sedation, consistent with an arousal-dependent examination. In eICU, the 14-day incidence was 64.8%, and transient first recovery was 22.7%, closely matching the primary cohort.

CONCLUSIONS: After acute brain injury, overt bedside command-following returns early but unsteadily, with phenotype-dependent timing, threshold fluctuation, and strong dependence on sedation. A single charted observation is an unreliable index of the underlying state.

We tested state-of-the-art LLMs under clinical-scale workloads using two designs: a single agent handling all tasks and a multi-agent orchestrator assigning each task to a dedicated worker. Across retrieval, extraction, and dosing tasks, batch sizes ranged from 5-80. Multi-agent accuracy remained high (90.6% at 5 tasks; 65.3% at 80), while single-agent accuracy collapsed (73.1% to 16.6%; p < 0.01). Multi-agent runs used up to 65-fold fewer tokens and limited latency growth. These findings show that lightweight orchestration preserves accuracy and efficiency under mixed-task clinical loads.

INTRODUCTION: Next generation of Theranostics studies are looking at novel combinations with radiation sensitizers to enhance PRRT's efficacy. Here, we present safety and efficacy data from a multi-center phase 1 study of a [¹⁷⁷Lu]lutetium-dotatate -triapine combination in patients with GEP-NETs.

METHODS: The study consisted of two phases (dose escalation and expansion) administering the recommended phase 2 doses (RP2D) for the two agents. All patients received 200 mCi of [¹⁷⁷Lu]lutetium-dotatate on day 1 of four 8-week cycles, in combination with oral triapine administered at assigned dose levels (100 mg, 150 mg or 200mg) from days 1 to 14 of each cycle.

RESULTS: A total of 31 (A: 15 ; B: 16 ) patients received treatment. Nine patients experienced dose-limiting toxicities; Grade 3 anemia (n=1), Grade 5 cardiac arrest (n=1), and Grade 4 neutropenia (n=7). Based on the overall safety and pharmacokinetics data, a [¹⁷⁷Lu]lutetium-dotatate (200 mCi) plus triapine (150 mg) dose was selected as the RP2D for the expansion phase. Grade ≥3 treatment related adverse events were observed in 77% patients: anemia (23%), nausea and vomiting (3% ), lymphopenia ( 58%), neutropenia ( 35%) and leukopenia ( 39%). The majority of cytopenias were transient and resolved within two weeks. Among the 28 evaluable patients, the objective response rate (ORR) was 21.4% and the median progression-free survival (mPFS) has not been reached (median follow-up period: 23.7 months).

CONCLUSIONS: The combination of [¹⁷⁷Lu]lutetium-dotatate (200 mCi) and oral triapine (150 mg D1-14) was well tolerated and demonstrated preliminary activity in patients with well-differentiated GEP-NETs. (NCT04234568).

PURPOSE: Bone metastases (BM) occur in approximately 30% of patients with metastatic renal cell carcinoma (mRCC) and are associated with poor survival and symptomatic skeletal events (SSEs). Radium-223, an alpha-emitting bone-seeking radioisotope, and cabozantinib, a tyrosine kinase inhibitor, have demonstrated activity in BM. RADICAL (Alliance A031801; ClinicalTrials.gov identifier: NCT04071223) evaluated cabozantinib ± radium-223 in mRCC with BM.

METHODS: This phase II trial enrolled patients with mRCC of any histology with ≥1 BM. Patients were randomly assigned 1:1 to cabozantinib ± radium-223, stratified by osteoclast-targeted therapy (OTT), prior therapy, opioid use, and International mRCC Database Consortium (IMDC) risk. The primary end point was SSE-free survival (SSE-FS). Secondary end points included safety, objective response rate (ORR), progression-free survival, and overall survival (OS). A target of 124 evaluable patients was planned, with a prespecified interim futility analysis at 50% of expected SSE-FS events; the trial would stop if the stratified hazard ratio (sHR) > 1.0.

RESULTS: The prespecified interim futility analysis was conducted after 90 patients were enrolled and crossed the futility boundary, leading to closure at 98 patients. The final analysis included all 98 patients. Median age was 63 years, 82.7% had clear cell histology, and 79.6% were using an OTT. IMDC risk was favorable (18.4%), intermediate (67.3%), and poor (14.3%). Median follow-up was 13.1 months. Median SSE-FS for cabozantinib with radium-223 versus cabozantinib was 16.7 versus 17.6 months (sHR, 1.46 [90% CI, 0.86 to 2.51]). Median OS was 28.3 versus 19.7 months (sHR, 1.40 [95% CI, 0.70 to 2.79]). ORR was 19.4% versus 25.0% (P = .78). Grade ≥3 adverse events were similar across arms (69.6% v 75.5%).

CONCLUSION: Radium-223 did not improve SSE-FS when added to cabozantinib. The combination demonstrated a manageable safety profile.

Denture stomatitis is a highly prevalent oral mucosal infection caused by Candida biofilm formation on the denture surface. In this study, an antifungal polymethyl methacrylate (PMMA) denture nanocomposite (MCZ-P-AgNPs/PMMA) was prepared by incorporating miconazole-loaded pectin-stabilized silver nanoparticles (MCZ-P-AgNPs) into the PMMA matrix. Response surface methodology was used to finalize the synthesis of AgNPs via the pectin-mediated green reduction method. To address the poor aqueous solubility of miconazole, the β-cyclodextrin inclusion complexation strategy was employed. MCZ-P-AgNPs exhibited potent antifungal activity with an MIC80 of 40 μg/mL and an MFC of 80 μg/mL for Candida albicans (CA) and Candida glabrata (CG). Biofilm inhibition and eradication assays demonstrated a BIC80 of 40 μg/mL for CA and 20-40 μg/mL for CG, along with a BEC80 of 80 μg/mL for both species. Mechanistic investigations revealed ergosterol depletion, oxidative and nitrosative stress induction, and disruption of extracellular matrix components. Subsequently, MCZ-P-AgNPs were incorporated into PMMA (0.53 wt%) using conventional heat polymerization, developing MCZ-P-AgNPs/PMMA. Physicochemical characterization by ATR-FTIR, Vickers microhardness, and SEM-EDX analyses confirmed polymerization and successful nanoparticle integration. The nanocomposites exhibited low water sorption (8.6% after 60 days) and a high water contact angle (104.45 ± 0.49°), which indicated a hydrophobic surface maintaining material integrity. In vitro release profile demonstrated sustained miconazole release. ICP-MS analysis confirmed minimal silver-ion release from the nanocomposites. Antifungal evaluation showed reduced fungal adhesion and metabolic activity on the nanocomposite surface, confirmed by XTT assay, CFU enumeration, and crystal violet staining. Additionally, in vitro cytotoxicity assay on the HEK293 cell line and the seed germination study on Brassica rapa established biosafety and ecological compatibility of MCZ-P-AgNPs. Collectively, MCZ-P-AgNPs/PMMA nanocomposite offers a promising approach in transforming conventional PMMA into an inherently antifungal denture material against denture stomatitis.

Epilepsy has been attributed to be a most common universal brain neurological disorder afflicting more than 50 million people globally. Neural network is known to be hyperexcitable and hypersynchronous which ultimately result in seizures. Bibliographic databases for peer reviewed journals were searched for key words like epilepsy, seizures, neurological disorders, gut microbiota brain axis, antiepileptic phytomedicines and diagnostic tools. Current review brings forth the putative mechanism to understand the etiological and other vital factors during epileptic seizures and further advancements in the management of the epilepsy along with the role of gut microbiota and herbal medicines in the management of epilepsy. Modern strategies adopted for epilepsy diagnosis and therapeutic treatment methods would certainly pave a way for the neuroscientists to formulate a strategy for comprehensive assessment of epilepsy patients and finding a sustainable cure for the disease through basic and translational research.

PURPOSE: Vision-language models (VLMs) are increasingly proposed for radiologic decision support, yet the security implications of deploying optical character recognition (OCR)-capable models in diagnostic workflows remain poorly characterized. When image-embedded text is not treated as untrusted input, the visual channel becomes vulnerable to adversarial manipulation.

APPROACH: Ten VLMs, none validated for clinical diagnosis, were evaluated on 600 brain magnetic resonance imaging studies for binary tumor detection under 5 conditions: clean input, visible radiology report injection, human-imperceptible stealth OCR injection, and multi-stage immune-prompt defense. A total of 27,000 inference calls were analyzed.

RESULTS: At baseline, performance was heterogeneous, with a median accuracy of 0.69, a sensitivity of 0.79, and a specificity of 0.59. Visible injection caused universal specificity collapse to 0.00 across all models with a false-positive rate (FPR) of 1.00 and a median attack success rate (ASR) of 0.97. Stealth injection, despite being imperceptible to human reviewers, drove substantial degradation with a median accuracy of 0.43, an ASR of 0.57, and an FPR of 0.84. Immune prompting achieved only partial mitigation: under stealth injection, median ASR decreased to 0.44, and accuracy improved to 0.56, yet residual overcalling persisted with a median FPR of 0.67, and three models maintained an FPR of 1.00.

CONCLUSIONS: Commercial VLMs exhibit a deployment-critical failure mode in radiology-like scenarios: OCR-readable text embedded in images can override pixel-level evidence, even under stealth conditions that evade human inspection. Prompt-level defenses provide insufficient protection. Any clinical integration of VLMs must be governed by system-level safeguards, including OCR-aware input handling, provenance controls, and enforced human verification, before deployment in safety-sensitive environments.

OBJECTIVE: To assess variability in parental leave and lactation policies affecting breast radiologists and examine their associations with job satisfaction and burnout.

METHODS: An anonymous 43-question survey was distributed to U.S.-based physician members of the Society of Breast Imaging between December 2023 and February 2024. Questions assessed parental leave and lactation policies, workplace experiences, and validated items on job satisfaction and burnout. Descriptive statistics, chi-square tests, and multivariable linear regression were performed.

RESULTS: 262 respondents (8.0% [262/3275] response rate) completed the survey. The mean age was 47 ± 10.4 years, with an average of 14.6 ± 10 years of post-training experience; 86% (223/262) identified as women. Among respondents, 61% (160/262) were aware of their workplace's parental leave policy, which included a median of 6 weeks of paid leave (IQR 10). Forty percent (88/220) were unsure if a lactation policy existed, 57% (125/220) reported no dedicated lactation time, and 72% (147/220) were unaware of a designated lactation space. Most respondents (87% [191/219]) said these policies were not discussed during job interviews, though 59% (128/216) considered them important when choosing a job. One-third (72/262) had welcomed a child within the last five years. Among these, 39% (27/69) reported insufficient lactation support, and 26% (18/69) stopped breastfeeding earlier than desired due to work constraints. Lactation support was inversely correlated with burnout (r = -0.516, P < 0.001) and positively correlated with job satisfaction (r = 0.440, P < 0.001).

CONCLUSION: Improved transparency and institutional investment in parental leave and lactation policies by radiology practices may support well-being and retention of breast radiologists.

Pulmonary embolism (PE), defined as blockage of the pulmonary arteries, is a common and serious condition that requires accurate diagnosis and standardized reporting. Noninvasive imaging is well established for the diagnosis and management of PE and is incorporated into multiple societal guidelines. However, specific technical recommendations for the optimal interpretation and standardized reporting of CT and MR angiography remain absent. Diagnostic imaging is used to identify the presence or absence of PE and to risk-stratify patients. Evolving treatment options can be considered once an acute clot is identified, the patient's status is defined, and the patient is referred for appropriate treatment in a timely manner. Patient management for PE often involves multiple care teams, and clear and consistent communication between care teams is critical to patient care. The goal of the Pulmonary Embolism Reporting and Data System (PE-RADS) is twofold: (a) to create a standard lexicon for the description of terms used for acute PE diagnosis at CT and MR angiography and (b) to develop a structured, hierarchical reporting system that incorporates anatomic and accessory findings to classify clot location and right heart imaging features in acute PE and to assist in determining the cardiovascular status of the patient to inform next-step management. © 2026 RSNA and the American College of Chest Physicians published by Elsevier Inc. Supplemental material is available for this article. This article is a simultaneous joint publication in Radiology and CHEST. The articles are identical except for stylistic changes in keeping with each journal's style. Either version may be used in citing this article.

Pulmonary embolism (PE), defined as blockage of the pulmonary arteries, is a common and serious condition that requires accurate diagnosis and standardized reporting. Noninvasive imaging is well established for the diagnosis and management of PE and is incorporated into multiple societal guidelines. However, specific technical recommendations for the optimal interpretation and standardized reporting of CT and MR angiography remain absent. Diagnostic imaging is used to identify the presence or absence of PE and to risk-stratify patients. Evolving treatment options can be considered once an acute clot is identified, the patient's status is defined, and the patient is referred for appropriate treatment in a timely manner. Patient management for PE often involves multiple care teams, and clear and consistent communication between care teams is critical to patient care. The goal of the Pulmonary Embolism Reporting and Data System (PE-RADS) is twofold: (a) to create a standard lexicon for the description of terms used for acute PE diagnosis at CT and MR angiography and (b) to develop a structured, hierarchical reporting system that incorporates anatomic and accessory findings to classify clot location and right heart imaging features in acute PE and to assist in determining the cardiovascular status of the patient to inform next-step management.