The thymus is one of the primary immune organs in childhood. During embryonic development, the migration of the thymus from the cervical region to the mediastinum coincides with the formation of other structures in the anterior cervical region, which can result in anomalous thymic locations. Among these, the most frequent are cervical remnants of accessory thymic tissue along the normal migration path and thymic extensions that project beyond their usual location. Ectopic locations, which deviate from the normal embryological course, are less common. Radiologists must recognize these variants and their imaging manifestations to avoid misdiagnosis and incorrect interventions. This article aims to review and illustrate, using imaging, the embryology, normal development, anatomy, and the most common locations of thymic tissue outside its normal position in the anterior mediastinum in children.
IntroductionUltrasound evaluation of thyroid nodules shows significant interobserver variability, contributing to the overutilization of fine-needle aspiration biopsy (FNA). Standardized systems such as TI-RADS aim to reduce this variability; however, their performance in real-world clinical practice remains heterogeneous. Artificial intelligence (AI) has emerged as a potential tool to support clinical decision-making in this setting.ObjectiveTo evaluate the clinical performance of an artificial intelligence model for recommending FNA in thyroid nodules and to compare it with ACR TI-RADS and Horvath TI-RADS classifications applied by specialists.Materials and methodsA retrospective cross-sectional study evaluating the clinical performance of an artificial intelligence model for FNA recommendation was conducted in adult patients who underwent thyroid ultrasound and FNA between January and December 2021. FNA recommendations generated by an AI model were compared with those issued by an expert radiologist and an expert endocrinologist using ACR TI-RADS and Horvath TI-RADS systems. The reference standard was cytology according to the Bethesda System, considering Bethesda ≥ III as a positive result, as an operational definition aligned with clinical decision-making for further diagnostic evaluation. Diagnostic performance metrics and concordance were calculated.ResultsA total of 101 patients were included (89.1% women), with a median age of 61 years and a median nodule size of 2.3 cm (IQR: 1.6–3.3). The AI model showed a sensitivity of 0.88 and a specificity of 0.41. Horvath TI-RADS, applied by an expert radiologist, demonstrated a sensitivity of 0.82 and a specificity of 0.69. Concordance between AI and TI-RADS–based methods were moderate.ConclusionIn a real-world clinical setting, the AI model demonstrated performance comparable to that of human specialists for recommending FNA in thyroid nodules. These findings support its potential role as a complementary decision-support tool, particularly in settings with variability in ultrasound interpretation.
BackgroundThe remarkable advances achieved in Parkinson's disease (PD) research across clinical science, genetics, molecular and cellular mechanisms, disease modeling, pathophysiology, biomarkers, and therapeutics reflect not only scientific innovation but also the evolution of collaborative research. The field has transitioned from single-investigator observations and isolated institutional efforts to regional networks and global consortia that now drive many of the most important PD discoveries.ObjectiveTo review the evolution of collaborative research approaches in PD, examine barriers and challenges to global research synergy, and discuss potential solutions to promote equitable and impactful international collaboration.State of the Art and Future DirectionsKey challenges to global PD research include funding inequities, regulatory and data-sharing complexities, difficulties in standardization and generalizability, language barriers, limited interdisciplinary communication, unequal resource allocation, insufficient training opportunities, regional mistrust, and the need to address diverse cultural contexts. Successful international initiatives have demonstrated the value of shared databases, harmonized protocols, cross-border funding mechanisms, and synergistic multidisciplinary, multicultural, and multinational partnerships. Future efforts should be grounded in trust, transparency, ethical reciprocity, equitable governance, and meaningful stakeholder engagement, while prioritizing capacity building, workforce development, and sustainable training opportunities.ConclusionsAccelerating progress in PD research requires collaborative frameworks that integrate diverse populations, disciplines, institutions, and regions. Strengthening research infrastructure, community engagement, culturally grounded education, participant-centered research practices, and scientific leadership, particularly in low- and middle-income countries, will be essential to ensure that all populations can contribute to and benefit from scientific advances, fostering a more equitable and effective global PD research ecosystem.
Background: FOBT is widely used for colorectal cancer screening in asymptomatic populations but is frequently applied in hospitalized patients with anemia or suspected gastrointestinal bleeding despite limited supporting evidence. Objectives: To evaluate the clinical utility of fecal occult blood testing (FOBT) in hospitalized patients, focusing on its indications and its association with endoscopic findings while accounting for differential endoscopic verification. Methods: We conducted a retrospective study of 160 hospitalized adults who underwent FOBT at a medium-complexity referral center. Demographic, clinical, and endoscopic data were extracted from electronic medical records. Group comparisons used Wilcoxon rank-sum, chi-square, or Fisher’s exact tests; multivariable logistic regression, verification-bias-corrected diagnostic accuracy (Begg–Greenes method), and multiple imputation assessed the association between FOBT and endoscopic findings. Results: FOBT was positive in 61.3% of patients. Anemia was the main indication (51%), followed by melena (26%) and hematochezia (6.9%). FOBT positivity was significantly associated with anemia at admission (82% vs. 68%, p = 0.044) and hematochezia (10% vs. 0%, p = 0.007). Endoscopic verification differed markedly by the FOBT result (71% vs. 29%), and no significant association between FOBT positivity and abnormal endoscopic findings persisted after multivariable adjustment or bias correction, for either EGD (OR 2.01, 95%CI 0.66–6.10) or colonoscopy (OR 4.58, 95%CI 0.39–54.3). Conclusions: FOBT shows no robust diagnostic association with endoscopic pathology, upper or lower, once differential verification is accounted for. Its main actionable finding was frequent guideline-discordant use in patients with overt bleeding, identifying institutional stewardship as the primary target for improving diagnostic efficiency in inpatient care.
