Objective:This study aimed to evaluate the efficacy of mammography, ultrasound, and magnetic resonance imaging (MRI) features in differentiating pure from mixed mucinous breast carcinoma and in identifying imaging characteristics specific to each subtype. Methods:This retrospective single-center study included 68 patients diagnosed with mucinous breast carcinoma between 2017 and 2024. The tumors were classified as pure or mixed mucinous breast carcinomas based on histopathological findings. All available mammography, ultrasound, and MRI examinations were evaluated by a radiologist blinded to the histopathological subtypes. The features, such as tumor shape, margin, signal intensity, mammographic density, echogenicity, and calcifications, were assessed to identify distinctive patterns associated with pure and mixed mucinous breast tumors. Results:Among the 68 patients, 31 (45.6%) had pure mucinous tumors, while 37 (54.4%) had mixed tumors. On ultrasound, pure mucinous carcinomas more frequently demonstrated an oval shape and a homogeneous internal echo pattern, whereas mixed tumors more frequently exhibited an irregular shape (p<0.05). Mammography showed that non-circumscribed margins were significantly more common in mixed tumors than in pure tumors (p=0.02). On MRI, pure mucinous carcinomas predominantly exhibited oval or lobulated shapes, whereas mixed tumors more frequently exhibited irregular shapes (p=0.02). Pure tumors also showed higher T2 signal intensity (p=0.02) and significantly higher median apparent diffusion coefficient (ADC) values than mixed tumors (1815 [interquartile range (IQR), 1596-2062.5] vs. 1336.5 [IQR, 904.25-1602.5]×10-6 mm²/s, p=0.01). Conclusions:A multimodal imaging approach facilitates differentiation between pure and mixed mucinous breast carcinomas. Among the evaluated modalities, MRI provided the greatest discriminatory value, particularly through T2 signal intensity and ADC measurements, and may complement core needle biopsy when tissue sampling is limited.
Objective:We set out to examine how completely artificial intelligence (AI)-based orthopedic studies report their methods. Methods:A PubMed search covering 2023-2025 was run with a predefined strategy. Screening of titles, abstracts and full texts left 280 eligible papers, and 200 of these were drawn at random for scoring. Each paper was rated against a six-item framework built from the TRIPOD-AI, STARD-AI and CONSORT-AI guidelines. Results:Mean score across the 200 studies was 4.8±0.9. Twenty-eight percent reached 6/6, 37% scored 5/6 and 23% scored 4/6; the remaining 12% scored 3 or below. Model description, dataset characteristics and performance metrics appeared in every paper (100%), and training and validation procedures in 88%. External validation was far less common, reported by only 32%, while 61% included some form of clinical comparison. Conclusions:Reporting in this literature is moderate to high overall, yet two weaknesses persist: external validation and clinical integration. Work in this area would benefit from closer attention to generalizability, clinical relevance and the existing reporting guidelines.
Objective:The neutrophil-to-high-density lipoprotein cholesterol ratio (NHR) is an emerging inflammatory-lipid biomarker. Whether NHR is associated with anatomically significant multivessel disease (MVD) across different acute coronary syndrome (ACS) phenotypes remains unclear. Methods:We analyzed 421 consecutive ACS patients [268 with non-ST-segment elevation myocardial infarction (NSTEMI) and 153 with ST-segment elevation myocardial infarction (STEMI)] who underwent coronary angiography. Anatomically significant MVD was defined as ≥70% stenosis in at least two major epicardial coronary arteries, or ≥70% stenosis in one epicardial coronary artery in addition to ≥50% stenosis of the left main coronary artery. Receiver operating characteristic analysis and multivariable logistic regression were performed. Results:Among NSTEMI patients, NHR predicted anatomically significant MVD with an area under the curve (AUC) of 0.694 [95% confidence inteval (CI): 0.630-0.757, p<0.001], using an optimal cut-off value of 0.1365 (78.0% sensitivity, 59.4% specificity). After multivariable adjustment, NHR remained independently associated with MVD (odds ratio: 5.870, 95% CI: 1.402-11.859, p<0.001). Among STEMI patients, NHR did not demonstrate discriminatory ability (AUC=0.481, p=0.690). In the overall ACS population, the NHR demonstrated modest discriminatory performance (AUC=0.615, p<0.001). Conclusions:NHR was associated with anatomically significant MVD mainly in patients with NSTEMI, whereas no meaningful discriminatory value was observed in patients with STEMI. This phenotype-specific finding suggests that NHR may better reflect the presence of MVD in NSTEMI than serve as a uniform marker across all ACS presentations.
Autism spectrum disorder (ASD) is a complex neurodevelopmental condition characterized by persistent impairments in social communication, restricted interests, and repetitive behaviors. This narrative review synthesizes advances in machine learning applications to ASD genomic research through May 2026, spanning gene expression analysis, whole-exome sequencing (WES), non-coding variant interpretation, multi-omics integration, single-cell transcriptomics, epigenetic profiling, and gut microbiome analysis. A purposive, thematic literature synthesis approach was employed, allowing broad coverage of emerging methodological innovations and biological insights. We critically evaluate state-of-the-art deep learning architectures-including the Separate Translated Autism Research Neural Network and SHapley Additive exPlanations-based explainable artificial intelligence frameworks. Reported discrimination across the field varies widely, from receiver operating characteristic-area under the curve (ROC-AUC) values near 0.66 to implausibly perfect values of 1.00; the best-validated specialized genomic architecture achieves only modest discrimination (ROC-AUC≈0.73). We emphasize that interpretability and predictive performance are orthogonal properties: specialized architectures yield biologically interpretable feature attributions despite modest discriminative power; and several extreme AUC values in the literature are, in our assessment, more consistent with overfitting or data leakage than with genuine signal, although the primary reports did not always provide the information needed to definitively attribute them. Key themes include: (1) identification of differentially expressed genes through meta-analysis of transcriptomic data; (2) validation of predictive gene features from large-scale WES; (3) detection of non-coding regulatory mutations affecting synaptic transmission pathways; (4) discovery of gut microbiome signatures associated with ASD classification; and (5) discovery of data-driven subtypes enabling precision medicine stratification. Critical challenges include population bias toward European ancestry, socioeconomic ascertainment bias, modest predictive effect sizes, conflation of association with causation, and gaps between computational prediction and clinical utility. Future directions emphasize multi-modal data integration, diverse cohort expansion, engagement with neurodiversity perspectives, and regulatory science development.
Childhood obesity is associated with early cardiometabolic abnormalities and subclinical vascular and cardiac changes. This narrative review summarizes the mechanisms underlying these changes and evaluates non-invasive methods used for early detection. PubMed/MEDLINE and Scopus were searched for pediatric studies, systematic reviews, and guidelines, and the principal evidence sources were appraised using design-appropriate tools. Blood pressure measurement, anthropometry, and age-and risk-based laboratory testing remain the basis of routine assessment. Carotid intima-media thickness, pulse wave velocity, endothelial function tests, heart rate variability, advanced echocardiographic measures, and epicardial adipose tissue assessment are promising; however, methodological heterogeneity and limited pediatric reference values restrict most of them to selected clinical or research settings. Standardized longitudinal studies are required to validate thresholds and determine whether test-guided strategies improve outcomes.
To synthesize evidence on pediatric bowel rehabilitation protocols for chronic constipation and complex colorectal dysfunction, with emphasis on sennoside dosing, disimpaction, mechanical evacuation, radiologic monitoring, outcomes, and adverse events, we conducted a systematic review following PRISMA 2020 and registered it in PROSPERO (CRD420261350563). PubMed/MEDLINE, Embase, Scopus, CENTRAL, LILACS, and SciELO were searched through March 10, 2026. Eligible studies included patients aged 0-21 years with functional or idiopathic constipation, constipation after anorectal malformation repair, or neurogenic bowel dysfunction, and provided extractable mechanicalevacuation data; patients were treated with sennosides, enemas, transanal irrigation, antegrade continence enemas, or surgical escalation. Etiologic groups were interpreted separately because fecal soiling and incontinence do not have a uniform pathophysiologic meaning across functional, anatomic, and neurogenic disorders. Risk of bias was assessed using RoB 2, ROBINS-I, or Joanna Briggs Institute tools, and certainty was evaluated with GRADE. Thirty-two records were identified. After duplicate removal, 31 full-text reports were assessed, and 21 studies were included in the qualitative synthesis; of these, 16 contributed quantitative protocol data. Common components included initial assessment, disimpaction, individualized titration, and objective confirmation of colonic emptying. Sennoside doses ranged from 0.45-0.9 mg/kg/day to high, individualized mg/day regimens, whereas transanal irrigation commonly uses 10-20 mL/kg or 300-700 mL. Radiography was primarily used to monitor therapeutic response. GRADE certainty was moderate for clinical-radiologic success after repair of anorectal malformations, low for most medical and mechanical protocol outcomes, and very low for surgical escalation. Reported adverse events included abdominal cramping and contact perineal injury among diapered children. Pediatric bowel rehabilitation should be stepwise, individualized, and etiology-sensitive; however, the certainty of the evidence remains limited by observational study designs and heterogeneous definitions, underscoring the need for prospective multicenter standardization.
Objective:This study explored the impact of septoplasty on cognitive functions, including selective attention, information processing speed, and response inhibition and investigated the factors associated with these effects. Methods:A total of 73 patients who underwent septoplasty for septal deviation were included. Assessments were conducted at baseline and again at six months postoperatively to evaluate the nasal obstruction symptom evaluation (NOSE) score, peak nasal inspiratory flow (PNIF), Sniffin' Sticks (SS), retronasal olfactory threshold test (ROTT), and Stroop test. Wilcoxon signed-rank and McNemar's tests were used to analyse differences between repeated measurements obtained before and after surgery. Additionally, Spearman's correlation, linear regression, and logistic regression analyses were performed. Results with p-value ≤ 0.05 were considered significant. Results:Postoperative assessments revealed statistically significant improvements in NOSE, PNIF, SS discrimination, SS TDI, ROTT, and Stroop A-D scores (each p<0.05). SS TDI and ROTT scores were significantly correlated both preoperatively (r=0.238) and postoperatively (r=0.295). Furthermore, significant correlations were observed among NOSE, PNIF, SS, ROTT, and Stroop tests. However, PNIF, SS, and ROTT did not show any statistically significant improvement in the postoperative cognitive test results. Conclusions:Septoplasty significantly improved nasal airflow, both orthonasal and retronasal olfaction, and cognitive functions, including selective attention, information-processing speed, and response inhibition. However, it is unclear whether cognitive improvements are attributable to enhanced olfactory function or alleviation of nasal obstruction.
Objective:CDH1 polymorphism has been suggested to be associated with susceptibility to gastric cancer (GC). However, relevant findings remain inconsistent across studies. This meta‑analysis was performed to evaluate the relationship between CDH1 -160C/A and -347G/GA polymorphisms and GC risk. Methods:Relevant studies were searched in PubMed, Web of Science, Google Scholar, Cochrane Library, Embase, CNKI, and Wanfang databases up to December 20, 2025. Pooled OR and 95% (95% CI) were calculated using fixed‑ or random‑effects models. Results:A total of 25 articles were included, involving 28 studies (4,836 cases and 6,187 controls) for the -160C/A polymorphism and 8 studies (1,201 cases and 1,611 controls) for the -347G/GA polymorphism. Overall, significant associations were identified between CDH1 polymorphisms and GC risk: -160C/A (recessive model: OR=1.28, 95% CI: 1.03-1.58; AA vs. CC: OR=1.28, 95% CI: 1.01-1.61); -347G/GA (G/GA vs. GG: OR=1.23, 95% CI: 1.04-1.44). In stratified analyses by histological type, the CDH1 -347G/GA polymorphism was associated with an elevated risk of diffuse‑type GC (G/GA vs. GG: OR=1.21, 95% CI: 1.01-1.62). Conclusions:This meta-analysis indicates that the two CDH1 promoter polymorphisms may contribute to GC susceptibility. Further large-scale and well-designed studies are needed to verify these results.
Idiopathic sudden sensorineural hearing loss (ISSNHL) is an otologic emergency. While systemic corticosteroids are first-line therapy, intratympanic corticosteroid (ITC) injection has emerged as an important modality. The optimal timing of ITC—as primary therapy, combined initial treatment, or salvage therapy—remains controversial. To critically synthesize current evidence regarding ITC efficacy at different treatment timings and provide evidence-based clinical recommendations. A structured search of PubMed, Embase, and the Cochrane Library was conducted from database inception to December 2025 using terms sudden sensorineural hearing loss, ISSNHL, sudden deafness, intratympanic injection, ITC, intratympanic dexamethasone, and intratympanic methylprednisolone. The search identified 321 records, and additional articles were found in the reference lists of key reviews, meta-analyses, and guidelines. Studies were selected using predefined criteria, prioritizing randomized controlled trials, systematic reviews, meta-analyses, clinical practice guidelines, and relevant observational studies in adults with ISSNHL. Eligible studies evaluated ITC as primary monotherapy, combined initial therapy, or salvage therapy, and reported quantitative audiometric outcomes. Exclusion criteria included non-idiopathic sudden hearing loss, pediatric populations, non-corticosteroid intratympanic therapies, animal or laboratory-only studies, case reports, conference abstracts without full text, duplicate publications, and studies without clinically interpretable hearing outcomes. After screening, 25 studies were included. Salvage ITC provides significant benefit (OR: 6.04; 95% CI: 3.26-11.2; NNT≈3) with Grade A evidence. Combined initial therapy is superior to systemic steroids alone (OR: 2.50; 95% CI: 1.95-3.21), particularly for severe hearing loss. ITC monotherapy is non-inferior to systemic steroids (PTA difference: 2.0 dB). A stratified approach based on treatment timing is recommended. Salvage ITC should be offered to all patients with incomplete recovery. Combined therapy should be considered for patients with severe hearing loss. ITC monotherapy is appropriate when systemic steroids are contraindicated.
Objective: Chronic suppurative otitis media (CSOM) with cholesteatoma is a potentially dangerous condition that can lead to extracranial and intracranial complications. Bacteria associated with CSOM cholesteatoma frequently produce biofilms, which contribute to antibiotic resistance and accelerate disease progression Methods: This cross-sectional study was conducted at the tertiary teaching hospital of Hasanuddin University, its affiliated hospitals, and the Hasanuddin University Medical Research Center (HUM-RC) between March 2024 and April 2025. Patients diagnosed with CSOM cholesteatoma who underwent mastoidectomy were enrolled. Bacterial isolates obtained from cholesteatoma tissue were evaluated for biofilm formation using crystal violet staining. Data were analyzed using SPSS software. Results: A total of 49 patients were included: 46.9% male and 53.1% female; age range 9-66 years. Of the bacterial isolates, 40 demonstrated biofilm formation. Pseudomonas aeruginosa was the most frequently identified species (42.5%), followed by 12 other species, all of which exhibited weak to moderate biofilm production. Based on the Telmesani grading system, 47% of patients presented with severe disease. However, the limited sample size restricted the ability to establish a statistically significant correlation between biofilm presence and clinical severity. Conclusions: Biofilm formation was detected in the majority of bacterial isolates, with Pseudomonas aeruginosa emerging as the predominant species. Although nearly half of the patients presented with severe disease, most isolates demonstrated only weak to moderate biofilm production. The limited sample size restricted the ability to establish a statistically significant correlation between biofilm presence and clinical severity. Nevertheless, these findings highlight the importance of biofilm in the pathogenesis of CSOM and underscore the need for larger multicenter studies to clarify its role and inform the development of biofilm-targeted therapeutic strategies.
Even though insulin therapy is the cornerstone of diabetes mellitus management, multiple daily injections are associated with poor adherence. Once-weekly basal insulin therapy has emerged as a novel therapeutic approach and is being evaluated in multiple ongoing clinical trials. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of once-weekly insulin efsitora therapy compared with once-daily basal insulin therapy in patients with type 1 or type 2 diabetes mellitus. Primary endpoints include glycemic control, assessed via HbA1c reduction, and hypoglycemia, classified as level 1 (54-69 mg/dL), level 2 (<54 mg/dl), or level 3 (any hypoglycemic episode characterized by altered mental and/or physical functioning requiring assistance). We have performed a systematic review and meta-analysis through an extensive literature search of major databases including Scopus, PubMed/Medline, and Cochrane databases, and have only included randomized controlled trials. We have included 5 randomized controlled trials comprising a total of 2,562 patients: 1,358 (53%) in the insulin efsitora arm and 1,204 (47%) in the insulin degludec arm. Our data show that insulin efsitora therapy achieved a similar HbA1c reduction overall (estimated treatment difference (ETD) 0.08%, 95% CI -0.01 to 0.17; I² = 42.6%), in patients with type 1 diabetes mellitus (ETD 0.10%, 95% CI -0.64-0.85; I² =24.0%) and in patients with type 2 diabetes mellitus (ETD 0.05%, 95% CI -0.25 - 0.26; I² = 38.1%) compared with insulin degludec therapy. Moreover, no statistically significant differences were identified in overall hypoglycemic events, level 2 or 3 hypoglycemic episodes, or nocturnal hypoglycemia, irrespective of diabetes mellitus subtype. Our meta-analysis shows no statistically significant difference between once-weekly insulin efsitora therapy and insulin degludec therapy in terms of glycemic control and hypoglycemic events.
Objective: The aim of this study was to evaluate the microbiological contamination rates of nasal topical preparations (sprays, drops, and ointments) used after septoplasty at the nozzle/tube tip and drug content levels. The study also aimed to compare contamination levels in different formulations. Methods: This prospective cross-sectional study included 110 patients (spray: n=38; drop: n=34; ointment: n=38) who underwent septoplasty at the ENT clinic. Patients returned their preparations after at least two weeks’ postoperative use. Two separate samples were obtained from each preparation: a swab of the nozzle or tube tip and the drug content. These specimens were inoculated onto blood agar, chocolate agar, and Sabouraud dextrose agar. Isolate identification was performed using the VITEK MS (MALDI-TOF MS) system. Results: Nozzle contamination was detected in 62.7% (n=69) of the 110 preparations, and content contamination was detected in 40.9% (n=45). Nozzle contamination was significantly higher in the spray group (89.5%) than in the drop (44.1%) and ointment (52.6%) groups (p<0.001). The most frequently isolated microorganisms were coagulase-negative staphylococci (particularly Staphylococcus epidermidis) and Staphylococcus aureus. Gram-negative bacteria (e.g., Klebsiella spp. and Pseudomonas aeruginosa) and yeast species (e.g., Candida parapsilosis and Candida haemulonii) were detected less frequently. Conclusions: Spray formulations showed higher nozzle contamination rates than other formulations, whereas drug-content contamination appeared similar across groups. These findings suggest that contamination may occur in topical nasal preparations used after septoplasty and highlight the importance of patient education regarding hygienic use during the postoperative period. However, because baseline sterility testing and laboratory negative controls were not performed, the source of contamination cannot be determined conclusively.
Objective:Skin cancer is a growing global health issue. Natural compounds with multi-pathway activity are promising chemopreventive agents. Cocoa extract contains bioactive components that may inhibit cancer-related molecular pathways, such as flavonoids, polyphenols, and alkaloids. This study aims to assess the chemopreventive potential of cocoa extract against skin cancer by targeting the adenosine A2 receptor and vascular endothelial growth factor receptor-2 (VEGFR-2), and by modulating B-cell lymphoma-2 (BCL-2) expression, using both in vivo and molecular docking methods. Methods:Thirty female Swiss mice were treated with (7,12-dimethylbenz[a] anthracene) and (12-O-tetradecanoylphorbol-13-acetate) to induce squamous cell carcinoma. Cocoa extract (1600 ppm) was administered as a preventive treatment for 12 weeks. Measurements included flavonoid and polyphenol content, malondialdehyde (MDA) levels, BCL-2 protein expression, and histopathological evaluation. Molecular docking was performed to assess interactions between cocoa compounds and adenosine A2 and VEGFR2 receptors. Results:The cocoa extract contained 118.72 μg of flavonoids and 66.24 mg of polyphenols. Theobromine inhibited adenosine A2 receptor activity and reduced interleukin-8 expression. Procyanidin and epicatechin bound to VEGFR2, potentially suppressing angiogenesis. Immunohistochemistry showed significant reductions in both BCL-2 expression (p=0.035) and MDA levels (p=0.001), indicating decreased oxidative stress. Histological analysis revealed milder dysplasia in the cocoa-treated group compared to controls (p=0.002). Conclusions:Cocoa extract demonstrates potential as a natural chemopreventive agent against skin cancer through antioxidant activity, anti-angiogenesis, and apoptosis modulation pathways.
Pain is one of the most common reasons for presentation to the emergency department, yet it remains frequently undertreated despite effective therapies. Emergency physicians must provide timely analgesia while accounting for diagnostic uncertainty, patient heterogeneity, and safety concerns, particularly related to opioid use. This narrative review synthesizes contemporary evidence on multimodal pain management in emergency medicine. A focused literature search of PubMed and Scopus was conducted to identify studies published between 2015 and 2025, as well as selected landmark studies and major clinical guidelines. Multimodal analgesia, combining pharmacological and non-pharmacological strategies targeting different pain pathways, is associated with improved pain control and reduced opioid use in emergency settings. Key elements include early pain assessment, timely initiation of therapy, opioid-sparing approaches, and use of non-opioid analgesics, low-dose ketamine, and regional anesthesia. Implementation remains inconsistent due to operational constraints such as overcrowding, workflow pressures, and variability in clinician experience. A structured, patient-centered multimodal approach may improve pain control and support safer, more consistent analgesic care in emergency medicine.
Objective: To investigate the value of point-of-care ultrasonography (POCUS) in identifying the causes of acute dyspnea (AD). Methods: In this prospective study, hospitalized adults with AD were enrolled. They underwent POCUS of the heart, lungs, and deep veins of the lower extremities, supplemented by lung auscultation (LA); all examinations were performed by an investigator blinded to the clinical diagnosis. The ultrasound profiles were compared with the clinical diagnoses to determine the diagnostic accuracy of the method. Results: A total of 150 patients, with a mean age of 65.8±15.7 years, were enrolled, and 53% were women. POCUS combined with LA showed a higher diagnostic accuracy [0.86 (95% confidence interval (CI), 0.81-0.91)] than POCUS alone [0.78 (95% CI, 0.72-0.84)]. The POCUS-based protocol showed the highest sensitivity for pleural effusion (1.0) and pericardial effusion [0.94 (95% CI, 0.81-1.00)], and the lowest sensitivity for pneumothorax (0.75 [95% CI, 0.20-1.00]) and pulmonary edema [0.78 (95% CI, 0.69-0.87)]. The examination duration was 12.5±3.9 min. Conclusions: The POCUS-based protocol was a rapid, informative tool for identifying the causes of AD in hospitalized adults, and the addition of LA further increased its diagnostic accuracy.
Objective: Proximal femur morphometry plays a crucial role in fracture management and hip arthroplasty by affecting implant fit, biomechanics, and surgical outcomes. Therefore, the utilization of anatomical data reflecting inter-individual variability is essential for optimizing implant design and minimizing implant-bone mismatch. This study aimed to evaluate proximal femoral morphometry and provide data relevant to implant design. Methods: A total of 73 unpaired dry femurs of unknown age and sex (43 right, 30 left) were analyzed. Measurements included femoral length, neck-body angle, and femoral head and neck dimensions. All measurements were independently performed by two anatomists and repeated using a tape measure, a digital caliper, and a protractor. Interobserver and intra observer reliabilities were assessed using intraclass correlation coefficients (ICC). Statistical analyses were performed, including descriptive statistics, pairwise comparisons, and correlation analyses. Results: Measurement reliability ranged from good to excellent (ICC: 0.749-0.999). Mean femoral length was 43.7±3.0 cm, and mean neck-body angle was 126.0°±4.6°. No significant side differences were observed for femoral length, femoral head, or femoral neck dimensions; however, the neck-body angle differed significantly (p<0.001). The correlation analysis revealed positive associations among parameters of the femoral head and neck. Femoral length showed strong correlations with head dimensions, whereas the neck-body angle demonstrated no significant correlations with other parameters. The lack of age and sex data should be considered when interpreting these findings. Conclusions: The proximal femur exhibits substantial morphometric variability. These findings provide preliminary data that may contribute to the existing literature and help inform the design of future implants and prostheses.
Objective: The Intermountain Risk Score (IMRS), derived from routine laboratory parameters, predicts cardiovascular outcomes. Its association with saphenous vein graft degeneration (SVGD) post-coronary artery bypass grafting (CABG) remains underexplored. Methods: This retrospective cohort study analyzed data from 261 CABG patients who underwent coronary angiography. SVGD was defined as ≥50% graft stenosis. IMRS was calculated using laboratory data, age, and sex. Multivariate logistic regression and receiver operating characteristic (ROC) analyses were used to assess IMRS’s predictive value for SVGD. Results: Of the 261 patients, 138 (52.9%) had SVGD. The SVGD group had higher median IMRS scores (12.5 vs. 10, p<0.001). After adjusting for confounders, IMRS was an independent predictor of SVGD (OR 1.640, 95% CI 1.310-2.054, p<0.001), as were chronic kidney disease and smoking. ROC analysis showed an area under the curve of 0.676, with a cutoff of IMRS >12 yielding a specificity of 83% and a sensitivity of 50%. Conclusions: Elevated IMRS independently predicts SVGD in post-CABG patients. As a cost-effective tool, IMRS may guide preoperative risk stratification and postoperative prevention strategies.
Objective:To assess the diagnostic performance and interobserver reproducibility of the odontoid retroflexion angle (ORA) and posterior basion-C2 (pB-C2) line in adult patients with type II basilar invagination (BI), using the odontoid apex-Chamberlain line distance (OA-CL) as the reference standard. Methods:This retrospective diagnostic accuracy study included adult patients with type II BI who underwent cranial magnetic resonance imaging between January 2015 and September 2021, along with age- and sex-matched control participants. Two blinded observers performed measurements on midline sagittal images. ORA and pB-C2 were evaluated as index tests, and OA-CL was the reference standard. Interobserver agreement was assessed using intraclass correlation coefficients (ICC). Group comparisons were performed using Student's t-test. The diagnostic performance was evaluated using receiver operating characteristic (ROC) analysis. Results:The study included 33 patients with BI and 34 controls. The OA-CL demonstrated excellent interobserver agreement (ICC=0.98),whereas the ORA showed moderate agreement (ICC=0.69), and pB-C2 showed good agreement (ICC=0.82). ORA was significantly lower and pB-C2 was significantly higher in patients than in controls (p<0.001 for both). ROC analysis revealed moderate diagnostic performance for ORA (AUC=0.79) and pB-C2 (AUC=0.77). Conclusions:Although ORA and pB-C2 differed significantly between patients with type II BI and controls, both parameters demonstrated limited reproducibility and moderate diagnostic performance. These measurements should be considered complementary morphometric descriptors rather than primary diagnostic markers of BI.
