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Quantifying In Vivo Arterial Deformation from CT and MRI: a Systematic Review of Segmentation, Motion Tracking, and Kinematic Metrics.
No full textThis article presents a systematic review on methods for quantifying three-dimensional, time-resolved (3D+t) deformation and motion of human arteries from Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched Scopus, Web of Science, IEEE Xplore, Google Scholar, and PubMed on 19 December 2025 for in vivo, patient-specific CT or MRI studies reporting motion or deformation of large human arteries. We included studies that quantified arterial deformation or motion tracking and excluded non-vascular tissues, in vitro or purely computational work. Thirty-five studies were included in the qualitative synthesis; most were small, single-centre observational cohorts. Articles were analysed qualitatively, and results were synthesised narratively. Across the 35 studies, the most common segmentation approaches are active contours and threshold, while temporal motion is tracked using either voxel registration or surface methods. These kinematic data are used to compute metrics such as circumferential and longitudinal strain, distensibility, and curvature. Several studies also employ inverse methods to estimate wall stiffness. The findings consistently show that arterial strain decreases with age (on the order of 20% per decade in some cases) and in the presence of disease, that stiffness correlates with geometric remodelling, and that deformation is spatially heterogeneous. However, insufficient data prevents meaningful comparison across methods.10.54499/PTDC/EMD-EMD/1230/2021/Fundação para a Ciência e Tecnologi
Proximal Junctional Kyphosis Following Spinal Thoracic Deformity Correction in a Patient with Kabuki Syndrome: A Case Report.
No full textIntroduction: Kabuki syndrome (KS) is a rare congenital disorder characterized by distinctive facial features, intellectual disability, and multiple musculoskeletal anomalies, including scoliosis, kyphosis, and generalized ligamentous laxity. The combination of connective tissue fragility and complex spinal deformity may predispose these patients to post-operative complications, such as proximal junctional kyphosis (PJK), though this association has not previously been reported.
Case report: We report a 15-year-old male with genetically confirmed KS who presented with severe thoracic hyperkyphosis (95°). Posterior spinal fusion and correction were performed, resulting in initial improvement. Within 8 months, the patient developed PJK above the upper instrumented vertebra, requiring multiple revision procedures. Post-operative infection with Staphylococcus aureus and rapid recurrent kyphosis further complicated management. A staged revision strategy, combining halo-gravitational traction followed by extended fusion and careful sagittal realignment, achieved stable correction and functional improvement at 1-year follow-up.
Conclusion: The association between these conditions has, to our knowledge, not yet been reported in literature. This case highlights the multifactorial etiology of PJK in KS, where intrinsic ligamentous laxity, immune dysfunction, and extensive deformity correction converge to increase mechanical vulnerability. Soft-tissue preservation at the upper instrumented level, careful sagittal contouring, and infection control are key preventive strategies. Due to inherent ligamentous laxity and connective tissue abnormalities, patients with KS could be predisposed to proximal junctional failure after spinal deformity correction. Pre-operative recognition of connective tissue and immunologic abnormalities, together with detailed surgical planning, is essential to minimize complications and optimize long-term outcomes
Giant Renal Tumor with Inferior Vena Cava Thrombus – a Case Report
No full textINTRODUCTION: Vascular migration and venous tumor thrombus are infrequent but unique aspects of renal cell carcinoma, and these features have signifcant therapeutic and prognostic implications. We report a case of renal neoplasm with a vena cava tumor thrombus treated with surgical resection and adjuvant chemotherapy.
CASE REPORT: A 53-year-old, otherwise healthy woman presented to the emergency department due to macroscopic hematuria and abdominal pain. A large abdominal mass was noted. A computed tomography angiography was performed, and a right renal tumor (105x207mm) with level II inferior vena cava tumor thrombus and local adenopathy was noted. After a multidisciplinary discussion, she was proposed for surgical resection. Through a bilateral subcostal incision (Chevron), a standard right radical nephrectomy and perivascular lymph node excision were performed. The IVC was exposed, and a thrombectomy was performed through a longitudinal cavotomy. Pathology revealed clear renal cell carcinoma and lymph node metastasis. The postoperative period was uneventful. However, the patient developed multiple liver and lung metastases at early follow-up and was treated with chemotherapy.
DISCUSSION: Tumor thrombus can extend up to the right atrium and occurs in nearly 10–25% of renal cell carcinoma patients. The natural history of this condition is poor, with a median survival of 5 months and signifcant survival improvements following radical nephrectomy and IVC tumor thrombus removal are observed, with 40- 60% 5-year survival. Surgical treatment should, therefore, be considered in this group of patients. Such operations can be challenging, particularly when thrombus extent is signifcant, and the combination of efforts between oncologists, urologists, and vascular surgeons can improve patient safety and perioperative outcomes with signifcant improvements in overall prognosis
Enhancing Recurrence-Free Survival Prediction in Hepatocellular Carcinoma: A Time-Updated Model Incorporating Tumor Burden and AFP Dynamics.
No full textBackground: Existing models to predict recurrence-free survival (RFS) after hepatectomy for hepatocellular carcinoma (HCC) rely on static preoperative factors such as alpha-fetoprotein (AFP) and tumor burden score (TBS). These models overlook dynamic postoperative AFP changes, which may reflect evolving recurrence risk. We sought to develop a dynamic, real-time model integrating time-updated AFP values with TBS for improved recurrence prediction.
Patients and methods: Patients undergoing curative-intent hepatectomy for HCC (2000-2023) were identified from an international, multi-institutional database with RFS as the primary outcome. AFP trajectory was monitored from preoperative to 6- and 12-month postoperative values, using time-varying Cox regression with AFP as a time-dependent covariate. The predictive accuracy of this time-updated model was compared with a static preoperative Cox model excluding postoperative AFP.
Results: Among 1911 patients, AFP trajectories differed between recurrent and nonrecurrent cases. While preoperative AFP values were similar, recurrent cases exhibited higher AFP at 6 and 12 months. Multivariable analysis identified TBS (hazard ratio (HR):1.043 [95% confidence interval (CI): 1.002-1.086]; p = 0.039) and postoperative log AFP dynamics (HR:1.216 [CI 1.132-1.305]; p < 0.001) as predictors. Contour plots depicted TBS's influence decreasing over time, while postoperative AFP became more predictive. The time-varying Cox model was created to update RFS predictions continuously on the basis of the latest AFP values. The preoperative Cox model, developed with age, AFP, TBS, and albumin-bilirubin score, had a baseline C-index of 0.61 [0.59-0.63]. At 6 months, the time-varying model's C-index was 0.70 [0.67-0.73] versus 0.59 [0.56-0.61] for the static model; at 12 months, it was 0.70 [0.66-0.73] versus 0.56 [0.53-0.59]. The model was made available online ( https://nm49jf-miho-akabane.shinyapps.io/AFPHCC/ ).
Conclusions: Incorporating postoperative AFP dynamics into RFS prediction after HCC resection enhanced prediction accuracy over time, as TBS's influence decreased. This adaptive, time-varying model provides refined RFS predictions throughout follow-up
Real-Life Experience of HER2 (Human Epidermal Growth Factor Receptor 2)-Positive Advanced Breast Cancer Patients Treated With T-DXd (Trastuzumab Deruxtecan): A Multicentric Portuguese Study.
No full textBackground: Substantial improvements in survival have been observed in HER2 (human epidermal growth factor receptor 2)-positive (HER2+) inoperable or metastatic breast cancer (advanced breast cancer [ABC]) in recent years, driven by the introduction and widespread use of multiple novel agents. The DESTINY-Breast02 trial compared the efficacy and safety of trastuzumab deruxtecan (T-DXd) in patients with HER2+ ABC formerly treated with trastuzumab emtansine (T-DM1), demonstrating significant improvements in both overall survival (OS) and progression-free survival (PFS).
Methods: We conducted a national, multicentric, retrospective study to describe real-world treatment patterns, PFS, OS, safety, and key toxicities associated with T-DXd use in Portugal, following the DESTINY-Breast02 inclusion criteria.
Results: A total of 100 women with HER2+ ABC from 17 centers were included, all of whom had received at least two prior treatments for advanced disease and were treated with T-DXd between July 2021 and May 2023. The mean age was 53.9 years n(standard deviation: 9.9). Thirty-six patients presented with synchronous metastatic disease. The most common metastatic site was bone, in 61 (61%) patients; 72 (72%) had visceral metastases, and 21 patients (21%) had brain metastases. The median follow-up was 10 months, with a median of 11 T-DXd cycles administered. Prior treatments included pertuzumab in 71 (71%) patients and T-DM1 in 84 (84%). T-DXd was administered as third-line therapy in 52 (52%) patients, as fourth-line therapy in 15 (15%), and as fifth-line therapy and beyond in 23 (23%) patients. The overall response rate (ORR) was 44%, and the clinical benefit rate (CBR) was 80%. The most frequent toxicities of any grade were nausea in 49 patients (49%), neutropenia in 37 (37%), and alopecia in 34 (34%). Serious adverse events (grade ≥ 3) occurred in 16 (16%) patients, with treatment discontinuation or delays due to adverse events observed in 46 cases (46%). Median OS was not reached, with a 12-month OS rate of 74%. The median PFS was 13 months (95% CI: 10-16 months), and the 12-month PFS rate was 54%.
Conclusions: This real-world analysis revealed that the efficacy, safety, and tolerability of T-DXd in the Portuguese population are consistent with the outcomes observed in the DESTINY-Breast02 clinical trial
HepatoPredict Accurately Selects Hepatocellular Carcinoma Patients for Liver Transplantation Regardless of Tumor Heterogeneity.
No full textBackground/objectives: Hepatocellular carcinoma (HCC) is a major cause of cancer-related deaths rising worldwide. This is leading to an increased demand for liver transplantation (LT), the most effective treatment for HCC in its initial stages. However, current patient selection criteria are limited in predicting recurrence and raise ethical concerns about equitable access to care. This study aims to enhance patient selection by refining the HepatoPredict (HP) tool, a machine learning-based model that combines molecular and clinical data to forecast LT outcomes.
Methods: The updated HP algorithm was trained on a two-center dataset and assessed against standard clinical criteria. Its prognostic performance was evaluated through accuracy metrics, with additional analyses considering tumor heterogeneity and potential sampling bias.
Results: HP outperformed all clinical criteria, particularly regarding negative predictive value, addressing critical limitations in existing selection strategies. It also demonstrated improved differentiation of recurrence-free and overall survival outcomes. Importantly, the prognostic accuracy of HP remained largely unaffected by intra-nodule and intra-patient heterogeneity, indicating its robustness even when biopsies were taken from smaller or non-dominant nodules.
Conclusions: These findings support the usage of HP as a valuable tool for optimizing LT candidate selection, promoting fair organ allocation and enhancing patient outcomes through integrated analysis of molecular and clinical data
Association of Preoperative Smoking With the Occurrence of Postoperative Pulmonary Complications: A Post Hoc Analysis of an Observational Study in 29 Countries.
No full textIntroduction: While smoking has been consistently identified as a significant contributor to postoperative complications, the existing literature on its association with postoperative pulmonary complications remains conflicting.
Aim: We examined the association of preoperative smoking with the occurrence of postoperative pulmonary complications (PPCs).
Methods: Post hoc analysis of an observational study in 146 hospitals across 29 countries. We included patients at increased risk of PPCs, according to the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score (≥ 26 points). The primary endpoint was the occurrence of one or more predefined PPCs in the first five postoperative days, including unplanned postoperative need for supplementary oxygen, respiratory failure, unplanned need for invasive ventilation, ARDS, pneumonia and pneumothorax. Secondary endpoints included length of hospital stay and in-hospital mortality. We performed propensity score matching to correct for factors with a known association with postoperative outcomes.
Results: Out of 2632 patients, 531 (20.2 %) patients were smokers and 2102 (79.8 %) non-smokers. At five days after surgery, 101 (19.0 %) smokers versus 404 (19.2) non-smokers had developed one or more PPCs (P = 0.95). Respiratory failure was more common in smokers (5.1 %) than non-smokers (3.0 %) (P = 0.02), while rates of other PPCs like need for supplementary oxygen, invasive ventilation, ARDS, pneumonia, or pneumothorax did not differ between the groups. Length of hospital stay and mortality was not different between groups. Propensity score matching did not change the findings.
Conclusion: The occurrence of PPCs in smokers is not different from non-smokers.
Funding: This analysis was performed without additional funding. LAS VEGAS was partially funded and endorsed by the European Society of Anaesthesiology through their Clinical Trial Network and the Amsterdam University Medical Centers, Amsterdam, The Netherlands.
Registration: LAS VEGAS was registered at Clinicaltrials.gov (NCT01601223).
Prior presentation: Preliminary study results have been presented at the Euroanaesthesia 2024 International Congress, in Munich, Germany
Study of the Prevalence of Hypertension in Children and Adolescents in Lisbon and Tejo Valley Region.
No full textIntrodução: A hipertensão arterial (HTA) é um fator de risco importante de doença cardiovascular (DCV) em qualquer idade. Estima-se uma prevalência na criança de 3-5%. O conhecimento da sua prevalência permite adequar medidas de controlo, tratamento e prevenção, procurando diminuir a morbilidade e mortalidade associadas à DCV.
Objetivos: Avaliar a prevalência da HTA em crianças e adolescentes em idade escolar e o efeito de variáveis sociodemográficas e somatométricas no perfil tensional.
Metodologia: Estudo multicêntrico, observacional, prospetivo e transversal que decorreu entre 2016 e 2019. Amostra com crianças entre os 6 e 18 anos, residentes na região de Lisboa e Vale do Tejo. Realizada medição da pressão arterial (PA) pelo método oscilométrico, em ambiente escolar. A classificação do perfil tensional em PA normal, PA elevada (PAE) e hipertensão arterial (HTA), baseou-se nos critérios da ESH-2016. Registados género, idade, raça, escolaridade, peso e estatura. Realizada análise estatística descritiva.
Resultados: Participantes: 1245 crianças, 215 participantes entre os 6-10 anos (17%); 720 entre 11-15 anos (58%) e 310 com 16 -18 anos (25%). Caucasianos: 88%; género feminino: 635 (51%). Registaram-se 16% com excesso de peso e 7% de obesos. A prevalência de HTA é de 8,4% e de PAE 12,8%. Registaram-se entre os 6-10 anos 5,6% de casos de HTA; 11-15 anos: 8,6% e 16-18 anos: 10%. Nos rapazes 10,5% tinham HTA (vs F.6,5%-p<0,001). Na raça caucasiana 8,7% apresentavam HTA, 6% na raça negra e 5,9 % entre asiáticos. As crianças com excesso de peso ou obesidade apresentaram valores mais elevados de HTA, 17% e 26% respetivamente.
Discussão/Conclusão: A prevalência de HTA é elevada (8,4%) e aumenta com a idade, género masculino e nível de escolaridade mais
avançado. Excesso de peso e obesidade contribuem para o aumento dos casos de HTA
