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Impact of Extent of Resection on Survival in Brain Metastasis: An Analysis of 867 Patients
No full textBackground and objectives: The association between extent of resection (EOR) and outcomes after brain metastasis (BM) surgery remains unclear. The aim of this study was to examine the relation between EOR and overall survival (OS)/intracranial progression-free survival (IC-PFS) in this patient group. Methods: We included patients who underwent BM resection and had postoperative MRI <72 hours. Presence of any residual on MRI was defined as subtotal resection (STR) as opposed to gross total resection. Multivariable analyses were adjusted for known confounders. Post hoc analysis explored the effect size across different subgroups. A secondary outcome was the occurrence of leptomeningeal disease (LMD). Results: We included 867 patients; median age was 61 years (IQR 53-68), and median BM diameter was 3.0 cm (IQR 2.2-3.9). Extracranial metastases were present in 310 (35.8%) patients, and 365 (42.1%) received stereotactic radiosurgery (SRS) to the resection cavity. No residual on MRI was present in 345 patients (39.9%). In multivariable analysis, STR correlated with decreased IC-PFS (hazard ratio [HR] 1.32, 95% CI 1.13-1.55, P < .001) and OS (HR 1.28, 95% CI 1.08-1.53, P = .005) and a higher occurrence of LMD (odds ratio 1.74, 95% CI 1.10-2.76, P = .02). STR + SRS also correlated with decreased IC-PFS compared with gross total resection (HR 1.35, 95% CI 1.02-1.66, P = .04). In subgroup analysis, the strongest association between EOR and outcomes was observed in large (>3 cm) BMs, supratentorial BMs, and patients without extracranial disease. The use of cavity SRS or the number of BMs had little impact on this association. Conclusion: Residual tumor on postoperative MRI after BM resection correlated with worse IC-PFS and OS after adjusting for confounding variables. An increased prevalence of LMD may be a possible mechanism through which these patients experience worse outcomes
PR-ENDO: Physically Based Relightable Gaussian Splatting for Endoscopy
No full textEndoluminal endoscopic procedures are essential for diagnosing colorectal cancer and other severe conditions in the digestive tract, urogenital system, and airways. 3D reconstruction and novel-view synthesis from endoscopic images are promising tools for enhancing diagnosis. Moreover, integrating physiological deformations and interaction with the endoscope enables the development of simulation tools from real video data. However, constrained camera trajectories and view-dependent lighting create artifacts, leading to inaccurate or overfitted reconstructions. We present PR-ENDO, a novel 3D reconstruction framework leveraging the unique property of endoscopic imaging, where a single light source is closely aligned with the camera. Our method separates light effects from tissue properties. PR-ENDO enhances 3D Gaussian Splatting with a physically based relightable model. We boost the traditional light transport formulation with a specialized MLP capturing complex light-related effects while ensuring reduced artifacts and better generalization across novel views. PR-ENDO achieves superior reconstruction quality compared to baseline methods on both public and in-house datasets. Unlike existing approaches, PR-ENDO enables tissue modifications while preserving a physically accurate response to light, making it closer to real-world clinical use. Repository: https://github.com/SanoScience/PR-ENDO
Simple mucinous cysts of the pancreas: Clinical and imaging findings - Case series and systematic review of the literature
No full textPurpose: To present the clinical and imaging features of simple mucinous cysts (SMCs) of the pancreas through a case series analysis and a systematic review of the literature. Methods: A literature search was conducted in MEDLINE, Scopus, and Embase databases on July 1, 2025. 72 cases from 18 articles were selected, and 4 cases from the author's institution were included. Two radiologists evaluated the demographic, clinical, and radiological data. Results: There were 49 women (64.5 %) and 27 men (35.5 %), with a mean age of 63 years (standard deviation, 7 years). Patients were asymptomatic in 50.9 % of cases. No dysplasia was found at pathology in 87 % of cases; high-grade dysplasia or invasive carcinoma was found in 9.3 % of cases. Lesions were in the pancreatic head in 34.2 % of cases. The mean lesion size was 44.6 mm (SD, 37.1 mm). Most lesions were unilocular (65.8 %). Main pancreatic duct dilatation was absent in most cases (78.4 %). Solid components were mainly absent (89.1 %). The most common preoperative diagnoses were branch-duct intraductal papillary mucinous neoplasm and mucinous cystic neoplasm. In most cases, SMCs demonstrated progressive size increase during imaging surveillance. Conclusions: SMC usually presents a solitary cystic lesion not communicating with the main pancreatic duct. Even though this is a challenging diagnosis, an SMC should be considered when a pancreatic cyst larger than 1 cm and consistent with a mucinous cystic neoplasm is detected in a man or in the pancreatic head
Renal epithelioid angiomyolipoma: A multi-institutional, international cohort study with emphasis on clinicopathologic prognostic indicators
No full textBackground: Renal angiomyolipoma (AML) is a benign perivascular epithelioid cell neoplasm that is often associated with tuberous sclerosis complex (TSC). Epithelioid AML (eAML), a very rare and potentially malignant variant, can be challenging to radiologically differentiate from benign AML and other renal tumors. Adverse histological features have previously been associated to poorer oncological outcomes. This study aimed to characterize this rare disease entity and validate previously reported adverse prognostic factors. Methods: This multicenter, retrospective cohort study analyzed 76 patients diagnosed with eAML between 2001 and 2024 across 15 participating centers. Inclusion criteria were histological diagnosis of eAML with negative cytokeratin markers and positive melanocytic markers. Patients were stratified according to previously described adverse pathological features. Results: A total of 76 patients were studied. Most were female (70%), with a median age of 48 years and, 19 patients had TSC. Median tumor size was 45 mm, with a rate of atypical epithelioid cells >70% in 26 (34.2%) patients. According to the Nese's and Brimo's classifications, 4% and 14% of patients were at high risk, respectively. During a median follow- up of 30-months, 5 (6.7 %) patients developed metastases, and 4 (5.3 %) died. At univariable analysis, the number of adverse pathological risk factors, according to both classifications, was significantly associated with worse metastasis free survival (MFS) and cancer specific survival (CSS). Due to the low number of events, a multivariable analysis was not carried out. Conclusions: eAML is extremely rare, and primarily affects middle-aged women. This cohort validated previously described pathological risk factors for worse prognosis, suggesting that patients with multiple adverse features may require more intensive follow-up
Towards precision medicine in non-invasive brain stimulation for chronic pain
No full text[no abstract available
Liver Fibrosis and the Risk of Coronary Artery Disease, Stent Thrombosis, Restenosis and Adverse Clinical Outcomes
No full textBackground and Aims: Liver fibrosis may be associated with coronary artery disease (CAD) and adverse cardiovascular outcomes, but data remain limited. This study aimed to explore the relationship between liver fibrosis and the incidence of CAD, stent thrombosis (ST), in-stent restenosis (ISR) and long-term clinical outcomes. Methods: Two cohorts were analysed: the UK Biobank (UKB) cohort examined liver fibrosis and CAD incidence and clinical outcomes in the general population, while the Wenzhou cohort assessed its relationship with ST and ISR and long-term outcomes in post-PCI patients. CAD incidence was defined as coronary stenosis >= 50% or clinical events, such as myocardial ischaemia, myocardial infarction and acute coronary syndrome. ST was confirmed via angiography, and ISR was defined as >= 50% stenosis within the stent. Major adverse cardiovascular events (MACE) included all-cause mortality, myocardial infarction, heart failure and stroke. Liver fibrosis was assessed using FIB-4, categorised as <= 1.3, 1.3-2.67 and > 2.67. Results: 394,625 participants were included. In the UKB cohort (n = 380,638), 7102 (1.9%) had FIB-4 > 2.67. Over 14.4 years, FIB-4 > 2.67 was associated with higher CAD incidence (aHR = 1.41, p < 0.001) and MACE (aHR = 1.69, p < 0.001). In the Wenzhou cohort (n = 13,987), 3173 (22.7%) had FIB-4 > 2.67. Over 3.0 years, FIB-4 > 2.67 was associated with increased risks of ST and ISR (aHR = 1.34, p = 0.001) and MACE (aHR = 1.97, p < 0.001). Conclusions: Liver fibrosis is common among patients with CAD and is associated with CAD incidence, stent thrombosis, restenosis and long-term cardiovascular risk
MADPOT: Medical Anomaly Detection with CLIP Adaptation and Partial Optimal Transport
No full textMedical anomaly detection (AD) is challenging due to diverse imaging modalities, anatomical variations, and limited labeled data. We propose a novel approach combining visual adapters and prompt learning with Partial Optimal Transport (POT) and contrastive learning (CL) to improve CLIP’s adaptability to medical images, particularly for AD. Unlike standard prompt learning, which often yields a single representation, our method employs multiple prompts aligned with local features via POT to capture subtle abnormalities. CL further enforces intraclass cohesion and inter-class separation. Our method achieves state-ofthe-art results in few-shot, zero-shot, and cross-dataset scenarios without synthetic data or memory banks. The code is available at https: //github.com/mahshid1998/MADPOT
Statistical matching: hot deck or propensity score?
No full textThis empirical study compares hot deck (HD) and propensity score (PS) statistical matching methods (SM) with the aim of providing useful guidance to researchers interested in implementing SM methods. Our main goal is to narrow the methodological gap between the two approaches to statistical matching. In our empirical setting, HD and PS yield similar results. We argue that the choice between HD or PS is not critical from a statistical point of view if the method is properly executed. The comparison of the HD and PS methods in this study shows the importance of unifying the two methods while minimizing the execution uncertainties caused by non-optimal modeling decisions made by practitioners
Diospyros kaki leaf polyphenolic extract as a new edible source of anti-glycative agents: bioaccessibility and structure-activity relationship investigation
No full textDiospyros kaki Thunb. is a plant belonging to the Italian biodiversity and its leaves are included in the Belfrit list; therefore, they can be used as a source of food supplement ingredients. D. kaki polyphenolic extract was investigated for its capacity to act as anti-glycative/anti-aging agent for the first time, using different in vitro model systems to simulate the glycation reaction steps. The extract was able to completely trap dicarbonyl compounds such as glyoxal and methylglyoxal and had good inhibitory activity toward argpyrimidine-like and vesperlysine-like Advanced Glycation End products (AGEs) (about 61–70% and 70%, respectively) in the intermediate step of glycation; differently, a very high activity against vesperlysine-like AGEs was registered (> than 93%) in the final step. In the extract, thirteen compounds were characterized by RP-HPLC-DAD-ESI-MS/MS and tested to investigate their interaction with AGEs receptor (RAGE) by molecular modelling. All the compounds (mainly kaempferol-3-O-glucoside) were able to bind RAGE V domain, with the electrostatic term as the main driving force. Considering the possibility to use the extract as food ingredient, bioaccessibility and Caco-2 permeability were investigated by in vitro Infogest digestion protocol coupled with Caco-2 cell-based assay. Seven kaempferol and quercetin derivatives were selected as marker compounds and the bioaccessibility index (BI) was measured. It never exceeded 40% after oral phase, and only kaempferol-3-O-galactoside and kaempferol-3-O-glucoside had a BI value of 5% at intestinal level, but no metabolites were detected in Caco-2 permeated samples. In conclusion, these results are promising; however, the need of a suitable carrier to stabilize the extract and to improve the polyphenols bioaccessibility was equally evident
Stimulator of interferon genes immunohistochemical expression in the spectrum of extrarenal perivascular epithelioid cell lesions
No full text: Angiomyolipoma is the prototype of the perivascular epithelioid cells (PEC) lesions whose pathogenesis is usually determined by mutations of the TSC1/2 genes, with eventual deregulation of the mTOR pathway, whereas a small subset of PEComas is driven by rearrangements of the TFE3 gene. It is well known that the mTOR complex protein is involved in autophagy, and the role of STING has recently been demonstrated in this process. As relevant STING immunolabelling in the PEC lesions of the kidney has already been reported, we sought to further investigate the immunohistochemical expression of this marker in a series of extrarenal PEComas. Thirty-nine PEComas from different sites (17 uterus, 5 lungs, 4 pancreas, 4 retroperitoneum, 3 soft tissues, 3 liver, 1 lymph node, 1 bowel, and 1 urinary bladder) were collected from 36 patients, including 35 primary tumors and 4 distant metastases. The cohort encompassed 27 epithelioid PEComas, 8 clear cell sugar tumors, and 4 lymphangioleiomyomatoses. Immunostaining for STING was carried out. Strong and diffuse immunolabeling of STING was documented in 90% of PEComas (35/39), with concordant expression in primary and metastatic samples (4/4, 100%). No TFE3 gene rearrangement was documented by FISH, although one STING-negative case showed minimally split fluorescent signals separated by a signal diameter. Our findings support the hypothesis of a STING-mediated alteration of the autophagic process in the PEComas and suggest a potential biological and therapeutic role for this marker and its related pathway