Archives of Clinical and Biomedical Research

Objective: To characterize pregnancy outcomes and menstrual irregularities in Mexican women with systemic lupus erythematosus (SLE) and identify clinical factors associated with adverse pregnancy outcomes and early-onset menopause. Methods: We conducted a cross-sectional study of women with SLE enrolled in the Mexican Lupus Registry (LupusRGMX) between May 2021 and September 2024. Clinical and reproductive data were collected using standardized questionnaires. Menopause was defined as the absence of menstruation for [≥]12 consecutive months, and early menopause as onset before age 40. Univariable and multivariable logistic regression analyses were used to identify factors associated with pregnancy complications and early menopause. Results: A total of 210 women were included. Median age was 38 years (IQR 29-46) and median disease duration was 4 years (IQR 1-10). Among women with a history of pregnancy (47%), full-term delivery predominated (61%), while pregnancy loss occurred in 26% and preterm delivery in 13%. Pregnancy complications were reported in 9.6%, most commonly preeclampsia (6.7%). Younger maternal age was independently associated with pregnancy complications (OR 0.89, 95% CI 0.83-0.95) and adverse outcomes (OR 0.95, 95% CI 0.92-0.98). Higher disease activity was associated with complications in univariable analysis. Most pregnancies (68.3%) occurred before diagnosis. Early menopause was observed in 6.2% and independently associated with longer disease duration and older age. Conclusion: Younger maternal age was independently associated with adverse pregnancy outcomes, whereas disease activity showed an association in univariable analysis. Most pregnancies occurred prior to SLE diagnosis. Early menopause was associated with longer disease duration, suggesting impact of cumulative disease burden on ovarian function.

IntroductionPneumonia is a common source of sepsis and carries significant morbidity and mortality. Prior research suggests patients with severe mental illness may receive disparate care and experience worse outcomes from infectious and cardiovascular conditions. Whether mental illness influences the radiographic presentation of pneumonia-related sepsis, which can guide antimicrobial selection and clinical decision making, remains poorly-understood. MethodsThis retrospective study examined chest imaging findings in 202 adult septic patients with respiratory source infection presenting to a large tertiary care emergency department between December 2017 and December 2019. Patients were stratified by the presence (n = 51, 25.2%) or absence (n = 151, 74.8%) of a comorbid mental illness, defined broadly to include neurocognitive, mood, personality, psychotic, and substance use disorders. Radiographic findings, including parenchymal abnormalities, pleural effusions, and laterality, were systematically abstracted from the medical record and compared between groups using Chi-squared testing. ResultsPatients with mental illness were more likely to have at least one radiographic finding (84% vs. 74%), though this difference did not reach statistical significance (p = 0.14). The average number of findings per patient was nearly identical between groups (3.14 vs. 3.12, p = 0.38), and no individual radiographic feature differed significantly between cohorts. DiscussionThese findings suggest that, contrary to our hypothesis, mental illness may not be associated with the radiographic appearance of pneumonia in septic patients. Larger, diagnosis-specific studies are needed to evaluate whether specific psychiatric subgroups exhibit distinct imaging patterns.

BackgroundRadiation protection is a fundamental component of diagnostic radiology to minimize occupational and patient exposure to ionizing radiation. ObjectiveTo assess compliance with radiation protection standards and identify key deficiencies in conventional radiology units. MethodsA descriptive cross-sectional study was conducted in the radiology department of Ibn Tofail University Hospital, Marrakech. Twenty-five occupationally exposed radiology personnel were included using exhaustive sampling. Data were collected using structured observation grids and self-administered questionnaires to assess compliance with radiation protection standards. ResultsThe study revealed major deficiencies, including absence of individual dosimetry, inadequate structural shielding, poor quality control procedures, and non-compliance with occupational safety standards. ConclusionRadiation protection practices remain suboptimal, requiring urgent institutional reinforcement of regulatory compliance and enforcement, monitoring systems, and training programs.

BackgroundPreterm birth remains a leading cause of neonatal mortality globally, with Nigeria bearing a disproportionately high burden. Racial disparities are well documented, with Black populations experiencing significantly higher rates than Caucasian populations. Active matrix metalloproteinase 8 (aMMP-8), a neutrophil derived collagenase, is the final effector in extracellular matrix degradation and has been implicated in membrane weakening and parturition. However, no trimester specific numeric aMMP-8 data exist for African populations, limiting cross population comparisons. Our earlier work hypothesized that elevated aMMP-8 may explain racial disparities in preterm birth, serving as a common pathway through which socioeconomic, psychosocial, infectious, genetic, and immunological risk factors operate. MethodsWe conducted a single center observational study establishing baseline aMMP-8 levels in Nigerian pregnant and non pregnant women at Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria. Mouthrinse samples were analyzed using the aMMP-8 Point of Care Test (Oralyzer) system. Pregnant women were sampled across all three trimesters and followed to delivery. Descriptive statistics, group comparisons (Mann-Whitney U), trimester comparisons (Wilcoxon signed rank), and subgroup analyses by education and oral hygiene status were performed. Statistical analyses were performed using standard formulas for non-parametric tests. ResultsA total of 40 pregnant women had complete trimester specific aMMP-8 values, with 40 non pregnant controls. Mean aMMP-8 levels were 28.7 ng/mL (T1), 25.38 ng/mL (T2), and 25.05 ng/mL (T3), with non pregnant controls at 19.2 ng/mL. All trimesters showed higher levels than non pregnant controls, reaching statistical significance (p < 0.05). T1 was higher than both T2 and T3, reaching statistical significance (p = 0.031 and p = 0.008, respectively). No significant differences in aMMP-8 levels were observed by education level or oral hygiene status. When compared with the only existing numeric reference from the global oral synthesis-- total MMP-8 in GCF at 6.25 ng/mL--our aMMP-8 values were numerically 4.6 times higher in T1. Baseline MMP-8 concentrations in amniotic fluid from control groups in intra amniotic inflammation studies are approximately 1-5 ng/mL. Our mouthrinse aMMP-8 (28.7 ng/mL in T1) is numerically 6-29 times higher than these values, despite mouthrinse being the most diluted oral compartment. This discrepancy supports a hypothesis that intrauterine aMMP-8 levels could be elevated in this population, though direct paired measurements are required to confirm this. ConclusionNigerian pregnant women in this cohort demonstrate aMMP-8 levels substantially higher than published Caucasian references and exceed control values from amniotic fluid studies by multiples. These findings are consistent with our earlier hypothesis that elevated aMMP-8 could represent a plausible final common pathway through which socioeconomic disadvantage, chronic stress, infection, genetic predisposition, and heightened baseline inflammation may contribute to preterm birth risk. The neglect of aMMP-8 in preterm birth disparity research may represent a missed opportunity for non invasive risk stratification, mechanistic understanding, and potential targeted intervention.

Background The use of oral retinoids and valproate during pregnancy can cause birth defects. In 2018, the EMA revised Pregnancy Prevention Programs (PPPs) for these medications. Pharmacy technicians in Denmark dispense prescription medications and must counsel customers. Aims This study aimed to examine knowledge of the teratogenicity of oral retinoids and valproate and use of the relevant PPPs among pharmacy technicians in Denmark. Methods A cross-sectional survey was conducted in spring 2025 using questionnaires developed for and tested in an international project. Data was collected via relevant Facebook groups and email invitations. Descriptive statistics were used for analyses. Results For oral retinoids, 80 respondents were analyzed; 95% were women, 86% were pharmacy technicians, the mean age was 37.2 years. Most dispensed oral retinoids several times per month. Two respondents did not know retinoids were teratogenic. The most used PPP measure was the outer packaging warning (54%). Informing women about teratogenic effects was the most common practice. For valproate, 41 respondents were analyzed. Their characteristics were similar to those of respondents in the oral retinoid survey. Most dispensed valproate once per month. One-third did not know valproate was teratogenic. The outer packaging warning was used by 19%. The most common practice was referring to the prescribing physician if pregnancy was suspected. Conclusion Danish pharmacy technicians knowledge about teratogenic drugs and the PPP was poorer than that of pharmacists, especially regarding valproate, and requires attention in educational programs. The feasibility of PPP measures for both oral retinoids and valproate should be optimized.

Medical imaging using CT is vital for diagnosing children, but it uses radiation that may increase long-term health risks due to their young age and sensitive bodies. In South Africa (SA), there are currently no national standards for how much radiation should be used for these scans. We conducted this study at a large hospital to audit our current practices and ensure we are keeping our youngest patients as safe as possible while still getting clear diagnostic images. We looked at 543 CT scans performed on children over a 3 year period. We specifically looked at the radiation doses used for the most common scans, such as brain scans, across different age groups. Our results showed that the radiation levels at our hospital are in line with both international safety standards and locally. We also noticed that scans performed afterhours use slightly higher radiation doses than those during the day. These results are encouraging because they show that our hospital is providing safe care that matches global benchmarks. However, the slightly higher doses during after-hours shifts suggest we should focus on more consistent training and standardized settings for all staff, regardless of when the scan is performed.

BackgroundPatient radiation exposure in diagnostic radiology is an important concern for radiation protection and patient safety. Monitoring radiation dose levels during radiographic examinations is essential to ensure compliance with diagnostic reference levels (DRLs) and to optimize radiological practices. ObjectiveThe aim of this study was to evaluate patient radiation dose during conventional lumbar spine radiography and compare the obtained values with diagnostic reference levels. MethodsA descriptive cross-sectional multicenter study was conducted in four hospitals in the Sous Massa region, Morocco, between April and June 2017. Data were collected from 142 patients undergoing lumbar spine radiography examinations and from 20 radiology technicians. Exposure parameters including tube voltage, tube current, exposure time, focus-to-film distance, and field size were recorded. Entrance surface dose (ESD) was estimated using MICADO software, and dose area product (DAP) values were subsequently calculated. The 75th percentile values were determined and compared with diagnostic reference levels. ResultsThe regional 75th percentile ESD values were 5.33 mGy for the anteroposterior projection and 7.38 mGy for the lateral projection. Corresponding DAP values were 1840.9 mGy.cm2 and 2783.65 mGy.cm2, respectively. All obtained values were below the diagnostic reference levels used for comparison. However, variations between hospitals were observed, likely due to differences in imaging protocols and equipment. ConclusionRadiation doses associated with lumbar spine radiography in the evaluated hospitals were within acceptable limits according to diagnostic reference levels. Continuous monitoring of patient radiation exposure and optimization of radiographic techniques remain essential to ensure effective radiation protection.

Background: Platinum-based chemotherapy is known to cause severe and debilitating hearing loss, but unlike cisplatin, the true incidence of carboplatin-induced hearing loss remains unclear. We evaluated functional hearing outcomes in children receiving carboplatin to determine the incidence and severity of ototoxicity. Procedure: We identified a large cohort of children with cancer treated with carboplatin and graded their audiograms using the SIOP ototoxicity scale. Patients with inadequate audiological follow-up, prior hearing loss, or exposure to cisplatin were excluded. Fishers exact test, logistic regression, and ROC analyses were performed to investigate associations of demographic, treatment, and exposure-related risk factors with incidence of hearing loss. Results: 200 patients were included, all of whom had been treated with carboplatin. Only nine (4.5%) patients developed clinically significant hearing loss (SIOP grade [&ge;]2). Younger age at first exposure to carboplatin was the only significant predictor of hearing loss (OR = 0.7888, p=0.0241). Age [&le;]28 months was significantly associated with hearing loss (OR 12.37, p=0.0042). No other risk factors or exposures were statistically significant. Conclusions: Clinically significant carboplatin-associated hearing loss was uncommon (incidence 4.5%). We show that young age is the single-most important risk factor for hearing loss; of nine children who developed hearing loss, eight were aged [&le;]28 months. Children below this age have twelve-fold higher odds of developing hearing loss compared to those above this age (OR 12.37). These findings will allow physicians to provide more appropriate counselling to families regarding ototoxic risk and support intensified hearing surveillance in young children.

Background. Lung metastases in osteosarcoma (OS) are the main cause of the death. The accuracy of the diagnosis of nodules by computed tomography (CT) of the lungs is critically important for determining the disseminated stage of the disease and planning surgical treatment. The use of artificial intelligence (AI) in the search for lung nodules increases the accuracy of diagnosis and reduces the chance of missing metastases. Objective: to evaluate the accuracy of lung nodules diagnosis in adolescents with OS using AI. Methods. A retrospective assessment of CT scans of adolescents with OS was performed. A pathological nodule with an average size of [&ge;]4 mm was considered a target finding. The diagnostic accuracy of an AI algorithm previously trained on an adult dataset was evaluated, and the number of false positives (FP) and false negatives (FN) was determined. Sensitivity, specificity, accuracy, area under the ROC curve (AUC), positive predictive value, negative predictive value, and F1-measure were calculated. Based on the obtained results, the effectiveness of the algorithm was assessed. Results. 248 CT scans of adolescents with OS were evaluated. The following results were obtained: in 5 cases, the AI algorithm showed a FP result (2.02%), in 34 cases, it showed a FN result (13.71%), and in 209 cases, a correct result (both true positive and true negative) (84.27%). The diagnostic accuracy of the algorithm was 0.843 (95% CI 0.794-0.887). The application of the AI algorithm in the practice of an X-ray doctor in a specific clinical task would allow to increase the sensitivity from 0.805 to 0.891, while ensuring an absolute decrease in the number of FN results by 8.59% and a relative decrease by 44%. Conclusion. The obtained results confirm the practical value of the application of the AI algorithm and justify the implementation of AI-assisted systems in the diagnostic protocols for lung metastases in adolescents with OS.

PurposeGlasdegib is a Sonic Hedgehog (SHH) pathway inhibitor used for treating newly diagnosed acute myeloid leukemia in elders or patients unfit for intensive chemotherapy. This study sought to demonstrate growth inhibition and increased apoptosis of B-cell acute lymphoblastic leukemia (B-ALL) in vitro under glasdegib, alone and combined with inotuzumab, using a novel co-culture system and validated chemosensitivity testing model to determine whether glasdegib with and without inotuzumab may represent a promising treatment strategy in B-ALL. MethodsSeven blood and marrow samples from B-ALL patients were co-cultured with HS-5 stromal cells in a co-culturing system designed to mimic the tumor microenvironment to maintain B-ALL cell viability for chemosensitivity testing under glasdegib and inotuzumab. ResultsCo-culturing improved B-ALL viability from four to nine days. Dosage-dependent responses to glasdegib were consistent among B-ALL samples on day four based on culture viability, and varied based on expressions of SSH genes GLI1, GLI3, SMO, and PTCH1. Combination with inotuzumab had varied effects on treatment response. ConclusionCo-culturing B-ALL cells with HS-5 stromal cells improves B-ALL growth and viability. Glasdegib with and without inotuzumab treatments impact the viability of co-cultured B-ALL cells by day four. SHH gene expressions suggest different B-ALL patients may be sensitive or resistant to glasdegib and inotuzumab.

BACKGROUND: Prostate cancer (PrCa) is the most commonly diagnosed cancer in men in many countries and is the most heritable of the common cancers. Precision medicine approaches to disease management are not routinely available to most men, yet we know that germline genetic testing can help identify those at high-risk of developing advanced or lethal disease and can influence selection of therapeutics. An integral part of healthcare delivery design is the inclusion of patients/consumers in the development of frameworks for managing health interventions that are tailored to meet their needs. METHODS: In Phase I, we undertook focus group discussions with men previously diagnosed with PrCa (n=20), to determine their opinions, perceptions and expectations of germline genetic testing for PrCa. Focus groups were tape-recorded, transcribed verbatim, coded and then thematically analysed using NVivo. In Phase II, themes were then used to design and development a Precision Medicine in Prostate Cancer Information Toolkit, which was reviewed by patients (n=14), their carers/family members (n=4) and healthcare providers (n=14). RESULTS: In Phase I, knowledge about precision medicine and genetic testing was generally low. The strongest motivation for undertaking testing was to identify family members' risk levels (n=7), and the biggest concern pertained to insurance discrimination (n=5). Phase II data revealed that generally healthcare providers (n=8) found the purpose of the toolkit to be clearer than patients (n=5). Though, patients found the task of imagining the usefulness of the toolkit at the time of diagnosis or beforehand when assessing genetic risk, quite difficult. Participants highlighted that information regarding life insurance, implications for their family and costs associated with testing were of concern. CONCLUSIONS: This study has revealed critical knowledge gaps, preferred communication/support needs, and concerns/risks associated with germline genetic testing in PrCa. Concerns pertaining to family members and insurance discrimination are obvious topics that need to be addressed. Our toolkit may be helpful in addressing knowledge gaps, but further testing is needed to ensure its accessibility across literary and cultural contexts.

BackgroundReusable menstrual products provide sustainable and cost-effective alternatives to disposable sanitary products; however, their adoption remains limited, even among healthcare professionals. ObjectivesTo assess awareness, knowledge, perceptions, and utilisation of reusable menstrual products among female medical students and healthcare professionals, and to identify predictors of willingness and use. DesignCross-sectional analytical study. SettingAn online survey was conducted among female medical students and healthcare professionals in Nigeria. ParticipantsA total of 203 female respondents aged 15-55 years. InterventionNot applicable. Primary Outcome MeasuresUtilisation of reusable menstrual products and willingness to adopt their use. Secondary Outcome MeasuresAwareness, knowledge, perceptions, and barriers. MethodsData were collected using a structured questionnaire and analysed using descriptive statistics, chi-square tests, and logistic regression. ResultsAwareness was high (96.06%), but utilisation was low, with 5.42% ever using and 4.43% currently using reusable products. About 31.53% were willing to use them. Respondent type was not associated with willingness (p = 0.735), although healthcare professionals had higher knowledge (p = 0.024). Positive perception predicted willingness (AOR = 7.58, 95% CI: 3.18-18.03, p < 0.001). Good knowledge (AOR = 14.96, p = 0.014) and increasing age (AOR = 1.28, p = 0.004) predicted utilisation. ConclusionDespite high awareness, utilisation remains low. Perception influences willingness, while knowledge drives use. Targeted behavioural and educational interventions are needed. Article SummaryStrengths and limitations of this study O_LI- This study used a cross-sectional design with a structured questionnaire to assess awareness, knowledge, perceptions, and utilisation of reusable menstrual products among healthcare trainees and professionals. C_LIO_LI- The inclusion of both medical students and healthcare professionals enabled comparison across groups with differing levels of clinical exposure. C_LIO_LI- The use of multivariable logistic regression allowed identification of independent predictors of willingness and utilisation. C_LIO_LI- The study employed convenience sampling and an online survey, which may limit the representativeness of the sample. C_LIO_LI- Data were self-reported, which may introduce recall and social desirability bias. C_LI

PurposeIn this study, we aimed to develop and evaluate an artificial intelligence-based diagnostic model for the diagnosis of acute cholecystitis (AC) using non-contrast CT images and clinical data. Materials and MethodsThis retrospective study included 199 patients (100 AC, 99 non-AC) treated between January 2016 and December 2025 at a single center. Patients were randomly divided into training (n=139) and test (n=60) datasets. Three models were constructed: an imaging-based deep learning model, a clinical data-based machine learning model, and a hybrid machine learning model integrating deep learning-derived imaging features with clinical data. CT images were preprocessed, and gallbladder regions were segmented. Clinical variables included white blood cell counts and levels of C-reactive protein and liver function markers. Model performance was evaluated using accuracy, precision, recall, specificity, F1 score, and area under the receiver operating characteristic curve (AUC). Statistical comparisons were performed using Welchs t-test and Chi-square test. ResultsThe imaging-based model achieved accuracy 0.883, precision 0.848, recall 0.933, specificity 0.833, and AUC 0.916. The blood-based model achieved accuracy 0.917, precision 0.931, recall 0.900, specificity 0.933, and AUC 0.949. The hybrid model showed the highest performance, with accuracy 0.950, precision 0.909, recall 1.000, specificity 0.900, F1 score 0.952, and AUC 0.986. ConclusionA hybrid model integrating CT imaging and clinical data improved diagnostic performance for AC compared with single-modality models.

Objective:This study aims to compare the advantages and disadvantages of DLIR and adaptive statistical iterative reconstruction-V (ASIR-V) in thin-slice (2.5 mm) CT images of hepatic lesions characterized by high and low contrast. Additionally, the study seeks to determine the optimal DLIR strength for the evaluation of liver lesions. Methods:A retrospective analysis was performed on 90 patients who underwent abdominal contrast-enhanced CT scans. Group A comprised 48 patients with low-contrast lesions, while Group B included 42 patients with high-contrast lesions. The acquired images were reconstructed using post-processing DLIR at low (DLIR-L), medium (DLIR-M), and high (DLIR-H) strengths, all with a slice thickness of 2.5 mm (subgroups A1-A3, B1-B3). Furthermore, images were reconstructed with ASIR-V at 50% strength at slice thicknesses of 2.5 mm and 5 mm (subgroups A4/B4 and A5/B5, respectively). CT values and standard deviations (SD) of the liver and lesions were measured, and the corresponding signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. The edge rise slope (ERS) was determined using ImageJ software by measuring CT values along a line from the liver parenchyma to the lesion. Objective metrics were compared using one-way ANOVA, with independent samples t-tests applied for inter-group differences. Subjective scoring, which encompassed noise level, diagnostic confidence, and lesion margin delineation, was conducted by two radiologists, with differences analyzed using the Kappa test. Results: Objective evaluation revealed a progressive decrease in lesion SD and a progressive increase in SNR and CNR from subgroups A1/B1 to A3/B3. The SD of Group A2 decreased by 57.4% compared to A4, while the SNR and CNR of A2 icreased by 19.3% and 24.6% compared to A4. Although subgroup B2 had a lower SNR than B5, the difference was not statistically significant. SNR and CNR in B2 increased by 24.1% and 11.9%, respectively, compared to B4. ERS gradually decreased from A1/B1 to A3/B3. ERS values in A2 and B2 increased by 27.0% and 39.4%, respectively, relative to A5 and B5. Although A3 had a lower ERS than A1 and A2, all DLIR subgroups exhibited higher ERS than A5; similar trends were observed in Group B. Subjective evaluation indicated good inter-reader agreement (Kappa > 0.61, p < 0.05). As DLIR strength increased, noise scores rose progressively in both groups. However, noise in A2 and B2 was lower than in A4/A5 and B4/B5. Diagnostic confidence and lesion margin delineation scores were highest in A2 and B2, while all subjective scores were lowest in A5 and B5. Discussion: Most prior studies evaluated the liver, vessels, or confirmed that image quality can be guaranteed at low doses. However, there are few studies on specific individual lesions. Therefore, this study aims to investigate specific individual lesions. The details and detection rate were analyzed separately to confirm the clinical acceptability of 2.5-mm DLIR image in different contrast lesions. Conclusion: For both high- and low-contrast hepatic lesions, DLIR provides superior image quality compared to ASIR-V, with the 2.5mm DLIR-M setting being optimal. DLIR-M reduces image noise, improves spatial resolution, and produces images more suitable for diagnostic purposes.

BackgroundPharmacogenomic testing (PGx) can optimise drug efficacy and minimise toxicity, but the extent of prescriber adherence to PGx recommendations remains unclear. We aimed to quantify clinician adherence to international genotype-guided prescribing recommendations in a cohort of paediatric oncology patients. MethodsWe reviewed files of children enrolled in the MARVEL-PIC (NCT05667766) randomised control trial, who had PGx recommendations available. Patients were included if 12 weeks had passed since their PGx report was released to clinicians. Prescribing events were identified for actionable PGx recommendations, and classified as "explicitly followed", "inadvertently followed", or "not followed". Adherence was assessed by patient, drug, and recommendation. Results2,063 PGx recommendations were available for 216 patients. 64 (3.1%) recommendations were actionable for 44 patients and 10 drugs within the 12-week study period. Recommendations were explicitly followed in 57/288 (19.8%) of prescribing events, inadvertently followed in 145 (50.3%), and not followed in 86 (29.9%). Mercaptopurine demonstrated the highest rate of explicit adherence (87.5%). No significant associations were observed between adherence and age group, cancer type, drug type, or strength of recommendation. ConclusionAdherence to pharmacogenomic recommendations was very low, highlighting the need to understand barriers to PGx implementation, and consideration of clinical decision supports to facilitate adherence. Plain Language SummaryPharmacogenomic medicine (PGx) looks at how our genes affect our response to drugs, including their effectiveness and toxicity. Through genetic analysis we can create recommendations for drug dosing, avoidance, and monitoring. The MARVEL-PIC study aims to understand if having PGx recommendations decreases the rate of adverse events in children with cancer. We aimed to understand how often prescribers follow PGx recommendations after they are made available, in the MARVEL-PIC trial. To do this, we reviewed medical records and identified relevant prescribing events. We marked these as "recommendation explicitly followed", "recommendation not followed", or "recommendation inadvertently followed" (where the recommendation was followed, but it wasnt clear if this due to PGx). We found that when recommendations were available, they were only explicitly followed in around 20% of cases. In 50% of cases, they were followed but it was unclear whether this was due to PGx. In the remaining 30%, they were not followed. We also found that alerts on our electronic system were fired in about 80% of events where the recommendation was not followed, but did not change the outcome. These findings show that prescriber adherence to PGx recommendations is low. We need to better understand why this is the case and implement more specific tools to assist prescribers in following recommendations. Article HighlightsO_LIPharmacogenomic (PGx) testing can reduce adverse drug reactions by guiding drug choice, dosing, and monitoring. C_LIO_LI!Prescriber to PGx recommendation adherence has not been widely investigated. C_LIO_LIRetrospective analysis showed that explicit adherence to recommendations occurred in only 19.8% of relevant prescribing events. C_LIO_LIIn 50.1% of prescribing events, recommendations were followed, but there was no clear reference to PGx. C_LIO_LIMercaptopurine had the highest explicit adherence (87.5%) from the drugs analysed. C_LIO_LIThere were no statistically significant associations between adherence and age group, cancer type, drug type, or recommendation strength. C_LIO_LIRecommendations were explicitly followed in 29% of events where an interruptive alert was fired, and inadvertently followed in 8%. C_LIO_LITailored interruptive alerts have been shown to increase adherence in other studies, suggesting that the specific design of interruptive alerts may influence adherence. C_LIO_LIWe concluded that explicit prescriber adherence to PGx recommendations is very low (19.8%), and further research needs to be done to understand barriers to implementation. C_LI

This study analyzes the adoption, barriers, and expectations of French radiologists regarding the use of Artificial Intelligence (AI) solutions in their daily practice. Despite a recognition of AI's potential to make radiology more precise, predictive, and personalized, its adoption remains limited. The main obstacles identified are the high cost of those solutions and the insufficient equipment of French imaging centers with AI technologies. Nevertheless, the survey reveals a strong willingness to adopt, with over 70% of radiologists expressing their desire to use AI and 0% declaring a refusal to use it. Furthermore, the radiologists' fears of being replaced by AI are very low (0 to 8.8%).

Head and neck cancer (HNC) requires accurate tumor delineation for effective radiotherapy planning. Manual segmentation of tumor regions is time-consuming and subject to considerable inter-observer variability. Although several automated approaches have been proposed, many rely on multimodal imaging such as PET/CT, which is expensive, less accessible in many clinical settings, and increases the burden on patients. In this work, we investigate a CT-only three-dimensional segmentation framework that provides a clinically practical and resource-efficient alternative. CT images of 136 head and neck cancer patients from the publicly available HN1 dataset in The Cancer Imaging Archive (TCIA) were used along with 30 additional cases from a private dataset collected at a tertiary care centre, Christian Medical College (CMC), Vellore, India. A fully automated segmentation model was developed to delineate the primary gross tumor volume (GTV) using the 3D nnU-Net framework. The models were trained using the HN1 dataset and an extended HN1+CMC dataset that included the additional private cases. Performance was evaluated using three-fold cross-validation with standard segmentation metrics including Dice Similarity Coefficient (DSC), Intersection over Union (IoU), and the 95th percentile Hausdorff Distance (HD95). The proposed CT-based model achieved a Global Dice of 0.63 and a Median Dice of 0.60 on the HN1 dataset. When the additional CMC cases were incorporated during training, the performance improved to a Global Dice of 0.65 and a Median Dice of 0.71. These results demonstrate that 3D nnU-Net can effectively segment head and neck tumors from CT images alone. The proposed CT-only approach provides a cost-effective and scalable solution that can support radiotherapy treatment planning and help reduce variability in clinical workflows.

AO_SCPLOWBSTRACTC_SCPLOWMany commonly used therapeutic drugs cause biliary toxicity, but it is unclear if they are directly responsible for the increasing incidence of cholangiocarcinoma (CCA). We tested experimentally and analyzed through a cohort approach whether drugs, such as the commonly used antibiotic Augmentin, which is a poster-child of biliary toxicity, are causally linked to CCA development. Using sophisticated analytical tools in cholangiocytes, including single extracellular vesicle (EV) analysis, we found no evidence that Augmentin increases the cholangiocyte malignancy marker YAP1 or phospho-YAP1. Furthermore, we analyzed the CCA incidence in our healthcare system and determined it to be 0.0932% (Augmentin group) and 0.0799% (amoxicillin control group). Although the Augmentin group showed a numerically higher CCA incidence, the association did not reach statistical significance (RR = 1.1669, 95% CI 0.6200-2.1961; Fishers exact test, P = 0.7493). Similarly, we found no evidence for cholangiocarcinoma development with other commonly used drugs, including chlorpromazine, floxuridine, 5-fluorouracil, flucloxacillin and terbinafine. We conclude that there is no direct causal relationship between clinical Augmentin doses and CCA development.

Kawasaki disease (KD) is a systemic vasculitis in young children, and early diagnosis remains challenging when clinical features are incomplete or overlap with those of other febrile illnesses. Because electrocardiography (ECG) is noninvasive and widely available, we investigated whether ECG-derived features could help distinguish complete KD from pediatric patients with fevers. We conducted a single-center retrospective study of hospitalized febrile children aged 1-8 years who underwent digital 12-lead ECG recording during the initial evaluation. Five amplitude features and six timing features extracted from the ECG were used to develop a logistic regression model to distinguish between complete KD and other febrile illnesses. The model discriminated between the KD and non-KD groups in the validation dataset. The prediction score was not significantly correlated with the age and body temperature. S-wave amplitude, the RR interval, and P-and Q-wave amplitudes were suggested to contribute to discrimination. These findings suggest that ECG-derived features may provide adjunctive information for distinguishing complete KD from other febrile illnesses. Author SummaryKawasaki disease is an inflammatory illness in young children that can lead to coronary artery complications if treatment is delayed. Early diagnosis is often difficult because its initial symptoms overlap with those of many common febrile illnesses. We investigated whether a routine 12-lead electrocardiogram (ECG), which is noninvasive, rapid, and widely available, contains information that can help distinguish complete Kawasaki disease from other febrile conditions. We retrospectively analyzed digital ECGs from hospitalized febrile children and extracted waveform amplitude and timing features. Using these features, we built a logistic regression model and evaluated it in a temporally separate validation cohort. The model distinguished patients with Kawasaki disease from patients with fever. P-, Q-, and S-wave amplitudes and the RR interval were repeatedly selected as important contributors, suggesting that both waveform morphology and heart-rate-related information may be relevant. These findings indicate that ECG-derived features may provide useful adjunctive information during the clinical assessment of complete Kawasaki disease.

Despite the remarkable progress of artificial intelligence represented by large language models, how AI technologies can contribute to the construction of evidence in evidence-based medicine (EBM) remains an overlooked issue. Now, we need an AI that can be compatible with EBM. In the present paper, we aim to propose an example analysis that may contribute to this approach using variable Vision Transformer.