Diagnostics最新文献

{"title":"The Human Labial Superficial Musculoaponeurotic System (SMAS): Anatomy, Imaging, and Biomechanical and Sensory Implications-A Narrative Review.","authors":"José Martín-Cruces, Estefanía Del Rocío Ocampo Poma, Luis Alberto Chauca Bajaña, Mirian Teulé-Trull, Patricia Cuendias, Yolanda García-Mesa, José A Vega","doi":"10.3390/diagnostics16193208","DOIUrl":"10.3390/diagnostics16193208","url":null,"abstract":"<p><p>The superficial musculoaponeurotic system (SMAS) is a fundamental concept in facial anatomy and surgery, but its organization within the human lips remains incompletely defined. This narrative review critically reassesses the anatomical evidence for a labial SMAS and its regional configuration. Published anatomical, histological, and imaging evidence was critically reviewed. The literature review is complemented by original qualitative histological and imaging observations of the human lips, included exclusively for morphological correlation with the published anatomical evidence and not as an independent quantitative study. The available evidence does not demonstrate a classical, readily separable laminar SMAS within the lips. Instead, it supports a three-dimensional connective tissue network extending from the oral mucosa to the skin and intimately incorporating the orbicularis oris muscle. This organization is associated with neurovascular structures and may have biomechanical and sensory implications, although these functional interpretations are not directly demonstrated by the present material. The labial connective tissue architecture differs from the classical laminar SMAS described in other facial regions and may represent its regional equivalent. Further three-dimensional anatomical studies are required to establish this interpretation conclusively. By defining the normal fibromuscular architecture of the lips and the limits of its visualization, this review provides an anatomical framework for interpreting lip imaging while emphasizing that a labial SMAS is not currently a validated diagnostic or prognostic marker.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"16 19","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting Retinopathy of Prematurity in Thailand: A Practical Model for Risk-Based Screening.","authors":"Suppachai Lawanaskol, Jayanton Patumanond, Phichayut Phinyo, Songklot Noppakaonamchokchai, Chompoonoot Kunaviktikul, Anavat Bupphachareonsuk, Pakawadi Vuttipittayamongkol, Apichat Tantraworasin, Janejit Choovuthayakorn","doi":"10.3390/diagnostics16193207","DOIUrl":"10.3390/diagnostics16193207","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Retinopathy of prematurity (ROP) screening must balance timely detection with feasibility, particularly in resource-limited settings. We aimed to develop a pragmatic, locally derived prediction model to support prioritization of ophthalmologic assessment among Thai neonates already eligible for ROP screening. <b>Methods</b>: We conducted a retrospective cohort study of neonates undergoing their first planned ROP screening examination at Chiang Rai Prachanukroh Hospital (2011-2015) and Lampang Hospital (2021-2022). Prespecified predictors included gestational age, birth weight, multiple pregnancy, respiratory distress syndrome, neonatal anemia, neonatal sepsis, necrotizing enterocolitis, bronchopulmonary dysplasia, duration of oxygen exposure, and duration of mechanical ventilation. A multivariable logistic regression model was developed. Performance was evaluated using discrimination, calibration, decision curve analysis, and bootstrap internal validation with 1000 resamples. <b>Results</b>: Among 681 infants, 50 (7.3%) had any ROP detected at the index examination. The apparent area under the receiver operating characteristic curve was 0.901 (95% CI, 0.856-0.946), and the optimism-corrected estimate was 0.883 (bootstrap 95% CI, 0.841-0.928). Optimism-corrected calibration-in-the-large was 0.008, the expected-to-observed ratio was 1.005, and the calibration slope was 0.866. At the sensitivity-constrained exploratory cut-off of 1.5%, sensitivity was 96.0% and specificity was 53.4%. The observed ROP risk was 14.0% in the higher-risk group and 0.6% in the lower-risk group. Decision curve analysis suggested net benefit across threshold probabilities up to 0.20. <b>Conclusions</b>: The model showed good discrimination and may support risk stratification and prioritization among infants already eligible for ROP screening. The 1.5% cut-off remains exploratory, and independent external validation, preferably in prospective contemporary cohorts, is required before clinical implementation.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"16 19","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Systemic Inflammatory Response Index at Labour Admission and Episiotomy Wound Dehiscence After Vaginal Delivery.","authors":"Zeynep Güvenç, Mehmet Efe Namlı, Hande Kurt Güven, Elif Yılmaz","doi":"10.3390/diagnostics16193198","DOIUrl":"10.3390/diagnostics16193198","url":null,"abstract":"<p><p><b>Background/Objectives:</b> We examined the association between the systemic inflammatory response index (SIRI) measured on admission in labour and complete episiotomy wound dehiscence, and whether the SIRI adds useful discrimination beyond available covariates. <b>Methods:</b> This retrospective case-control study included 200 cases and 200 controls attending postpartum clinics at a tertiary maternity unit (September 2019-September 2022). Controls were randomly sampled from eligible attendees on the same clinic days. The SIRI was calculated from pre-delivery blood counts. Unconditional logistic regression adjusted for maternal age, primiparity, education, income, birthweight and gestational age. Important intrapartum and repair variables were unavailable. <b>Results:</b> The median SIRI was 3.00 in cases and 2.52 in controls (<i>p</i> < 0.001). The log-transformed SIRI was associated with dehiscence after adjustment (OR 1.49 per doubling, 95% CI 1.13-1.97; <i>p</i> = 0.005), whereas the untransformed term was not statistically significant (<i>p</i> = 0.063). The SIRI had poor discrimination (AUC 0.601, 95% CI 0.544-0.655). Adding the SIRI increased the reference-model AUC from 0.699 to 0.713 (ΔAUC 0.014, 95% CI 0.001-0.039); adding neutrophil count yielded an AUC of 0.712. <b>Conclusions:</b> In this selected clinic-attending population, the SIRI showed a model-dependent association with dehiscence but insufficient discrimination for individual risk prediction. Residual confounding remains possible. The small incremental gain does not support using the SIRI for clinical risk stratification or treatment decisions.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"16 19","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine Learning for Risk Prediction in Colorectal Surgery-Game Changer or Unnecessary? An Institutional Pilot Study.","authors":"He Ayu Xu, Philip Deslarzes, Jean Louis Raisaro, Dieter Hahnloser, Martin Hübner, Fabian Grass","doi":"10.3390/diagnostics16193190","DOIUrl":"10.3390/diagnostics16193190","url":null,"abstract":"<p><p><b>Background</b>: The aim of the present study was to identify machine learning (ML)-driven risk constellations to predict specific postoperative outcomes and recovery targets to support the development of targeted interventions, optimized to individual risk profiles. <b>Methods</b>: This retrospective institutional cohort study included consecutive patients who underwent elective colorectal surgery over an 11-year study period focusing on baseline patient characteristics, intraoperative details, and postoperative complications. Five supervised classification algorithms for specific complications and recovery targets were used: logistic regression, support vector machine (SVM), XGBoost, decision tree, and gradient boosting. The dataset was randomly divided into training (80%) and testing (20%) subsets. Model performance was assessed using F1-score for classification task, and for each prediction target; the best-performing model and hyperparameter combination were selected based on validation results. To interpret the contribution of individual features to model predictions, SHAP (Shapley Additive exPlanations) analysis was applied to the best-performing model identified for each prediction target. <b>Results</b>: Logistic regression was the best-performing model for six of the seven postoperative outcomes, whereas SVM performed best for postoperative ileus, indicating that optimal model selection was outcome-specific. Overall, however, none of the tested models clearly outperformed the others in their predictive potential. The discriminative power of the models, as measured by ROC-AUC (receiver operating characteristics-area under the curve), was consistently higher than the baseline of 0.50, peaking at 0.93 for renal dysfunction. In terms of classification accuracy, the prediction of postoperative ileus was the most robust, yielding an F1-score of 0.87. For mobilization, the model showed balanced performance across F1-score (0.72), precision (0.74), and recall (0.71). Given the limited performance across all selected models, SHAP analysis was used to improve the interpretability of the predictions to better understand the contributions of each clinical variable. <b>Conclusions</b>: Complex models in the setting of a structured perioperative dataset only slightly outperform simpler approaches, highlighting the importance of data quality and feature richness rather than just increased model complexity. Future work on improving ML-based risk prediction strategies should thus ensure data quality and focus on integrating dynamic perioperative and postoperative measurements, exploring more flexible modeling frameworks, and validating model performance in larger external cohorts.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"16 19","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Associated with Pain During Transperineal Prostate Fusion Biopsy Under Local Anaesthesia: A Prospective Study.","authors":"Bartłomiej Marczak, Katarzyna Skrobisz, Aleksandra Gostomska, Justyna Klecha, Kevin Miszewski, Maciej Dolny, Dorota Szczodrowska, Anna Koelmer, Amir Naziri, Adam Kaftan, Marcin Matuszewski","doi":"10.3390/diagnostics16193195","DOIUrl":"10.3390/diagnostics16193195","url":null,"abstract":"<p><p><b>Background</b>/<b>Objectives</b>: Transperineal MRI-fusion prostate biopsy under local anaesthesia is increasingly performed in the outpatient setting, which places greater weight on procedural tolerability. Psychological and anatomical determinants of pain have rarely been compared within a single model, and MRI-derived perineal anatomical parameters have not been evaluated. We aimed to identify factors associated with procedural pain and to determine at which step pain peaks. <b>Methods</b>: In this prospective, pre-registered, single-centre cohort study (OSF: osf.io/pbacu), 182 consecutive men referred for transperineal MRI-ultrasound fusion biopsy under local anaesthesia were assessed for eligibility, and 177 constituted the Full Analysis Set. State anxiety was measured with the STAI-S before and after biopsy. Pain was rated on a Numeric Rating Scale (NRS 0-10) by a nurse not involved in the procedure at four predefined steps: probe insertion, skin infiltration, periprostatic nerve block and core sampling. Midline perineal tissue thickness (MPT) and levator ani thickness were measured on pre-biopsy T2-weighted MRI by a radiologist blinded to outcomes. The primary outcome was the maximum NRS score; ten candidate predictors were entered simultaneously into a multivariable linear regression model. <b>Results</b>: Clinically significant pain (maximum NRS score ≥ 4) was reported by 157 of 177 men (88.7%). Pain differed markedly across steps (F(2.68, 472.39) = 230.51, <i>p</i> < 0.001, partial η² = 0.567) and peaked at the periprostatic nerve block (5.88 ± 2.03), exceeding core sampling by 2.62 points (95% CI 1.85-3.40). In multivariable analysis (R² = 0.192), pre-biopsy anxiety was the strongest independent predictor (standardised β = 0.30, partial R² = 0.094, <i>p</i> < 0.001), followed by prostate volume (β = 0.19, <i>p</i> = 0.014); MPT showed only an exploratory, borderline association (β = 0.17, <i>p</i> = 0.052). Core number, body mass index and levator ani thickness were not associated with pain. <b>Conclusions</b>: Most men undergoing transperineal MRI-fusion biopsy experience clinically significant pain, peaking at administration of the periprostatic block rather than at core sampling. Pre-procedural anxiety and prostate volume, both available beforehand, support simple risk stratification, while the block itself is the most logical target for analgesic improvement.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"16 19","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anxiety Symptom Burden at the Time of Forensic Evaluation in Child Victims of Sexual Assault: A Prospective Study Using the Beck Anxiety Inventory.","authors":"Kenan Kaya, Ahmet Aygün, Fatma Çam Aygün, Tuğçe Koca Yavuz","doi":"10.3390/diagnostics16193192","DOIUrl":"10.3390/diagnostics16193192","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Research on child sexual abuse has largely addressed long-term sequelae, whereas anxiety at the time of forensic evaluation has rarely been quantified. This prospective study measured anxiety symptoms in child victims of sexual assault at forensic evaluation and identified the associated sociodemographic and incident-related factors. <b>Methods:</b> Children aged 6 to 17 years referred on suspicion of sexual assault and undergoing genital examination at a university forensic medicine department (Adana, Türkiye; May 2024 to May 2025) were evaluated prospectively. The Beck Anxiety Inventory (BAI) was administered immediately before examination. A proportional-odds ordinal regression model was fitted, with sensitivity analyses restricted to adolescents (12 to 17 years) and robustness analyses (bootstrap resampling, outcome dichotomisation and Firth penalization). <b>Results:</b> Of 104 children (82.7% female), 35 (33.7%) had severe anxiety. After adjustment, age group (aOR 1.95, 95% CI 1.05 to 3.65), penetration (aOR 5.16, 2.02 to 13.22) and disclosure to a formal recipient (aOR 2.48, 1.09 to 5.67) remained associated with anxiety. When restricted to adolescents, penetration (aOR 5.60) and formal disclosure (aOR 2.50) persisted while age lost significance (aOR 2.08); both were confirmed in bootstrap, dichotomised and Firth-penalised models. <b>Conclusions:</b> One third of children carried a severe anxiety burden at forensic evaluation, associated most strongly with penetration and formal disclosure and less consistently with older age, which may be partly artefactual. Without a comparison group, these exploratory findings describe associations rather than causal relationships and support routine psychiatric assessment and psychological support at forensic evaluation.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"16 19","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multivariate Analysis of the Spatial Distance Between the Corneal Thinnest Point and Maximum Keratometry in Keratoconic Corneas: Association with Disease Severity.","authors":"Umberto Camellin, Marco Lombardo, Francesco Franchina, Ivan Ninotta, Gianluigi Latino, Antonio Valastro, Pasquale Aragona, Domenico Schiano-Lomoriello, Anna M Roszkowska","doi":"10.3390/diagnostics16193194","DOIUrl":"10.3390/diagnostics16193194","url":null,"abstract":"<p><p><b>Background:</b> This study quantified the planar distance (D, mm) between the corneal thinnest point (TP) and maximum keratometry (Kmax) and examined its association with tomographic features and keratoconus severity. <b>Methods:</b> Tomographic data from 140 patients (280 eyes) with bilateral manifest keratoconus were obtained with a Scheimpflug camera (Pentacam HR; Oculus, Wetzlar, Germany). D was calculated from the Cartesian coordinates of TP and Kmax. A multiple linear regression model included simulated anterior average keratometry (SimKavg), anterior and posterior radii of curvature (ARC and PRC), and anterior Q-value (Q-ant). Inference used patient-clustered robust standard errors. Internal validation comprised repeated grouped 10-fold cross-validation and patient-level bootstrap resampling. Performance was assessed using R², root-mean-square error (RMSE), mean absolute error (MAE), and Bland-Altman limits of agreement. <b>Results:</b> The model explained 51.8% of the apparent variance in D (adjusted R² = 0.511; <i>p</i> < 0.001). Apparent RMSE and MAE were 0.568 and 0.428 mm. Mean grouped cross-validated performance was R² = 0.472, RMSE = 0.594 mm, and MAE = 0.443 mm. The out-of-fold bias was -0.005 mm, with 95% limits of agreement from -1.162 to +1.151 mm. ARC, SimKavg, and Q-ant remained significant with patient-clustered inference, whereas PRC did not (<i>p</i> = 0.111). <b>Conclusions:</b> D was associated with keratoconus severity and could be estimated with moderate internal performance from routinely available tomographic variables. Collinearity, fellow-eye dependence, and limits of agreement of approximately ±1.1 mm restrict interpretation of individual coefficients and preclude interchangeability with direct measurement. External and longitudinal validation is required before clinical use.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"16 19","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atrial Cardiomyopathy in Patients with Cardiovascular-Kidney-Metabolic Syndrome: Non-Invasive Characterization (ATRIO-CKM).","authors":"Maria-Mihaela Godun, Marius-Traian-Dragoș Marcu, Paula Cristina Morariu, Alexandru-Florinel Oancea, Mugurel-Costel Apetrii, Anca-Elena Ștefan, Diana-Elena Floria, Laura Huiban, Bogdan Todiraș, Mariana Pavel-Tănasă, Anca Trifan, Adrian Covic, Mariana Floria","doi":"10.3390/diagnostics16193196","DOIUrl":"10.3390/diagnostics16193196","url":null,"abstract":"<p><p><b>Background/Objectives</b>: In cardiovascular-kidney-metabolic (CKM) syndrome, left atrium (LA) involvement begins early: reservoir function declines before the chamber dilates, and the resulting atrial cardiomyopathy (ACM) precedes atrial fibrillation (AF), heart failure with preserved ejection fraction (HFpEF), and cardioembolic stroke. How ACM is distributed across CKM stages has not yet been characterized in routine clinical practice. ATRIO-CKM aims to characterize ACM non-invasively across the range of CKM stages in patients assessed in an internal medicine and cardiology department and to identify the parameters most strongly associated with ACM within CKM syndrome. <b>Methods</b>: Single-center, prospective, observational study with cross-sectional phenotyping at the index visit. We will enroll consecutive adults at their first assessment in our department (target, 200; minimum, 150). The primary objective is to estimate the stage-specific prevalence of ACM among participants in sinus rhythm without documented AF, who form the main cohort and are grouped as CKM with versus without ACM. Patients in sinus rhythm are phenotyped with 12-lead electrocardiogram (P-wave duration, Bayés interatrial block), echocardiography with speckle-tracking of the left ventricle (LV), LA (biplane reservoir, conduit, and contractile strain), and right ventricular (RV) free wall, and biomarkers including MR-proANP, Fetuin-A, FGF-23, and NT-proBNP, with cardiac magnetic resonance in an exploratory subset. Participants with AF documented at any time, including previously documented paroxysmal AF, are allocated to a separate established-AF cohort irrespective of the rhythm at the index visit. <b>Results</b>: We will report ACM prevalence by CKM stage with confidence intervals, the profile separating the two groups, LA volume index across three groups of increasing severity (no ACM, ACM in sinus rhythm, and established AF), and the parameters associated with ACM. <b>Conclusions</b>: Using only measurements already available in routine cardiology, ATRIO-CKM will describe how ACM is distributed across CKM stages and identify the parameters most strongly associated with ACM within CKM syndrome, as candidates for a classification index to be developed and validated in a larger cohort.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"16 19","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Performance of 99mTc-MAG3 Renal Scintigraphy for Acute Tubular Necrosis and Acute Rejection in Kidney Transplant Recipients with Suspected Graft Dysfunction During the First 90 Days: A Single-Center, Biopsy-Referenced Retrospective Study.","authors":"Ashraf Imam, Suha Shabaneh, Riham Imam, Michael Rivin, Ahmad Salhab, Itamar Tamir, Keren Tzukert, Roy Abel, Simona Ben-Haim, Harbi Khalayleh, Oded Cohen-Arazi, Abed Khalaileh","doi":"10.3390/diagnostics16193193","DOIUrl":"10.3390/diagnostics16193193","url":null,"abstract":"<p><p><b>Background:</b> Acute tubular necrosis (ATN) and acute rejection are the principal parenchymal causes of early kidney allograft dysfunction, and biopsy is the reference standard for distinguishing them. We assessed 99mTc-MAG3 scintigraphy against biopsy. <b>Methods:</b> Single-center retrospective study of transplants (2016 to 2025) scanned within 90 days for suspected graft dysfunction: 42 transplants in 41 recipients, 10% of 420 screened. Accuracy was calculated only in the 25 with a paired biopsy, with exact 95% confidence intervals (CIs). Because biopsy was performed on clinical indication and not in all patients, verification bias was quantified by Begg-Greenes correction and extreme-case bounds. <b>Results:</b> Scintigraphy was performed a median of 8 days after transplantation; 69% had delayed graft function. Scans were read as ATN in 31 (74%), normal in seven (17%), rejection in three (7%) and obstruction in one; biopsy showed ATN in 15, rejection in six and normal histology in four. For ATN, sensitivity was 14/15 (93.3%; CI 68.1 to 99.8), specificity 7/10 (70.0%; 34.8 to 93.3) and positive predictive value 14/17 (82.4%; 56.6 to 96.2). For rejection, sensitivity was 3/6 (50.0%; 11.8 to 88.2) and specificity 19/19 (100%; 82.4 to 100), the predictive value of three positive scans being uninformative (CI 29.2 to 100). Correcting for verification placed ATN specificity between 29.2% and 76.9% and rejection sensitivity between 13.0% and 50.0%. <b>Conclusions:</b> Scintigraphy rarely missed biopsy-proven ATN but was not specific and identified only half of the rejection episodes. These estimates rest on small numbers in a clinically selected population; biopsy remains necessary whenever rejection is suspected, and they do not apply to routine or protocol scintigraphy.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"16 19","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Giant 90-mm Ossified Stylohyoid Chain Associated with Restricted Mouth Opening.","authors":"Jakub Bargiel, Michał Gontarz, Tomasz Marecik, Krzysztof Gąsiorowski, Grażyna Wyszyńska-Pawelec","doi":"10.3390/diagnostics16193197","DOIUrl":"10.3390/diagnostics16193197","url":null,"abstract":"<p><p>A 62-year-old man was referred with a six-month history of right submandibular pain followed by dysphagia. At presentation, maximal interincisal opening was 25 mm. Computed tomography angiography demonstrated an ossified right stylohyoid chain extending from the skull base to the hyoid region. It measured 90 mm in length and 17.5 × 10.5 mm at maximal cross-section. The chain contacted the external carotid artery, lay 1.1 mm from the internal carotid artery, and was associated with focal narrowing of the internal jugular vein between the chain and the transverse process of the atlas, with preserved venous patency. Because of restricted mouth opening, tracheal intubation required combined fiberoptic and videolaryngoscopic guidance. Under general anesthesia and neuromuscular blockade, maximal passive interincisal opening, measured with a ruler by the operating surgeon, remained 25 mm before resection and increased immediately to 45 mm after transcervical resection using a diamond burr. Distally, the chain was attached to the lesser horn of the hyoid bone by a residual stylohyoid ligament, which was released without hyoid bone osteotomy. The two excised fragments measured 80 mm in combined length, with an approximately 10-mm proximal segment intentionally retained. Pain was resolved, and maximal interincisal opening was 42 mm at six months. This case highlights the value of vascular imaging, precise definition of stylohyoid measurements, and consideration of Eagle syndrome in unexplained restriction of mouth opening.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"16 19","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}