Diagnostics最新文献

{"title":"Development and Internal Validation of a Preoperative Risk Stratification Model for Difficult Laparoscopic Cholecystectomy in Acute Cholecystitis.","authors":"Sinan Aslan, Şebnem Çimen","doi":"10.3390/diagnostics16193191","DOIUrl":"10.3390/diagnostics16193191","url":null,"abstract":"<p><p><b>Background:</b> Difficult laparoscopic cholecystectomy (DLC) in patients with acute cholecystitis (AC) is associated with greater operative complexity and increased perioperative morbidity, yet reliable preoperative risk stratification remains limited. This study aimed to develop and internally validate a preoperative prediction model for DLC and to compare its predictive performance with that of an alternative C-reactive protein-albumin-lymphocyte (CALLY)-based model. <b>Materials and Methods:</b> We retrospectively analyzed consecutive adult patients who underwent laparoscopic cholecystectomy (LC) for AC at a single center between 1 January 2022 and 31 December 2025. DLC was defined as operative time >90 min, conversion to open surgery, subtotal cholecystectomy or a Nassar grade ≥4. Preoperative clinical, laboratory and ultrasonographic variables were evaluated using multivariable logistic regression. Model performance was assessed by discrimination, calibration, Brier score, decision curve analysis and bootstrap internal validation. <b>Results:</b> Among 8530 screened patients, 7736 met the inclusion criteria and 1736 (22.4%) experienced DLC. In the primary multivariable model, Tokyo Guidelines 2018 (TG18) grade II, TG18 grade III and preoperative C-reactive protein (CRP) were independently associated with DLC. The model demonstrated modest discrimination (area under curve (AUC), 0.617; optimism-corrected AUC, 0.612) with a Brier score of 0.167. In the alternative model, TG18 grade III and a lower CALLY index remained independent predictors; however, predictive performance did not improve (AUC, 0.580; Brier score, 0.171). In the sensitivity analysis excluding operative time, severe DLC occurred in 378 patients (4.9%) and none of the candidate predictors remained independently associated with this endpoint. <b>Conclusions:</b> TG18 severity grade and preoperative CRP were independently associated with the composite DLC endpoint, which was predominantly driven by prolonged operative time. Discrimination was limited and no independent associations were identified for severe DLC when operative time was excluded. The alternative CALLY-based model showed lower discrimination than the conventional model. These findings do not support using the model to guide clinical decisions regarding severe operative difficulty.</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/PMC13664390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191862","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 Vertical Skeletal Pattern and Mandibular Cortical Morphology: A CBCT-Based Radiomorphometric Study.","authors":"Buket Erdem, Mustafa Ozcan, Eda Didem Yalcin, Cagla Sar","doi":"10.3390/diagnostics16193174","DOIUrl":"10.3390/diagnostics16193174","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Mandibular cortical morphology has been associated with vertical facial patterns, but differences in standardized radiomorphometric indices remain unclear. This study compared five mandibular indices among vertical skeletal patterns using CBCT-derived panoramic reconstructions. <b>Methods</b>: This retrospective cross-sectional study included 181 adults classified as hypodivergent (<i>n</i> = 42), normodivergent (<i>n</i> = 67), or hyperdivergent (<i>n</i> = 72) according to the sella-nasion-to-mandibular-plane angle. Mental (MI), panoramic mandibular (PMI), gonial (GI), antegonial (AI), and mandibular cortical (MCI) indices were assessed by a blinded dentomaxillofacial radiologist, and bilateral measurements were averaged. Continuous indices were compared using ANOVA or Welch ANOVA and ANCOVA adjusted for age and sex, and the MCI using the chi-square test and logistic regression. <i>p</i> values across the five indices were corrected using the Holm method. <b>Results</b>: No index differed significantly among the groups after correction for multiple comparisons. The MI showed the most notable nominal between-group difference (hypodivergent, 3.92 ± 0.73 mm; normodivergent, 3.73 ± 0.60 mm; hyperdivergent, 3.61 ± 0.68 mm). After adjustment for age and sex, the MI was 0.35 mm greater in hypodivergent than in hyperdivergent subjects (95% CI, 0.04-0.66), but the overall group effect did not remain significant after correction (<i>p</i> = 0.024; Holm <i>p</i> = 0.118). The unadjusted association between the MCI and vertical skeletal pattern (<i>p</i> = 0.035) did not remain significant after correction (Holm <i>p</i> = 0.174) or after adjustment. The PMI, GI, and AI showed no differences. <b>Conclusions</b>: After correction for multiple comparisons, vertical skeletal pattern was not significantly associated with any of the five radiomorphometric indices.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"16 19","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191835","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":"Problem Formulation Outweighs Loss-Function Choice in Deep-Learning Cervical Vertebral Maturation Staging: A Multi-Seed Study on an Imbalanced Public Benchmark.","authors":"Nazlı Tokatlı","doi":"10.3390/diagnostics16193183","DOIUrl":"10.3390/diagnostics16193183","url":null,"abstract":"&lt;p&gt;&lt;p&gt;(1) &lt;b&gt;Background&lt;/b&gt;: Cervical vertebral maturation (CVM) staging on lateral cephalograms informs the timing of orthodontic treatment, and automated deep-learning approaches are widely studied. A recurring but under-examined obstacle is that public CVM datasets are severely imbalanced across the six stages. Using a public dataset and a rigorous eight-seed protocol, we quantify how strongly imbalance constrains performance, whether common imbalance-handling and ordinal-aware loss functions overcome it, and whether a clinically motivated three-group reformulation is more tractable than the native six-stage task. (2) &lt;b&gt;Methods&lt;/b&gt;: Using the public Aariz dataset (1000 lateral cephalograms with expert CVM-stage labels; 700/150/150 train/validation/test, one radiograph per patient), we trained an ImageNet-pretrained ResNet-18 under four strategies: unweighted cross-entropy (baseline), class-weighted cross-entropy with balanced sampling, focal loss, and a rank-consistent ordinal (CORAL) head. Each configuration was trained with eight random seeds. Both tasks were evaluated over this multi-seed protocol, and sensitivity analyses examined the ordinal model's sampling scheme and the focal-loss focusing parameter. Performance was assessed by accuracy, macro-F1, mean absolute error in stages (MAE), and quadratic weighted kappa (QWK), and compared across strategies with the Kruskal-Wallis test; secondary pairwise contrasts were Holm-corrected, and Wilson binomial confidence intervals (accuracy), seed-level confidence intervals (macro-F1), and analytically derived majority and frequency-weighted random classifiers were added as trivial reference baselines. Both the native six-stage task and a three-group scheme (pre-peak = CS1-3, peak = CS4, post-peak = CS5-6) were evaluated. (3) &lt;b&gt;Results&lt;/b&gt;: On the six-stage task the extreme imbalance (CS1 &lt;i&gt;n&lt;/i&gt; = 18 vs. CS5 &lt;i&gt;n&lt;/i&gt; = 311 in training) produced poor minority-stage recognition (macro-F1 ≈ 0.22-0.25), with the rarest stages essentially unclassified even after imbalance handling. Reframing into three clinically meaningful groups roughly doubled macro-F1 (to ≈0.47-0.51) across all strategies. Critically, in the three-group setting no loss function significantly outperformed the others: across eight seeds the Kruskal-Wallis test was non-significant for every metric (macro-F1 &lt;i&gt;p&lt;/i&gt; = 0.09, QWK &lt;i&gt;p&lt;/i&gt; = 0.05, MAE &lt;i&gt;p&lt;/i&gt; = 0.07, accuracy &lt;i&gt;p&lt;/i&gt; = 0.41), and the unweighted baseline matched the best specialized loss on macro-F1 (0.507 ± 0.045 vs. ordinal 0.505 ± 0.044). In secondary pairwise comparisons the ordinal loss nominally exceeded the weighted and focal losses (uncorrected &lt;i&gt;p&lt;/i&gt; = 0.04 and &lt;i&gt;p&lt;/i&gt; = 0.01), but after Holm correction only the comparison with focal loss remained significant (adjusted &lt;i&gt;p&lt;/i&gt; = 0.03), and no pairwise difference survived a conservative six-comparison Bonferroni bound; focal loss was the least stable. All strategies clearly exceeded trivial baselines on m","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"16 19","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192065","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":"Comparative Analysis of Bilateral-Based Noise Reduction Algorithms in Low-Dose Pediatric Computed Tomographic Images.","authors":"Minji Park, Hajin Kim, Sang Woong Park, Min-Hee Lee, Youngjin Lee","doi":"10.3390/diagnostics16193186","DOIUrl":"10.3390/diagnostics16193186","url":null,"abstract":"<p><p><b>Background:</b> Noise reduction in low-dose pediatric computed tomography (CT) requires effective suppression of quantum noise without compromising subtle anatomical structures. This study compared three bilateral-based noise reduction algorithms, namely the conventional bilateral filter (BF), adaptive BF (ABF), and trainable BF (TBF), using eight low-dose pediatric abdominal CT cases. <b>Methods:</b> Denoising performance was evaluated in the axial and coronal planes through visual assessment and quantitative measurements of the coefficient of variation (CV) within the liver parenchyma and the contrast-to-noise ratio (CNR) between the liver and portal vein. Statistical comparisons were performed using the Friedman test, followed by the Wilcoxon signed-rank tests with Holm-adjustment. All three methods reduced the visible noise present in the original images. <b>Results:</b> ABF improved uniformity in homogeneous liver regions while preserving anatomical detail, whereas TBF produced the strongest apparent noise suppression but introduced greater blurring and occasional ambiguous structures. Quantitatively, the CV decreased progressively from BF to ABF and TBF. The TBF method achieved the lowest average CV and the highest average CNR. Significant differences were observed among the four conditions for both metrics in each imaging plane. However, CNR differences between the three denoising methods were less consistent, particularly for comparisons involving TBF. <b>Conclusions:</b> Overall, ABF provided a favorable balance between noise reduction and structural preservation, whereas TBF offered stronger image specific denoising with additional concerns regarding signal fidelity and reproducibility. Further refinement is required to ensure clinical reliability without compromising quantitative accuracy or anatomical details.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"16 19","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191866","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":"Gastrointestinal Involvement in Pediatric Behçet's Disease: A Focused Analysis from a Comprehensive Systematic Review.","authors":"Dimitri Poddighe, Donato Rigante, Micol Romano, Zaure Mukusheva, Nicola Ughi, Erdal Sag, Selcan Demir, Natalie Zitoun, David Piskin, Erkan Demirkaya","doi":"10.3390/diagnostics16193184","DOIUrl":"10.3390/diagnostics16193184","url":null,"abstract":"<p><p><b>Background</b>: Gastrointestinal (GI) involvement is a clinically relevant but still incompletely characterized manifestation of pediatric Behcet's disease (PedBD). This systematic review provides a focused analysis of GI involvement in PedBD (addressing its frequency, clinical symptomatology, anatomical/endoscopic features, and therapeutic management) as a dedicated sub-analysis of a broader systematic review. <b>Methods</b>: A systematic search of MEDLINE, EMBASE, CINAHL, CENTRAL, and ClinicalTrials.gov was conducted, following PRISMA 2020 guidelines. Observational studies reporting GI involvement in patients with PedBD (disease onset before 16 years of age) were included, and data on frequency, symptoms, anatomical/endoscopic findings, and treatment of GI-PedBD were extracted and synthesized. <b>Results</b>: Thirty studies were included. Most studies were not focused on GI manifestations in PedBD as a (primary) study aim. The frequency of GI involvement ranged widely across the selected articles with a median of approximately 15% among studies with ≥50 pediatric BD patients. Abdominal pain and diarrhea were the most consistently reported symptoms. Endoscopic data indicated frequent involvement of the ileocecal region and terminal ileum, with mucosal ulcers and erosions as the predominant findings. Therapeutic data specific to GI-PedBD were limited to two studies only. As an appendix to the systematic review in the discussion, relevant case reports were described: anti-TNF agents, particularly adalimumab, showed favorable outcomes in refractory cases. <b>Conclusions</b>: GI involvement in PedBD is not negligible and can be severe. Its clinical and endoscopic characterization remains incomplete due to substantial heterogeneity in reporting practices across studies. Anti-TNF agents may represent an effective therapeutic option, especially for refractory GI-PedBD. Prospective and multicenter studies with standardized GI assessment protocols are needed to better characterize this clinically relevant subgroup of PedBD patients.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"16 19","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192059","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":"Quantitative Assessment of Postoperative Lumbar Morphology Using Geometric Morphometrics: Within-Subject Changes Following TLIF and Decompression.","authors":"Amit Benady, Owen Zhou, Amit Hadad, Hila May, Ryan David Quarrington, Afek Ash, Stone Sima, Victor Chen, Morsi Khashan, Ashish Diwan","doi":"10.3390/diagnostics16193177","DOIUrl":"10.3390/diagnostics16193177","url":null,"abstract":"<p><p><b>Background:</b> Conventional radiographic assessment of postoperative lumbar alignment relies predominantly on Cobb angle measurements, which incompletely characterize global spinal morphology. We evaluated whether geometric morphometrics (GM) provides complementary quantitative information for assessing postoperative lumbar morphology after TLIF and decompression. <b>Methods:</b> Ninety-nine patients (TLIF <i>n</i> = 70; decompression <i>n</i> = 29) underwent landmark-based GM analysis of pre- and post-surgical lateral lumbar radiographs (48 landmarks, L1-S1). Because TLIF and decompression patients were imaged at markedly different postoperative intervals as a matter of routine clinical practice, the primary analyses tested whether each technique's own pre-to-post shape change, adjusted for baseline L1-S1 angle, log centroid size, sex, age, number of operated levels, and degenerative spondylolisthesis, was significant (sign-flip permutation test), along with lordosis change (paired <i>t</i>-test, unadjusted). Cobb analyses assessed global lumbar lordosis (L1-S1) and operated level(s). <b>Results:</b> TLIF showed a significant within-group reduction in global lumbar lordosis at early postoperative imaging (Δ = -3.75°, paired <i>t</i>-test <i>p</i> < 0.001) and a significant, systematic change in overall lumbar shape (sign-flip permutation <i>p</i> < 0.001); decompression showed no significant within-group change in global lordosis (Δ = +0.47°, <i>p</i> = 0.733) or overall shape (<i>p</i> = 0.31), but a small increase in segmental lordosis at the operated level(s) (Δ = +1.44°, <i>p</i> = 0.036) that was not robust to sensitivity analysis. <b>Conclusions:</b> In this retrospective cohort, TLIF was associated with reduced lumbar lordosis and a systematic shape change at early postoperative imaging, while decompression showed preserved global lordosis and a small gain in segmental lordosis at long-term imaging. GM provided a consistent quantitative framework, with strong correlation and level-dependent agreement against manual Cobb measurement, for characterizing these within-technique postoperative changes.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"16 19","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191987","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":"Severity Stratification Changes What Hallucination Rates Mean: An Item-Matched Audit of Five Large Language Models in Orthodontic Decision Support.","authors":"Ferdi Allaf, Mustafa Ozcan","doi":"10.3390/diagnostics16193180","DOIUrl":"10.3390/diagnostics16193180","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Large language models (LLMs) are consulted for clinical decision support, and their reliability is judged by hallucination prevalence-a measure treating every unsupported element as equivalent, although a fabricated citation and a fabricated protocol differ in what a clinician acting on them would do. We tested whether prevalence tracks clinical risk. <b>Methods:</b> Five LLMs answered a 100-item orthodontic benchmark validated by three external orthodontists (content validity index 0.923). The reference standard was fixed by construction for the 45 items naming a non-existent entity, so any substantive elaboration is unsupported by design; citations were adjudicated against PubMed and CrossRef. Responses were coded with a seven-category taxonomy and assigned to clinical, operational, or epistemic severity tiers in a post hoc exploratory stratification, pre-specified rather than prospectively registered. Because all models answered the same items, comparisons used Cochran's Q with pairwise McNemar tests and generalised estimating equations clustered on item. <b>Results:</b> Of 500 responses, 449 (89.8%) contained a hallucination but only 65 (13.0%; 95% CI 10.3-16.2) were clinically consequential: prevalence was roughly sevenfold greater than the rate of clinically consequential output as the authors defined it. Between-model differences were large for undifferentiated prevalence (73-100%; Q = 50.51, <i>p</i> < 0.001) and contracted at the clinical tier (10-16%; Q = 10.00, <i>p</i> = 0.040), where no pairwise contrast survived adjustment. Item-level clustering was far stronger for clinically consequential output than for undifferentiated prevalence (intra-class correlation 0.83 versus 0.07). <b>Conclusions:</b> Prevalence and clinically consequential error are not interchangeable and rank models differently. The stratification is exploratory and author-defined, and the benchmark stress-tests susceptibility to fabricated premises rather than surveying natural use.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"16 19","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192110","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":"Artificial Intelligence in Gastroenterology: Towards Explainable, Generalisable and Clinically Actionable Decision Support.","authors":"İsmail Baydili, Burak Tasci, Sengul Dogan, Turker Tuncer","doi":"10.3390/diagnostics16193182","DOIUrl":"10.3390/diagnostics16193182","url":null,"abstract":"<p><p>Artificial intelligence is increasingly used in gastroenterology for endoscopic detection and characterisation, disease-activity assessment, risk prediction, treatment-response estimation and workflow support. However, high retrospective accuracy does not necessarily translate into reliable or beneficial clinical decision support. This structured narrative review examines the clinical development of artificial intelligence across gastrointestinal endoscopy, inflammatory bowel disease, hepatology and pancreaticobiliary diseases through three translational dimensions: explainability, generalisability and clinical actionability. Communication, human oversight and lifecycle governance are considered cross-cutting determinants of implementation. The evidence is most mature in gastrointestinal endoscopy, particularly for computer-aided polyp detection, although benefits vary across operators, indications and practice settings. Applications in inflammatory bowel disease, hepatology and pancreaticobiliary care remain predominantly retrospective, with limited prospective evidence that model outputs alter management or improve patient outcomes. Explainability is commonly represented by heatmaps or feature-attribution methods, but rarely evaluated in terms of clinician understanding, calibrated trust or patient communication. External validation is becoming more frequent, yet geographic and technological transportability, calibration and performance under dataset shift remain insufficiently assessed. Prospective implementation and health-economic studies are uncommon, and available economic evidence is largely model-based. Clinical artificial intelligence should therefore be evaluated as a sociotechnical intervention comprising the model, interface, users, workflow, communication process and associated care pathway. Translation requires clinically defined use cases, representative multicentre validation, human-centred evaluation, prospective assessment of benefits and harms, and continuous post-deployment surveillance. Clinical AI in gastroenterology should complement clinical expertise through transparent, contestable and continuously monitored decision support that preserves clinician accountability and supports informed, patient-centred decisions.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"16 19","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191795","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":"The Least Understood Placental Galectins: Galectin-14 and Galectin-16 in Human Pregnancy and Placental Biology.","authors":"Zoltan Kozinszky, Yakov Rachamin Karo, Jakó Mária, Márió Vincze, János Sikovanyecz, János Sikovanyecz, Zsolt Tidrenczel, Bálint Koppány, Giuseppe Gullo, László Kaiser, Eszter Ducza, Szabolcs Várbíró, Andrea Surányi","doi":"10.3390/diagnostics16193188","DOIUrl":"10.3390/diagnostics16193188","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Galectins represent a family of proteins which are capable of specifically binding to beta-galactoside-containing sugar molecules, known as glycans. Galectins possess carbohydrate recognition domains (CRDs) that fundamentally determine their ability to bind to sugars. Galectin-14 (Gal-14) and galectin-16 (Gal-16) are members of the galectin family that is particularly associated with the placenta. The galectins in the placenta constitute a specialized subgroup functioning at the maternal-fetal interface. They are expressed primarily in the syncytiotrophoblasts. This trophoblast layer is in direct contact with maternal blood and plays a crucial role in the metabolic, hormonal and immunological interactions between the fetus and the pregnant woman. In order to prepare this structured narrative review, we conducted a structured literature search across the MEDLINE (PubMed), Embase, Cochrane Library and Web of Science Core Collection databases; the final search has been performed on 1 July 2026. The search strategy has combined the terms galectin-14/LGALS14 and galectin-16/LGALS16 with terms related to the placenta, trophoblast, pregnancy, placentation and pregnancy complications. Search results were imported into Mendeley Reference Manager to remove duplicates, and the reference lists of relevant review articles and studies were manually screened. Two reviewers (Z.K. and A.S.) independently screened the titles and abstracts and subsequently evaluated the potentially relevant full-text articles. The final evidence synthesis included primary studies that directly investigated the expression, function, regulation, or clinical associations of LGALS14 or LGALS16; secondary publications were used for background and contextual information. In experimental studies, galectin-14 has been linked to trophoblast migration and invasion-involving mechanisms such as the PI3K/Akt signaling pathway, MMP-9 and N-cadherin-as well as to the modulation of activated maternal immune cell function. Galectin-16 is structurally more distinct and exhibits reduced classical β-galactoside-binding capacity; it appears to be closely associated with trophoblast differentiation and syncytialization, presumably through intracellular protein interactions. Altered expression of placenta-specific galectins has been observed in preeclampsia and fetal growth restriction; however, the causal relationship remains unclear. Clinical evidence regarding their use as biomarkers is emerging at this time; therefore, neither galectin-14 nor galectin-16 can be currently considered as a validated, clinically applicable biomarker. Altogether, available evidence mandates further study of galectin-14 and galectin-16, as they may be important regulators of placental biology and potential biomarker candidates. However, their physiological functions and clinical utility have not yet been sufficiently confirmed; therefore, further prospective and functional studies are required. The strongest putative","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"16 19","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192054","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":"Intraoperative 3D Tomosynthesis of the Elbow in a Simulated Prone-Position Setup: A Cadaveric Study.","authors":"Benno Bullert, Livia Morlock, Fenna Brunken, Jula Gierse, Paul A Gruetzner, Sven Y Vetter, Nils Beisemann","doi":"10.3390/diagnostics16193178","DOIUrl":"10.3390/diagnostics16193178","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Fractures of the distal humerus and olecranon often require surgical intervention due to their complexity and intra-articular fracture pattern. Precise implant positioning and articular surface reconstruction are crucial for optimal outcomes. Intraoperative 3D imaging offers advantages over 2D fluoroscopy by providing enhanced visualization of fracture reduction and implant alignment. However, limited space in the prone position restricts the use of standard 3D imaging with complete orbital rotation. This cadaver study investigates the feasibility and intra-articular screw detection performance of intraoperative 3D tomosynthesis with reduced orbital rotation at the elbow. <b>Methods</b>: In this cadaver study, six distal humeri and six olecranons were examined using an isocentric 3D C-arm with a complete 200° acquisition. The disarticulated upper extremities were positioned to reproduce the prone surgical setup. Reduced-angle datasets ranging from 200° to 100° were reconstructed retrospectively from the complete acquisition, with and without metal artifact reduction (MAR). Double-plate osteosynthesis was applied to the distal humerus, while an anatomic olecranon plate was used for fixation on the olecranon. To evaluate detection capabilities, screw positions were deliberately modified to include both correct placements and intra-articular malpositions. Image quality (5-point Likert scale) and certainty of intra-articular screw assessment were evaluated by three blinded raters; sensitivity and specificity were calculated relative to the complete 200° imaging-based reference condition. <b>Results</b>: Image quality, sensitivity, and specificity decreased with reduced orbital rotation. MAR significantly improved image quality and specificity, but not sensitivity. At an orbital rotation of 160°, MAR-reconstructed tomosynthesis achieved acceptable image quality (3.36 ± 0.53), high sensitivity (94.9%), and high specificity (93.9%) for detecting intra-articular screws. <b>Conclusions</b>: Intraoperative tomosynthesis with MAR provides acceptable image quality and high performance for intra-articular screw detection at the elbow under the present experimental conditions. This approach may support intraoperative assessment in prone-position elbow surgery when full orbital rotation is not feasible. Clinical studies are needed to confirm its value in routine practice.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"16 19","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191918","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}