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Abstract Large medical image repositories present challenges related to unstructured data. A data enrichment process allows the storage of additional information for fast identification of the content and properties of medical imaging studies. The aim of this study is to develop a metadata enrichment pipeline to facilitate the secondary use of medical images in a high-throughput environment. Our aim was to develop a categorization tool for the MR series to generate standardized tags that identify relevant image characteristics such as patient orientation, sequence type, weighting type, or the presence of fat suppression. Three models that make use of machine learning (ML) and DICOM tags are proposed. The dataset for their development consists of 4666 MR series from cancer patients, labeled by expert radiologists and acquired from different manufacturers, clinical centers and anatomical regions, covering as much variability as possible with the aim of making the models generalizable to other databases. Moreover, the inference performance of the end system has been evaluated on 25,596 MR series as well as the final model outputs with an external evaluation set of 1286 MR series. The weighting model achieves very reliable results with a f1 score of 88% in the validation set. Junk and chemical shift models achieved scores of 82% and 83% respectively. These results open the door to the automatic application of image post-processing and deep learning algorithms after accurate labeling, minimizing human intervention. Furthermore, the proposed solution can infer thousands of DICOM series in less than one minute. Thanks to the fast inference times provided by this solution, it fits well in a big data ecosystem, eliminating any performance issues on ingestion in a semi-real-time environment. Graphical Abstract

Abstract Good practices in artificial intelligence (AI) model validation are key for achieving trustworthy AI. Within the cancer imaging domain, attracting the attention of clinical and technical AI enthusiasts, this work discusses current gaps in AI validation strategies, examining existing practices that are common or variable across technical groups (TGs) and clinical groups (CGs). The work is based on a set of structured questions encompassing several AI validation topics, addressed to professionals working in AI for medical imaging. A total of 49 responses were obtained and analysed to identify trends and patterns. While TGs valued transparency and traceability the most, CGs pointed out the importance of explainability. Among the topics where TGs may benefit from further exposure are stability and robustness checks, and mitigation of fairness issues. On the other hand, CGs seemed more reluctant towards synthetic data for validation and would benefit from exposure to cross-validation techniques, or segmentation metrics. Topics emerging from the open questions were utility, capability, adoption and trustworthiness. These findings on current trends in AI validation strategies may guide the creation of guidelines necessary for training the next generation of professionals working with AI in healthcare and contribute to bridging any technical-clinical gap in AI validation. Relevance statement This study recognised current gaps in understanding and applying AI validation strategies in cancer imaging and helped promote trust and adoption for interdisciplinary teams of technical and clinical researchers. Key Points Clinical and technical researchers emphasise interpretability, external validation with diverse data, and bias awareness in AI validation for cancer imaging. In cancer imaging AI research, clinical researchers prioritise explainability, while technical researchers focus on transparency and traceability, and see potential in synthetic datasets. Researchers advocate for greater homogenisation of AI validation practices in cancer imaging. Graphical Abstract

IntroductionNeuroblastoma, the most prevalent solid cancer in children, presents significant biological and clinical heterogeneity. This inherent heterogeneity underscores the need for more precise prognostic markers at the time of diagnosis to enhance patient stratification, allowing for more personalized treatment strategies. In response, this investigation developed a machine learning model using clinical, molecular, and magnetic resonance (MR) radiomics features at diagnosis to predict patient’s overall survival (OS) and improve their risk stratification.MethodsPRIMAGE database, including 513 patients (discovery cohort), was used for model training, validation, and testing. Additional 22 patients from different hospitals served as an external independent cohort. Primary tumor segmentation on T2-weighted MR images was semi-automatically edited by an experienced radiologist. From this area, 107 radiomics features were extracted. For the development of the prediction model, radiomics features were harmonized following the nested ComBat methodology and nested cross-validation approach was employed to determine the optimal preprocessing and model configuration.ResultsThe discovery cohort yielded a 78.8 ± 4.9 and 77.7 ± 6.1 of C index and time-dependent area under de curve (AUC), respectively, over the test set, with a random survival forest exhibiting the best performance. In the independent cohort, a C-index of 93.4 and a time-dependent AUC of 95.4 were achieved. Interpretability analysis identified lesion heterogeneity, size, and molecular variables as crucial factors in OS prediction. The model stratified neuroblastoma patients into low-, intermediate-, and high-risk categories, demonstrating a superior stratification compared to standard-of-care classification system in both cohorts.DiscussionOur results suggested that radiomics features improve current risk stratification systems in patients with neuroblastoma.

This research provides a comprehensive view of the geolocation of physical health assets in the city of Tarragona (Spain) and how these assets are used and recommended by healthcare professionals to promote healthy lifestyles. Focusing on the distribution and accessibility of sports facilities, such as outdoor gyms or football and basketball courts, this study highlights the importance of these assets in leading a healthy life and preventing chronic diseases. This article investigates the availability of these assets and their prescription by healthcare professionals to improve people’s quality of life through surveys and fieldwork. It evaluates both the knowledge healthcare professionals have about these available assets in the area and the types of physical activity they prescribe. The results show significant variability in the availability of physical health assets across different neighbourhoods. However, most residents have good walking access to these assets, especially in the central and western parts of the city. This study concludes that while physical health assets are an underutilised resource for healthcare professionals, enhancing the awareness and prescription of these assets could improve public health outcomes, particularly for older adults.

Abstract Background This multicentre retrospective observational study aims to develop imaging-based prognostic and predictive models for relapsed/refractory (R/R) B-cell lymphoma patients undergoing CAR-T therapy by integrating clinical data and imaging features. Specifically, our aim was to predict 3- and 6-month treatment response, overall survival (OS), progression-free survival (PFS), and the occurrence of the immune effector cell-associated neurotoxicity syndrome (ICANS). Results Sixty-five patients of R/R B-cell lymphoma treated with CAR-T cells in two centres were included. Pre-infusion [18F]FDG PET/CT scans and clinical data were systematically collected, and imaging features, including kurtosis, entropy, maximum diameter, standardized uptake value (SUV) related features (SUVmax, SUVmean, SUVstd, SUVmedian, SUVp25, SUVp75), total metabolic tumour volume (MTVtotal), and total lesion glycolysis (TLGtotal), were extracted using the Quibim platform. The median age was 62 (range 21–76) years and the median follow-up for survivors was 10.47 (range 0.20–45.80) months. A logistic regression model accurately predicted neurotoxicity (AUC: 0.830), and Cox proportional-hazards models for CAR-T response at 3 and 6 months demonstrated high accuracy (AUC: 0.754 and 0.818, respectively). Median predicted OS after CAR-T therapy was 4.73 months for high MTVtotal and 37.55 months for low MTVtotal. Median predicted PFS was 2.73 months for high MTVtotal and 11.83 months for low MTVtotal. For all outcomes, predictive models, combining imaging features and clinical variables, showed improved accuracy compared to models using only clinical variables or imaging features alone. Conclusion This study successfully integrates imaging features and clinical variables to predict outcomes in R/R B-cell lymphoma patients undergoing CAR-T. Notably, the identified MTVtotal cut-off effectively stratifies patients, as evidenced by significant differences in OS and PFS. Additionally, the predictive models for neurotoxicity and CAR-T response show promising accuracy. This comprehensive approach holds promise for risk stratification and personalized treatment strategies which may become a helpful tool for optimizing CAR-T outcomes in R/R lymphoma patients.

Objectives: The aim of this study was to evaluate the use of phase-contrast MR imaging to diagnose normal pressure hydrocephalus (NPH) and differentiate it from other neurological disorders with similar clinical symptoms. Methods: The study included 108 subjects, of whom 61 were healthy controls and 47, patients; in the patient group, 19 had cerebrovascular disease (CVD) and 28 had NPH. All patients underwent a phase-contrast MRI study and several CSF flow and velocity parameters were measured at the aqueduct of Sylvius. Discriminant analyses were performed to evaluate the classification capacity of both individual parameters and the combination of different parameters. Results: Maximum diastolic velocity, mean flow, and stroke volume showed statistically significant differences that could be used to distinguish between NPH and CVD patients (P

Resumen: Objetivos: El objetivo de este estudio es valorar si la RM en contraste de fase es una herramienta útil en el diagnóstico de la hidrocefalia a presión normal (HPN), así como su diferenciación con otras afecciones neurológicas muy similares clínicamente. Métodos: Se incluyó a un total de 108 sujetos, de los cuales 61 eran sujetos sanos control, y 47 pacientes; 19 de ellos fueron clasificados en el grupo de pacientes con enfermedad cerebrovascular isquémica (ECI) y 28 pacientes dentro del grupo de HPN. A todos los pacientes se les realizó una RM en contraste de fase con cuantificación de parámetros de flujo y velocidad de LCR en el acueducto de Silvio. Se evaluó la capacidad de clasificación de los parámetros individualmente y combinándolos mediante análisis discriminantes. Resultados: Los parámetros de velocidad máxima diastólica, flujo promedio y volumen por ciclo mostraron diferencias estadísticamente significativas para separar a los pacientes con HPN y con ECI (p

Background: The craving for sexuality and closeness continues into old age, although the means of expressing it may change. Beyond direct sexual encounters, older adults can express their sexuality through gentle affection, warm embraces, holding hands, and other intimate gestures. However, aging can also impact their sexual experiences. Objective: This study aimed to explore the lived experiences of sexuality among older adults living in the countryside of Cebu, Philippines, during their senior years. Methods: A qualitative descriptive phenomenological design was employed. Purposive sampling was used to select ten participants. Data were collected from September to December 2023, and Colaizzi’s method of data analysis was applied to ensure thorough interpretation. Results: Three major themes emerged: 1) Being Centered: An actualized form of sexuality in later years; 2) Being Connected: A strong sense of intimacy in later years; and 3) Being Conveyed: Diversifying expressions of sexuality in later years. Conclusion: Despite advancing age, older adults can remain active in their intimate relationships and achieve a healthy marital life characterized by life satisfaction. They express their love for their partners by being centered, connected, and attuned to each other’s needs and feelings. These findings highlight the importance for geriatric nurses to recognize and support the sexual health and intimacy needs of older adults, facilitating discussions and providing resources that promote overall well-being and quality of life.

WW domain binding protein 1-like (WBP1L), also known as outcome predictor of acute leukemia 1 (OPAL1), is a transmembrane adaptor protein, expression of which was shown to correlate with ETV6-RUNX1 translocation and favorable prognosis in childhood leukemia. It has a broad expression pattern in hematopoietic and non-hematopoietic cells. Our previous work described WBP1L as a regulator of CXCR4 signaling and hematopoiesis. Here, we show that hematopoiesis in the mice with Wbp1l germline deletion is dysregulated, already at the level of hematopoietic stem cells and early progenitors. We further demonstrate that thymi of WBP1L-deficient mice are significantly enlarged and contain increased numbers of thymocytes of all subsets. This can potentially be explained by increased generation of multipotent progenitors 4 (MPP4) in the bone marrow, from which the thymus-seeding progenitors are derived. We also observed increases in multiple cell types in the blood. In addition, we show that WBP1L regulates hematopoietic stem cell functionality and leukocyte progenitor proliferation and gene expression during hematopoietic stem and progenitor cell transplantation, which contribute to more efficient engraftment of WBP1L-deficient cells. WBP1L thus emerges as a regulator of hematopoietic stem and progenitor cell function, which controls leukocyte numbers at the steady state and after bone marrow transplantation.

Objective To evaluate the impact of coadministering statins with direct oral anticoagulants (DOACs) on the risk of major bleeding events in patients with venous thromboembolism (VTE).Design Observational cohort analysis based on a multicentre international registry.Setting Data were extracted from the Registro Informatizado de Enfermedad TromboEmbolica Registry, which involves 205 centres across 27 countries.Participants A total of 73 659 patients diagnosed with VTE were classified based on their anticoagulant therapy (DOACs) versus low-molecular-weight heparin (LMWH) or vitamin K antagonists (VKAs) and concurrent use of statins.Methods Multivariable Cox proportional hazards models adjusted for confounding variables to assess the risk of major bleeding events stratified by the type of anticoagulant use and statin use.Results From October 2013 to February 2023, 73 659 patients were recruited: 2573 were statin users on DOACs, 14 090 were statin users on LMWH or VKA therapy, 10 088 were non-statin users on DOACs and 46 908 were non-statin users on LMWH or VKA therapy. Statin users were 10 years older and more likely to have hypertension, diabetes, renal failure or prior artery disease. During anticoagulation (median, 187 days), 1917 patients (2.6%) suffered major bleeding. Rates of major bleeding per 100 patient-years were 2.33 (95% CI 1.72 to 3.09), 3.75 (95% CI 3.43 to 4.10), 1.39 (95% CI 1.13 to 1.69) and 3.10 (95% CI 2.93 to 3.27), respectively. On multivariable analysis, patients treated with DOACs had a significantly lower risk of major bleeding compared with those on LMWH or VKA therapy (adjusted HR 0.59; 95% CI 0.48 to 0.74). The adjusted HR in statin users versus non-users was 1.03 (95% CI 0.92 to 1.14), while in statin users on DOACs versus the rest of patients, it was 1.18 (95% CI 0.79 to 1.76).Conclusions In patients with VTE receiving statins, long-term anticoagulation with DOACs was associated with a reduced risk of major bleeding, regardless of the statin use. These findings support the safety profile of DOACs over VKAs or LMWH in the management of VTE in patients requiring statins.

Reducing urban environmental inequity is one of the main objectives in advancing towards more sustainable cities. This situation implies developing tools that allow for an integrated assessment environmental and social impacts, to reveal inequalities in the distribution of resources and environmental risks. Applying indicators by using Geographic Information Systems (GIS) and statistical tools can be a valid option for fulfilling this aim, since it allows for territorial patterns in disparities to be exposed. The aim of this work is to identify and classify the environmental equity indicators applied to date in studies that use statistical methods and GIS for processing and analysing them. Thus, a scoping review was conducted using the SALSA Framework and PRISMA extension for scoping reviews protocol based on the Scopus, Web of Science and Scielo databases. A total of 31 articles were identified that fulfilled the search criteria and which were developed mainly by countries in North American and Europe. They involved 167 different indicators that demonstrate the complexity and heterogeneity in addressing this topic. Negative aspects of the environment such as pollution, and social factors such as the socioeconomic status, were the most used.

Summary: Background: The clinical relevance of recurrent venous thromboembolism (VTE) after discontinuing anticoagulation in patients with COVID-19-associated VTE remains uncertain. We estimated the incidence rates and mortality of VTE recurrences developing after discontinuing anticoagulation in patients with COVID-19-associated VTE. Methods: A prospective, multicenter, non-interventional study was conducted between March 25, 2020, and July 26, 2023, including patients who had discontinued anticoagulation after at least 3 months of therapy. All patients from the registry were analyzed during the study period to verify inclusion criteria. Patients with superficial vein thrombosis, those who did not receive at least 3 months of anticoagulant therapy, and those who were followed for less than 15 days after discontinuing anticoagulation were excluded. Outcomes were: 1) Incidence rates of symptomatic VTE recurrences, and 2) fatal PE. The rate of VTE recurrences was defined as the number of patients with recurrent VTE divided by the patient-years at risk of recurrent VTE during the period when anticoagulation was discontinued. Findings: Among 1106 patients with COVID-19-associated VTE (age 62.3 ± 14.4 years; 62.9% male) followed-up for 12.5 months (p25-75, 6.3–20.1) after discontinuing anticoagulation, there were 38 VTE recurrences (3.5%, 95% confidence interval [CI]: 2.5–4.7%), with a rate of 3.1 per 100 patient-years (95% CI: 2.2–4.2). No patient died of recurrent PE (0%, 95% CI: 0–7.6%). Subgroup analyses showed that patients with diagnosis in 2021–2022 (vs. 2020) (Hazard ratio [HR] 2.86; 95% CI 1.45–5.68) or those with isolated deep vein thrombosis (vs. pulmonary embolism) (HR 2.31; 95% CI 1.19–4.49) had significantly higher rates of VTE recurrences. Interpretation: In patients with COVID-19-associated VTE who discontinued anticoagulation after at least 3 months of treatment, the incidence rate of recurrent VTE and the case-fatality rate was low. Therefore, it conceivable that long-term anticoagulation may not be required for many patients with COVID-19-associated VTE, although further research is needed to confirm these findings. Funding: Sanofi and Rovi, Sanofi Spain.

Osteoporosis is a chronic disease that is characterized by a loss of bone density, which mainly affects the microstructure of the bones due to a decrease in bone mass, thereby making them more fragile and susceptible to fractures. Osteoporosis is currently considered one of the pandemics of the 21st century, affecting around 200 million people. Its most serious consequence is an increased risk of bone fractures, thus making osteoporosis a major cause of disability and even premature death in the elderly. In this review, we discuss its causes, the biochemical mechanisms of bone regeneration, risk factors, pharmacological treatments, prevention and the effects of diet, focusing in this case on compounds present in a diet that could have palliative and preventive effects and could be used as concomitant treatments to drugs, which are and should always be the first option. It should be noted as a concluding remark that non-pharmacological treatments such as diet and exercise have, or should have, a relevant role in supporting pharmacology, which is the recommended prescription today, but we cannot ignore that they can have a great relevance in the treatment of this disease.