Search Results (489)

Background: Obesity is a heterogeneous chronic disease, yet it is still commonly defined and managed using body mass index alone. Identifying clinically meaningful subgroups may support more efficient, precise and practical care. Objective: To identify and characterize population-level heterogeneity among adults with obesity in a large Israeli healthcare cohort. Methods: In this cross-sectional study, we analyzed deidentified electronic health record data from the Leumit Obesity Registry. Adults with obesity who had at least one documented weight measurement and height or BMI record during 2024 were included. Demographic, socioeconomic, lifestyle, clinical, and treatment variables were analyzed using K-prototypes cluster analysis to identify subgroups within a mixed-data population. Results: The study included 68,203 adults with obesity. Five distinct patient clusters were identified: metabolically healthy young adults, 19% of the cohort; adults with low comorbidity, 18%; middle-aged adults with moderate comorbidity, 23%; multimorbid seniors with socioeconomic disadvantage, 24%; and higher socioeconomic status advanced age with high clinical burden, 16%. The clusters differed substantially in age, comorbidity burden, socioeconomic status, and obesity-treatment utilization. GLP-1 use was most common in the older multimorbid clusters, particularly among low SES. Dietitian use was lower in the oldest and sickest cluster, despite high disease burden. Bariatric surgery was overall relatively rare and was concentrated mainly in the younger clusters. Conclusions: Adults with obesity in this large population-based registry did not represent a single clinical group, but rather several distinct phenotypes with different clinical and treatment patterns. These findings support a shift toward more phenotype-informed obesity care and resource planning. Full article

Background/Objectives: Lower limb congenital deficiencies represent challenging disorders that require a complex strategy for limb reconstruction and lengthening procedures guided by the anatomical type and severity of the deformity. This review aims to summarize current treatment approaches in limb reconstruction and lengthening for patients with common congenital lower limb deficiencies, including fibular hemimelia, congenital femoral deficiency, and tibial hemimelia. Methods: A literature search was conducted using major databases, complemented by the senior author’s clinical experience and case series, to identify relevant studies and current procedures for the management of common congenital lower limb deficiencies, including limb reconstruction and lengthening techniques. Results: The various clinical presentation and classification systems of congenital lower limb deficiencies are presented, as well as up to date surgical techniques including limb reconstruction and lengthening. These approaches demonstrated effectiveness in congenital limb deficiencies management by facilitating joint stabilization and subsequent limb lengthening, leading to improved functional outcomes. However, significant challenges persist, including prolonged treatment duration and patient discomfort. Modern surgical approaches have significantly improved the outcomes of treatment for congenital limb deficiencies. However, the complexity of these clinical entities requires individualized treatment strategies. Conclusions: Successful management of congenital lower limb deficiencies relies on individualized, patient-specific treatment planning, incorporating preparatory surgical interventions and sequential limb lengthening procedures to maximize functional outcomes. Full article

Background/Objectives: Pretreatment imaging may help estimate axillary response after neoadjuvant chemotherapy (NAC) in clinically node-positive (cN+) breast cancer. This study compared routinely available magnetic resonance imaging (MRI) and ultrasound (US) descriptors from the primary tumor and axillary nodes for predicting axillary nodal response, defined as postneoadjuvant pathologic node-negative status (ypN0). Methods: This retrospective multicenter study included 243 patients from three centers: 146 in the training cohort, 59 in the internal validation cohort, and 38 in the external validation cohort. The index breast tumor and axillary node were identified by a senior radiologist, and two radiologists independently assessed structured descriptors based on BI-RADS 2025. Least absolute shrinkage and selection operator regression and logistic regression were used to develop imaging-only, clinical-only, and clinicoradiologic models. Performance was evaluated using area under the curve (AUC), calibration, decision curve analysis, net reclassification improvement, and integrated discrimination improvement. Results: In the internal and external validation cohorts, the trimodal imaging model achieved AUCs of 0.761 and 0.806, and the clinicoradiologic model achieved the highest AUCs of 0.858 and 0.931, respectively. In pooled validation subgroup analyses, AUCs were 0.928, 0.804, and 0.700 for HR-positive/HER2-negative, HER2-positive, and triple-negative tumors, and 0.898 and 0.880 for cN1 and cN2–3 disease, respectively. Conclusions: MRI tumor descriptors provided the strongest imaging signal for ypN0 prediction, while US descriptors offered modest complementary information. The clinicoradiologic model may support pretreatment risk stratification and multidisciplinary planning for post-NAC axillary reassessment, but should not independently determine sentinel lymph node biopsy, axillary lymph node dissection, or omission of axillary staging. Full article

Background: Delirium management remains inconsistently implemented in intensive care units (ICUs), and existing studies provide limited insight into how assessment capability, organisational opportunity, and emotional motivation interact in Chinese tertiary care settings. Aim: To explore ICU nurses’ perceived barriers and facilitators to delirium assessment and management using the Capability, Opportunity and Motivation model of Behaviour (COM-B). Methods: A qualitative descriptive exploratory study was conducted with 14 registered ICU nurses from two tertiary hospitals in Chongqing, China, between December 2025 and February 2026. Purposive sampling captured variation in clinical experience, educational background, and ICU type. The first author conducted face-to-face interviews in Mandarin Chinese and completed the initial coding. COM-B informed both the interview guide and the deductive organisation of the analysis, while six themes and 33 lowest-level factors were developed within the three domains. During revision, the fixed analytic structure was audited against all 14 Mandarin transcripts, and the second author independently applied the fixed codebook to five complete transcripts selected for maximum variation; disagreements were resolved by returning to the original Mandarin context and predefined coding boundaries. Results: Eighteen barriers and fifteen facilitators were identified across six themes within the COM-B domains. Capability was strengthened by clinical experience, senior nurses’ intuitive pattern recognition, and conversational assessment, but constrained by difficulty recognising hypoactive delirium, uncertainty when assessing older adults, inconsistent use of CAM-ICU, and insufficient targeted training. Opportunity was enhanced by staffing, environmental control, peer support, family engagement, and physician collaboration, but restricted by fragmented visibility, sensory overstimulation, workload, restrictive visiting, and delayed medical responses. Motivation reflected the tension between professional duty and accountability for safety on one hand and emotional burden, verbal abuse, and violence on the other. Cross-domain accounts showed that opportunity constraints could amplify anxiety and safety-first motivation, narrowing feasible behaviour toward containment, whereas social support could sustain relational care. Conclusions: Delirium management was shaped by interacting behavioural, organisational, and emotional conditions. Strengthening assessment capability alone is unlikely to produce consistent practice without staffing, workflow, environmental, and interprofessional support. Mapping the findings to Behaviour Change Wheel intervention functions highlighted training, environmental restructuring, enablement, and modelling as priority candidate functions for prospective evaluation; education alone was unlikely to be sufficient. Reporting Method: This study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research checklist. Patient or Public Contribution: No patient or public contribution was involved in the design, conduct or reporting of this study. Participants were registered intensive care unit nurses. Full article

Background/Objectives: Incidental findings (IFs) on emergency computed tomography (CT) are increasingly common as cross-sectional imaging utilization expands. Data from the Middle East are limited. We aimed to determine the report-documented frequency, anatomical distribution, and proportion of clinically actionable IFs on emergency abdominopelvic CT examinations at a tertiary-care center in southwestern Saudi Arabia. Methods: This retrospective cross-sectional study reviewed 705 consecutive emergency abdominopelvic CT examinations performed at King Fahd Central Hospital, Jazan, between 1 January 2023 and 31 December 2025. Two senior radiology residents (R3 and R4) extracted findings unrelated to the presenting indication from consultant-approved reports, applying a predefined terminology-standardization framework. Clinical actionability was defined a priori as a documented recommendation for further evaluation or follow-up. Descriptive statistics with 95% Wilson confidence intervals (CI) were calculated using R Software. Results: At least one IF was identified in 138 of 705 examinations, yielding a patient-level report-documented rate of 19.6% (95% CI 16.8% to 22.7%). A total of 255 IFs were recorded, averaging 1.85 findings per affected patient. The mean age was 42.3 ± 18.2 years; 78 patients (56.5%) were male and 116 (84.1%) were Saudi nationals. Findings were most often within the abdominopelvic cavity (159; 62.4%), followed by miscellaneous (64; 25.1%) and thoracic-vascular (32; 12.5%). At the secondary-category level, the most prevalent groups were spine (38; 14.9%), hepatobiliary (37; 14.5%), and genitourinary (31; 12.2%). Documented further work-up was recommended in 48 of 138 patients with IFs (34.8%; 95% CI 27.3% to 43.0%). Conclusions: Approximately one in five emergency abdominopelvic CT examinations contained incidental findings, with one-third requiring further evaluation. Spine, hepatobiliary, and genitourinary findings were most common. Variability in reported rates likely reflects differences in study methods and definitions. Future multicenter studies should evaluate standardized reporting approaches and follow-up strategies, together with their impact on reporting consistency, downstream investigations, and patient outcomes. Full article

Introduction: Sudden cardiac death in children and adolescents is a devastating yet potentially preventable event. There is, therefore, an urgent need for early recognition of young patients at elevated cardiac risk. Electrocardiographic screening may play a central role in this effort. However, interpreting paediatric ECGs requires advanced diagnostic skills. Checklists have been advocated to mitigate errors in a number of complex fields, both medical and non-medical; however, their effectiveness in interpreting paediatric ECGs remains uncertain. Objective: To evaluate whether the use of a structured checklist improves primary care paediatricians’ performance in interpreting paediatric ECGs, and to assess the influence of professional experience on diagnostic accuracy. Methods: We conducted a prospective, parallel-group study involving primary care paediatricians in the Balearic Islands (Spain). Participants were randomly assigned to interpret paediatric ECGs, either using routine unstructured interpretation or with checklist support. Outcomes included diagnostic validity ratios, and appropriateness of referral to paediatric cardiologists. Performance was analysed according to checklist use or years of clinical experience. It was also analysed whether diagnostic accuracy varied according to whether the ECG was classified as normal, or abnormal with or without an increased risk of sudden cardiac death. Results: Thirty-one paediatricians completed the study, generating 310 ECG interpretations. Checklist use did not significantly improve sensitivity, specificity, or likelihood ratios for detecting ECG abnormalities associated with sudden cardiac death risk, nor did it increase appropriate referral rates. We report a trend towards higher specificity and likelihood ratios among paediatricians with fewer than 20 years of professional experience than among their more senior counterparts. Significantly, this study found true positive rates of normal ECGs, and of abnormal ECGs with risk of sudden cardiac death, to be around 90%, as opposed to true positive rates of around 60% for abnormal ECGs without risk of sudden cardiac death (91% vs. 85% vs. 59%, respectively). Conclusions: In this study, checklist support did not enhance diagnostic performance in paediatric ECG interpretation. This finding highlights the need for targeted efforts to improve diagnostic accuracy in this sensitive subset. We also report that mid-career paediatricians appear to achieve the highest ECG diagnostic accuracy, and we show a particularly high rate of correct interpretation of both simple ECGs and high-risk abnormal ECGs. Full article

Background and Objectives: Digitalization studies often emphasize perceived benefits while overlooking professionals who cannot determine whether digital tools are useful. This study quantified digital hesitancy among anesthesia and intensive-care professionals, examined its relationship with professional role and experience, and compared it with reported barriers and technology use. Methods: A single-centre cross-sectional survey included 161 professionals (80.1% of 201 eligible departmental staff): 55 nurses and 106 physicians. A four-item Uncertainty Index measured inability to appraise digital benefits in patient safety, clinical decisions, management, and education. Barrier Burden and Resource-Efficiency indices were also calculated. Group differences were assessed using nonparametric tests, and predictors of high uncertainty were examined by multivariable logistic regression. Results: Nurses had substantially higher uncertainty than physicians (mean Uncertainty Index 1.60 vs. 0.49, difference 1.11, 95% CI 0.80 to 1.42; p < 0.001), particularly regarding educational and clinical benefits. Reported barriers were similar across professional groups, with technical problems being the most common. Any reported prior use of training simulators, irrespective of frequency or recency, was markedly lower among nurses than physicians (1.8% vs. 47.2%; absolute gap 45.4 percentage points, 95% CI 35.2 to 55.5; p < 0.001). After adjustment, physician status remained strongly associated with lower odds of high uncertainty, whereas overall seniority was not significant. In an exploratory within-nurse analysis, uncertainty was higher among more experienced nurses, reaching its highest level among those with more than 20 years of practice (Spearman ρ = 0.49, 95% CI 0.24 to 0.68; p < 0.001); the seniority bands were small (n = 7 to 18), so this gradient is hypothesis-generating. Conclusions: Digital hesitancy was concentrated among nurses and was distinct from shared technical barriers; within nurses it was higher at greater seniority. Because patient-safety outcomes and intervention effects were not measured, targeted simulator-based training and role-specific feedback should be regarded as hypotheses for prospective evaluation alongside, rather than established alternatives to, generic infrastructure improvements. Full article

Background and Objectives: This retrospective cohort study aimed to analyze the surgical evolution, clinical outcomes, and adoption of uterus-preserving techniques in placenta previa (PP) and placenta accreta spectrum (PAS) cases managed by a single senior surgeon over an uninterrupted 13-year period. Materials and Methods: A total of 324 patients who underwent cesarean section by a single experienced surgeon with a diagnosis of placenta previa between 1 January 2013 and 1 January 2026 were included in the study. The demographic and obstetric characteristics of the patients, the surgical methods applied, perioperative blood product requirements, complications, and neonatal outcomes were evaluated retrospectively. Uterus-preserving surgical methods included a temporary uterine tourniquet, intrauterine hemostatic sutures, bilateral internal iliac artery ligation (IIAL), Bakri balloon tamponade, B-Lynch suture, uterine lower segment resection, and uterine packing, applied in a stepwise manner. The perioperative hemoglobin change (ΔHb) was calculated as an objective indicator of blood loss. Results: Placenta previa constituted a substantial proportion of all cesarean sections performed by the same surgeon during the study period. Total previa was the predominant type, and almost half of the operations were carried out under emergency conditions. Peripartum hysterectomy was required in a minority of patients, and placenta accreta spectrum was histopathologically confirmed in most of these hysterectomy specimens. The proportion of cases managed with uterus-preserving techniques increased progressively across the series, rising from none in the first year to the great majority of cases in the later years, while the peripartum hysterectomy rate declined correspondingly. On multivariable analysis, a greater number of previous cesarean sections independently increased, and operation during the later years of the series independently reduced the likelihood of peripartum hysterectomy. Perioperative transfusion of at least one blood product was required in more than half of the patients, whereas intensive care admission and perioperative complications were infrequent; bladder perforation was the most common complication. Compared with women whose uterus was preserved, those undergoing hysterectomy were older and had markedly longer operative times, greater blood product consumption, longer hospital stays, and a substantially higher complication rate. No maternal death occurred throughout the 13-year period. Conclusions: In this 13-year single-surgeon experience, the gradual adoption of uterus-preserving techniques was sustainably associated with low maternal morbidity and zero maternal mortality. The markedly higher complication burden observed in the hysterectomy group compared with the uterus-preserving group demonstrates that a standardized step-up surgical approach offers an applicable and effective management strategy even in resource-limited centers. Full article

Background: This study aimed to develop and evaluate a deep learning (DL) algorithm based on magnetic resonance imaging (MRI) for the classification of temporomandibular joint degenerative joint disease (TMJDJD), thereby exploring its potential role in assisting cone-beam computed tomography (CBCT) examinations and minimizing patient radiation exposure. Methods: A retrospective analysis was conducted on 104 patients who had undergone both MRI and CBCT examinations of the temporomandibular joint. A total of 1769 sagittal and 1448 coronal MRI images were collected. After image preprocessing, the datasets were grouped according to different imaging features. Three DL frameworks—ResNet101, DenseNet201, and MobileNetV2—were developed to classify TMJDJD using various MRI image categories. The classification performance of these models was evaluated using accuracy, precision, recall, F1 score, Matthews correlation coefficient (MCC), and the results were compared with classifications made by two senior clinical experts in a blinded image-level reader experiment. Results: DenseNet201 achieved the best performance in the sagittal (Sg) group, with an accuracy of 80.11%, precision of 80.26%, recall of 75.31%, and an MCC of 0.60. DenseNet201 achieved the best performance among the evaluated DL models, with higher overall performance metrics than ResNet101 and MobileNetV2. In a constrained image-level reader comparison, DenseNet201 demonstrated comparable overall agreement metrics to the two experts, although one expert achieved higher recall and a lower false-negative rate. t-Distributed Stochastic Neighbor Embedding (t-SNE) and training curve analyses confirmed that DenseNet201 demonstrated superior feature extraction capability and a more stable training process. Grouping MRI images, however, did not improve model accuracy. Conclusions: DenseNet201 showed preliminary potential for MRI-based TMJDJD classification, particularly on sagittal images. Based on image-level classification results, the model may provide preliminary support for identifying MRI findings associated with TMJDJD and assisting decisions regarding further CBCT evaluation. Full article

Background/Objectives: Postoperative free flap monitoring relies on clinical assessment of colour, turgor, and capillary refill time (CRT). The high frequency of required assessments renders this process labour-intensive and inherently subjective, with sensitivity dependent on observer experience and fatigue. This study evaluated the feasibility of a large multimodal AI (Artificial Intelligence) model (Gemini 3 Flash, Google AI Studio) applied without any task-specific training or fine-tuning, with each video analysed in an independent session, to establish whether meaningful diagnostic agreement is achievable before any domain-specific training is introduced, with the ultimate goal of supporting the development of a machine-based secondary safety net that augments, rather than replaces, the primary clinical assessment of the responsible surgeon in postoperative free flap surveillance. Methods: One hundred and forty-three postoperative video recordings from 143 different patients who underwent fasciocutaneous free flap reconstruction for extraoral defects were analysed. The cohort was deliberately enriched for pathological cases to ensure adequate representation of each vascular compromise category. Assessment was based on intrapatient comparison between flap and adjacent native tissue, without task-specific training or prior clinical information. AI outputs were compared against consensus assessments of three senior plastic surgeons (two associate professors, one full professor) for four parameters: flap colour, turgor, CRT interpretation, and clinical diagnosis. Agreement was evaluated using Cohen’s kappa (κ). Receiver operating characteristic (ROC) analysis assessed the discriminative performance of the AI confidence score. Results: Statistically significant agreement was demonstrated across all four parameters (p < 0.001 for all): flap colour (κ = 0.613, 95% CI: 0.489–0.737, 80.4%), turgor (κ = 0.676, 95% CI: 0.558–0.794, 83.9%; assessed from visual surrogates rather than direct palpation), CRT interpretation (κ = 0.487, 95% CI: 0.360–0.614, 74.1%), and clinical diagnosis (κ = 0.524, 95% CI: 0.399–0.649, 74.1%). Normal flaps were correctly identified in 81.0% of cases and venous compromise in 69.4%. ROC analysis identified a confidence score percentile cutoff of 89 as the optimal threshold for discriminating compromised from normal flaps, with scores below 89 indicating a compromised (pathological) result (AUC = 0.667, 95% CI: 0.579–0.755; sensitivity 77.0%, specificity 52.4%; overall accuracy 62.9%). Conclusions: A structured-prompted multimodal LLM (Large Language Model) demonstrated statistically significant agreement with the consensus judgement of senior plastic surgeons in postoperative free flap assessment without task-specific training, relying solely on intrapatient visual comparison. These findings constitute a proof-of-concept for AI-based video analysis as a potential adjunctive approach in free flap surveillance, warranting prospective validation with independent clinical outcome data before any claim of clinical utility, with possible broader applicability across clinical domains pending such validation. Key limitations include the absence of independent clinical outcome or confirmation of diagnostic categories, deliberately enriched sampling, a small arterial insufficiency subgroup, and the current absence of a formal data processing agreement for the cloud-based AI platform used. Full article

Background/Objectives: Cardiovascular diseases are the leading cause of morbidity and mortality in older adults and are frequently associated with multidimensional frailty and reduced quality of life. The present study aimed to investigate the associations among multiple domains of the Comprehensive Geriatric Assessment (CGA), including frailty, cognitive status, emotional status, nutritional status, functional status, fall risk, psychological resilience, and perceived quality of life, in older adults with cardiovascular disease. Methods: A cross-sectional observational study was conducted on 100 patients aged ≥60 years admitted to the Geriatrics Department of the “Dr. C.I. Parhon” Clinical Hospital, Iași. Cognitive, emotional, nutritional, and functional status, fall risk, frailty (Fried and Tilburg scales), resilience- Connor–Davidson Resilience Scale-25 (CD-RISC-25), and quality of life- World Health Organization Quality of Life–BREF (WHOQOL-BREF) were assessed. Statistical analysis included chi-square or Fisher’s exact tests and exploratory discrimination analysis using ROC curves. Results: Overall, 61% of participants reported a very good quality of life, whereas the remaining 39% reported a moderately reduced quality of life. Better perceived quality of life was significantly associated with preserved cognitive status, fewer depressive symptoms, better nutritional status, lower frailty (as assessed by both the Fried Frailty Phenotype and the Tilburg Frailty Indicator), preserved functional independence, lower fall risk, and greater psychological resilience (all p < 0.05). In contrast, neither demographic characteristics nor cardiovascular diagnoses were significantly associated with quality of life. Exploratory receiver operating characteristic (ROC) analysis demonstrated modest discriminatory performance for cognitive status— Mini-Mental State Examination (MMSE) (AUC = 0.660; p = 0.007), nutritional status— Mini Nutritional Assessment (MNA) (AUC = 0.624; p = 0.038), and the Tilburg Frailty Indicator (AUC = 0.635; p = 0.024), whereas psychological resilience exhibited an inverse relationship with the predefined outcome (AUC = 0.293; p = 0.001). Conclusions: In hospitalized older adults with cardiovascular disease, perceived quality of life was primarily associated with multidimensional geriatric, functional, nutritional, cognitive, and psychosocial factors, rather than with demographic characteristics or cardiovascular diagnoses. Psychological resilience was identified as an important psychosocial correlate of better perceived quality of life, supporting its inclusion in individualized comprehensive geriatric interventions. These findings highlight the importance of comprehensive geriatric assessment in identifying factors associated with quality of life. Given the cross-sectional design, the observed relationships should be interpreted as associations rather than causal effects and require confirmation in prospective longitudinal studies. Full article

The PR-IHC-40X dataset comprises a high-resolution collection of region-of-interest (ROI) images and corresponding ground-truth (GT) annotations for progesterone receptor (PR) immunohistochemistry (IHC) analysis in breast cancer pathology. We obtained 50 glass slides from the University of Malaya Medical Centre (UMMC) and digitized them into whole-slide images (WSIs) at 40× magnification using a 3DHistech Pannoramic DESK scanner. Pathologists annotated ROIs on the collaborative Cytomine platform, which formed the basis of dataset extraction. Ground-truth masks were generated in a multi-stage process: binary nuclei masks for segmentation were first created with a StarDist deep learning model and refined by manual correction, while the classification ground truth was first determined using a CNN-based approach and then modified by diaminobenzidine (DAB) intensity thresholding into four expression classes: Strong (red), Moderate (yellow), Weak (green), and Negative (blue). The classification outputs were re-corrected in a loop against the pathologists’ feedback and the manually checked results. There were approximately 32,000 nuclei within 250 ROI images that were manually checked and validated by senior pathologists individually. Each ROI comes with its binary segmentation mask and four-class color annotations, which make it a reliable dataset for deep learning research on nuclei segmentation, PR expression classification, and Allred scoring. To ensure a fair and reproducible evaluation, the dataset is released with a predefined slide-level (patient-wise) partition into training, testing, and evaluation subsets so that no slide contributes regions of interest to more than one subset and data leakage across subsets is avoided. Full article

Background/Objectives: Myocardial perfusion PET/CT, e.g., using Rb-82, enables the measurement of absolute myocardial blood flow (MBF) and, hence, the blood flow reserve, which plays a crucial role in the diagnosis of coronary artery disease. However, the values might depend on the observer’s analysis and, thus, depend on the observer’s experience. We investigated the inter-observer reliability of MBF measurements in Rb-82-PET/CT. Methods: Thirty consecutive patients who underwent Rb-82-PET/CT for suspected myocardial ischemia were analyzed. Stress conditions were simulated using 400 µg Regadenoson. MBF was measured using Corridor 4DM software. Myocardial flow reserve (MFR) is the ratio of absolute flow measurements under stress and rest conditions. Four different physicians with different levels of experience (two senior physicians and two residents) measured the MBF. The experience of the two residents was one year of experience and no previous experience, respectively. Intraclass correlation coefficients (ICC) were calculated for MBF and MFR in the three main vascular territories as well as in the whole left ventricle. Additionally, the left ventricular ejection fraction (EF) was determined. Results: The evaluation of MBF showed an excellent correlation between all observers, indicated by a low inter-observer variability. Comparing the two different levels of experience, senior physicians showed a slightly higher accordance in MBF assessment (ICC ranging from 0.9 to 0.98) than the residents (ICC ranging from 0.86 to 0.94). The MFR calculations showed a slightly lower reliability due to the accumulation of variability in rest and stress measurements (ICC between 0.78 and 0.81), still indicating a good reliability. The EF calculations also showed a good reliability among the different observers (ICC 0.83). Conclusions: Measurement of MBF, MFR and EF in Rb-82-PET/CT is highly robust with a very low inter-observer variability. A slightly higher inter-observer reliability was found for more experienced physicians. Full article

(1) Background: Hepatitis E remains a major public health challenge in India. (2) Methods: In August 2025, the recombinant HEV 239 vaccine was approved in India for adults aged 18 to 65 years. To establish clinical guidelines tailored to the Indian setting, an expert panel consensus was conducted using a modified Delphi process in accordance with the ACCORD reporting guidelines. (3) Results: A steering committee put forth 18 statements covering vaccine safety, efficacy, and clinical indications, which were independently evaluated by 33 senior Indian hepatologists and epidemiologists. Consensus was assessed using the GRADE framework for level of evidence, balance of benefits and harms, and strength of recommendations. Of the 18 statements, 12 reached the 70% consensus threshold. The panel concluded that the vaccine, which is administered on a standard three-dose schedule, is safe and highly effective in healthy adults, providing protection for up to 10 years. Targeted vaccination was recommended for five high-risk populations: outbreak-affected groups, hyperendemic pockets, women of childbearing age, patients with CLD, and solid organ transplant recipients. Although derived from HEV genotype 1, the vaccine demonstrated cross-protective efficacy against HEV genotype 4. (4) Conclusions: This consensus report provides a framework for deploying the HEV vaccine to mitigate disease burden in India while emphasizing the need for real-world effectiveness and safety data from India. Full article

Background: Bile leaks complicate 5–25% of liver transplants and are among the most common early postoperative biliary events. Their management within the first 14 postoperative days has traditionally been framed around the timing of intervention. Objective: To evaluate whether leak characteristics and patient stability provide more consistent guidance than intervention timing for early post-transplant bile leaks. Methods: A structured narrative review using a dual-source search (AI-assisted semantic search [Elicit Plus] and PubMed/MEDLINE) was conducted. A PICO-informed (Population, Intervention, Comparator, Outcome) framework guided inclusion; two independent reviewers preformed screening, with senior adjudication, yielding 37 sources. Because “early” was defined heterogeneously—by leak onset in most studies (definitions exceeding 14 days) and by intervention timing in others—and no study compared timing within a 14-day window, quantitative pooling was not undertaken. Results: No included study directly compared intervention timing within the first 14 postoperative days. In the largest available analysis of ERCP timing, resolution and adverse event rates did not differ by whether endoscopy was performed within one day, on days two to three, or after three days; endoscopic success was consistently high (80–98%) across temporal windows. Leak type was a consistent correlate of management intensity and resolution: anastomotic leaks were associated with higher surgical-intervention rates (40% vs. 8.3% for T-tube exit-site leaks in one cohort) and lower resolution rates (58–69%) than non-anastomotic leaks (90–100%). Within endoscopic therapy, bridging stent placement—not leak location—was the strongest independent predictor of resolution, and any bile leak, irrespective of subtype, independently predicted subsequent biliary stricture (pooled adjusted OR ≈ 4). Ultra-early leaks (≤72 h), frequently technical failures, formed the one subset favoring early surgical re-exploration. Conclusions: The absence of a demonstrated timing effect reflects a lack of direct comparative data rather than proof that timing is unimportant. Leak type, patient stability, and management modality offer more consistent and actionable guidance than temporal urgency, forming the basis for a leak-stratified framework. Prospective multicenter registries with standardized timing strata and leak type stratification are needed to test whether timing independently influences outcomes. Full article