Background and Objectives: Neoadjuvant chemotherapy (NAC) improves survival by increasing pathologic complete response (pCR). Blood-based indexes have been studied in breast cancer for predicting pCR and prognosis, but the results are conflicting. We aimed to assess the impact of inflammatory and nutritional indexes on pCR and survival. Materials and Methods: We retrospectively analyzed 304 patients. Pre-NAC laboratory data were used to calculate their neutrophil-to-lymphocyte ratios (NLR), pan-immune inflammation values (PIV), lactate dehydrogenase–albumin ratios (LAR), and prognostic nutritional indexes. The optimal cut-off values were determined through an analysis of the receiver operating characteristic curve. Survival analyses were performed using the Kaplan–Meier method. Multivariate regression analyses were performed to reveal the factors predicting pCR. Univariate and multivariate survival analyses were conducted to identify prognostic factors predicting survival. Results: The median follow-up was 38.5 months. pCR was achieved in 41.4% of the patients. In the univariate analyses, the NLR (p = 0.032) and PIV (p = 0.002) were indexes associated with pCR. In the multivariate analysis, the PIV (p = 0.008) was the only index significantly correlated with pCR. According to the multivariate Cox regression analyses, clinical stage 3 (p = 0.032), a pathologic response other than pCR (p = 0.021), and a high LAR (≥4.72) (p = 0.002) were correlated with increased recurrence risk. The univariate Cox regression analyses revealed that failure to achieve pCR (p = 0.037) and the presence of a high LAR (p = 0.044) were significant predictors of overall survival. However, the multivariate analyses failed to identify any significant predictors of death. Conclusions: We found that the PIV was more effective than the other indexes in predicting pCR. To our knowledge, this study is the first to determine an association between the LAR and disease-free survival in patients with breast cancer receiving NAC. We concluded that a high LAR was a poor prognostic factor, especially in patients without a pCR. Therefore, close postoperative monitoring and the intensification of adjuvant treatment should be considered for these patients. However, further studies are needed to confirm our findings.

Background/Objectives: Guidelines for the risk stratification of thyroid nodules are based on certain well-recognized sonographic features of nodules. However, significant variations in reported sensitivity and specificity values are observed due to the overlap of imaging characteristics between benign and malignant nodules. Additionally, differences in ultrasound (US) equipment and the varying experience levels of radiologists performing the imaging procedures contribute to these discrepancies. Inevitably, there are also interobserver differences. The aim of this study was to investigate interobserver agreement on these criteria using the international thyroid imaging reporting and data system (I-TIRADS) thyroid evaluation framework, independently assessed by three residents and one consultant. Methods: We included 393 patients who underwent ultrasound-guided fine needle aspiration biopsy (FNAB) within four months. In each case, longitudinal and transverse video images of the thyroid gland, neck chain, and biopsied nodules were recorded. The evaluations of the parameters defined in the I-TIRADS dictionary were then performed by a radiologist with 15 years of experience and radiology assistants with 3, 3, and 2 years of experience, respectively, blinded to the images, pathology data, and patient demographics. The parameters evaluated included composition, echogenicity, margin, direction of growth, calcification, extension beyond the thyroid, and lymph node. An interobserver comparison between the US lexicon classifications of thyroid nodules was then performed. Results: The results of our study showed that the highest level of consensus was observed in the ‘mixed predominantly cystic’ classification, indicating a solid consistency between the assessors (κ = 0.729). Conversely, the subcategories ‘Solid’, ‘Mixed Predominantly Solid’ and ‘Spongiform’ showed moderate agreement, while the “Pure Cyst” subcategory exhibited the lowest level of agreement among the assessors (κ = 0.292). Agreement among the three radiology assistants was strong concerning the evaluation of nodule composition, growth direction, and lymph node assessment. In contrast, a moderate level of consensus was noted regarding the assessment of extrathyroidal extension, margins, and echogenicity. Notably, the parameter exhibiting moderate agreement across all readers was the presence of echogenic foci or calcifications. Conclusions: the reproducibility observed in the parameters defined within the lexicon supports its potential to enhance consistency and interobserver agreement in thyroid nodule assessment.

Cystic echinococcosis (CE) is a disease that is endemic in our country and is caused by the contamination of eggs of the parasite Echinococcus granulosus. Appendiceal mucocele is an obstructive dilatation of the appendix as a result of intraluminal accumulation of mucoid material. We aimed to present a patient with simultaneous appendiceal mucocele and liver CE. A 55-year-old male patient presented to the emergency department with abdominal pain. In the radiological examinations of the patient, CE 2 lesion with a diameter of approximately 7x6cm in liver segment 7 and a lesion compatible with an appendiceal mucocele of approximately 4x4.5cm in the right lower quadrant were observed. The patient underwent laparoscopic partial cystectomy and laparoscopic appendectomy. The patient was discharged. In appropriate cases, laparoscopy can be safely performed simultaneously for appendiceal mucocele and liver CE.

Background/Aims: This study aimed to investigate the relationship between obesity indices and non-alcoholic fatty liver disease (NAFLD) in patients with ankylosing spondylitis (AS). Materials and Methods: A total of 170 patients with AS were included in this observational study with both prospective and retrospective components. Anthropometric measurements (height, weight, waist circumference [WC]) were prospectively recorded by the investigators during routine clinical visits. Obesity indices, including body mass index (BMI), WC, and waist-to-height ratio (WHtR), were calculated. Non-alcoholic fatty liver disease was diagnosed based on existing abdominal ultrasonography reports. Laboratory data, including liver enzymes, lipid profiles, and inflammatory markers, were retrospectively collected. The diagnostic performance of WC for NAFLD was assessed using receiver operating characteristic (ROC) curve analysis. Results: Non-alcoholic fatty liver disease was detected in 57% of AS patients. Higher BMI and WHtR were significantly associated with both the prevalence and severity of NAFLD (P < .001). Patients with NAFLD exhibited significantly higher levels of C-reactive protein, triglycerides, and alanine aminotransferase, as well as lower high-density lipoprotein levels, compared to those without NAFLD (P < .05). Additionally, the aspartate aminotransferase/alanine aminotransferase ratio was <1 in 66% of NAFLD patients, suggesting its potential as a biochemical marker for NAFLD in AS. The ROC analysis identified WC cutoff values of 100 cm for males and 90 cm for females, demonstrating high sensitivity and specificity in predicting NAFLD. Conclusion: Obesity is strongly associated with NAFLD in AS patients. Body mass index and WHtR may serve as valuable indicators for assessing hepatic steatosis risk. Routine metabolic evaluations, including obesityrelated parameters and liver enzyme levels, could facilitate the early detection of NAFLD in AS patients. Further prospective studies are warranted to clarify the causal relationship between obesity and liver involvement in AS.Cite this article as: Kutluk O, Dabak NE, Yucel AA, Alparslan AS, H, Cay F. The association between obesity indices and non-alcoholic fatty liver disease in patients with ankylosing spondylitis. Arch Rheumatol. 2025;40(4):482-491.

Background and Objectives: Delayed cerebral ischemia (DCI) is a major determinant of poor outcome after aneurysmal subarachnoid hemorrhage (aSAH), yet early risk prediction remains difficult, particularly in sedated or ventilated intensive care patients. We evaluated whether a large language model (LLM) could predict DCI from phase-based dynamic clinical data, compared with intensive care specialists. Materials and Methods: In this single-center, retrospective study, 216 consecutive patients with aSAH were assessed at three predefined phases of accumulating clinical data (day 1; days 1 + 3; days 1 + 3 + 5). For each patient–phase, an LLM (ChatGPT, GPT-5.5 Thinking) and two blinded intensive care specialists predicted DCI risk using only the data available up to that time point. DCI was adjudicated by a blinded three-member panel. Discrimination was assessed by the area under the receiver operating characteristic curve (AUC), with non-inferiority defined a priori as Δ = 0.10. Calibration, decision-curve analysis, and reproducibility were also assessed. Results: Of 216 patients, 60 (27.8%) were DCI-positive and 15 were indeterminate; the primary sample comprised 201 patients. In the prespecified primary analysis, the LLM met the non-inferiority criterion relative to both specialists across all three phases (LLM AUC 0.703–0.747; specialists 0.712–0.764); however, in an equal-granularity sensitivity analysis, non-inferiority remained supported only in Phases 2 and 3 and was not demonstrated in Phase 1. Discrimination increased numerically as data accumulated (Phase 1 vs. 3, p = 0.072), an increase that was attenuated in a landmark-restricted analysis accounting for DCI-onset timing. The LLM showed the lowest false-reassurance rate (3.3–11.7%), reflecting a more cautious threshold rather than better discrimination. Confidence did not reliably indicate accuracy (~25% of high-confidence predictions were wrong); outputs were highly reproducible (Fleiss κ 0.887; intraclass correlation coefficient (ICC) 0.968). Conclusions: An LLM achieved DCI discrimination that was non-inferior to—but not better than—that of experienced specialists; its unreliable confidence scores support clinician-supervised rather than autonomous use.

Alparslan AS. Korean J Radiol. 2026 Sep;27(9):906-907. https://doi.org/10.3348/kjr.2026.0897