Optimal Surgical Approaches for Thyroid Cancer: A Comparative Analysis of Efficacy and Complications - Article abstract #942619

Background: Accurate burn size and depth assessment at first contact guides fluid resuscitation, referral, and operative planning, yet both tasks show meaningful inter-clinician variability. General-purpose multimodal large language models may offer scalable, image-based decision support in emergency care, but prospective benchmarking against clinicians and a robust reference standard remains limited. Methods: We conducted a prospective, single-centre diagnostic accuracy and agreement study in a tertiary emergency department (22 July–8 September 2025). Consecutive acute burn presentations (< 24 h) were screened; protocol-conformant cases contributed standardized three-view photographs per anatomically distinct burn region. A multimodal large language model generated region-level estimates of total body surface area (TBSA) contribution and burn depth class. Eighteen emergency physicians independently rated the same images and minimal metadata, blinded to model and reference outputs. A three-member expert panel served as the reference standard by consensus. The primary endpoint was non-inferiority of the model versus the physician median for region-level absolute TBSA error relative to the panel, with a pre-specified margin of 3 percentage points, using patient-level cluster bootstrap for inference. Secondary endpoints included TBSA agreement and depth agreement (quadratic-weighted kappa). Results: Of 413 screened presentations, 52 patients were enrolled, yielding 64 analyzable burn region-cases (35 pediatric, 29 adult). The model’s mean absolute TBSA error versus the panel was 1.40 percentage points (median 1.00); 87.5% of cases were within ± 3 percentage points and 98.4% within ± 5. The physician median had a mean absolute error of 0.89 percentage points (median 0.75). The paired non-inferiority analysis met the pre-specified criterion (Hodges–Lehmann median Δ = 0.25; one-sided 95% upper bound = 0.50), indicating the model was non-inferior to physicians for TBSA estimation. In contrast, depth agreement versus the panel was slight for the model (quadratic-weighted kappa 0.14), with systematic underestimation of deeper burns, while physician consensus showed substantially higher agreement (quadratic-weighted kappa 0.65). Conclusions: In this prospective emergency department evaluation, a general-purpose multimodal model achieved non-inferior performance to emergency physicians for region-level TBSA estimation but performed substantially worse for burn depth classification. These findings support a narrowly defined adjunct role for TBSA estimation, while depth-dependent decisions should remain clinician-led and require further method development and external validation.

Objective: The prognosis of breast cancer (BC) is determined directly based on the stage of disease at the time of diagnosis. Proliferative breast lesions (PBLs) are an important risk factor for BC development. The risk of developing BC varies according to the presence of extent of proliferation in the breast lesions. We aimed to investigate the effect of BC risk factors on the PBLs in this study. Materials and Methods: Patients who visited the surgical clinic of the university during the past 6 years who presented with PBLs with or without atypia by fine/core needle aspiration biopsy were included in this study. The relationship between PBLs and BC risk factors such as the age, mass size, Body Mass index (BMI), smoking, sports activity, BC family history, the use of hormone replacement therapy, number of pregnancies, and the duration of breastfeeding were compared. Results: A total of 74 (96.1%) of all patients were women and three were men. The median age of the patients was 38 (range: 19-74) years; the cut-off value of age was 35.5 years. The mean age of patients with PBL-with atypia (PBL-WA) was higher (p=0.005) in the malignant group based on the final pathology and radiological imaging features (for both, p<0.001). The mean size of the mass was large at 2.53 +/- 1.33 (1-6) cm; and the cut-off value of the tumor size was 2.5 cm. The mean size was greater in the PBL-WA patients (p=0.171) in the malignant group based on the final pathology and radiological characteristic (respectively, p=0.004 and p=0.016). The mean BMI was 26.8 +/- 4.4 kg/m(2) (18.8-35.1) and the cut-off value was 25.4 kg/m(2). BMI was greater in the PBL-WA group and in the malignant group based on the final pathology (respectively, p=0.002 and p=0.001). Smoking was positive in 66.2% (n=51) of the patients, and it was high in the PBL-WA patients (p=0.001). The percentage of patients with no sports activity was 63.6% (n=49), while it was 20.8% (n=16) for those with once a week sports activity and 15.6% (n=12) for those with twice a week activity. There was family history of BC in 16.9% (n=13) of all patients. The number of positive cases of family history of BC was greater in the malignant group (p=0.001). Hormone replacement therapy was recorded in 11.7% (n=9) of the patients. The mean numbers of pregnancies (2.1 +/- 2.4) and breastfeeding duration (32.5 +/- 37.4 months) were low in the benign groups due to the relatively lower average age of the patients. Conclusion: Based on our analysis, age is an extremely important aspect for assessing PBLs. The age of the patient was statistically significantly greater in the patients with malignant lesions in all groups. The factors lesion size, BMI, smoking habit, and BC family history were also more frequent in the malignant groups. The rate of sports activity was lower in the malignant groups. Thus, it is necessary to evaluate patients individually when evaluating PBLs. It is recommended to evaluate PBLs together with BC risk factors for the better understanding.

Objective: The inferior mesenteric vein (IMV) is an important component of the portal venous system; however, normative developmental data during childhood remain limited. This study aimed to evaluate age- and sex-related changes in IMV caliber using contrast-enhanced computed tomography in a pediatric population. Methods: Radiologic images of 200 subjects aged 1–20 years were included in the examination. Terminal (IMV1), intermediate (IMV2), and pelvic (IMV3) calibers of the IMV were measured. Ratios of vessel calibers to the transverse diameter of the first lumbar vertebral body (L1TD) were calculated. In addition, the drainage pattern of the IMV was recorded. Results: L1TD, IMV1, IMV2, and IMV3 demonstrated significant age-related changes (p < 0.001). All IMV calibers increased from infancy to the postpubescent period. Among the calculated ratios, IMV1/L1TD and IMV3/L1TD demonstrated significant age-related variation (p < 0.05), whereas IMV2/L1TD remained relatively stable throughout childhood and adolescence (p > 0.05). No significant sex-related differences were observed for most parameters, although IMV3 was significantly greater in males than in females (p = 0.043). The splenic vein was the most common termination site of the IMV (47.5%), followed by the superior mesenteric vein (29.5%) and the splenomesenteric confluence (23.0%). Conclusions: The present study provides normative age-specific values for IMV caliber and IMV-to-L1TD ratios in the pediatric population. These data may facilitate the radiological assessment of IMV-related abnormalities and provide a practical reference for routine computed tomography evaluation of the pediatric mesentericoportal venous system.

Early identification of patients at high risk of amputation remains a major challenge in frostbite management, particularly in resource-limited settings wh

Background: We evaluated associations of CT-defined sarcopenia and myosteatosis with complicated acute left-sided colonic diverticulitis (ALCD) and their incremental discrimination beyond clinical characteristics and inflammatory markers. Methods: This retrospective single-center cohort included 164 adults hospitalized with CT-confirmed ALCD. L3 skeletal muscle index (SMI) and attenuation classified patients as having neither abnormality, CT-defined sarcopenia only, myosteatosis only, or both abnormalities. Complicated ALCD was defined as World Society of Emergency Surgery (WSES) CT stage ≥ 1A. Multivariable logistic regression and bootstrap internal validation of discrimination and calibration were performed. An additional sensitivity analysis used WSES stage ≥ 1B. Results: Complicated ALCD occurred in 93/164 patients (56.7%). Proportions differed across the four phenotypes (34.7%, 48.0%, 61.5% and 78.4%; overall p < 0.001). A separate analysis showed a positive trend with the number of muscle abnormalities (0, 1 or 2; p < 0.001). After adjustment, myosteatosis alone (aOR, 4.27; 95% CI, 1.34–13.62) and both abnormalities (aOR, 9.27; 95% CI, 2.85–30.17) remained independently associated with complicated ALCD, whereas CT-defined sarcopenia alone did not. Adding muscle phenotypes to a clinical reference model containing age, sex, ASA class, ACCI, WBC and CRP increased the apparent AUC from 0.837 to 0.877 (apparent ΔAUC, 0.040; 95% CI, 0.004–0.078). Optimism-corrected AUCs were 0.812 and 0.845 (corrected ΔAUC, 0.033). The phenotype-extended clinical model had an optimism-corrected calibration slope of 0.806, indicating residual overfitting. Associations for myosteatosis and the combined phenotype were also observed using WSES stage ≥ 1B. Twelve-month CT-confirmed repeat attacks occurred in 11/121 evaluable patients (9.1%), without phenotype differences (p = 0.553). Conclusions: Myosteatosis and the combined phenotype were associated with complicated ALCD and added discriminatory information beyond the clinical reference model. Residual overfitting and the absence of external validation limit clinical application; clinical net benefit remains unestablished.