Search Results (203)

Background: Sarcopenia is increasingly recognized as a prognostic factor in surgical populations. This study evaluated the association between cranial CT-based markers of sarcopenia and neurological outcomes in patients undergoing surgery for chronic subdural hematoma (CSDH). Methods: This retrospective case–control study included 82 patients who underwent surgery for unilateral CSDH. Demographic data, comorbidities, use of anticoagulant and antiplatelet therapy, postoperative complications and length of hospital stay were collected from patients’ medical records. Radiological parameters of sarcopenia, including temporal muscle thickness, temporal muscle area, and occipital fat pad thickness, as well as standard radiological features of CSDH, were measured preoperatively on the initial CT scan. Neurological outcome 3 months after surgery was assessed using the Glasgow Outcome Scale, with scores ≥ 4 defined as favourable and scores 1–3 as poor. Results: Demographic and clinical characteristics, including age, sex, comorbidities, hematoma thickness and intracranial midline shift, did not differ significantly between outcome groups. Temporal muscle thickness (4.7 vs. 2.8 mm, p < 0.001), temporal muscle area (160 vs. 106 mm², p = 0.04), and occipital fat pad thickness (4.7 vs. 3.4 mm, p = 0.04) were significantly greater in patients with favourable neurological outcomes. After corrections for age and comorbidities, multivariate logistic regression with temporal muscle thickness, area and density, temporal bone thickness and density, and occipital fat pad thickness demonstrated that temporal muscle thickness was the only independent predictor of good neurological recovery (OR 3.20, 95% CI 1.37–7.46, p = 0.007). ROC analysis showed good discriminatory power of temporal muscle thickness (AUC 0.812, 95% CI 0.695–0.930, p < 0.001), with a cut-off value of ≥3.37 mm for its ability to predict favourable neurological outcome. Conclusions: Temporal muscle thickness is a reliable, non-invasive imaging biomarker for predicting good neurological recovery after CSDH surgery and may aid in risk stratification, particularly in elderly or frail patients. Full article

Background/Objectives: Reinforced radiculoplasty (RRP) is effective for symptomatic sacral cysts, yet postoperative recovery varies significantly. This study aimed to systematically identify preoperative predictors of delayed short-term symptomatic recovery, with a specific focus on the prognostic impact of concomitant bladder–bowel dysfunction. Methods: A retrospective analysis was conducted on a cohort of 148 consecutive patients who underwent RRP. Comprehensive clinical, high-resolution imaging, and detailed surgical data were collected. The primary outcome was defined as symptom resolution within 9 months postoperatively. Independent prognostic factors were identified using univariate and subsequent multivariate logistic regression analysis. Results: Short-term symptom resolution was achieved in 86 patients (58.1%). Multivariate analysis identified three independent risk factors for prolonged recovery: a history of prior cyst surgery (OR 8.389, 95% CI 2.328–30.230), multi-segment cyst involvement (OR 2.682, 95% CI 1.066–6.744), and preoperative bladder–bowel dysfunction (OR 7.859, 95% CI 3.478–17.759). The predictive model demonstrated good discriminative ability (sensitivity 83.7%, specificity 61.3%). Conclusions: Prior surgical history, multi-segment cyst involvement, and preoperative bladder–bowel dysfunction are independent predictors of delayed short-term recovery after RRP for sacral cysts. Full article

Background/Objectives: Early neurological deterioration (END) is a frequent and clinically relevant complication in patients with a single small subcortical infarction (SSI), including lacunar infarction and branch atheromatous disease (BAD). Despite initially mild symptoms, END occurs in approximately 20–25% of cases and is strongly associated with poor functional outcomes. However, definitions, mechanisms, predictors, and therapeutic strategies remain heterogeneous. This review aims to synthesize current evidence regarding the incidence, pathophysiology, predictors, and management of END in SSI. Methods: We performed a narrative review of published studies addressing END in patients with lacunar stroke or SSI. We analyzed data on END definitions and incidence, imaging and clinical predictors, proposed pathophysiological mechanisms, and preventive and rescue therapeutic strategies. Results: END definitions vary across studies, most commonly defined as a ≥2-point increase in the National Institutes of Health Stroke Scale within 48–72 h. Hemodynamic compromise due to proximal perforator pathology, particularly in BAD, appears central to END development. Advanced imaging studies demonstrate perfusion abnormalities beyond the infarct core, supporting the concept of a “lacunar penumbra.” Lesion topology, proximal infarct patterns, parent artery plaques, larger infarct size, and vertical extension are consistent imaging predictors. Clinical factors such as diabetes mellitus, higher baseline severity, systemic inflammation, and increased arterial stiffness further modulate risk. Preventive strategies, including early dual antiplatelet therapy and intensified antithrombotic regimens, show promising signals, while induced hypertension may benefit selected patients as a rescue therapy. However, evidence remains largely observational or derived from subgroup analyses. Conclusions: END in SSI is a multifactorial and potentially modifiable process driven by interactions between proximal vascular pathology, hemodynamic failure, and tissue vulnerability. Standardized definitions, MRI-based phenotyping, and mechanism-driven trials are needed to optimize risk stratification and develop targeted preventive and rescue strategies. Full article

Introduction: Clinical staging based on digital rectal examination is imprecise, leading to pathological upstaging in patients with prostate cancer (PCa). Accurate preoperative assessment remains a challenge despite the use of multiparametric magnetic resonance imaging (mpMRI) and fusion-guided biopsy. This study aims to identify key predictors of upstaging in preoperative patients. Materials and Methods: A retrospective analysis of 924 patients who underwent radical prostatectomy between July 2012 and January 2025 was performed. Variables included prostate-specific antigen, prostate volume, biopsy type, MRI, body mass index and age. Upstaging was defined as ≥pT3 in patients staged clinically as cT1–2. Optimal cut-offs for continuous variables were defined statistically. Multivariable logistic regression was applied to identify independent predictors of upstaging and minor staging upgrading (MSU)—defined as any upward shift in the pathological T stage relative to the clinical T stage. Model performance was evaluated using the area under the Receiver Operating Characteristic (ROC) curve (AUC). Results: Upstaging occurred in 31.9% and MSU in 50.6% of patients. The mean age was 65 years. Cut-off values for PSA density (PSAD) were 0.29 for upstaging and 0.28 for MSU. In the full-cohort model (AUC = 0.628), PSAD (odds ratio (OR) = 2.55), age (OR = 1.04), and hypertension (HT) (OR = 1.47) were associated with upstaging. In PIRADS-based models, PIRADS 5 and PSAD predicted both upstaging (OR = 1.62 and 6.10, respectively; AUC = 0.664) and MSU (OR = 1.75 and 4.67, respectively; AUC = 0.659). MSU was also associated with HT and a lack of fusion biopsy (AUC = 0.622). Conclusions: PSAD and PIRADS 5 lesions are strong determinants of pathological upstaging and MSU in PCa. These factors should be considered in preoperative risk stratification to improve staging accuracy. Despite advances in imaging and biopsy techniques, upstaging remains a common phenomenon, underlining the need for further refinement of diagnostic protocols. Full article

Background/Objectives: Pulmonary embolism (PE) represents a major thrombotic complication in hospitalized patients with coronavirus disease 2019 (COVID-19), yet data on its incidence, clinical predictors, and short-term outcomes in actual cohorts remain heterogeneous. Methods: We conducted a retrospective observational cohort study including 395 consecutive adults hospitalized with RT-PCR-confirmed COVID-19 at a tertiary infectious diseases center between March 2020 and December 2024. Clinical, laboratory, imaging, and treatment data were extracted from electronic records, and PE was defined by computed tomography pulmonary angiography. Univariable and multivariable logistic regression analyses were used to identify independent predictors of PE in the subset of patients who underwent CTPA (n = 120), in whom PE status was definitively ascertained (47 with PE and 73 without PE). Results: Pulmonary embolism was diagnosed in 47 patients (11.9%). Patients with PE more frequently had prior venous thromboembolism (19.1% vs. 8.3%) and prolonged immobilization (61.7% vs. 23.0%), and were more often admitted to the intensive care unit (12.8% vs. 4.3%) than those without PE. Peak D-dimer levels were almost ten-fold higher in the PE group (median 5322 vs. 529.5 µg/L). In multivariable logistic regression, peak D-dimer was independently associated with PE (per log-unit increase, adjusted OR 3.9, 95% CI 2.1–7.1), and prolonged immobilization conferred a substantially higher risk of PE (adjusted OR 5.1, 95% CI 2.4–10.9). Patients with PE experienced more complex hospital courses and more frequent need for advanced therapies, although in-hospital mortality did not differ significantly between groups. Conclusions: In hospitalized COVID-19 patients, PE is frequent and closely linked to marked D-dimer elevation and acquired in-hospital risk factors, particularly prolonged immobilization. This evidence supports the use of dynamic D-dimer assessment and careful evaluation of immobilization status to improve risk stratification, guide decisions on diagnostic imaging and anticoagulation intensity, and identify patients who may benefit from closer post-discharge cardiovascular follow-up (this hypothesis requires confirmation in future prospective studies). Full article

Objectives: To investigate clinical and imaging predictors of short- and long-term outcomes in patients with posterior circulation stroke (PCS), with particular focus on infarct topography and ischemic burden. Methods: We conducted a retrospective multicenter observational study including 251 consecutive patients with acute PCS. All patients underwent CT angiography within 24 h and follow-up CT/MRI at 48–72 h. Clinical data, vascular risk factors, stroke severity (NIHSS), and functional outcome assessed by modified Rankin Scale (mRS), were collected. Short-term outcome was defined as mRS at discharge and long-term outcome as mRS at 3 months. Favorable outcome was defined as independence, graded as mRS 0–1. Imaging analysis included pc-ASPECTS, collateral scores, and quantitative ischemic volume assessment. Multivariable logistic regression was performed to identify independent predictors of outcome. Results: Among 251 patients, 105 (41.8%) had LVO. Patients with LVO presented with higher NIHSS scores, larger infarct volumes, and more frequent multiregional involvement. Basilar artery occlusion was associated with the most severe clinical and radiological profile. Infarct location, ischemic volume, baseline NIHSS, and pre-stroke mRS were independently associated with short-term outcome. For long-term outcome, age, infarct location, diabetes, and pre-stroke mRS remained significant predictors. LVO status and treatment variables were not independently associated with outcome. Conclusions: In PCS, outcome is primarily influenced by infarct topography and clinical factors rather than LVO status alone. Multiregional involvement and baseline disability are key determinants of prognosis. These findings underscore the need for PCS-specific prognostic models and highlight the importance of detailed imaging assessment beyond vessel occlusion. Full article

Background: Intracranial fusiform aneurysms represent a rare but clinically aggressive subtype of cerebrovascular disease, characterized by circumferential arterial dilation and a high risk of growth, ischemic complications, and rupture. Unlike saccular aneurysms, fusiform lesions lack well-established medical therapies to prevent progression or stabilize the aneurysm wall. Tumor necrosis factor-alpha (TNF-α) has emerged as a central mediator of aneurysm-associated inflammation and vascular remodeling, raising interest in TNF-α modulation as a potential therapeutic strategy. This study aimed to systematically review and synthesize the available clinical and translational evidence evaluating TNF-α signaling and anti-TNF-α therapies in the context of intracranial fusiform aneurysms. Methods: A systematic literature search was conducted in PubMed/MEDLINE, Embase, and Google Scholar from database inception through February 2026 in accordance with PRISMA guidelines. Eligible studies included human, animal, and translational investigations examining TNF-α biology or anti-TNF-α interventions in relation to intracranial fusiform aneurysms, intracranial dolichoectasia, or vertebrobasilar dolichoectatic aneurysms. Study selection, deduplication, and screening were performed using Covidence systematic review software. Extracted outcomes included aneurysm growth, rupture, ischemic events, imaging characteristics, inflammatory signaling, and vascular remodeling. Given substantial heterogeneity in study design and outcome reporting, findings were synthesized narratively using structured evidence mapping. Results: From the 368 records identified, 14 studies met inclusion criteria following full-text review. Included studies encompassed preclinical models, translational mechanistic investigations, and limited clinical observational data. Across experimental models, TNF-α signaling was consistently associated with macrophage infiltration, matrix metalloproteinase activation, vascular smooth muscle cell phenotypic modulation, and aneurysm wall degeneration. TNF-α inhibition was associated with reduced aneurysm progression and rupture in preclinical settings, including when initiated after aneurysm formation. Clinical evidence remains limited but suggests a potential association between TNF-α modulation and aneurysm stability, although direct therapeutic data in intracranial fusiform aneurysm populations are sparse. Conclusions: The existing translational and preclinical evidence supports a contributory role for TNF-α-mediated inflammation in the progression of intracranial fusiform aneurysms and suggests that TNF-α inhibition may represent a promising disease-modifying strategy. However, clinical data remain insufficient to support routine therapeutic use. Prospective observational studies and early-phase clinical trials are needed to define the safety, timing, and efficacy of anti-TNF-α therapies in patients with intracranial fusiform aneurysms. Full article

Background: Transperineal magnetic resonance (MRI)/ultrasound (US) fusion-guided prostate biopsy has emerged as a promising alternative to the transrectal approach by improving lesion targeting and reducing infectious complications. However, real-world data addressing factors that influence the detection of clinically significant prostate cancer (csPCa), including imaging characteristics and procedural experience, remain limited. Objective: To evaluate the diagnostic performance, safety profile, and independent predictors of csPCa detection in patients who underwent transperineal MR/US fusion-guided prostate biopsy, with particular emphasis on PIRADS category, prostate-specific antigen (PSA) level, and procedural learning curve. Methods: In this study, patient data were prospectively recorded in a routinely maintained institutional database, while the present analysis was conducted retrospectively. A total of 136 patients with clinical suspicion of prostate cancer—defined as elevated prostate-specific antigen (PSA), abnormal digital rectal examination, or PIRADS ≥3 on multiparametric MRI—underwent transperineal MR/US fusion-guided biopsy between January 2023 and October 2024. Results: Prostate cancer was detected in 45.5% of patients, whereas csPCa was identified in 32.3%. The PIRADS category emerged as the strongest independent predictor of csPCa detection, with PIRADS-5 lesions showing a significantly greater likelihood of csPCa than PIRADS-3 lesions (OR 6.70, p = 0.006). The PSA level was also independently associated with csPCa detection (OR 1.06 per ng/mL increase, p = 0.033). Although csPCa detection rates increased across learning curve groups, procedural experience was not an independent predictor after adjustment. The procedure demonstrated a favorable safety profile, with a low rate of infectious and noninfectious complications despite minimal use of antibiotic prophylaxis. The multivariable model showed moderate explanatory power and acceptable overall classification accuracy. Conclusions: Transperineal MR/US fusion-guided prostate biopsy provides reliable detection of clinically significant prostate cancer with a low complication rate and consistent performance across different stages of institutional experience. The PIRADS category and PSA level remain key determinants of csPCa detection, supporting the integration of MRI-based risk stratification into contemporary prostate cancer diagnostic methods. Full article

Background and Objectives: Non-O ABO blood groups have been linked to higher coronary risk, plausibly via hemostatic and lipid pathways. However, evidence in Japanese populations and imaging-defined disease is limited. We examined whether ABO status relates to serum lipids and coronary CT imaging findings in Japanese adults. Materials and Methods: We reviewed adults who underwent coronary CT angiography (CCTA) at our institution. After prespecified exclusions, 865 patients comprised the imaging cohort. For lipid analyses, we excluded patients receiving lipid-lowering therapy at the time of blood sampling, leaving 636 patients (lipid subset). ABO blood group was obtained from the medical record as recorded at registration (patient-reported) and was not re-confirmed by laboratory testing for this study. Outcomes were any coronary artery calcium (Agatston score > 0) and ≥50% luminal stenosis on CCTA. Results: In the lipid subset (n = 636), coronary calcium was present in 44–54% of patients across the four ABO groups and did not differ across groups (p = 0.33). Among assessable scans in the imaging cohort, ≥50% stenosis did not differ across the four ABO groups. In multivariable models (n = 636), older age, male sex, hypertension, and diabetes were independently associated with both outcomes (CAC presence and ≥50% stenosis) (all p < 0.05). For ≥50% stenosis, higher High-Density Lipoprotein-cholesterol (HDL-C) was additionally associated with lower odds (p < 0.05). ABO status (O vs. non-O) was not independently associated with either outcome. Conclusions: In Japanese adults undergoing CCTA, type O blood was tied to lower HDL-C and higher diastolic pressure—features that track with cardiometabolic risk—yet ABO type did not independently relate to coronary calcium or CT-defined stenosis once standard risk factors were considered. These data suggest that, in this setting, ABO adds little beyond conventional risk profiling. Full article

Background: In this study, we aimed to explore the relationship between quantitative indices derived from computed tomography (CT) attenuation histograms and disease prognosis in patients with pneumonia and acute respiratory failure. We also sought to assess the effectiveness of these parameters as clinical prognostic markers. Methods: CT images of patients with pneumonia and acute respiratory failure were analyzed using Vitrea^® Advanced Visualization software. The analyzed quantitative CT (qCT) indices included mean lung Hounsfield unit (HU) and density-based volume measurements, specifically low-, medium-, and high-density volume (LDV, MDV, and HDV). Comparative analyses were performed to examine the differences in the volume density between the lungs bilaterally; these were accompanied by regional analyses and density indices. All indices were calculated using previously defined and validated Hounsfield unit (HU) thresholds, which helped to ensure accurate and consistent quantitative measurements and facilitated a more robust evaluation of the prognostic potential of qCT parameters. Results: Quantitative CT indices proved to have significant prognostic value in predicting mortality. In multivariable analysis, Difference for Lung HDV > 193 mL emerged as an independent risk factor (aOR: 4.29, p = 0.041). The prognostic significance was especially evident in patients with unilateral dominant pneumonia, where Difference for Lung MDV >219 mL (aOR: 9.30, p = 0.03) and Difference for Lung HDV > 193 mL (aOR: 10.85, p = 0.02) emerged as strong independent predictors of mortality. In this subgroup, lung volume differences demonstrated the strongest diagnostic performance (AUC: 0.808, 95% CI: 0.667–0.908, p < 0.001). Conclusions: Clinical outcomes are associated with quantitative CT-derived lung volume and density difference indices. Inter-lung differences in Lung MDV and Lung HDV are linked to mortality and may provide additional prognostic information beyond conventional imaging methods. Prospective studies should be conducted to validate these findings, and caution should be exercised during their interpretation. Full article

Backgrounds: Single-arm studies evaluating reduced intensity (de-escalated) therapy for low-risk Human Papillomavirus-related oropharyngeal cancer (HPV+OPC) patients demonstrated high cure rates and reduced toxicity compared with historical results of standard of care (SOC). However, randomized studies demonstrated that the outcomes of de-escalated therapies were inferior to standard therapy, suggesting that a minority of patients may not benefit from de-escalation. Objectives: to review strategies and prognostic biomarkers before or early during therapy to identify low-risk HPV+OPC patients who may require SOC and who should be excluded from de-escalation trials to avoid compromising outcomes. Methods: A comprehensive narrative literature review between January 2000 and August 2025 was performed to identify prognostic biomarkers in HPV+OPC, as well as studies reporting early-response indicators with prognostic potential in clinically defined good-prognosis HPV+OPC treated with chemo-irradiation. Preclinical studies were excluded unless their findings had implications for clinical outcomes. Data were synthesized qualitatively in this narrative report due to the substantial heterogeneity of the clinical and methodological aspects of the reviewed studies. The risk of bias in non-randomized studies was assessed using the Newcastle–Ottawa Scale (NOS) for cohort studies. Results: Multiple candidate prognostic biomarkers were identified, including molecular, histopathological, imaging, and clinical factors. Almost all studies were retrospective, included small cohorts and lacked internal or external validation, and had poor NOS scores, mostly due to lack of sufficient follow-up and lack of information about loss to follow-up, thereby precluding most biomarkers from current clinical utilization. Response-based selection based on induction chemotherapy is effective but limited by its added toxicity. Early tumor responses assessed by hypoxia, metabolic imaging, and circulating HPV DNA kinetics show encouraging preliminary results that need to be validated. Conclusions: Current evidence indicates major methodological limitations in most studies of prognostic biomarkers in clinically defined good-prognosis HPV+OPC. Early tumor response-based selection strategies are promising and warrant comparison with SOC in multi-center randomized trials. Full article

Background: Early detection of dental caries is essential for effective oral health management. Current diagnostic workflows rely heavily on radiographic imaging, which involves infrastructure requirements, workflow coordination, and resource considerations that may limit frequent use in high-throughput or resource-constrained settings. These contextual factors motivate exploration of adjunct screening concepts that could support front-end triage decisions within existing care pathways. This study evaluates, in simulation, whether modeled tooth-percussion response signals contain sufficient discriminative information to justify further translational and managerial investigation. Implementation costs, workflow optimization, and economic outcomes are not evaluated directly; rather, the objective is to assess whether the technical preconditions for a potentially scalable screening concept are satisfied under controlled in silico conditions. Methods: An in silico model of tooth percussion was developed in which enamel, dentin, and pulp/root structures were represented as a simplified layered mechanical system. Impulse responses generated from simulated tapping were used to compute the modeled surface-vibration response (enamel-layer displacement), which served as a proxy for a measurable percussion-related signal (e.g., contact vibration), rather than a recorded acoustic waveform. Carious conditions were simulated through depth-dependent reductions in stiffness and effective mass and increases in damping to represent enamel and dentin demineralization. A synthetic dataset of labeled simulated signals was generated under varying structural parameters and measurement-noise assumptions. Machine-learning models using Mel-frequency cepstral coefficient (MFCC) features were trained to classify healthy teeth, enamel caries, and dentin caries at a screening (triage) level. Results: Under baseline simulation conditions, the classifier achieved an overall accuracy of 0.97 with balanced macro-averaged F1-score (0.97). Misclassifications occurred primarily between healthy and enamel-caries categories, whereas dentin-caries cases were most consistently identified. When measurement noise and structural variability were increased, performance declined gradually, reaching approximately 0.90 accuracy under the most challenging simulated scenario. These results indicate that discriminative information is present within the modeled signals at a screening (triage) level, meaning that higher-risk categories can be distinguished probabilistically rather than with definitive diagnostic certainty. Sensitivity and specificity trade-offs were not optimized in this study, as the objective was to assess separability rather than to define clinical decision thresholds. Conclusions: Within the constraints of the in silico model, simulated tooth-percussion response signals demonstrated discriminative patterns between healthy, enamel caries, and dentin caries categories at a screening (triage) level. These findings establish technical plausibility under controlled simulation conditions and support further investigation of percussion-based screening as a potential adjunct to clinical assessment. From a healthcare management perspective, the present results address a prerequisite question—whether such signals contain sufficient information to justify translational research, rather than demonstrating workflow optimization, cost reduction, or system-level impact. Clinical validation, threshold optimization, and implementation studies are required before managerial or operational benefits can be evaluated. Full article

Background: Extranodal extension (ENE) is a critical prognostic factor in head and neck squamous cell carcinoma (HNSCC) and was incorporated into the AJCC eighth-edition staging system. However, the concordance between clinical (cENE) and pathological (pENE) ENE remains poorly understood in real-world practice. Methods: We conducted a retrospective analysis using Taiwan Cancer Registry (TCR) long-form data from 2018 to 2022, focusing on four major HNSCC sites (oral cavity, oropharynx, hypopharynx, and larynx). The diagnostic gap was defined as the difference between pENE and cENE positivity rates. Results: Among 29,830 patients, a persistent diagnostic gap was observed across all sites: laryngeal (20.8%), hypopharyngeal (20.4%), oropharyngeal (11.5%), and oral cavity (9.9%). For oral cavity cancer, the gap did not narrow over the 5-year period (p = 0.9788). Furthermore, in oral cavity cancer, medical centers demonstrated a larger gap than non-medical centers (10.5% vs. 8.4%), a phenomenon we term the “Quality-Gap Paradox”. Conclusions: A significant diagnostic gap persists in HNSCC, highlighting the limitations of current imaging. The Quality-Gap Paradox, observed in oral cavity cancer, suggests this is driven by a complex interplay of factors including superior pathological detection in high-volume centers. Our findings underscore the need for advanced, personalized risk-stratification tools to bridge this gap and improve patient management. Full article

Background: Sex-related differences in cardiovascular disease outcomes are well recognized. Their impact on short-term outcomes in acute pulmonary embolism (PE) remains unclear. This study aimed to assess the association between sex and in-hospital outcomes in patients with acute PE. Methods: We performed a retrospective observational cohort study including 322 consecutive adult patients with acute PE admitted to a university hospital. Clinical, hemodynamic, laboratory, and imaging data were collected at presentation. The primary outcome was a composite poor outcome defined as intensive care unit (ICU) admission, systemic thrombolysis, or in-hospital mortality. Multivariable logistic regression analysis was used to evaluate whether sex independently predicted adverse outcomes after adjustment for established prognostic factors. Results: This study included 322 patients with acute pulmonary embolism (mean age 64.4 ± 13.1 years), of whom 50.0% were women. The composite poor outcome occurred more frequently in women than in men (34.0% vs. 22.7%, p = 0.032). Female sex was associated with increased odds of poor outcome in univariate analysis (odds ratio (OR) 1.76; 95% confidence interval (CI) 1.08–2.88). This association remained significant after multivariable adjustment (adjusted OR 1.69; 95% CI 1.02–2.82; p = 0.042). No significant sex differences were observed for individual components of the composite endpoint. Conclusions: Female sex was independently associated with a higher risk of adverse in-hospital outcomes in acute PE, suggesting that sex-specific factors may influence early prognosis and should be considered in future risk stratification models. Full article

Background/Objectives: Abdominal obesity, especially visceral adipose tissue (VAT), is an independent risk factor for coronary artery disease. This study aimed to investigate the association between single-slice CT-measured VAT and significant coronary artery stenosis and to establish an optimal VAT cut-off value for Taiwanese adults. Methods: Patients who underwent abdominal CT and coronary CT angiography (CTA) within 1 month of each other were enrolled in this retrospective study. Axial images of abdominal CT at the L4 pedicle level were selected for further VAT, subcutaneous adipose tissue, and paraspinal muscles analysis. Significant coronary artery stenosis was defined as any luminal stenosis of >50% of the diameter of the vessel that was measured in coronary CTA. Anthropometric and laboratory measurements, including height, weight, waist circumference (WC), blood pressure, blood glucose, and blood lipids, were also analyzed. Results: A total of 779 patients (300 females; 54.9 ± 9.96 years) were enrolled. Only VAT and systolic blood pressure correlated significantly with significant coronary artery stenosis. No significant differences were found in other demographic and anthropometric characteristics between the groups with and without significant coronary artery stenosis. Conclusions: Single-slice CT-measured VAT was associated with significant coronary artery stenosis, and a lower VAT cut-off is recommended for the Taiwanese population. Full article