Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 30 appraisals
BMJ open
Current evidence on radiofrequency denervation for chronic low back pain: a systematic review and meta-analysis
OBJECTIVE: To assess the effects of radiofrequency (RF) denervation for chronic low back pain (LBP) from facet joint, sacroiliac joint, discogenic and non-specific pain. DESIGN: Systematic review and meta-analysis. DATA SOURCES: We searched Medline, Embase, Cochrane Library, CINAHL, PsycINFO, ClinicalTrials.gov and WHO ICTRP up to 18 February 2025 for randomised controlled trials (RCTs). STUDY SELECTION, DATA EXTRACTION AND SYNTHESIS: Pairs of reviewers independently selected studies, extracted data and assessed risk of bias (Cochrane RoB 2). Meta-analyses with clinically homogeneous studies were performed and certainty of evidence was assessed using Grades of Recommendation, Assessment, Development and Evaluation. RESULTS: 55 RCTs (n=4394) were included; many outcomes were at some risk of bias. Low to moderate certainty evidence suggested small improvements in pain and function with RF denervation versus sham for facet joint pain, sacroiliac, discogenic and non-specific chronic LBP. None exceeded predefined minimally clinically important between-group differences, suggesting limited clinical relevance. CONCLUSIONS: RF denervation showed small improvements in pain and function compared with sham, steroid injection or standard care, but the effects did not reach clinically meaningful thresholds and the certainty of evidence was very low to moderate. Additional research is needed to clarify the effects of RF denervation and guide clinical decision-making. PROSPERO REGISTRATION NUMBER: CRD42023460743.
18 July 2026
Read appraisal →Proceedings of the National Academy of Sciences of the United States of America
Magnetically actuated microrobotic system for sequential treatment of biofilm
Biofilm-associated infections present a critical therapeutic challenge due to antibiotic resistance and impaired tissue healing. Here, we present a microrobotic system (MZ-8) that integrates real-time human-steered navigation with autonomous, microenvironment-responsive therapy to actively eradicate biofilms and promote tissue regeneration. This microrobotic system features a spine-inspired structure for mechanical biofilm disruption, a pH-responsive ZIF-8 coating for immunomodulatory Zn2+ release, and closed-loop actuation under second near-infrared fluorescence guidance. In a rat model of periprosthetic joint infection, MZ-8 achieved effective biofilm removal, induced a pro-regenerative immune response by polarizing macrophages toward the M2 phenotype, and significantly enhanced tissue regeneration. Transcriptomic analysis further revealed the activation of immunomodulatory pathways and upregulation of M2-associated genes, confirming the system's sequential shift from eradication to repair. Moreover, validation in a rabbit model and human knee joint confirmed its operational feasibility under clinical imaging guidance and excellent biosafety. This work establishes that integrating physical eradication, biochemical immunomodulation, and interactive control within a single system is essential for advancing from infection clearance to functional tissue restoration. Thus, it provides a therapeutic paradigm for biofilm-associated diseases and lays a foundation for future intelligent, clinically adaptive anti-infective systems.
15 July 2026
Read appraisal →ACS nano
Design and Applications of Magnetically Actuated Microrobots in Endovascular Embolization
Endovascular embolization is one of the core techniques in minimally invasive interventional medicine. It allows catheters to be accurately delivered to target blood vessels under image guidance for the implantation of embolic materials to achieve vascular occlusion. Although this technique has become increasingly mature, it still faces major challenges in precise delivery due to the limitations of embolic-agent properties and design concepts, restricting further improvement of the embolization therapeutic efficacy. Driven by continuous breakthroughs in materials science and control engineering, as well as the inevitable trend of medical development toward miniaturization, precision, and intelligence, microrobots show broad application prospects in precision disease treatment. They present advantages in accurate embolization and remote control in endovascular embolization, which can effectively improve embolization outcomes and reduce the risk of ectopic embolism. Taking the embolic microrobot system as the research focus, this paper systematically elaborates the design strategies, validation models, and practical applications of magnetically actuated embolic microrobots, comprehensively evaluates various imaging systems, and summarizes the supporting magnetic actuation technologies. It concludes the multimodule collaboration and adaptation framework of embolic microrobot systems. Finally, it analyzes the current limitations and potential translational challenges and presents a systematic prospect of its future development trends.
8 July 2026
Read appraisal →Current opinion in anaesthesiology
Preoperative considerations for nonoperating room anesthesia
PURPOSE OF THE REVIEW: This review aims to address the unique challenges in nonoperating room anesthesia (NORA) locations, emphasizing the importance of patient selection, risk stratification, and comprehensive preoperative evaluation to ensure safe anesthetic care for increasingly complex patients. RECENT FINDINGS: The volume of NORA procedures has risen significantly, with patients often presenting higher comorbidity burdens and advanced age. Standardized protocols and validated assessment tools, such as the STOP-Bang questionnaire and a simple frailty questionnaire (e.g., FRAIL), can aid anesthesiologists in effectively stratifying risk and tailoring anesthesia plans. Challenges in NORA include logistical constraints, personnel dynamics, and environmental factors that can compromise patient safety. The integration of telemedicine and artificial intelligence into preoperative assessments shows promise in improving efficiency and safety by allowing for remote evaluations and tailored care. SUMMARY: Adequate patient selection and preoperative optimization are essential for enhancing outcomes in NORA locations. Adherence to national safety guidelines and multidisciplinary collaboration is crucial for navigating the complexities of remote anesthesia care. Future research should focus on refining preoperative screening methods and utilizing artificial intelligence to better address the unique needs of patients undergoing procedures outside traditional operating rooms.
23 June 2026
Read appraisal →Current opinion in anaesthesiology
Traditional learning meets adaptive learning: the present and future of education in nonoperating room anesthesia.
PURPOSE OF REVIEW: Nonoperating room anesthesia (NORA) and continuing education in this setting are both in a state of change. Procedures performed outside the operating room, especially those that require nuanced anesthetic care, are becoming increasingly prevalent. Numerous new innovations are transforming care across NORA settings, especially within gastroenterology, interventional and neurointerventional radiology, and electrophysiology. Concurrently, education for NORA providers is rapidly evolving, influenced by technological advancements and artificial intelligence. RECENT FINDINGS: Traditional learning, a mode of education in which each learner receives essentially the same content, is now blending with adaptive learning, a field of precision education in which dynamic educational content is curated for individual learners, timed and paced to their preferences and progress, and coupled with artificial intelligence-generated feedback. The mainstays of traditional education for NORA providers remain relevant: content created by professional societies, podcasts, textbooks, and primary literature. Yet new, artificial intelligence-driven approaches for adaptive learning have entered the scene: clinical decision-making tools, literature review and knowledge mapping assistants, online platforms for precision education, virtual reality, and synthetic patients or avatars. SUMMARY: This article explores the blending of traditional and adaptive educational modalities in NORA continuing education and discusses the implications and obstacles for the future.
23 June 2026
Read appraisal →Med (New York, N.Y.)
Sintilimab and lenvatinib plus hepatic arterial infusion chemotherapy and embolization as conversion therapy for uHCC: A phase 2 trial
BACKGROUND: Transarterial chemoembolization (TACE) or systemic treatments are recommended for unresectable hepatocellular carcinoma (uHCC) but have low conversion-to-resection rates. This single-arm phase II trial (PLATIC) aims to investigate the conversion efficacy of PD-1 inhibitor sintilimab, lenvatinib plus TACE and hepatic arterial infusion chemotherapy (TACE-HAIC) in uHCC. METHODS: 57 uHCC patients received 200 mg of sintilimab and lenvatinib (8/12 mg for body weight <60 kg or ≥60 kg) and TACE-HAIC every 3-4 weeks. The primary endpoint was conversion-to-resection rate. A historical-based cohort treated with TACE-HAIC was included as control. FINDINGS: After a median of three treatment cycles, 44 (77.2%; 95% confidence interval [CI], 0.64-0.87]) patients underwent conversion resection. The objective response rates were 80.7% (95% CI, 0.68-0.90) according to modified Response Evaluation Criteria in Solid Tumors (mRECIST) and 43.8% (95% CI, 0.31-0.58) according to RECIST 1.1. Grade ≥ 3 treatment-related adverse events (TRAEs) occurred in 37 (64.9%) patients; no treatment-related deaths were reported. Among the 44 patients receiving resection, the median progression-free survival (PFS) was 17.3 months, and the median overall survival (OS) was unavailable. After inverse probability of treatment weighting analysis, the PLATIC cohort exhibited longer PFS (hazard ratio [HR] = 0.55, 95% CI, 0.33-0.94; p = 0.020) and OS (HR, 0.50, 95% CI, 0.28-0.92; p = 0.029) than the historical cohort. CONCLUSIONS: Sintilimab, lenvatinib, and TACE-HAIC demonstrated favorable conversion-to-resection rates and acceptable TRAEs in uHCC. FUNDING: Supported by grants from the National Natural Science Foundation of China (no. 82172815 and 82272887) and Cancer Innovative Research Program of Sun Yat-sen University Cancer Center (no. PT22040201).
14 June 2026
Read appraisal →PloS one
Time-to-event ensemble machine learning approach for predicting long-term survival of abdominal aortic aneurysm patients undergoing endovascular aneurysm repair
BACKGROUND: Endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) is associated with risks such as endoleaks and late aneurysm rupture, highlighting the importance of long-term survival prediction. Despite recent advancements in machine learning (ML), predictive models utilizing time-to-event analysis remain limited for AAA patients undergoing EVAR. We aimed to develop a stacking ensemble ML model to predict long-term outcomes in EVAR-treated AAA patients. METHODS: From 2002 to 2019, a total of 12,312 patients underwent EVAR. The primary outcome was AAA-related mortality, with follow-up until December 31, 2019. Using 5 ML algorithms, we developed a model comprising 34 variables. Model performance was assessed using the time-dependent C-index and Brier score. Variable importance was evaluated through permutation-based and partial dependent plots. RESULTS: The stacking ensemble model showed the best predictive performance among the tested models (time-dependent C-index: 0.759 at 30 days, 0.716 at 365 days). The time-dependent Brier scores generally increased slightly over time but remained stable across all ML algorithms. Important predictors included age, smoking status, duration between diagnosis and surgery, household income, renal function, and blood pressure. Variable importance differed over time, and each predictor presented a nonlinear relationship with AAA-related mortality risk. CONCLUSION: The stacking ensemble ML model for time-to-event prediction identified dynamic, time-varying changes in predictor importance, providing improved risk stratification and phase-specific management after EVAR.
14 June 2026
Read appraisal →Translational stroke research
Transcarotid Artery Revascularization for Asymptomatic Carotid Stenosis: A Systematic Review and Meta-Analysis
Management of asymptomatic carotid stenosis remains controversial despite advances in contemporary best medical therapy. Transcarotid artery revascularization (TCAR) has been introduced as an alternative revascularization option alongside carotid endarterectomy (CEA) and transfemoral carotid artery stenting (TF-CAS). Evidence focused specifically on asymptomatic carotid disease, however, remains limited and is derived mainly from observational analyses of clinical databases, with only a small amount of single-center retrospective evidence. The present study therefore examined the available comparative evidence on TCAR for asymptomatic carotid stenosis. A systematic review and meta-analysis was performed of studies reporting outcomes of TCAR in asymptomatic carotid stenosis. Eligible studies included asymptomatic cohorts or mixed populations with extractable asymptomatic subgroup data and reported outcomes after TCAR with comparison against CEA and/or TF-CAS. The primary pooled outcomes were stroke, death, stroke or death, and myocardial infarction at 30 days, together with the corresponding stroke, death, and stroke or death outcomes at approximately 1 year. For TCAR versus CEA, no significant between-group differences were identified in the pooled 30-day risks of stroke (risk ratio (RR), 1.25; 95% CI, 0.98-1.59; I²=82%), death (RR, 0.94; 95% CI, 0.64-1.38; I²=57%), or stroke or death (RR, 1.10; 95% CI, 0.95-1.26; I²=75%). In contrast, myocardial infarction within 30 days occurred less frequently after TCAR (RR, 0.68; 95% CI, 0.48-0.96; I²=71%). At approximately 1 year, pooled estimates likewise showed no significant difference in stroke (RR, 1.27; 95% CI, 0.70-2.29; I²=0%) or death (RR, 1.14; 95% CI, 0.97-1.35; I²=0%), whereas the pooled estimate for stroke or death favored CEA (RR, 1.25; 95% CI, 1.15-1.36; I²=31%). A different pattern emerged in the TCAR versus TF-CAS comparison. TCAR was associated with significantly lower pooled 30-day risks of stroke (RR, 0.60; 95% CI, 0.48-0.73; I²=0%), death (RR, 0.55; 95% CI, 0.38-0.81; I²=20%), and stroke or death (RR, 0.60; 95% CI, 0.52-0.70; I²=6%), while no significant difference was observed for 30-day myocardial infarction (RR, 0.91; 95% CI, 0.65-1.29; I²=44%). At approximately 1 year, stroke remained comparable between the 2 groups (RR, 0.75; 95% CI, 0.46-1.23; I²=26%), whereas death (RR, 1.09; 95% CI, 1.00-1.20; I²=66%) and stroke or death (RR, 0.79; 95% CI, 0.71-0.87; I²=45%) differed, with the pooled stroke-or-death estimate favoring TCAR. Current observational evidence suggests that TCAR compares favorably with TF-CAS in asymptomatic carotid stenosis. When compared with CEA, TCAR does not appear to provide a clear benefit in pooled perioperative neurologic outcomes, although myocardial infarction may occur less frequently after TCAR.
11 June 2026
Read appraisal →Neurosurgical review
Rho-associated kinase inhibitors in cerebral cavernous malformations: a preclinical systematic review
Cerebral cavernous malformations (CCMs) are vascular abnormalities characterized by clusters of dilated capillaries. They are most associated with loss-of-function mutations in three genes (Ccm1, Ccm2, and Pdcd10/Ccm3). In capillary endothelial cells, mutations activate the Rho-associated coiled-coil-containing protein kinase (ROCK), leading to non-heme iron deposition and lesion formation, thereby contributing to CCM pathophysiology. To address this, ROCK inhibitors are being explored as potential stabilizing therapies in CCM. By reviewing the existing literature, this study aims to provide a descriptive evaluation of their effects on non-heme iron deposition and lesion formation in murine models. This systematic review followed the PRISMA 2020 guideline and was registered in PROSPERO (CRD420251048073). PubMed, Embase, Web of Science, and Scopus were searched from inception to 2 February 2026. Eligible studies included in vivo murine CCM models with mutations in the Ccm1, Ccm2, and Pdcd10/Ccm3 genes. Studies had to evaluate direct ROCK inhibitors, such as fasudil and BA-1049, or indirect modulators of the RhoA/ROCK pathway, such as statins, regardless of dosage, route, or duration, and provide molecular evidence of RhoA/ROCK pathway modulation. The primary outcome was lesion burden, and the secondary outcomes included non-heme iron deposition and ROCK activity. Systematic searches identified 389 records, of which 4 studies were included, demonstrating that fasudil, a ROCK inhibitor, consistently reduced non-heme iron deposition and lesion burden in preclinical CCM models in mice. In Ccm1+/-Msh2-/- mice, fasudil reduced non-heme iron deposition and stage 2 lesions; in Ccm2+/-Msh2-/- mice, fasudil reduced non-heme iron deposition and lesion burden. One study demonstrated that BA-1049 caused a dose-dependent reduction in non-heme iron deposition and lesion burden. Studies have shown that ROCK pathway modulation reduces non-heme iron deposition and lesion burden. Further clinical investigations involving patients with CCM are essential to verify whether these experimental benefits can be reproduced in clinical settings.
9 June 2026
Read appraisal →The New England journal of medicine
Ultrasound-Facilitated, Catheter-Directed Fibrinolysis for Acute Pulmonary Embolism
BACKGROUND: Whether anticoagulation alone is an adequate treatment for acute, intermediate-risk pulmonary embolism is uncertain. METHODS: We conducted a multinational, adaptive-design trial with blinded outcome adjudication. Patients with intermediate-risk pulmonary embolism (with a ratio of right ventricular end-diastolic diameter to left ventricular end-diastolic diameter of ≥1.0 and an elevated troponin level) were eligible if they had at least two indicators of cardiorespiratory distress (systolic blood pressure of ≤110 mm Hg, a heart rate of ≥100 beats per minute, or a respiratory rate of >20 breaths per minute). Patients were randomly assigned to undergo ultrasound-facilitated, catheter-directed fibrinolysis with alteplase plus anticoagulation (the intervention group) or anticoagulation alone (the control group) according to prespecified treatment protocols. The primary outcome was a composite of pulmonary embolism-related death, cardiorespiratory decompensation or collapse, or symptomatic recurrence of pulmonary embolism within 7 days. RESULTS: The intention-to-treat population comprised 544 patients: 273 in the intervention group and 271 in the control group. The mean (±SD) age was 58.2±13.5 years, and 42.6% of the patients were women. A primary-outcome event occurred in 11 patients (4.0%; 95% confidence interval [CI], 2.3 to 7.1) in the intervention group and 28 (10.3%; 95% CI, 7.2 to 14.5) in the control group (relative risk, 0.39; 95% CI, 0.20 to 0.77; P = 0.005). The effect was driven primarily by a lower risk of cardiorespiratory decompensation or collapse in the intervention group. Major bleeding occurred within 7 days after randomization in 11 patients (4.1%) in the intervention group and 6 (2.2%) in the control group (P = 0.32); major bleeding occurred within 30 days in 11 patients (4.1%) and 8 patients (3.0%), respectively (P = 0.64). No substantial between-group differences in the incidence of other serious adverse events were observed up to 30 days after randomization; no intracranial hemorrhage occurred. CONCLUSIONS: In patients with acute, intermediate-risk pulmonary embolism, ultrasound-facilitated, catheter-directed fibrinolysis plus anticoagulation led to a lower risk of the composite of pulmonary embolism-related death, cardiopulmonary decompensation or collapse, or symptomatic recurrence of pulmonary embolism within 7 days than anticoagulation alone. (Funded by Boston Scientific; HI-PEITHO ClinicalTrials.gov number, NCT04790370.).
29 May 2026
Read appraisal →Journal of robotic surgery
Robot-assisted percutaneous pelvic channel screw placement for unstable pelvic ring injuries: a systematic review and meta-analysis with narrative technical comparison of multi-platform differences
Percutaneous pelvic channel screw fixation is a key technique for the minimally invasive treatment of pelvic ring injuries. Robotic-assisted systems aim to improve accuracy and reduce radiation, but direct comparative studies across platforms are lacking. This systematic review and meta-analysis primarily compares robot-assisted versus conventional fluoroscopy-guided pelvic channel screw placement, with a secondary narrative comparison of technical differences across TiRobot, Mazor X, and ROSA platforms. We systematically searched PubMed, Web of Science, Embase, Cochrane Library, CNKI, Wanfang, and CBM databases up to April 2026. Comparative studies of robot-assisted versus conventional fluoroscopy-guided pelvic channel screw placement in adult pelvic ring injury patients were included. Primary outcomes were screw accuracy (Gras classification) and radiation exposure. Secondary outcomes included operative time, functional recovery (Majeed score), complications, and cost. No direct head-to-head studies comparing different robotic platforms for pelvic screw placement were identified; therefore, platform comparisons are primarily narrative and indirect, with spine surgery data presented as hypothesis-generating only. Risk of bias was assessed using ROBINS-I and RoB-2, and evidence was graded using the GRADE system. Fifteen studies (1,247 patients, 2,893 screws) were included. Primary meta-analysis showed that robot-assisted placement significantly improved screw accuracy (excellent/good rate: 98.2% vs. 86.4%; OR = 5.32, 95%CI: 3.18-8.89, p < 0.001; GRADE: Low certainty due to risk of bias) and reduced radiation exposure (SMD=-1.84, 95%CI: -2.43 to -1.25; GRADE: Low certainty due to serious inconsistency). Operative time showed no significant difference in studies by experienced surgeons (MD=-5.2 min, 95%CI: -11.0 to 0.6). Functional outcomes (Majeed score) were comparable between groups (MD = 0.8, 95%CI: -0.7 to 2.3). Overall complications were significantly reduced with robotic assistance (OR = 0.46, 95%CI: 0.30-0.71; GRADE: Low certainty due to risk of bias). For platform comparisons, TiRobot has the strongest pelvic trauma-specific evidence from 11 studies (847 patients). Evidence for Mazor X and ROSA in pelvic trauma is limited to technical descriptions and indirect spine surgery data; no direct pelvic trauma validation is available. Robot-assisted pelvic channel screw placement is superior to conventional methods in accuracy and radiation reduction, with comparable functional outcomes and fewer complications. TiRobot demonstrates the strongest pelvic trauma-specific evidence based on available comparative studies. Mazor X and ROSA require direct pelvic trauma validation before their performance can be reliably compared. TiRobot may have lower acquisition costs in Chinese healthcare settings, but formal cost-effectiveness analyses are lacking for all platforms. Significant evidence gaps remain, including lack of high-quality RCTs, absence of direct platform comparisons in pelvic trauma, and insufficient cost-effectiveness analyses.
28 May 2026
Read appraisal →BMC urology
Comparison of suction and standard ureteral access sheath versus sheathless flexible ureteroscopy in management of upper ureteral and renal calculi
PURPOSE: Comparative effectiveness of suction versus traditional ureteral access sheath (UAS) remains an area of ongoing research. We aim to compare the outcomes of retrograde intrarenal surgery (RIRS) with suction and standard UAS versus without UAS in the management of renal and upper ureteric stones, with a specific focus on operative efficiency, stone-free rates, and postoperative complications. METHODS: This study was conducted between October 2023 and January 2025, including 90 patients with renal stones ≤ 3 cm and upper ureteric stones ≤ 1.5 cm. Patients were divided into three groups by random Allocation Software (version 2): Group A1 (standard UAS, n = 30), Group A2 (suction UAS, n = 30), and Group B (no UAS, n = 30). Operative time, vision quality, stone clearance, complications, and hospital stay were assessed. RESULTS: Group A2 had the shortest mean operative time (70.1 ± 10.3 min) with significantly better vision compared to Group A1 (114.3 ± 27.0 min) and Group B (125.0 ± 28.01 min) (p < 0.001). Residual stone rates were lowest in Group A2 (3.3%) compared to Group A1 (10.0%) and Group B (26.7%) (p = 0.035). The need for a second procedure was significantly higher in Group B (26.7%) compared to Group A1 (10.0%) and absent in Group A2 (p = 0.002). Hospital stay was significantly shorter in Group A2 compared to Group A1 and Group B (p = 0.005). Fever incidence (Clavien Grade II) was significantly higher in Group B (23.3%) compared to Group A1 (16.7%) and absent in Group A2 (p = 0.005). CONCLUSION: Suction ureteral access sheaths in flexible ureteroscopic lithotripsy for renal stones ≤ 3 cm and upper ureteric stones ≤ 1.5 cm was associated with improved stone clearance, reduced operative time and hospital stay, provide better endoscopic vision, minimized infectious complications and need for second procedure, compared to standard UAS or no sheath. However, outcomes may be influenced by surgeon experience and familiarity with suction-assisted systems. Prospective multicenter studies with larger sample sizes and varying surgeon experience levels are recommended.
27 May 2026
Read appraisal →Renal failure
Complication rates of 16- and 18-gauge needles for native kidney biopsies: a systematic review and proportional meta-analysis
This systematic review and meta-analysis evaluated complication rates and diagnostic yield reported in studies of adult native kidney biopsy using 16-gauge (16 G) or 18-gauge (18 G) needles. We included randomized trials and cohort studies of real-time ultrasound-guided biopsies, including case series. MEDLINE, Embase, and CENTRAL were searched through October 2024. Two reviewers independently performed study selection, data extraction, and risk of bias assessment using Joanna Briggs Institute tools. Random-effects meta-analyses estimated pooled proportions with 95% confidence intervals (CI), and univariable random-effects meta-regression explored study-level associations with major complications, transfusion, or gross hematuria. We screened 4,499 titles and abstracts and reviewed 319 full-text articles; 62 studies comprising 68 biopsy series were included. The pooled major complication rate in studies using 16 G needles was 1.83% (95% CI: 1.20-2.79) and 1.29% (95% CI: 0.78-2.13) in studies using 18 G needles, with no statistically significant difference. Mean glomerular yield was 18.8 with 16 G and 17.5 with 18 G needles. In study-level meta-regression, studies with higher prevalence of acute kidney injury, lower mean estimated glomerular filtration rate, or lower mean hemoglobin reported higher pooled complication rates. Most studies were single-arm cohorts; between-needle differences therefore reflect indirect study-level contrasts. Interpretation is limited by retrospective design and heterogeneity across studies. Overall, studies using both needle sizes reported low complication rates and similar diagnostic yield, although definitions and reporting varied. Direct comparative studies are needed to determine whether meaningful differences exist. What was knownKidney biopsy is essential for diagnosing many medical kidney diseases and guiding treatment, requiring adequate tissue samples for subsequent analyses.Modern biopsy techniques use spring-loaded, ultrasound-guided devices with smaller gauge needles, but optimal needle size remains uncertain.While 14G needles are associated with higher complication risk, evidence on whether 16G or 18G needles differ in safety or diagnostic yield is conflicting.This study addsIn this systematic review and meta-analysis of 62 studies involving 22,208 adult native kidney biopsies, we found no statistically significant difference in major complication rates between studies using 16G and 18G needles.In study-level meta-regression analyses, studies with a higher prevalence of acute kidney injury, lower mean estimated glomerular filtration rate, and lower mean hemoglobin reported higher pooled major complication rates.Potential impactStudies using both 16G and 18G needles reported similarly low major complication rates, although comparisons are based on indirect evidence with substantial heterogeneity.Findings support the ethical feasibility and clinical relevance of a large, randomized controlled trial to definitively guide needle size selection in native kidney biopsies.
26 May 2026
Read appraisal →World journal of urology
Retrograde intrarenal surgery versus miniaturized percutaneous nephrolithotomy for renal calculi: a grade-assessed meta-analysis of randomized controlled trials with trial sequential analysis
BACKGROUND: The optimal management of medium-sized (1-3 cm) renal stones remains a clinical dilemma, with retrograde intrarenal surgery (RIRS) and miniaturized percutaneous nephrolithotomy (mPCNL) serving as competing minimally invasive options. To overcome the selection bias inherent in previous meta-analyses that included observational data, we aimed to compare the efficacy and safety of both techniques by exclusively analyzing randomized controlled trials (RCTs). METHODS: A systematic literature search of five databases was conducted up to February 2026. Only RCTs comparing RIRS and mPCNL were included. The primary outcomes were the single session stone-free rate (SFR) and overall complication rate. Secondary outcomes included stone clearance-related outcomes, operative performance outcomes, and recovery-related outcomes. Data were pooled using a random-effects model, and trial sequential analysis (TSA) was applied. RESULTS: Thirty RCTs encompassing 4173 patients were included. mPCNL demonstrated a significantly higher single-session SFR compared to RIRS (R.R: 0.92, 95% C.I: 0.88-0.96, p < 0.001). RIRS showed a trend toward a lower overall complication rate although the difference did not reach statistical significance (RR = 0.79, 95% CI: 0.63-1.01; p = 0.057), reduced blood transfusion requirements, smaller hemoglobin drops, and shorter hospitalization times. However, RIRS required significantly more postoperative auxiliary procedures. Operative times and high-grade Clavien-Dindo III-V complication rates were comparable between both techniques. TSA confirmed that the cumulative evidence for single-session SFR was sufficient and conclusive, whereas TSA findings for overall complication rate should be interpreted cautiously. CONCLUSIONS: mPCNL achieves significantly higher SFR than RIRS in the management of 1-3 cm renal calculi. However, RIRS was associated with lower bleeding-related morbidity and shorter hospitalization, although no statistically significant difference was observed in the overall complication rate. Therefore, the choice between RIRS and mPCNL should be individualized, balancing maximal SFR against procedural invasiveness according to patient characteristics and stone complexity.
25 May 2026
Read appraisal →World journal of urology
From conventional imaging software to artificial intelligence: tools for stone volume assessment in urolithiasis. Α review by the EAU and YAU sections of endourology.
INTRODUCTION: Accurate assessment of stone burden is fundamental in urolithiasis, as it directly influences treatment selection and prognostic evaluation. Although maximum stone diameter on non-contrast computed tomography remains the most widely used parameter, it does not adequately reflect the three-dimensional complexity of urinary calculi. This review aimed to summarize the evolution of stone burden assessment from conventional imaging-based methods to software-assisted volumetry and artificial intelligence (AI)-driven tools, with emphasis on their accuracy, reproducibility, and clinical utility. METHODS: A narrative review of the literature was performed using PubMed/MEDLINE, Scopus, and Google Scholar for English-language studies published up to March 2026. Original studies, validation studies, technical reports, reviews, and guideline-related papers addressing conventional CT-based measurement, software-assisted volumetry, AI-based stone segmentation, and the clinical significance of stone volume were included. Due to heterogeneity in study design and reported outcomes, the evidence was synthesized narratively. RESULTS: Maximum stone diameter remains simple and widely available, but it incompletely represents true stone burden, particularly in larger or irregular stones. Formula-based ellipsoid calculations are practical yet show limited accuracy in complex geometries. Semi-automated CT-based segmentation software provides more reliable volumetric assessment, with excellent agreement with reference standards and reduced interobserver variability. AI-based approaches have further improved efficiency by enabling rapid and highly accurate automated stone detection and volume calculation. Across the reviewed literature, stone volume was consistently shown to be more clinically informative than linear dimensions for predicting spontaneous passage, stone-free rates after shockwave lithotripsy and ureteroscopy, and future symptomatic events during surveillance. CONCLUSIONS: Stone volume offers a more accurate and clinically meaningful estimate of stone burden than maximum stone diameter alone. The transition from formula-based methods to software-assisted and AI-driven volumetry represents an important advance in urolithiasis imaging. Wider adoption will depend on standardized imaging protocols, improved software accessibility, and validation of volume-based thresholds for routine clinical practice.
25 May 2026
Read appraisal →Medicine
Machine learning identifies a NETs-related four-gene diagnostic signature for abdominal aortic aneurysm
Abdominal aortic aneurysm (AAA) is a chronic degenerative disease characterized by localized aortic dilation and persistent inflammation. While neutrophil extracellular traps (NETs) are increasingly recognized as key drivers of vascular inflammation and aneurysm progression, the transcriptomic landscape of NETs-related genes (NRGs) in AAA remains inadequately characterized. This study aimed to identify reliable diagnostic biomarkers and explore the immune heterogeneity of AAA to facilitate early risk stratification. We integrated transcriptomic datasets from the Gene Expression Omnibus to elucidate the role of dysregulated NRGs. A comprehensive bioinformatics pipeline was employed, combining weighted gene co-expression network analysis with differential expression profiling to screen for AAA-specific NRGs. Rigorous feature selection was conducted through the intersection of 3 machine learning algorithms - least absolute shrinkage and selection operator, support vector machine-recursive feature elimination, and random forest - to derive a diagnostic signature. The model was constructed using the GSE232911 cohort and validated in an independent external cohort. A robust 4-gene diagnostic signature comprising CXCR4, GZMB, ITGA6, and CD47 was identified. This signature demonstrated a favorable diagnostic performance, achieving an area under the curve of 0.920 in the training cohort. The model maintained consistent discriminatory ability in the external validation cohort, primarily driven by the high discriminative ability of CXCR4 and GZMB. Consensus clustering based on these hub genes revealed 2 distinct molecular subtypes, with Cluster 2 characterized by significant enrichment of neutrophils and innate immune pathways, suggesting intense NETosis activity. Furthermore, drug prediction analyses identified candidate therapeutic compounds, including Eugenol and Tretinoin, offering potential avenues for targeting the NETs-associated molecular landscape. Our findings underscore the pivotal role of NETs-mediated inflammation in AAA pathogenesis and validate a robust 4-gene signature for early diagnosis. By delineating immune-related molecular subtypes and identifying potential drug candidates, this study provides a foundational framework for precision risk stratification and the development of targeted nonsurgical therapies for aneurysm management.
25 May 2026
Read appraisal →Signal transduction and targeted therapy
HILL: the efficacy and safety of hepatic arterial infusion chemotherapy with the FOLFOX regimen combined with lenvatinib and the PD-L1 inhibitor durvalumab in unresectable hepatocellular carcinoma: a prospective, single-arm, phase 2 clinical trial
Despite numerous available treatment options, the overall prognosis for patients with unresectable hepatocellular carcinoma (uHCC) remains poor. This study aimed to evaluate the efficacy and safety of combining hepatic arterial infusion chemotherapy with FOLFOX (FOLFOX-HAIC), lenvatinib, and the PD-L1 inhibitor durvalumab in this population, with all uHCC patients receiving the triple-combination regimen as initial therapy. The primary objective was progression-free survival (PFS), and secondary outcomes included objective response rate (ORR), disease control rate (DCR), overall survival (OS), and safety. From August 2021 to September 2023, 40 uHCC patients were enrolled, with a median follow-up of 23.1 months (95% confidence interval [CI], 19.0-23.8); 3 deaths and 12 disease progressions were recorded. The median PFS was 15.8 months (95% CI, 8.3-23.3) with a 6-month PFS rate of 77.5% (95% CI, 63-90%), and 1- and 2-year OS rates were 97.5% and 94.0%, respectively. Per modified RECIST criteria, ORR was 75.0% (9 CR/pCR, 21 PR) and DCR was 95.0% (8 SD); median time to response (TTR) was 2.2 months and median duration of response (DOR) was 10.4 months. Seven patients (17.5%) underwent R0 conversion surgery, 3 (42.9%) achieving pCR. Safety was favorable: 85.0% had grade 1-2 adverse events, with grade 3 elevated alanine aminotransferase and thrombocytopenia each occurring in 2 patients (5.0%). No grade 4 adverse events were observed. Collectively, the triple-combination therapy of FOLFOX-HAIC, lenvatinib, and durvalumab exhibits promising therapeutic efficacy, favorable disease control, and a well-tolerated safety profile, providing a potential new treatment option for patients with uHCC. Trial number: NCT04961918.
18 May 2026
Read appraisal →Journal of radiological protection : official journal of the Society for Radiological Protection
Fast occupational upper-limb radiation dose prediction using machine learning and Monte Carlo simulation
Interventional procedures expose physicians to scattered radiation, particularly to their upper extremities, posing occupational health risks. Existing extremity dosimeters such as thermoluminescents, optically stimulated luminescence rings and active personal dosimeters provide limited spatial information, exhibit angular and energy dependence and offer little or no real-time feedback. This study develops machine learning (ML) models to estimate radiation dose values at discrete upper-limb locations using Monte Carlo (MC)-derived data and procedure-specific parameters. A dataset of 10 000 MC dose maps was generated under varied clinical and geometric conditions. After log-transformation and normalisation, several ML models, including deep neural networks and tree-based regressor, were trained and assessed using five-fold cross-validation. Mean absolute error and relative error (RE) were evaluated on the original dose scale, and an ensemble of the three best-performing models was constructed to improve robustness. The ensemble consistently outperformed individual models, achieving an average RE of 3.69% and demonstrating stable performance across anatomical regions and dose levels. Highest accuracy was obtained for standard beam geometries, whereas larger discrepancies occurred in extreme configurations with steep dose gradients. Predicted dose patterns were consistent with the expected distributions across the upper-limb regions. The findings demonstrate the feasibility of ML-based extremity dose estimation in interventional environments. The proposed ensemble provides a rapid (around 10 ms), scalable alternative to full MC simulations, enabling near real-time predictions of upper-limb occupational dose and supporting optimisation of radiation protection practices in image-guided procedures.
16 May 2026
Read appraisal →World journal of urology
Complications of thulium fiber laser lithotripsy: a systematic review and meta-analysis by the EAU-YAU endourology and urolithiasis working group
BACKGROUND: Thulium Fiber Laser (TFL) has emerged as a promising alternative to Holmium: YAG for lithotripsy, yet its safety profile remains fragmented across various trials. This study aims to synthesize available evidence to determine the pooled complication rates associated with TFL lithotripsy . METHODS: A systematic review was conducted following PRISMA guidelines. We searched PubMed, Cochrane CENTRAL, and ClinicalTrials.gov for studies reporting complications of TFL in adult patients with urolithiasis. The primary outcome was the overall complication rate. Secondary outcomes included Clavien-Dindo grading, specific adverse events (fever, sepsis, injury), and stone-free rate (SFR). A random-effects meta-analysis was performed using the Freeman-Tukey double-arcsine transformation. RESULTS: Thirty-eight studies involving 3,329 patients were included. The pooled overall complication rate was 10.42% (95% CI: 8.01%-13.10%; I²=81.9%). Major complications (Clavien-Dindo III-V) were rare, with a pooled rate of 1.19% (95% CI: 0.68%-1.84%). Specific event rates included fever (2.45%), ureteral injury (1.37%), bleeding (1.07%), urosepsis (0.77%), ureteral strictures (0.70) and acute pyelonephritis (0.59%). Meta-regression identified operative time as a significant predictor of complications (p = 0.041), whereas stone size was not (p = 0.358). Subgroup analysis showed higher complication rates in pure renal stone treatments (13.83%) compared to ureteral stones (10.64%). The pooled Stone-Free Rate (SFR) was 87.61% (95% CI: 83.61%-91.12%). CONCLUSION: Thulium Fiber Laser lithotripsy demonstrates a pretty favorable safety profile with a very low incidence of high-grade complications (< 1.2%) and high efficacy.
14 May 2026
Read appraisal →World journal of urology
Clinical and procedural factors influencing ureteral stent dwell time and removal methods after endourological procedures: a systematic review.
INTRODUCTION: Ureteral stents are routinely used following endourological procedures to ensure adequate drainage and prevent obstruction. However, stent-related morbidity remains common, and optimal stent dwell time and removal methods are not well defined. This systematic review aimed to evaluate clinical and procedural factors influencing ureteral stent dwell time and the methods used for stent removal after endourological interventions. METHODS: A systematic review was conducted in accordance with PRISMA guidelines and registered on PROSPERO. MEDLINE and Embase were searched from inception to October 2025. Randomized controlled trials and comparative observational studies evaluating ureteral stent dwell time and/or removal methods in adults undergoing endourological procedures were included. Risk of bias was assessed using RoB 2 and ROBINS-I tools. RESULTS: Thirty-two studies encompassing 4,373 patients were included. Reported stent dwell times varied widely, most commonly ranging between 10 and 14 days in uncomplicated cases, with longer durations associated with increased rates of encrustation and removal difficulty. Removal techniques included rigid cystoscopy (48.7%), flexible cystoscopy (19.9%), extraction strings (23.5%), and device-assisted methods (7.9%). Less invasive approaches, particularly flexible cystoscopy and extraction-string removal, were consistently associated with reduced pain scores and improved patient comfort, although extraction strings carried a small risk of premature dislodgement. CONCLUSIONS: While practice patterns vary, the evidence suggests that a 10-14 day dwell time might be the optimal window to balance healing with the prevention of encrustation. Less invasive removal approaches, particularly flexible cystoscopy and extraction-string techniques, were generally associated with lower pain scores and high procedural success rates in selected patients. While these methods are safe and better tolerated, extraction strings carried a small, reproducible risk of premature dislodgement. High-quality prospective studies are needed to define determinant-based, individualized stent management strategies.
10 May 2026
Read appraisal →European journal of cancer (Oxford, England : 1990)
Stereotactic body radiotherapy versus hepatic resection for recurrent small hepatocellular carcinoma: A post-hoc analysis with propensity score adjustment from two randomized trials
BACKGROUND: Stereotactic body radiotherapy (SBRT) has been proven effective for treating small hepatocellular carcinoma (sHCC); however, the comparative efficacy of SBRT and surgical resection remains unknown. This analysis aims to compare the outcomes of SBRT and resection in treating recurrent sHCC. METHODS: Two randomized controlled trials enrolled recurrent sHCC undergoing resection (NCT01833286) or SBRT (NCT04047173). Patients with single recurrent HCC ≤ 5 cm were included in this study. The primary endpoint was local progression-free survival (LPFS). RESULTS: A total of 158 patients were included, with 83 and 75 patients assigned to the SBRT and resection cohorts, respectively. The cumulative 3-year LPFS rates were 84.3% (95% CI, 76.1-92.5) with SBRT and 76.8% (95% CI, 67.2-86.4) with resection, respectively (HR, 0.70 [95% CI, 0.35-1.40]; P = 0.311). The median progression-free survival time of the SBRT and resection group was 37.6 (95% CI, 26.0-49.2) and 26.3 (95% CI, 18.8-33.8) months, respectively, with no significant differences (HR, 0.80 [95% CI, 0.53-1.21]; P = 0.287). The 3-year overall survival rates were 90.3% (95% CI, 83.4-97.2) in the SBRT group, and 81.1% (95% CI, 76.5-90.1) in the resection group (HR, 0.53 [95% CI, 0.23-1.20]; P = 0.118). The comparison results remained consistent after adjusting for confounding variables. The incidences of adverse events were similar between the two groups (P = 0.695). CONCLUSIONS: SBRT provides satisfactory tumor control and long-term outcomes, comparable to those of resection. SBRT could be a potential alternative to resection in recurrent sHCC.
10 May 2026
Read appraisal →European journal of nuclear medicine and molecular imaging
Machine learning models classifiers enable a strong prediction of radioembolization-induced liver disease, and define a new bilirubin threshold for selection of patients.
PURPOSE: Selective Internal Radiotherapy (SIRT) is an established treatment option for hepatocellular carcinoma (HCC). However, a major complication is radioembolization-induced liver disease (REILD). METHODS: This retrospective study, analyzed patients treated with SIRT for HCC to identify clinical factors associated with REILD and to predict treatment response. Machine learning (ML) methods were applied to two distinct cohorts to determine predictors of toxicity and response. RESULTS: Among 138 patients analyzed for REILD, ML identified bilirubin as a key predictor. A refined threshold of 26.5 µmol/L (1.55 mg/dL) was associated with toxicity risk. In the response cohort (136 patients), predictive performance was limited, nevertheless tumor dose appeared as the most frequent feature selected by the models. CONCLUSIONS: Bilirubin was confirmed as a critical factor for REILD prediction with the identification of a new threshold that may improve patient risk stratification. While tumor dose appears as the main predictor of treatment outcome, robust response models require additional features.
5 May 2026
Read appraisal →Journal of vascular and interventional radiology : JVIR
A Deep Learning Model for Artery of Adamkiewicz Detection in Bronchial Artery Embolization: A Multicenter Retrospective Study
PURPOSE: To evaluate the effectiveness of a deep learning model for recognizing the artery of Adamkiewicz and anterior spinal artery (ASA) to prevent spinal artery non-target embolization during bronchial artery embolization (BAE). MATERIALS AND METHODS: This multicenter, retrospective study included 2036 patients from January 2019 to December 2023 with hemoptysis who underwent de novo BAE. A deep learning-based framework was proposed for spinal artery identification, comprising region of interest (ROI) perception and target spinal artery identification. The ROI perception extracted vessel-related regions to improve the conspicuity of the spinal artery. The target spinal artery identification utilized a progressive refinement learning network, localizing the artery from the global view, and progressively refined the identification results through cross-scale information interaction. RESULTS: Seventy-eight patients (3.8%) had an identifiable artery of Adamkiewicz and ASA on right intercostal-bronchial artery angiography. The sensitivity of the proposed method was 92.1% and the specificity was 84.6%, with no statistically significant difference from a fellow radiologist interpretation. CONCLUSIONS: The deep learning system for spinal artery detection during BAE exhibited high sensitivity and performance, comparable to radiology fellows.
4 May 2026
Read appraisal →Taiwanese journal of obstetrics & gynecology
Segmentation of uterus and myoma from MRI image based on deep learning
OBJECTIVE: Myoma is a common gynecologic condition with abnormal muscular and fibrotic tissue growth in the uterus. Compared with sonography, magnetic resonance imaging (MRI) provides more detailed information with a better diagnostic accuracy. However, the interpretation of the imagery is shrewdness- and experience-dependent. The therapeutic strategy of myoma can be directly affected by the relative location and size in the uterus. Hence, this study aimed to generate an objective standardized modality in interpreting the imagery. MATERIALS AND METHODS: Deep learning (DL) was used to train two models using MRI imagery labeled by radiologists: 1) Model Uterus + Endometrium: segmentation of uterus and endometrium; 2) Model Myoma: segmentation of myoma. The myomas were classified based on their relative position in the uterus according to FIGO criteria. Each set of MRI image sequence was obtained from uterine sagittal sections with 5.5-mm interval of 30 slices per case. The dataset was divided into training, validation, and test sets. The number of images was first increased by data augmentation before implementing a DL semantic segmentation DeepLabV3+model. Cross entropy and Dice function were used for the loss and evaluation functions, respectively. RESULTS: The Dice values of uterus, endometrium and myoma segmentation reached 81.55%, 73.49% and 67.34%, respectively. Thus, the 3-D prediction of the uterine, endometrial and myomatous regions had a positive effect on determining the classification of myomas. CONCLUSION: DL can be used as a tool to improve the diagnosis and classification of uterine myoma. This model can also be applied to other gynecologic diseases.
4 May 2026
Read appraisal →Renal failure
Factors influencing patency after percutaneous transluminal angioplasty for autogenous arteriovenous fistulae: a systematic review and meta-analysis
This systematic review and meta-analysis identified factors influencing patency after percutaneous transluminal angioplasty (PTA) for autogenous arteriovenous fistulae (AVF) in hemodialysis patients. Literature through July 2025 was searched for observational and randomized trials. Two reviewers independently performed study selection, quality assessment (Newcastle-Ottawa Scale/Cochrane tool), and data extraction. Meta-analyses used fixed-/random-effects models in R (per I2 statistic), with sensitivity and publication bias analyses. Fifty-two studies (n = 6,407) were included, 45 of high quality. For primary patency, independent risk factors were diabetes (OR = 1.02, 95% CI 1.01-1.02), lesion length >2 cm (OR = 2.87, 1.38-5.96), previous intervention (OR = 3.13, 1.69-5.79), failed AVF history (OR = 1.69, 1.22-2.35), brachiocephalic configuration (vs. radiocephalic, OR = 1.73, 1.33-2.26), vascular calcification, and multiple comorbidities. High post-PTA flow was protective, and drug-coated balloons outperformed conventional angioplasty. Secondary patency was compromised by diabetes (OR = 1.05, 95% CI 1.02-1.08), longer lesions (OR = 1.01, 95% CI 1.01-1.02), and residual stenosis (OR = 1.02, 95% CI 1.01-1.04), with procedural success protective. Intimal hyperplasia strongly predicted failure. Restenosis risk was elevated by diabetes (OR = 1.72, 95% CI 1.28-2.31) and hypertension (OR = 1.59, 95% CI 1.04-2.44), while medical therapy with nitrates (OR = 0.20, 95% CI 0.05-0.79) and higher albumin were protective. Conventional biomarkers had limited value. Long-term AVF patency after PTA depends on anatomical, historical, and pathological factors, emphasizing the need to target modifiable procedural and hemodynamic variables in clinical practice.
25 Apr 2026
Read appraisal →JAMA
Tumor Debulking in Combination With Chemotherapy in Multiorgan Metastatic Colorectal Cancer: The ORCHESTRA Randomized Clinical Trial
IMPORTANCE: Local therapy, including surgery, radiation, and ablation, is increasingly used in patients with multiorgan metastatic colorectal cancer (mCRC). However, prospective evidence for a survival benefit of tumor debulking is lacking. OBJECTIVE: To investigate whether tumor debulking added to palliative chemotherapy improves survival of patients with multiorgan mCRC. DESIGN, SETTING, AND PARTICIPANTS: This investigator-initiated, open-label, multicenter, randomized clinical trial enrolled patients with multiorgan mCRC between May 2013 and May 2023. The last date of follow-up was April 4, 2024. Patients were enrolled in 27 hospitals in the Netherlands and 1 in the UK. Adult patients with multiorgan mCRC were considered eligible if more than 80% tumor debulking was deemed feasible by resection, radiotherapy, and/or thermal ablation prior to starting first-line palliative chemotherapy. INTERVENTIONS: After achieving objective tumor response or stable disease after 3 cycles of capecitabine and oxaliplatin or 4 cycles of 5-fluorouracil and oxaliplatin with or without bevacizumab, patients were randomized 1:1 to receive chemotherapy alone (standard care group) or tumor debulking followed by chemotherapy. MAIN OUTCOMES AND MEASURES: The primary end point was overall survival. Secondary end points included progression-free survival and serious adverse events. These outcomes were analyzed in the intention-to-treat population, applicable from randomization. A prespecified interim analysis performed after the initial 100 participants were enrolled revealed that the trial was both safe and feasible to proceed. RESULTS: A total of 382 of 454 enrolled patients were randomized: 192 in the chemotherapy alone group (133 [69%] male) and 190 in the chemotherapy plus tumor debulking group (127 [67%] male). The median age was 64 years in both groups. After a median follow-up of 32.3 months, median overall survival in the chemotherapy alone group was 27.5 months vs 30.0 months in the chemotherapy plus tumor debulking group (adjusted hazard ratio, 0.88 [95% CI, 0.70-1.10]; P = .26). Median progression-free survival in the chemotherapy alone group was 10.4 months vs 10.5 months in the chemotherapy plus tumor debulking group (adjusted hazard ratio, 0.83 [95% CI, 0.67-1.02]; P = .08). More patients in the chemotherapy plus tumor debulking vs chemotherapy alone group had any serious adverse events (101 [53%] vs 74 [39%]; P = .006). CONCLUSIONS AND RELEVANCE: Tumor debulking in addition to first-line palliative systemic treatment failed to improve overall survival compared with systemic treatment alone for patients with multiorgan mCRC and should not be considered standard care. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01792934.
23 Apr 2026
Read appraisal →Journal of clinical oncology : official journal of the American Society of Clinical Oncology
Transarterial Chemoembolization Combined With Camrelizumab and Rivoceranib for Unresectable Hepatocellular Carcinoma (CHANCE2005/CARES-005): A Randomized Phase II Trial
PURPOSE: Transarterial chemoembolization (TACE) alone has shown limited efficacy in improving survival among patients with unresectable hepatocellular carcinoma (HCC). This phase II trial compared TACE combined with camrelizumab (anti-PD-1 antibody) and rivoceranib (vascular endothelial growth factor receptor 2 inhibitor) versus TACE in unresectable HCC. METHODS: Patients with unresectable HCC (Barcelona Clinic Liver Cancer stage A to C without extrahepatic metastases) and Child-Pugh class A liver function were randomly assigned (1:1), stratified by macrovascular invasion, previous tyrosine kinase inhibitor treatment, and number of previous TACE procedures, to receive TACE combined with camrelizumab (200 mg once every 3 weeks) and rivoceranib (250 mg once daily; TACE-C-R) or TACE alone. The primary end point was progression-free survival (PFS) per composite criteria (progression per Response Evaluation Criteria in Cancer of the Liver version 5, transient deterioration to Child-Pugh class C, or TACE failure or refractoriness) in the intention-to-treat population. RESULTS: Between December 28, 2020, and October 29, 2023, 200 patients were randomly assigned (100 in each group). Median PFS per composite criteria was significantly longer with TACE-C-R than with TACE (10.8 months [95% CI, 8.8 to 13.7] v 3.2 months [95% CI, 2.4 to 4.2]; hazard ratio, 0.34 [95% CI, 0.24 to 0.50], P < .001). Grade ≥3 treatment-related adverse events occurred in 74.5% (70 of 94) of patients with TACE-C-R and 22.3% (23 of 103) of patients with TACE, with the most common being increased AST (29 [30.9%] and 13 [12.6%]) and increased ALT (23 [24.5%] and 14 [13.6%]). CONCLUSION: The addition of camrelizumab and rivoceranib to TACE showed statistically significant improvement in PFS for patients with unresectable HCC, with a manageable safety profile. Follow-up for further overall survival analysis is ongoing.
10 Apr 2026
Read appraisal →Angiology
Artificial Intelligence Techniques for Prognostic and Diagnostic Assessments in Peripheral Artery Disease: A Scoping Review
Peripheral artery disease (PAD) is a major public health concern worldwide, associated with high risk of mortality and morbidity related to cardiovascular and adverse limb events. Despite significant advances in both medical and interventional therapies, PAD often remains under-diagnosed, and the prognosis of patients can be difficult to predict. Artificial intelligence (AI) has brought a wide range of opportunities to improve the management of cardiovascular diseases, from advanced imaging analysis to machine-learning (ML)-based predictive models, and medical data management using natural language processing (NLP). The aim of this review is to summarize and discuss current techniques based on AI that have been proposed for the diagnosis and the evaluation of the prognosis in patients with PAD. The review focused on clinical studies that proposed AI-methods for the detection and the classification of PAD as well as studies that used AI-models to predict outcomes of patients. Through evaluation of study design, we discuss model choices including variability in dataset inputs, model complexity, interpretability, and challenges linked to performance metrics used. In the light of the results, we discuss potential interest for clinical decision support and highlight future directions for research and clinical practice.
4 Apr 2026
Read appraisal →Computer methods in biomechanics and biomedical engineering
Reconstruction of blood flow velocity with deep learning information fusion from spectral ct projections and vessel geometry
In this work, we investigate a new deep learning reconstruction method of blood flow velocity within deformed vessels from contrast enhanced X-ray projections and vessel geometry. The principle of the method is to perform linear or nonlinear dimension reductions on the Radon projections and on the mesh of the vessel. These low dimensional projections are then fused to obtain the velocity field in the vessel. The accuracy of the reconstruction method is proved using various neural network architectures with realistic unsteady blood flows. The approach leverages the vessel geometry information and outperforms the simple PCA-net.
4 Apr 2026
Read appraisal →Methodist Debakey Cardiovasc J
Vascular Robotics: Webcast
This 55-minute webcast features a conversation about "Vascular Robotics"-the focus of Issue 21.5. Led by the issue's editors, the discussion engages the authors on emerging themes and lessons learned while researching and writing the articles. View the video at https://vimeo.com/event/5556427.
1 Jan 2025
Read appraisal →