Franklin University

Handheld ultrasound (HHUS) devices are increasingly used in clinical practice due to their portability and cost-effectiveness. However, HHUS image quality remains variable, and a standardized expert-based evaluation protocol is lacking. This study compares the image quality of B-mode recordings of five HHUS models with a high-end reference system (HEUS) using a blinded assessment to identify differences, covariates, offering a standardized evaluation framework.In this blinded, multi-center study, video sequences of the liver, pancreas, and sigmoid colon were recorded in ten volunteers using 5 HHUS devices - Vscan Air, Butterfly iQ+, Philips Lumify, Clarius C3, and Clarius C3 HD3 - and one HEUS (GE Logiq E10). Twenty-two physicians with many years of abdominal ultrasound experience rated blinded clips for 5 image quality parameters.The HEUS consistently received the highest ratings. Image quality differed significantly between HHUS devices. Clarius systems showed the smallest deviation from the reference, followed by Vscan Air and Philips Lumify. All image parameters significantly correlated with the overall impression, without a single dominant factor. The patients' BMI had no relevant influence. Examiner experience was less impactful than device familiarity and personal preference.The image quality of HEUS remained superior to all tested HHUS devices. Further subdivision of image quality aspects did not provide additional information. Furthermore, we could not identify significant covariates in our setup. These findings could justify simplified setups with reduced questionnaires and requirements for examiners.

Haemorrhage and blood product usage are common in venoarterial extracorporeal membrane oxygenation (VA ECMO) and associated with increased mortality. A prospective, investigator-initiated, longitudinal observational cohort study on major haemorrhagic events in 12 ECMO centres from 3 continents for three predefined subgroups (VA ECMO initiated during cardio-pulmonary resuscitation (ECPR), after cardiothoracic surgery (CTS), for cardiogenic shock (CS)). The aim was to describe haemorrhagic complications as well as transfusion practice and anticoagulation for the whole population as well as the subgroups. In addition, independent baseline predictors for red blood cell (RBC) transfusions were evaluated. 545 prospective patients were included between 2019 and 2022 (ECPR 149, CTS 169, CS 227). Hospital mortality was 46%. Over 2796 days 406 major haemorrhage events in 286 (52%) patients were recorded. CTS and ECPR patients had more frequent events occurring earlier in their course. 88% received RBC transfusions (1.27 (95%CI 1.22 – 1.31) units/day) with significantly more transfusions for CTS and ECPR patients. Platelet transfusion rates were highest in the CTS group (0.58 (95%CI 0.53–0.64) units/day). Haemoglobin and platelet count prior to transfusion were independent of subgroups and averaged (78 g/L (IQR 73, 84), 58 × 10^9/L (IQR 37, 85), respectively). However, platelet count prior transfusion was only marginally higher on days with major haemorrhage (74 × 10^9/L (IQR 50, 104). Systemic anticoagulation was started within the first 24 h in 83% (95% CI 80–87%) of patients, most frequently in CS patients (90%, CI 85–95%). Independent baseline predictors for RBC transfusion were ECPR (IRR 1.50, 95%CI 1.19–1.89) and prior use of antiplatelets (IRR: 1.43, 95%CI 1.13–1.80). Myocarditis and pulmonary embolism were associated with a lower rate of transfusion when compared to myocardial infarct (IRR: 0.57 (0.37–0.89), IRR: 0.67 (0.45–1.00, respectively). Haemorrhagic complications differ in clinical subgroups and RBC transfusion exposure is by far higher than in other critically unwell populations. We identified ECPR and antiplatelet therapy as additional predictors. Transfusion practice for RBC and platelets is variable and does not always follow international guidelines.

Based on anonymized inpatient service data from 2023 using the InEK-DatenBrowser (according to § 21 KHEntgG), the correlation between restrictions in the activities of daily living - measured with the Barthel Index - and the assigned level of care was examined. The aim was to demonstrate that the Barthel Index can be used as a practical tool for assessing the need for care in everyday medical practice. The results show that a lower Barthel Index is significantly associated with a higher level of care. Using ordinal logistic regression analyses (OR for level of care>1 are between 1.40 and 14.52) and the Kendall correlation test (τ=0.32; p<0.001; Cohen's d=1.10) we were able to demonstrate a statistically significant correlation. Thus, the Barthel Index can be used as an indicator for care needs - especially in cases where no formal level of care has yet been assigned. These findings can support medical decision-making and contribute to more needs-based care. Additionally, they could potentially ease physicians' daily routines by enabling the early identification of a need for long-term care.

Abstract Abstract A multifactorial porcine model of cardio-metabolic HFpEF highlights miR-483-3p as a promising target therapy. Background Heart failure with preserved ejection fraction (HFpEF) is associated with risk factors such as metabolic syndrome, diabetes, and hypertension, ultimately leading to endothelial dysfunction. Recent findings suggest a maladaptive role for miR-483-3p in endothelial cells and M2 macrophages in type 2 diabetes, but its role in HFpEF remains unclear. Purpose This study aimed to establish a multifactorial porcine model of cardio-metabolic HFpEF and investigate the expression of miR-483-3p during disease progression. Methods Adult female Göttingen minipigs (n=9) received subcutaneous drug-eluting implants releasing DOCA (50 mg/kg BW) for 60 days and were fed a high-fat, high-fructose, high-cholesterol, high-salt diet for 20 weeks. Assessments were performed every 4 weeks, including blood pressure, echocardiography, blood sampling, and at Week 20, invasive hemodynamic measurements (PCWP, LV conductance catheter), and coronary flow reserve (CFR). Six (n=6) adult female Göttingen minipigs, without DOCA and fed a standard diet, were used as controls and underwent the same investigations as the HFpEF animals. Results Animals developed a metabolic syndrome, including obesity, dyslipidaemia and glucose intolerance. Although the LVEF remained preserved throughout the study by echocardiography, cardiac remodeling was evident. This manifested as concentric LV hypertrophy, since the relative wall thickness (RWT) increased from 0.47 ± 0.11 (Week 0) to 0.73 ± 0.19 (Week 20). The control animals maintained their value of 0.49 ± 0.11. At Week 20, HFpEF animals were hypertensive (SBP: 182,8 ± 20,4mmHg vs. 114,1 ± 9,1mmHg; DBP: 127,3 ± 9,06mmHg vs. 63,0 ± 18,04mmHg; mAOP: 134,0 ± 18,02mmHg vs. 76,5 ± 10,8mmHg), showed a PCWP of 17,2±5,4mmHg and a compromised CFR (1.26±0.15 vs 2.10±0.3). LV PV-loop assessment revealed increased end-diastolic pressure (20.16±7.35 vs 9.96 ± 2.0 mmHg), as well as stroke work (5197 ± 1191J vs. 3299 ± 816J) and potential energy (1193 ± 217J vs. 722,5 ± 187.5J). Notably, the expression profile of miR-483-3p showed a continuous increase throughout the disease progression, reaching a plateau at week 12 with an approximately 1000-fold increase compared to baseline in M2 macrophages. In circulating plasma, miR-483-3p expression, normalized to the housekeeping gene miR-16-5p, was elevated up to 8-fold in the HFpEF group at weeks 12, 16, and 20 compared to the control group. Conclusion This study successfully establishes a clinically relevant porcine model of cardio-metabolic HFpEF. The progressive upregulation of miR-483-3p correlates with disease severity, supporting its potential as a therapeutic target in HFpEF.

Current psychiatric neuroimaging supports the view that major depressive disorder (MDD) is a dysconnection syndrome, characterized by structural brain dysconnectivity. Recent studies investigating this question, however, did not evaluate the involvement of comorbid disorders, of which anxiety disorders (ANX) are particularly prevalent. Here, we investigated the structural connectivity alterations observed in MDD with and without comorbid ANX. To this end, we reconstructed structural brain networks of n = 781 individuals with a diagnosis of MDD who had at least one diagnosis of an ANX (n = 249) and those without any diagnosis of ANX (n = 532), as well as n = 906 healthy controls (HC) from structural and diffusion-weighted MRI. The network-based statistic (NBS) toolbox was employed to evaluate network-level differences in structural connectivity among the three groups. Transdiagnostic analyses were conducted to explore the dimensional relationship between anxiety and structural connectivity. NBS revealed decreased structural connectivity in MDD patients without comorbid ANX and increased structural connectivity in MDD patients with comorbid ANX relative to HC, with both effects found in spatially overlapping white matter connections. Transdiagnostic analyses suggested that increases in anxiety were associated with increased structural connectivity across all groups. Our finding that hyperconnectivity rather than hypoconnectivity characterizes the structural connectome of MDD patients with comorbid ANX challenges the applicability of the dysconnection syndrome hypothesis to MDD with comorbid ANX, warranting symptom-based investigations of brain changes in mental disorders.

Abstract Background Metabolic rewiring is integral to immune cell activation and tissue inflammation, but its spatial and cell type–specific organization in Crohn’s disease (CD) remains poorly understood. In this study, we aimed to construct a spatially resolved single-cell atlas of immunometabolic states in human ileal CD, spanning active inflammation, remission, and health, to identify activity-linked and persistent metabolic signatures. Methods Terminal ileal tissue was obtained from patients with active CD (n = 10), CD in remission (n = 8), and controls (n = 10). Imaging mass cytometry was performed using a 37-marker panel incorporating lineage, structural and 14 metabolic proteins. Data were analyzed at single-cell resolution to define metabolic programs across identified cell clusters and spatial neighborhoods. In parallel, peripheral blood mononuclear cells were profiled by suspension mass cytometry to assess systemic signatures. Comparative and spatial correlation analyses were conducted in R using Phenograph clustering and neighborhood interaction modelling. Results IMC revealed extensive, cell type–resolved metabolic reprogramming in active CD. Inflammation was characterized by reduced mitochondrial and tricarboxylic acid cycle activity (ATP5A, CytC, VDAC1) with a concurrent shift towards the pentose phosphate pathway (G6PD) and dampened mTOR signaling. CD68+ macrophages and neutrophils displayed pronounced PPP activation, whereas B cells showed persistent depression of anaplerosis (GLUD1/2) and lipid uptake (CD36). Spatial neighborhood analysis uncovered compartment-specific metabolic coupling, particularly in remission, where immune-epithelial proximity correlated with restored mitochondrial activity. Peripheral blood exhibited only modest, myeloid-restricted changes, indicating that metabolic rewiring is predominantly tissue-embedded. Conclusion Crohn’s ileitis is defined by spatially organized, cell type–specific metabolic remodeling that persists beyond clinical remission. This immunometabolic atlas provides a framework for identifying tissue-specific therapeutic targets and biomarkers of disease activity in inflammatory bowel disease. Conflict of interest: Lehmann, Malte: No conflict of interest Walling, Sonja: No conflict of interest Adrian, Huck: No conflict of interest Kunkel, Désirée: No conflict of interest Glauben, Rainer: No conflict of interest Kühl, Anja A.: No conflict of interest Siegmund, Britta: Grant: Pfizer Other: Consultant: Abbvie, Abivax, Boehringer Ingelheim, Bristol Myers Squibb, Dr. Falk Pharma, Eli Lilly, Endpoint Health, Galapagos, Janssen/Johnson &amp; Johnson, Materia Prima, MSD, Pfizer, Takeda, Wedbush Securities. Speaker: Abbvie, AlfaSigma, Bristol Myers Squibb, CED Service GmbH, Dr. Falk Pharma, Eli Lilly, Ferring, Galapagos, Janssen/Johnson &amp; ampJohnson, MD Education, MSD, Pfizer, Tr1xBio. Haag, Lea Maxie: No conflict of interest

BackgroundCardiovascular magnetic resonance (CMR) offers state-of-the-art volume, function, fibrosis and oedema imaging. Quality assurance (QA) tasks, such as quantitative parameter reproducibility assessments, the evaluation of AI methods, and the assessment of trainees have become essential to CMR. However, the explainability of how qualitative differences impact quantitative differences remains underexplored. Our aim is to demonstrate a semi-automated QA tool, Lazy Luna’s (LL) applicability to typical CMR QA application cases.MethodsA software feature error-tracing is designed that allows for quickly pinpointing qualitative reasons for quantitative differences and outliers. Three QA application cases were designed. First, LL was applied to perform outlier detection for inter- and intraobserver analyses to detect failure cases and provide qualitative explanations. Outlier detection was performed on several typical images types. Second, LL supported an Artificial intelligence (AI) evaluation, in which an AI method was compared to a CMR-expert of 144 patients. LL assessed the acceptability of AI biases for left and right ventricular (LV, RV) end-systolic, –diastolic, and stroke volumes (ESV, EDV, SV), ejection fractions (EF) and the myocardial mass (LVM). Annotations were examined to explain the qualitative differences that resulted in good and poor parameters. The AI investigation was recorded as a video. Third, LL was used to provide a Trainee Feedback to a CMR beginner. The trainee was compared to an expert on several imaging techniques to investigate outliers.ResultsFor the outlier detection, LL detected segmentation differences that caused parameter differences on multiple sequences. For the AI evaluation calculated clinical parameter biases to be: LVESV:-3.1 ml, LVEDV:2.1 ml, LVSV:6.5 ml, LVEF:3.0 ml, RVESV:0.3 ml, RVEDV:-3.8 ml, RVSV:-4.2 ml, RVEF:-1.4 ml, LVM:-2 g. Inspecting the causes for outlier differences revealed that juxtaposed basal slice failures caused unacceptable LVSV deviations between AI and expert. For the trainee assessment, LL showed that trainee parameters exceeded tolerance ranges. The segmentations could be improved to better mirror expert segmentations and close the parameter gaps.ConclusionLazy Luna, as a semi-automated quality assurance tool, is applicable to several quality assurance application cases in CMR.Supplementary informationThe online version contains supplementary material available at 10.1186/s12911-025-03271-6.