Evgenia Efthymiou

Lower back pain (LBP) is a leading cause of disability globally, characterized by multifactorial origins that complicate accurate diagnosis and effective treatment planning. Artificial intelligence (AI), including machine learning (ML), deep learning (DL), and radiomics, has shown promise for improving the reproducibility and quantitative assessment of spine neuroimaging. This narrative review synthesizes current evidence on AI-derived imaging biomarkers in magnetic resonance imaging (MRI) and computed tomography (CT), with emphasis on disc degeneration, spinal stenosis, endplate signal abnormalities, paraspinal muscle composition, vertebral fractures, and spinal alignment. AI-based reconstruction, segmentation, and classification methods may reduce reader variability and enable standardized quantification of imaging features. However, the current evidence base remains dominated by technical and retrospective validation studies, and high diagnostic performance should not be interpreted as proof of improved patient-centered outcomes. The present review distinguishes technical feasibility, diagnostic assistance, prognostic association, and clinical utility, and highlights the persistent efficacy-effectiveness gap in AI-based spine imaging. Although multimodal models integrating imaging, clinical, biomechanical, and patient-reported data may improve future risk stratification, clinical translation remains constrained by heterogeneous datasets, limited external validation, incomplete interpretability, and evolving regulatory frameworks. Prospective multicenter validation and outcome-linked evaluation are required before AI-derived imaging biomarkers can be considered established tools for routine LBP management.

Purpose To retrospectively compare long-term oncologic outcomes of percutaneous computed tomography-guided microwave ablation (MWA) and robot-assisted partial nephrectomy (RAPN) for the treatment of stage 1 (T1a and T1b) renal cell carcinoma (RCC) patients. Materials and Methods Institutional database research identified all T1 RCC patients who underwent either MWA or RAPN. Models were adjusted with propensity score matching. Kaplan–Meier log-rank test analyses and Cox proportional hazard regression models were used to compare the oncologic outcomes. Patient and tumor characteristics, technical success as well as oncologic outcomes were evaluated and compared between the 2 groups. Results After propensity score matching, a total of 71 patients underwent percutaneous MWA (mean age 70 ± 10 years) and 71 underwent RAPN (mean age 60 ± 9 years). At 8-year follow-up, the estimated survival rates for MWA cohort were 98% (95% confidence interval [CI] 95–100%) for overall survival, 97% (95% CI 93–100%) for recurrence-free survival, and 97% (95% CI 93–100%) for metastasis-free survival. The matched cohort that underwent RAPN exhibited survival rates of 100% (95% CI 100–100%) for overall survival, 98% (95% CI 94–100%) for recurrence-free survival, and 98% (95% CI 94–100%) for metastasis-free survival. After performing log-rank testing, these rates were not significantly different (p values of 0.44, 0.67, and 0.67, respectively). Conclusion The results of the present study suggest that both MWA and RAPN are equally effective in terms of oncologic outcome for the treatment of T1 RCC.

Research plays an indispensable role in the field of medicine, driving the advancement of health care and facilitating the development of novel and effective approaches for diagnosing, monitoring, and treating diseases^{(1 1 Institute of Medicine. Beyond the HIPAA privacy rule: enhancing privacy, improving health through research. Washington, D.C.: The National Academies Press; 2009. ) . By sharing their research outcomes, medical professionals contribute to the collective knowledge base, promoting a continuous cycle of learning, refinement, and advancement within the medical field. In addition, published research often serves as a reference for future studies, building upon existing information and driving further scientific exploration(1 1 Institute of Medicine. Beyond the HIPAA privacy rule: enhancing privacy, improving health through research. Washington, D.C.: The National Academies Press; 2009. ) . Furthermore, publishing research manuscripts brings recognition and credibility to medical professionals; it allows them to showcase their expertise and contributions, enhancing their professional reputation and career growth opportunities(2 2 Asnake M. The importance of scientific publication in the development of public health. Cien Saude Colet. 2015;20:1972-3. ) . Consequently, the publication of research manuscripts has progressively become an essential requirement intertwined with the careers of medical professionals. However, due to immense competition, physicians may have to continuously increase the number of publications they produce in order to succeed and advance in their field, a phenomenon otherwise referred to as the “publish or perish” mentality(3 3 Rawat S, Meena S. Publish or perish: where are we heading? J Res Med Sci. 2014;19:87-9. ) . Beyond the production of the actual research, the publication process itself can often be time-consuming, involving multiple rounds of peer review and revisions by physicians who already have limited spare time. It is not uncommon for them to have to work diligently during weekends or outside regular working hours to fulfill their responsibilities, such as completing research projects, conducting peer reviews, and meeting critical deadlines. Juggling research and clinical work under these conditions can become overwhelming and may lead to unorthodox time management strategies and ineffective prioritization. The combination of the above can significantly increase the risk of burnout syndrome, which has been observed in up to one-third of health care workers at any given point in time(4 4 De Hert S. Burnout in healthcare workers: prevalence, impact and preventative strategies. Local Reg Anesth. 2020;13:171-83. ) . This concerning fact underscores the potential for serious repercussions, including a diminished standard of clinical care. That raises an important question: Is the need for rigorous and intensive publication overshadowing the other tasks to which physicians devote their time, such as their primary clinical responsibilities, thereby leading to a decline in the quality of services provided to patients?}

Objectives The purpose of the current study is to evaluate the performance of RENAL and mRENAL scores, in the prediction of oncological outcomes in patients treated with microwave ablation (MWA) for (T1) renal cell carcinomas (RCC). Methods Institutional database retrospective research identified 76 patients with a biopsy-proven solitary T1a (84%) or T1b (16%) RCC; all patients underwent CT-guided MWA ablation. Tumor complexity was reviewed by calculating RENAL and mRENAL scores. Results The majority of the lesions were exophytic (82.9%), with > 7 mm nearness to the collecting system (53.9%), located posteriorly (73.6%), and lower to polar lines (61.8%). Mean RENAL and mRENAL scores were 5.7 (SD = 1.9) and 6.1 (SD = 2.1) respectively. Progression rates were significantly higher with greater tumor size (> 4 cm), with < 4 mm nearness to the collecting system, for tumors crossing a polar line and with the anterior location. None of the above was associated with complications. RENAL and mRENAL scores were significantly higher in patients with incomplete ablation. The ROC analysis showed the significant prognostic ability of both RENAL and mRENAL scores for progression. In both scores, the optimal cut-off point was 6.5. Univariate Cox regression analysis for progression showed a hazard ratio of 7.73 for the RENAL score and 7.48 for the mRENAL score. Conclusion The results of the present study show that the risk of progression was higher in patients with RENAL and mRENAL score of > 6.5, in T1b tumors, close to the collective system (< 4 mm), crossing polar lines and anterior location. Clinical relevance statement CT-guided percutaneous MWA is a safe and effective technique for the treatment of T1a renal cell carcinomas. Different morphometric parameters of RCC tumors including RENAL and mRENAL score > 6.5, size, proximity to the collecting system, and crossing of polar lines impact the efficacy of MWA and progression survival rates. Key Points • The risk of progression is higher in patients with RENAL and mRENAL score > 6.5, in T1b tumors, close to the collective system (< 4 mm), crossing polar lines and anterior location. • The significant prognostic ability of the mRENAL score for progression was higher than the respective of the RENAL score. • Complications were not associated with any of the above factors.

Sarcomas are heterogenous mesenchymal neoplasms with more than 80 different histologic subtypes. Lung followed by liver and bone are the most common sites of sarcoma metastatic disease. Ablative techniques have been recently added as an additional alternative curative or palliative therapeutic tool in sarcoma metastatic disease. When compared to surgery, ablative techniques are less invasive therapies which can be performed even in non-surgical candidates and are related to decreased recovery time as well as preservation of the treated organ’s long-term function. Literature data upon ablative techniques for sarcoma metastatic disease are quite heterogeneous and variable regarding the size and the number of the treated lesions and the different histologic subtypes of the original soft tissue or bone sarcoma. The present study focuses upon the current role of minimal invasive thermal ablative techniques for the management of metastatic sarcoma disease. The purpose of this review is to present the current minimally invasive ablative techniques in the treatment of metastatic soft tissue and bone sarcoma, including local control and survival rates.