To develop the REporting checklist for FoundatIon and large laNguagE models (REFINE), an international reporting guideline for transparent and reproducible reporting of foundation model (FM) and large language model (LLM) studies in medical research, including imaging artificial intelligence (AI) applications.

The protocol was prespecified and publicly archived. A modified Delphi process was conducted to establish reporting standards for unimodal and multimodal FM and LLM applications involving text, imaging, and structured data. The steering committee coordinated protocol development, expert recruitment, all Delphi rounds, and the harmonization phase. Decisions were made based on predefined consensus thresholds. In Rounds 1 and 2, structured ratings and free-text feedback informed iterative revisions. In the post-Delphi harmonization phase, terminology was standardized, and detailed reporting instructions were finalized.

The REFINE development group comprised 57 contributors from 17 countries, and 54 panelists from 16 countries completed Rounds 1 and 2. The harmonization phase was completed by three expert panelists and the steering committee. The entire process produced a 44-item, six-section framework with standardized terminology and detailed reporting instructions, supported by an online platform for practical use (https://refinechecklist.github.io/refine/checklist.html).

The REFINE provides a comprehensive, consensus-based reporting standard for medical FM and LLM research, including imaging AI studies. The online version facilitates practical implementation.

The REFINE enables transparent, comparable, and reproducible reporting of FM and LLM studies, supporting reliable evidence synthesis in medical and imaging-focused AI studies.

Uhl's anomaly is an extremely rare congenital heart defect, with approximately 100 cases reported since its first description in 1952 by Dr Henry Uhl. Characterized by partial or complete absence of the right ventricular myocardium, it leads to progressive right ventricle dilation and right heart failure. Due to its rarity, there is no consensus regarding its surgical or medical management. We present a case of an 18-year-old male patient with Uhl's anomaly diagnosed in early infancy, managed by palliative Glenn shunt. This report provides insight into management of this rare condition.

Omics imaging has emerged as an interdisciplinary field focused on integrating data collected from biomedical images and omics analysis. Historically, there is precedent for omics imaging to serve as a superior model for prediction of human diseases, including brain disorders and cancer, versus single technique models (e.g., only imaging data or only omics data). Most of the previous studies in the field of omics imaging have focused on single organ analysis. However, the advent of total-body Positron Emission Tomography (PET) imaging for clinical use has the potential to transform this landscape by enabling high sensitivity or high throughput multi-organ analysis with methodologies previously established for analysis of omics datasets, such as connectome and pathway analysis tools. Conversely, traditional omics analysis, which lack spatial and structural multi-organ information, can benefit from total-body PET imaging of molecular targets in vivo across multiple organs in humans. In this commentary, the importance of whole-person research enabled by total-body PET, integration of total-body PET with omics techniques and examples successful case studies of imaging omics are described. Although the field of imaging omics is relatively new, discoveries already enabled by this field provide seminal evidence of its importance to advance human disease diagnosis, prognosis and treatment.

Stroke is a major global health concern, particularly among the elderly, who frequently present with multiple comorbidities, most notably cardiovascular diseases. Importantly, atrial fibrillation confers a nearly fivefold increase in stroke risk and accounts for up to one-quarter of ischemic strokes in older adults. Stroke is a neurological disease characterised by a strong cardiovascular interplay, and its multifactorial nature requires an integrated preventive approach. This review focuses on primary and secondary prevention in this population, with a frailty-informed perspective. We synthesise evidence on blood pressure control, lipid-lowering (including LDL-C targets), glycemic management, and antithrombotic strategies-particularly oral anticoagulation for atrial fibrillation-as well as the role of frailty indices in guiding individualised risk-benefit decisions. We also discuss practical care pathways, including structured post-discharge programs, continuity of care, and the need for multidisciplinary collaboration involving cardiologists, neurologists, and primary care. We highlight how frailty indices refine risk-benefit assessments without justifying therapeutic nihilism, and how sex- and age-related factors shape treatment effectiveness and safety. By narrowing scope and emphasising practical, multidisciplinary prevention strategies, this review aims to support clinicians in reducing recurrent events, disability, and mortality in very old patients. Future work should prioritise pragmatic trials, including those involving the oldest old and the use of standardised frailty metrics, to inform prevention decisions.

Objective: To evaluate the impact of recommendations issued by the Pharmacovigilance Risk Assessment Committee (PRAC) and endorsed by the European Medicines Agency (EMA) and the Italian Medicines Agency (AIFA) on rheumatologists' prescribing patterns of Janus kinase inhibitors (JAK inhibitors) and biologic disease-modifying antirheumatic drugs (bDMARDs) in patients with rheumatoid arthritis (RA), within a personalized, risk-adapted care framework. Methods: A brief survey was conducted across 21 Italian rheumatology centers. This retrospective multicenter study included 4421 RA patients assessed before PRAC recommendations (1 January 2022-1 January 2023) and 4376 patients evaluated afterward (2 January 2023-1 January 2024). Prescribing behaviors, cardiovascular risk management, and clinical outcomes were compared between cohorts. Results: Following PRAC recommendations, a more individualized cardiovascular risk management strategy was observed, with increased use of targeted treatments for hypercholesterolemia, hypertension, and diabetes. The post-PRAC cohort showed a significant reduction in myocardial infarction incidence (0.90% vs. 0.47%; p = 0.02) and increased statin use (8.25% vs. 11.1%; p = 0.05). No increase in cardiovascular risk was observed among JAK inhibitor users. Notably, upadacitinib utilization remained stable despite regulatory restrictions. Conclusions: PRAC recommendations promoted safer prescribing practices and improved cardiovascular risk stratification in RA. These findings support a shift toward precision medicine, integrating real-world evidence with advanced diagnostic and decision-support tools, including future artificial intelligence-based approaches, to optimize personalized therapeutic strategies in autoimmune diseases.

Background/Objectives: This study aims to assess the relation between the ADA score with the severity of pneumonia, as evaluated by chest tomography using a severity score. Methods: In this observational study we enrolled 350 consecutive adult patients (≥18 years) with COVID-19-related severe acute pneumonia requiring hospitalization, consecutively admitted to non-intensive care unit (ICU) medical wards from April 2020 to March 2022. A standard high-resolution chest computed tomography (HRCT) was performed in all cases with a multidetector CT scanner without intravenous contrast injection, except in case of suspicion of pulmonary embolism. The ADA score and semi-quantitative 25-point CT Severity Score (CTSS) were calculated for all patients. Results: A total of 350 COVID-19 patients (154 males (44%) and 196 females (56%)) were recruited. A logistic regression analysis showed that CTSS is statistically associated with the ADA score (Exp(B): 1.116; 95% CI: 1.027-1.212; p = 0.009) and the need for ICU (Exp(B): 8.719; 95% CI: 2.994-25.390; p < 0.001), while the linear regression analysis showed a relation between the CTSS and ADA score, GFR and CRP (p = 0.003) (predictors: ADA score [β coeff 0.276; 95% CI: 0.041--0.402; p = 0.017], GFR [β coeff -0.219; 95% CI: -0.095--0.001; p = 0.045], CRP [β coeff -0.226; IC 95% -0.077--0.001; p = 0.044]). Furthermore, a ROC curve analysis determined the optimal ADA score cut-off values for predicting severe CT findings at 44.5 (sensibility: 0.971; 1-specificity: 0.670; AUC: 0.750; SE 0.039; p < 0.001; 95% CI: 0.674-0.826; Youden's J index= 0.301). Conclusions: This study highlights the potential clinical utility of integrating laboratory- and imaging-based scores for a comprehensive assessment of patients hospitalized with SARS-CoV-2 infection. The combined use of these scores may enable a more accurate identification of patients with extensive pulmonary involvement and an increased prothrombotic burden at hospital admission, facilitating the early recognition of high-risk patients.

Patients with prior acute myocardial infarction (AMI) generally show low rates of achieving secondary prevention targets. Here we evaluated adherence to guideline-recommended secondary prevention strategies after AMI in Saudi Arabia. This ambispective multicenter cohort study included consecutive patients seen for follow-up visits 6-24 months after hospitalization for AMI. A standardized questionnaire was used to evaluate control of blood pressure (<130/80 mmHg), HbA1c (<7%), LDL-C (<1.4 mmol/L), lipoprotein(a) (<50 mg/dL), body mass index (18.5-24.9 kg/m²), physical activity targets, smoking habits, guideline-directed medical therapy (GDMT), and referral to cardiac rehabilitation. Among 108 AMI patients (mean age 58.4 ± 10.9 years; 80.6% male; 76.9% Saudi nationals), 53.7% had uncontrolled blood pressure, ~40% uncontrolled glucose, and 67% above-target LDL-C levels. Most participants were overweight (40.7%) or obese (37%), and 28.7% achieved the physical activity targets. One-third of patients were not receiving all GDMT, 15.7% were current smokers, and 25% had been referred to cardiac rehabilitation. No patient met all guideline-recommended secondary prevention targets. This pilot study highlights gaps in secondary prevention among AMI survivors. Upcoming study phases will aim for national representation and help identify key clinical and demographic drivers to improve secondary prevention efforts across Saudi Arabia.

Atherosclerosis is a chronic, progressive disease of the arterial wall and the principal pathological substrate underlying most cardiovascular diseases, including ischemic heart disease, stroke, and peripheral arterial disease. Despite advances in prevention, imaging, and therapy, atherosclerosis remains the leading cause of cardiovascular morbidity and mortality worldwide. From a pathological perspective, the disease represents a dynamic and heterogeneous process characterized by endothelial dysfunction, lipid retention and modification, chronic inflammation, immune activation, smooth muscle cell phenotypic modulation, extracellular matrix remodeling, and thrombogenic surface alterations. This review provides a comprehensive overview of atherosclerosis from a pathologist's perspective, integrating classical morphological concepts with contemporary insights into immunopathology, plaque classification, and mechanisms of plaque instability. We summarize the structure and function of the arterial wall, the stepwise pathogenesis of lesion initiation and progression, and the histopathological classification systems established by the American Heart Association and subsequently refined through Virmani's framework. Particular emphasis is placed on plaque instability, highlighting the qualitative features-such as fibrous cap thinning, necrotic core expansion, macrophage-driven inflammation, plaque erosion, and calcification patterns-that determine clinical outcomes rather than luminal stenosis alone. Furthermore, the review discusses the expanding role of immunohistochemical markers in defining plaque biology, including lineage markers and functional indicators of inflammation, matrix integrity, osteogenic signaling, and local anticoagulant balance. These pathological insights are integrated with contemporary risk assessment tools, imaging modalities, preventive strategies, and therapeutic interventions, including emerging lipid-lowering and RNA-based therapies. In conclusion, pathology remains central to understanding atherosclerosis as a biologically active disease and to refining concepts of plaque instability. Integrating histopathology with molecular profiling, imaging, and clinical data is essential for advancing precision prevention and targeted treatment strategies in atherosclerotic cardiovascular disease.