Radioiodine Ablation Therapy Feasible in Hemodialysis-Dependent ESKD Patients with Low-Risk Thyroid Cancer: Case Series

Australia: In a recently published case series in BMC Nephrology, researchers from the University of Sydney, led by Dr. Raymond Lin, have demonstrated that with tailored protocols and safety precautions, radioiodine (I-131) therapy can be safely administered to patients with end-stage kidney disease (ESKD) on haemodialysis (HD) who are being treated for thyroid cancer.    

Radioiodine therapy is a well-established adjuvant treatment for differentiated thyroid cancer (DTC), particularly following thyroidectomy. However, its use in patients with impaired renal function poses a significant challenge. In those with ESKD, the clearance of I-131 is severely reduced, increasing the risk of prolonged radiation exposure and myelotoxicity. Currently, there is no universally accepted protocol for administering radioiodine in patients on dialysis, making treatment planning complex.

To address this, Dr. Lin and colleagues reported on two ESKD patients undergoing chronic haemodialysis who received I-131 therapy for low-risk thyroid cancer. The team adapted its institutional approach by implementing modifications to infrastructure, scheduling, and radiation safety protocols. This included pre-treatment patient training, altered dialysis timing, and close monitoring of serum radioactivity to ensure patient and staff safety.

Patient 1, who had undergone bilateral nephrectomy, was trained to self-cannulate in preparation for therapy, while Patient 2 had several comorbidities, including morbid obesity and a colostomy. Both patients underwent haemodialysis at 24, 72, and 144 hours post-I-131 administration. This schedule helped achieve radiation retention profiles comparable to those seen in individuals with normal kidney function.
Radiation exposure to the bone marrow—a primary concern in patients with impaired clearance—remained within acceptable safety margins (<0.3 Gy in both cases). The majority of radiation exposure to bone marrow occurred before the initial dialysis session, accounting for 60% in Patient 1 and 47% in Patient 2. Additionally, cumulative radiation exposure to dialysis staff remained well below the local annual safety threshold, measuring only 7 and 23 μSv, respectively.
At 24 months of follow-up, both patients showed undetectable thyroglobulin levels, indicating effective disease control. There were no significant complications during or after therapy.
The findings from this case series reinforce that radioiodine therapy can be administered safely in dialysis-dependent patients with proper planning. The study highlights the importance of adapting existing treatment pathways and monitoring protocols to address the unique risks posed by renal impairment.
While the small number of cases limits generalizability, the authors stress the value of sharing such clinical experiences. As standardization remains lacking in this area, collaborative efforts and pooled data from multiple centers could support the development of practical, flexible guidelines for managing radioiodine therapy in ESKD patients.
Reference:
Lin, R., Malaroda, A., Ryder, W. et al. Management of radioiodine ablation therapy in haemodialysis patients with thyroid cancer: a case series of two patients. BMC Nephrol 26, 420 (2025). https://doi.org/10.1186/s12882-025-04348-0

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New tracer could enable surgeons to see and hear prostate cancer: Study

A preclinical evaluation of a new ’dual-mode’ tracer agent shows promise in not only helping surgeons image and plan prostate cancer procedures, but also provide them with much more consistent and targeted guidance during surgery.

The agent uses a single tracer molecule labeled with Fluorine-18-a common isotope used in Positron Emission Tomography (PET) scans-for diagnostic imaging. It also provides a one-step, widely accessible solution that would enable combined fluorescence-guided and radio-guided surgery.

“Precision medicine is increasingly being practiced and developed to address the sophisticated treatment methods for diseases like cancer,” says Dr. David M Perrin, a University of British Columbia chemist and senior author on the paper, published in advance in the Journal of Medical Chemistry.

“Our tracer provides high-resolution visual guidance, but would also allow a surgeon to use a hand-held Geiger counter probes to ‘hear’ areas of high radiation density that would accumulate in cancerous tissue not immediately visible-whether it’s a lymph node, or distant metastasis, or local invasion in the like the bowel or the gut.”

The tracer targets and binds to PSMA-prostate-specific membrane antigen-a protein that is highly expressed on the surface of prostate cancer cells. It not only has a high uptake by the tumour for PET images, but high optical brightness in the fluorescent mode without requiring special visual equipment.

“There’s a real lack of good clinical options when it comes to dual-mode PSMA tracers,” adds Dr. Perrin. “So we feel this could fill an incredibly useful function in the treatment spectrum for prostate cancer, and potentially other diseases like larynx and ovarian cancer if the same approach can be applied to these.”

Dr. Perrin’s team and colleagues with the Department of Molecular Oncology at BC Cancer tested the tracer on mice with human tumours implanted in them. The next steps include Good Manufacturing Practices assessments, toxicity testing, and validation runs.

“By combining the technology of 18F-organotrifluoroborates with fluorescein, we have a very bright future in bringing dual-mode tracers closer to clinical applications,” says radiochemist Jerome Lozada, first author on the paper who conducted the experiments while at UBC. “The tracer is highly translatable to a larger variety of healthcare settings and smaller hospitals that typically have access to more standard suites of equipment.”

According to the Canadian Cancer Society, about one in eight Canadian men will develop prostate cancer during their lifetime-one in 30 will die from it. Treatment often involves trade-offs between complete tumour removal and preserving critical structures like nerves, the seminal vesicle, bowel, and bladder, particularly in cases of advanced localized disease.

“The implementation of dual mode fluorescent-PET racers in the surgical field is an exciting new approach to maximize benefit and minimize harm associated with more extended lymph node removal as well as to decrease the rate of positive surgical margins of a radical prostatectomy,” says Dr Larry Goldenberg, associate director of development and supportive care at the Vancouver Prostate Centre and a professor with the department of Urologic Sciences at UBC, who was not involved in the study.

“This novel approach has the potential to maximize local disease control and theoretically improve oncologic outcomes.”

“We already have similar approaches in breast cancer treatment using a radioactive tracer and methylene blue given as a separate injection,” explains Dr. Philip F Cohen, division head of nuclear medicine at Lions Gate Hospital, who was not involved in the research. “The surgeon uses a radioactive probe to detect the radioactivity and then sees if there is blue dye when they try to identify the lymph node visually. This new dual tracer does the same thing, but with potentially just one injection.”

Reference:

Jerome Lozada,Helen Merkens, Synthesis and Preclinical Evaluation of Dual-Mode Fluorescent 18F-PET Tracers Targeting PSMA, Journal of Medicinal Chemistry, DOI: 10.1021/acs.jmedchem.5c01480 

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Living in a food desert doubles stroke risk for patients with atrial fibrillation, study finds

Patients with atrial fibrillation who live in neighborhoods with poor access to full-service grocery stores face sharply higher odds of stroke and death, according to a new study from Tulane University.

Researchers at Tulane University School of Medicine found that, compared with similar patients in better-served areas, those in food deserts had more than double the risk of ischemic stroke and nearly four times the risk of death.

The study, published in the journal JACC: Advances, analyzed electronic health records for 1,553 patients treated for atrial fibrillation (an irregular heartbeat) in the New Orleans area between 2010 and 2019. Using federal maps that flag “food deserts,” defined as places where many residents live more than a mile from a supermarket, the team sorted patients by ZIP code into two groups: 1,115 living inside food deserts and 438 living outside them.

Researchers then compared patients with similar medical profiles but different levels of neighborhood food access. They tracked who was hospitalized, suffered stroke or died and adjusted for age, sex, body mass index, common health conditions (such as hypertension and diabetes) and medications, including blood thinners.

The differences were stark. After accounting for other risks, food-desert residence was linked to a 2.21-times higher risk of ischemic stroke and a 3.84-times higher risk of death over five years. A combined measure of “any bad outcome” (hospitalization, stroke or death) was 42% higher. Researchers believe it is likely that residents living in food deserts nationwide experience similar increased risks.

The findings demonstrate an urgent need to increase cardiovascular screenings for conditions such as atrial fibrillation, particularly in New Orleans and communities with similar socioeconomic profiles, said corresponding author Dr. Nassir Marrouche, director of the Tulane University Heart and Vascular Institute.

“This research shows that for patients with AF, the environment they live in, the basic infrastructure of their neighborhood, can be just as important as the care they receive in the clinic,” Dr. Marrouche said. “Something as fundamental as access to healthy food could literally save lives.”

Researchers used the REACHnet clinical research database to identify local patients and matched their ZIP codes to the U.S. Department of Agriculture’s Food Access Research Atlas. They then used standard survival curves and risk models to compare outcomes while controlling for other factors.

To help reduce risks for patients, the authors suggest clinicians ask simple screening questions about food access and connect at-risk patients to nutrition programs or social services. Policymakers and health systems could target nutrition support and grocery access in neighborhoods where medically vulnerable residents live.

“At the Tulane Research Innovation for Arrhythmia Discovery (TRIAD) Center, our research team is committed to addressing the specific needs of the New Orleans community,” Marrouche said. “Early detection through expanded screening efforts can save lives in these vulnerable communities where we’ve unearthed these striking disparities. By focusing on local data and real-world health disparities, we’re working to create more inclusive models of care and improve cardiovascular outcomes where it’s needed most.”

Reference: 

Christianson, E, Liu, Y, Dahl, A. et al. Impact of Food Desert Residence on Ischemic Stroke and Hospitalization Risk in Atrial Fibrillation Patients. JACC Adv. 2025 Oct, 4 https://doi.org/10.1016/j.jacadv.2025.102083

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AI could soon detect early voice box cancer from the sound of your voice, suggests study

Cancer of the voice box or larynx is an important public health burden. In 2021, there were an estimated 1.1 million cases of laryngeal cancer worldwide, and approximately 100,000 people died from it. Risk factors include smoking, alcohol abuse, and infection with human papillomavirus. The prognosis for laryngeal cancer ranges from 35% to 78% survival over five years when treated, depending on the tumor’s stage and its location within the voice box.

Catching cancer early is key for a patient’s prospects. At present, laryngeal cancers are diagnosed through video nasal endoscopy and biopsies – onerous, invasive procedures. Getting to a specialist who can perform these procedures can take time, causing delays in diagnosis. But now, researchers have shown in Frontiers in Digital Health that abnormalities of the vocal folds can be detected from the sound of the voice. Such ‘vocal fold lesions’ can be benign, like nodules or polyps, but may also represent the early stages of laryngeal cancer. These proof-of-principle results open the door for a new application of AI: namely, to recognize the early warning stages of laryngeal cancer from voice recordings.

“Here we show that with this dataset we could use vocal biomarkers to distinguish voices from patients with vocal fold lesions from those without such lesions,” said Dr Phillip Jenkins, a postdoctoral fellow in clinical informatics at Oregon Health & Science University, and the study’s corresponding author.

Voice messages

Jenkins and his colleagues are members of the ‘Bridge2AI-Voice’ project within the US National Institute of Health’s ‘Bridge to Artificial Intelligence’ (Bridge2AI) consortium, a nationwide endeavor to apply AI to complex biomedical challenges. Here, they analyzed variations in tone, pitch, volume, and clarity within the first version of the public Bridge2AI-Voice dataset, with 12,523 voice recordings of 306 participants from across North America.

A minority were from patients with known laryngeal cancer, benign vocal fold lesions, or two other conditions of the voice box: spasmodic dysphonia and unilateral vocal fold paralysis.

The researchers focused on differences in a number of acoustic features of the voice: for example, the mean fundamental frequency (pitch); jitter, variation in pitch within speech; shimmer, variation of the amplitude; and the harmonic-to-noise ratio, a measure of the relation between harmonic and noise components of speech.

The researchers found marked differences in the harmonic-to-noise ratio and fundamental frequency between men without any voice disorder, men with benign vocal fold lesions, and men with laryngeal cancer. They didn’t find any informative acoustic features among women, but it is possible that a larger dataset would reveal such differences.

The authors concluded that especially variation in the harmonic-to-noise ratio can be helpful to monitor the clinical evolution of vocal fold lesions, and to detect laryngeal cancer at an early stage, at least in men.

“Our results suggest that ethically sourced, large, multi‑institutional datasets like Bridge2AI‑Voice could soon help make our voice a practical biomarker for cancer risk in clinical care,” said Jenkins.

Building a bridge to AI

Now that the proof-of-principle has been established, the next step is to use these algorithms on more data and test them in clinical settings on patient voices.

“To move from this study to an AI tool that recognizes vocal fold lesions, we would train models using an even larger dataset of voice recordings, labeled by professionals. We then need to test the system to make sure it works equally well for women and men,” said Jenkins.

“Voice-based health tools are already being piloted. Building on our findings, I estimate that with larger datasets and clinical validation, similar tools to detect vocal fold lesions might enter pilot testing in the next couple of years,” predicted Jenkins.

Reference:

Phillip Jenkins, Rylan Harrison, Steven Bedrick, Voice as a biomarker: exploratory analysis for benign and malignant vocal fold lesions, Frontiers in Digital Health, https://doi.org/10.3389/fdgth.2025.1609811

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Process for dealing with sexual misconduct by UK doctors requires major reform, say experts

The current process for managing sexual misconduct perpetrated by doctors in the UK requires major reform, say experts in The BMJ.

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Study: Tirzepatide improves blood sugar control in children with poorly controlled type 2 diabetes

New research shows that the diabetes/obesity medication tirzepatide can cause clinically meaningful improvements in blood sugar control and weight loss in children and adolescents with type 2 diabetes aged 10–17 years whose diabetes and weight are inadequately controlled with an existing treatment regimen of metformin, insulin, or both.

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Cardiovascular Risk Highest in Mothers with Hypertension, Diabetes, or Both: Study

A new study has determined that mothers who experienced pre-pregnancy hypertension, hypertensive disorders of pregnancy (HDP), diabetes, or any combination of these three diseases are at greatly elevated risks of coronary heart disease (CHD) and all-cause mortality in the first five years postpartum. The study was published in BMC Cardiovascular Diabetology journal by Angela M. and fellow researchers. These results underscore the imperative to better screen for risk factors and provide follow-up care for such women, particularly in racial groups that are disproportionately affected.

This retrospective cohort analysis examined information from 430,545 women aged 12–49 with at least one singleton live birth in South Carolina during 2004–2016. The cohort consisted of 59.2% non-Hispanic White (NHW), 31.4% non-Hispanic Black (NHB), and 9.4% Hispanic women. Birth certificate and hospitalization/emergency department (ED) data were used to determine women with pre-pregnancy hypertension, HDP (preeclampsia, eclampsia, and gestational hypertension), and pre-pregnancy and gestational diabetes. Incident CHD and all-cause mortality were followed through hospitalization/ED and death certificate records over a follow-up duration of up to 14 years.

The Cox proportional hazard models were utilized to estimate the adjusted risk of CHD and all-cause death according to the presence of individual or combined conditions (diabetes, HDP, pre-pregnancy hypertension). The aim was to evaluate the independent and cumulative effect of such conditions on maternal cardiovascular outcomes at 5 years post-delivery and during the full duration of the study. The analysis was also controlled for age, race, and other complications and comorbidities at delivery.

Key Findings

Within five years of giving birth, women with any one of the three maternal conditions were at significantly higher risk of developing coronary heart disease:

  • Diabetes on its own was linked with a 57% increased risk of CHD (HR = 1.57; 95% CI: 1.28–1.92).

  • HDP on its own increased the risk by 85% (HR = 1.85; 95% CI: 1.60–2.15).

  • Both HDP and diabetes were associated with a 129% increased risk (HR = 2.29; 95% CI: 1.73–3.03).

  • HDP with pre-pregnancy hypertension had a 213% increased risk (HR = 3.13; 95% CI: 2.66–3.68).

  • Women with all three conditions had an almost five-fold higher risk (HR = 4.87; 95% CI: 3.95–6.01).

In the analysis of all-cause mortality at five years:

  • Diabetes alone had a 34% increased risk (HR = 1.34; 95% CI: 1.01–1.78).

  • HDP with pre-pregnancy hypertension had a 53% increased risk (HR = 1.53; 95% CI: 1.15–2.03).

  • All three conditions together were associated with a 125% higher risk of death (HR = 2.25; 95% CI: 1.51–3.36).

  • HDP alone or HDP with diabetes did not have statistically significant higher mortality risk.

This large-scale investigation offers strong evidence that the co-existence and concomitance of diabetes, pre-pregnancy hypertension, and hypertensive disorders during pregnancy excessively raise the risk of coronary heart disease development and all-cause mortality in subsequent years post-childbirth.

Reference:

Malek, A.M., Wilson, D.A., Mateus, J. et al. Maternal coronary heart disease and mortality following hypertensive disorders of pregnancy and/or diabetes. Cardiovasc Diabetol 24, 282 (2025). https://doi.org/10.1186/s12933-025-02811-8

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Estimates predict over 4 million missing people who would be alive in 2025 if not for inadequate type 1 diabetes care

The global type 1 diabetes (T1D) burden continues to increase rapidly, driven by rising cases, aging populations, improved diagnosis and falling death rates, according to the results of a new modeling study presented at the Annual Meeting of the European Association for the Study of Diabetes (EASD), Vienna (15–19 Sept).

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Midazolam Reduces Breathing Flexibility, While S-Ketamine Preserves It: Pilot Trial Finds

Netherlands: Midazolam sedation can noticeably restrict the natural adaptability of breathing, while s-ketamine largely preserves it, a recent randomized controlled pilot study published in PLOS ONE has shown.

Researchers observed that midazolam significantly reduced the variability of both respiratory rate and tidal volume, resulting in a more uniform breathing pattern that may raise the risk of complications in patients with already fragile respiratory function. In contrast, s-ketamine showed only a minor effect on tidal volume variability and left respiratory rate variability largely unchanged, suggesting it could be the safer sedative when spontaneous breathing must be maintained.
The investigation was led by Oscar F. C. van den Bosch and colleagues from the Department of Anesthesiology at Amsterdam UMC, Vrije Universiteit, in the Netherlands. Their goal was to clarify how these commonly used sedatives influence the natural fluctuations in breathing—known as respiratory variability—which help the body adapt to changing demands.
The team enrolled 28 adults with fibromyalgia syndrome who were otherwise healthy. In a double-blind design, participants were randomly assigned to receive a continuous intravenous infusion of s-ketamine (0.3 mg kg⁻¹ h⁻¹), midazolam (0.05 mg kg⁻¹ h⁻¹), or saline as a control. Using a non-invasive bio-impedance method, the researchers continuously monitored mean respiratory rate along with two key indicators: variability of respiratory rate (VRR) and variability of tidal volume (VTV). Data from 57 experimental sessions were analyzed with a linear mixed model to account for repeated measures and missing data.
The study revealed the following findings:
  • The average respiratory rate stayed stable across all groups.
  • Midazolam caused a significant decrease in variability of respiratory rate (VRR) (β = −0.071).
  • Midazolam also led to a marked reduction in variability of tidal volume (VTV) (β = −0.117), resulting in a more rigid breathing pattern.
  • S-ketamine showed only a small decline in VTV (β = −0.062).
  • S-ketamine left VRR statistically unaffected (β = −0.036).
  • Overall, s-ketamine preserved much of the respiratory system’s natural variability and adaptability.
The authors cautioned that the pilot trial had limitations. Participants were fibromyalgia patients without significant lung disease, and respiratory data were incomplete for roughly one-fifth of sessions. Moreover, clinical sedation often involves multiple drugs or different dosing strategies. Despite these factors, the researchers believe the observed differences are relevant for broader patient populations, particularly those with compromised pulmonary function.
Overall, the study highlights a critical distinction between two frequently used sedatives. Midazolam’s tendency to dampen respiratory variability could pose added risks in settings such as intensive care or procedural sedation, where maintaining spontaneous, adaptable breathing is essential. S-ketamine, by preserving variability, may offer an advantage when clinicians require sedation without suppressing a patient’s natural respiratory responsiveness.
“Larger, multi-center trials are now needed to confirm these results and to explore their implications for anesthesiology and critical care practice,” the authors concluded.
Reference:
Alvarez-Jimenez, R., M. Evers, A. W., H. Steegers, M. A., Schober, P., & Loer, S. A. (2025). Effects of s-ketamine and midazolam on respiratory variability: A randomized controlled pilot trial. PLOS ONE, 20(9), e0331358. https://doi.org/10.1371/journal.pone.0331358

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Low hemoglobin glycation index Linked to Higher Mortality in Critically Ill Patients: Study

China: Researchers have found in new research that lower hemoglobin glycation index (HGI) values are associated with increased short- and long-term mortality among critically ill patients. Hemoglobin glycation index may be a useful prognostic biomarker for risk stratification in intensive care unit (ICU) settings.

The study, led by Benji Wang from the Department of Anesthesiology, Critical Care and Pain Medicine at The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Zhejiang, China, was recently published in the Journal of Health, Population and Nutrition. It sheds new light on the importance of glycemic variation, particularly HGI, in influencing patient outcomes in the ICU.

Although glycemic variability has been increasingly acknowledged as a determinant of outcomes in critical care, the specific prognostic value of the hemoglobin glycation index has not been thoroughly explored before. This study aimed to bridge that gap by examining the relationship between HGI and all-cause mortality among ICU patients.

Using data from the MIMIC-IV database—a large, publicly available critical care database—the researchers conducted a retrospective cohort analysis involving 9,695 ICU patients. They assessed mortality outcomes at 30, 90, and 365 days, with in-hospital mortality as an additional outcome. Advanced statistical methods, including Kaplan-Meier survival analysis, Cox proportional hazards models, restricted cubic spline (RCS) modeling, and propensity score matching (PSM), were employed to ensure the validity and robustness of the findings.

The key findings of the study were as follows:

  • Patients with lower HGI values (below -0.40) showed significantly higher mortality across all measured time points.
  • A non-linear association between HGI and 30-day mortality was identified using restricted cubic spline (RCS) analysis.
  • Higher HGI values were consistently linked to a reduced risk of death, with hazard ratios ranging from 0.43 to 0.76.
  • These associations remained statistically significant even after adjusting for potential confounding variables.
  • The results held true following propensity score matching, underscoring the robustness of the findings.
  • Subgroup analyses confirmed that the association between HGI and mortality was consistent across different patient demographics and clinical characteristics.
  • The findings suggest that HGI may serve as a broadly applicable prognostic marker in ICU settings.

According to the authors, the study is the first large-scale investigation to evaluate HGI as a mortality predictor among critically ill patients. The researchers propose that HGI could serve as an effective and easily accessible biomarker to guide individualized glycemic management and risk assessment in ICU settings.

The authors concluded, “The findings point toward a meaningful link between low HGI and increased mortality in critical care, reinforcing the potential utility of HGI in clinical decision-making and ICU patient stratification.”

Reference:

Pan, L., Lu, F., Cheng, B. et al. Association between hemoglobin glycation index and mortality in critically ill patients: a retrospective cohort study. J Health Popul Nutr 44, 249 (2025). https://doi.org/10.1186/s41043-025-01008-9

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