Miracle-dz/UniFAR-FTUs huggingface dataset:
Artificial intelligence and its impact on quality improvement in upper and lower gastrointestinal endoscopy

Artificial intelligence (AI) and its application in medicine has grown large interest. Within gastrointestinal (GI) endoscopy, the field of colonoscopy and polyp detection is the most investigated, however, upper GI follows the lead. Since endoscopy is performed by humans, it is inherently an imperfect procedure. Computer‐aided diagnosis may improve its quality by helping prevent missing lesions and supporting optical diagnosis for those detected. An entire evolution in AI systems has been established in the last decades, resulting in optimization of the diagnostic performance with lower variability and matching or even outperformance of expert endoscopists. This shows a great potential for future quality improvement of endoscopy, given the outstanding diagnostic features of AI. With this narrative review, we highlight the potential benefit of AI to improve overall quality in daily endoscopy and describe the most recent developments for characterization and diagnosis as well as the recent conditions for regulatory approval.
Racial/ethnic variation in PSA testing and prostate cancer incidence following the 2012 U.S.P.S.T.F. recommendation.

BACKGROUND The 2012 US Preventive Services Task Force (USPSTF) recommendation against routine prostate-specific antigen (PSA) testing led to a decrease in prostate cancer screening, but the heterogeneity of its impact by race/ethnicity remains unclear. METHODS The proportion of 40-74 year-old men who self-reported receiving a routine PSA test in the past year was estimated in the Behavioral Risk Factor Surveillance System (BRFSS; 2012-2018). Odds ratios (ORs) of undergoing screening by race/ethnicity were estimated, adjusting for healthcare-related factors. Prostate cancer incidence rates and rate ratios (IRRs) by race/ethnicity were estimated using Surveillance, Epidemiology and End Results registry data (2004-2017). RESULTS PSA testing frequencies were 32.3% (95% CI = 31.7 to 32.8%) among non-Hispanic White (NHW), 30.3% (95% CI = 28.3 to 32.3%) among non-Hispanic Black (NHB), 21.8% (95% CI = 19.9 to 23.7%) among Hispanic, and 17.7% (95% CI = 14.1 to 21.3%) among Asian/Pacific Islander men in 2012. The absolute screening frequency declined by 9.5% from 2012 to 2018, with a larger decline among NHB (11.6%) than NHW men (9.3%). The relative annual decrease was greater among NHB (OR = 0.86, 95% CI = 0.84 to 0.88) than NHW men (OR = 0.89, 95% CI = 0.89 to 0.90; Pheterogeneity =0.005), driven by a larger decline among NHB men ages 40-54 y. The NHB: NHW IRR for total prostate cancer increased from 1.73 (95% CI = 1.69 to 1.76) in 2011 to 1.87 (95% CI = 1.83 to 1.92) in 2012 and has remained elevated, driven by differences in localized tumor incidence. Metastatic disease incidence is rising across all racial/ethnic groups. CONCLUSIONS The frequency of prostate cancer screening varies by race/ethnicity, and there was a modestly steeper decline in PSA testing among younger NHB men relative to NHW men since 2012. The NHB: NHW IRR for localized prostate cancer modestly increased following 2012.
HCV Genetic Diversity Can Be Used to Infer Infection Recency and Time since Infection

HIV-1 genetic diversity can be used to infer time since infection (TSI) and infection recency. We adapted this approach for HCV and identified genomic regions with informative diversity. We included 72 HCV/HIV-1 coinfected participants of the Swiss HIV Cohort Study, for whom reliable estimates of infection date and viral sequences were available. Average pairwise diversity (APD) was calculated over each codon position for the entire open reading frame of HCV. Utilizing cross validation, we evaluated the correlation of APD with TSI, and its ability to infer TSI via a linear model. We additionally studied the ability of diversity to classify infections as recent (infected for <1 year) or chronic, using receiver-operator-characteristic area under the curve (ROC-AUC) in 50 patients whose infection could be unambiguously classified as either recent or chronic. Measuring HCV diversity over third or all codon positions gave similar performances, and notable improvement over first or second codon positions. APD calculated over the entire genome enabled classification of infection recency (ROC-AUC = 0.76). Additionally, APD correlated with TSI (R2 = 0.33) and could predict TSI (mean absolute error = 1.67 years). Restricting the region over which APD was calculated to E2-NS2 further improved accuracy (ROC-AUC = 0.85, R2 = 0.54, mean absolute error = 1.38 years). Genetic diversity in HCV correlates with TSI and is a proxy for infection recency and TSI, even several years post-infection.
A case series evaluating the impact of a combination treatment for acne vulgaris containing linoleic acid, linolenic acid, and lecithin

Dear Editor, Acne vulgaris is a chronic inflammatory skin condition affecting the face, the most significant area in terms of cosmetic appearance. Clinical treatment approaches primarily include oral antibiotics or isotretinoin, topical tretinoin, and photodynamic therapy. However, there is an urgent need to optimize acne treatment due to the range of side effects associated with current approaches, such as dryness, rebound, desquamation, and drug resistance. In this article, we present a case series involving four subjects selected from a larger ongoing study which aims to determine the effectiveness of treatment with a topical cream containing 20% linolenic acid, 60% linoleic acid, and 2% lecithin.
Cortical Mechanisms for Reaches Versus Saccades: Progression of Effector-Specificity Through Target Memory to Movement Planning and Execution

Effector-specific cortical mechanisms can be difficult to establish using fMRI, in part because low time resolution might temporally conflate different signals related to target representation, motor planning, and motor execution. Here, we used an event-related fMRI protocol and a cue-separation paradigm to temporally separate these three major sensorimotor stages for saccades vs. reaches. In each trial, subjects (N=12) 1) briefly viewed a target 4-7° left or right of midline fixation on a touchscreen, followed by an 8 second delay (effector-independent target memory phase), 2) were instructed by an auditory cue to perform a reach or a saccade, followed by a second delay of 8 seconds (effector-specific planning phase), and finally 3) were prompted to move by reaching-to-touch or performing a saccade towards the remembered target (effector-specific execution phase). Our analysis of saccade and reach activation (vs. a non-spatial control task) revealed modest effector-agnostic target memory activity (left AG, bilateral mIPS) followed by independent effector parietofrontal sites and time courses during the motor components of the task, specifically: more medial (pIPS, mIPS, M1, and PMd) activity during both reach planning and execution, and more lateral (mIPS, AG, and FEF) activity only during saccade execution. These motor activations were bilateral, with a left (contralateral) preference for reach. A conjunction analysis revealed that left mIPS and right AG, PCu, SPOC, FEF/PMv and LOTC showed activation for both saccades and reaches. Overall, effector-preference contrasts (reach vs. saccade) revealed significantly more parietofrontal activation for reaches than saccades during both planning and execution, with the exception of FEF. Cross-correlation of reach, saccade, and reach-saccade activation through time revealed correlated activation both within and across effectors in each hemisphere, but with a tendency toward higher correlations in the right hemisphere, especially between the eye and hand. These results demonstrate substantially independent but temporally correlated cortical networks for human eye, hand, and eye-hand control, that follow explicit spatiotemporal rules for effector-specific timing, medial-lateral distribution, and hemispheric lateralization.
Hyperthrombotic Milieu in COVID-19 Patients

COVID-19 infection has protean systemic manifestations. Experience from previous coronavirus outbreaks, including the current SARS-CoV-2, has shown an augmented risk of thrombosis of both macrovasculature and microvasculature. The former involves both arterial and venous beds manifesting as stroke, acute coronary syndrome and venous thromboembolic events. The microvascular thrombosis is an underappreciated complication of SARS-CoV-2 infection with profound implications on the development of multisystem organ failure. The telltale signs of perpetual on-going coagulation and fibrinolytic cascades underscore the presence of diffuse endothelial damage in the patients with COVID-19. These parameters serve as strong predictors of mortality. While summarizing the alterations of various components of thrombosis in patients with COVID-19, this review points to the emerging evidence that implicates the prominent role of the extrinsic coagulation cascade in COVID-19-related coagulopathy. These mechanisms are triggered by widespread endothelial cell damage (endotheliopathy), the dominant driver of macro- and micro-vascular thrombosis in these patients. We also summarize other mediators of thrombosis, clinically relevant nuances such as the occurrence of thromboembolic events despite thromboprophylaxis (breakthrough thrombosis), current understanding of systemic anticoagulation therapy and its risk–benefit ratio. We conclude by emphasizing a need to probe COVID-19-specific mechanisms of thrombosis to develop better risk markers and safer therapeutic targets.
Factors associated with the symptomatic status of carotid artery stenosis: identification in a cross-sectional study and development of a scoring system.

INTRODUCTION Identification of asymptomatic patients with high risk for internal carotid artery (ICA) stenosis destabilization and symptoms occurrence is important for the prognosis estimation. OBJECTIVES To identify the differences between the patients with symptomatic and asymptomatic ICA stenosis and to develop a predictive model for the risk of symptomatic stenosis based on the data accumulated in routine clinical practice. PATIENTS AND METHODS The study included 163 patients with asymptomatic and 182 patients with symptomatic ICA stenosis >70%. Comparisons between the groups were made in terms of stroke risk factors and comorbidities, coexisting ICA stenosis on the contralateral side, atherosclerosis in other arterial areas and morphology of the atherosclerotic plaque by transcervical ultrasound. RESULTS Independent risk factors for symptomatic ICA stenosis were: male sex [odds ratio (OR) 2.94, 95% confidence intervals (CI): 1.87-4.32, p<0.001], diabetes mellitus (OR 2.86, 95% CI: 1.62-5.12, p<0.001), body mass index >25 kg/m2 (OR 1.81, 95% CI: 1.72-1.86, p<0.001), chronic kidney disease (OR 3.34, 95% CI: 1.34-8.87, p=0.007), increased-risk features of ultrasound plaque morphology (OR 2.52, 95% CI: 1.29-3.72, p=0.009) and coexisting atherosclerosis in three or four vascular areas (OR 3.72, 95% CI: 1.77-7.23, p<0.001). The sensitivity and specificity for the scoring model created to estimate the risk of symptomatic ICA stenosis were 77.6% and 76.9%, respectively. CONCLUSIONS This cross-sectional study indicates that analysis of selected imaging and clinical parameters may allow to estimate the risk of ICA stenosis symptomatic conversion. The scoring system we propose requires further, prospective validation.
Radioprotection and Radiomitigation: From the Bench to Clinical Practice

The development of protective agents against harmful radiations has been a subject of investigation for decades. However, effective (ideal) radioprotectors and radiomitigators remain an unsolved problem. Because ionizing radiation-induced cellular damage is primarily attributed to free radicals, radical scavengers are promising as potential radioprotectors. Early development of such agents focused on thiol synthetic compounds, e.g., amifostine (2-(3-aminopropylamino) ethylsulfanylphosphonic acid), approved as a radioprotector by the Food and Drug Administration (FDA, USA) but for limited clinical indications and not for nonclinical uses. To date, no new chemical entity has been approved by the FDA as a radiation countermeasure for acute radiation syndrome (ARS). All FDA-approved radiation countermeasures (filgrastim, a recombinant DNA form of the naturally occurring granulocyte colony-stimulating factor, G-CSF; pegfilgrastim, a PEGylated form of the recombinant human G-CSF; sargramostim, a recombinant granulocyte macrophage colony-stimulating factor, GM-CSF) are classified as radiomitigators. No radioprotector that can be administered prior to exposure has been approved for ARS. This differentiates radioprotectors (reduce direct damage caused by radiation) and radiomitigators (minimize toxicity even after radiation has been delivered). Molecules under development with the aim of reaching clinical practice and other nonclinical applications are discussed. Assays to evaluate the biological effects of ionizing radiations are also analyzed.
Fractional-order model predictive control as a framework for electrical neurostimulation in epilepsy

Objective. Electrical neurostimulation is an increasingly adopted therapeutic methodology for neurological conditions such as epilepsy. Electrical neurostimulation devices are commonly characterized by their limited sensing, actuating, and computational capabilities. However, the sensing mechanisms are often used only for their detection potential (e.g. to detect seizures), which automatically and dynamically trigger the actuation capabilities, but ultimately deploy prespecified stimulation doses that resulted from a period of manual (and empirical) calibration. The potential information contained in the measurements acquired by the sensing mechanisms is, therefore, considerably underutilized, given that this type of stimulation strategy only entails an event-triggered relationship between the sensors and actuators of the device. Such stimulation strategies are suboptimal in general and lack theoretical guarantees regarding their performance. Approach. In order to leverage the aforementioned information, harvested during normal sensing-actuating operation, we must consider a real-time feedback (closed-loop) strategy. More precisely, the stimulation signal itself should automatically adapt based upon the state of the neurophysiological system at hand, estimated from data collected in real-time through sensors in the device. Main results. In this work, we propose a model-based approach for (real-time) closed-loop electrical neurostimulation, in which the evolution of the system is captured by a fractional-order system (FOS). More precisely, we propose a model predictive control (MPC) approach with an underlying FOS predictive model, due to the ability of fractional-order dynamics to more accurately capture the long-term dependence present in biological systems, compared to the standard linear time-invariant models. Furthermore, MPC offers, by design, an additional layer of robustness to compensate for system-model mismatch, which the more traditional strategies lack. To establish the potential of our framework, we focus on epileptic seizure mitigation by computational simulation of our proposed strategy upon seizure-like events. Lastly, we provide evidence of the effectiveness of our method on seizures simulated by commonly adopted models in the neuroscience and medical community present in the literature, as well as real seizure data as obtained from subjects with epilepsy. Significance Our study thus paves the way for the development and implementation of robust real-time closed-loop electrical neurostimulation which can then be used for the construction of more effective devices for epileptic seizure mitigation.
Papillary thyroid carcinoma in Ukraine after Chernobyl and in Japan after Fukushima: different histopathological scenarios.

BACKGROUND A significant increase in the incidence of papillary thyroid carcinoma (PTC) in subjects exposed to radiation at a young age is a well-documented health consequence of the Chernobyl accident. The ongoing Thyroid Ultrasound Examination (TUE) program in children and adolescents of Fukushima Prefecture in Japan also indicated a high prevalence of PTC although its attribution to radiation exposure is a subject of debate. The objective of this study was to perform histopathological analysis of tumor architecture and invasive properties in: i) radiogenic post-Chernobyl and sporadic PTCs from Ukraine, and ii) PTCs in patients from Fukushima and other Prefectures of Japan of comparable age groups. METHODS The Ukrainian radiogenic PTCs included 245 PTCs from patients who resided in three highly 131I-contaminated regions and 165 sporadic PTCs diagnosed in residents of the same regions who were born after the accident and therefore not exposed to radioiodine. The Japanese series included 115 PTCs detected during the preliminary and the first full-scale surveys of the TUE in Fukushima and 223 PTCs from patients resident in other Prefectures. All of the subjects were included in the main statistical analysis. Three additional analyses were performed limiting the subjects to children, adolescents and adults. RESULTS Ukrainian radiogenic PTC was characterized by the higher frequency of tumors with dominant solid-trabecular growth pattern and higher invasiveness, more frequent extrathyroidal extension, lymphatic/vascular invasion, regional and distant metastases when compared to sporadic Ukrainian PTC. The integrative "invasiveness score", based on five cancer characteristics, was also higher in the radiogenic group. The differences were most pronounced in children. In contrast, no significant differences in tumor morphology or invasiveness were observed between the two Japanese groups or the three age subgroups. The only statistically significant findings were the higher proportion of male patients, smaller mean tumor size and higher frequency of T1b tumors in the Fukushima group. CONCLUSIONS The difference in morphological features that indicate biological behavior of PTC between the radiation-related and sporadic groups from Ukraine, together with the lack of such in the two groups from Japan, strongly suggest a non-radiogenic etiology of PTC from Fukushima and other Prefectures.
Are web-based personally tailored physical activity videos more effective than personally tailored text-based interventions? Results from the three-arm randomised controlled TaylorActive trial

Objectives Some online, personally tailored, text-based physical activity interventions have proven effective. However, people tend to ‘skim’ and ‘scan’ web-based text rather than thoroughly read their contents. In contrast, online videos are more engaging and popular. We examined whether web-based personally tailored physical activity videos were more effective in promoting physical activity than personally tailored text and generic information. Methods 501 adults were randomised into a video-tailored intervention, text-tailored intervention or control. Over a 3-month period, intervention groups received access to eight sessions of web-based personally tailored physical activity advice. Only the delivery method differed between intervention groups: tailored video versus tailored text. The primary outcome was 7-day ActiGraph-GT3X+ measured moderate-to-vigorous physical activity (MVPA) assessed at 0, 3 and 9 months. Secondary outcomes included self-reported MVPA and website engagement. Differences were examined using generalised linear mixed models with intention-to-treat and multiple imputation. Results Accelerometer-assessed MVPA increased 23% in the control (1.23 (1.06, 1.43)), 12% in the text-tailored (1.12 (0.95, 1.32)) and 28% in the video-tailored (1.28 (1.06, 1.53)) groups at the 3-month follow-up only, though there were no significant between-group differences. Both text-tailored (1.77 (1.37, 2.28]) and video-tailored (1.37 (1.04, 1.79)) groups significantly increased self-reported MVPA more than the control group at 3 months only, but there were no differences between video-tailored and text-tailored groups. The video-tailored group spent significantly more time on the website compared with text-tailored participants (90 vs 77 min, p=0.02). Conclusions The personally tailored videos were not more effective than personally tailored text in increasing MVPA. The findings from this study conflict with pilot study outcomes and previous literature. Process evaluation and mediation analyses will provide further insights. Trial registration number ACTRN12615000057583
Post-acute psychological effects of classical serotonergic psychedelics: a systematic review and meta-analysis

Abstract Background Scientific interest in the therapeutic effects of classical psychedelics has increased in the past two decades. The psychological effects of these substances outside the period of acute intoxication have not been fully characterized. This study aimed to: (1) quantify the effects of psilocybin, ayahuasca, and lysergic acid diethylamide (LSD) on psychological outcomes in the post-acute period; (2) test moderators of these effects; and (3) evaluate adverse effects and risk of bias. Methods We conducted a systematic review and meta-analysis of experimental studies (single-group pre-post or randomized controlled trials) that involved administration of psilocybin, ayahuasca, or LSD to clinical or non-clinical samples and assessed psychological outcomes ⩾24 h post-administration. Effects were summarized by study design, timepoint, and outcome domain. Results A total of 34 studies (24 unique samples, n = 549, mean longest follow-up = 55.34 weeks) were included. Classical psychedelics showed significant within-group pre-post and between-group placebo-controlled effects on a range of outcomes including targeted symptoms within psychiatric samples, negative and positive affect-related measures, social outcomes, and existential/spiritual outcomes, with large between-group effect in these domains (Hedges' gs = 0.84 to 1.08). Moderator tests suggest some effects may be larger in clinical samples. Evidence of effects on big five personality traits and mindfulness was weak. There was no evidence of post-acute adverse effects. Conclusions High risk of bias in several domains, heterogeneity across studies, and indications of publication bias for some models highlight the need for careful, large-scale, placebo-controlled randomized trials.
Psychological well-being of South Korean employees in different occupational classes

Abstract We compared the mental health of waged Korean workers in different occupational classes. This was a secondary analysis of data from the fifth Korean Working Conditions Survey, conducted in 2017. Men who were “Unskilled manual workers” were more likely to report poor psychological well-being; however, analysis that adjusted for multiple factors (including work stressors and stress relievers) indicated that status as an “Unskilled manual worker” was not associated with poor psychological well-being. Male and female “Service and Sales workers” were less likely to report poor psychological well-being (aOR = 0.794 and 0.797, respectively). In addition, poor psychological well-being increased as the number of work stressors increased and decreased as the number of stress relievers increased. Work stressors and stress relievers are more deterministic than occupational categories on psychological well-being.