bluuebunny/crossref_metadata_2025_split huggingface dataset:
Postoperative adjuvant immunotherapy for pathological stage II–IVa esophageal squamous cell carcinoma after radical surgery does not improve disease-free recurrence rates
Authors: Xie Xihao , Zhang Hai , He Haiquan , Wu Bomeng , Chen Ying , Lin Wanli , Feng Qingyi , Chen Qunqing 
Published: December 2024

Background/objectivesPostoperative adjuvant therapy for esophageal squamous cell carcinoma (ESCC) primarily includes chemotherapy and chemoradiotherapy. The survival benefits of postoperative adjuvant therapy for R0-resected ESCC remain controversial. Immunotherapy is being gradually applied perioperatively for esophageal cancer, but the efficacy of postoperative immunotherapy in ESCC is unclear. This study aimed to evaluate the effectiveness of postoperative immunotherapy for esophageal cancer. Toward this goal, we explored the differences between postoperative immunotherapy combined with chemotherapy and postoperative adjuvant chemotherapy alone.MethodsThis retrospective study evaluated patients who underwent radical surgery for esophageal cancer at Gaozhou People’s Hospital between January 2020 and August 2022 and received postoperative adjuvant therapy. Patients were divided into two groups according to the adjuvant treatment regimens: postoperative adjuvant chemotherapy (aCT) and postoperative adjuvant immunotherapy combined with chemotherapy (aICT) groups. Data on baseline characteristics, surgical-related indicators, adverse event rates during adjuvant therapy, and 2-year postoperative follow-up were collected for both groups.ResultsA total of 76 patients were included: 36 and 40 patients in the aICT and aCT groups, respectively. There were no significant differences in baseline data between the two groups. During the adjuvant treatment period, the incidence of hypothyroidism was significantly higher in the aICT group than in the aCT group (25.0% vs. 2.5%, p = 0.007). During the 2-year follow-up, local and recurrence rates were 17.5 and 12.5% in the aCT group and 13.9 and 5.6% in the aICT group, respectively, showing no significant difference between the two groups (p = 0.489).ConclusionFor patients with pathologically confirmed locally advanced ESCC after surgery, postoperative immunotherapy did not confer better disease-free recurrence rates compared to postoperative adjuvant therapy. Nonetheless, with research advancements, the role of immunotherapy in the treatment of ESCC is likely to expand, offering new hope for these patients.
Cross-attention swin-transformer for detailed segmentation of ancient architectural color patterns
Authors: Yongyin Lv , Caixia Yu 
Published: December 2024

IntroductionSegmentation tasks in computer vision play a crucial role in various applications, ranging from object detection to medical imaging and cultural heritage preservation. Traditional approaches, including convolutional neural networks (CNNs) and standard transformer-based models, have achieved significant success; however, they often face challenges in capturing fine-grained details and maintaining efficiency across diverse datasets. These methods struggle with balancing precision and computational efficiency, especially when dealing with complex patterns and high-resolution images.MethodsTo address these limitations, we propose a novel segmentation model that integrates a hierarchical vision transformer backbone with multi-scale self-attention, cascaded attention decoding, and diffusion-based robustness enhancement. Our approach aims to capture both local details and global contexts effectively while maintaining lower computational overhead.Results and discussionExperiments conducted on four diverse datasets, including Ancient Architecture, MS COCO, Cityscapes, and ScanNet, demonstrate that our model outperforms state-of-the-art methods in accuracy, recall, and computational efficiency. The results highlight the model's ability to generalize well across different tasks and provide robust segmentation, even in challenging scenarios. Our work paves the way for more efficient and precise segmentation techniques, making it valuable for applications where both detail and speed are critical.
Development and verification of a nomogram for recurrence risk of Benign Paroxysmal Positional Vertigo in middle-aged and older populations
Authors: Tang Bo , Zhang Chuang , Wang Dan , Luo Minghua , He Yuqin , Xiong Yao , Yu Xiaojun 
Published: December 2024

BackgroundBenign Paroxysmal Positional Vertigo (BPPV) is the most common cause of peripheral vertigo, with frequent recurrence, particularly pronounced among middle-aged and elderly populations, significantly affecting patients’ quality of life. This study aimed to identify predictive factors for recurrence in middle-aged and older patients with BPPV and to develop a nomogram prediction model based on these predictors.MethodsThis retrospective study included 582 participants aged ≥45 years who were selected from the electronic medical records system of the First Hospital of Changsha between March 2021 and March 2024. Randomly chosen participants (n = 407, 70%) constituted the training group, whereas the remaining participants (n = 175, 30%) formed the validation group. This study used LASSO binomial regression to select the most predictive variables. A predictor-based nomogram was developed to calculate the risk of BPPV recurrence. The performance of the nomogram was evaluated using the area under the receiver operating characteristic curve (AUC) and calibration curves with 1,000 bootstrap resampling validations. Decision curve analysis (DCA) was conducted to assess the clinical usefulness of the nomogram.ResultsAccording to findings from least absolute shrinkage and selection operator (LASSO) binomial regression and logistic regression screening, older age, higher levels of uric acid (UA) and homocysteine (HCY), diabetes, migraine, anxiety, and insomnia were identified as independent factors associated with an increased recurrence risk of BPPV. A nomogram model for predicting recurrence risk was developed based on these predictors. The nomogram achieved an AUC (C-statistic) of 0.8974 (95% CI: 0.8603–0.9345) in the training group and 0.8829 (95% CI: 0.8253–0.9406) in the validation group. Calibration curves, after 1,000 bootstrap resamples, demonstrated good agreement between the predicted and actual probabilities in the development and validation cohorts. DCA indicated that the nomogram had clinical utility.ConclusionThe nomogram model incorporating age, UA, HCY, diabetes, migraine, anxiety status, and insomnia demonstrated a strong predictive capability for estimating the probability of BPPV recurrence in middle-aged and elderly patients. This tool is valuable for identifying individuals at high risk of BPPV recurrence and can aid physicians in making informed treatment decisions aimed at reducing recurrence rates.
Middle ear biofilm and sudden deafness - a light and transmission electron microscopy study
Authors: Li Hao , Staxäng Karin , Ladak Hanif M. , Agrawal Sumit , Rask-Andersen Helge 
Published: December 2024

BackgroundThere still exists controversy about whether the healthy human middle ear mucosa is sterile or if it may harbor a diverse microbiome. Considering the delicacy of the human round window membrane (RWM), different mechanisms may exist for avoiding inner ear pathogen invasion causing sensorineural deafness. We re-analyzed archival human RWMs using light and transmission electron microscopy after decalcification to determine if bacteria are present in clinically normal human middle ears. We also searched for the presence of inborn immune defensive mechanisms within the round window niche (RWN), as previously reported in non-human primate ears.Materials and methodsFive round window niches, removed and directly fixed at transcochlear petroclival meningioma surgery, were re-investigated after ethical permission using light and transmission electron microscopy. The morphology of the RWM, including its bony attachment and pseudomembrane outline, was analyzed. Moreover, 64 human temporal bones were investigated using synchrotron phase-contrast imaging (SR-PCI) aiming to identify potentially “hidden” spaces, including the RWN potentially harboring infectious material.ResultsHistologic evidence of free-living bacteria and biofilm was found in 40% of RWNs in seemingly “healthy” middle ears. The RWM in these ears was pathologically changed with repealed epithelial and intercellular junctional integrity. Putative membranous defense machinery consisted of a lymphatic drainage system together with free phagocytic cells seemingly serving to protect the inner ear from alleged pathogens. Synchrotron analyses showed that a pseudomembrane was present in the human round window niche (RWN) in 80% of the specimens, of which 20% were complete. In 3%, the RWN contained dense tissue or serous fluid plugs partly obstructing the RWN. Infralabyrinthic clefts and tympanomeningeal fissures (Hyrtl’s fissure) were occasionally enclosed by delicate membranes near the round window. These may represent predilection sites for “hidden” infections potentially endangering inner ear function, particularly in connection with round window surgery.ConclusionConsidering the fragility of the normal human RWM, we speculate that occult colonies of biofilm may be a factor in surgeries involving the RWM, sensorineural hearing loss, and hearing preservation/fibrosis following cochlear implantation, and more controversially in hidden perilymph leaks causing sudden deafness and labyrinthine pathology.
A study of long-term GABA and high-energy phosphate alterations in the primary motor cortex using anodal tDCS and 1H/31P MR spectroscopy
Authors: Patel Harshal Jayeshkumar , Stollberg Lea-Sophie , Choi Chang-Hoon , Nitsche Michael A. , Shah N. Jon , Binkofski Ferdinand 
Published: December 2024

IntroductionAnodal transcranial direct current stimulation (tDCS) has been reported to modulate gamma-aminobutyric acid levels and cerebral energy consumption in the brain. This study aims to investigate long-term GABA and cerebral energy modulation following anodal tDCS over the primary motor cortex.MethodTo assess GABA and energy level changes, proton and phosphorus magnetic resonance spectroscopy data were acquired before and after anodal or sham tDCS. In anodal stimulation, a 1 mA current was applied for 20 min, and the duration of ramping the current up/down at the start and end of the intervention was 10 s. In the sham-stimulation condition, the current was first ramped up over a period of 10 s, then immediately ramped down, and the condition was maintained for the next 20 min.ResultsThe GABA concentration increased significantly following anodal stimulation in the first and second post-stimulation measurements. Likewise, both ATP/Pi and PCr/Pi ratios increased after anodal stimulation in the first and second post-stimulation measurements.ConclusionThe approach employed in this study shows the feasibility of measuring long-term modulation of GABA and high-energy phosphates following anodal tDCS targeting the left M1, offering valuable insights into the mechanisms of neuroplasticity and energy metabolism, which may have implications for applications of this intervention in clinical populations.
Nutritional scores predict the prognosis of patients with pulmonary tuberculosis
Authors: Tan Junyi , Shi Xiaofeng , Pi Yinhuan , Xiang Mingque , Li Tianju 
Published: December 2024

BackgroundAlthough malnutrition is associated with poor prognosis in Pulmonary Tuberculosis (PTB) patients, no nutrition-based prediction model has been established for PTB. Herein, we explored the clinical utility of common nutrition scores in predicting the prognosis of PTB patients.MethodsWe retrospectively collected clinical baseline data from 167 patients with secondary PTB who had not previously received anti-TB treatment. Subsequently, we determined the CONUT score, PNI index, and NPS score and evaluated the treatment efficacy using changes in lung lesions revealed by the chest CT scan. The Area Under the Receiver Operating Characteristic (AUROC) curve was used to quantify the predictive values of CONUT, PNI, and NPS scores for anti-TB efficacy in new-onset PTB patients, and the critical CONUT, PNI, and NPS values were determined using the Youden Index. We also performed univariate and multivariate analyses of prognostic factors in PTB patients to determine the nutrition scores and other clinical factors associated with the prognosis of patients with the new-onset PTB.ResultsThe Youden Index revealed that the critical CONUT score value for patients with PTB was 4.5, with a sensitivity of 72.2% and specificity of 96.6%. In contrast, the critical cut-off values of the PNI index and the NPS score were 39.825 and 3.5, respectively. Univariate analysis of the predictors of poor prognosis in PTB patients showed that patients with diabetes, COPD, pneumonia, and hypoproteinemia (which were risk factors) had a poor prognosis (p &lt; 0.05). Multivariate analysis revealed that the CONUT score, PNI, NPS, and NRS-2002 were independent predictors of unfavorable PTB outcomes, with adjusted ORs of 60.419 (95%CI: 16.186–225.524, p &lt; 0.0001), 23.667 (95% CI: 9.317–60.115, p &lt; 0.0001), 8.512 (95% CI: 3.762–19.257, p &lt; 0.0001), 0.612 (95% CI: 4.961–39.161, p &lt; 0.0001), respectively. The Area Under the Curve (AUC) of the CONUT score in predicting poor prognosis of PTB patients was 0.885 (95% CI:0.830–0.940, p &lt; 0.0001), which is comparable to that of the PNI index (0.862, 95% CI: 0.805–0.920, p &lt; 0.0001), but higher than that of NPS (0.774, 95% CI: 0.702–0.846, p &lt; 0.0001), BMI (0.627, 95% CI: 0.541–0.717, p &lt; 0.0001), and NRS-2002 (0.763, 95% CI: 0.688–0.838, p &lt; 0.0001). We discovered that older patients (p &lt; 0.0001), male participants (p &lt; 0.05), and patients with Diabetes Mellitus (DM) (p &lt; 0.0001) and Chronic Obstructive Pulmonary Disease (COPD) (p &lt; 0.05) were more likely to have a high CONUT score.ConclusionThe poor prognosis of PTB patients was related to a high CONUT score, low PNI index, and high NPS score, of which the specificity and sensitivity of the CONUT score were higher than those of the PNI index and the NPS score.
Huge extramedullary hematopoiesis mass in the posterior mediastinum: a case report
Authors: Junjun Zhao , Lingjun Dong , Zhifeng Ma , Chu Zhang , Haiyong Wang 
Published: December 2024

BackgroundExtramedullary hemopoiesis (EMH) is a rare condition characterized by abnormal blood cell production outside the bone marrow, commonly occurring in the liver, spleen, lymph nodes, and less frequently in the mediastinum.Case presentationThis case involves a 68-year-old male patient who was found to have a posterior mediastinal mass upon examination. A surgical biopsy was performed, and pathological examination confirmed it to be extramedullary hemopoiesis (EMH). Further investigation revealed that the patient also suffered from hemolytic anemia.ConclusionsThe report presents a case of a large posterior mediastinal mass, which was confirmed to be extramedullary hemopoiesis (EMH) upon surgical pathology. It is challenging to differentiate posterior mediastinal tumors from EMH, and the possibility of EMH should be considered in patients with posterior mediastinal masses that have similar CT findings and laboratory test results.
Implementation of the ProMisE classifier and validation of its prognostic impact in Brazilian endometrial carcinomas
Authors: Andrade Diocésio Alves Pinto , Bonatelli Murilo , de Paula Flávia Escremim , Berardinelli Gustavo Noriz , Teixeira Gustavo Ramos , dos Reis Monise Tadin , Barbin Flávia Fazzio , Andrade Carlos Eduardo Mattos da Cunha , Aguiar Vinicius Pereira , Hermoza Alejandro Delfos , Hirai Welinton Yoshio , Schmidt Ronaldo Luís , Reis Rui Manuel , dos Reis Ricardos 
Published: December 2024

PurposeMolecular classification of endometrial cancer (EC) has emerged as a key approach to individualize therapy and define prognostic outcomes. This study aimed to implement the traditional ProMisE classification in a Brazilian population, compared with a molecular setting of ProMisE biomarkers, and evaluate its impact on patients’ prognosis.Patient and methodsA prospective cohort of 114 patients with primary EC treated at Barretos Cancer Hospital (BCH) between October 2020 and December 2022 was conducted. Pathology diagnosis, staging, treatment, and follow-up data were collected. The traditional ProMisE methodology was carried out by POLE hotspot sequencing and immunohistochemistry (IHC) for p53 and mismatch repair (MMR) proteins. We further evaluate the MMR and TP53 status by molecular approach, namely microsatellite instability (MSI) by PCR-based and TP53 mutation analysis by next-generation sequencing (NGS). The results of the 4 molecular groups in both methodologies were compared regarding agreement accuracy and survival outcomes.ResultsAmong the 114 cases, the traditional ProMisE groups were: POLEmut 15.8%, MMRd 28.1%, p53abn 27.2%, and no specific molecular profile (NSMP) 28.9%. Considering the molecular classification approach, we observed a POLEmut group of 15.8%, MSI group of 23.7%, TP53 mutation of 27.2%, and NSMP of 33.3%. The concordance rate of both approaches was 86.8% (99/114 cases) with an overall accuracy of 0.87. Importantly, both traditional and molecular ProMisE approaches were associated with significant distinct overall survival (OS) and progression-free survival (PFS) outcomes, with POLEmut patients exhibiting a better prognosis (93.8% OS, at 24 months), whereas the p53abn having a worse survival time (68.9% of OS, at 24 months).ConclusionWe reported for the first time the Brazilian profile of the ProMisE classification of endometrial cancer and demonstrated the prognostic impact of the traditional and molecular ProMisE classification on patient outcomes.
Deep learning-based automated diagnosis of temporomandibular joint anterior disc displacement and its clinical application
Authors: Yu Yue , Wu Shu Jun , Zhu Yao Min 
Published: December 2024

IntroductionThis study aimed to develop a deep learning-based method for interpreting magnetic resonance imaging (MRI) scans of temporomandibular joint (TMJ) anterior disc displacement (ADD) and to formulate an automated diagnostic system for clinical practice.MethodsThe deep learning models were utilized to identify regions of interest (ROI), segment TMJ structures including the articular disc, condyle, glenoid fossa, and articular tubercle, and classify TMJ ADD. The models employed Grad-CAM heatmaps and segmentation annotation diagrams for visual diagnostic predictions and were deployed for clinical application. We constructed four deep-learning models based on the ResNet101_vd framework utilizing an MRI dataset of 618 TMJ cases collected from two hospitals (Hospitals SS and SG) and a dataset of 840 TMJ MRI scans from October 2022 to July 2023. The training and validation datasets included 700 images from Hospital SS, which were used to develop the models. Model performance was assessed using 140 images from Hospital SS (internal validity test) and 140 images from Hospital SG (external validity test). The first model identified the ROI, the second automated the segmentation of anatomical components, and the third and fourth models performed classification tasks based on segmentation and non-segmentation approaches. MRI images were classified into four categories: normal (closed mouth), ADD (closed mouth), normal (open mouth), and ADD (open mouth). Combined findings from open and closed-mouth positions provided conclusive diagnoses. Data augmentation techniques were used to prevent overfitting and enhance model robustness. The models were assessed using performance metrics such as precision, recall, mean average precision (mAP), F1-score, Matthews Correlation Coefficient (MCC), and confusion matrix analysis.ResultsDespite lower performance with Hospital SG’s data than Hospital SS’s, both achieved satisfactory results. Classification models demonstrated high precision rates above 92%, with the segmentation-based model outperforming the non-segmentation model in overall and category-specific metrics.DiscussionIn summary, our deep learning models exhibited high accuracy in detecting TMJ ADD and provided interpretable, visualized predictive results. These models can be integrated with clinical examinations to enhance diagnostic precision.
Intimate partner violence and its relation to sexual health outcomes across different adult populations: a systematic review
Authors: Calvillo Cristobal , Marshall Alexandra , Gafford Stefani , Montgomery Brooke E. E. 
Published: December 2024

IntroductionIntimate Partner Violence (IPV) significantly impacts adults' wellbeing, causing both physical and psychological harm. IPV has been consistently linked to adverse sexual health outcomes, including an increased risk of sexually transmitted infections, unintended pregnancies, and sexual dysfunction. This systematic review examines the evolving relationship between IPV and sexual health outcomes in adults from 2014 to 2024, addressing gaps in understanding across diverse populations and exploring the complex interplay between violence, sexuality, and health.MethodsA comprehensive search of multiple databases was conducted for peer-reviewed articles published between January 2014 and February 2024. Studies examining the association between IPV and sexual health variables in adult populations (aged 18 and older) were included. The review followed PRISMA guidelines, and 27 articles met the inclusion criteria after full-text screening and quality assessment.ResultsIPV was consistently associated with poorer sexual health outcomes across diverse populations and contexts. Studies utilized various validated instruments to assess IPV and sexual health. Research primarily focused on cisgender heterosexual women, with limited studies on cisgender heterosexual men, men who have sex with men, and transgender individuals. IPV was linked to an increased risk of sexually transmitted infections, unintended pregnancies, sexual dysfunction, and decreased sexual satisfaction. The relationship between IPV and sexual health was influenced by factors such as gender identity, sexual orientation, and cultural context.DiscussionThe review highlights the complex relationship between IPV and sexual health, emphasizing the need for targeted interventions and culturally sensitive approaches. Significant research gaps exist, particularly regarding lesbian women and non-binary individuals. Future studies should employ mixed-methods approaches and consider intersectionality to provide a more comprehensive understanding of IPV's impact on sexual health across diverse populations.
A Multidrug Donor Preconditioning Improves Steatotic Rat Liver Allograft Function and Recipient Survival After Transplantation
Authors: Xu Min , Alwahsh Salamah M. , Kim Myung-Ho , Kollmar Otto 
Published: December 2024

The scarcity of donors has prompted the growing utilization of steatotic livers, which are susceptible to injuries following orthotopic liver transplantation (OLT). This study aims to assess the efficacy of multidrug donor preconditioning (MDDP) in alleviating injuries of steatotic grafts following rat OLT. Lean rats were subjected to a Western-style diet with high-fat (HF) and high-fructose (HFr) for 30 days to induce steatosis. Both lean and steatotic livers were implanted into lean recipients fed with a chow diet after OLT. The HF + HFr diet effectively elevated blood triglyceride and cholesterol levels and induced fat accumulation in rat livers. Our results demonstrated a significant decrease in alanine aminotransferase levels (p = 0.003), aspartate aminotransferase levels (p = 0.021), and hepatic Suzuki scores (p = 0.045) in the steatotic rat liver allograft group following MDDP treatment on post-operation day (POD) 7. Furthermore, the survival rates of steatotic rat liver allografts with MDDP (19/21, 90.5%) were significantly higher than those in the steatotic control (12/21, 57.1%, *p = 0.019). These findings indicate that MDDP treatment improves steatotic rat liver allograft function and recipient survival following OLT.