bluuebunny/crossref_metadata_2025_split huggingface dataset:
Deep Learning for Automated Segmentation of Basal Cell Carcinoma on Mohs Micrographic Surgery Frozen Section Slides
Authors: Varra Vamsi , Shahwan Kathryn T. , Johnson Kirsten , Kirven Rachel M. , Walker Trent D. , Geijs Daan , Litjens Geert , Carr David R. 
Published: December 2024

BACKGROUND
Deep learning has been used to classify basal cell carcinoma (BCC) on histopathologic images. Segmentation models, required for localization of tumor on Mohs surgery (MMS) frozen section slides, have yet to reach clinical utility.

OBJECTIVE
To train a segmentation model to localize BCC on MMS frozen section slides and to evaluate performance by BCC subtype.

MATERIALS AND METHODS
The study included 348 fresh frozen tissue slides, scanned as whole slide images, from patients treated with MMS for BCC. BCC foci were manually outlined using the Grand Challenge annotation platform. The data set was divided into 80% for training, 10% for validation, and 10% for the test data set. Segmentation was performed using the Ultralytics YOLOv8 model.

RESULTS
Sensitivity was .71 for all tumors, .87 for nodular BCC, .79 for superficial BCC, .74 for micronodular BCC, and .51 for morpheaform and infiltrative BCC. Specificity was .75 for all tumors, .59 for nodular BCC, .58 for superficial BCC, .83 for micronodular BCC, and .74 for morpheaform and infiltrative BCC.

CONCLUSION
This study trained a segmentation model to localize BCC on MMS frozen section slides with reasonably high sensitivity and specificity, and this varied by BCC subtype. More accurate and clinically relevant performance metrics for segmentation studies are needed.
Microfocused Ultrasound With Visualization: A Systematic Review of Adverse Events and Risk of Subsequent Facelift Compromise
Authors: Humphrey Victoria S. , Rambhia Pooja H. , Gmyrek Robyn , Chapas Anne 
Published: December 2024

BACKGROUND
Plastic surgery colleagues have expressed unconfirmed concerns regarding the deleterious implications of noninvasive energy-based therapies for skin laxity, such as microfocused ultrasound with visualization (MFU-V), on preexisting facial fat or subsequent surgical facelifts.

OBJECTIVE
The authors conducted a systematic review to summarize treatment-related adverse events (TRAEs) following MFU-V and elucidate their impact on future rhytidectomies.

MATERIALS AND METHODS
The authors performed a PubMed/MEDLINE search using the keywords “MFU-V,” “fat loss,” “adverse events,” “facelift,” and their derivatives. In addition, the authors searched the manufacturer and user facility device experience (MAUDE) database using the brand name “Ulthera.”

RESULTS
Nineteen articles with data on 506 patients were identified. Transient edema, erythema, and postprocedural pain were observed most often. Instances of significant TRAEs were limited in the scientific literature, apart from 1 case of subcutaneous atrophy. Data from 106 records were extracted from the MAUDE database. Notably, lipoatrophy, neurologic sequelae (including nerve damage, focal numbness, dysesthesia, and ptosis), and scarring were reported with the most frequency. There was 1 report of facelift compromise.

CONCLUSION
While the scientific literature lacks supporting evidence regarding the impact of MFU-V on subsequent facelift procedures, anecdotal, largely unverified reports exist. Hence, peer-reviewed literature detailing such occurrences would be valuable in understanding the potential ensuing risks.
Menopausal age, adipokines, and heart failure incidence in postmenopausal women of the Multi-Ethnic Study of Atherosclerosis
Authors: Ebong Imo A. , Wilson Machelle , Michos Erin D. , Appiah Duke , Schreiner Pamela J. , Racette Susan B. , Allison Matthew , Watson Karol , Bertoni Alain 
Published: December 2024

Abstract

Objective
The mechanisms through which menopausal age influences heart failure (HF) development are controversial. Adiposity increases after menopause and could affect HF risk by influencing serum adipokine secretion. We investigated the associations of early menopause, and serum adipokines with incident HF in postmenopausal women.

Methods
We included 746 postmenopausal women from the Multi-Ethnic Study of Atherosclerosis who reported their menopausal age and had data on adipokines and incident HF at the end of follow-up. Multivariable Cox proportional hazards models were used for analysis.

Results
The mean age was 65.1 years. Over a median follow-up period of 17.8 years, 45 HF events occurred. After adjusting for waist circumference, other cardiovascular disease risk factors and myocardial infarction, the hazard ratios (95% confidence intervals) of incident HF attributable to early menopause were 4.50 (1.41-14.3), 4.64 (1.46-14.7), and 5.16 (1.59-16.7) in models that additionally included adiponectin, leptin, and resistin, respectively. In adjusted analyses, adiponectin was independently associated with incident HF 2.20 (1.35-3.57), while leptin and resistin were not. The interaction terms of early menopause with adiponectin, leptin, and resistin for incident HF were not significant (P
int = 0.08-0.82).

Conclusions
Early menopause was significantly associated with incident HF. This association did not differ by serum adipokine levels. Only adiponectin was independently associated with incident HF in postmenopausal women when waist circumference, body mass index, and waist-hip ratio were used as the adiposity metric.
Management of Complex Postburn Scar Contracture of the Dorsum of Pediatric Hand
Authors: Akkour Mousa , Almadani Jamal , Alammar Alwaleed , Alsaeed Ahmed , Alshammery Ahmad , Gabr Mostafa , Al-Qattan Mohammed 
Published: December 2024

Summary:
This case report details the challenging management of a 3-year-old girl with a severe left-hand extension contracture resulting from a scald burn. Delayed presentation prompted a 2-stage surgical approach. The first stage involved excising contracted skin and using a groin flap for reconstruction. Two weeks later, donor site closure was performed. The patient later underwent syndactyly release and extensor tenotomy, achieving significant metacarpophalangeal and proximal interphalangeal joint flexion. This case underscores the importance of burn injury intervention and reconstructive surgery for functional and aesthetic outcomes in challenging hand deformities.
Optical Microangiography and Progressive Retinal Nerve Fiber Layer Loss in Primary Angle Closure Glaucoma
Authors: Rao Harsha L. , Dasari Srilakshmi , Puttaiah Narendra K. , Pradhan Zia S. , Moghimi Sasan , Mansouri Kaweh , Webers Carroll A.B. , Weinreb Robert N. 
Published: December 2024

Précis:
Younger patient age (coefficient: 0.10, P=0.04) and greater peak IOP during follow-up (coefficient: −0.14, P=0.03), but not baseline optical microangiography parameters, were significantly associated with a faster rate of RNFL loss in mild-moderate PACG.

Purpose:
To evaluate the association between optical microangiography (OMAG) measurements and progressive retinal nerve fiber layer (RNFL) loss in primary angle closure glaucoma (PACG).

Methods:
In a prospective study, 45 eyes of 30 PACG patients (86 hemifields) with mild to moderate functional damage were longitudinally studied for at least 2 years and with a minimum of 3 optical coherence tomography (OCT) examinations. OMAG imaging was performed at the baseline visit. Effect of clinical parameters (age, sex, presence of systemic diseases, central corneal thickness, mean, peak, and fluctuation of intraocular pressure during follow-up), baseline hemifield mean deviation (MD) and baseline OMAG [quadrant peripapillary and macular perfusion density(PD)] on the rate of RNFL change was evaluated using linear mixed models.

Results:
The average (±SD) hemifield MD, RNFL thickness, peripapillary PD and macular PD of the analyzed quadrants at baseline were −6.0±3.4 dB, 89±21 µm, 40.1±3.5%, and 29.6±10.3%, respectively. The rate of quadrant RNFL change was −2.5±1.7 µm/year. Multivariate mixed models showed that younger patient age (coefficient: 0.10, P=0.04) and higher peak IOP during follow-up (coefficient: −0.14, P=0.03) were significantly associated with a faster rate of RNFL loss.

Conclusions:
Younger patient age and greater peak IOP during follow-up were significantly associated with a faster rate of RNFL loss in PACG patients with mild to moderate severity of functional damage. None of the OMAG parameters at baseline were associated with RNFL thinning suggesting a limited role of OCTA imaging in predicting structural progression in mild-moderate PACG.
Midterm Effects of SARS-CoV-2 on Respiratory Function in Judokas With and Without Exercise-Induced Bronchoconstriction: A Retrospective Study
Authors: Bostancı Özgür , Karaduman Emre , Yılmaz Ali Kerim , Kabadayı Menderes , Bilgiç Sait 
Published: December 2024

Objectives:
The clinical consequences of coronavirus infection in elite judokas with exercise-induced bronchoconstriction (EIB) are unclear. We aimed to determine potential respiratory function abnormalities and recovery in athletes with and without EIB after severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection.

Design:
Retrospective cohort study.

Setting:
Türkiye Olympic Preparation Centre.

Participants:
This retrospective study analyzed data collected from 25 consecutive elite judokas diagnosed with and without EIB and SARS-CoV-2 infection, routinely followed at an Olympic Sports Center between September 2020 and 2021.

Independent Variables:
Respiratory muscle strength and pulmonary function data were collected before and up to 90 days after SARS-CoV-2 infection.

Main Outcome Measures:
Measurements included maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, and peak expiratory flow (PEF).

Results:
Infected athletes with EIB had more markedly reduced respiratory muscle strength and pulmonary function than those without EIB. Maximal inspiratory pressure was decreased by 14% and MEP by 8% from baseline in infected athletes with EIB during follow-up. Likewise, FEV1 and FVC decreased by 4%. Maximal inspiratory pressure, MEP, FEV1, and FVC remained abnormal after 90 days of SARS-CoV-2 infection in EIB athletes but normalized rapidly in non-EIB athletes. Peak expiratory flow seemed unaffected during follow-up. Exercise-induced bronchoconstriction severity was moderately correlated with the maximum fall in MEP during follow-up.

Conclusions:
Severe acute respiratory syndrome coronavirus-2 infection notably decreases respiratory muscle strength and pulmonary function in judokas, especially those with pre-existing EIB, thereby prolonging spontaneous recovery time.
Preferences and Acceptability of Testing for Sexually Transmitted Infections in an HIV Pre-Exposure Prophylaxis clinic in Hanoi, Vietnam
Authors: Bui Hao T. M. , Adamson Paul C. , Nguyen Thanh C. , Dau Nguyen S. , Nguyen Khanh D. , Pham Loc Q. , Le Giang M. , Klausner Jeffrey D. 
Published: December 2024

Abstract

Background
Men who have sex with men (MSM) using HIV Pre-Exposure Prophylaxis (PrEP) are a vulnerable population with a high prevalence of sexually transmitted infections (STIs). Self-collection of specimens could improve STI testing, yet implementation in low-resource settings is limited. The study aimed to assess the feasibility and acceptability of self-collection for STI testing and to understand STI testing preferences among PrEP clients in Hanoi, Vietnam.

Methods
From January to December 2022 MSM aged 16 and older, participating in a clinic-based HIV PrEP program were enrolled. Participants self-collected pharyngeal, anal, and urine samples for Chlamydia trachomatis and Neisseria gonorrhoeae testing. Testing preferences were assessed through conjoint analysis using eight hypothetical testing profiles across five testing attributes; each profile was rated on a Likert scale (0-5) to create an impact score. Differences between attributes were assessed using a two-sided, one-sample t-test of the impact score.

Results
There were 529 participants enrolled; all were male. Specimens from three sites were provided by 97.9% (518/529). Mean satisfaction with self-collection was 4.3 (SD: 1.0), 99.4% reported they would perform again. In conjoint analysis, cost (free vs. $17USD) had the highest impact on testing preference (Impact Score: 25.2; p = <0.001). A one-week time to test result notification was preferred to 90 minutes (Impact Score: -0.8; p = 0.03).

Conclusion
We found high acceptability of self-collection for STI testing among HIV PrEP clients in Vietnam. Cost was the most important factor affecting testing uptake. Expanding self-collection and lowering costs could improve STI testing in HIV PrEP programs.
The Environmental Impact of Iodinated Contrast Media: Strategies for Optimized Use and Recycling
Authors: Toia Giuseppe V. , Ananthakrishnan Lakshmi 
Published: December 2024

Abstract
Iodinated contrast media (ICM) is an integral and ubiquitous component of modern diagnostic imaging. Although most radiology practices are familiar with ICM administration and physiological excretion, they may be less aware of how much ICM is wasted on a per exam basis. Furthermore, radiologists may not recognize the environmental fate of discarded ICM waste. In an evolving world where medical practices are increasingly cognizant of their environmental footprint and radiology practices are considered high consumers of resources, it behooves the radiology community to understand the ICM lifecycle and ways to mitigate unnecessary waste. This review article explains the origin and environmental fate of discarded ICM, with special focus on wastewater contamination. Secondly, the article focuses on feasible options to both optimize use and decrease consumable waste. Specifically, the article addresses ICM vial size inventory diversification, multi-use ICM vials, syringeless contrast injectors, and the potential for using multi-energy imaging (dual-energy or photon counting CT) to accomplish these goals. Finally, the authors share their institutional experience participating in an ICM recycling program and its current departmental impact.
Resident Education in the Age of AI
Authors: Gomez Erin , Lin Cheng Ting 
Published: December 2024

Abstract
Artificial intelligence (AI) is a rapidly expanding field of interest to radiologists for its utility as an adjunct in detecting and reporting disease and its potential influence on the role of radiologists and their practices. As radiology educators, we are responsible for developing and providing access to curricular elements that will prepare residents to be good stewards of artificial intelligence resources while also acquiring fundamental knowledge and skills that are essential to daily practice. Residency programs should consider collaborative approaches as well as solicit support from national societies in the development and curation of their AI curricula.
Predicting In-Hospital Mortality in Critical Orthopaedic Trauma Patients with Sepsis Using Machine Learning Models
Authors: Long Ze , Tan Shengzhi , Sun Baisheng , Qin Yong , Wang Shengjie , Han Zhencan , Han Tao , Lin Feng , Lei Mingxing 
Published: December 2024

Abstract

Purpose: This study aims to establish and validate machine learning-based models to predict death in hospital among critical orthopaedic trauma patients with sepsis or respiratory failure.

Methods: This study collected 523 patients from the Medical Information Mart for Intensive Care database. All patients were randomly classified into a training cohort and a validation cohort. Six algorithms, including logistic regression (LR), extreme gradient boosting machine (eXGBM), support vector machine (SVM), random forest (RF), neural network (NN), and decision tree (DT), were used to develop and optimize models in the training cohort, and internal validation of these models were conducted in the validation cohort. Based on a comprehensive scoring system, which incorporated ten evaluation metrics, the optimal model was obtained with the highest scores. An artificial intelligence (AI) application was deployed based on the optimal model in the study.

Results: The in-hospital mortality was 19.69%. Among all developed models, the eXGBM had the highest area under the curve (AUC) value (0.951, 95%CI: 0.934-0.967), and it also showed the highest accuracy (0.902), precise (0.893), recall (0.915), and F1 score (0.904). Based on the scoring system, the eXGBM had the highest score of 53, followed by the RF model (43) and the NN model (39). The scores for the LR, SVM, and DT were 22, 36, and 17, respectively. The decision curve analysis confirmed that both the eXGBM and RF models provided substantial clinical net benefits. However, the eXGBM model consistently outperformed the RF model across multiple evaluation metrics, establishing itself as the superior option for predictive modeling in this scenario, with the RF model as a strong secondary choice. The SHAP analysis revealed that SAPS II, age, respiratory rate, OASIS, and temperature were the most important five features contributing to the outcome.

Conclusions: This study develops an artificial intelligence application to predict in-hospital mortality among critical orthopaedic trauma patients with sepsis or respiratory failure.
Recent advances in portable, low-field magnetic resonance imaging in cerebrovascular disease
Authors: Zabinska Julia , de Havenon Adam , Sheth Kevin N. 
Published: December 2024

Purpose of review
This review aims to describe recent advances in low-field (0.064 T) magnetic resonance imaging (LF-MRI) of cerebrovascular disease, including ischemic and hemorrhagic stroke and white matter hyperintensities.

Recent findings
Since 2023, several studies have highlighted the rapidly changing landscape of portable, low-field MRI (LF-MRI) and its applications in stroke and cerebrovascular disease. The advantages of using LF-MRI in these settings are multifold: cheaper and dynamic imaging of this patient population confers closer observation during the acute and chronic stages of cerebrovascular disease. Initial deployments of the device span a variety of acute and emergency settings, including imaging around thrombolytic administration, endovascular reperfusion, intracerebral hemorrhage management, and cardiovascular intensive care. LF-MRI also has an important role in cerebrovascular disease monitoring and prevention, namely white matter hyperintensity (WMH) progression and vascular and Alzheimer's dementia. Early studies suggest reliable sensitivity and specificity for these pathologies. With further improvements to LF-MRI hardware, software and postprocessing on the horizon, we anticipate the device's ability to provide inexpensive and flexible neuroimaging to a wide array of healthcare settings that treat, prevent, and manage cerebrovascular disease.

Summary
Recent studies indicate that LF-MRI promotes rapid, cost-effective, and clinically useful neuroimaging at various clinical timepoints throughout stroke and cerebrovascular disease progression and management.
C2AM-Unet: Coordinate and Channel Attention Mixing Flexible Architecture for Retinal Vessel Segmentation
Authors: Zhang Jingling , Zheng Shuting , Zhang Wen , Gu Jia 
Published: December 2024

AbstractRecently, CNN-based and Transformer-based network have become the de-facto standard for vessel segmentation, due to their strong feature representation capabilities. However, CNNs fall short in explicitly capturing global dependencies between different spatial locations, while Transformers require quadratic computation by virtue of the long sequences and lack fine-grained local correlations. Seeking to model both local correlations and long-range dependencies, our research revisits this issue and introduces a novel retinal vessel segmentation network based on U-Net, the Coordinate and Channel Attention Mixing Flexible Architecture (C2AM-Unet), a new lightweight network that combines the U-Net model with a multi-attention mechanism. Specifically, we present a core Dual Global Coordinate Attention (DGCA) module, which embeds two types of serial global spatial-specific property information: one with a direction-aware mechanism, responsible for encoding long-range dependencies and coordinate information in both horizontal and vertical directions, and another with a transformer-like coordinate module that focuses on the connections and interactions between each spatial location. Next, the C2AM feature maps are aggregated with the direction-aware feature maps to enhance their ability to represent the objects of interest. To further strengthen the long-distance semantic dependencies, we utilize the transformer-like channel attention model to capture the cross-channel communication of global information. To verify the effectiveness of our method, we also construct other similar variant components that can be flexibly applied to other networks. The experimental results on three retinal vessel and two coronary angiography datasets, including DRIVE, STARE, CHASE_DB1, DCA1 and CHUAC, demonstrate that C2AM-Unet achieves competitive scores compared to the state-of-the-art methods.
Synaptic acetylcholine induces sharp wave ripples in the basolateral amygdala through nicotinic receptors
Authors: Bratsch-Prince Joshua X. , Jones Grace C. , Warreni James W. , Mott David D. 
Published: December 2024

AbstractWhile the basolateral amygdala (BLA) is critical in the consolidation of emotional memories, mechanisms underlying memory consolidation in this region are not well understood. In the hippocampus, memory consolidation depends upon network signatures termed sharp wave ripples (SWR). These SWRs largely occur during states of awake rest or slow wave sleep and are inversely correlated with cholinergic tone. While high frequency cholinergic stimulation can inhibit SWRs through muscarinic acetylcholine receptors, it is unclear how nicotinic acetylcholine receptors or different cholinergic firing patterns may influence SWR generation. SWRs are also present in BLAin vivo. Interestingly, the BLA receives extremely dense cholinergic inputs, yet the relationship between acetylcholine (ACh) and BLA SWRs is unexplored. Here, using brain slice electrophysiology in male and female mice, we show that brief stimulation of ACh inputs to BLA reliably induces SWRs that resemble those that occur in the BLAin vivo. Repeated ACh-SWRs are induced with single pulse stimulation at low, but not higher frequencies. ACh-SWRs are driven by nicotinic receptors which recruit different classes of local interneurons and trigger glutamate release from external inputs. In total, our findings establish a previously undefined mechanism for SWR induction in the brain. They also challenge the previous notion of neuromodulators as purely modulatory agents gating these events but instead reveal these systems can directly instruct SWR induction with temporal precision. Further, these results intriguingly suggest a new role for the nicotinic system in emotional memory consolidation.Significance StatementSharp wave ripples represent a key network signature believed to be important in memory consolidation. These network events have been largely studied in the hippocampus and are suppressed by the basal forebrain cholinergic system. Sharp wave ripples also occur in the basolateral amygdala, a region critically involved in emotional memory consolidation. Here, we show a novel mechanism by which low frequency stimulation of synaptic acetylcholine in basolateral amygdala brain slices can reliably induce sharp wave ripples through a nicotinic receptor-mediated mechanism. These findings update the view of neuromodulatory systems in sharp wave ripple induction, moving past a purely modulatory role for these systems and instead establish a role where modulators, like acetylcholine, can directly drive SWRs with temporal precision.