bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reducing motion artifacts in craniocervical background subtraction angiography with deformable registration and unsupervised deep learning
Authors: Zhou Chaochao , Abdalla Ramez N , An Dayeong , Faruqui Syed H A , Sadrieh Teymour , Alzein Mohayad , Nehme Rayan , Shaibani Ali , Ansari Sameer A , Cantrell Donald R 
Published: August 2024

Abstract

Background
In clinical practice, digital subtraction angiography (DSA) often suffers from misregistration artifact resulting from voluntary, respiratory, and cardiac motion during acquisition. Most prior efforts to register the background DSA mask to subsequent postcontrast images rely on key point registration using iterative optimization, which has limited real-time application.

Purpose
Leveraging state-of-the-art, unsupervised deep learning, we aim to develop a fast, deformable registration model to substantially reduce DSA misregistration in craniocervical angiography without compromising spatial resolution or introducing new artifacts.

Materials and Methods
We extend HyperMorph, an open source deep learning deformable registration framework, to reduce motion artifacts in DSA. Novel image similarity loss functions with vessel layer estimation were introduced to optimize background registration, making it robust to the variable presence of intravascular iodinated contrast.

Results
A total of 516 studies with 5,240 angiographic series were collected and divided into training (5,046 series) and hold-out test (194 series) sets. Blinded algorithm rankings and Likert scores on 5-point scales (1 = worst, 5 = best) were generated by 3 practicing interventional neuroradiologists using 50 series randomly selected from the hold-out test set. Compared to traditional DSA, our learning-based background subtraction angiography (BSA) significant improved vascular fidelity (2.4 ± 0.6 for DSA vs. 3.6 ± 0.5 for BSA), subtraction artifacts (2.0 ± 0.4 for DSA vs. 3.9 ± 0.3 for BSA), and overall quality (2.1 ± 0.5 for DSA vs. 3.9 ± 0.4 for BSA) (P &lt; .0001). Learning-based BSA also significantly outperformed affine registration-based BSA (P &lt; .0001). The average inference time for learning-based BSA was 30 milliseconds per frame on our hardware.

Conclusion
The results demonstrate that deep learning deformable registration, combined with an appropriate loss function, can significantly reduce the motion artifacts that degrade DSA.
Budesonide and N-acetylcysteine inhibit activation of the NLRP3 inflammasome by regulating miR-381 to alleviate acute lung injury caused by the pyroptosis-mediated inflammatory response
Authors: Zhang Rongfang , Yang Aiping , Fu Jin , Zhang Li , Yin Liyue , Xu Ting , Dai Chunhui , Su Wenbing , Shen Wanling 
Published: August 2024

Abstract

Background
The anti-inflammatory effects of budesonide (BUN) and N-acetylcysteine (NAC) attenuate acute lung injury (ALI). The aim of this study was to investigate the effects of combination therapy consisting of BUN and NAC on ALI and the underlying mechanisms.

Methods
In vitro and in vivo models of ALI were generated by LPS induction. Western blotting was used to detect the expression levels of pyroptosis-related proteins and inflammation-related factors, and RT–qPCR was used to detect the expression of miR-381. Cell proliferation and apoptosis were detected by CCK-8 and flow cytometry, respectively. ELISA was used to detect the levels of inflammation-related factors. HE staining was used to detect lung injury.

Results
The results showed that LPS effectively induced pyroptosis in cells and promoted the expression of pyroptosis-related proteins (Caspase1, Gasdermin D and NLRP3) and inflammatory cytokines (TNF-α, IL-6 and IL-1β). The combination of BUN and NAC significantly alleviated LPS-induced pyroptosis and inflammation. In addition, the combination of BUN and NAC effectively promoted miR-381 expression. Transfection of miR-381 mimics effectively alleviated LPS-induced pyroptosis and inflammation, while transfection of miR-381 inhibitors had the opposite effect. miR-381 negatively regulates NLRP3 expression. Treatment with a miR-381 inhibitor or pc-NLRP3 reversed the effects of the combination of BUN and NAC. In a mouse model of ALI, the combination of BUN and NAC effectively improved lung injury, while treatment with a miR-381 inhibitor or pc-NLRP3 effectively reversed this effect.

Conclusion
Overall, this study revealed that BUN + NAC inhibits the activation of NLRP3 by regulating miR-381, thereby alleviating ALI caused by pyroptosis-mediated inflammation.
The Supply of Surgical Specialists and Subspecialists to the U.S. Medicare Population: National Trends from 2013 to 2019
Authors: Talbott Jennifer , Khurana Aditya , Wasson Megan 
Published: August 2024

Abstract

Purpose
The U.S. population is rapidly aging. The supply of surgeons needed to meet this demand should be evaluated. This study evaluated the trends in supply of Medicare surgeons by specialty and by U.S. state and region.

Method
All surgeons associated with a National Provider Identifier for cardiothoracic surgery, colorectal surgery, general surgery, gynecologic oncology, hand surgery, neurosurgery, obstetrics-gynecology, ophthalmology, oral and maxillofacial surgery, orthopedic surgery, otolaryngology, plastic and reconstructive surgery, surgical oncology, urology, and vascular surgery from 2013 to 2019 on the Centers for Medicare & Medicaid Services website were included. The absolute number of physicians was adjusted per 100,000 Medicare beneficiaries. Annual change was calculated by linear regression model, and the compound annual growth rate (CAGR) was calculated per specialty.

Results
The absolute number of physicians per 100,000 beneficiaries increased in 6 of 15 specialties during the study period. Vascular surgery had the largest annual increase (+0.23; CAGR, +2.75%), and obstetrics-gynecology had the largest annual decrease (−1.08; CAGR, −1.44%). Surgical oncology showed the largest positive CAGR (+4.20%). Oral and maxillofacial surgery had the largest negative CAGR (−2.86%). The Northeast was above the national average in supply for each specialty. The Midwest had the most specialties with positive CAGRs. The South did not meet the national average for physicians in any specialty.

Conclusions
This analysis of 15 surgical specialties provides important context to predicted physician shortages to the Medicare population. The study found geographic variation by region across specialty, which has important implications for health care planning from the level of undergraduate medical education to provision of hospital resources. Overall, the supply of surgeons across all specialties may not be sufficient to meet the demand of the rapidly aging U.S. population. Future study is needed to evaluate why surgeons are leaving the Medicare program.
Gender Differences in Autonomy Granted to Residents and Fellows During Procedural Training: A Systematic Review and Meta-Analysis
Authors: Lund Sarah , Griffeth Elaine M. , Williamson Andrea , Collings Amelia , Gudmundsdottir Hallbera , Han Amy , Kearse LaDonna , Kratzke Ian M. , Wilkins Parvathi , Prokop Larry J. , Cook David A. 
Published: August 2024

Abstract

Purpose
Supervisors may be prone to implicit (unintentional) bias when granting procedural autonomy to trainees due to the subjectivity of autonomy decisions. The authors aimed to conduct a systematic review and meta-analysis to assess the differences in perceptions of procedural autonomy granted to physician trainees based on gender and/or race.

Method
MEDLINE, Embase, CENTRAL, Scopus, and Web of Science were searched (search date: January 5, 2022) for studies reporting quantitative gender- or race-based differences in perceptions of procedural autonomy of physician trainees. Reviewers worked in duplicate for article selection and data abstraction. Primary measures of interest were self-reported and observer-rated procedural autonomy. Meta-analysis pooled differences in perceptions of procedural autonomy based on trainee gender.

Results
The search returned 2,714 articles, of which 16 were eligible for inclusion. These reported data for 6,109 trainees (median, 90 per study) and 2,763 supervisors (median, 54 per study). No studies investigated differences in perceptions of autonomy based on race. In meta-analysis of disparities between genders in autonomy ratings (positive number favoring female trainees), pooled standardized mean differences were −0.12 (95% confidence interval [CI], −0.19 to −0.04; P = .003; n = 10 studies) for trainee self-rated autonomy and −0.05 (95% CI, −0.11 to 0.01; P = .07; n = 9 studies) for supervisor ratings of autonomy.

Conclusions
Limited evidence suggests that female trainees perceived that they received less procedural autonomy than did males. Further research exploring the degree of gender- and race-based differences in procedural autonomy, and factors that influence these differences is warranted.
Predicting Surgical Resident Performance With Situational Judgment Tests
Authors: Gardner Aimee K. , Costa Paula 
Published: August 2024

Abstract

Purpose
Situational judgment tests (SJTs) have been proposed as an efficient, effective, and equitable approach to residency program applicant selection. This study examined how SJTs can predict milestone performance during early residency.

Method
General surgery residency program applicants during 3 selection cycles (2018–2019, 2019–2020, 2020–2021) completed SJTs. Accreditation Council for Graduate Medical Education milestone performance data from selected applicants were collected in March and April 2019, 2020, and 2021 and from residents in March 2020, August 2020, March 2021, September 2021, and March 2022. Descriptive statistics and correlations were computed and analysis of variance tests performed to examine differences among 4 SJT performance groups: green, top 10% to 25%; yellow, next 25% to 50%; red, bottom 50%; and unknown, did not complete the SJT.

Results
Data were collected for 70 residents from 7 surgery residency programs. Differences were found for patient care (F
3,189 = 3.19, P = .03), medical knowledge (F
3,176 = 3.22, P = .02), practice-based learning and improvement (F
3,189 = 3.18, P = .04), professionalism (F
3,189 = 3.82, P = .01), interpersonal and communication skills (F
3,190 = 3.35, P = .02), and overall milestone score (F
3,189 = 3.44, P = .02). The green group performed better on patient care, medical knowledge, practice-based learning and improvement, professionalism, and overall milestone score. The yellow group performed better than the red group on professionalism and overall milestone score, better than the green group on interpersonal and communication skills, and better than the unknown group on all but practice-based learning and improvement. The red group outperformed the unknown group on all but professionalism and outperformed the green group on medical knowledge.

Conclusions
SJTs demonstrate promise for assessing important noncognitive attributes in residency applicants and align with national efforts to review candidates more holistically and minimize potential biases.
First In Vivo Electromyographic Analysis of Mechanical Load Scenarios of the Cervicothoracic Junction During Daily Activities as a Basis for Future Postoperative Behavioral Instructions
Authors: Schröder Bennet Mathis , Koller Heiko , Liodakis Emmanouil , Sehmisch Stephan , Körner Sonja , Decker Sebastian 
Published: August 2024

Study Design:
Clinical Research.

Objectives:
Study participants were twenty- eigth healty volunteers.

Background:
Soft tissue complications after posterior cervicothoracic fusion surgery occur frequently. Postoperative myofascial dehiscence (PMD) can cause disability and pain. So far, it is unknown whether patients can affect PMD development through behavioral adjustment. Consequently, this study aimed to analyze how much mechanical stress daily activities exert on the posterior muscles and fascia at the cervicothoracic junction.

Materials and Methods:
Surface electromyography was applied next to the upper thoracic spine at the trapezius muscle. All volunteers performed 22 different daily activities, such as tooth brushing, dressing, standing up, and different horizontal positions. During the exercises, the electromyographic activity was measured. For each volunteer, root mean square values were determined. All exercises were then repeated with the use of a clavicular bandage to unload the shoulder and cervicothoracic muscles. Afterwards, the rankings were statistically compared interindividually.

Results:
Among the different tasks, significant differences in regard to the root mean square values were noted. For instance, horizontal positions caused significantly lower muscle activation compared with all other exercises (P ≤ 0.001). Notably, no relevant electromyographic differences were detected between the tasks with and without a clavicular bandage.

Conclusions:
This in vivo electromyographic analysis of cervicothoracic muscle activity during daily activities demonstrates that myofascial strain differs among various daily activities. Data indicate that potential postoperative mobilization protocols and behavioral instructions may have the potential to reduce the biomechanical load and consequently the risk of PMD and, therefore, may reduce the risk for surgical wound-related complications, disability, and need for revision surgery.
Pelvic congestion syndrome analysis through quantitative 2-dimensional phase-contrast MRI: a promising vision from an observational cohort study
Authors: Li Chen-Yu , Chen Chien-Wei , Kao Chih-Chen , Hsu Yin-Chen , Lee Chung-Yuan , Lin Chieh-Chao , Yang Teng-Yao , Wang Shih-Chung , Chen Sheng-Ya , Lin Yu-Hui , Wong Min Yi , Chang Chee-Jen , Huang Yao-Kuang 
Published: August 2024

Background:
To examine the application of quantitative 2-dimensional phase-contrast MRI (2D PC-MRI) for treating patients with pelvic congestion syndrome (PCS).

Materials and Methods:
The authors conducted a retrospective cross-sectional analysis by using quantitative 2D PC-MRI data enrolled between April 2017 and September 2023. In addition, 32 healthy female controls (HCs) were included.

Results:
Most patients with PCS presented with chronic pelvic pain and more than half had extrapelvic venous symptoms (80/81, 98% and 45/81, 56%, respectively). Quantitative 2D PC-MRI analyzed the 81 patients with PCS, 239 patients without PCS, and 32 HCs. The patients with PCS had higher stroke volume (SV), absolute SV (ASV), and mean flux (MF) in the calf region (interstitial pixel shift) than did the HCs. In the left gonadal vein, the patients with PCS had higher SV, backward flow volume (BFV), ASV, and MF and lower forward flow volume (FFV), stroke distance (SD), and mean velocity (MV) than did the HCs. However, the patients with PCS had lower SV, FFV, MF, SD, and MV in the great saphenous veins. Quantitative 2D PC-MRI analysis revealed that the PCS group had higher SV, FFV, BFV, ASV, and MF in the calf region than did the non-PCS group. The variables that most strongly differentiated the patients with PCS from the HCs were SV in the great saphenous veins, SD in the great saphenous veins and left gonadal vein, and MV in the great saphenous veins and left gonadal vein. Caudal flow in the left gonadal vein was identified in half of the patients with PCS (39/81, 48.1%); 14 of them received embolization for left gonadal vein.

Conclusions:
In additional to providing an objective 3-dimensional morphology of the pelvic veins and extrapelvic leaks, quantitative 2D PC-MRI analysis reveals distinct hemodynamic profiles between patients with PCS, those without PCS, and HCs, especially in the gonadal veins and regional perfusion of the calves.
Efficacy and safety of combining short-course neoadjuvant chemoradiotherapy with envafolimab in locally advanced rectal cancer patients with microsatellite stability: a phase II PRECAM experimental study
Authors: Wang Fei , Lai Chuanxi , Lv Yiming , Zhang Feixiang , Shi Liming , Wang Yunfei , Shen Yanbin , Xu Lingna , Hu Peng , Tang Wen , Xu Dengyong , Cao Gaoyang , Shan Lina , Jia Xiya , Chen Yiyi , Larson David W. , Wang Da , Lao Weifeng , Gu Hongcang , Sun Xiaonan , Huang Xuefeng , Dai Sheng 
Published: August 2024

Background:
Conventional neoadjuvant chemoradiotherapy (nCRT) yields a pathologic complete response (pCR) rate of 15–30% for locally advanced rectal cancer (LARC). This study ventures to shift this paradigm by incorporating short-course nCRT with immunotherapy, specifically Envafolimab, to achieve improved treatment efficacy and possibly redefine the standard of care for LARC.

Materials and methods:
The PRECAM study is a prospective, single-arm, phase 2 clinical trial for LARC in patients with microsatellite stable (MSS) tumors. Participants received short-course radiotherapy (25Gy/5f), followed by two cycles of CAPEOX chemotherapy and six weekly doses of Envafolimab, a PD-L1 antibody, before total mesorectal excision surgery. The primary endpoint was the pCR rate.

Results:
From April to December 2022, 34 patients were enrolled, of whom 32 completed the study, each diagnosed with an MSS rectal adenocarcinoma. All patients underwent preoperative CRT combined with Envafolimab. Remarkably, a pCR rate of 62.5% (20/32) was attained, and a significant pathologic response rate of 75% (24/32) was achieved. Additionally, 21 of 32 participants achieved a neoadjuvant rectal (NAR) score below 8, suggesting an effective treatment response. Common adverse events included tenesmus (78.1%), diarrhea (62.5%), and leukocyte decrease (40.6%). Two Grade 3 adverse events were noted, one related to liver function abnormality and the other to a decrease in platelet count. Surgical procedures were performed in all cases, with minor complications, including ileus, infections, and anastomotic leakage. As of this report, there have been no reported cases of recurrence or death during the follow-up period, ranging from 12 to 20 months.

Conclusion:
In LARC patients exhibiting MSS tumors, combining short-course nCRT with Envafolimab demonstrated favorable efficacy, leading to a significant pCR rate. Minor adverse effects and surgical complications were observed. These preliminary but promising results underscore the potential of this approach and call for further exploration and validation through a randomized controlled trial.
Exploring the causal relationships between cholelithiasis, cholecystitis, cholecystectomy, and gastroesophageal reflux disease: a bidirectional two-sample Mendelian randomization study
Authors: Lin Huahang , Lu Runda , Shang Qixin , Gu Yimin , Liu Yixin , Yang Yushang , Chen Longqi 
Published: August 2024

Background:
Biliary disorders and gastroesophageal reflux disease (GERD) frequently coexist. However, precise linkages between these conditions remain to be clarified.

Methods:
Univariable Mendelian randomization (MR), Bayesian weighted MR (BWMR) along with multivariable MR approaches were conducted using genetic instruments to evaluate the causality involving biliary disorders and GERD. Furthermore, an investigation was conducted on the potential mediating roles of biliary disorders (or GERD), on the linkage involving BMI and GERD (or biliary disorders).

Results:
Univariable MR analyses revealed significant causal effects of genetically predicted cholelithiasis [odds ratio (OR)=1.04, P=0.0001], cholecystitis (OR=1.06, P=0.0004), and cholecystectomy (OR=2.56, P=1.05×10-6) on GERD. These findings were replicated in the FinnGen cohort and were also confirmed by BWMR and multivariable MR analyses. Additionally, mediation analyses demonstrated that cholelithiasis and cholecystitis acted as partial mediators, linking BMI causally to GERD. Conversely, GERD exhibited causal effect on cholelithiasis (OR=1.52, P=9.17×10-30) and cholecystitis (OR=1.90, P=3.32×10-28), which remained significant after BWMR and multivariable MR analyses. Mediation analyses further revealed significant mediating effect of GERD on how BMI influenced cholelithiasis/cholecystitis.

Conclusion:
Our study elucidates the bidirectional causal linkages involving cholelithiasis, cholecystitis, cholecystectomy, and GERD. These results highlight the significance of GERD risk assessment in individuals suffering from biliary diseases and vice versa.
Severe acquired hemophilia A associated with COVID-19 vaccination: A case report and literature review
Authors: Kim Hong Jun , Jung Ye Ji , Lee Jun Ho , Lee Hyun Jung , Maeng Chi Hoon , Baek Sun Kyung , Han Jae Joon 
Published: August 2024

Rationale:
Acquired hemophilia A (AHA) is a rare autoimmune disease caused by an antibody that inhibits coagulation factor VIII activity. More than half of patients with AHA cannot identify underlying disorders. The remaining patients are associated with malignancies, autoimmune diseases, skin diseases, infections, and medications. Here, we present a case of 56-year-old Korean man with underlying hypertension, dyslipidemia, and diabetes mellitus who developed AHA following the second dose of BNT162b2 COVID-19 vaccination.

Patient concerns:
He presented with a large 20 × 30 cm-sized hematoma along the psoas muscle and intracranial hemorrhage, necessitating intensive care with mechanical ventilation and continuous renal replacement therapy. Laboratory testing demonstrated that activated partial thromboplastin time and prothrombin times were 74.7 seconds (normal range 29–43 seconds) and 17.2 seconds (normal range 12.5–14.7 seconds), respectively.

Diagnoses:
Laboratory tests confirmed AHA with undetectable factor VIII activity (<1.5%) and a positive factor VIII antibody with a titer of 8.49 Bethesda units/mL.

Interventions:
Recombinant factor VIIa (NovoSeven®) was administered every 2 hours to control the bleeding, alongside immunosuppression with methylprednisolone 1 mg/kg daily and cyclophosphamide 2 mg/kg daily to eliminate the autoantibody.

Outcomes:
Despite the treatments, the patient developed sepsis and succumbed 14 weeks after admission.

Lessons:
This rare case underscores the importance of monitoring for AHA following COVID-19 vaccination. Although the benefits outweigh the risks of vaccination, AHA should be considered in the differential diagnosis of unusual bleeding following the vaccinations. Early diagnosis and management before severe bleeding are critical for successfully controlling life-threatening bleeding.
Psychiatric Diagnosis
Authors: Aftab Awais , Banicki Konrad , Ruffalo Mark L. , Frances Allen 
Published: August 2024

Abstract
The controversies surrounding the Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases have generated significant debate across the psy-sciences. This debate has been further fueled by the launch of the Research Domain Criteria as a framework to facilitate advances in neuroscientific research, a renewed emphasis on dimensional models of psychopathology, currently exemplified by the Hierarchical Taxonomy of Psychopathology, and development of the Psychodynamic Diagnostic Manual by the psychodynamic community. In this article, we provide a clinical overview of recent debates surrounding categorical and dimensional approaches to psychiatric diagnosis, offer a critical assessment of proposed alternatives, and discuss how clinicians can navigate a plurality of diagnostic frameworks. Our discussion emphasizes that diagnostic frameworks need to be contextualized within the process of a comprehensive clinical evaluation, and their advantages and disadvantages should be understood in relationship to the theoretical orientations and practical needs of clinicians.