bluuebunny/crossref_metadata_2025_split huggingface dataset:
BT08 Mapping UK frameworks for ethical artificial intelligence applied to dermatology
Authors: Shah Syed Fazal Hussein , Matin Rubeta N 
Published: June 2023

Abstract
There is significant enthusiasm to apply artificial intelligence (AI) in dermatology with an emphasis on image-based analyses for risk assessment of suspicious skin lesions. However, the rapid development and deployment of such AI tools raises concerns that ethical issues arising from their widespread, long-term use may not have been adequately considered during design or implementation. Dermatology, in particular, has been identified as lacking sufficient bioethics research that could standardize the approach to regulating AI-assisted applications. Despite significant efforts to develop robust guidelines for ‘ethical AI’ across private, national and international organizations, debate continues surrounding which ethical principles should be included. The 2022 National AI Strategy positions the UK as leading global efforts toward achieving safe and ethical deployment of AI. We sought to systematically review and analyse policy documents to map UK principles for promoting ethical AI as applied to dermatology. Our review identified five UK policy documents relevant to ethical AI published between 2016 and 2022. All included frameworks highlighted the importance of upholding transparency and fairness along the entire lifecycle of AI development and decision-making. The five frameworks also incorporated autonomy through reference to maintaining informed consent, data privacy and human contestability of AI decisions. The principles of accountability and nonmaleficence were each identified in four policy documents, emphasizing the needs for clear definitions of legal and organizational responsibility and for thorough testing of AI tools to avoid unintended/unwanted outcomes. The principles of beneficence (designing AI to promote good on both individual and societal levels) and sustainability (continually monitoring and adjusting AI tools for longevity and efficacy) were each included in two policy documents. Current UK policy frameworks for ethical AI converge around five key values: fairness, transparency, autonomy, nonmaleficence and accountability. The principles of beneficence and sustainability were advanced, although less frequently highlighted. Despite a reassuring level of convergence across policy documents, the practical implementation of these ethical principles in health care and particularly for skin-specific AI tools remains unclear. Furthermore, evidence of real-world integration of these ethical frameworks into developing AI-based skin cancer diagnostic tools is lacking. Future work seeks to address this gap by analysing commercially available skin cancer diagnostic applications using predefined ethical themes to identify case-specific ethical issues and to evaluate the extent to which these issues are addressed within the existing ethical frameworks. This will provide guidance for developers and adopters of these tools, ensuring responsible design and deployment.
BT09 Clinical performance of an artificial intelligence-based medical device deployed within an urgent suspected skin cancer pathway
Authors: Jenkins Rachel , Brewer Christopher Felix , Kalsi Dilraj , Mullarkey Daniel 
Published: June 2023

Abstract
A secondary care trust received over 2800 urgent suspected skin cancer referrals (USCRs) in 2021, 50% more than in 2016 (www.england.nhs.uk/statistics/statistical-work-areas/cancer-waiting-times), &lt; 1 in 10 of which resulted in diagnosis of skin cancer (www.cancerdata.nhs.uk/cwt_conversion_and_detection). Judicious implementation of artificial intelligence (AI) may improve referral accuracy. We conducted a prospective, postdeployment, single-centre clinical performance review of a UK Conformity Assessed Class IIa-approved, AI-based, skin lesion analysis medical device intended for use in the screening, triage and assessment of skin lesions suspicious for skin cancer (AIaMD). The AIaMD is deployed at the trust as a decision-support tool following USCR from primary care, with a second read of all cases by a consultant dermatologist. Patients assessed by the two most recent versions of AIaMD from October 2021 to October 2022 were eligible for inclusion. Outcomes were confirmed from histology reports for cancerous lesions and histology reports or Consultant teledermatology assessment for noncancerous lesions. The AIaMD assessed 1363 lesions with outcomes confirmed, including 51 melanomas, 64 squamous cell carcinomas (SCCs), 96 basal cell carcinomas, 8 rare skin cancers and 244 premalignancies. The AIaMD referral sensitivity for melanoma, all skin cancer and premalignancy was 100% (n = 51/51), 99.5% (n = 218/219) and 96.3% (n = 235/244), respectively. The AIaMD benign lesion specificity was 55.9% (n = 434/777). The negative predictive value (how often AIaMD labelled lesions as premalignant/benign and correctly ruled out cancer) was 99.8% (n = 539/540). The conversion rate (the percentage of lesions classified as high risk by AIaMD that resulted in a diagnosis of melanoma or SCC) was 13.8% (n = 122/886), while the USCR conversion in the local clinical commissioning group was 9.9% in 2020–2021. The service discharged 9.4% (n = 239/2551) of patients during this time without using trust dermatologist capacity, with the potential to have discharged 18.3% (n = 467/2551) without a second read. This postmarket service evaluation reported the clinical outcomes of an AI device used for assessment of skin lesions. The pathway was sensitive, identifying 218 of 219 skin cancers, and specific, correctly identifying over half of benign lesions. Moreover, AIaMD was able to improve the conversion rate of USCRs. The integration of AIaMD into skin cancer diagnostic pathways could significantly improve the accuracy of USCRs.
Conflicts of interest: these were commercial deployments of the AI, and three of the authors are employed by the AI provider.
BT13 MySkinDoctor: lessons learnt from assessing 120 000 teledermatology patients
Authors: Shergill Bav 
Published: June 2023

Abstract
MySkinDoctor is a novel teledermatology platform that enables dermatologists to review images submitted directly by the patient via their smartphone, in addition to any metadata and the standard general practitioner referral. The three sets of data are used to triage or provide advice and guidance to National Health Service patients throughout the south east of England. Since its inception in 2019, the service has completed the assessment of &gt; 120 000 cases. Analysis of the data shows that an unnecessary first appointment has been avoided in 48% of cases. This has led to a sharp reduction in waiting times in the areas in which it is being used (an average of 6 weeks) vs. neighbouring areas where waiting times remain between 27 and 50 weeks. Another benefit of the service is that, on average, each patient using it submits three digital images that are subsequently tagged inter alia with their age, sex, body location and the consultant’s diagnosis. This has resulted in a large, and growing, digital image library with associated dataset of patients that has been used to develop an artificial intelligence platform called ‘dermXai’. Using convolutional neural networks for image identification has produced an accuracy of determination of &gt; 90% for the top 20 conditions seen. We will discuss the implementation schedule and regulatory challenges that need to be met in order for dermXai to support clinical decision-making. There are also environmental and economic benefits associated with using MySkinDoctor. Since its inception, it has saved &gt; 40 000 road miles—over twice Earth’s circumference. This is a CO2 saving of 16 488 kg. The benefit to patients and their carers in terms of saving travel and regaining otherwise lost productivity time is difficult to quantify but could be studied prospectively. Patient-led digital dermatology is the obvious evolution of traditional teledermatology and our successful experience with MySkinDoctor and dermXai in southern England provides a template for a national service that will eliminate backlogs and significantly reduce patient waiting times.
Conflicts of interest: Dr Bav Shergill is the Chief Medical Officer of MySkinDoctor Ltd and a Director of dermXai.
BT17 Patient Assessment Wrap-up Session: the utility of consensus decision-making in teledermatology
Authors: Butt Sanaa , Nahar Sayeda , Gazzani Paul , Shah Farida , Martin-Clavijo Agustin , Akufo-Tetteh Emily , Velangi Shireen 
Published: June 2023

Abstract
In our unit, skin cancer referrals are triaged via teledermatology following high-quality image capture of lesions, including dermoscopic views. Patients are discharged, invited for a face-to-face assessment or listed directly for surgery. Remote and asynchronous consultations are at odds with the traditional clinical training all our consultants underwent, and therefore introduce new uncertainty into our work. As a way to maximize remote discharges, and improve the consistency of and the confidence in our own teledermatology diagnoses, we developed Patient Assessment Wrap-up Session (PAWS). This is an email-based discussion group allowing consensus decision-making on cases with lesions that demonstrate some ambiguity and that individually we would usually bring to a face-to-face appointment. Between March and April 2022, a total of 566 teledermatology cases were allocated to five consultants within the department. In total, 476 (84.1%) were dealt with independently by the allocated consultant. The remaining 90 cases (15.9%) were discussed via PAWS, with 48 (53%) being discharged as a result. On average, four clinicians responded to the PAWS request, and the average time to reach a consensus was 14 h. Of those discharged, two were re-referred within 6 months, one for different lesions and one for the same noncancerous lesion; however, both were discharged again. The additional discharges led to 16 h of clinic time saved, but the PAWS time cost between 12 and 18 h. Although PAWS is currently probably consultant-time neutral, the timing is more flexible than a face-to-face clinic. Additional advantages have also become apparent while using the process. It aids continued professional development and peer assessment while simultaneously providing a service. The patients discharged after PAWS are also saved from a fossil fuel burning visit to the hospital and having to take time off work, and so on. The PAWS also allows for junior colleagues to leverage support from more experienced clinicians when balancing risk and dealing with difficult decision-making. We would like to share our PAWS process as it may also benefit other services using teledermatology.
Severe homozygous HbE disease: the first case report from Nepal
Authors: Bhattarai Urza , Adhikari Dibasha , Gautam Arun , Anand Ayush , Shah Bhupendra , Sharma Sanjib Kumar 
Published: June 2023

Abstract
Hemoglobin E (HbE) is the most prevalent hemoglobinopathy in the eastern Indian subcontinent. We presented the case of a 53-year-old male from Nepal with a history of multiple blood transfusions who presented with abdominal fullness for 15 years and easy fatigability for 2 months. He had pallor and massive splenomegaly. Laboratory parameters showed pancytopenia with microcytic anemia, indirect hyperbilirubinemia, target cells in the peripheral smear and iron overload. A computed tomography scan of the abdomen showed multiple splenic infarcts. Hemoglobin electrophoresis was suggestive of HbE homozygous disease. Based on these findings, we made a diagnosis of HbE homozygous disease. We provided symptomatic treatment and folic acid supplementation and counseled him for splenectomy and genetic screening. Our case highlighted the uncommon presentation of Hb E disease.
Bioinformatics Analysis of the Regulatory lncRNA–miRNA–mRNA Network and Drug Prediction in Patients with Pulmonary Arterial Hypertension
Authors: Jin Xiao , Jin Ling , Han Li , Zhu Shiping 
Published: June 2023

Objective:
Pulmonary arterial hypertension (PAH) is a cardiovascular disease caused by primary proliferative lesions in pulmonary arterioles. Competing endogenous RNAs (ceRNAs) have been reported to act as sponges for microRNAs (miRNAs). To date, however, the mechanisms underlying ceRNA involvement in PAH have not been investigated. This study aimed to construct a PAH-related ceRNA network to further explore the mechanisms of PAH.

Methods:
A probe reannotation was conducted to identify the long non-coding RNAs (lncRNAs) and messenger RNAs (mRNAs) involved in PAH. Based on the reannotation results, the “limma” package was used to identify the differentially expressed genes (DEGs) and lncRNAs. The miRcode database was used to predict the lncRNA–miRNA interactions. Then, the mRNAs targeted by the miRNAs were predicted by using TargetScan, miRTarBase, and miRDB. Based on the above interactions, a ceRNA network was constructed, which was mapped and visualized with Cytoscape 3.6.1 software. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses were performed using the database. To predict possible drugs or molecules that may mitigate PAH, C-Map analysis was applied to find relevant molecular compounds that can reverse the expression of DEGs in cell lines.

Results:
The ceRNA network consisted of 174 nodes and 304 links, which included 10 lncRNAs, 23 miRNAs, and 53 mRNAs. The hub genes of the ceRNA network for PAH included hsa-miR-17-5p, hsa-miR-20b-5p, MEG3, HCP5, hsa-miR-27a-3p, hsa-miR-107, hsa-miR-142-3p, hsa-miR-363-3p, hsa-miR-301b-3p, and hsa-miR-23b-3p. Calprotectin, irinotecan, and medrysone were found to be the 3 significant compounds.

Conclusion:
This study found that hsa-miR-17-5p, hsa-miR-20b-5p, MEG3, HCP5, hsa-miR-27a-3p, hsa-miR-107, hsa-miR-142-3p, hsa-miR-363-3p, hsa-miR-301b-3p, and hsa-miR-23b-3p maybe the underlying biomarkers and targets for diagnosis and treatment of PAH.
War-related urethral and penile injuries' management and short-term outcomes: Experience from war in Yemen
Authors: Elkady Amr , Abdullah Abdulfattah Mohammed , Lotfi Mohamed Amr , Rammah Ahmed M. , Torad Hesham , Abdel-Rassoul Mohammed , El Ghoneimy Mohamed 
Published: June 2023

Abstract

Objectives
To investigate the mechanisms of injury, wound patterns, surgical management, and outcomes of urethral and penile injuries caused by firearms and explosives during the ongoing war in Yemen.

Materials and methods
The present prospective descriptive study included 46 patients who sustained penile and/or urethral injuries during the ongoing Yemeni war. The patients received primary surgical care in Yemen and were referred for definitive treatment in Egypt between October 2018 and October 2020. Patient demographics, cause of injury, site and severity of injury, and associated injuries were evaluated together with management outcomes.

Results
The median age was 28 years (range, 18–50 years); 27 patients (58.7%) had posterior urethral injuries, 11 (23.9%) of whom had posterior urethral distraction defect injuries, 5 (10.9%) had a posterior urethral distraction defect injuries associated with urethrorectal fistulas, and the remaining 11 patients developed posterior urethral strictures; 9 patients (19.6%) sustained anterior urethral injuries, and 10 (21.7%) had isolated penile tissue injuries. Injuries to the penis (90%) and anterior urethra (67%) were primarily due to improvised explosive devices, whereas injuries to the posterior urethra (85%) were mostly caused by firearms. During the posttreatment follow-up period (6–12 months), 4 patients (8.7%) developed recurrent urethral strictures.

Conclusions
Urethral injuries caused by firearms and improvised explosive devices showed a greater association with urethrorectal fistulas or penile tissue injuries than what is typically observed in our practice. Management of these injuries by highly experienced urologists enhances patient outcomes and minimizes future complications.
Open fractures: Current treatment perspective
Authors: Minehara Hiroaki , Maruo Akihiro , Amadei Rafael , Contini Achille , Braile Adriano , Kelly Michael , Jenner Lydia , Schemitsch Geoffrey W. , Schemitsch Emil H. , Miclau Theodore 
Published: June 2023

Summary:
Severe open fractures present challenges to orthopaedic surgeons worldwide, with increased risks of significant complications. Although different global regions have different resources and systems, there continue to be many consistent approaches to open fracture care. Management of these complex injures continues to evolve in areas ranging from timing of initial operative debridement to the management of critical-sized bone defects. This review, compiled by representative members of the International Orthopaedic Trauma Association, focuses on several critical areas of open fracture management, including antibiotic administration, timing of debridement, bone loss, soft tissue management, and areas of need for future investigation.
Brain Dopamine Receptor System is Not Altered in Obesity: Bayesian and Frequentist Meta-Analyses
Authors: Pak Kyoungjune , Nummenmaa Lauri 
Published: June 2023

ABSTRACTBackgroundFeeding induces dopamine release in the striatum, and a dysfunction of the dopaminergic reward system can lead to overeating, and obesity. Studies have reported inconsistent findings of dopamine receptor (DR) positron emission tomography (PET) scans in obesity. Here we investigated the association between DR availability and overweight/obesity using Bayesian and frequentist meta-analysis.MethodsWe performed a systematic search of Embase, Medline, Scopus and Web of Science for studies which compared striatal DR availability between lean subjects and overweight/obese subjects. The standardized mean difference (Hedge’s g) of DR availability was calculated after extraction of data from each study. Studies were divided into two groups according to the definition of overweight/obese subjects (BMI cutoff of 25 and 30kg/m2). Both Bayesian and conventional meta-analysis was done in R Statistical Software version 4.2.2 (The R Foundation for Statistical Computing).ResultsNine studies were eligible for inclusion in this study. Three studies with C11-raclopride, one with C11-PNHO, two with F18-fallypride, one with I123-IBZM, one with C11-NMB and one with both C11-raclopride and C11-PNHO were included. In Bayesian meta-analysis, the standardized mean difference of DR availability between lean and overweight/obese subjects markedly overlapped with zero regardless of BMI cutoff for obesity. In frequentist meta-analysis the pooled standardized mean difference of DR availability did not show the significant difference between lean and overweight/obese subjects. There was an effect of the radiopharmaceutical on the standardized mean difference of DR availability in meta-analysis of BMI cutoff of 25 kg/m2.ConclusionsBrain DR availability is not different between lean and overweight/obese subjects. However, the effect is dependent on the radiopharmaceutical and the degree of obesity. Further studies with multi-radiopharmaceutical in the same individuals are need to understand the association between DR and obesity.
Short-term thinning effect on inter- and intra-annual radial increment of Mediterranean Scots pine-oak mixed forest
Authors: Aldea J. , del Río M. , Cattaneo N. , Riofrío J. , Ordóñez C. , Uzquiano S. , Bravo F. 
Published: June 2023

AbstractThinning treatment and mixed forest stands have been suggested as possible adaptation strategies to cope to climate change but there is still scarce knowledge about the combination of both subjects. In this study, we aim to better understand the thinning effect and the growth differences between two coexisting species on inter- and intra-annual cumulative radial increment patterns. We studied radial increment of a Scots pine-oak (Pinus sylvestris-Quercus pyrenaica) Mediterranean mixed forest during two climatically contrasted years (2016-2017) in north-western Spain. Data came from a thinning trial consisting in a randomized block experimental design with a control and two thinning treatments from below: a moderate and heavy thinning removing 25% and 50 % of initial basal area respectively focused on both species. Tree radial increment was analyzed based on bi-weekly readings from band dendrometers installed in 90 oak and pine trees. Non-linear mixed model based on double-Richards curve was fitted to show thinning and species differences in intra-annual cumulative radial increment patterns. Inter-annual basal area increment at species and stand levels were estimated using the model previously fitted at tree level and aggregating the results for exploring thinning effects at these levels. Scots pine leaded the tree and stand growth, and had also a better respond to early spring drought compared to oak. Heavy thinning increased tree radial increment for both species at the expense of decreased stand basal area. At species level, basal area increment decreased for Scots pine, however, heavy thinning generated the same oak basal area increment than control. Thus, heavy thinning may be good strategy towards a conversion from overaged coppice stands into high forests to conform a stable mixed forest stand.HighlightsScots pine leaded growth at tree and stand levelScots pine trees may take advantage during early spring droughtsHeavy thinning increased tree radial increment for both speciesHeavy thinning decreases stand basal area growth
A non-invasive photoactivatable split-Cre recombinase system for genome engineering in zebrafish
Authors: Elsaid Ramy , Mikdache Aya , Diabangouaya Patricia , Gros Gwendoline , Hernández Pedro P. 
Published: June 2023

SummaryThe cyclic recombinase (Cre)/loxPrecombination system is a powerful technique forin vivocell labeling and tracking. However, achieving high spatiotemporal precision in cell tracking using this system is challenging due to the requirement for reliable tissue-specific promoters. In contrast, light-inducible systems offer superior regional confinement, tunability and non-invasiveness compared to conventional lineage tracing methods. Here, we took advantage of the unique strengths of the zebrafish to develop an easy-to-use highly efficient, genetically encoded, Magnets-based, light-inducible transgenic Cre/loxPsystem. Our system relies on the reassembly of split Cre fragments driven by the affinity of the Magnets and is controlled by the zebrafishubiquitinpromoter. We demonstrate that our system does not exhibit phototoxicity or leakiness in the dark, and it enables efficient and robust Cre/loxPrecombination in various tissues and cell types at different developmental stages through noninvasive illumination with blue light. Our newly developed tool is expected to open novel opportunities for light-controlled tracking of cell fate and migrationin vivo.HighlightszPA-Cre is a novel zebrafish transgenic optogenetic split-Cre toolzPA-Cre allows loxP-mediated DNA recombination in various tissues and cell typesIt enables light-induced DNA recombination at different developmental stages.It allows spatio-temporal DNA recombination in a specific tissue region with high resolution