tbuckley/cabot-search huggingface dataset:
Artificial intelligence-based diagnosis of standard endoscopic ultrasonography scanning sites in the biliopancreatic system: a multicenter retrospective study
Authors: Shuxin Tian, Huiying Shi, Weigang Chen, Shijie Li, Chaoqun Han, Fan Du, Weijun Wang, Hongxu Wen, Yali Lei, Liang Deng, Jing Tang, Jinjie Zhang, Jianjiao Lin, Lei Shi, Bo Ning, Kui Zhao, Jiarong Miao, Guobao Wang, Hui Hou, Xiaoxi Huang, Wenjie Kong, Xiaojuan Jin, Zhen Ding, Rong Lin
Journal: International Journal of Surgery (2023)

There are challenges for beginners to identify standard biliopancreatic system anatomical sites on endoscopic ultrasonography (EUS) images. Therefore, the authors aimed to develop a convolutional neural network (CNN)-based model to identify standard biliopancreatic system anatomical sites on EUS images. The standard anatomical structures of the gastric and duodenal regions observed by EUS was divided into 14 sites. The authors used 6230 EUS images with standard anatomical sites selected from 1812 patients to train the CNN model, and then tested its diagnostic performance both in internal and external validations. Internal validation set tests were performed on 1569 EUS images of 47 patients from two centers. Externally validated datasets were retrospectively collected from 16 centers, and finally 131 patients with 85 322 EUS images were included. In the external validation, all EUS images were read by CNN model, beginners, and experts, respectively. The final decision made by the experts was considered as the gold standard, and the diagnostic performance between CNN model and beginners were compared. In the internal test cohort, the accuracy of CNN model was 92.1-100.0% for 14 standard anatomical sites. In the external test cohort, the sensitivity and specificity of CNN model were 89.45-99.92% and 93.35-99.79%, respectively. Compared with beginners, CNN model had higher sensitivity and specificity for 11 sites, and was in good agreement with the experts (Kappa values 0.84-0.98). The authors developed a CNN-based model to automatically identify standard anatomical sites on EUS images with excellent diagnostic performance, which may serve as a potentially powerful auxiliary tool in future clinical practice.
Decoding surgical skill: an objective and efficient algorithm for surgical skill classification based on surgical gesture features –experimental studies
Authors: Zixin Chen, Dewei Yang, Ang Li, Louzong Sun, Jifan Zhao, Jie Liu, Linxun Liu, Xiaobo Zhou, Yonghua Chen, Yunqiang Cai, Zhong Wu, Ke Cheng, He Cai, Ming Tang, Bing Peng, Xin Wang
Journal: International Journal of Surgery (2023)

Background: Various surgical skills lead to differences in patient outcomes and identifying poorly skilled surgeons with constructive feedback contributes to surgical quality improvement. The aim of the study was to develop an algorithm for evaluating surgical skills in laparoscopic cholecystectomy based on the features of elementary functional surgical gestures (Surgestures). Materials and methods: Seventy-five laparoscopic cholecystectomy videos were collected from 33 surgeons in five hospitals. The phase of mobilization hepatocystic triangle and gallbladder dissection from the liver bed of each video were annotated with 14 Surgestures. The videos were grouped into competent and incompetent based on the quantiles of modified global operative assessment of laparoscopic skills (mGOALS). Surgeon-related information, clinical data, and intraoperative events were analyzed. Sixty-three Surgesture features were extracted to develop the surgical skill classification algorithm. The area under the receiver operating characteristic curve of the classification and the top features were evaluated. Results: Correlation analysis revealed that most perioperative factors had no significant correlation with mGOALS scores. The incompetent group has a higher probability of cholecystic vascular injury compared to the competent group (30.8 vs 6.1%, P =0.004). The competent group demonstrated fewer inefficient Surgestures, lower shift frequency, and a larger dissection-exposure ratio of Surgestures during the procedure. The area under the receiver operating characteristic curve of the classification algorithm achieved 0.866. Different Surgesture features contributed variably to overall performance and specific skill items. Conclusion: The computer algorithm accurately classified surgeons with different skill levels using objective Surgesture features, adding insight into designing automatic laparoscopic surgical skill assessment tools with technical feedback.
Inequalities in health system coverage and quality: a cross-sectional survey of four Latin American countries
Authors: Javier Roberti, Hannah H Leslie, Svetlana V Doubova, Jesús Medina Ranilla, Agustina Mazzoni, Laura Espinoza, Renzo Calderón, Catherine Arsenault, Ezequiel García-Elorrio, Patricia J García
Journal: The Lancet Global Health (2023)

The premise of health as a human right in Latin America has been challenged by health system fragmentation, quality gaps, a growing burden of chronic disease, sociopolitical upheaval, and the COVID-19 pandemic. We characterised inequities in health system quality in Colombia, Mexico, Peru, and Uruguay. We did a cross-sectional telephone survey with up to 1250 adults in each country. We created binary outcomes in coverage, user experience, system competence, and confidence in the system and calculated the slope index of inequality by income and education. Although access to care was high, only a third of respondents reported having a high-quality source of care and 25% of those with mental health needs had those needs met. Two-thirds of adults were able to access relevant preventive care and 42% of older adults were screened for cardiovascular disease. Telehealth access, communication and autonomy in most recent visit, reasonable waiting times, and receiving preventive health checks showed inequalities favouring people with a high income. In Uruguay, inequality between government and social security services explained a substantial proportion of disparities in preventive health access. In other study countries, inequalities were also substantial within government and social security subsectors. Essential health system functions are unequal in these four Latin American countries.
The path to universal health coverage in five African and Asian countries: examining the association between insurance status and health-care use
Authors: Emily Odipo, Prashant Jarhyan, Jacinta Nzinga, Dorairaj Prabhakaran, Amit Aryal, Emma Clarke-Deelder, Sailesh Mohan, Moshabela Mosa, Munir Kassa Eshetu, Todd P Lewis, Neena R Kapoor, Margaret E Kruk, Günther Fink, Emelda A Okiro
Journal: The Lancet Global Health (2023)

Despite major efforts to achieve universal health coverage (UHC), progress has lagged in many African and Asian countries. A key strategy pursued by many countries is the use of health insurance to increase access and affordability. However, evidence on insurance coverage and on the association between insurance and UHC is mixed. We analysed nationally representative cross-sectional data collected between 2022 and 2023 in Ethiopia, Kenya, South Africa, India, and Laos. We described public and private insurance coverage by sociodemographic factors and used logistic regression to examine the associations between insurance status and seven health-care use outcomes. Health insurance coverage ranged from 25% in India to 100% in Laos. The share of private insurance ranged from 1% in Ethiopia to 13% in South Africa. Relative to the population with private insurance, the uninsured population had reduced odds of health-care use (adjusted odds ratio 0·68, 95% CI 0·50-0·94), cardiovascular examinations (0·63, 0·47-0·85), eye and dental examinations (0·54, 0·42-0·70), and ability to get or afford care (0·64, 0·48-0·86); private insurance was not associated with unmet need, mental health care, and cancer screening. Relative to private insurance, public insurance was associated with reduced odds of health-care use (0·60, 0·43-0·82), mental health care (0·50, 0·31-0·80), cardiovascular examinations (0·62, 0·46-0·84), and eye and dental examinations (0·50, 0·38-0·65). Results were highly heterogeneous across countries. Public health insurance appears to be only weakly associated with access to health services in the countries studied. Further research is needed to improve understanding of these associations and to identify the most effective financing strategies to achieve UHC.
Population confidence in the health system in 15 countries: results from the first round of the People's Voice Survey
Authors: Margaret E Kruk, Neena R Kapoor, Todd P Lewis, Catherine Arsenault, Eleni C Boutsikari, João Breda, Susanne Carai, Kevin Croke, Rashmi Dayalu, Günther Fink, Patricia J Garcia, Munir Kassa, Sailesh Mohan, Mosa Moshabela, Jacinta Nzinga, Juhwan Oh, Emelda A Okiro, Dorairaj Prabhakaran, Gillian K SteelFisher, Rosanna Tarricone, Ezequiel Garcia-Elorrio
Journal: The Lancet Global Health (2023)

Population confidence is essential to a well functioning health system. Using data from the People's Voice Survey—a novel population survey conducted in 15 low-income, middle-income, and high-income countries—we report health system confidence among the general population and analyse its associated factors. Across the 15 countries, fewer than half of respondents were health secure and reported being somewhat or very confident that they could get and afford good-quality care if very sick. Only a quarter of respondents endorsed their current health system, deeming it to work well with no need for major reform. The lowest support was in Peru, the UK, and Greece—countries experiencing substantial health system challenges. Wealthy, more educated, young, and female respondents were less likely to endorse the health system in many countries, portending future challenges for maintaining social solidarity for publicly financed health systems. In pooled analyses, the perceived quality of the public health system and government responsiveness to public input were strongly associated with all confidence measures. These results provide a post-COVID-19 pandemic baseline of public confidence in the health system. The survey should be repeated regularly to inform policy and improve health system accountability.
Multidimensional sleep health and diabetic retinopathy: Systematic review and meta-analysis
Authors: Matthew Simonson, Yanliang Li, Bingqian Zhu, J. Jason McAnany, Naricha Chirakalwasan, Thasarat Sutabutr Vajaranant, Erin C. Hanlon, Silvana Pannain, Thunyarat Anothaisintawee, Sirimon Reutrakul
Journal: Sleep Medicine Reviews (2023)
Radial incision and cutting for post-esophageal endoscopic submucosal dissection stricture with prior perforation during dilation
Authors: Jun Takada, Yukari Uno, Kentaro Kojima, Sachiyo Onishi, Masaya Kubota, Takashi Ibuka, Masahito Shimizu
Journal: Endoscopy (2023)

Extensive mucosal resection by esophageal endoscopic submucosal dissection (ESD) can lead to strictures [1]. Oral or locoregional steroid injections are used to prevent stenosis, but they are not effective in all cases [2] [3]. Endoscopic balloon dilation is the primary option for treating post-ESD strictures [4]; however, its applicability in previously perforated areas is challenging because of the risk of reperforation. Herein, we present a valuable case of radial incision and cutting for managing a post-ESD esophageal stricture with a prior perforation during endoscopic balloon dilation.
Rescue technique after endoscopic ultrasound-guided hepaticogastrostomy stent dislocation
Authors: Takeshi Ogura, Taro Iwatsubo, Atsushi Okuda, Saori Ueno, Hiroki Nishikawa
Journal: Endoscopy (2023)

Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) has been indicated after failed endoscopic retrograde cholangiopancreatography (ERCP). Critical adverse events such as stent migration or dislocation can occur during EUS-HGS [1] [2] [3]. If a fistula is not formed after the occurrence of these adverse events, an alternative biliary drainage technique is required, such as percutaneous transhepatic biliary drainage and endoscopic suture of the anastomotic defect left behind after the EUS-HGS stent. A novel endoscopic suture using an endoloop and endoclips has recently been reported for use after upper gastrointestinal perforations [4] [5]. We herein describe the successful use of these techniques for endoscopic treatment after EUS-HGS stent dislocation.
Surgical salvage intervention for a migrated metal stent during endoscopic ultrasound-guided hepaticogastrostomy
Authors: Rei Ryozawa, Hiroyuki Kojima, Kenjiro Yamamoto, Yuichi Nagakawa, Takasyoshi Tsuchiya, Shuntaro Mukai, Takao Itoi
Journal: Endoscopy (2023)

Proximal metal stent migration during or after endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS is a serious adverse event, causing severe biliary peritonitis [1]. Although it is sometimes possible to endoscopically remove a migrated stent into the abdominal cavity, most cases require open salvage surgery [2] [3] [4] [5]. Herein, we report a case of successful minimally invasive laparoscopic repair of a migrated metal stent guided by a guidewire left at the gastric puncture site.
Endoscopic ultrasound-guided gastrojejunopexy using an improvised T-anchor for successful endoscopic gastrojejunostomy
Authors: Sanjay M. Salgado, Kamal Maher Hassan, Mohamad-Noor Abu-Hammour, David L. Carr-Locke, Kartik Sampath, Reem Z. Sharaiha, SriHari Mahadev
Journal: Endoscopy (2023)

Endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) is a minimally invasive alternative treatment for gastric and duodenal outlet obstruction. However, technical difficulty arises from bowel motility. To address this, we present a novel technique using an improvised EUS-directed T-anchor to improve safety and feasibility, particularly for patients with ascites or retained intragastric food.
A collaborative application for characterizing colorectal lesions could improve quality of tumor resection
Authors: Pierre Lafeuille, Orlando Chuquimia, Clara Yzet, Jérémie Jacques, Victoria Nurcelli, Jérôme Rivory, Mathieu Pioche
Journal: Endoscopy (2023)

Accurate endoscopic characterization of colorectal lesions is essential for predicting histology and choosing the most appropriate resection technique, but it remains very difficult for endoscopists [1]. Lesions are characterized in real time according to their macroscopic appearance, vascular pattern, and pit pattern, in white light and virtual chromoendoscopy. Numerous classifications are required to fully characterize the various colorectal lesions, but few gastroenterologists are familiar with the classifications or use them in daily practice [1].
Successful closure of gastric wall defect after endoscopic full-thickness resection using novel anchor pronged clips: a case report
Authors: Hiroya Mizutani, Yosuke Tsuji, Hiroyuki Hisada, Yoshiyuki Miwa, Koichi Yagi, Yasuyuki Seto, Mitsuhiro Fujishiro
Journal: Endoscopy (2023)

We present the case of a 52-year-old woman who underwent endoscopic full-thickness resection (EFTR) with one port placement for a 20-mm large gastric submucosal tumor originating from the muscularis propria layer ([Fig. 1]).
Cervical Lymph Node Metastasis as the Initial Presentation of Femoral Epithelioid Hemangioendothelioma Revealed by 18F-FDG PET/CT
Authors: Xianwen Hu
Journal: Clinical Nuclear Medicine (2023)

Abstract Femoral epithelioid hemangioendothelioma with cervical lymph node metastasis is rare. We report the FDG PET/CT findings of cervical lymph node metastasis from left femoral epithelioid hemangioendothelioma in a 50-year-old woman with painless enlargement of the left cervical lymph nodes as the initial presentation. Ultrasound and MRI revealed multiple enlarged lymph nodes in the left cervical sheath area. PET/CT showed strong radioactive uptake in the left cervical lymph nodes, and there was additional lesion with increased FDG uptake in the left femur, which was later confirmed as cervical lymph nodes metastasis from left femoral epithelioid hemangioendothelioma by pathological examination.
Efficacy and toxicity of bimodal radiotherapy in WHO grade 2 meningiomas following subtotal resection with carbon ion boost: Prospective phase 2 MARCIE trial
Authors: Maximilian Y Deng, Sybren L N Maas, Felix Hinz, Christian P Karger, Philipp Sievers, Tanja Eichkorn, Eva Meixner, Philipp Hoegen-Sassmannshausen, Juliane Hörner-Rieber, Jonathan W Lischalk, Katharina Seidensaal, Denise Bernhardt, Christine Jungk, Andreas Unterberg, Antje Wick, Wolfgang Wick, Andreas von Deimling, Felix Sahm, Stephanie Combs, Klaus Herfarth, Jürgen Debus, Laila König
Journal: Neuro-Oncology (2023)

Abstract Background Novel radiotherapeutic modalities using carbon ions provide an increased relative biological effectiveness (RBE) compared to photons, delivering a higher biological dose while reducing radiation exposure for adjacent organs. This prospective phase 2 trial investigated bimodal radiotherapy using photons with carbon-ion (C12)-boost in patients with WHO grade 2 meningiomas following subtotal resection (Simpson grade 4 or 5). Methods A total of 33 patients were enrolled from July 2012 until July 2020. The study treatment comprised a C12-boost (18 Gy [RBE] in 6 fractions) applied to the macroscopic tumor in combination with photon radiotherapy (50 Gy in 25 fractions). The primary endpoint was the 3-year progression-free survival (PFS), and the secondary endpoints included overall survival, safety and treatment toxicities. Results With a median follow-up of 42 months, the 3-year estimates of PFS, local PFS and overall survival were 80.3%, 86.7%, and 89.8%, respectively. Radiation-induced contrast enhancement (RICE) was encountered in 45%, particularly in patients with periventricularly located meningiomas. Patients exhibiting RICE were mostly either asymptomatic (40%) or presented immediate neurological and radiological improvement (47%) after the administration of corticosteroids or bevacizumab in case of radiation necrosis (3/33). Treatment-associated complications occurred in 1 patient with radiation necrosis who died due to postoperative complications after resection of radiation necrosis. The study was prematurely terminated after recruiting 33 of the planned 40 patients. Conclusions Our study demonstrates a bimodal approach utilizing photons with C12-boost may achieve a superior local PFS to conventional photon RT, but must be balanced against the potential risks of toxicities.
The PRIMARY Score
Authors: Shikuan Guo, Fei Kang, Shuaijun Ma, Jianhua Jiao, Jing Ren, Jing Wang, Jingliang Zhang, Weijun Qin
Journal: Clinical Nuclear Medicine (2023)

Purpose Multiparametric MRI is the current standard for detecting clinically significant prostate cancer (csPCa). However, men with negative or equivocal MRI often undergo unnecessary biopsies due to concerns about false-negative results. The recently proposed 68 Ga-PSMA PET/CT-based PRIMARY score exhibited good diagnostic performance for csPCa. This study aimed to externally validate the performance of the PRIMARY score and evaluate its added diagnostic value to MRI triage in detecting csPCa. Patients and Methods This retrospective cohort study included 431 men who underwent both 68 Ga-PSMA PET/CT and MRI before biopsy. Performance was assessed using the area under the receiver operating characteristic curve and the decision curve analysis. The PRIMARY score + MRI was considered positive for either PRIMARY score 3–5 or Prostate Imaging Reporting and Data System (PI-RADS) 4/5. Results The prevalence of csPCa was 51.7% (223/431). The area under the receiver operating characteristic curve of the 5-level PRIMARY score for csPCa was significantly higher than that of MRI (0.873 vs 0.786, P &lt; 0.001). For the entire group, sensitivity, specificity, positive predictive value, and negative predictive value of the PRIMARY score were 90.6%, 61.1%, 71.4%, and 85.8%, respectively, which outperformed 87.9%, 49.0%, 64.9%, and 79.1% of PI-RADS on MRI. The PRIAMRY score + MRI improved sensitivity (96.0% vs 87.9%, P &lt; 0.001) and negative predictive value (91.5% vs 79.1%, P &lt; 0.001) without compromising specificity and positive predictive value compared with MRI alone. This combined approach avoided 24.6% (106/431) of unnecessary biopsies, while missing 4.0% (9/223) of csPCa cases. The addition of the PRIMARY score in men with PI-RADS 1–3 showed a net benefit, but not in men with PI-RADS 4/5. Conclusions The PRIMARY score was superior to MRI in detecting csPCa, and its added diagnostic value was in men with negative or equivocal MRI results. The PRIMARY score + MRI improved negative predictive value and sensitivity for csPCa compared with MRI alone. Further prospective trials will validate whether men with clinical suspicion of csPCa but negative PRIMARY score + MRI can safely avoid unnecessary biopsies.
C-X-C Motif Chemokine Receptor 4–Targeted Radioligand Therapy in Hematological Malignancies—Myeloablative Effects, Antilymphoma Activity, and Safety Profile
Authors: Niklas Dreher, Anna-Lena Dörrler, Sabrina Kraus, Takahiro Higuchi, Sebastian E. Serfling, Samuel Samnick, Hermann Einsele, Götz Ulrich Grigoleit, Andreas K. Buck, Rudolf A. Werner
Journal: Clinical Nuclear Medicine (2023)

Background After C-X-C motif chemokine receptor 4 (CXCR4)–directed radioligand therapy (RLT), lymphoma patients are scheduled for conditioning therapy (CON) followed by hematopoietic stem cell transplantation (HSCT). We aimed to determine whether CXCR4-RLT can achieve bone marrow ablation and direct antilymphoma activity independent from CON/HSCT and also evaluated the safety profile of this theranostic approach in an acute setting. Patients and Methods After CXCR4-directed 68 Ga-pentixafor PET/CT, 21 heavily pretreated patients with hematological malignancies underwent CXCR4-directed RLT using 90 Y-pentixather. The extent of myeloablative efficacy was determined by investigating hematologic laboratory parameters before RLT (day −1), at the day of RLT (day 0), 2 days after RLT (day 2), and before CON (median day 10). Serving as surrogate marker of antilymphoma activity, lactate dehydrogenase (LDH) levels were also assessed until CON. We also screened for laboratory-defined tumor lysis syndrome after the Cairo-Bishop definition and recorded acute laboratory adverse events using the Common Terminology Criteria for Adverse Events version 5.0. Results After RLT, we observed a significant decline of leukocyte levels by 79.4% ± 18.7% till CON (granulocytes, drop by 70.3% ± 21%; platelets, reduction by 43.1% ± 36%; P ≤ 0.0005 vs day 0, respectively). After RLT, LDH levels already reached a peak at day 2, which was followed by a rapid decline thereafter (peak vs day of CON, P = 0.0006), indicating that 90 Y-pentixather exhibits direct antilymphoma activity. At day of CON, LDH levels were also significantly lower when compared with day −1 ( P = 0.04), suggestive for durable response mediated by RLT. No patient fulfilled the criteria of tumor lysis syndrome, whereas 25 laboratory adverse events attributable to CXCR4-directed treatment were identified (≥grade 3 in 2/25 [8%]). During further treatment course, all patients (100%) received HSCT. Conclusions CXCR4-directed RLT causes effective myeloablation, which allows for HSCT. In addition, it also exerts direct antilymphoma activity independent of subsequent therapeutic steps, whereas safety profile was acceptable.