tbuckley/cabot-search huggingface dataset:
Clinical value of aortic arch morphology in transfemoral TAVR: artificial intelligence evaluation
Authors: Yu Mao, Yang Liu, Mengen Zhai, Ping Jin, Fangyao Chen, Yuhui Yang, Guangyu Zhu, Tingting Yang, Gejun Zhang, Kai Xu, Xiaoke Shang, Yuan Zhao, Buqing Ni, Hongxin Li, Min Tang, Zhao Jian, Yining Yang, Haibo Zhang, Lai Wei, Jian Liu, Timothée Noterdaeme, Ruediger Lange, Yingqiang Guo, Xiangbin Pan, Yongjian Wu, Jian Yang
Journal: International Journal of Surgery (2025)

The impact of aortic arch (AA) morphology on the management of the procedural details and the clinical outcomes of the transfemoral artery (TF)-transcatheter aortic valve replacement (TAVR) has not been evaluated. The goal of this study was to evaluate the AA morphology of patients who had TF-TAVR using an artificial intelligence algorithm and then to evaluate its predictive value for clinical outcomes. A total of 1480 consecutive patients undergoing TF-TAVR using a new-generation transcatheter heart valve at 12 institutes were included in this retrospective study. The AA measurements were evaluated by deep learning, and then the approach index (IA) was determined. The machine learning algorithm was used to construct the predictive model and was validated externally. The area under the curve of the IA model using random forest and logistic regression was 0.675 [95% confidence interval (CI): 0.586-0.764] and 0.757 (95% CI: 0.665-0.849), respectively. The IA model was validated externally, and consistent distinctions were obtained. After we used a generalized propensity score matching method for continuous exposure, the IA was the strongest correlation factor for major procedural events (odds ratio: 3.87; 95% CI: 2.13-7.59, P < 0.001). When leaflet morphology or transcatheter heart valve type was an interactive item with IA, neither of them was statistically significant in terms of clinical outcomes. IA may be used to identify the impact of AA morphology on procedural and clinical outcomes in patients having TF-TAVR and to help to predict the procedural complications.
Comparative impact of tertiary lymphoid structures and tumor-infiltrating lymphocytes in cholangiocarcinoma
Authors: Shin-Yi Chung, Yi-Chen Yeh, Chien-Jung Huang, Nai-Jung Chiang, Dennis Shin-Shian Hsu, Ming-Hsien Chan, Meng-Lun Lu, Tzu-Sheng Hsu, Yi-Ping Hung, Chun-Nan Yeh, Michael Hsiao, Yu-Chan Chang, Yu-Chao Wang, Ming-Huang Chen
Journal: Journal for ImmunoTherapy of Cancer (2025)

Background Cholangiocarcinoma is a challenging malignancy with limited responses to conventional therapies, particularly immune checkpoint inhibitor therapy. Tumor-infiltrating lymphocytes (TILs) and tertiary lymphoid structures (TLSs) are key components of the tumor microenvironment (TME) and have been implicated in the immune response to cancer. However, the role and difference of TLSs and TILs in patients with cholangiocarcinoma remains unclear. This study elucidates their contributions to the TME. Methods We examined 16 tumor samples from a single-arm, phase II trial of nivolumab plus modified gemcitabine and S-1 and various datasets. Immunohistochemistry and RNA sequencing were employed to assess TLSs and TILs presence and activity. Differential gene expression and signature of immune cell composition were examined by GeoMx Digital Spatial Profiler and Cancer Transcriptome Altas analysis. Results TLS-positive (N=7) patients demonstrated significantly better immunotherapy outcomes compared with TLS-negative (N=9) patients, including higher objective response rates (71% vs 0%) and disease control rates (100% vs 67%). The presence of TLSs correlated with improved progression-free and overall survival (p=0.03). TLSs were associated with “inflamed” tumors characterized by substantial immune infiltration, particularly involving T and B cells. Gene expression analyses identified significant upregulation of B cell-related genes in TLSs. Additionally, TLSs exhibited higher properties of memory B cells and myeloid dendritic cells but lower levels of innate immune cells compared with TILs. T cells within TLSs showed elevated expression of precursor-exhausted-related genes and lower cytotoxicity signature. Furthermore, TILs in TLS-positive tumors had higher levels of exhaustion signatures compared with TILs in TLS-negative tumors. Clinical data corroborated these findings, with higher PD-L1 and LAG-3 expression in TLS-positive tumors. Conclusion Our findings revealed that TILs in TLS-positive tumors have more exhausted T cell signature and PD-1 and LAG-3 protein expression in CCA which support our clinical finding. TLSs can predict favorable immunotherapy responses in patients with cholangiocarcinoma, highlighting their potential as a biomarker and therapeutic target to enhance treatment efficacy.
Update on Hepatorenal Syndrome: From Pathophysiology to Treatment
Authors: Saro Khemichian, Mitra K. Nadim, Norah A. Terrault
Journal: Annual Review of Medicine (2025)

Hepatorenal syndrome–acute kidney injury (HRS-AKI) occurs in the setting of advanced chronic liver disease, portal hypertension, and ascites. HRS-AKI is found in ∼20% of patients presenting to the hospital with AKI, but it may coexist with other causes of AKI and/or with preexisting chronic kidney disease, thereby making the diagnosis challenging. Novel biomarkers such as urinary neutrophil gelatinase–associated lipocalin may be useful. While HRS-AKI is a functional form of AKI related to circulatory and neurohormonal dysfunction, there is increasing recognition of the importance of systemic inflammation and the renal microenvironment. Early diagnosis and initiation of HRS-AKI-specific treatment can improve outcomes. The mainstay of therapy is a vasoconstrictor (terlipressin or norepinephrine) combined with albumin, which achieves resolution of HRS in 40–50% of cases. Liver transplantation is the only option for patients failing to respond to medical therapies.
Update on HIV Chemoprevention
Authors: Cheríe S. Blair, Mary Catherine Cambou, Raphael J. Landovitz
Journal: Annual Review of Medicine (2025)

Despite rapid advances in the field of HIV prevention and treatment, unacceptably high global HIV incidence rates highlight the ongoing need for effective HIV prevention interventions for populations at risk for HIV acquisition. This article provides an updated review of the current data surrounding HIV prevention strategies, including treatment as prevention (TasP), preexposure prophylaxis (PrEP), and postexposure prophylaxis (PEP), as well as advances in sexually transmitted infection biomedical prevention. This review provides an overview of the multiple PrEP modalities that are available globally, such as oral PrEP, injectable cabotegravir, and the dapivirine vaginal ring, and describes their respective clinical trials, efficacies, and regulatory approvals. We also discuss ongoing research into novel PrEP agents, such as broadly neutralizing antibodies, and efforts toward HIV vaccine development.
Extracorporeal shockwave therapy rescued mouse critical limb ischemia via upregulating GPR120 against inflammation and promoting angiogenesis for restoring the blood flow in ischemic zone-experimental study
Authors: Pei-Hsun Sung, Jui-Ning Yeh, Tsung-Cheng Yin, Han-Tan Chai, John Y. Chiang, Chi-Ruei Huang, Yi-Ling Chen, Mel S. Lee, Hon-Kan Yip
Journal: International Journal of Surgery (2025)

Background: This study tested the hypothesis that extracorporeal shockwave therapy (ECSWT) effectively rescues critical limb ischemia (CLI) in mice through the upregulation of GPR120, which protects against inflammation and angiogenesis to restore blood flow in the ischemic area. Methods and results: Compared with the control, ECSWT-induced GPR120-mediated anti-inflammatory effects significantly suppressed the expression of inflammatory signaling biomarkers (TAK1/MAPK family/NF-κB/IL-1β/IL-6/TNF-α/MCP-1) in HUVECs, and these effects were abolished by silencing GPR120 or by the GPR120 antagonist AH7614 (all P &lt; 0.001). C57BL/6 mice ( n = 40) were equally categorized into Groups 1 (sham-operated control), 2 (CLI), 3 (CLI + ECSWT), and 4 (CLI + ECSWT + AH7614). By Days 7, 14, and 28 just prior to harvesting the quadriceps muscle, the laser Doppler results showed that the ratio of ischemia to normal blood flow (INBF) in the CLI area was highest in Group 1, lowest in Group 2, and significantly greater in Group 3 than in Group 4 (all P &lt; 0.0001). Endothelial cell markers (CD31/vWF) and GPR120 + cells exhibited identical patterns of INBF among the groups, whereas angiogenesis biomarkers (CXCR4/SDF-1/VEGF/VEGFR2) were significantly and progressively upregulated from Groups 1 to 4 (all P &lt; 0.0001). The protein levels of inflammation (MMP-9, IL-6, and TNF-α) and oxidative stress (NOX-1 and NOX-2) and the cellular levels of inflammation (CD68+)/DNA damage (γ-H2AX+) displayed opposite patterns, whereas the small vessel density in the CLI area displayed an identical pattern of INBF among the groups (all P &lt; 0.0001). Conclusions: ECSWT rescued CLI by increasing GPR120-mediated suppression of inflammation and enhancing angiogenesis via activation of VEGFR2.
Global trends in surgically based treatment of anal fistula in Crohn’s disease: a bibliometric and visualization analysis
Authors: Xingtao Jin, Ye Han, Min Yang, Qianqian Ye, Qingming Wang, De Zheng, Zubing Mei
Journal: International Journal of Surgery (2025)

Crohn's disease (CD) is a chronic, recurrent gastrointestinal disorder characterized by a complex etiology. Among its perianal complications, anal fistulas represent a challenging comorbidity. With the increase of surgical options, a comprehensive bibliometric analysis was deemed necessary to consolidate the vast array of research in this field. We extracted 1608 articles spanning from 1 January 1994, to 1 May 2024, from the Web of Science Core Collection. Using VOSviewer, CiteSpace, and Scimago Graphica for visual analytics, we synthesized key trends across multiple bibliometric indicators, encompassing geographic and institutional contributions, individual authorship, journal prominence, citation metrics, and thematic prevalence. From the delineated corpus, we identified publications from 325 countries and 5110 research institutions, with the US and UK at the forefront of publication volume and academic impact. The data indicated a leading role for institutions like the Cleveland Clinic and Imperial College London. "Diseases of the Colon and Rectum" emerged as a central journal due to its high publication and citation frequency. Distinctly, the analysis uncovered trending keywords, signifying the field's prioritization on surgical intervention, biologic therapy, imaging modalities, and emerging biological treatments. Our findings elucidate a trajectory toward prominent advancements in CD fistula research. This analysis underscores the field's shift towards integrative treatment strategies, spotlighting the pressing need for comprehensive comparative studies of surgical approaches. It underscores the imperative for robust clinical trials to standardize treatments and extend care to a broader CD patient population.
Deep learning for kidney trauma detection: CT image algorithm performance and external validation: experimental study
Authors: Chien-Hung Liao, Chun-Hsiang Ouyang, Chih-Chi Chen, Hou-Shian Lin, Yi-Liam Li, Shih-Chin Kang, Huan-Wu Chen, Kuo-Chin Kao, Chi-Tung Cheng
Journal: International Journal of Surgery (2025)

Background: Detecting kidney trauma on CT scans can be challenging and is sometimes overlooked. While deep learning (DL) has shown promise in medical imaging, its application to kidney injuries remains underexplored. This study aims to develop and validate a DL algorithm for detecting kidney trauma, using institutional trauma data and the Radiological Society of North America (RSNA) dataset for external validation. Methods: We developed RenoTrNet, a DL model trained on institutional data. We evaluated the model’s performance through external validation on randomly selected cases from the RSNA dataset. Performance metrics included the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Heatmap visualizations were used to aid interpretability. Results: In the internal testing dataset, the model achieved an accuracy of 0.88 (95% CI: 0.82–0.92), with a sensitivity of 0.75 (95% CI: 0.62–0.85) and a specificity of 0.95 (95% CI: 0.89–0.98). PPV and NPV were 0.89 (95% CI: 0.76–0.95) and 0.88 (95% CI: 0.81–0.93), respectively. In external RSNA validation, the algorithm c demonstrated robust performance with an accuracy of 0.93 (0.91–0.95), a sensitivity of 0.73 (0.60–0.83), a specificity of 0.94 (0.93–0.96), a PPV of 0.45 (0.35–0.56), and an NPV of 0.98 (0.97–0.99). Conclusion: The RenoTrNet DL algorithm demonstrated high accuracy in detecting kidney trauma on CT scans, both in internal and external validation. By optimizing image segmentation and computational efficiency, this model has potential for clinical deployment, potentially aiding in trauma diagnosis in real-world clinical scenarios.
The development and evaluation of nine obesity-based indices for gallstones in U.S. adults
Authors: Xiaodong Wu, Yanhong Song, Shuodong Wu
Journal: International Journal of Surgery (2025)

Objective: Gallstones have gradually become a highly prevalent digestive disease worldwide. This study aimed to investigate the association of nine different obesity-related indicators (BRI, RFM, BMI, WC, LAP, CMI, VAI, AIP, TyG) with gallstones and to compare their predictive properties for screening gallstones. Methods: Data for this study were obtained from the National Health and Nutrition Examination Survey (NHANES) for the 2017-2020 cycle, and weighted logistic regression analyses with multi-model adjustment were conducted to explore the association of the nine indicators with gallstones. Subject working curves were analyzed to assess the screening ability of the nine indicators. In addition, the association between the most predictive indicator and gallstones was investigated with smooth curve fitting, and differences in risk across populations were explored with subgroup analyses. Results: In total, 3654 participants were involved in the final analysis and 383 (10.48%) carried gallstones. The results of weighted multifactorial logistic regression analysis indicated that BRI, RFM, BMI, WC, LAP, and CMI were independent risk factors for gallstones. The ORs for the highest quartile were 4.13 for RFM, 3.13 for BRI, 2.85 for BMI, 2.86 for WC, 2.45 for LAP, and 1.49 for CMI. The area under the ROC curve for RFM was 0.70. The Delong test compared the performance of different ROCs and revealed that the difference between the area under the curve of RFM and the other metrics was significant ( P &lt; 0.05). Smooth curve fitting suggested a linear positive correlation between RFM and gallstones (LLR &gt; 0.05), especially in women, non-Hispanic White, insufficient physical activity, hypertensive, and diabetic populations. Conclusion: RFM, BRI, BMI, WC, LAP, and CMI were essential indicators for recognizing gallstones. By comparison, we realized that RFM was a better predictor of gallstones.
Assessment of simulation training efficacy in improving microsurgical skills: a retrospective analysis
Authors: Xuecheng He, Tao Gao, Jianfei Tang, Zengxin Jiang, Zeng Zhang, E. Lin, Hengfeng Yuan
Journal: International Journal of Surgery (2025)

Background: Microsurgery demands an intensive period of skill acquisition due to its inherent complexity. The development and implementation of innovative training methods are essential for enhancing microsurgical outcomes. This study aimed to evaluate the impact of a simulation training program on the clinical results of fingertip replantation surgeries. Materials and methods: A total of 276 replanted digits from 232 patients were included in this study, with a follow-up period of 6 months. Surgeons were identified and divided into trained and control groups, with the trained group receiving the rat tail training program. Primary outcomes included survival rates, replantation duration for each fingertip, degrees of flexion, Semmes–Weinstein monofilament test results, static two-point discrimination scores, Michigan Hand Questionnaire (MHQ) scores, and the incidence rates of complications such as arterial insufficiency and pulp atrophy. Results: Out of 1191 patients screened, 232 met the criteria for analysis. The average patient age was 41.3 years, predominantly male (87.1%). Trained microsurgeons performing Zone 1A replantation had higher success rates, shorter surgery durations, and fewer arterial complications compared to their untrained counterparts. For Zone 1B, they also showed improved operation times, decreased venous congestion and pulp atrophy, and better sensation outcomes. The results of trained group remained consistent across both single and multiple replantation, while the control group’s outcomes varied in multiple replantation with less favorable results. The trained group reported better scores on the MHQ at 6-month follow-ups, particularly regarding work performance, pain levels, aesthetics, and satisfaction. Conclusions: The simulation training program using a rat tail model has proven effective in enhancing the skills necessary for improved fingertip replantation. Participants in the program performed surgeries more efficiently and achieved better clinical outcomes. The structure of the training has demonstrated benefits, which may lead to improvements in various microsurgical procedures, positively impacting trainee surgeons, patient care, and the broader medical community.
Termination of Resuscitation Rules for In-Hospital Cardiac Arrest
Authors: Mathias J. Holmberg, Asger Granfeldt, Ari Moskowitz, Kasper G. Lauridsen, Daniel Bergum, Christian F. Christiansen, Jerry P. Nolan, Lars W. Andersen
Journal: JAMA Internal Medicine (2025)

Importance There are no validated decision rules for terminating resuscitation during in-hospital cardiac arrest. Decision rules may guide termination and prevent inappropriate early termination of resuscitation. Objective To develop and validate termination of resuscitation rules for in-hospital cardiac arrest. Design, Setting, and Participants In this prognostic study, potential decision rules were developed using a national in-hospital cardiac arrest registry from Denmark (data from 2017 to 2022) and validated using registries from Sweden (data from 2007 to 2021) and Norway (data from 2021 to 2022). Six variables (age, initial rhythm, witnessed status, monitored status, intensive care unit location, and resuscitation duration) were considered based on their bedside availability. Prognostic metrics were computed for all possible variable combinations. CIs were obtained using bootstrapping. Rules with a false-positive rate below 1% (predicting death in patients who might otherwise survive) and a positive rate of more than 10% (proportion of all cases for whom termination is proposed) were considered appropriate. Main Outcomes and Measures The primary outcome was 30-day mortality. Results The cohorts included 9863 Danish, 12 781 Swedish, and 1308 Norwegian patients. The overall median (IQR) age was 74 (66-81) years, 63% were male, and the median (IQR) resuscitation duration was 13 (5-23) minutes. Of 53 864 possible termination rules, 5 were identified as relevant for clinical use. The best performing rule included 4 variables (unwitnessed, unmonitored, initial rhythm of asystole, and resuscitation duration more than or equal to 10 minutes). The rule proposed termination in 110 per 1000 cardiac arrests (positive rate, 11%; 95% CI, 10%-11%) and predicted 30-day mortality incorrectly in 6 per 1000 cases (false-positive rate, 0.6%; 95% CI, 0.3%-0.9%). All 5 rules performed similarly across all 3 cohorts. Conclusions and Relevance In this prognostic study, 5 termination of resuscitation rules were developed and validated for in-hospital cardiac arrest. The best performing rule had a low false-positive rate and a reasonable positive rate in all national cohorts. These termination of resuscitation rules may aid decision-making during resuscitation.
Apixaban to Prevent Covert Infarcts After Cryptogenic Stroke in Patients With Atrial Cardiopathy
Authors: Maarten G. Lansberg, Max Wintermark, Hui Chen, George Howard, Christy Cassarly, Qi Pauls, Stephanie Kemp, Tashia L. Harris, Balaji Krishnaiah, Robert J. Stanton, Michael J. Lyerly, Benjamin R. Miller, Eric E. Smith, David L. Tirschwell, Kevin N. Sheth, Hooman Kamel, William T. Longstreth, Mitchell S. V. Elkind, Joseph P. Broderick, Ronald M. Lazar
Journal: JAMA Neurology (2025)

Importance In the Atrial Cardiopathy and Antithrombotic Drugs in Prevention After Cryptogenic Stroke (ARCADIA) randomized clinical trial, anticoagulation did not prevent recurrent stroke among patients with a recent cryptogenic stroke and atrial cardiopathy. It is unknown whether anticoagulation prevents covert infarcts in this population. Objective To test the use of apixaban vs aspirin for prevention of nonlacunar covert infarcts after cryptogenic stroke in patients with atrial cardiopathy. Design, Setting, and Participants ARCADIA-MRI, an ancillary study to the ARCADIA trial with a median follow-up period of 27 months, enrolled participants from 75 sites in the US from November 14, 2019, until December 2, 2022. Participants in ARCADIA were invited to coenroll in ARCADIA-MRI if they had not permanently discontinued the study drug and had no contraindications on magnetic resonance imaging (MRI). A total of 310 (31%) of the 1015 ARCADIA participants enrolled in ARCADIA-MRI and of those 174 (56%) with adequate quality baseline and follow-up MRI were included in the present analyses. Interventions MRI performed at the time of the index stroke served as the baseline image unless it was unavailable or of insufficient quality, in which case a new research MRI was obtained. A follow-up research MRI was performed upon each participant’s completion of participation in the ARCADIA parent study. Main Outcomes and Measures The primary outcome was incident nonlacunar covert infarct on the follow-up MRI assessed by 2 independent raters who were masked to treatment assignment. Results Baseline characteristics were balanced between the apixaban (n = 79) and aspirin (n = 95) arms. The mean (SD) age was 66 (10.6) years, and the median (IQR) modified Rankin Scale (mRS) score 1 (0-2). Ninety-one participants (52.3%) were male. During the median (IQR) follow-up of 811 (487-1288) days, the risk of incident nonlacunar covert infarcts was lower in the apixaban group (5.1%) than the aspirin group (17.9%) (weighted relative risk, 0.29; 95% CI, 0.10-0.83). Conclusions and Relevance Apixaban compared to aspirin was associated with fewer incident nonlacunar covert infarcts among a subset of patients with a recent cryptogenic ischemic stroke and atrial cardiopathy who were enrolled in ARCADIA. Trial Registration ClinicalTrials.gov Identifier: NCT03192215