tbuckley/cabot-search huggingface dataset:
Artificial intelligence-assisted precise preoperative prediction of lateral cervical lymph nodes metastasis in papillary thyroid carcinoma via a clinical-CT radiomic combined model
Authors: Junze Du, Xinyun He, Rui Fan, Yi Zhang, Hao Liu, Haoxi Liu, Shangqing Liu, Shichao Li
Journal: International Journal of Surgery (2025)

Objectives: This study aimed to develop an artificial intelligence-assisted model for the preoperative prediction of lateral cervical lymph node metastasis (LCLNM) in papillary thyroid carcinoma (PTC) using computed tomography (CT) radiomics, providing a new noninvasive and accurate diagnostic tool for PTC patients with LCLNM. Methods: This retrospective study included 389 confirmed PTC patients, randomly divided into a training set ( n = 272) and an internal validation set ( n = 117), with an additional 40 patients from another hospital as an external validation set. Patient demographics were evaluated to establish a clinical model. Radiomic features were extracted from preoperative contrast-enhanced CT images (venous phase) for each patient. Feature selection was performed using analysis of variance and the least absolute shrinkage and selection operator algorithm. We employed support vector machine, random forest (RF), logistic regression, and XGBoost algorithms to build CT radiomic models for predicting LCLNM. A radiomics score (Rad-score) was calculated using a radiomic signature-based formula. A combined clinical-radiomic model was then developed. The performance of the combined model was evaluated using the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). Results: A total of 1724 radiomic features were extracted from each patient’s CT images, with 13 features selected based on nonzero coefficients related to LCLNM. Four clinically relevant factors (age, tumor location, thyroid capsule invasion, and central cervical lymph node metastasis) were significantly associated with LCLNM. Among the algorithms tested, the RF algorithm outperformed the others with five-fold cross-validation on the training set. After integrating the best algorithm with clinical factors, the areas under the ROC curves for the training, internal validation, and external validation sets were 0.910 (95% confidence interval [CI]: 0.729–0.851), 0.876 (95% CI: 0.747–0.911), and 0.821 (95% CI: 0.555–0.802), respectively, with DCA demonstrating the clinical utility of the combined radiomic model. Conclusions: This study successfully established a clinical-CT radiomic combined model for predicting LCLNM, which may significantly enhance surgical decision-making for lateral cervical lymph node dissection in patients with PTC.
Multiparametric MRI and transfer learning for predicting positive margins in breast-conserving surgery: a multi-center study
Authors: Xue Zhao, Jing-Wen Bai, Sen Jiang, Zhen-Hui Li, Jie-Zhou He, Zhi-Cheng Du, Xue-Qi Fan, Shao-Zi Li, Guo-Jun Zhang
Journal: International Journal of Surgery (2025)

This study aimed to predict positive surgical margins in breast-conserving surgery (BCS) using multiparametric MRI (mpMRI) and radiomics. A retrospective analysis was conducted on data from 444 BCS patients from three Chinese hospitals between 2019 and 2024, divided into four cohorts and five datasets. Radiomics features from preoperative mpMRI, along with clinicopathological data, were extracted and selected using statistical methods and LASSO logistic regression. Eight machine learning classifiers, integrated with a transfer learning (TL) method, were applied to enhance model generalization. The model achieved an AUC of 0.889 in the internal test set and 0.771 in the validation set. Notably, TL significantly improved performance in two external validation sets, increasing the AUC from 0.533 to 0.902 in XAH and from 0.359 to 0.855 in YNCH. These findings highlight the potential of combining mpMRI and TL to provide accurate predictions for positive surgical margins in BCS, with promising implications for broader clinical application across multiple hospitals.
Estrogen receptor alpha ablation reverses muscle fibrosis and inguinal hernias
Authors: Tanvi Potluri, Tianming You, Ping Yin, John S. Coon V, Jonah J. Stulberg, Yang Dai, David J Escobar, Richard L. Lieber, Hong Zhao, Serdar E. Bulun
Journal: Journal of Clinical Investigation (2025)

Fibrosis of the lower abdominal muscle (LAM) contributes to muscle weakening and inguinal hernia formation, an ailment affecting a noteworthy fifty percent of men by age 75, necessitating surgical correction as the singular therapy. Despite its prevalence, the mechanisms driving LAM fibrosis and hernia development remain poorly understood. Utilizing a humanized mouse model that replicates elevated skeletal muscle tissue estrogen concentrations akin to aging men, we identified estrogen receptor alpha (ESR1) as a key driver of LAM fibroblast proliferation, extracellular matrix deposition, and hernia formation. Fibroblast-specific ESR1 ablation effectively prevented muscle fibrosis and herniation, while pharmacological ESR1 inhibition with fulvestrant reversed hernias and restored normal muscle architecture. Multiomic analyses on in vitro LAM fibroblasts unveiled an estrogen/ESR1-mediated activation of a distinct profibrotic cistrome and gene expression signature, concordant with observations in inguinal hernia tissues in human males. Our findings hold significant promise for prospective medical interventions targeting fibrotic conditions and presenting non-surgical avenues for addressing inguinal hernias.
Sleep-wake variation in body temperature regulates tau secretion and correlates with CSF and plasma tau
Authors: Geoffrey Canet, Felipe Da Gama Monteiro, Emma Rocaboy, Sofia Diego-Diaz, Boutheyna Khelaifia, Kelly Godbout, Aymane Lachhab, Jessica Kim, Daphne I. Valencia, Audrey Yin, Hau-Tieng Wu, Jordan C. Howell, Emily Blank, Francis Laliberté, Nadia Fortin, Emmanuelle Boscher, Parissa Fereydouni-Forouzandeh, Stéphanie Champagne, Isabelle Guisle, Sébastien S. Hébert, Vincent Pernet, Haiyan Liu, William Lu, Ludovic Debure, David M. Rapoport, Indu Ayappa, Andrew W. Varga, Ankit Parekh, Ricardo S. Osorio, Steve Lacroix, Mark P. Burns, Brendan P. Lucey, Esther M. Blessing, Emmanuel Planel
Journal: Journal of Clinical Investigation (2025)

Sleep disturbance is bidirectionally associated with increased risks of Alzheimer's disease and other tauopathies. While the sleep-wake cycle regulates interstitial and cerebrospinal fluid (CSF) tau levels, the underlying mechanisms remain unknown. Understanding these mechanisms is crucial given evidence indicates that tau pathology spreads through neuron-to-neuron transfer, involving the secretion and internalization of pathological tau forms. Here, we combine in vitro, in vivo and clinical methods to reveal a pathway by which changes in body temperature (BT) over the sleep-wake cycle modulate extracellular tau levels. In mice, higher BT during wakefulness and sleep-deprivation increased CSF and plasma tau levels, while also upregulating unconventional protein secretion pathway-I (UPS-I) components, including (i) intracellular tau dephosphorylation, (ii) caspase-3-mediated cleavage of tau (TauC3) and (iii) its membrane translocation through binding to PIP2 and syndecan-3. In humans, the increase in CSF and plasma tau levels observed post-wakefulness correlated with BT increase during wakefulness. By demonstrating that sleep-wake variation in BT regulates extracellular tau levels, our findings highlight the importance of thermoregulation in linking sleep disturbances to tau-mediated neurodegeneration, and the preventative potential of thermal interventions.
Patient-reported outcome measures are highly needed for patients with skin of colour with atopic dermatitis
Authors: Laura von Kobyletzki, Åke Svensson
Journal: British Journal of Dermatology (2025)

Journal Article Accepted manuscript Patient-reported outcome measures are highly needed for patients with skin of colour with atopic dermatitis Get access Laura von Kobyletzki, Laura von Kobyletzki Department of Occupational and Environmental Dermatology, Lund University Faculty of Medicine, Malmö, Sweden Correspondence: Laura von Kobyletzki, Email:[email protected] Search for other works by this author on: Oxford Academic Google Scholar Åke Svensson Åke Svensson Department of Occupational and Environmental Dermatology, Lund University Faculty of Medicine, Malmö, Sweden Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, ljaf043, https://doi.org/10.1093/bjd/ljaf043 Published: 04 February 2025 Article history Received: 29 January 2025 Accepted: 30 January 2025 Published: 04 February 2025
Comparison of percutaneous versus cutdown access in patients after endovascular abdominal aortic repair: a randomized controlled trial (SWEET-EVAR trial)
Authors: Yuhang Zhou, Jiarong Wang, Jichun Zhao, Ding Yuan, Chengxin Weng, Bin Huang, Tiehao Wang
Journal: International Journal of Surgery (2025)

Introduction: The optimal choice of either percutaneous or cutdown access for endovascular abdominal aortic repair (EVAR) remains uncertain due to insufficient evidence, particularly regarding patient-centered outcomes (PCOs). This study aimed at comparing both clinician-reported outcomes (ClinROs) and PCOs of percutaneous versus cutdown access in patients after EVAR. Methods: The study was a single-blind, single-center, non-inferiority, randomized controlled trial. After eligibility screening, patients diagnosed with abdominal aortic diseases were randomly assigned to either the intervention group receiving percutaneous EVAR or the control group receiving cutdown EVAR. Primary ClinRO was access-related complications, and primary PCO was time return to normal life/work. Results: Overall, 120 patients (containing 240 accesses) were allocated to either intervention group ( n = 62) or control group ( n = 58). Percutaneous EVAR (10/124, 8.1%) was non-inferior and not superior to cutdown EVAR (17/116, 14.7%) regarding access-related complications ( P = 0.110; OR: 0.521, 95% CI: 0.225–1.157). As for PCOs, the recovery time back to normal life or work was superior in percutaneous EVAR compared to cutdown EVAR (16 vs. 28 days, P = 0.025; median difference: 7 days, 95% CI: 0–13 days). Moreover, percutaneous access did better in other PCOs, including a reduction in the duration of access-related pain (4 vs. 8 days, P = 0.001), decreased use of analgesics for access-related pain (0/61, 0% vs. 6/55, 10.9%; P = 0.026), and improved quality of life scores at 2 weeks following EVAR (0.876 vs. 0.782; P = 0.022). Prespecified subgroup analyses demonstrated percutaneous access significantly reduced the incidence of access-related complications compared to cutdown access in patients with thick subcutaneous tissue (1/42, 2.4% vs. 7/32, 21.9%; P = 0.026). Conclusion: In patients without massive common femoral artery calcification, percutaneous access may accelerate postoperative recovery and enhance patient experience and quality of life following EVAR, but did not provide obvious advantages regarding access-related complications.
Postoperative acute pain trajectory and chronic postsurgical pain after abdominal surgery: a prospective cohort study and mediation analysis
Authors: Dong Xu Chen, Yu Yang Zhang, Jing Liu, Yu Chen
Journal: International Journal of Surgery (2025)

Background: This study aimed to investigate the trajectories of acute postoperative pain intensity during the initial 5 days after abdominal surgery, and to analyze their association with the risk of developing chronic postsurgical pain (CPSP). Methods: We enrolled patients with elective abdominal surgery with pain measurements taken across postoperative days 1 through 5. Since postoperative pain is often unavoidable and its initial intensity is closely related to the invasiveness of the surgery, focusing on the overall pain trajectory may be more meaningful than evaluating pain at a single time point. Therefore, the primary outcome of this study was to identify distinct pain trajectories. Secondary outcome was the incidence of CPSP between differences pain trajectories. Lastly, mediation analyses were performed to explore the mediating role of the quality of recovery and subacute pain on the studied associations. Results: The final analysis encompassed 1170 patients (36.75% female) with a median age of 55 years. Two distinct clusters were identified: with movement (high: 533 [45.56%]; low: 637 [54.44%]) and at rest (high: 363 [31.03%]; low: 807 [68.97%]). Patients in the high pain trajectory group (during movement [odds ratio [OR] 2.04, 95% CI 1.56–2.68] or at rest [OR 1.90, 95% CI 1.44–2.53]) exhibited nearly doubled risk of CPSP. Moreover, these patients exhibited a significantly poorer recovery quality. Mediation analyses revealed that the poor recovery quality at postoperative 5 days (17.62%–18.57%) and higher subacute pain at postoperative 1 month (29.46%–32.75%) were significant mediators in the association between adverse postoperative acute pain trajectory patterns and CPSP. Conclusion: This study highlights the clinical significance of postoperative pain trajectory profiles in predicting the risk of CPSP, emphasizing postoperative acute pain trajectory as a critical indicator and subacute pain as a significant mediator. The findings underscore the potential for tailored pain management strategies targeting acute pain trajectories to reduce such risk.
Iatrogenic nerve injury following pelvic ring injury: a network meta-analysis
Authors: Yu-Cheng Su, Yung-Heng Hsu, Ying-Chao Chou, I-Jung Chen, Chih-Yang Lai, Yi-Hsun Yu
Journal: International Journal of Surgery (2025)

Background: Pelvic ring injuries are common in multi-trauma patients and can be life-threatening, necessitating prompt surgical intervention to improve outcomes. However, surgery can lead to complications such as iatrogenic nerve injury. This network meta-analysis aimed to improve outcomes in multi-trauma patients with pelvic ring injuries by evaluating the incidence of iatrogenic nerve injuries, identifying vulnerable nerves, and comparing different fixation methods. Materials and Methods: A systematic search of MEDLINE, EMBASE, and Scopus from inception to 5 December 2023, revealed 29 comparative studies on the incidence of iatrogenic nerve injury in 1561 adult patients with pelvic ring injuries. Data were extracted on study and patient characteristics, iatrogenic nerve injury incidences, and specific nerve injuries. A random-effects model assessed treatment effects, with subgroup analysis and meta-regression. The main outcomes included odds ratios (ORs) and confidence intervals (CIs) for iatrogenic nerve injuries. Results: Compared with closed reduction internal fixation, robotic-assisted techniques had the highest, and open reduction internal fixation had the lowest ORs for iatrogenic nerve injuries. The robotic-assisted approach ranked best with an OR of 0.22 (95%CI: 0.02–2.16), while closed reduction internal fixation with the anterior approach (OR: 0.71; 95%CI: 0.21–2.48) and open reduction internal fixation with the anterior approach performed the worst. The lateral femoral cutaneous nerve was injured in all open reduction internal fixation with anterior approach procedures and in 66.7% of open reduction internal fixation with posterior approach procedures. Meta-regression showed a significantly lower OR for iatrogenic nerve injuries in patients aged &gt;41.4 years in the open reduction internal fixation with anterior approach group (OR: 0.02; 95%CI: 0.001–0.63; p = 0.026) compared with younger patients. Conclusion: The robotic-assisted technique may result in the fewest iatrogenic nerve injuries during the treatment of pelvic ring injuries. The posterior approach may also reduce the risk of iatrogenic nerve injuries.
The incidence and outcomes of hyperacute cardiovascular dysfunction following isolated traumatic brain injury: an observational cohort study
Authors: Flora L. Bird, Mark Wilson, Shadman Aziz, Moustafa Shebl, Alexander Pickard, David Sims, Gareth Grier, David Lockey, Ross Davenport
Journal: International Journal of Surgery (2025)

Background: The relationship between early cardiovascular dysfunction (CVD) in isolated traumatic brain injury (iTBI) and outcome has not been fully described. We aimed to (1) determine the prevalence and phenotype of CVD after iTBI in the hyper-acute phase and (2) compare treatment and outcomes in those with CVD vs non-CVD. Methods: An observational cohort database study of severe iTBI patients (Head AIS 3+) at a level 1 trauma centre (2008–2019) and physician-led air ambulance service (2019–2020). CV dysfunction was defined as tachycardia or bradycardia, with hypotension. Physiology, laboratory results, 24-hour transfusion, and computer-topography (CT) findings were recorded. Outcomes were 28-day mortality and Glasgow Outcome Score (GOS). Results: A total of 168 patients met inclusion criteria, average age 46 years (IQR 30–61), 77% male, median ISS 25 (IQR 17–29) with 51% Head AIS 5. Time from injury to pre-hospital assessment was 31 minutes (IQR 20–42) with 20% demonstrating CVD on initial observations. The CVD group were more shocked (lactate 6.1 (1.7–10.9) vs. 2.4 (1.4–3.3), P &lt; 0.001) and coagulopathic (43% vs. 15%, P = 0.001). There was no difference in Head AIS or CT findings between groups, except frequency of hypoxic ischemic encephalopathy (HIE) (CVD: 21% vs. non-CVD: 1%, P &lt; 0.001). A 24-hour transfusion was higher in CVD patients: 3 (0–8) vs. 0 (0–0) units, P &lt; 0.001. Mortality was greater in CVD vs non-CVD iTBI (61% vs. 31%, P = 0.002), but in patients with AIS 5, there was no difference ( P = 0.262). One-third of CVD survivors (13/33) were discharged home, and 4/18 patients with recorded GOS had good neurological outcome. Conclusion: One in five patients with severe iTBI develop early CVD, associated with increased mortality, coagulopathy, and HIE. However, mortality and neurological outcome is highly variable in those with CVD across the iTBI severity spectrum. Further research is needed to define the pathophysiology and optimal treatment to improve outcomes for this subgroup of iTBI.
Targeting gut S. aureofaciens Tü117 serves as a new potential therapeutic intervention for the prevention and treatment of hypertension
Authors: Tingting Zhou, Zhiwei Wang, Xiaowang Lv, Mengting Guo, Ning Zhang, Liangju Liu, Li Geng, Jing Shao, Ka Zhang, Mengru Gao, Aiqin Mao, Yifei Zhu, Fan Yu, Lei Feng, Xiaoyan Wang, Qixiao Zhai, Wei Chen, Xin Ma
Journal: Cell Metabolism (2025)
RNase L represses hair follicle regeneration through altered innate immune signaling
Authors: Charles S. Kirby, Nasif Islam, Eric Wier, Martin P. Alphonse, Evan Sweren, Gaofeng Wang, Haiyun Liu, Dongwon Kim, Ang Li, Sam S. Lee, Andrew M. Overmiller, Yingchao Xue, Sashank Reddy, Nathan K. Archer, Lloyd S. Miller, Jianshi Yu, Weiliang Huang, Jace W. Jones, Sooah Kim, Maureen A. Kane, Robert H. Silverman, Luis A. Garza
Journal: Journal of Clinical Investigation (2025)

Mammalian injury responses are predominantly characterized by fibrosis and scarring rather than functional regeneration. This limited regenerative capacity in mammals could reflect a loss of pro-regeneration programs or active suppression by genes functioning akin to tumor suppressors. To uncover programs governing regeneration in mammals, we screened transcripts in human subjects following laser rejuvenation treatment and compared them to mice with enhanced Wound Induced Hair Neogenesis (WIHN), a rare example of mammalian organogenesis. We found that Rnasel-/- mice exhibit an increased regenerative capacity, with elevated WIHN through enhanced IL-36α. Consistent with RNase L's known role to stimulate caspase-1, we found that pharmacologic inhibition of caspases promoted regeneration in an IL-36 dependent manner in multiple epithelial tissues. We identified a negative feedback loop, where RNase L activated caspase-1 restrains the pro-regenerative dsRNA-TLR3 signaling cascade through the cleavage of toll-like adaptor protein TRIF. Through integrated single-cell RNA sequencing and spatial transcriptomic profiling, we confirmed Oas & Il36 genes to be highly expressed at the site of wounding and are elevated in Rnasel-/- mice wounds. This work suggests that RNase L functions as a regeneration repressor gene, in a functional tradeoff that tempers immune hyper-activation during viral infection at the cost of inhibiting regeneration.
Intra- and early postoperative predictors of delirium risk in cardiac surgery: results from the prospective observational FINDERI study
Authors: Paul T. Itting, Monika Sadlonova, Manuel J. Santander, Maria Knierim, Carlotta Derad, Thomas Asendorf, Christopher M. Celano, Niels Hansen, Hermann Esselmann, Stephanie Heinemann, Charlotte Eberhard, Melanie Hoteit, Mirjam F. Schröder, Ingo Kutschka, Jens Wiltfang, Christine A.F. von Arnim, Hassina Baraki
Journal: International Journal of Surgery (2025)

Postoperative delirium (POD) is a severe complication following cardiac surgery and is associated with increased morbidity and mortality. The impact of intra- and early postoperative factors on the occurrence of POD following cardiac surgery remains controversial. To close this gap, we investigated intra- and early postoperative factors and their predictive values for POD. We performed a prospective observational study that aimed to FIND DElirium RIsk factors (FINDERI) for patients undergoing elective cardiac surgery. POD was assessed using the Confusion Assessment Method (CAM) algorithm. Intra- and early postoperative factors were extracted from electronic medical records and reviewed by cardiac surgeons. To identify potential predictors of POD, we used univariate and multivariate logistic regression along with machine learning (ML) with tenfold cross-validation. In our study cohort of 490 patients, 106 screened positive for POD (21.6%). In the multivariate analysis, we found a positive association between POD occurrence and age (p<0.001), duration of surgery (p = 0.027), combined (versus isolated) surgical procedures (p = 0.024), opening of the cardiac chambers (p = 0.046), and ventilation time (p<0.001). The ML-based decision tree identified a two level-algorithm including ventilation time and aortic cross-clamping time, with an AUC of 0.7116 (p = 0.0002) in the validation set. In the ML-based LASSO regression analysis, we identified ventilation time, administration of erythrocyte concentrates (EC), and usage of cardiopulmonary bypass (CPB) as predictors of POD, with an AUC of 0.7407 (p<0.0001) in the validation set. The results of this analysis highlight the associations between ventilation time, aortic cross-clamping time, administration of EC, and usage of CPB and POD. Additionally, they suggest that the optimization of surgical protocols has the potential to reduce POD risk in individuals undergoing cardiac surgery.