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Generative pretrained transformer 4:an innovative approach to facilitate value-based healthcare

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Intelligent Medicine 2024年第1期4卷 10-15页

作者： Han Lyu Zhixiang Wang Jia Li Jing Sun Xinghao Wang Pengling Ren Linkun Cai Zhenchang Wang Max Wintermark department of radiology Capital Medical University Affiliated Beijing Friendship HospitalBeijing 100050China department of Medical Imaging Capital Medical University Affiliated Beijing Friendship HospitalBeijing 100050China School of Biological Science and Medical Engineering Beihang UniversityBeijing 100191China department of neuroradiology University of Texas MD Anderson CenterHoustonTX 77030USA

Objective Appropriate medical imaging is important for value-based *** aim to evaluate the performance of generative pretrained transformer 4(GPT-4),an innovative natural language processing model,providing appropriate medical imaging automatically in different clinical *** Institutional Review Boards(IRB)approval was not required due to the use of nonidentifiable ***,we used 112 questions from the American College of radiology(ACR)radiology-TEACHES Program as prompts,which is an open-sourced question and answer program to guide appropriate medical *** included 69 free-text case vignettes and 43 simplified *** the performance evaluation of GPT-4 and GPT-3.5,we considered the recommendations of ACR guidelines as the gold standard,and then three radiologists analyzed the consistency of the responses from the GPT models with those of the *** set a five-score criterion for the evaluation of the consistency.A paired t-test was applied to assess the statistical significance of the *** For the performance of the GPT models in free-text case vignettes,the accuracy of GPT-4 was 92.9%,whereas the accuracy of GPT-3.5 was just 78.3%.GPT-4 can provide more appropriate suggestions to reduce the overutilization of medical imaging than GPT-3.5(t=3.429,P=0.001).For the performance of the GPT models in simplified scenarios,the accuracy of GPT-4 and GPT-3.5 was 66.5%and 60.0%,*** differences were not statistically significant(t=1.858,P=0.070).GPT-4 was characterized by longer reaction times(27.1 s in average)and extensive responses(137.1 words on average)than *** As an advanced tool for improving value-based healthcare in clinics,GPT-4 may guide appropriate medical imaging accurately and efficiently。

关键词： Generative pretrained transformer 4 model Natural language processing Medical imaging Appropriateness

High Prevalence of Anatomical Variations and Anomalies of the Coronary Arteries Detected by CT Angiography in Symptomatic Patients

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Congenital Heart Disease 2024年第2期19卷 197-206页

作者： Ghazi A.Alshumrani department of radiology College of MedicineKing Khalid UniversityAbha61421Saudi Arabia

Objective:Coronary artery anatomical variations and anomalies are an important topic due to their potential clinical *** study aims to investigate the prevalence of coronary artery anatomical variations and anomalies in symptomatic patients with coronary computed tomography angiography(CCTA).Methods:This is a retrospective study that included all symptomatic patients who had CCTA in a tertiary care hospital in Saudi Arabia during a period of seven ***:The total number of included patients was 507(60%males)with a mean age of 57.4 *** 41%had luminal stenoses,averaging 49.7%.The total num-ber of patients with coronary anatomical variations(CAV)and coronary artery anomalies(CAA)was 217(43%).CAV prevalence was 26%,which included 14%non-right coronary dominance,5%short left main coronary artery(LMCA),and 7%division variations(trifurcation and quadrifurcarion)of the *** prevalence of CAA was 29%,which included 5%origin anomalies,22%myocardial bridge,and 2%course ***:A high prevalence of coronary artery anatomic variations and anomalies in symptomatic patients is reported in this *** reviews,meta-analyses,reporting guidelines,and unified definitions and classifications of cor-onary variations and anomalies are lacking in the literature,presenting potential opportunities for future research and publications.

关键词： Coronary artery anomalies coronary anatomical variation coronary CT angiography

Acute coalescent mastoiditis in a 16-month-old child due to Streptococcus pneumoniae infection

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Journal of Acute Disease 2024年第1期13卷 36-39页

作者： Magdalena Pszczołowska Monika Morawska-Kochman Katarzyna Resler Katarzyna Pękalska Tomasz Zatoński department and Clinic of Otolaryngology Head and Neck SurgeryWrocław Medical UniversityBorowska 213WrocławPoland department of General radiology Interventional Radiology and NeuroradiologyWrocław Medical UniversityBorowska 213WrocławPoland

Rationale:Acute otitis media is a common disease in early childhood,and is usually caused by Streptococcus pneumoniae(***).Acute mastoiditis is a complication of acute otitis media and can involve not only the mucoperiosteum of the middle ear but can also spread to the periosteum by destroying the mastoid bone(acute coalescent mastoiditis).In addition,the infection can extend through the surrounding bones or the emissary veins beyond the mastoid’s air cells,leading to subperiosteal ***’s Concern:A 16-month-old female patient was hospitalized due to the purulent discharge of the left ear and the symptoms of right mastoiditis(swelling and redness of the skin).Diagnosis:Bilateral acute coalescent mastoiditis caused by *** *** computer tomography revealed bilateral bone destruction of the mastoid and abscesses found behind the auricle on both ***:The patient underwent intravenous antibiotic therapy and surgical ***:The patient was discharged 14 days after hospitalization with an improved ***:Improperly treated acute coalescent mastoiditis can lead to extracranial and intracranial complications,sometimes serious and even *** are prevalent in children under 2 years,in whom the disease progresses more rapidly and *** vaccination with a 13-valent vaccine may not result in sufficient immunity against ***,a predominant pathogen in children affected by acute coalescent mastoiditis.

关键词： Acute otitis media Acute coalescent mastoiditis Streptococcus pneumoniae Children Case report

Solid-state atomic hydrogen as a broad-spectrum RONS scavenger for accelerated diabetic wound healing

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National Science Review 2024年第2期11卷 196-206页

作者： Man Luo Qin Wang Gang Zhao Wei Jiang Cici Zeng Qingao Zhang Ruyu Yang Wang Dong Yunxi Zhao Guozhen Zhang Jun Jiang Yucai Wang Qing Zhu Key Laboratory of Precision and Intelligent Chemistry School of Chemistry and Materials Science University of Science and Technology of China department of radiology The First Affiliated Hospital of University of Science and Technology of China Division of Life Sciences and Medicine University of Science and Technology of China Shenzhen Senior High School Institute of Intelligent Innovation Henan Academy of Sciences

Hydrogen therapy shows great promise as a versatile treatment method for diseases associated with the overexpression of reactive oxygen and nitrogen species（RONS）. However, developing an advanced hydrogen therapy platform that integrates controllable hydrogen release, efficient RONS elimination, and biodegradability remains a giant technical challenge. In this study, we demonstrate for the first time that the tungsten bronze phase H0.53WO3（HWO） is an exceptionally ideal hydrogen carrier, with salient features including temperature-dependent highly-reductive atomic hydrogen release and broad-spectrum RONS scavenging capability distinct from that of molecular hydrogen. Moreover, its unique p H-responsive biodegradability ensures post-therapeutic clearance at pathological sites. Treatment with HWO of diabetic wounds in an animal model indicates that the solid-state atomic H promotes vascular formation by activating M2-type macrophage polarization and anti-inflammatory cytokine production, resulting in acceleration of chronic wound healing. Our findings significantly expand the basic categories of hydrogen therapeutic materials and pave the way for investigating more physical forms of hydrogen species as efficient RONS scavengers for clinical disease treatment.

关键词： atomic hydrogen RONS scavenger inflammatory regulation diabetic wound healing hydrogen therapy

Superior rectus/levator complex in acquired anophthalmic socket repaired with spheric implant—a computed tomography scan and topographic study

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International Journal of Ophthalmology(English edition) 2024年第8期17卷 1483-1488页

作者： Shaikha Al Eid Hamad M AlSulaiman Sahar M Elkhamary Osama Al Sheikh Alicia Ferrero-Galindo Rajiv Kandekhar Silvana A Schellini Oculoplastic division King Khaled Eye Specialist HospitalRiyadh 11462Saudi Arabia radiology division King Khaled Eye Specialist HospitalRiyadh 11462Saudi Arabia department of Diagnostic radiology Mansoura Faculty of MedicineMansoura 35511Egypt University Hospital Rio Hortega Valladolid 47012Spain Research department King Khaled Eye Specialist HospitalRiyadh 11462Saudi Arabia Ophthalmology department Medical SchoolState University of Sao PauloBotucatu 18618-687Brazil

AIM:To determine whether the levator palpebrae superioris(LPS)/superior rectus(SR)muscle complex,can influence the position of the upper lid and fornix in acquired anophthalmic ***:This comparative non-randomized and non-interventional study included retrospective data of 21 patients with unilateral acquired anophthalmic sockets repaired with spheric ***-resolution computed tomography(CT)measurements of the LPM/SR muscle complex and clinical topographic position of the upper lid,superior and inferior fornix depth in primary gaze position were *** data were presented as frequency and percentage proportions and quantitative variables comparing the socket measurements with the normal contralateral orbit was statistically analyzed using non-parametric tests considering P0.05,all comparisons).The superior fornix depth was similar in the anophthalmic socket and the contralateral normal orbit(P=0.192)as well the inferior fornix depth(P=0.351).CONCLUSION:Acquired anophthalmic sockets repaired with spheric implants have shorter LPS,thicker SR,and more lagophthalmos than normal *** relationship of the LPS and SR with other orbital structures,associated with passive or active forces acting in the final position of the lids and external ocular prosthesis should be further investigated.

关键词： anophthalmic socket spheric implant levator palpebrae superioris superior rectus lagophthalmos fornix depth

Developing a diagnostic model for predicting prostate cancer: a retrospective study based on Chinese multicenter clinical data

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Asian Journal of Andrology 2024年第1期26卷 34-40页

作者： Chang-Ming Wang Lei Yuan Xue-Han Liu Shu-Qiu Chen Hai-Feng Wang Qi-Fei Dong Bin Zhang Ming-Shuo Huang Zhi-Yong Zhang Jun Xiao Tao Tao department of Urology The First Affiliated Hospital of USTCDivision of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefei 230001China department of radiology The First Affiliated Hospital of USTCDivision of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefei 230001China Core Facility Center for Medical Sciences The First Affiliated Hospital of USTcDivision of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefei 230001China department of Urology Affiliated Zhongda Hospital of Southeast UniversityNanjing 210009China department of Urology Shanghai East HospitalTongji University School of MedicineShanghai 200120China department of Urology Shanghai Changhai HospitalSecond Military Medical UniversityShanghai 200000China department of Urology Affiliated Anhui Provincial Hospital of Anhui Medical UniversityHefei 230001China

The overdiagnosis of prostate cancer(PCa)caused by nonspecific elevation serum prostate-specific antigen(PSA)and the overtreatment of indolent PCa have become a global problem that needs to be solved *** aimed to construct a prediction model and provide a risk stratification system to reduce unnecessary *** this retrospective study,clinical data of 1807 patients from three Chinese hospitals were *** final model was built using stepwise logistic regression *** apparent performance of the model was assessed by receiver operating characteristic curves,calibration plots,and decision curve ***,a risk stratification system of clinically significant prostate cancer(csPCa)was created,and diagnosis-free survival analyses were *** multivariable screening and evaluation of the diagnostic performances,a final diagnostic model comprised of the PSA density and Prostate Imaging-Reporting and Data System(PI-RADS)score was *** validation in the development cohort and two external cohorts showed excellent discrimination and ***,we created a risk stratification system using risk thresholds of 0.05 and 0.60 as the cut-off *** follow-up results indicated that the diagnosis-free survival rate for csPCa at 12 months and 24 months postoperatively was 99.7%and 99.4%,respectively,for patients with a risk threshold below O.05 after the initial negative prostate biopsy,which was significantly better than patients with higher *** diagnostic model and risk stratification system can achieve a personalized risk calculation of *** provides a standardized tool for Chinese patients and physicians when considering thenecessity of prostatebiopsy.

关键词： nomogram prostate biopsy prostate cancer Prostate Imaging-Reporting and Data System prostate-specific antigen density

Pseudoaneurysm formation following transarterial embolization of traumatic carotid-cavernous fistula with detachable balloon:An institutional cohort long-term study

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World Journal of radiology 2024年第4期16卷 94-108页

作者： Prasert Iampreechakul Korrapakc Wangtanaphat Songpol Chuntaroj Yodkhwan Wattanasen Sunisa Hangsapruek Punjama Lertbutsayanukul Pimchanok Puthkhao Somkiet Siriwimonmas department of Neurosurgery Neurological Institute of ThailandBangkok 10400Thailand department of neuroradiology Neurological Institute of ThailandBangkok 10400Thailand department of Medical Services Neurological Institute of ThailandBangkok 10400Thailand department of radiology Bumrungrad International HospitalBangkok 10110Thailand

BACKGROUND The goal of therapy for traumatic carotid-cavernous fistula(TCCF)is the elimination of fistula while maintaining patency of the parent *** treatment for TCCF has evolved from surgery to endovascular management using detachable balloons,coils,liquid embolic agents,covered stents,or flow-diverter stent through arterial or venous *** the withdrawal of detachable balloons from the market in the United States since 2004,transarterial embolization with detachable balloons has currently remained the best initial treatment for TCCF in several ***,the pseudoaneurysm formation following transarterial detachable balloon embolization has rarely been observed in long-term *** To determine the occurrence and long-term follow-up of pseudoaneurysm after transarterial detachable balloon for *** Between January 2009 and December 2019,79 patients diagnosed with TCCF were treated using detachable latex balloons(GOLDBAL)of four *** sizes were stratified into five grades for *** and follow-up assessments involved computed tomography angiography at 1 month,6 month,1 year,and longer intervals for significant *** follow-ups occurred semi-annually for 2 years,then *** analyzed included sex,age,fistula size and location,and balloon *** In our cohort of 79 patients treated for TCCF,pseudoaneurysms formed in 67.1%,with classifications ranging from grade 0 to grade 3;no grade 4 or giant pseudoaneurysms were *** majority of pseudoaneurysms did not progress in size,and some regressed *** developed in most large pseudoaneurysms over 5-10 *** artery occlusion occurred in 7.6%and recurrent fistulas in 16.5%.The primary risk factors for pseudoaneurysm formation were identified as the use of specific balloon sizes,with balloon SP and No.6 significantly associated with its occurrence(P=0.005 and P=0.002,respectively),whereas sex,age,f

关键词： Pseudoaneurysm formation Traumatic carotid-cavernous fistula Direct carotid-cavernous fistula Transarterial embolization Detachable balloon Endovascular treatment Computed tomography angiography Long-term follow-up

Extravasated contrast volumetric assessment on computed tomography angiography in gastrointestinal bleeding:A useful predictor of positive angiographic findings

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World Journal of radiology 2024年第5期16卷 115-127页

作者： Laura Maria Cacioppa Chiara Floridi Alessandra Bruno NicolòRossini Tommaso Valeri Alessandra Borgheresi Riccardo Inchingolo Francesco Cortese Giacomo Novelli Alessandro Felicioli Mario Torresi Pietro Boscarato Letizia Ottaviani Andrea Giovagnoni division of Interventional radiology Department of Radiological SciencesUniversity Politecnica Delle MarcheAncona 60126Italy department of Clinical Special and Dental SciencesUniversity Politecnica Delle MarcheAncona 60126Italy division of radiology Department of Radiological SciencesUniversity Hospital"Azienda Ospedaliero Universitaria Delle Marche"Ancona 60126Italy Interventional radiology Unit "F Miulli"Regional General HospitalAcquaviva delle Fonti 70021Italy department of radiology IRCCS INRCAAncona 60126Italy

BACKGROUND Gastrointestinal bleeding(GIB)is a severe and potentially life-threatening condition,especially in cases of delayed *** tomography angiography(CTA)plays a pivotal role in the early identification of upper and lower GIB and in the prompt treatment of the *** To determine whether a volumetric estimation of the extravasated contrast at CTA in GIB may be a predictor of subsequent positive angiographic *** In this retrospective single-centre study,35 patients(22 men;median age 69 years;range 16-92 years)admitted to our institution for active GIB detected at CTA and further submitted to catheter angiography between January 2018 and February 2022 were ***-three(65.7%)patients underwent endoscopy before *** volumetry was evaluated in both arterial and venous phases via a semi-automated dedicated *** rate was obtained from volume change between the two phases and standardised for unit *** were divided into two groups,according to the angiographic signs and their concordance with *** Upper bleeding accounted for 42.9%and lower GIB for 57.1%.Mean haemoglobin value at the admission was 7.7 g/dL.A concordance between positive CTA and direct angiographic bleeding signs was found in 19(54.3%)*** no significant differences in terms of bleeding volume in the arterial phase(0.55 mL vs 0.33 mL,P=0.35),a statistically significant volume increase in the venous phase was identified in the group of patients with positive angiography(2.06 mL vs 0.9 mL,P=0.02).In the latter patient group,a significant increase in bleeding rate was also detected(2.18 mL/min vs 0.19 mL/min,P=0.02).CONCLUSION In GIB of any origin,extravasated contrast volumetric analysis at CTA could be a predictor of positive angiography and may help in avoiding further unnecessary procedures.

关键词： Gastrointestinal haemorrhage Computed tomography angiography Volumetric analysis Computer-assisted image interpretation Therapeutic embolization Transcatheter arterial embolization

Global geoepidemiology of gastrointestinal surgery rates in Crohn’s disease

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World Journal of Gastrointestinal Surgery 2024年第6期16卷 1835-1844页

作者： Simcha Weissman Muhammad Aziz Ayrton Bangolo Vignesh K Nagesh Htat Aung Midhun Mathew Lino Garcia Shiva A Chandar Praveena Karamthoti Harinder Bawa Aseel Alshimari Yabets Kejela Nazish Mehdi Chrishanti A Joseph Athri Kodali Rohan Kumar Priya Goyal Sanya Satheesha Fnu Nivedita Nicole Tesoro Tanni Sethi Gurpreet Singh Areej Belal Alina Intisar Hirra Khalid Samuel Cornwell Suchith B Suresh Kareem Ahmed Karabo K Marole Om P Anand Rahat B Reshi Tej I Mehta Sameh Elias Joseph D Feuerstein department of Medicine Hackensack Meridian Health Palisades Medical CenterNorth BergenNJ 07047United States division of Gastroenterology and Hepatology University of Toledo Medical CenterToledoOH 43614United States department of Medicine University of WashingtonSeattleWA 98195United States department of radiology Johns Hopkins University HospitalBaltimoreMD 21218United States division of Gastroenterology Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA 02215United States

BACKGROUND Data regarding the worldwide gastrointestinal surgery rates in patients with Crohn’s disease(CD)remains *** To systematically review the global variation in the rates of surgery in *** A comprehensive search analysis was performed using multiple electronic databases from inception through July 1,2020,to identify all full text,randomized controlled trials and cohort studies pertaining to gastrointestinal surgery rates in adult patients with *** included continent based demographic data,CD surgery rates over time,as well as the geoepidemiologic variation in CD surgery *** analyses were conducted using *** Twenty-three studies spanning four continents were *** median proportion of persons with CD who underwent gastrointestinal surgery in studies from North America,Europe,Asia,and Oceania were 30%(range:1.7%-62.0%),40%(range:0.6%-74.0%),17%(range:16.0%-43.0%),and 38%*** clear association was found regarding the proportion of patients undergoing gastrointestinal surgery over time in North America(R^(2)=0.035)and Europe(R^(2)=0.100).A moderate,negative association was seen regarding the proportion of patients undergoing gastrointestinal surgery over time(R^(2)=0.520)in *** There appears to be significant inter-continental variation regarding surgery rates in *** evidencebased guidelines accounting for the geographic differences in managing patients with CD is ***,as a paucity of data on surgery rates in CD exists outside the North American and European continents,future studies,particularly in less studied locales,are warranted.

关键词： Gastrointestinal surgery Crohn’s disease Geoepidemiology Inflammatory bowel disease Prevalence