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摘要： Artificial Intelligence (AI), particularly in the domains of computer vision and deep learning (DL), is increasingly being integrated into medical diagnostics. Although it has not yet entirely transformed clinical practice, its role in medical image analysis is rapidly expanding, offering the potential for more accurate, efficient, and accessible diagnostic capabilities that contribute to improved patient outcomes. Currently, DL techniques are employed in a variety of medical imaging tasks, such as anomaly detection, pathology classification, and anatomical structure segmentation across modalities, including endoscopy, MRI, and CT scans. Despite these advancements, the widespread clinical adoption of DL models remains constrained by several limitations, including the opacity of model decision-making, data imbalance, and lack of interpretability. To address these challenges, this study proposes an explainable knowledge distillation (KD) framework that integrates Gradient-weighted Class Activation Mapping (Grad-CAM) with a ResNet-based teacher-student architecture. The proposed methodology was evaluated on a class-imbalanced dataset comprising ten categories of gastrointestinal (GI) abnormalities derived from the Capsule Vision 2024 Challenge. The resulting student model achieved a classification accuracy of 96.52% and an F1-score of 96.37%, thereby surpassing previously reported methods.

摘要： We present an independent calibration of the photometric redshift (photo-z) distributions for source galaxies in the Hyper Suprime-Cam year 3 (HSC Y3) weak lensing survey using small-scale galaxy-galaxy lensing. By measuring the tangential shear around spectroscopic lens galaxies from Galaxy and Mass Assembly, Sloan Digital Sky Survey, and Dark Energy Spectroscopic Instrument (DESI), divided into 15 narrow redshift bins, we compute shear ratios that are sensitive to the mean redshift of source galaxies. Using a blinded analysis, we derive constraints on the photo-z bias parameters in source bins 2, 3, and 4, achieving signal-to-noise ratios of 59, 75, and 62, respectively. Our constraints for Δz2, Δz3, and Δz4 are consistent with those from HSC Y3 cosmic shear modeling. We observe a mild shift in the Δz3−Δz4 plane due to the heterogeneous depth of the lens sample, which disappears when using only DESI Data Release 1 lenses. Combining shear-ratio measurements with cosmic shear data, we obtain joint constraints on cosmological parameters: Ωm=0.304−0.029+0.03 and S8=0.773−0.031+0.031, consistent with cosmic shear-only results. This work demonstrates the utility of small-scale lensing as an independent probe for calibrating photometric redshift bias in weak lensing cosmology.

关键词： high-risk percutaneous coronary intervention   major adverse cardiovascular and cerebrovascular events   coronary artery calcification   atherectomy   PROTECT III   CABG   coronary artery bypass graft   CAC   coronary artery calcification   CAD   coronary artery disease   HRPCI   high-risk percutaneous coronary intervention   LVEF   left ventricular ejection fraction   MACCE   major adverse cardiovascular and cerebrovascular event(s)   MI   myocardial infarction   PCI   percutaneous coronary intervention   pLVAD   percutaneous left ventricular assist device   SYNTAX   synergy between percutaneous coronary intervention with taxus and cardiac surgery  

摘要： Severe coronary artery calcification (CAC) complicates high-risk percutaneous coronary intervention (HRPCI), particularly in patients with impaired left ventricular function. Atherectomy may facilitate lesion preparation, but its use in high-risk settings is limited. We therefore aimed to assess the impact of CAC severity and atherectomy on outcomes in Impella-supported HRPCI. In the PROTECT III study (NCT04136392), 1,015 of 1,237 patients had data on CAC severity and atherectomy. Patients were grouped as severe CAC without atherectomy (n = 298), severe CAC with atherectomy (n = 326), and no severe CAC (n = 400). The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE: all-cause death, myocardial infarction, stroke/TIA, or repeat revascularization) at 30- and 90-days. Secondary endpoints included 1-year mortality, PCI-related complications, and hemodynamic instability. Patients with severe CAC had higher baseline SYNTAX scores and more left main disease. Atherectomy was associated with slightly longer procedural times, but not increased periprocedural complications or hemodynamic instability. At 90 days, MACCE was highest in the untreated severe CAC group (16.1% vs 12.6% vs 9.2%; overall log-rank p = 0.048). One-year mortality was also highest in this group (23.7%; p = 0.02). However, CAC severity and atherectomy use were not independent predictors of outcomes. Sensitivity analysis excluding patients with atherectomy but no severe CAC showed higher mortality risk in untreated severe CAC cases (adjHR: 0.59; overall p = 0.026). In conclusion, Severe CAC is common in patients undergoing Impella-supported HRPCI and is associated with worse outcomes. Atherectomy was safe but its benefit remains uncertain. These findings highlight the prognostic relevance of CAC and the potential role of calcium modification in HRPCI.

关键词： Tropane alkaloids   Atropine   Scopolamine   Stability   Degradation   Charged Aerosol Detection   Mixed Mode Column  

摘要： Medicines often have a much longer shelf life than stated by the manufacturer. Due to the high costs of emergency stockpiling, but also due to supply shortages, an extended shelf life can offer many advantages. In this study, three injection solutions containing atropine, scopolamine and belladonna total alkaloids, respectively, manufactured between 1940 and 1960 and stored under uncontrolled conditions, were tested, to show that pharmaceutical products, containing tropane alkaloids, are significantly more stable than expected after some 80 years. To analyze the stability of the main alkaloids atropine and scopolamine, a method using charged aerosol detection (CAD) was developed and validated. CAD enables the detection of degradation products that lack a chromophore and cannot be detected using pharmacopoeial (UV) methods. For separation a SIELC Primesep 200 column (4.6 ×150 mm; 100 Å; 3 µm) and gradient elution with water, acetonitrile and formic acid were used. The results indicated a high stability of atropine, with a determined content of 101.9 % and a small amount of degradation products. Scopolamine, however, showed higher degree of degradation with a remaining content of 68 %.

关键词： Drug-eluting stent   Polymer-free stent   Vascular healing   Percutaneous coronary intervention   Stent thrombosis   ACS   Acute coronary syndrome   CAD   Coronary artery disease   DES   Drug-eluting stent   PCI   Percutaneous coronary intervention   TLF   Target lesion failure  

摘要： In contemporary coronary intervention, an intriguing shift is taking place. The central question may no longer be which drug-eluting stent performs best, but rather which revascularization strategy allows the vessel to heal best. This perspective ...

关键词： breast cancer   breast cancer awareness   breast cancer awareness measure (Breast-CAM)   early detection   systematic review   meta-analysis   psychometric properties  

摘要： Background/Objectives: Breast cancer awareness is essential for early detection and timely help-seeking among women and represents a key component of multidisciplinary breast cancer prevention. The Breast Cancer Awareness Measure (Breast-CAM) is widely used to assess awareness of breast cancer symptoms, risk factors, and screening behaviors. Its measurement quality across populations has not yet been comprehensively evaluated. As Breast-CAM is a population-reported measurement instrument, evaluation using a standardized framework for measurement properties is required. This systematic review and meta-analysis aimed to assess the psychometric properties of the Breast-CAM across diverse populations and cultural adaptations, in accordance with COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) methodological standards. Methods: Major bibliographic databases and trial registries were systematically searched for peer-reviewed English-language studies published between 2010 and 2025 that evaluated at least one psychometric property of the Breast-CAM in adult women. Methodological quality was assessed using the COSMIN Risk of Bias checklist. Measurement properties were evaluated according to COSMIN criteria, and the certainty of evidence was graded using a modified GRADE approach. Meta-analysis was performed when data were sufficiently comparable. Results: Seventeen studies met the inclusion criteria for narrative synthesis, of which eleven were included in a meta-analysis, representing fourteen cultural adaptations of the instrument. A descriptive random-effects meta-analysis of reported Cronbach's alpha yielded a pooled estimate of 0.89 (95% confidence interval 0.85-0.92). This value should be interpreted cautiously, as structural validity was frequently insufficient across cultural adaptations, limiting interpretation of internal consistency according to COSMIN guidance. Other measurement properties, including reliability and measurem

关键词： complex PCI   high bleeding risk   major adverse cardiac events   percutaneous coronary intervention   clinical outcomes   ARC   Academic Research Consortium   CAD   Coronary artery disease   DAPT   Dual antiplatelet therapy   HBR   High-bleeding risk   MACE   Major adverse cardiac events   MI   Myocardial infarction   PCI   Percutaneous coronary intervention   TLR   Target lesion revascularization   TVR   Target vessel revascularization  

摘要： The impact of complex coronary anatomy on outcomes in patients at high bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI) remains unclear. Patients from a large PCI referral center were labeled as HBR in presence of ≥1 major or ≥2 minor Academic Research Consortium HBR criteria and undergoing complex PCI if they had any of the following: ≥3 vessels treated, ≥3 stents implanted, ≥3 lesions treated, stent length >60 mm, bifurcation lesion with ≥2 stents, PCI of chronic total occlusion, left main, saphenous venous graft or requiring the use of atherectomy. Primary outcomes at 1 year were major adverse cardiac event (MACE), a composite of all-cause death, myocardial infarction or target vessel revascularization, and major bleeding. Of 16,966 patients, 7,295 (43.0%) were HBR with 3,611 (49.5%) undergoing complex PCI and 9,671 (57.0%) were non-HBR with 4,103 (42.4%) undergoing complex PCI. At 1 year, patients with complex PCI had a higher risk of MACE in both HBR (adjusted Hazard Ratio [adj. HR] 1.78, 95% Confidence Interval [95% CI] 1.54 to 2.06) and non-HBR (adj. HR 1.82 95% CI 1.55 to 2.12, respectively, p_int 0.64) groups and a higher risk of major bleeding (adj. HR 1.55, 95% CI 1.29 to 1.87 and adj. HR 1.36, 95% CI 1.03 to 1.78, respectively; p_int = 0.46), as compared to patients undergoing noncomplex PCI. In conclusion, complex PCI was associated with significantly higher risk of ischemic and bleeding adverse outcomes at 1-year in both HBR and non-HBR patients.

关键词： CABG   CAD   PCI   SAVR   TAVR  

摘要： The optimal management of patients presenting with the dual burden of severe aortic stenosis (AS) and concomitant coronary artery disease (CAD) is a hotly debated issue in cardiovascular medicine. Historically, surgical aortic valve replacement (S...

关键词： Cup positioning   dual mobility prosthesis   intraprosthetic impingement   prosthesis neck design   thumb biomechanics   trapeziometacarpal arthroplasty  

摘要： Introduction: Posteroanterior cup angulation relative to the proximal articular surface of the trapezium (PAST) and neck type (15 degrees offset or 0 degrees straight) may influence the risk of intraprosthetic impingement in the TOUCH (R) prosthesis. We assessed this relationship using a computer-aided design (CAD) simulation and a cadaver ***: In the CAD simulation, cup orientation was varied anteriorly and posteriorly from 0 to 30 degrees. For each cup placement, both necks were tested by simulating flexion and extension of the thumb until impingement occurred between the neck and the cup's rim. In the cadaver study, which included 24 hands, 14 cups were tilted between 0 and 15 degrees anteriorly, eight cups were tilted 15 degrees or more anteriorly and two cups were tilted between 0 and 15 degrees posteriorly. For all specimens, and both neck types, the occurrence of impingement was determined when the thumb was flexed to 10 degrees, then extended to 20 and 40 ***: For both necks and with the cup in a neutral position, there was no impingement. An incorrect cup orientation caused mechanical impingement when the thumb was extended. For extensions of 30 degrees (CAD) and 40 degrees (cadaver), impingement occurred when the cup was tilted 15 degrees anteriorly with the offset neck, whereas it occurred with a cup tilted 30 degrees anteriorly with the straight neck. The neck length did not influence the risk of ***: Posteroanterior cup angulation influences the choice of neck type. To minimize the risk of impingement, cup placement parallel to the PAST is optimal. When the cup is tilted 15 degrees or more anteriorly, we recommend using a straight neck to reduce the risk of impingement during thumb extension.