The SunoCaps dataset aims to provide an innovative contribution to music data. Expert description of human-made musical pieces, from the widely used MusicCaps dataset, are used as prompts for generating complete songs for this dataset. This Automatic Music Generation is done with the state-of-the-art Suno generator of audio-based music. A subset of 64 pieces from MusicCaps is currently included, with a total of 256 generated entries. This total stems from generating four different variations for each human piece; two versions based on the original caption and two versions based on the original aspect description. As an AI-generated music dataset, SunoCaps also includes expert-based information on prompt alignment, with the main differences between prompt and final generation annotated. Furthermore, annotations describing the main discrete emotions induced by the piece. This dataset can have an array of implementations, such as creating and improving music generation validation tools, training systems for multi-layered architectures and the optimization of music emotion estimation systems.
In the contemporary landscape of information technology, the advent of artificial intelligence (AI) in music composition marks a transformative era. This study examines differences in emotional expression accuracy between AI-generated music and compositions by traditional musicians, with a particular focus on Suno AI within the theoretical framework of Plutchik's "Wheel of Emotions." Emotional expression accuracy is defined as the degree of correspondence between the intended target emotion of a musical piece and the emotion perceived by listeners. An empirical approach was adopted to compare AI-generated and human-composed music and to evaluate the accuracy of emotional expression across four primary high-intensity emotions (ecstasy, rage, grief, and terror). A total of 32 musical pieces were analyzed, comprising 16 compositions by traditional composers and 16 works generated by Suno AI. Survey data were collected from 300 university students without formal music training, yielding 283 valid responses. The results revealed that emotional expression accuracy differed significantly between human-composed and AI-generated music for rage (χ2 = 40.66, p < 0.001, Cramer's V = 0.27), ecstasy (χ2 = 25.53, p < 0.001, V = 0.21), and terror (χ2 = 16.46, p < 0.001, V = 0.17), whereas no significant difference was observed for grief (χ2 = 2.44, p = 0.12, V = 0.07). Across emotions, the largest accuracy gap was observed for rage (25.40%), followed by ecstasy (21.50%) and terror (17.00%), while the difference for grief was comparatively smaller (4.20%) and not statistically significant. These findings suggest that the advantage of human-composed music over AI-generated music may vary across emotional categories, with more pronounced differences observed for high-arousal emotions. The results further indicate that, despite substantial advances in generative systems such as Suno AI, current AI models may still face limitations in representing high-intensity emotional states. Future research could further explore improvements in emotional conditioning mechanisms and training data diversity to enhance the emotional expression accuracy of AI-generated music.
Postoperative pancreatic fistula is a critical and feared complication after pancreaticoduodenectomy. While indocyanine green fluorescence angiography has successfully reduced anastomotic leaks in other surgeries, its role in assessing pancreaticojejunostomy perfusion remains unclear. Similarly, the use of indocyanine green-cholangiography for the early detection of bile leakage from the hepaticojejunostomy has limited evidence. This study aimed to evaluate intraoperative indocyanine green fluorescence angiography for assessing pancreaticojejunostomy perfusion and correlation with postoperative pancreatic fistula risk (primary endpoint) and to assess indocyanine green-cholangiography for detecting bile leakage from the hepaticojejunostomy during pancreaticoduodenectomy (secondary endpoint). We conducted a prospective cohort study of 100 patients undergoing pancreaticoduodenectomy. Indocyanine green fluorescence angiography was used to evaluate pancreaticojejunostomy perfusion and indocyanine green-cholangiography to assess hepaticojejunostomy integrity. Four blinded expert surgeons independently performed visual perfusion scoring of the pancreaticojejunostomy using a standardized 1-10 scale. Interobserver variability was assessed. Outcomes, including postoperative pancreatic fistula grades and bile leakage, were analyzed. Clinically relevant postoperative pancreatic fistula (grades B/C) occurred in 21 patients. Median visual indocyanine green risk scores were significantly higher in patients with postoperative pancreatic fistula compared with those without (4.75 vs 3.5; P = .014). Interobserver agreement was good (intraclass correlation coefficient, 0.76). Intraoperative indocyanine green-cholangiography detected bile leakage in 5 patients; 4 subsequently developed a postoperative leak. No adverse events from indocyanine green administration were observed. Intraoperative indocyanine green fluorescence angiography is feasible during pancreaticoduodenectomy and may assist in identifying patients at increased risk of postoperative pancreatic fistula, although its interpretation is limited by subjectivity. Indocyanine green-cholangiography offers valuable real-time insight into hepaticojejunostomy sufficiency, enabling the immediate detection of bile duct leakage and potentially facilitating timely surgical intervention.
Color vision in catarrhine primates relies on red-, green-, and blue-sensitive cone pigments that share an 11-cis-retinal chromophore but differ in absorption maxima. Red and green pigments arose by recent gene duplication and differ at only a few residues. Here, we report cryo-electron microscopy structures of red and green cone pigments from the cynomolgus macaque (Macaca fascicularis) integrated with low-temperature vibrational spectroscopy and quantum mechanical and molecular mechanical modeling. The red-green spectral shift is dominated by threonine 285, the hydroxyl dipole of which modulates chromophore electrostatics, whereas steric effects appear modest. We also identified membrane-facing lateral openings in cone pigments but not in inactive rhodopsin. Comparisons with active-state structures suggest activation-dependent gating, and mutational and spectroscopic analyses support a role for this opening in retinal uptake and rapid pigment regeneration.
Remimazolam (RMZ) is an ultrashort-acting benzodiazepine used in general anesthesia, metabolized rapidly by carboxylesterase 1, an enzyme primarily located in the liver. The Pringle maneuver (PM), an established technique commonly employed during hepatectomies to reduce bleeding, involves clamping major vessels, potentially affecting drug metabolism and clearance. Therefore, we conducted a study to investigate the changes in plasma concentration (Cp) of RMZ associated with the PM during hepatectomy and the impact on bispectral index (BIS) values. This single-center prospective observational pilot study included ten patients undergoing hepatectomy using the PM. Our findings showed that the changes in RMZ Cp immediately following each PM tended to be higher than those before PM in six cases, though this was not observed in others. However, there was no statistically significant difference between the median RMZ Cp after the final PM (1099 [723-1386] ng/mL) and before the initial PM (707 [641-856] ng/mL). Similarly, the median BIS value after the final PM (45 [40-46]) was comparable to the BIS prior to initiation of PM (46 [44-50]). This study suggested that RMZ may be safely administered during hepatectomies with PM in patients with Child-Pugh classification A. Clinical trial number: not applicable.
Complete endograft occlusion involving the main body and both limbs after endovascular aneurysm repair (EVAR) is rare, and the optimal treatment remains unclear. We report an 85-year-old male with late complete endograft occlusion after EVAR for an abdominal aortic aneurysm. Computed tomography (CT) showed complete thrombotic occlusion extending from just below the renal arteries to both iliac limbs and distally to the level of the external iliac arteries. A hybrid procedure was performed. After proximal recanalization under right renal artery protection, thrombectomy was performed through the left groin. Next, unilateral endograft relining was carried out using Ovation iX limbs, followed by femoro-femoral bypass. Postoperative CT confirmed patency of the relined limb, femoro-femoral bypass, and left external iliac artery reconstruction, with preserved bilateral renal perfusion. The ankle-brachial index improved from 0.58/0.49 to 0.95/0.88. Hybrid revascularization based on unilateral inflow reconstruction may be an effective option for selected patients with this rare complication.
Minimally invasive liver surgery usually involves the use of standard pneumoperitoneal pressure (12-15 mmHg) and low central venous pressure (CVP) management to reduce intraoperative bleeding while hereby possibly increasing the risk for gas embolism. The purpose of this study is to evaluate the efficacy and safety of low pneumoperitoneum pressure (Low-PP: 10 mmHg) compared to standard pneumoperitoneum pressure (Standard-PP: 12 mmHg) in patients undergoing robotic liver surgery (RLS) without active CVP management. A single-center retrospective cohort study was conducted from June 2019 to February 2024. Propensity-score matching analysis (1:1) was performed based on age, sex, BMI, ASA classification, diagnosis, and extent of resection (minor or major) for Low-PP group to Standard-PP group. The primary outcome were estimated blood loss (EBL), operating time (OT), length of stay (LOS), and complications (Clavien-Dindo classification). Before the propensity-score matching (PSM) analysis, the Low-PP group comprised 63 patients and the Standard-PP group comprised 130 patients. Following PSM analysis, each group comprised 62 patients. The pringle maneuver was performed significantly more frequently in the Low-PP group (87.1% vs 50.0%, p < 0.001). There were no statistically significant differences with regards EBL, OT, LOS, or overall/major complications between the two groups. Intraoperative anesthetic parameters were comparable, and no signs of gas embolism were observed in either group. In a subgroup analyis for minor and major resections, no statistically significant differences were observed in perioperative outcomes between the groups. Our study did not find any statistically significant difference in perioperative outcomes of patients undergoing RLS at a pneumoperitoneal pressure of 10 mmHg versus 12 mmHg. We therefore conclude that performing RLS using a pneumoperitoneal pressure of 10 mmHg PP is feasible and safe. Randomized controlled trials are needed to further investigate the potential and benefit of this strategy.
Medical students often struggle to engage with and retain complex pharmacology topics during their preclinical education. Traditional teaching methods can lead to passive learning and poor long-term retention of critical concepts. This study aims to enhance the teaching of clinical pharmacology in medical school by using a multimodal generative artificial intelligence (genAI) approach to create compelling, cinematic clinical narratives (CCNs). We transformed a standard clinical case into an engaging, interactive multimedia experience called "Shattered Slippers." This CCN used various genAI tools for content creation: GPT-4 for developing the storyline, Leonardo.ai and Stable Diffusion for generating images, Eleven Labs for creating audio narrations, and Suno for composing a theme song. The CCN integrated narrative styles and pop culture references to enhance student engagement. It was applied in teaching first-year medical students about immune system pharmacology. Student responses were assessed through the Situational Interest Survey for Multimedia and examination performance. The target audience comprised first-year medical students (n=40), with 18 responding to the Situational Interest Survey for Multimedia survey (n=18). The study revealed a marked preference for the genAI-enhanced CCNs over traditional teaching methods. Key findings include the majority of surveyed students preferring the CCN over traditional clinical cases (14/18), as well as high average scores for triggered situational interest (mean 4.58, SD 0.53), maintained interest (mean 4.40, SD 0.53), maintained-feeling interest (mean 4.38, SD 0.51), and maintained-value interest (mean 4.42, SD 0.54). Students achieved an average score of 88% on examination questions related to the CCN material, indicating successful learning and retention. Qualitative feedback highlighted increased engagement, improved recall, and appreciation for the narrative style and pop culture references. This study demonstrates the potential of using a multimodal genAI-driven approach to create CCNs in medical education. The "Shattered Slippers" case effectively enhanced student engagement and promoted knowledge retention in complex pharmacological topics. This innovative method suggests a novel direction for curriculum development that could improve learning outcomes and student satisfaction in medical education. Future research should explore the long-term retention of knowledge and the applicability of learned material in clinical settings, as well as the potential for broader implementation of this approach across various medical education contexts.
Erythroid cells contribute to embryonic organ development and adult tissue repair supplying oxygen to tissues. During mouse development, the primitive erythroid cells produced in the extraembryonic blood islands of the yolk sac begin to circulate as immature and nucleated erythroblasts with the onset of cardiac contractions around embryonic day 9.5 (E9.5). On the other hand, the definitive erythroid progenitors derived from the yolk sac and arterial vessels colonize the fetal liver, where they mature into small, enucleated definitive erythrocytes that are released into circulation at E11.5. In many cases, however, erythroblasts are also generated in situ during the development of tissue vasculature. We hypothesized that the properties of erythroid cells generated by peripheral tissue hematopoiesis may differ from those of contemporaneously circulating erythroid cells because hematopoiesis is spatiotemporally distinct from typical primitive and definitive hematopoiesis. Comparative in situ protein expression analyses of erythroid cells in developing tongue, circulation, and liver of fetal mice were performed at E12.5 and E14.5, using immunofluorescence staining of several marker proteins for erythroid and endothelial cells. At E12.5, irregularly elongated immature vascular endothelial cells, many of which were in contact with nucleated erythroblasts, were distributed in the developing tongue. In the three fetal locations examined (tongue, circulation, and liver), most erythroid cells at E12.5 expressed CD31, which is involved in cell-cell interactions; however, the expression was downregulated by E14.5. Interestingly, at E12.5, several erythroblasts strongly expressing CD31 were found in the tongue, but less abundant in the circulation and fetal liver. Nearly all erythroblasts in E12.5 fetuses expressed primitive erythroid cell-specific βH1-globin; however, those strongly expressing the embryonic globin were scattered, particularly in the tongue, fewer in the circulation and fetal liver. On the contrary, erythroid cells expressing adult β1-globin were scarcely found in the tongue, which is in stark contrast to those in the circulation and fetal liver, where nearly all erythroid cells weakly expressed β1-globin at the embryonic stage. At E14.5, the number of βH1-globin-expressing cells drastically decreased; however, it was still significantly higher in the tongue than in the circulation and fetal liver. In all three locations, β1-globin accumulation and the enucleation of erythroid cells progressed uniformly and rapidly from E12.5 to E14.5. The results indicate that primitive erythroblasts in the tongue highly express CD31, mature more slowly, and are replaced by definitive erythroid cells more slowly than those in the circulation and fetal liver. Primitive erythroblasts produced together with immature vascular endothelial cells during vasculogenesis in the developing tongue may perform functions other than oxygen supply, such as regulating vascular remodeling.
The M2 muscarinic receptor (M2R) is a prototypical G protein-coupled receptor (GPCR) that serves as a model system for understanding ligand recognition and GPCR activation. Here, using vibrational spectroscopy, we identify the mechanisms governing M2R activation by its native agonist, acetylcholine. Combined with mutagenesis, computational chemistry, and organic synthetic chemistry, our analyses found that the precise distance between acetylcholine and Asn404, one of the amino acids constituting the ligand-binding site, is important for M2R activation and that the N404Q mutant undergoes partial active state-like conformational changes. We discovered that a water molecule bridging acetylcholine and Asn404 forms a precise and flexible hydrogen bond network, triggering the outward movement of transmembrane helix 6 in M2R. Consistent with this observation, disruptions in this hydrogen bond network via chemical modification at the α- or β-position of acetylcholine failed to activate M2R. Collectively, our findings pinpoint Asn404 as a critical residue that both senses acetylcholine binding and induces M2R activation.
A 65-year-old man presented with Stanford type B aortic dissection complicated by rupture of the distal aortic arch, originating from the false lumen. Due to the short distance between the supra-aortic branches, the lack of peripheral access from malperfusion, and the invasiveness of combined arch and descending aortic replacement via left thoracotomy, emergency total arch replacement with a frozen elephant trunk was chosen to close the primary entry and control the rupture. However, intraoperative deployment of the prosthesis into the false lumen was suspected due to increasing bleeding and transesophageal echocardiographic findings. Seamless endovascular fenestration of the dissection flap was performed intraoperatively using the tail of a stiff wire under fluoroscopic guidance. By adding stent grafts to the distal true lumen, bleeding from the ruptured aorta was successfully controlled. This case highlights the feasibility and utility of a rapid, simplified intraoperative endovascular fenestration technique in a critical emergency time setting, demonstrating a life-saving strategy when the device is inadvertently deployed into the false lumen.
Postoperative pancreatic fistula (POPF) remains the most severe complication following distal pancreatectomy (DP). The preoperative distal fistula risk score (D-FRS) was introduced to predict the POPF risk. The aim of this study was to externally validate the D-FRS in an international expert center cohort. This international, multicenter, retrospective cohort study included open and minimally invasive DP for benign and malignant lesions performed from 01/2014 until 12/2023 in 12 centres from 6 countries, that each performed more than 50 pancreatectomies annually. The D-FRS was calculated from pancreatic thickness and duct size. Predicted and actual POPF were compared using sensitivity, specificity and area under the curve (AUC). A total of 778 patients underwent DP of whom 284 (39%) underwent robotic, 278 (38%) open and 165 (23%) laparoscopic DP. The rate of POPF was 32%. The sensitivity, specificity and AUC of the D-FRS for the overall cohort was 32%, 63% and 48% (95% CI 44-51%), respectively. The AUC for open, laparoscopic and robotic DP was 54% (48-60%), 47% (39-55%) and 45% (39-50%), respectively. For neoadjuvant therapy naïve patients the AUC was 52.3%. On multivariate analysis POPF was associated with body mass index (odds ratio 1.04 (95% CI 1.01-1.07)), protective factors were neoadjuvant therapy (OR 0.54 (0.22-0.94)) and the robotic approach (OR 0.64 (0.42-0.97)). The preoperative D-FRS showed insufficient discrimination to identify patients who develop POPF after DP irrespective of the surgical approach. Novel preoperative POPF risk scores are needed, considering the standard minimally invasive approach and the widespread use of neoadjuvant therapy.
Filgotinib (FLG) is a Janus kinase 1 inhibitor and is metabolized to an active metabolite, GS-829845. There is no report on the method for simultaneous quantification of FLG and GS-829845 in clinical samples. We developed a liquid chromatography-tandem mass spectrometry method for simultaneous determination of FLG and GS-829845 in patient plasma. FLG and GS-829845 were extracted from an aliquot of 50 μL of human plasma by simple deproteinization using methanol. Chromatographic separation was performed using a Shim-pack Scepter C18-120 column with a combined mobile phase of water and methanol containing 0.1% formic acid and gradient elution at a flow rate of 0.2 mL/min. Detection was performed by positive electrospray ionization using a QTRAP 4500 mass spectrometer. The method was validated in the concentration range of 2.5-50 ng/mL for FLG and 250-5000 ng/mL for GS-829845. Intra- and inter-day assay accuracy and precision were within 11.4% and 13.9%, respectively. Recoveries and matrix effects were consistent and reproducible. This developed and fully validated method is simple, rapid, and cost-effective and was used successfully for therapeutic drug monitoring in a patient with rheumatoid arthritis.
Reduced port surgery (RPS) for colorectal cancer has been associated with favorable cosmetic outcomes; however, its safety and efficacy are inconclusive. The purpose of this study is to clarify the efficacy and safety of laparoscopic RPS for colorectal cancer. A randomized controlled trial of laparoscopic multi-port surgery (MPS) and RPS for colorectal cancer except lower rectal cancer was conducted from 2014 to 2020. The eligibility criteria were elective surgery for clinical stages 0-III and D2 or D3 lymph node dissection. MPS was defined as 4- to 5-port and RPS as 1- to 2-port. Short- and long-term results and health-related quality of life (HRQOL) scores at 1 month and 1 year postoperatively were compared. Ninety-one patients (46 MPS; 45 RPS) were analyzed. The short-term results (MPS: RPS), operative time, blood loss, and incidence of early complications did not differ. There was a significant difference in the length of postoperative stay (11:9 days, p = 0.034). The long-term results showed no differences in the 5-year overall survival rates and cancer-specific survival rates. Regarding HRQOL, there were no differences in the eight subscales and two summary scores at 1 month and 1 year postoperatively. Short- and long-term outcomes and HRQOL scores of RPS for colorectal cancer were similar to those of MPS. RPS may be a potential therapeutic option for colorectal cancer.
This is the first case report of single-incision laparoscopic surgery using the Dome Port for colon cancer. Dome Port is designed to enhance the operability and safety of single-incision surgery. The key advantages are as follows. First, this device is made of transparent silicone, allowing the surgeon to directly visualize the insertion of surgical instruments. Second, the flexible silicone material minimizes interference between surgical instruments and the port. A 70-year-old female visited our hospital with occult blood test positive. She underwent a myoma resection approximately 20 years ago. A lower midline abdominal incision was present. Preoperative examination revealed the presence of advanced tumor in the cecum colon. Ileocecal resection was performed as the laparoscopic single-port technique using Dome Port. The procedure was performed safely, with an operation time of 138 min. The patient experienced minimal postoperative pain and resumed oral intake on postoperative day 2. The patient was discharged on postoperative day 6 without major complications. The Dome Port's transparent silicone construction allowed direct visualization of instrument insertion, enhancing procedural safety, while its flexible material minimized instrument interference and improved ergonomic manipulation. Compared to conventional single-incision ports, these features may reduce operative difficulty and the risk of instrument collisions, potentially contributing to smoother workflows and lower complication rates. The Dome Port was effective for single-incision laparoscopic ileocecal resection and may facilitate safer surgical procedures. It is expected to become one of the options for future reduced port surgery.
Lenvatinib (LEN) concentrations in patients undergoing hemodialysis (HD) have not been examined. Herein, we report the effect of HD on total and free LEN concentrations in a patient with mRCC. The hemodialyzed patient was a 55-year-old Japanese male who was treated with 20 mg LEN daily. The area under the plasma concentration-time curve for LEN from 0 to 24 h (AUC0-24) was calculated on Day 8 (off HD) and Day 9 (on HD) after starting administration of LEN. For total LEN on Days 8 and 9, the AUC0-24 was 2553 and 2783 ng × h/mL, respectively. The free LEN concentration just after HD on Day 9 was 40% lower than that at the same time on Day 8 (1.8 vs. 3.0 ng/mL). Although the free LEN concentration is reduced just after HD, LEN will have sufficient pharmacological activity on HD days for patients undergoing HD.
The κ-opioid receptor (KOR) is a member of the G protein-coupled receptor (GPCR) family, modulating cellular responses through transducers such as G proteins and β-arrestins. G-protein-biased KOR agonists aim to retain analgesic and antipruritic actions while limiting aversion and sedation. Aiming to inform G-biased KOR agonist design, we analyze signaling-relevant residues from structural and dynamic views. Here we show, using multiple complementary methods, shared residues that determine β-arrestin recruitment by nalfurafine and U-50,488H. Cryo-electron microscopy structures of the KOR-Gi signaling complexes identify the ligand binding mode in the activated state. Vibrational spectroscopy reveals ligand-induced conformational changes. Cell-based mutant experiments pinpoint four amino acids (K2275.40, C2866.47, H2916.52, and Y3127.34; Ballesteros-Weinstein numbering is shown in superscript) that play crucial roles in β-arrestin recruitment. Furthermore, MD simulations revealed that the four mutants tend to adopt conformations with reduced β-arrestin recruitment activity. Our research findings provide a foundation for enhancing KOR-mediated therapeutic effects while minimizing unwanted side effects by targeting specific residues within the KOR ligand-binding pocket, including K2275.40 and Y3127.34, which have previously been implicated in biased signaling.
Robotic distal pancreatectomy is increasingly utilized for the treatment of both benign and malignant lesions in the body and tail of pancreas. The aim of the current study was to report outcomes of the implementation of robotic distal pancreatectomy in a high-volume center with special emphasis on the learning curve. This was a retrospective single-center study of consecutive patients undergoing robotic distal pancreatectomy performed by a dedicated team of three surgeons at a high-volume HPB center from September 2019 to November 2023. Patients with borderline or locally advanced tumors, or ingrowth in neighboring organs were not included for robotic approach. Intra- and postoperative outcomes were registered and compared across three pre-defined time periods of the first 40, middle 40 and remaining 40 procedures. Cumulative sum analysis was performed for the outcomes duration of surgery and textbook outcome. A total of 120 consecutive patients were included. The mean duration of surgery decreased significantly from 264 min to 239 min and lastly 222 min per procedure (P = 0.003) and the learning curve for this outcome was reached after 70 cases. The rate of splenic preservation was highest in the last period (12.5% vs. 12.5% vs. 30.0%, P = 0.066). The rate of textbook outcome across the three time periods increased (62.5% vs. 70.0% vs. 82.5%) and most benchmark values were obtained in the third period. The learning curve effect reached benchmark outcome values after 60 procedures and achieved better than expected outcomes after 90 procedures. Robotic distal pancreatectomy was safely implemented in a high volume HPB-center going from open to robotic approach. The learning curve was surpassed after 19 procedures reaching benchmark outcome values after 60 procedures.
This study evaluated a novel contrast-enhanced (CE) fluoroscopy protocol for endoscopic retrograde cholangiopancreatography, which optimizes image processing to enhance contrast of devices and contrast media. We compared the CE protocol with the conventional standard protocol to assess its potential for reducing radiation exposure while improving image visibility. The study utilized a multidirectional fluoroscopy unit and phantoms to evaluate the new CE protocol against the conventional protocol. Comparisons included radiation dose rates, spatial resolution, and concentration resolution under various fluoroscopic conditions. The investigation aimed to determine if the CE protocol offered improved visibility while potentially reducing radiation exposure. Three CE protocol modes (LOW-7.5 fps, MID-3.75 fps, and LOW-3.75 fps) achieved lower dose rates than the standard MID-7.5 fps mode commonly used in clinical practice. Dynamic spatial resolution was significantly superior in all three CE modes compared to the standard protocol (p < 0.0167). Static spatial resolution did not differ significantly between protocols. Only the CE MID-3.75 fps mode showed superior concentration resolution compared to the standard protocol (p < 0.00833). The novel CE fluoroscopy protocol provides superior dynamic spatial resolution in endoscopic retrograde cholangiopancreatopgraphy while reducing radiation exposure, potentially enhancing procedure guidance and safety for both patients and clinicians.