Miracle-dz/UniFAR-FTUs huggingface dataset:
Endoscopic ultrasound-guided colo-colostomy in a case of acute large bowel obstruction

Abstract Bowel obstruction is one of the most common surgical emergencies and a major cause of morbidity and mortality. Standard supportive measures must be instituted as soon as the diagnosis is confirmed. Anastomotic strictures are a benign etiology of intestinal obstruction, occurring in up to 22 % of patients following colorectal resection. Traditionally, endoscopic balloon dilation (EBD) has been the intervention of choice in such cases; however, it may not be feasible in all settings. We report a novel application of the AXIOS stent and electrocautery-enhanced delivery system (Boston Scientific, Marlborough, Massachusetts, United States) to create a colo-colostomy to bypass a sigmoid colon stricture in a 51-year-old woman who presented with acute intestinal obstruction. Despite stent dislodgment during the procedure, the preexisting tract allowed us to improvise our technique with a second LAMS placement. The patient was discharged well 48 hours after the procedure. However, 4 months later, she required a session of EBD following a presentation for fecal impaction. She is currently asymptomatic and being followed up regularly as an outpatient.
Lymph Node Tumor Burden Correlates With Tumor Budding and Poorly Differentiated Clusters: A New Prognostic Factor in Colorectal Carcinoma?

INTRODUCTION: Molecular lymph node (LN) staging in early colorectal cancer (CRC) has demonstrated to be more precise than conventional histopathology pN staging. Tumor budding (TB) and poorly differentiated clusters (PDCs) are associated with LN metastases, recurrences, and lower survival in CRC. We evaluated the correlation between the total tumor load (TTL) in LNs from CRC surgical specimens with patient outcome, TB, and PDC. METHODS: In this retrospective multicentre study, 5,931 LNs from 342 stage I–III CRC were analyzed by both hematoxylin and eosin and molecular detection of tumor cytokeratin 19 mRNA by one-step nucleic acid amplification. TB and PDC were evaluated by hematoxylin and eosin and cytokeratin 19 immunohistochemistry. Results: One-step nucleic acid was positive in 38.3% patients (n = 131). Tumor Budding was low in 45% cases, intermediate in 25%, and high in 30%. Poorly Differentiated Clusters were low-grade G1 in 53%, G2 in 32%, and G3 in 15%. TB and PDC correlated with TTL, high-grade, lymphovascular and perineural invasion, pT, pN and stage (P < 0.001). TB, PDC, and TTL ≥ 6,000 copies/µL were associated with worse overall survival (P = 0.002, P = 0.013, and P = 0.046) and disease-free survival (P < 0.001). Discussion: The implementation of more sensitive molecular methods to assess LN status is a promising alternative approach to pN staging, which could be integrated to other factors to help risk stratification and management of patients with early-stage CRC. This study demonstrates the correlation of the amount of LN tumor burden with TB and PDCs. TTL is related to the outcome and could be used as a new prognostic factor in CRC (see Visual Abstract, Supplementary Digital Content 2, http://links.lww.com/CTG/A512).
Pathologic-Based Nomograms for Predicting Overall Survival and Disease-Free Survival Among Patients with Locally Advanced Rectal Cancer

Purpose Preoperative neoadjuvant therapy is standard before surgery for locally advanced rectal cancer in current clinical treatment. However, patients with the same clinical TNM stage before treatment vary in clinical outcomes. More and more studies noted that pathological findings after preoperative neoadjuvant therapy are better prognostic factors to determine prognosis than clinical TNM stage in patients with locally advanced rectal cancer. The purpose of this study is to develop and validate models based on pathological findings to predict overall survival (OS) and disease-free survival (DFS). Patients and Methods A total of 3026 patients from two hospitals were included. The endpoint was OS and DFS. Significant predictors of OS on multivariate analysis were used to establish the nomogram. Results The Harrell’s C index for OS prediction was 0.72 (95% confidence interval [CI], 0.68 to 0.77) in the training cohort, 0.66 (95% CI, 0.60 to 0.72) and 0.68 (95% CI, 0.64 to 0.73) in the internal and external validation cohorts. Using this nomogram, high- and low-risk groups for OS were defined in the training cohort. The 3-year OS was 78.1% (95% CI: 72.4–84.2%) for the high-risk group and 95% (95% CI: 93.6–96.5%) in the low-risk group (HR: 4.42, 95% CI: 3.22–6.05; P<0.001). This finding was also applied in the two external cohorts. Similarly, a nomogram that contained the same indices was developed and validated to predict for DFS. Conclusion Nomograms based on pathological findings are a reliable tool to predict 3-year OS and DFS rate in patients with locally advanced rectal cancer.
Acute biliary pancreatitis has better outcomes but increased resource utilization compared to acute alcohol-induced pancreatitis: insights from a nationwide study

Background The differences in outcomes between acute biliary pancreatitis (ABP) and acute alcohol-induced pancreatitis (AAP) have not been well studied. We sought to examine the differences between ABP and AAP as regards to in-hospital outcomes and resource utilization, using a large nationwide database. Methods We queried the National Inpatient Sample databases 2016 and 2017 using the International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) coding system to identify the patients with a primary diagnosis of AAP and ABP. The primary outcome was all-cause in-hospital mortality. Secondary outcomes were hospital length of stay (LOS), hospitalization charge/cost, shock, acute kidney injury (AKI), intensive care unit (ICU) admission, and home discharge. Analysis was performed with STATA software. Results There was no significant difference in mortality between patients with AAP and ABP (0.42% vs. 0.82%, adjusted odds ratio [aOR] 0.95, 95% confidence interval [CI] 0.69-1.31; P=0.79). Patients with ABP had a significantly longer LOS (+0.48 days, P<0.001). Patients with ABP had significantly higher adjusted mean hospitalization charges ($+19,958, P<0.001) and costs ($+4,848, P<0.001). Patients with ABP had a significantly lower likelihood of shock (aOR 0.75, 95%CI 0.59-0.95; P=0.02), AKI (aOR 0.76, 95%CI 0.71-0.82; P<0.001) or ICU admission (aOR 0.74, 95%CI 0.62-0.88; P=0.001). They were more likely to be discharged home (aOR 1.26, 95%CI 1.18-1.34; P<0.001). Conclusion Although there was no difference in all-cause mortality, patients with ABP had better hospitalization outcomes but greater resource utilization.
Prevalence of Eclampsia and Its Maternal-Fetal Outcomes at Gandhi Memorial Hospital, Addis Ababa Ethiopia, 2019: Retrospective Study

Background Eclamptic disorder during pregnancy is one of the common problems in sub-Saharan countries and forms one of the deadly triads along with hemorrhage and infection which complicates feto-maternal outcomes of pregnancy. So, the purpose of this study was to assess the prevalence of eclampsia and its maternal and fetal outcome in Gandhi Memorial Hospital, Addis Ababa Ethiopia, 2019. Methods A descriptive retrospective cross-sectional study was employed on a review of all cases of women who were delivered at Gandhi memorial Hospital from 1st of September 2017 to –last of August 2018. Data were analyzed using SPSS version 25 software. Descriptive statistics were used to calculate frequencies and percentages and data was presented using texts and, tables. Results Out of the total deliveries, the prevalence of eclampsia was found to be 6.2%. In our experience of a very high rate of eclampsia, fortunately, we had only 3 maternal deaths out of the total cases. However, neonatal mortality and stillbirths had been extremely high: 41 (22.1%) of stillbirths and 30.3% neonatal deaths (a total burden of 52.4% of perinatal mortality). About 70.8% had reported a history of prior pregnancy-induced hypertension and 73.5% induced their current pregnancy following eclampsia. From mothers who required interventions to terminate the pregnancy by induction, 47.8% ended by cesarean section secondary to non-reassuring fetal status (29.2%). The majority (91.9%) had taken magnesium sulfate for the management of convulsion and 86.5% had taken hydralazine for hypertension management. Abruption of the placenta (96.2%), postpartum-hemorrhage (89.2%), and HELLP syndrome (83.8%) were major maternal adverse outcomes reported, and 22.1% of pregnancy was ended as stillbirth. Over 53.6% of delivered babies, 18.4% of neonates required admission to nursery/NICU referral. Conclusion The prevalence of eclampsia was relatively high, with corresponding high maternal and perinatal morbidity and mortality. Increasing early detection before pregnancy, antenatal screening, and the use of magnesium sulfate to control convulsions will reduce the disorder and associated morbidity and mortality for both mother and fetus.
High sensitivity of ROSE-supported ERCP-guided brushing for biliary strictures

Abstract Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) plays a major role in biliary strictures, with brushing being a cheap and fast method to acquire a cytological specimen, despite a sensitivity around 45 %. Rapid on-site evaluation (ROSE) is widely used for endoscopic ultrasound-acquired cytological specimen adequacy, improving its sensitivity and specificity. Nevertheless, no study has evaluated its role for ERCP-guided brushing. Our aim was to assess the diagnostic yield of ERCP-guided brushing of biliary strictures when supported by ROSE. Patients and methods This was a retrospective single-center study that included patients undergoing ERCP-guided brush cytology supported by ROSE for biliary strictures. Recorded data included patient clinical-radiological and ERCP features. Final diagnosis was determined after surgery, intraductal biopsy or adequate follow-up. The diagnostic yield was calculated and a subgroup analysis for factors associated with false-negative or true-positive results was performed. Results Two hundred six patients were included, 57.3 % males, median age 72 years, 77.2 % having extrahepatic biliary strictures. Of the patients, 99 % had an adequate sample at ROSE after a mean of 2.6 passages. The diagnostic yield was accuracy 83 %, sensitivity 74.6 %, and specificity 98 %, positive and negative predictive values 98 % and 71 % respectively, with an area under the curve of 0.86. A diagnosis of cholangiocarcinoma was significantly more frequent among true-positive cases (68 % vs 46.8 %; P = 0.04). Conclusions This is the first study evaluating the use of ROSE as support for ERCP-guided brushing of biliary strictures, with a sensitivity far higher than those reported for brushing alone and at least comparable to those of more expensive and invasive techniques.
Current Trends in Endoscopic Diagnosis and Treatment of Early Esophageal Cancer

Simple Summary Early esophageal cancer is diagnosed in the context of reflux disease, surveillance of Barrett’s metaplasia, or during upper gastrointestinal endoscopy for other indications. High definition and virtual or dye chromoendoscopy are mandatory for the screening and evaluation of neoplasia. Endoscopic treatment options include endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). Resection is considered curative if histopathology confirms low or absent risk of lymph node metastasis. Barrett’s high-grade dysplasia or early adenocarcinoma is treated by EMR or ESD, followed by ablation of Barrett’s epithelium to avoid metachronous cancer. ESD is the treatment of choice for squamous cell neoplasia. Excellent outcomes have been reported if the ESD of squamous cell cancer with slight submucosal infiltration and thus substantial risk for lymph node metastasis was combined with adjuvant chemo-radiotherapy. In contrast, infiltration of squamous cell cancer exceeding the lamina propria mucosae is not curative. However, despite a substantial risk of lymph node metastasis, excellent outcomes have recently been reported if endoscopic resection of tumors with up to 200 µm submucosal infiltration was combined with adjuvant chemo-radiotherapy. Abstract Diagnosis of esophageal adenocarcinoma mostly occurs in the context of reflux disease or surveillance of Barrett’s metaplasia. Optimal detection rates are obtained with high definition and virtual or dye chromoendoscopy. Smaller lesions can be treated with endoscopic mucosal resection. Endoscopic submucosal dissection (ESD) is an option for larger lesions. Endoscopic resection is considered curative (i.e., without significant risk of lymph node metastasis) if histopathology confirms en bloc and R0 resection of a well-differentiated (G1/2) tumor without infiltration of lymphatic or blood vessels and the maximal submucosal infiltration depth is 500µm. Ablation of remaining Barrett’s metaplasia is important, to reduce the risk of metachronous cancer. Esophageal squamous cell cancer is associated with different risk factors, and most of the detected lesions are diagnosed during upper gastrointestinal endoscopy for other indications. Virtual high definition and dye chromoendoscopy with Lugol’s solution are used for screening and evaluation. ESD is the preferred resection technique. The criteria for curative resection are similar to Barrett’s cancer, but the maximum infiltration depth must not exceed lamina propria mucosae. Although a submucosal infiltration depth of up to 200 µm carries a substantial risk of lymph node metastasis, ESD combined with adjuvant chemo-radiotherapy gives excellent results. The complication rates of endoscopic resection are low, and the functional outcomes are favorable compared to surgery.
Physical-Layer Security via Distributed Beamforming in the Presence of Adversaries with Unknown Locations

We study the problem of securely communicating a sequence of information bits with a client in the presence of multiple adversaries at unknown locations in the environment. We assume that the client and the adversaries are located in the far-field region, and all possible directions for each adversary can be expressed as a continuous interval of directions. In such a setting, we develop a periodic transmission strategy, i.e., a sequence of joint beamforming gain and artificial noise pairs, that prevents the adversaries from decreasing their uncertainty on the information sequence by eavesdropping on the transmission. We formulate a series of nonconvex semi-infinite optimization problems to synthesize the transmission strategy. We show that the semi-definite program (SDP) relaxations of these nonconvex problems are exact under an efficiently verifiable sufficient condition. We approximate the SDP relaxations, which are subject to infinitely many constraints, by randomly sampling a finite subset of the constraints and establish the probability with which optimal solutions to the obtained finite SDPs and the semi-infinite SDPs coincide. We demonstrate with numerical simulations that the proposed periodic strategy can ensure the security of communication in scenarios in which all stationary strategies fail to guarantee security.
Data Management in Microservices: State of the Practice, Challenges, and Research Directions

Microservices have become a popular architectural style for data-driven applications, given their ability to functionally decompose an application into small and autonomous services to achieve scalability, strong isolation, and specialization of database systems to the workloads and data formats of each service. Despite the accelerating industrial adoption of this architectural style, an investigation of the state of the practice and challenges practitioners face regarding data management in microservices is lacking. To bridge this gap, we conducted a systematic literature review of representative articles reporting the adoption of microservices, we analyzed a set of popular open-source microservice applications, and we conducted an online survey to cross-validate the findings of the previous steps with the perceptions and experiences of over 120 experienced practitioners and researchers. Through this process, we were able to categorize the state of practice of data management in microservices and observe several foundational challenges that cannot be solved by software engineering practices alone, but rather require system-level support to alleviate the burden imposed on practitioners. We discuss the shortcomings of state-of-the-art database systems regarding microservices and we conclude by devising a set of features for microservice-oriented database systems.
Weak local limit of preferential attachment random trees with additive fitness

We consider linear preferential attachment random trees with additive fitness, where fitness is defined as the random initial vertex attractiveness. We show that when the fitness distribution has positive bounded support, the weak local limit of this family can be constructed using a sequence of mixed Poisson point processes. We also provide a rate of convergence of the total variation distance between the rneighbourhood of the uniformly chosen vertex in the preferential attachment tree and that of the root vertex of its weak local limit. We apply the theorem to obtain the limiting degree distributions of the uniformly chosen vertex and its ancestors, that is, the vertices that are on the path between the uniformly chosen vertex and the initial vertex. Rates of convergence in the total variation distance are established for these results.
Contrast sensitivity functions in autoencoders

Abstract Three decades ago, Atick et al. suggested that human frequency sensitivity may emerge from the enhancement required for a more efficient analysis of retinal images. Here we reassess the relevance of low-level vision tasks in the explanation of the contrast sensitivity functions (CSFs) in light of 1) the current trend of using artificial neural networks for studying vision, and 2) the current knowledge of retinal image representations. As a first contribution, we show that a very popular type of convolutional neural networks (CNNs), called autoencoders, may develop human-like CSFs in the spatiotemporal and chromatic dimensions when trained to perform some basic low-level vision tasks (like retinal noise and optical blur removal), but not others (like chromatic) adaptation or pure reconstruction after simple bottlenecks). As an illustrative example, the best CNN (in the considered set of simple architectures for enhancement of the retinal signal) reproduces the CSFs with a root mean square error of 11% of the maximum sensitivity. As a second contribution, we provide experimental evidence of the fact that, for some functional goals (at low abstraction level), deeper CNNs that are better in reaching the quantitative goal are actually worse in replicating human-like phenomena (such as the CSFs). This low-level result (for the explored networks) is not necessarily in contradiction with other works that report advantages of deeper nets in modeling higher level vision goals. However, in line with a growing body of literature, our results suggests another word of caution about CNNs in vision science because the use of simplified units or unrealistic architectures in goal optimization may be a limitation for the modeling and understanding of human vision.
The Diffusion Coefficient of the Splashback Mass Function as a Probe of Cosmology

We present an analytic model for the splashback mass function of dark matter halos, which is parameterized by a single coefficient and constructed in the framework of the generalized excursion set theory and the self-similar spherical infall model. The value of the single coefficient that quantifies the diffusive nature of the splashback boundary is determined at various redshifts by comparing the model with the numerical results from the Erebos N-body simulations for the Planck and the WMAP7 cosmologies. Showing that the analytic model with the best-fit coefficient provides excellent matches to the numerical results in the mass range of 5 ≤ M/(1012 h −1 M ⊙) < 103, we employ the Bayesian and Akaike Information Criterion tests to confirm that our model is most preferred by the numerical results compared to previous models at redshifts of 0.3 ≤ z ≤ 3 for both of the cosmologies. We also found that the diffusion coefficient decreases almost linearly with redshift, converging to zero at a certain threshold redshift, z c , whose value significantly differs between the Planck and WMAP7 cosmologies. Our result implies that the splashback mass function of dark matter halos at z ≥ z c is well described by a parameter-free analytic formula and that z c may have the potential to independently constrain the initial conditions of the universe.
Dynamic Underwater Acoustic Channel Tracking for Correlated Rapidly Time-Varying Channels

In this work, we focus on the model-mismatch problem for model-based subspace channel tracking in the correlated underwater acoustic channel. A model based on the underwater acoustic channel’s correlation can be used as the state-space model in the Kalman filter to improve the underwater acoustic channel tracking compared that without a model. Even though the data support the assumption that the model is slow-varying and uncorrelated to some degree, to improve the tracking performance further, we cannot ignore the model-mismatch problem because most channel models encounter this problem in the underwater acoustic channel. Therefore, in this work, we provide a dynamic time-variant state-space model for underwater acoustic channel tracking. This model is tolerant to the slight correlation after decorrelation. Moreover, a forward-backward Kalman filter is combined to further improve the tracking performance. The performance of our proposed algorithm is demonstrated with the same at-sea data as that used for conventional channel tracking. Compared with the conventional algorithms, the proposed algorithm shows significant improvement, especially in rough sea conditions in which the channels are fast-varying.
Organ-Specific Branching Morphogenesis

A common developmental process, called branching morphogenesis, generates the epithelial trees in a variety of organs, including the lungs, kidneys, and glands. How branching morphogenesis can create epithelial architectures of very different shapes and functions remains elusive. In this review, we compare branching morphogenesis and its regulation in lungs and kidneys and discuss the role of signaling pathways, the mesenchyme, the extracellular matrix, and the cytoskeleton as potential organ-specific determinants of branch position, orientation, and shape. Identifying the determinants of branch and organ shape and their adaptation in different organs may reveal how a highly conserved developmental process can be adapted to different structural and functional frameworks and should provide important insights into epithelial morphogenesis and developmental disorders.