bluuebunny/crossref_metadata_2025 huggingface dataset:
ReARTSim: an ReRAM ARray Transient Simulator with GPU optimized runtime acceleration
Authors: Sui Yu , Yu Tianhe , Song Shiming
Published: February 2024

The demand for computation driven by machine learning and deep learning applications has experienced exponential growth over the past five years (Sevilla et al 2022 2022 International Joint Conference on Neural Networks (IJCNN) (IEEE) pp 1-8), leading to a significant surge in computing hardware products. Meanwhile, this rapid increase has exacerbated the memory wall bottleneck within mainstream Von Neumann architectures (Hennessy and Patterson et al 2011 Computer architecture: a quantitative approach (Elsevier)). For instance, NVIDIA graphical processing units (GPUs) have gained nearly a 200x increase in fp32 computing power, transitioning from P100 to H100 in the last five years (NVIDIA Tesla P100 2023 (www.nvidia.com/en-us/data-center/tesla-p100/); NVIDIA H100 Tensor Core GPU 2023 (www.nvidia.com/en-us/data-center/h100/)), accompanied by a mere 8x scaling in memory bandwidth. Addressing the need to mitigate data movement challenges, process-in-memory designs, especially resistive random-access memory (ReRAM)-based solutions, have emerged as compelling candidates (Verma et al 2019 IEEE Solid-State Circuits Mag.
11 43–55; Sze et al 2017 Proc. IEEE
105 2295–329). However, this shift in hardware design poses distinct challenges at the design phase, given the limitations of existing hardware design tools. Popular design tools today can be used to characterize analog behavior via SPICE tools (PrimeSim HSPICE 2023 (www.synopsys.com/implementation-and-signoff/ams-simulation/primesim-hspice.html)), system and logical behavior using Verilog tools (VCS 2023 (www.synopsys.com/verification/simulation/vcs.html)), and mixed signal behavior through toolbox like CPPSIM (Meninger 2023 (www.cppsim.org/Tutorials/wideband_fracn_tutorial.pdf)). Nonetheless, the design of in-memory computing systems, especially those involving non-CMOS devices, presents a unique need for characterizing mixed-signal computing behavior across a large number of cells within a memory bank. This requirement falls beyond the scope of conventional design tools. In this paper, we bridge this gap by introducing the ReARTSim framework—a GPU-accelerated mixed-signal transient simulator for analyzing ReRAM crossbar array. This tool facilitates the characterization of analog circuit and device behavior on a large scale, while also providing enhanced simulation performance for complex algorithm analysis, sign-off, and verification.
Phylogenomics and plastomics offer new evolutionary perspectives on Kalanchoideae (Crassulaceae)
Authors: Han Shiyun , Zhang Sijia , Yi Ran , Bi De , Ding Hengwu , Yang Jianke , Ye Yuanxin , Xu Wenzhong , Wu Longhua , Zhuo Renying , Kan Xianzhao
Published: February 2024

Background and Aims

Kalanchoideae is one of three subfamilies within Crassulaceae and contains four genera. Despite previous efforts, the phylogeny of Kalanchoideae remains inadequately resolved with persistent issues including low support, unstructured topologies and polytomies. This study aimed to address two central objectives: (1) resolving the pending phylogenetic questions within Kalanchoideae by using organelle-scale ‘barcodes’ (plastomes) and nuclear data; and (2) investigating interspecific diversity patterns among Kalanchoideae plastomes.

Methods

To explore the plastome evolution in Kalanchoideae, we newly sequenced 38 plastomes representing all four constituent genera (Adromischus, Cotyledon, Kalanchoe and Tylecodon). We performed comparative analyses of plastomic features, including GC and gene contents, gene distributions at the IR (inverted repeat) boundaries, nucleotide divergence, plastomic tRNA (pttRNA) structures and codon aversions. Additionally, phylogenetic inferences were inferred using both the plastomic dataset (79 genes) and nuclear dataset (1054 genes).

Key Results

Significant heterogeneities were observed in plastome lengths among Kalanchoideae, strongly correlated with LSC (large single copy) lengths. Informative diversities existed in the gene content at SSC/IRa (small single copy/inverted repeat a), with unique patterns individually identified in Adromischus leucophyllus and one major Kalanchoe clade. The ycf1 gene was assessed as a shared hypervariable region among all four genera, containing nine lineage-specific indels. Three pttRNAs exhibited unique structures specific to Kalanchoideae and the genera Adromischus and Kalanchoe. Moreover, 24 coding sequences revealed a total of 41 lineage-specific unused codons across all four constituent genera. The phyloplastomic inferences clearly depicted internal branching patterns in Kalanchoideae. Most notably, by both plastid- and nuclear-based phylogenies, our research offers the first evidence that Kalanchoe section Eukalanchoe is not monophyletic.

Conclusions

This study conducted comprehensive analyses on 38 newly reported Kalanchoideae plastomes. Importantly, our results not only reconstructed well-resolved phylogenies within Kalanchoideae, but also identified highly informative unique markers at the subfamily, genus and species levels. These findings significantly enhance our understanding of the evolutionary history of Kalanchoideae.
Health-Related Quality of Life Among Patients With Stroke: A Cross-Sectional Study
Authors: Ayasrah Shahnaz M , Ahmad Muayyad M , Abuadas Fuad H , Abu-Snieneh Hana M , Basheti Iman A
Published: February 2024

Purpose

To assess levels and predictive factors of health-related quality of life (HRQOL) among stroke patients.

Methods

The study employed a cross-sectional predictive correlational design. Levels of HRQOL were assessed using the Stroke-Specific Quality of Life (SS-QOL) scale, and the Hospital Anxiety and Depression Scale was employed to assess psychological aspects among 209 Saudi stroke patients. The analysis included demographic and medical variables to comprehensively explore influencing factors.

Results

A two-step hierarchical multiple regression analysis was performed. The overall SS-QOL summary score (49 items) showed a mean score of 94.4 (SD = 8.1), indicating poor functioning. Nine predictor variables were found to significantly predict HRQOL levels, including age (β = −0.212, p ≤ .001), female (β = −5.33, p ≤ .001), unmarried (β = 2.48, p ≤ .001), low gross monthly income (GMI) (β = −9.02, p ≤ .001), medium GMI (β = −8.36, p ≤ .001), having a medical history of hypertension (β = 2.7, p ≤ .01), time since stroke (β = 3.26 p ≤ .001), and being a probable case of anxiety (β = −4.29, p ≤ .001) and/or depression (β = −2.75, p ≤ .001). These variables collectively explained ~76% of the variance in HRQOL scores (adjusted R2 = .762, F (16,192) = 42.6, p ≤ .001).

Conclusions

Stroke patients exhibited poor HRQOL levels influenced by various factors. Clinicians should consider these predictors and intervene early to enhance HRQOL among patients at risk, emphasizing the importance of optimizing patient outcomes.
Estimation of inbreeding and kinship coefficients via latent identity-by-descent states
Authors: Guan Yongtao , Levy Daniel
Published: February 2024

Motivation

Estimating the individual inbreeding coefficient and pairwise kinship is an important problem in human genetics (e.g. in disease mapping) and in animal and plant genetics (e.g. inbreeding design). Existing methods, such as sample correlation-based genetic relationship matrix, KING, and UKin, are either biased, or not able to estimate inbreeding coefficients, or produce a large proportion of negative estimates that are difficult to interpret. This limitation of existing methods is partly due to failure to explicitly model inbreeding. Since all humans are inbred to various degrees by virtue of shared ancestries, it is prudent to account for inbreeding when inferring kinship between individuals.

Results

We present “Kindred,” an approach that estimates inbreeding and kinship by modeling latent identity-by-descent states that accounts for all possible allele sharing—including inbreeding—between two individuals. Kindred used non-negative least squares method to fit the model, which not only increases computation efficiency compared to the maximum likelihood method, but also guarantees non-negativity of the kinship estimates. Through simulation, we demonstrate the high accuracy and non-negativity of kinship estimates by Kindred. By selecting a subset of SNPs that are similar in allele frequencies across different continental populations, Kindred can accurately estimate kinship between admixed samples. In addition, we demonstrate that the realized kinship matrix estimated by Kindred is effective in reducing genomic control values via linear mixed model in genome-wide association studies. Finally, we demonstrate that Kindred produces sensible heritability estimates on an Australian height dataset.

Availability and implementation

Kindred is implemented in C with multi-threading. It takes vcf file or stream as input and works seamlessly with bcftools. Kindred is freely available at https://github.com/haplotype/kindred.
A methodological primer of extracellular vesicles isolation and characterization via different techniques
Authors: Aliakbari Farhang , Stocek Noah B , Cole-André Maxximuss , Gomes Janice , Fanchini Giovanni , Pasternak Stephen H , Christiansen Gunna , Morshedi Dina , Volkening Kathryn , Strong Michael J
Published: February 2024

We present four different protocols of varying complexity for the isolation of cell culture-derived extracellular vesicles (EVs)/exosome-enriched fractions with the objective of providing researchers with easily conducted methods that can be adapted for many different uses in various laboratory settings and locations. These protocols are primarily based on polymer precipitation, filtration and/or ultracentrifugation, as well as size-exclusion chromatography (SEC) and include: (i) polyethylene glycol and sodium chloride supplementation of the conditioned medium followed by low-speed centrifugation; (ii) ultracentrifugation of conditioned medium; (iii) filtration of conditioned media through a 100-kDa exclusion filter; and (iv) isolation using a standard commercial kit. These techniques can be followed by further purification by ultracentrifugation, sucrose density gradient centrifugation, or SEC if needed and the equipment is available. HEK293 and SH-SY5Y cell cultures were used to generate conditioned medium containing exosomes. This medium was then depleted of cells and debris, filtered through a 0.2-µM filter, and supplemented with protease and RNAse inhibitors prior to exosomal isolation. The purified EVs can be used immediately or stably stored at 4°C (up to a week for imaging or using intact EVS downstream) or at −80°C for extended periods and then used for biochemical study. Our aim is not to compare these methodologies but to present them with descriptors so that researchers can choose the “best method” for their work under their individual conditions.
Optimal antiseptic skin preparation agents for minimizing surgical site infection following surgery: cost and cost-effectiveness analysis
Authors: Deeming Simon , Dolja-Gore Xenia , Gani Jon , Carroll Rosemary , Lott Natalie , Attia John , Reeves Penny , Smith Stephen R
Published: February 2024

Background

The application of antiseptic skin agents prior to incision minimizes the rate of surgical site infection. Despite their ubiquity, the optimal skin preparation agent remains uncertain. A retrospective economic analysis was conducted to complement the results from the NEWSkin Prep trial which prospectively compared three preparation agents.

Methods

A cost and cost-effectiveness analysis was performed from a healthcare service perspective to compare chlorhexidine with 70% ethanol, and aqueous povidone-iodine, against povidone-iodine with 70% ethanol. Resource use estimates accounted for hospital admissions, readmissions associated with surgical site infection, outpatient and general practitioner attendances, visits from community nurses and therapeutic consumables. The measure of effectiveness comprised the net difference in number of patients with surgical site infections per 1000 patients. Costs were compared using a two-sample Welch's t-test. Deterministic and probabilistic sensitivity analyses were performed to evaluate the incremental cost-effectiveness ratio.

Results

The null hypothesis that the mean costs for the trial arms were significantly different was not rejected (Welch's t-test P value: 0.771 for chlorhexidine with 70% ethanol against povidone-iodine with 70% ethanol; and 0.955 for aqueous povidone-iodine against povidone-iodine with 70% ethanol). Based on bootstrap averages, the chlorhexidine with 70% ethanol intervention generated 8.0 fewer surgical site infections per 1000 patients and net cost savings of €151,698 (Euros) per 1000 patients compared with povidone-iodine with 70% ethanol, and aqueous povidone-iodine produced a net cost saving of €37,494 per 1000 patients but generated an additional 11.6 surgical site infections per 1000 patients compared with povidone-iodine with 70% ethanol. The comparison of chlorhexidine with 70% ethanol to povidone-iodine with 70% ethanol was sensitive to the inclusion of cost outliers, while the comparison of aqueous povidone-iodine to povidone-iodine with 70% ethanol was sensitive to the estimated cost per surgical site infection.

Conclusion

Based on the outcomes from the NEWSkin Prep study, this economic analysis found no definitive evidence in favour of any one of the study comparators. Future model-based economic analyses of alternative skin preparations should critically address the quality of evidence and integrate the results from the NEWSkin Prep study.
Emergence of rapidly spreading antimicrobial-resistant Salmonella in traditional blood-based foods
Authors: Yang Tian , Wu-Chen Ricardo A , Zhang Runrun , Liao Xinyu , Lou Yiyang , Gölz Greta , Ding Tian , Feng Jinsong
Published: February 2024

Objectives

This study aims to investigate the survival ability and risk of Salmonella isolated from traditional blood-based food, using both phtnotypic and genotypic analysis.

Materials and Methods

We characterized and identified seventeen Salmonella isolates using 16s rRNA sequencing, real-time PCR and whole-genome sequencing (WGS). Cell counts were recorded to monitor growth ability and temperature tolerance. Virulence genes and whole genome phylogenies were confirmed by WGS. The minimum inhibitory concentration (MIC) of corresponding strains to different antibiotics and antimicrobial resistance (AMR) genes predicted by WGS were evaluated.

Results

In this study, we characterized 17 Salmonella isolates obtained from contaminated traditional blood-based food in China. Compared to laboratory strain S. Typhimurium ATCC 14028, these Salmonella isolates generally grew more rapidly and developed less biofilm, but their tolerance to food processing-associated cold and heat stresses was distinct. Whole-genome phylogenies pointed out the potential for cross-contamination during food practices. In addition, 21 antibiotic-resistance genes were found among blood-based food isolates, including high-prevalent resistance genes gyrA (including associated mutations D87G and S83F), blaTEM, and aadA1. Antibiotic susceptibility test confirmed the in-silico prediction and revealed a 41.18% (7/17) multidrug resistance (MDR) rate. Resistance to ceftiofur, kanamycin, and nalidixic acid was observed without corresponding resistance genes, suggesting overlooked resistance mechanisms.

Conclusions

This study revisited microbial safety concerns associated with traditional blood-based food and underlined the emergence of high-risk MDR Salmonella strains. It also underscores the importance of implementing better hygiene practices in the production and handling of traditional food products.
Drinfeld’s Lemma forF-isocrystals, I
Authors: Kedlaya Kiran S
Published: February 2024

We prove that in either the convergent or overconvergent setting, an absolutely irreducible $F$-isocrystal on the absolute product of two or more smooth schemes over perfect fields of characteristic $p$, further equipped with actions of the partial Frobenius maps, is an external product of $F$-isocrystals over the multiplicands. The corresponding statement for lisse $\overline{{\mathbb{Q}}}_{\ell }$-sheaves, for $\ell \neq p$ a prime, is a consequence of Drinfeld’s lemma on the fundamental groups of absolute products of schemes in characteristic $p$. The latter plays a key role in V. Lafforgue’s approach to the Langlands correspondence for reductive groups with $\ell $-adic coefficients; the $p$-adic analogue will be considered in subsequent work with Daxin Xu.
A mathematical model of photoinhibition: exploring the impact of quenching processes
Authors: Nies Tim , Matsubara Shizue , Ebenhöh Oliver
Published: February 2024

Plants are constantly exposed to changing environments, sometimes leading to extreme conditions and stress. For example, sudden exposure to high light leads to excess absorbed light energy, causing reactive oxygen species (ROS) formation. ROS damages the photosynthetic machinery, particularly the D1 protein in photosystem II (PSII), which, therefore, needs to be continuously repaired and replaced. The effect of the damage inflicted by high light is a prolonged decrease in photosynthetic efficiency. Hence, it is not surprising that photoinhibition has been subject to numerous experimental studies investigating its effects in the context of crop productivity. However, it has become apparent that classical measures of photoinhibition, that is, changes in the chlorophyll fluorescence parameter Fv/Fm, are not only determined by the loss of PSII core function but also by processes such as energy transfer and quenching. Mathematical models can help dissect the influences on such fluorescence signals and quantify the contributions of various interacting mechanisms. We present a mathematical model with a dynamic description of the photosynthetic electron transport chain, non-photochemical quenching and photoinhibition. With our model, we investigate the interconnection among quenching, photoprotection and fluorescence using simulations and experimental data. We found that different energy-dissipating properties of intact and damaged PSIIs, as well as energy transfer between PSIIs, are critical components that need to be included in the model to ensure a satisfactory fit to the experimental data. We envisage that our model provides a framework for future investigations of photoinhibition dynamics and its importance for plant growth and yield.
A314 UNDIFFERENTIATED PANCREATIC CARCINOMA WITH OSTEOCLAST-LIKE GIANT CELLS: A CASE REPORT
Authors: Parvizian M K , Hurlbut D , Rai M S
Published: February 2024

Background

Pancreatic undifferentiated carcinoma with osteoclast-like giant cells (UCOGC) is a rare form of pancreatic cancer representing under 1% of cases. UCOGC is hypothesized to be a variant of pancreatic adenocarcinoma and while the pathophysiology is incompletely defined, it is felt to be an undifferentiated sarcomatoid carcinoma variant with chemotaxis of osteoclastic giant cells. Clinical, radiographic, or biochemical features do not reliably differentiate this from other tumors. Definitive diagnosis is made by histologic examination demonstrating non-neoplastic multinucleated osteoclastic giant cells (CD68 positive), mononuclear histiocytes, and neoplastic mononuclear cells.

Aims

To describe the case of a patient with UCOGC, highlighting key clinicopathologic features and management.

Methods

Case report and literature review.

Results

A 79-year-old man with atrial fibrillation on Xarelto presented with 4 months of abdominal pain, nausea, vomiting, and weight loss (22 kg). An MRI revealed a dilated main pancreatic duct and side branches with abrupt cutoff in the neck due to an ill-defined lesion. Endoscopic ultrasound confirmed a 36 mm hypoechoic ill-defined mass in the pancreatic neck. Biopsy performed with a 22-gauge needle with dry suction showed tissue fragments consistent with UCOGC (Figure 1).

Unfortunately, the patient presented to hospital with worsened abdominal pain and nausea and was found to have new portal, superior mesenteric, and splenic vein thrombosis. His anticoagulant was changed to Dalteparin. A multidisciplinary cancer conference was held including input from experts in Toronto, and due to surrounding inflammation and new thrombosis he was not considered a surgical candidate at the time and neoadjuvant treatment with standard adenocarcinoma chemotherapy was planned.

Unfortunately, the patient continued to decline and he was treated with palliative intent FOLFIRINOX for 2 cycles before opting for a medical assistance in dying procedure.

Conclusions

Treatment for UCOGC has not been well studied due to its rarity. Surgery is first-line therapy if appropriate based on patient status and cancer stage. The efficacy of chemotherapy and radiation is unclear but as a suspected adenocarcinoma variant, standard chemotherapy regimens are often used. Research is ongoing with an area of interest being PD-L1 inhibition due to high tumor PD-L1 positivity rates. Recognition of this rare entity is crucial due to its distinct diagnostic and therapeutic characteristics with more research needed to establish optimal therapy.

Figure 1: Pathologic examination with HPS and CD68 stains demonstrating UCOGC

Funding Agencies

None
Paediatric dermatofibrosarcoma protuberan—a case report in an Afro-Caribbean boy
Authors: Neblett Carlos , Appiah Kenneth , Jones Javier , Lawrence Tahjeme , Dawkins Shanna Kay , Crookendale Graeme , Thompson Rory
Published: February 2024

Dermatofibrosarcoma protuberans is a rare low-grade sarcoma, which rarely metastasizes, but it is locally aggressive with a propensity to recur. It usually affects persons of African descent and is extremely rare in childhood with a favourable prognosis. We present a case of paediatric dermatofibrosarcoma protuberans to the midline of the lower back of a 9-year-old Afro-Caribbean boy who was biopsied with a 2-mm margin. After histological confirmation, a 4-cm margin was then performed. Surveillance for recurrence, though none has been seen thus far after 6-month follow-up, will be done for at least 5 years and possibly longer, given this is the first case of this nature ever seen in our institution and the Caribbean region.
Migrated biliary stent into the portal vein: a case report
Authors: Christensen Sanne H , Roga Nawal F , Kirkegaard Jakob , Nygaard Jacob
Published: February 2024

Biliary stent insertion is a well-established treatment of bile duct obstruction. Stent migration is a late-onset complication and can be life-threatening. We present a case of proximal biliary stent migration to the portal vein. An upper endoscopy was performed, and the biliary stent was retracted. Bleeding was seen from the papilla of Vater. The hepatoduodenal ligament was explored, and the common bile duct was found fully adherent to the portal vein, with a fistula between the common bile duct and the portal vein. The patient underwent surgery with extrahepatic bile duct resection and hepaticoduodenostomy. The patient survived and was discharged without surgical postoperative complications on postoperative Day 8.
Pre-perihelion observations of long-period comet C/2013 X1 (PANSTARRS)
Authors: Shubina Olena , Ivanova O , Petrov D , Luk’yanyk I , Rosenbush V , Kiselev N
Published: February 2024

We present and analyse the results of quasi-simultaneous spectroscopic, photometric, and polarimetric observations of hyperbolic comet C/2013 X1 (PANSTARRS) obtained at the 6-m Big Telescope Alt-azimuth (BTA) telescope Special Astrophysical Observatory (SAO) and 2.6-m Shajn telescope Crimean Astrophysical Observatory (CrAO). A wide fan-shaped structure and a weak tail were detected in the comet. The mean V − R colour of the coma was estimated to be neutral compared to the solar value. The Afρ parameter, a proxy to the dust production in the comet, was about 1672 ± 21 cm in the R band. Emissions of the CN, C2, C3, and NH2 molecules were identified in the cometary spectrum, which covers the wavelength range 3800 – 7100 Å. When the comet was at a distance of 2.66 au from the Sun, the minimum degree of polarization of about −1.5 per cent was detected in the near-nucleus region of the coma, in the range up to about 10 000 km from the optocentre. Further, polarization gradually increased (in absolute value) with distance from the nucleus, reaching −6.5 per cent at about 50 000 km. To reproduce the observed values of linear polarization and the phase-angle dependence of polarization for long-period comets, we used the Sh-matrix method with conjugated Gaussian random particles as light scatters, and the chemical composition of dust particles in the coma of 74 per cent amorphous carbon, 25 per cent of Mg-rich silicates, and 1 per cent of water ice.
Mergers of double NSs with one high-spin component: brighter kilonovae and fallback accretion, weaker gravitational waves
Authors: Rosswog S , Diener P , Torsello F , Tauris T M , Sarin N
Published: February 2024

Neutron star (NS) mergers where both stars have negligible spins are commonly considered as the most likely ‘standard’ case. In globular clusters, however, the majority of NSs have been spun up to millisecond (ms) periods and, based on observed systems, we estimate that a non-negligible fraction of all double NS mergers ($\sim 4\pm 2\, {{\ \rm per\ cent}}$) contains one component with a spin of a (few) ms. We use the Lagrangian numerical relativity code SPHINCS_BSSN to simulate mergers where one star has no spin and the other has a dimensionless spin parameter of χ = 0.5. Such mergers exhibit several distinct signatures compared to irrotational cases. They form only one, very pronounced spiral arm and they dynamically eject an order of magnitude more mass of unshocked material at the original, very low electron fraction. One can therefore expect particularly bright, red kilonovae. Overall, the spinning case collisions are substantially less violent and they eject smaller amounts of shock-generated semirelativistic material. Therefore, the ejecta produce a weaker blue/ultraviolet kilonova precursor signal, but – since the total amount is larger – brighter kilonova afterglows months after the merger. The spinning cases also have significantly more fallback accretion and thus could power late-time X-ray flares. Since the post-merger remnant loses energy and angular momentum significantly less efficiently to gravitational waves, such systems can delay a potential collapse to a black hole and are therefore candidates for merger-triggered gamma-ray bursts with longer emission time-scales.
An updated fluorescence emission model of CO+ for cometary science
Authors: Bromley S J , Noonan J Wm , Cochran A L , Stachová B , Országh J , Ivanova O , Pierce D M , Fortenberry R C , Bodewits D
Published: February 2024

A new CO$^+$ fluorescence emission model for analysing cometary spectra is presented herein. Accurate line lists are produced using the PGOPHER software for all transitions between the three electronic states (X $^2\Sigma$, A $^2\Pi$, B $^2\Sigma$) with vibrational states up to $v_\textrm {max} = 9, 8, 6$, respectively, and maximum rotational states with rotational quantum numbers $N\le 20$. As a result of improved molecular constants and theoretical transition rates, an expansion of the utilized solar spectrum into the infrared, and the substantial expansion of the included rovibronic states, the model provides an update of the fluorescence efficiencies of the CO$^+$ cation. The dependencies on heliocentric velocity and distance are explicitly included. We report, for the first time, quantification of the fluorescence efficiencies for the ground state rovibrational transitions of CO$^+$ and predict the positions and relative intensities of CO$^+$ lines in windows accessible to both ground- and space-based observatories. The computed fluorescence efficiencies show excellent agreement with UV/optical observations of both C/2016 R2 (PanSTARRS) and 29P/Schwassmann-Wachmann 1. The updated fluorescence efficiencies allow for revised N$_2$/CO abundances for comets 1P/Halley, C/1987 P1 (Bradfield), and C/2016 R2 (PanSTARRS), which can change by up to 30 per cent when accounting for recent improvements to CO$^+$ and N$_2^+$ fluorescence efficiencies. The model code, input files, and fluorescence efficiencies are publicly available and distributed on permanent archives for future uses in cometary analyses.
Intraoperative hypotension and its association with acute kidney injury in patients undergoing elective cardiac surgery: a large retrospective cohort study
Authors: Jung Hilke , Mohr Niklas , Hulde Nikolai , Krannich Alexander , Storm Christian , von Dossow Vera
Published: February 2024

BACKGROUND

Intraoperative hypotension (IOH) is known to affect renal outcomes in noncardiac surgery. However, it is unclear whether intraoperative hypotension (IOH) causes postoperative acute kidney injury following cardiac surgery.

OBJECTIVE

This study aimed to determine whether the duration of IOH during cardiac surgery is associated with the incidence of postoperative acute kidney injury (AKI) and identify its impact on long-term outcomes.

DESIGN

Retrospective cohort study.

SETTING

Academic university hospital (Heart and Diabetes Center, Bad Oeynhausen, Germany).

PATIENTS

A cohort of 28 909 patients who underwent elective cardiac surgery between 1 January 2009 and 31 December 2018.

INTERVENTIONS

IOH was defined as intraoperative mean arterial blood pressure (MAP) of less than 60 mmHg for more than 2 min. The cumulative duration of these IOH events was recorded each patient.

MAIN OUTCOME MEASURES

The primary outcome was the incidence of AKI according to the KDIGO criteria (Kidney Disease: Improving Global Outcomes). Logistic regression analysis was used to analyse the associations between IOH and the incidence of AKI. Secondary outcomes were the independent predictors for the incidence of AKI.

RESULTS

Postoperative AKI was observed in 42.9% of patients. The cumulative duration of IOH (minutes) had a significant influence on the incidence of AKI [odds ratio (OR) 1.004; 95% confidence interval (CI) 1.003 to 1.005; P < 0.001] (P > 0.001 versus P < 0.001). The survival time was significantly shorter in patients with a higher cumulative duration of IOH, patients aged more than 70 years, and those who developed AKI (P < 0.001). Logistic regression analysis identified eight predictors of AKI: age, cumulative duration of IOH, duration of surgery, chronic obstructive pulmonary disease, body mass index, type of surgery, American Society of Anesthesiologists stage, and Euroscore 2.

CONCLUSIONS

The cumulative duration of IOH is an independent risk factor for the occurrence of postoperative AKI after cardiac surgery.

TRIAL REGISTRATION

Ethics Committee of the Ruhr University Bochum (Register number 2019-491).
An External Validation Study for Automated Segmentation of Vestibular Schwannoma
Authors: Suresh Krish , Luo Guibo , Bartholomew Ryan A. , Brown Alyssa , Juliano Amy F. , Lee Daniel J. , Welling D. Bradley , Cai Wenli , Crowson Matthew G.
Published: February 2024

Objective

To validate how an automated model for vestibular schwannoma (VS) segmentation developed on an external homogeneous dataset performs when applied to internal heterogeneous data.

Patients

The external dataset comprised 242 patients with previously untreated, sporadic unilateral VS undergoing Gamma Knife radiosurgery, with homogeneous magnetic resonance imaging (MRI) scans. The internal dataset comprised 10 patients from our institution, with heterogeneous MRI scans.

Interventions

An automated VS segmentation model was developed on the external dataset. The model was tested on the internal dataset.

Main Outcome Measure

Dice score, which measures agreement between ground truth and predicted segmentations.

Results

When applied to the internal patient scans, the automated model achieved a mean Dice score of 61% across all 10 images. There were three tumors that were not detected. These tumors were 0.01 ml on average (SD = 0.00 ml). The mean Dice score for the seven tumors that were detected was 87% (SD = 14%). There was one outlier with Dice of 55%—on further review of this scan, it was discovered that hyperintense petrous bone had been included in the tumor segmentation.

Conclusions

We show that an automated segmentation model developed using a restrictive set of siloed institutional data can be successfully adapted for data from different imaging systems and patient populations. This is an important step toward the validation of automated VS segmentation. However, there are significant shortcomings that likely reflect limitations of the data used to train the model. Further validation is needed to make automated segmentation for VS generalizable.
Misdiagnosis of eosinophilic cystitis: A case report and literature review
Authors: Shi Guanyu , Wang Leibo , Peng Guangxu , An Xu , Lu Xingyong , Wu Huagu , Li Yongjun
Published: February 2024

Rationale:

Eosinophilic cystitis (EC) is a rare and specific transmural inflammatory disease in clinic. At present, its etiology is unknown, its clinical manifestations are diverse, and its auxiliary examination lacks specificity, so it is easy to be missed or misdiagnosed in clinical practice.

Patient concerns:

A 72-year-old male patient with symptoms of lower urinary tract obstruction accompanied by hematuria was diagnosed with benign prostatic hyperplasia with bleeding by B-ultrasound and urinary CT examination. After being treated with catheterization, anti-infection and hemostasis, he was selectively treated with transurethral resection of prostate, but he saw a pattern mass on the right back wall of the bladder during the operation. Considering bladder tumor, he removed the lesion and gave pirarubicin for bladder perfusion. However, the postoperative pathological result was EC.

Diagnosis:

The diagnosis of EC can only rely on pathological examination, and the accurate and positive rate of biopsy can be improved by obtaining muscle tissue as much as possible at the same time of multi-point biopsy.

Intervention:

Prednisone and cetirizine were given orally after transurethral resection of lesions, and tamsulosin and finasteride were given regularly to treat benign prostatic hyperplasia.

Outcomes:

No recurrence and abnormal urination were found during the follow-up for half a year, and the upper urinary tract function was normal.

Lessons:

The clinical manifestations of EC are atypical, the laboratory examination and imaging examination are not specific, and it is difficult to make a definite diagnosis before operation. The diagnosis depends on pathological examination. Transurethral resection of the lesion can obviously improve the positive rate of biopsy while completely removing the lesion, and the combined drug treatment can achieve satisfactory results in a short period of time. Active follow-up after operation is very important to identify the recurrence of the disease and prevent the upper urinary tract function from being damaged.
The synergistic effect of herbal medicine and probiotics in pediatric functional constipation: A systematic review and meta-analysis
Authors: Kim Eunjin , Chang Seokjoo , Nam Jisoo , Park Nanjoo , Min Sang Yeon
Published: February 2024

Background:

Pediatric functional constipation (PFC) is a prevalent and persistent gastrointestinal disorder, that requires various treatments, including alternative approaches. This review assessed the synergistic efficacy of herbal medicine (HM) and probiotics for PFC.

Methods:

We conducted a comprehensive search of 11 databases, including English, Chinese, and Korean databases, until June 29, 2023. The inclusion criteria were randomized clinical trials (RCTs) comparing the intervention of HM with probiotics to that of the same probiotics. Statistical analyses included calculation of the mean difference (MD), standardized MD, risk ratio (RR) with a 95% confidence interval (CI), and assessment of risk of bias using Review Manager Version 5.4 software. The Grading of Recommendations Assessment, Development, and Evaluation rating system was used to evaluate evidence quality. Potential publication bias was assessed using funnel plots, Egger test, the fail-safe N test, and Duval and Tweedie trim and fill method.

Results:

A total of 22 RCTs involving 2228 patients were included in the meta-analysis. The HM and probiotics group exhibited superior outcomes compared to the probiotics alone group in various parameters: total effective rate (RR: 1.24, 95% CI: 1.19–1.29,P < .001), Bristol fecal Score (MD: 0.80, 95% CI: 0.71–0.89,P < .001), gastrointestinal peptide hormone (motilin) (MD: 35.37, 95% CI: 24.64–64.10,P < .001), inflammation indicator (nitrous oxide) (MD: −12.45, 95% CI: −15.12 to −9.77,P < .001), minimal sensitive volume of the rectum (MD: −8.7, 95% CI: −10.91 to −6.49,P < .001), and recurrence rate (RR: 0.30, 95% CI: 0.21–0.43,P < .001).

Conclusion:

The combination of HM and probiotics may exhibit a synergistic effect on PFC. Nevertheless, it is imperative to undertake rigorously planned RCTs to comprehensively evaluate the synergistic efficacy of HM and probiotics.
Adult-type granulosa cell tumor associated with elevated luteinizing hormone: Two rare case reports
Authors: Wang Yujing , Wang Na , Zhang Xuejiao , Fu Zijie , Pang Chao , Zhang Yuan , Li Xiaodong
Published: February 2024

Introduction:

Adult-type granulosa cell tumors (AGCTs), which account for 2% to 5% of all malignant ovarian tumors, are rare sex cord-stromal tumors that usually secrete excess estrogens, but they can also secrete androgens.

Patient concerns:

We report 2 patients of childbearing age with AGCT who presented with the complaint of abnormal menstruation and elevated luteinizing hormone (LH), and mildly elevated testosterone.

Diagnosis:

The ovarian tumors had hormonal activity.

Interventions:

The 2 patients underwent laparoscopic left adnexectomy. The second patient underwent 4 cycles of chemotherapy with paclitaxel and carboplatin as adjuvant treatments.

Outcomes:

Their postoperative pathology confirmed AGCTs. Also, their menstrual cycle returned to normal, with normal serum LH and testosterone levels. There was no sign of recurrence.

Conclusion:

The cases suggest that elevated serum LH levels may be a sign of unknown tumors in cases of oligomenorrhea or secondary amenorrhea. It is useful to evaluate the serum levels of inhibin B and anti-Müllerian hormone to improve the early recognition of ovarian granulosa cell tumors.
The role of the microbiome in liver disease
Authors: Schöler David , Schnabl Bernd
Published: February 2024

Purpose of review

The intestinal microbiome and the gut-liver axis play a major role in health and disease. The human gut harbors trillions of microbes and a disruption of the gut homeostasis can contribute to liver disease. In this review, the progress in the field within the last 3 years is summarized, focusing on metabolic dysfunction-associated steatotic liver disease (MASLD), alcohol-associated liver disease (ALD), autoimmune liver disease (AILD), and hepatocellular carcinoma (HCC).

Recent findings

Changes in the fecal virome and fungal mycobiome have been described in patients with various liver diseases. Several microbial derived metabolites including endogenous ethanol produced by bacteria, have been mechanistically linked to liver disease such as MASLD. Virulence factors encoded by gut bacteria contribute to ALD, AILD and HCC. Novel therapeutic approaches focused on the microbiome including phages, pre- and postbiotics have been successfully used in preclinical models. Fecal microbiota transplantation has been effective in attenuating liver disease. Probiotics are safe in patients with alcohol-associated hepatitis and improve liver disease and alcohol addiction.

The gut–liver axis plays a key role in the pathophysiology of liver diseases. Understanding the microbiota in liver disease can help to develop precise microbiota centered therapies.
Empowering Dementia Caregivers
Authors: Ko Eunjung , Rose Karen M. , Wright Kathy D.
Published: February 2024

Purpose/Objectives

We aim to explore Current Procedural Terminology (CPT) codes for caregiving training services and their potential impacts on caregivers of people living with dementia.

Description of the Project/Program

In response to the growing need for support for caregivers of people living with physical and mental health issues, CPT codes for caregiving training services will be activated for the calendar year 2024. These codes cover (1) family group behavior management and modification training services and (2) caregiver training for techniques to help patients maintain their quality of life. Caregivers will access such training support through the CPT codes provided by treating practitioners. The duration of training will vary by code.

Outcome

Implementing CPT codes for caregiver training services highlights the vital role of caregivers in patient care. This support may improve their skills and communication with healthcare providers. However, timing and accessibility in care delivery need clarification, especially for caregivers of people living with dementia. Regular skill assessment and culturally competent care are essential. Before providing the service, provider training may also promote person-centered care, benefiting patients and their caregivers.

Conclusion

Activating CPT codes for caregiving training services may enhance caregivers' support and skills, including dementia care.
Roadmap for Connecting Cancer Rehabilitation With Survivorship to Improve Patient Outcomes and Clinical Efficiency
Authors: Alfano Catherine M. , Pugh Terrence M. , Tortorella Brooke , Jacob Regina A. , Mitchell Charles H. , Raj Vishwa S.
Published: February 2024

An evolved model of comprehensive cancer care is needed that begins at cancer diagnosis to proactively manage cancer treatment toxicities and optimize patient health, function, and well-being. Building new care models requires connecting oncology, primary care, and specialized clinicians from many disciplines including cancer rehabilitation. Having a vision for an evolved standard of comprehensive cancer care is a requirement, but it is not enough to bring an innovative clinical program to life and sustain it over the long term. To inform the development of new clinical programs, two example programs are presented that successfully integrate cancer rehabilitation services along with details of a three-step process these programs used to facilitate their success and build robust business models that ensure their sustainability. Following the roadmap for growth presented here, gaining input from stakeholders and ensuring their buy-in, leveraging existing programmatic priorities, as well as developing a strategic growth plan can help clinical innovators ensure that new programs anticipate and continually meet the needs of oncology, primary care, subspecialty care, and programs, while addressing the business needs of administrators and improving the experience for patients.
Proposing a Cancer Rehabilitation Medicine Curriculum for Physical Medicine and Rehabilitation Trainees
Authors: Custodio Christian M. , Stein Adam B.
Published: February 2024

With the rapid growth and rising interest in the subspecialty of cancer rehabilitation medicine, establishing a structured training and educational curriculum in cancer rehabilitation medicine has become more crucial than ever. For those who are responsible for the educational experiences of students, residents, fellows, or other healthcare professionals, this article provides a systematic approach for establishing a curriculum template relevant for cancer rehabilitation medicine training. This included the assessment of general and targeted needs for learners and educators, rotation goals and objectives, educational strategies, implementation, and evaluation and feedback.
Development of a Cancer Rehabilitation Dashboard to Collect Data on Physical Function in Cancer Patients and Survivors
Authors: Cristian Adrian , Rubens Muni , Orada Romer , DeVries Kristen , Syrkin Grigory , DePiero Mallori T. , Estenoz Michele , Kothakapu Sharat , McGranaghan Peter , Lindeman Paul R.
Published: February 2024

Objective

The aim of the study is to describe the development of a cancer rehabilitation dashboard that collects data on physical function for cancer survivors in a cancer institute.

Methods

This project was conducted at the Miami Cancer Institute. The cancer rehabilitation dashboard was developed by a team of physicians, biostatistician, and medical informatics teams to record, report and track the physical function of cancer survivors. A multimodal approach to the measurement of physical function was used and included the Patient-Reported Outcome Measurement Information System–Physical Function short form, Patient-Reported Outcome Measurement Information System–Fatigue short form, Timed Up and Go Test, Sit-to-Stand Test in 30-sec test, four-stage balance test, and grip strength. To develop this system, a Cerner Power Form was developed based on the physical function data. To display the data, a dedicated flowsheet was developed and placed within the Oncology Viewpoint in Cerner Millennium. Thus, from inside any patient record, the flowsheet could easily be accessed by providers without leaving normal clinician workflows. Using native functionality, the data can also be shown in graphical format to facilitate dialog with patients and oncology teams. All patient data from the Cerner Power Form discrete task assays were integrated into an existing Oncology Data Warehouse for all patients. The data elements in the Cerner Power Form were identified in the electronic medical record system, loaded into the Oncology Data Warehouse, and related to the other source systems to develop reports and data visualizations such as the cancer rehabilitation dashboard. The cancer rehabilitation dashboard allows visualization of numerous parameters of physical function in cancer survivors evaluated and treated and their change over time. Rendered in Tableau, the cancer rehabilitation dashboard acts as a centralized, interactive data source to analyze and connect clinicians to near real-time data.

Results

The cancer rehabilitation dashboard was successfully developed and implemented into a cancer rehabilitation practice in a cancer institute and used to collect and track physical function data for cancer survivors receiving treatment and cancer survivors. This information has been used to direct the treatment plan and educate individual patients about the impact of the cancer and its treatment on physical function as well as oncology teams in a cancer institute.

Conclusions

The cancer rehabilitation dashboard provides an insight into the physical function of cancer survivors receiving treatment and cancer survivors using both self-reported and objective metrics. It can be customized to suit the interests of clinicians and researchers wishing to improve the quality of life of this population.