Rare primary gastric peripheral T-cell lymphoma not otherwise specified:A case report

BACKGROUND Gastrointestinal lymphoma typically arises in the stomach,small bowel,or colorectum and is usually a B-cell lymphoma.However,primary T-cell lymp-homas originating in the stomach are particularly rare.Gastric peripheral T-cell lymphoma-not otherwise specified(PTCL-NOS)is an extremely rare subtype.CASE SUMMARY We report a 63-year-old male presenting with epigastric pain.Esophagogastro-duodenoscopy revealed a large ulcerative lesion in the gastric cardia.Biopsy and immunohistochemical profiling confirmed PTCL-NOS.Imaging indicated stage II disease involving the stomach and intra-abdominal lymph nodes.The patient is planned to undergo cyclophosphamide,doxorubicin,vincristine,and prednisone or cyclophosphamide,doxorubicin,vincristine,prednisone,and etoposide chemo-therapy.CONCLUSION This case highlights the necessity of considering PTCL-NOS in differential diag-noses of gastric lesions.Comprehensive histopathological and immunohistoche-mical analysis is crucial for accurate diagnosis and guiding treatment.

Autoimmune pancreatitis not otherwise specified(NOS): Clinical features and outcomes of the forgotten type

Background:Autoimmune pancreatitis(AIP)is a well-recognized fibroinflammatory disease of the pancreas.Despite the significant number of studies published on AIP type 1 and 2,no studies have been focused on AIP type not otherwise specified(NOS)and therefore very little is known about clinical features and long-term outcomes of these patients.The aim of this study was to investigate clinical and radiological features of AIP type NOS-patients.Methods:Patients classified as AIP type NOS at clinical onset included in our database prospectively maintained since 1995 were evaluated.Epidemiological,clinical data were collected and analyzed.Results:Forty-six patients were included in the study.The clinical onset was mainly characterized by weight loss,jaundice and acute pancreatitis.Eight patients(17.4%)were reclassified as AIP type 2 during follow-up because of the development of ulcerative colitis.Seven patients(15.2%)experienced relapse after steroid treatment but only one(2.2%)needed immunosuppressive drugs because of recurrent relapses.Conclusions:AIP type NOS shares clinical features similar to AIP type 2 and a relevant proportion of patients was reclassified as AIP type 2 during follow-up because of the development of ulcerative colitis.The risk of relapse is low but not irrelevant.

Function of pioneer neurons specified by the basic helix-loop-helix transcription factor atonal in neural development

Basic helix-loop-helix （bHLH） transcription factors regulate the differentiation of various tissues in a vast diversity of species. The bHLH protein Atonal was first identified as a proneural gene involved in the formation of mechanosensory cells and photoreceptor cells in Drosophila （larman et al., 1993, 1994）. Atonal is expressed in sensory organ precursors and is required and sufficient for the development of chordotonal organs （Jar- man et al., 1993）. Moreover, Atonal expression is observed in the developing eye and is essential for the differentiation of R8 photoreceptors, which are the first photoreceptors that appear during development. Atonal is not involved in the formation of other photoreceptors （R1-R7） directly. However, R8 photore- ceptors recruit other photoreceptors from the surrounding cells （Jarman et al., 1994）.

Backward Dijkstra Algorithms for Finding the Departure Time Based on the Specified Arrival Time for Real-Life Time-Dependent Networks

A practical transportation problem for finding the “departure” time at “all source nodes” in order to arrive at “some destination nodes” at specified time for both FIFO (i.e., First In First Out) and Non-FIFO “Dynamic ” Networks is considered in this study. Although shortest path (SP) for dynamic networks have been studied/documented by various researchers, contributions from this present work consists of a sparse matrix storage scheme for efficiently storing large scale sparse network’s connectivity, a concept of Time Delay Factor (TDF) combining with a “general piece- wise linear function” to describe the link cost as a function of time for Non-FIFO links’ costs, and Backward Dijkstra SP Algorithm with simple heuristic rules for rejecting unwanted solutions during the backward search algorithm. Both small-scale (academic) networks as well as large- scale (real-life) networks are investigated in this work to explain and validate the proposed dynamic algorithms. Numerical results obtained from this research work have indicated that the newly proposed dynamic algorithm is reliable, and efficient. Based on the numerical results, the calculated departure time at the source node(s), for a given/specified arrival time at the destination node(s), can be non-unique, for some Non-FIFO networks’ connectivity.

A Fatal Case of Chronic Eosinophilic Leukemia Not Otherwise Specified (CEL-NOS) in a 19-Year-Old Male with Acute Transformation into Blast Crisis

Chronic eosinophilic leukemia (CEL) is a rare disorder that is characterized by hypereosinophilia with increased number of blood or marrow blasts (>5% and <20%). CEL is distinguished from hypereosinophilic syndrome (HES) by the presence of eosinophilic clonality. Chronic eosinophilic leukemia not otherwise specified (CEL-NOS) diagnosis is made when no fusion genes are detected by most modern molecular testing, particularly the most common fusion gene FIP1L-1/PDGFRA (Factor Interacting with PAP like-1/Platelet-Derived Growth Factor Receptor Alpha). This disease is very rare, and its description in the literature is not well characterized. We report a fetal case of severe CEL-NOS in a 19-year-old male who presented with a plethora of clinical features consists of constitutional symptoms, pancytopenia, intravascular thrombosis, acute stroke and endomyocardial infiltrates. The course of his disease was aggressive and resistant to conventional treatment. After a short period of improvement, an acute transformation into blast crisis (BC) had occurred. The diagnosis was confirmed by morphology and immunophenotyping of bone marrow biopsy. The patient eventually died of heart failure and sepsis. To our knowledge this is the first case report of fatal CEL-NOS transforming into severe blast crisis.

Overall Survival with Adjuvant Pembrolizumab in Renal-Cell Carcinoma

Background:Adjuvant pembrolizumab therapy after surgery for renal-cell carcinoma was approved on the basis of a significant improvement in disease-free survival in the KEYNOTE-564 trial.Whether the results regarding overall survival from the third prespecified interim analysis of the trial would also favor pembrolizumab was uncertain.Methods:In this phase 3,double-blind,placebo-controlled trial,we randomly assigned(in a 1:1 ratio)participants with clear-cell renal-cell carcinoma who had an increased risk of recurrence after surgery to receive pembrolizumab(at a dose of 200 mg)or placebo every 3 weeks for up to 17 cycles(approximately 1 year)or until recurrence,the occurrence of unacceptable toxic effects,or withdrawal of consent.A significant improvement in disease-free survival according to investigator assessment(the primary end point)was shown previously.Overall survival was the key secondary end point.Safety was a secondary end point.

Lock-in phenomenon of tip clearance flow and its influence on aerodynamic damping under specified vibration on an axial transonic compressor rotor

In this study,the lock-in phenomenon of Tip Clearance Flow(TCF)instabilities and their relationship to blade vibration are investigated numerically on an axial transonic rotor with a large tip clearance.The capabilities of simulating instability flow and lock-in phenomenon are verified on a transonic rotor and a NACA0012 airfoil by comparing with the test data,respectively.The lock-in phenomenon is first numerically confirmed that may occur to TCF instabilities when its frequency is close to the blade vibration frequency.The lock-in region becomes wider with the vibration amplitude increasing,and it is also affected by modal shapes.For the rotor at the simulation conditions in this study,the bending mode results in a wider lock-in region than the torsional mode.In the lock-in region,the phase difference between the Tip Clearance Vortex(TCV)and the blade vibration changes with the flow condition and the frequency ratio of the blade vibration and the TCV instabilities.The frequency of the TCV instabilities reduces with the mass flow decreasing.Therefore,reducing mass flow and increasing frequency ratio have similar effects on the TCV phase,which causes a significant variation on the unsteady pressure amplitude in the blade tip area.Thus,the aerodynamic damping changes significantly with the TCV phase.The aerodynamic damping displays a nonlinear relationship with the vibration amplitude,and it changes from negative to positive with the vibration amplitude increasing at the same frequency ratio.The negative damping is mainly provided by the tip area of the blade.For unlocked conditions,the period of the TCF instabilities fluctuates over time,and it cannot be directly separated by their frequency features.Inter Blade Phase Angle(IBPA)also has an important influence on the feature of the TCV instabilities.The occurrence of frequency lock-in also requires“appropriate”IBPA.For the examined working conditions,the frequency lock-in occurs under 0 ND(Nodal Diameter),but not under 8 ND.However,no matter 0 ND or 8 ND,the phase of TCV always locks onto the IBPA at the examined conditions.

Leader-following cooperative guidance law with specified impact time

The problem of guidance law is investigated for multiple interceptors to attack a target cooperatively.A leader-following cooperative guidance strategy is presented to render the leader and the followers reach the target at specified impact time.The guidance law of leader is given to meet the demand of specified impact time.The arrival time is synchronized by enforcing the ranges-to-go of followers keep consensus with that of leader.The convergence time bound is estimated without dependence on the initial states,since the proposed leader-following cooperative guidance law is fixed-time convergent.The simulation is developed to validate the availability of proposed cooperative guidance law.

Efficient processing of partially specified twig pattern queries

As huge volumes of data are organized or exported in tree-structured form, it is quite necessary to extract useful information from these data collections using effective and efficient query processing methods. A natural way of retrieving desired information from XML documents is using twig pattern （TP）, which is, actually, the core component of existing XML query languages. Twig pattern possesses the inherent feature that query nodes on the same path have concrete precedence relationships. It is this feature that makes it infeasible in many actual scenarios. This has driven the requirement of relaxing the complete specification of a twig pattern to express more flexible semantic constraints in a single query expression. In this paper, we focus on query evaluation of partially specified twig pattern （PSTP） queries, through which we can reap the most flexibility of specifying partial semantic constraints in a query expression. We propose an extension to XPath through introducing two Samepath axes to support partial semantic constraints in a concise but effective way. Then we propose a stack based algorithm, pTwigStack, to process a PSTP holistically without deriving the concrete twig patterns and then processing them one by one. Further, we propose two DTD schema based optimization methods to improve the performance of pTwigStack algorithm. Our experimental results on various datasets indicate that our method performs significantly better than existing ones when processing PSTPs.

Bivalirudin is superior to heparins alone with bailout GP Ⅱb / Ⅲa inhibitors in patients with ST-segment elevation myocardial infarction transported emergently for primary percutaneous coronary intervention: a pre-specified analysis from the EUROMAX tria

Aims In the HORIZONS trial, in-hospital treatment with bivalirudin reduced bleeding and mortality in primary percutaneous coronary intervention（PCI） compared with heparin and routine glycoprotein Ⅱb / Ⅲa inhibitors（GPI）. It is unknown whether this advantage of bivalirudin is observed in comparison with heparins only with GPI used as bailout. Methods and results In the EUROMAX study, 2198 patients with ST-segment elevation myocardial infarction（STEMI） were randomized during transport for primary PCI to bivalirudin or to heparins with optional GPI. Primary and principal outcome was the composites of death or nonCABG-related major bleeding at 30 days. This pre-specified analysis compared patients receiving bivalirudin（n = 1089） with those receiving heparins with routine upstream GPI（n = 649） and those receiving heparins only with GPI use restricted to bailout（n = 460）. The primary outcome death and major bleeding occurred in5.1% with bivalirudin, 7.6% with heparin plus routine GPI（HR 0.67 and 95% CI 0.46-0.97, P = 0.034）,and 9.8% with heparins plus bailout GPI（HR 0.52 and 95% CI 0.35-0.75, P = 0.006）. Following adjustment by logistic regression, bivalirudin was still associated with significantly lower rates of the primary outcome（odds ratio 0.53, 95% CI 0.33-0.87） and major bleeding（odds ratio 0.44, 95% CI 0.24 – 0.82） compared with heparins alone with bailout GPI. Rates of stent thrombosis were higher with bivalirudin（1.6 vs. 0.6 vs.0.4%, P = 0.09 and 0.09）. Conclusion Bivalirudin, started during transport for primary PCI, reduces major bleeding compared with both patients treated with heparin only plus bailout GPI and patients treated with heparin and routine GPI, but increased stent thrombosis.

A general Boolean semantic modelling approach for complex and intelligent industrial systems in the framework of DES

Discrete event system(DES)models promote system engineering,including system design,verification,and assessment.The advancement in manufacturing technology has endowed us to fabricate complex industrial systems.Consequently,the adoption of advanced modeling methodologies adept at handling complexity and scalability is imperative.Moreover,industrial systems are no longer quiescent,thus the intelligent operations of the systems should be dynamically specified in the model.In this paper,the composition of the subsystem behaviors is studied to generate the complexity and scalability of the global system model,and a Boolean semantic specifying algorithm is proposed for generating dynamic intelligent operations in the model.In traditional modeling approaches,the change or addition of specifications always necessitates the complete resubmission of the system model,a resource-consuming and error-prone process.Compared with traditional approaches,our approach has three remarkable advantages:(i)an established Boolean semantic can be fitful for all kinds of systems;(ii)there is no need to resubmit the system model whenever there is a change or addition of the operations;(iii)multiple specifying tasks can be easily achieved by continuously adding a new semantic.Thus,this general modeling approach has wide potential for future complex and intelligent industrial systems.

Application Specified Soft-Error Failure Rate Analysis Using Sequential Equivalence Checking Techniques

Soft errors have become a critical challenge as a result of technology scaling. Existing circuit-hardening techniques are commonly associated with prohibitive overhead of performance, area, and power. However,evaluating the influence of soft errors in Flip-Flops(FFs) on the failure of circuit is a difficult verification problem.Here, we proposed a novel flip-flop soft-error failure rate analysis methodology using a formal method with respect to application behaviors. Approach and optimization techniques to implement the proposed methodology based on the given formula using Sequential Equivalence Checking(SEC) are introduced. The proposed method combines the advantage of formal technique-based approaches in completeness and the advantage of application behaviors in accuracy to differentiate vulnerability of components. As a result, the FFs in a circuit are sorted by their failure rates, and designers can use this information to perform optimal hardening of selected sequential components against soft errors. Experimental results of an implementation of a SpaceWire end node and the largest ISCAS’89 benchmark sequential circuits indicate the feasibility and potential scalability of our approach. A case study on an instruction decoder of a practical 32-bit microprocessor demonstrates the applicability of our method.

On a Spanning K-tree Containing Specified Vertices in a Graph

A k-tree is a tree with maximum degree at most k. In this paper, we give a sharp degree sum condition for a graph to have a spanning k-tree in which specified vertices have degree less than t, where 1≤t≤k.We denote by σ_k(G) the minimum value of the degree sum of k independent vertices in a graph G. Let k≥2,s≥0 and 1≤t≤k be integers, and suppose G is an(s + 1)-connected graph with σ_k(G)≥|G|+(k-t)s-1.Then for any s specified vertices, G contains a spanning k-tree in which every specified vertex has degree at most t. This improves a result obtained by Matsuda and Matsumura.

A New Method for State Simplification in Incompletely Specified Sequential Machines

This paper presents a method for state simplification in incompletely specified sequential machines. The new method adopts Inclusive-OR operation of column vectors for multi-level output matrix E_k! Compared with other algorithms in use, this method is theoretically more strict, while its structure is simple and the results obtained are accurate.

Health Phys.Abstracts,Volume 124,Number 5

Aligning Exposure Limits for Contact Currents with Exposure Limits for Electric Fields Robert Kavet1 and Richard A.Tell2(1.Kavet Consulting LLC,4455 Worden Way,Oakland,CA 94619;2.Richard Tell Associates,Inc.,10037 Long Meadow Road,Madison,AL 35756.)Abstract:The Institute for Electrical and Electronic Engineers(IEEE)and the International Commission on Non-ionizing Radiation Protection(ICNIRP)have established limits for exposures to electromagnetic fields across the 0-300 GHz(non-ionizing)spectrum,including limits on contact currents(CC)specified by IEEE for 0-110 MHz(ICNIRP issued a CC“guidance level”).

Differences between DSM-5-TR and ICD-11 revisions of attention deficit/hyperactivity disorder:A commentary on implications and opportunities

Current ICD-11 descriptions for attention deficit hyperactivity disorder(ADHD)were recently published online,in the same year as the DSM-5-TR(text revised edition)was released.In this commentary,we compare and contrast the DSM-5/DSM-5-TR and ICD-11 diagnostic criteria,summarize important differences,and underscore their clinical and research implications.Overall,three major differences emerge:(1)The number of diagnostic criteria for inattention(IA),hyperactivity(HY)and impulsivity(IM)symptoms(i.e.,DSM-5-TR has nine IA and nine HY/IM symptoms,whereas ICD-11 has 11 IA and 11 HY/IM symptoms);(2)the clarity and standardization of diagnostic thresholds(i.e.,the diagnostic thresholds for symptom count in IA and HY/IM domains are explicitly specified in DSM-5-TR,whereas in ICD-11 they are not);and(3)the partitioning of HY and IM symptoms into sub-dimensions(i.e.,difference in partitioning HY and IM symptom domains relates to the differences between the current and previous editions of DSM and ICD,and this has important research implications).Currently,no ICD-11 based ADHD rating scales exist and while this absence represents an obstacle for respective research and clinical practice,it also presents opportunities for research development.This article highlights these challenges,possible remedies and novel research opportunities.

Radial and longitudinal density variations in Abies cephalonica and Pinus halepensis

Basic wood density is an excellent indicator of quality,it is correlated with numerous physical,physiological and mechanical characteristics of a species and is a good descriptor of wood quality and important indicator of tree performance in community ecology.An accurate method is thus needed to estimate wood density.The standard way is to calculate the ratio of the oven-dried mass of a wood sample divided by its green volume,but wood characteristics within and between growth rings are highly variable;the density can vary in the longitudinal and the radial directions.The present study investigates the longitudinal and radial fl uctuations in the basic density of Abies cephalonica Loud and Pinus halepensis Mill.Four logs were cut from four diff erent trees for each species and 16 discs were formed(two discs from each log,one at the base and one at the top).Each disc was cut into cubes where their distance from the pith was measured and then sorted into 2 cm wide concentric zones.The results revealed a mild decreasing trend in basic density from the foot of the trunk upward for both species.The pith in both species also seems to have a relatively high density,which in the immediate next growth rings decreases only to resume increasing toward the bark.

Shakedown Criterion Employing Actual Residual Stress Field and Its Application in Numerical Shakedown Analysis

Construction of the static admissible residual stress field and searching the optimal field are key tasks in the shakedown analysis methods applying the static theorem. These methods always meet dimension obstacles when dealing with complex problems. In this paper, a novel shakedown criterion is proposed employing actual residual stress field based on the static shakedown theorem. The actual residual stress field used here is produced under a specified load path, which is a sequence of proportional loading and unloading from zero to all the vertices of the given load domain. This ensures that the shakedown behavior in the whole load domain can be determined based on the theorem proposed by K6nig. The shakedown criterion is then implemented in numerical shakedown analysis, The actual residual stress fields are calculated by incremental finite element elastic-plastic analysis technique for finite deformation under the specified load path with different load levels. The shakedown behavior and the shakedown limit load are determined according to the proposed criterion. The validation of the criterion is performed by a benchmark shakedown example, which is a square plate with a central hole under biaxial loading. The results are consistent with existing results in the literatures and are validated by full cyclic elastic-plastic finite element analysis. The numerical shakedown analysis applying the proposed criterion avoids processing dimension obstacles and performing full cyclic elastic-plastic analysis under arbitrary load paths which should be accounted for appearing. The effect of material model and geometric changes on shakedown behavior can he considered conveniently.

Modified Static Floor Field and Exit Choice for Pedestrian Evacuation

An improved floor field model is proposed to simulate the pedestrian evacuation behavior in a room with multiple exits by modifying the static floor field.The modified static floor field is determined additionally by two cognitive coefficients of exit width and congestion degree around the exits.The logit-based discrete choice principle is used to govern the initial exit selection strategy based on the modified static floor field in such a scenario that pedestrians are distributed in the room's specified zone.Simulation results show that the proposed model can better perform the evacuation process.Sensitivity analyses of the model parameters are also presented.

Disordered eating behaviors in type 1 diabetic patients

Patients with type 1 diabetes mellitus are at high risk for disordered eating behaviors (DEB). Due to the fact that type 1 diabetes mellitus is one of the most common chronic illnesses of childhood and adolescence, the coexistence of eating disorders (ED) and diabetes often affects adolescents and young adults. Since weight management during this state of development can be especially diff icult for those with type 1 diabetes, some diabetics may restrict or omit insulin, a condition known as diabulimia, as a form of weight control. It has been clearly shown that ED in type 1 diabetics are associated with impaired metabolic control, more frequent episodes of ketoacidosis and an earlier than expected onset of diabetes-related microvascular complications, particularly retinopathy. The management of these conditions requires a multidisciplinary team formed by an endocrinologist/diabetologist, a nurse educator, a nutritionist, a psychologist and, frequently, a psychiatrist. The treatment of type 1 diabetes patients with DEB and ED should have the following compo- nents: diabetes treatment, nutritional management and psychological therapy. A high index of suspicion of the presence of an eating disturbance, particularly among those patients with persistent poor metabolic control, repeated episodes of ketoacidosis and/or weight andshape concerns are recommended in the initial stage of diabetes treatment, especially in young women. Given the extent of the problem and the severe medical risk associated with it, more clinical and technological research aimed to improve its treatment is critical to the future health of this at-risk population.