Role of preoperative magnetic resonance imaging on the surgical outcomes of radical prostatectomy:Does preoperative tumor recognition reduce the positive surgical margin in a specific location?Experience from a Thailand prostate cancer specialized center

Objective Multiparametric magnetic resonance imaging(MRI)has become the standard of care for the diagnosis of prostate cancer patients.This study aimed to evaluate the influence of preoperative MRI on the positive surgical margin(PSM)rates.Methods We retrospectively reviewed 1070 prostate cancer patients treated with radical prostatectomy(RP)at Siriraj Hospital between January 2013 and September 2019.PSM rates were compared between those with and without preoperative MRI.PSM locations were analyzed.Results In total,322(30.1%)patients underwent MRI before RP.PSM most frequently occurred at the apex(33.2%),followed by posterior(13.5%),bladder neck(12.7%),anterior(10.7%),posterolateral(9.9%),and lateral(2.3%)positions.In preoperative MRI,PSM was significantly lowered at the posterior surface(9.0%vs.15.4%,p=0.01)and in the subgroup of urologists with less than 100 RP experiences(32%vs.51%,odds ratio=0.51,p<0.05).Blood loss was also significantly decreased when a preoperative image was obtained(200 mL vs.250 mL,p=0.02).Multivariate analysis revealed that only preoperative MRI status was associated with overall PSM and PSM at the prostatic apex.Neither the surgical approach,the neurovascular bundle sparing technique,nor the perioperative blood loss was associated with PSM.Conclusion MRI is associated with less overall PSM,PSM at apex,and blood loss during RP.Additionally,preoperative MRI has shown promise in lowering the PSM rate among urologists who are in the early stages of performing RP.

Marginal donor liver versus standard donor liver: A single-center observational study

Background:The effectiveness and safety of marginal donor livers remain controversial.This study aimed to investigate the clinical efficacy of marginal donor livers in patients with liver transplantation(LT).Methods:This study included 199 liver donors(including 16 split donors)and 206 liver recipients from January 1,2018 to January 27,2020,with case follow-up until July 31,2021.Clinical data of donors and recipients were retrospectively analyzed and were divided into the marginal donor and standard donor groups according to the criteria of marginal donor livers.Indices of liver and kidney functions,complications,and survival curves of the two groups were compared.Results:Compared with the standard donor group,the blood creatinine levels were significantly higher in the marginal donor group in the first week after operation(P<0.05);there were no significant differences in alanine aminotransferase,aspartate aminotransferase,and total bilirubin levels after LT(all P>0.05);there was no significant difference in the incidence of complications after LT(P>0.05);there was also no significant difference in the survival curve(P=0.335).Conclusions:There were no significant differences in liver and kidney function and survival curve between the standard donor and marginal donor groups.The marginal donor liver appears safe and reliable for LT and may be an important strategy to expand the donor pool and solve the shortage of organs.

Marginal zone lymphoma with severe rashes: A case report

BACKGROUND Marginal zone lymphoma(MZL)is an indolent subtype of non-Hodgkin lymphoma(NHL),which is rare clinically with severe rashes as the initial symptom.CASE SUMMARY This study reports a case of MZL with generalized skin rashes accompanied by pruritus and purulent discharge.First-line treatment with rituximab combined with zanubrutinib had poor effects.However,after switching to obinutuzumab combined with zanubrutinib,the case was alleviated,and the rashes disappeared.CONCLUSION For patients with advanced stage MZL not benefiting from type I anti-CD20 monoclonal antibody(mAb)combination therapy,switching to a type II anti-CD20 mAb combination regimen may be considered.This approach may provide a new perspective in the treatment of MZL.

The Contribution Margin due to a Limiting Factor in the Presence of Several Sales Options: Actuality Is Not Always As It Appears at the Beginning of the Analysis

The analysis of company data useful for economic decisions,if not interpreted in an overall view of the company situation,can lead to wrong conclusions.This is the case when a company has to choose between several sales options for one or more products in the presence of a limiting factor.The continuation of the investigation often denies the initial analysis.Not everything is as it appears,therefore,at the beginning of the deepening of the data useful for economic decisions.As it is well known,the choices of profitability concerning the planning of the sale of company products take place,at least in the majority of cases,through the determination of the contribution margin,i.e.the profitability margin connected to the individual goods/services sold by the companies(selling price net of variable costs).The contribution margin can be determined with four objectives:(1)Determination of the yield of the single product,net of variable costs only.In this case,the margin defines unitary,from net product yield to unitary contribution margin.(2)Determination of the return on total sales of an individual product,net of variable costs.In this hypothesis,reference is made to the first level(or gross)contribution margin.(3)Determination of the ability of the individual product to contribute to the coverage of fixed costs common to the company.This margin is determined net of special product variable and fixed costs.This aggregate is defined as a Level II(or semi-gross)margin.(4)Determination of the useful value in the planning choices in case of presence of scarce productive factors.In this case,it must identify the so-called unitary margin for low factor.Here we will only deal with the problem of the use of the contribution margin in the presence of rare factors.To complete the analysis,below are some very brief considerations regarding,respectively,the unitary,level I,and level II contribution margin in order to better understand where the problem of the most convenient choice of income is located in the event of the presence of rare production factors,especially in an environment characterized by a plurality of sales options.

Resilient performance of self-centering hybrid rocking walls with curved interface under pseudo-static loading

Frame and rocking wall(FRW)structures have excellent resilient performance during earthquakes.However,the concrete at interfacial corners of rocking walls(RWs)is easily crushed due to local extreme compression during the rocking process.An innovative RW with a curved interface is proposed to prevent interfacial corners from producing local damage,enhancing its earthquake resilient performance(ERP).The precast wall panel with a curved interface is assembled into an integral self-centering hybrid rocking wall(SCRW)by two post-tensioned unbonded prestressed tendons.Moreover,two ordinary energy dissipation steel rebars and two shear reinforcements are arranged to increase the energy dissipation capacity and lateral resistance.Two SCRW specimens and one monolithic reinforced concrete(RC)shear wall(SW)were tested under pseudo-static loading to compare the ERPs of the proposed SCRW and the SW,focusing on studying the effect of the curved interface on the SCRW.The key resilient performance of rocking effects,failure modes,and hysteretic properties of the SCRW were explored.The results show that nonlinear deformations of the SCRW are concentrated along the interface between the SCRW and the foundation,avoiding damage within the SCRW.The restoring force provided by the prestressed tendons can effectively realize self-centering capacity with small residual deformation,and the resilient performance of the SCRW is better than that of monolithic SW.In addition,the curved interface of the SCRW makes the rocking center change and move inward,partially relieving the stress concentration and crush of concrete.The rocking range of the rocking center is about 41.4%of the width of the SCRW.

Deep tectonics and seismogenic mechanisms of the seismic source zone of the Jishishan M_(s)6.2 earthquake on December 18,2023,at the northeast margin of the Tibetan Plateau

On December 18,2023,an M_(s)6.2 earthquake occurred in Jishishan,Gansu Province,China.This earthquake happened in the eastern region of the Qilian Orogenic Belt,which is situated at the forefront of the NE margin of the Tibetan Plateau(i.e.,Qinghai-Tibet Plateau),encompassing a rhombic-shaped area that intersects the Qilian-Qaidam Basin,Alxa Block,Ordos Block,and South China Block.In this study,we analyzed the deep tectonic pattern of the Jishishan earthquake by incorporating data on the crustal thickness,velocity structure,global navigation satellite system(GNSS)strain field,and anisotropy.We discovered that the location of the earthquake was related to changes in the crustal structure.The results showed that the Jishishan M_(s)6.2 earthquake occurred in a unique position,with rapid changes in the crustal thickness,Vp/Vs,phase velocity,and S-wave velocity.The epicenter of the earthquake was situated at the transition zone between high and low velocities and was in proximity to a low-velocity region.Additionally,the source area is flanked by two high-velocity anomalies from the east and west.The principal compressive strain orientation near the Lajishan Fault is primarily in the NNE and NE directions,which align with the principal compressive stress direction in this region.In some areas of the Lajishan Fault,the principal compressive strain orientations show the NNW direction,consistent with the direction of the upper crustal fast-wave polarization from local earthquakes and the phase velocity azimuthal anisotropy.These features underscore the relationship between the occurrence of the Jishishan M_(s)6.2 earthquake and the deep inhomogeneous structure and deep tectonic characteristics.The NE margin of the Tibetan Plateau was thickened by crustal extension in the process of northeastward expansion,and the middle and lower crustal materials underwent structural deformation and may have been filled with salt-containing fluids during the extension process.The presence of this weak layer makes it easier for strong earthquakes to occur through the release of overlying rigid crustal stresses.However,it is unlikely that an earthquake of comparable or larger magnitude would occur in the short term(e.g.,in one year)at the Jishishan east margin fault.

The largest CPIES array in the marginal sea:abundant dynamics in the northeast South China Sea

The South China Sea(SCS)is a marginal sea connecting the Pacific and Indian oceans and has gained much attention in recent decades.The dynamics in the northeast SCS are considerably influenced by topography,monsoons,tropical cyclones,the Kuroshio intrusion,and water exchange through the Luzon Strait(LS).

Cortical hem signaling center: functions, development, and potential implications for evolution and brain disorders

Development of the telencephalon relies upon several signaling centers-localized cellular populations that supply secreted factors to pattern the cortical neuroepithelium.One such signaling center is the cortical hem,which arises during embryonic development at the telencephalic dorsal midline,adjacent to the choroid plexus and hippocampal primordium(Figure 1A).While the cortical hem has also been described in reptiles and birds,most of our knowledge about the developmental roles of the cortical hem is derived from the analysis in mice.The cortical hem produces several types of secreted molecules,including wingless-related integration site(Wnt)and bone morphogenetic(Bmp)proteins.The cortical hem is particularly important for the development of the hippocampus,which is involved in learning and memory,and the neocortex,which is the most complex brain region that mediates multiple types of behavior and higher cognitive functions(Mangale et al.,2008;Dal-Valle-Anton and Borrell,2022).

Generation of macroscopic entanglement in ensemble systems based on silicon vacancy centers

Entanglement in macroscopic systems,as a fundamental quantum resource,has been utilized to propel the advancement of quantum technology and probe the boundary between the quantum and classical realms.This study focuses on a unique hybrid quantum system comprising of an ensemble of silicon vacancy(SiV)centers coupled to phononic waveguides in diamond via strain interactions.By employing two sets of time-dependent,non-overlapping driving fields,we investigate the generation process and dynamic properties of macroscopic quantum entanglement,providing fresh insights into the behavior of such hybrid quantum systems.Furthermore,it paves the way for new possibilities in utilizing quantum entanglement as an information carrier in quantum information processing and quantum communication.

Preparing highly entangled states of nanodiamond rotation and NV center spin

A nanodiamond with an embedded nitrogen-vacancy(NV)center is one of the experimental systems that can be coherently manipulated within current technologies.Entanglement between NV center electron spin and mechanical rotation of the nanodiamond plays a fundamental role in building a quantum network connecting these microscopic and mesoscopic degrees of motions.Here we present a protocol to asymptotically prepare a highly entangled state of the total quantum angular momentum and electron spin by adiabatically boosting the external magnetic field.

Prevalence of Enteric Pathogens Associated with Infections among Table Egg Consumers in Some Primary Health Establishments in the Center Region of Cameroon

Method: In Cameroon limited data are available regarding the prevalence of enteric bacteria associated with table egg consuming infections. As such, a situational-based study was performed in patients with complains of stomach disorders after egg consumption. Data related to sociodemographic characteristics and other factors were collected using a structured based questionnaire. Stool culture of utmost importance in stomach disorders patients and serum were collected for typhoid serological test. Results: A total of 207 participants took part in the survey, Results indicated nontyphoidal Salmonella infections were highest in the 3 areas of study with Mfoundi (73.44%) having the highest level of infection compared to other bacterial infection. other enteric bacteria associated to this infection were E. coli serotype 157, Aeromonas, Citrobacter freundii, Enterobacter cloaca and typhi salmonella. Meanwhile salmonelosis caused by typhic salmonella had highest prevalence in the Lekie Division (13.11%) as a result of poor hygienic practices associated with the conservation and preparation of eggs, Stool culture was observed to detect more positive cases in the diagnosis of typhoid fever than Widal test, but with no statistically significant (p > 0.05) difference between the stool culture and Widal test in the 3 areas of study. Conclusion: this study revealed that egg consumers are pruned to enteric bacterial and salmonella infections depending on how and where egg is consumed.

Distal margin distance in radical resection of locally advanced rectal cancer after neoadjuvant therapy

Colorectal cancer has a high incidence and mortality rate in China, with the majority of cases being middle and low rectal cancer. Surgical intervention is currently the main treatment modality for locally advanced rectal cancer, with the common goal of improving oncological outcomes while preserving function. The controversy regarding the circumferential resection margin distance in rectal cancer surgery has been resolved. With the promotion of neoadjuvant therapy concepts and advancements in technology, treatment strategies have become more diverse.Following tumor downstaging, there is an increasing trend towards extending the safe distance of distal rectal margin. This provides more opportunities for patients with low rectal cancer to preserve their anal function.However, there is currently no consensus on the specific distance of distal resection margin.

The Peripheral Hospital as Focal Point for Pacemaker Activity: Review of the Last 300 Implantations Carried out at the Haute Correze Hospital Center

Background: Pacemaker implantation is a very old activity which has revolutionized the cardiology practice throughout the world. This activity is effective at the Haute Correze Hospital Center since more than 20 years. Due to progress in this area, and the increasing request within this center located at the outskirts of town, we set out to evaluate our pacemaker activity in general and more specifically to assess the post-procedural complications in our series patients. Methodology: This was a retrospective longitudinal study. Data were recorded for period of 90 months from 27/05/2016 to 19/11/2023. This data collection was possible via a specific register completed by computerized patient data from the SillageTM software. All files of patients implanted with single or dual chamber pacemakers were included, generator replacements, upgrading procedures and addition of leads were excluded. The sampling was non-probabilistic, consecutive and non-exhaustive. Statistical analysis was carried out using the Excel 2019 spreadsheet and SPSS version 23 software. The quantitative variables were presented as mean ± standard deviation, the qualitative data as proportions. Results: A total of 303 first-time pacemaker’s implantations were carried out during the study period (rate of 40 per year). The average age in the population was 79.7 ± 9.4 years (44 - 99 years) with a male predominance of 63.7% (n = 193). Atrioventricular block (2nd and 3rd degree) was the main indication for pacemaker implantation in 42.9% of cases (n = 130). Patients were most often implanted with a dual-chamber pacemaker (57.7%, n = 175). The approach was most often cephalic in 72.6% of cases (n = 220), followed by the subclavian access in 27.4% of cases (n = 84). The average fluoroscopy time was 7.9 min ± 2.4 (1 - 43). The average irradiation dose in gray/cm2 was 12.4 ± 9.3 (0.22 - 117.5). The average length of hospitalization was 7 ± 4 (2 - 26) days. The overall complication rate at one year was 12.9% (n = 39). These complications are distributed as follows: Leads dislodgement in 8.2% (n = 25), hematoma 3.6% (n = 11) all without clinical consequences, pneumothorax 0.7% (n = 2), both cases of pneumothorax did not require specific care, infection (superficial) in 0.3% (n = 1). Leads dislodgement occurred after a median time of 18 days (IQR: 3 - 36). The earliest dislodgement was observed on D0 and the latest on D207. No serious complications were recorded. The average atrial threshold at implantation/first control/last follow-up was 0.7/1.3/0.8 V, respectively. The average ventricular threshold at implantation/first control/last follow-up was 0.5/1.08/0.87 V, respectively. The average atrial detection at implantation/first control/last follow-up was 3.2/2.3/ 2.05 mv, respectively. The average ventricular detection at implantation/first control/last follow-up was 10.3/11.03/10.8 mv. The average atrial impedance at implantation/first control/last follow-up was 610/457/457 ohms. The average ventricular impedance at implantation/first control/last follow-up was 754/547/563 ohms. Conclusion: Pacemaker implantation is safe at the Haute Correze Hospital Center with a relatively low rate of complications, in this case an almost zero major infection and no serious hematoma. The peripheral hospital should remain a focal point of this activity in order to respond more quickly to the needs of the populations.

Comment on“Robotic surgery and liver transplantation:A single-center experience of 501 robotic donor hepatectomies”

To the Editor:We read with great interest the article by Schulze et al.entitled“Robotic surgery and liver transplantation:A single-center experience of 501 robotic donor hepatectomies”[1].It is the first single-center report including over 500 fully robotic donor hepatectomies.For the donors,the overall complication rate was 6.4%(n=32).Postoperative self-limiting bleeding(0.4%)and bile leakage from the resection plane(1.8%)were rare.

Dynamic Routing of Multiple QoS-Required Flows in Cloud-Edge Autonomous Multi-Domain Data Center Networks

The 6th generation mobile networks(6G)network is a kind of multi-network interconnection and multi-scenario coexistence network,where multiple network domains break the original fixed boundaries to form connections and convergence.In this paper,with the optimization objective of maximizing network utility while ensuring flows performance-centric weighted fairness,this paper designs a reinforcement learning-based cloud-edge autonomous multi-domain data center network architecture that achieves single-domain autonomy and multi-domain collaboration.Due to the conflict between the utility of different flows,the bandwidth fairness allocation problem for various types of flows is formulated by considering different defined reward functions.Regarding the tradeoff between fairness and utility,this paper deals with the corresponding reward functions for the cases where the flows undergo abrupt changes and smooth changes in the flows.In addition,to accommodate the Quality of Service(QoS)requirements for multiple types of flows,this paper proposes a multi-domain autonomous routing algorithm called LSTM+MADDPG.Introducing a Long Short-Term Memory(LSTM)layer in the actor and critic networks,more information about temporal continuity is added,further enhancing the adaptive ability changes in the dynamic network environment.The LSTM+MADDPG algorithm is compared with the latest reinforcement learning algorithm by conducting experiments on real network topology and traffic traces,and the experimental results show that LSTM+MADDPG improves the delay convergence speed by 14.6%and delays the start moment of packet loss by 18.2%compared with other algorithms.

Bendamustine and rituximab as frontline therapy in extranodal marginal zone lymphoma:a single-institution experience

Extranodal marginal zone lymphoma(EMZL)encompasses 70%of cases of marginal zone lymphoma.Frontline bendamustine and rituximab(BR)were derived from trials involving other indolent non-Hodgkin’s lymphomas.Only one trial has evaluated frontline BR prospectively in EMZL.This retrospective study reports outcomes among EMZL patients receiving frontline BR.Twenty-five patients were included with a median age of 69 years(40–81).Five(20.0%)patients had stage Ⅰ/Ⅱ disease,and 20(80.0%)had stage Ⅲ/Ⅳ disease.The median number of cycles was 6.0(3.0–6.0).Maintenance rituximab was administered to 10(41.7%)individuals.Overall response rate(ORR)was 100.0%(60.0%complete response,40.0%partial response).Medians of overall survival and progression-free survival were not reached.The estimated 2-year progression-free survival was 85.2%and overall survival was 100.0%.Four(16.6%)patients had infections related to treatment;3(12.0%)transformed to diffuse large B-cell lymphoma;5(20.8%)had a relapse or progression of EMZL;and 3(12.0%)died unrelated to BR.BR is an efficacious and well-tolerated front-line regimen for EMZL with response data consistent with existing literature.

Management of Acute Malnutrition in Children Aged 0 to 24 Months Boulbinet Health Center

Introduction: Malnutrition is a pathological state resulting from the relative deficiency or excess of one or more essential nutrients, whether manifested clinically or detected only by biochemical, anthropometric or physiological analyses. The overall objective was to assess the quality of management of acute malnutrition in children aged 0 - 24 months at the Boulbinet health center. Methodology: This was a prospective descriptive study lasting six (06) months from May 5 to October 5, 2018. The study included all children aged 0 to 24 months. Results: Acute malnutrition in children aged 0 - 24 months accounted for 2.11% of cases. The sex ratio was 1.41 in favor of males. The mean age of our patients was 5 months 7 days, with extremes of 1 month and 6 months. The majority came from Ra toma (40.24%). Exclusive breastfeeding was most common (54.02%). The main clinical signs were: pallor 49.42%, diarrhea 46.67, oral lesions37.96%. SAM represented 89.66% and MAM 10.34%. Most associated pathologies: anemia 49.42% and oral candidiasis 37.93%. In terms of outcome, we recorded 56.32% cures, 20.69% deaths, 18.39% dropouts and 4.60% cures. Conclusion: Improving the quality of care for malnourished children aged 0 - 24 months requires raising awareness among mothers and the general public of the consequences of malnutrition.

Introducing hydroxyl groups to tailor the d-band center of Ir atom through side anchoring for boosted ORR and HER

Tuning the coordination atoms of central metal is an effective means to improve the electrocatalytic activity of atomic catalysts.Herein,iridium(Ir) is proposed to be asymmetrically anchored by sp-N and pyridinic N of hydrogen-substituted graphdiyne(HsGDY),and coordinated with OH as an Ir atomic catalyst(Ir_(1)-N-HsGDY).The electron structures,especially the d-band center of Ir atom,are optimized by these specific coordination atoms.Thus,the as-synthesized Ir_(1)-N-HsGDY exhibits excellent electrocatalytic performances for oxygen reduction and hydrogen evolution reactions in both acidic and alkaline media.Benefiting from the unique structure of HsGDY,IrN_(2)(OH)_(3) has been developed and demonstrated to act as the active site in these electrochemical reactions.All those indicate the fresh role of the sp-N in graphdiyne in producing a new anchor way and contributing to promote the electrocatalytic activity,showing a new strategy to design novel electrochemical catalysts.

In-situ construction of abundant active centers on hierarchically porous carbon electrode toward high-performance phosphate electrosorption: Synergistic effect of electric field and capture sites

Phosphate removal is crucial for eutrophication control and water quality improvement.Electro-assisted adsorption,an eco-friendly elec-trosorption process,exhibited a promising potential for wastewater treatment.However,there are few works focused on phosphate electro-sorption,and reported electrodes cannot attach satisfactory removal capacities and rates.Herein,electro-assisted adsorption of phosphate via in-situ construction of La active centers on hierarchically porous carbon(LaPC)has been originally demonstrated.The resulted LaPC composite not only possessed a hierarchically porous structure with uniformly dispersed La active sites,but also provided good conductivity for interfacial electron transfer.The LaPC electrode achieved an ultrahigh phosphate electrosorption capability of 462.01 mg g^(-1) at 1 V,outperforming most existing electrodes.The superior phosphate removal performance originates from abundant active centers formed by the coupling of electricfield and capture sites.Besides,the stability and selectivity toward phosphate capture were maintained well even under comprehensive conditions.Moreover,a series of kinetics and isotherms models were employed to validate the electrosorption process.This work demonstrates a deep understanding and promotes a new level of phosphate electrosorption.

Design of compact integrated diamond nitrogen-vacancy center quantum probe

An integrated quantum probe for magnetic field imaging is proposed,where the nitrogen–vacancy(NV)center fixed at the fiber tip is located on the periphery of flexible ring resonator.Using flexible polyimide(PI)as the substrate medium,we design a circular microstrip antenna,which can achieve a bandwidth of 140 MHz at Zeeman splitting frequency of 2.87 GHz,specifically suitable for NV center experiments.Subsequently,this antenna is seamlessly fixed at a three-dimensional-printed cylindrical support,allowing the optical fiber tip to extend out of a dedicated aperture.To mitigate errors originating from processing,precise tuning within a narrow range can be achieved by adjusting the conformal amplitude.Finally,we image the microwave magnetic field around the integrated probe with high resolution,and determine the suitable area for placing the fiber tip(SAP).