Seagrass ecosystems worldwide have been declining, leading to a decrease in associated fish populations, especiallythose with low mobility such as syngnathids (pipefish and seahorses). This two-year pilot study invest...Seagrass ecosystems worldwide have been declining, leading to a decrease in associated fish populations, especiallythose with low mobility such as syngnathids (pipefish and seahorses). This two-year pilot study investigated seasonal patterns indensity, growth, site fidelity, and population dynamics of Tampa Bay (FL) syngnathid fishes at a site adjacent to two marinas underconstruction. Using a modified mark-recapture technique, fish were collected periodically from three closely located sites thatvaried in seagrass species (Thalassia spp., Syringodium spp., and mixed-grass sites) and their distance from open water, but hadconsistent physical/chemical environmental characteristics. Fish were marked, photographed for body size and gender measurements,and released the same day at the capture site. Of the 5695 individuals surveyed, 49 individuals were recaptured, indicatinga large, flexible population. Population density peaks were observed in July of both years, with low densities in late winter andlate summer. Spatially, syngnathid densities were highest closest to the mouth of the bay and lowest near the shoreline. Sevenspecies of syngnathid fishes were observed, and species-specific patterns of seagrass use emerged during the study. However,only two species, Syngnathus scovelli and Hippocampus zosterae, were observed at high frequencies. For these two species, bodysize decreased across the study period, but while S. scovelli's population density decreased, H. zosterae's increased. Across six ofthe seven species, population size declined over the course of this preliminary study; however, seasonal shifts were impossible todistinguish from potential anthropogenic effects of展开更多
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 tria...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.展开更多
Introduction:Traumatic brain injury(TBI)is a common diagnosis among veterans secondary to combat experiences.TBI is also rampant among those experiencing homelessness,possibly due to veterans making up 12.3%of the hom...Introduction:Traumatic brain injury(TBI)is a common diagnosis among veterans secondary to combat experiences.TBI is also rampant among those experiencing homelessness,possibly due to veterans making up 12.3%of the homeless population(Tsai and Rosenheck,2015),or due to the high risk of violence or trauma among those experiencing homelessness.TBI is up to 10×more prevalent among those experiencing homelessness(Stubbs et al.,2020;Dell et al.,2021).展开更多
BACKGROUND Cervical cancer is a rare primary tumor resulting in metastases to the breast with few cases reported in literature.Breast metastases are associated with poor prognosis.The following case highlights the dia...BACKGROUND Cervical cancer is a rare primary tumor resulting in metastases to the breast with few cases reported in literature.Breast metastases are associated with poor prognosis.The following case highlights the diagnostic challenges associated with metastatic cervical cancer to the breast along with individualized treatment.CASE SUMMARY A 44-year-old G7P5025 with no significant past medical or surgical history presented with heavy vaginal to an outside emergency department where an exam and a pelvic magnetic resonance imaging showed a 4.5 cm heterogenous lobulated cervical mass involving upper two thirds of vagina,parametria and lymph node metastases.Cervical biopsies confirmed high grade adenocarcinoma with mucinous features.A positron emission tomography/computed tomography(PET/CT)did not show evidence of metastatic disease.She received concurrent cisplatin with external beam radiation therapy.Follow up PET/CT scan three months later showed no suspicious fluorodeoxyglucose uptake in the cervix and no evidence of metastatic disease.Patient was lost to follow up for six months.She was re-imaged on re-presentation and found to have widely metastatic disease including breast disease.Breast biopsy confirmed programmed death-ligand 1 positive metastatic cervical cancer.The patient received six cycles of carboplatin and paclitaxel with pembrolizumab.Restaging imaging demonstrated response.Patient continued on pembrolizumab with disease control.CONCLUSION Metastatic cervical cancer to the breast is uncommon with nonspecific clinical findings that can make diagnosis challenging.Clinical history and immunohistochemical evaluation of breast lesion,and comparison to primary tumor can support diagnosis of metastatic cervical cancer to the breast.Overall,the prognosis is poor,but immunotherapy can be considered in select patients and may result in good disease response.展开更多
This perspective focuses on the recent literature regarding the role of the gut-brain axis(GBA) in fecal microbiota transplantation(FMT) and stem cell therapy(SCT) in Parkinson's disease(PD).PD is the second most ...This perspective focuses on the recent literature regarding the role of the gut-brain axis(GBA) in fecal microbiota transplantation(FMT) and stem cell therapy(SCT) in Parkinson's disease(PD).PD is the second most common neurodegenerative disease in the United States,yet therapies remain limited.Current research suggests that the GBA may play a role in the pathogenesis of PD.GBAbased FMT as well as SCT offer promising new avenues for PD treatment.Pro bing the interactions between FMT and SCT with the GBA may reveal novel therapeutics for PD.展开更多
1.Introduction For decades,substantial disagreement has persisted as to whether dynamic knee valgus is the cause of the majority of anterior cruciate ligament(ACL)injuries or rather the result of the ACL rupture.1 Con...1.Introduction For decades,substantial disagreement has persisted as to whether dynamic knee valgus is the cause of the majority of anterior cruciate ligament(ACL)injuries or rather the result of the ACL rupture.1 Consequently,great effort and expense has gone into capturing 3-dimensional kinetics and kinematics from live athletes to drive in vitro and in silico models of ACL injury in order to elucidate the actual mechanism of injury,as these factors have been demonstrated to be surrogates of intraarticular structural loading on the ACL.2,3 The elucidation of injury mechanisms for non-contact ACL injuries is of great medical value as such knowledge consequently permits quantified examination and validation of interventions and their respective effectiveness in both prevention and rehabilitation of these traumatic knee injuries.展开更多
The focus of outcome-based education has shifted from the process of training to the end“product”of education.This has necessitated a reframing of the teaching,learning,and assessment.Therefore,in 2013,the Accredita...The focus of outcome-based education has shifted from the process of training to the end“product”of education.This has necessitated a reframing of the teaching,learning,and assessment.Therefore,in 2013,the Accreditation Council for Graduate Medical Education(ACGME)implemented the educational milestones for all accredited residencies and fellowship programs.[1]The milestones have been described as“developmentally based,specialty-specific achievements that residents are expected to demonstrate at established intervals as they progress through training.”[1]Milestones are based on the six core competencies established by the ACGME and American Board of Medical Specialties(ABMS),which consist of medical knowledge(MK),patient care(PC),interpersonal and communication skills(ICS),practice-based learning and improvement(PBLI),professionalism(PROF),and systems-based practice(SBP).[2,3]ACGME,in conjunction with the American Board of Emergency Medicine(ABEM),drafted 23 detailed subcompetencies relevant to emergency medicine(EM).[4]展开更多
We have previously evaluated asbestos exposure associated with various maintenance procedures on light aircraft. The purpose of this study was to evaluate asbestos exposure during engine maintenance on light aircraft....We have previously evaluated asbestos exposure associated with various maintenance procedures on light aircraft. The purpose of this study was to evaluate asbestos exposure during engine maintenance on light aircraft. This test was designed to evaluate the potential for asbestos exposure to mechanics and others who remove asbestos-containing engine gaskets from reciprocating style aircraft engines. Utilized in this test was an air cooled, horizontally opposed, aviation gasoline burning engine, assembled during 1986 and operated intermittently up into 2015, having accumulated 1680 hours run time. Nearly 75% of the asbestos-containing gaskets installed during 1986 were still in place at the time of testing. Chrysotile asbestos contents of such gaskets ranged from 55% to 60% by area, for those of sheet style and 5% by area, for the spiral wound metal/asbestos style. Despite the levels of effort required to effect gasket removals, the professional aircraft mechanic was not exposed to airborne asbestos fibers at the lower limits of sampling and analytical detection achieved;all of which were substantially less than the current Occupational Safety and Health Administration Permissible Exposure Limits for asbestos. The results of this testing indicate an absence of gasket related asbestos exposure risk to mechanics who work with light aircraft engines, including those having asbestos-containing gaskets. These results are consistent with the findings of Mlyarek and Van Orden who studied the asbestos exposure risk occasioned during overhaul of larger radial style reciprocating aircraft engines [1].展开更多
Dystonia characterizes a group of neurological movement disorders characterized by abnormal muscle movements,often with repetitive or sustained contraction resulting in abnormal posturing.Different types of dystonia p...Dystonia characterizes a group of neurological movement disorders characterized by abnormal muscle movements,often with repetitive or sustained contraction resulting in abnormal posturing.Different types of dystonia present based on the affected body regions and play a prominent role in determining the potential efficacy of a given intervention.For most patients afflicted with these disorders,an exact cause is rarely identified,so treatment mainly focuses on symptomatic alleviation.Pharmacological agents,such as oral anticholinergic administration and botulinum toxin injection,play a major role in the initial treatment of patients.In more severe and/or refractory cases,focal areas for neurosurgical intervention are identified and targeted to improve quality of life.Deep brain stimulation(DBS)targets these anatomical locations to minimize dystonia symptoms.Surgical ablation procedures and peripheral denervation surgeries also offer potential treatment to patients who do not respond to DBS.These management options grant providers and patients the ability to weigh the benefits and risks for each individual patient profile.This review article explores these pharmacological and neurosurgical management modalities for dystonia,providing a comprehensive assessment of each of their benefits and shortcomings.展开更多
Blastomas,characterized by a mixture of mesenchymal,epithelial,and undifferentiated blastematous components,are rare malignant neoplasms originating from precursor blast cells.This review focuses on digestive system b...Blastomas,characterized by a mixture of mesenchymal,epithelial,and undifferentiated blastematous components,are rare malignant neoplasms originating from precursor blast cells.This review focuses on digestive system blastomas in adult patients,including gastroblastoma,hepatoblastoma,and pancreatoblastoma.Gastroblastoma is a biphasic,epitheliomesenchymal tumor,with only sixteen cases reported to date.In addition to the characteristic histology,metastasisassociated lung adenocarcinoma transcript 1-glioma-associated oncogene homolog 1 gene fusion is typical,although recently novel ewing sarcoma breakpoint region 1-c-terminal binding protein 1 and patched 1-glioma-associated oncogene homolog 2 fusions have been described.Hepatoblastoma is exceptionally rare in adults and can show a variety of histologic patterns which may cause diagnostic difficulty.Pancreatoblastoma,primarily a pediatric tumor,displays acinar differentiation and squamoid nests with other lines of differentiation also present,especially neuroendocrine.Diagnostic approaches for these blastomas include a combination of imaging modalities,histopathological examination,and molecular profiling.The treatment generally involves surgical resection,which may be supplemented by chemotherapy or radiotherapy in some cases.Prognoses vary with gastroblastoma generally showing favorable outcomes post-surgery whereas hepatoblastoma and pancreatoblastoma often have poorer outcomes,particularly in the setting of metastases.This review highlights the complexity of diagnosing and managing these rare adult blastomas as well as the need for ongoing research to better understand their pathogenesis and improve treatment strategies.展开更多
In this paper, the authors extend [1] and provide more details of how the brain may act like a quantum computer. In particular, positing the difference between voltages on two axons as the environment for ions undergo...In this paper, the authors extend [1] and provide more details of how the brain may act like a quantum computer. In particular, positing the difference between voltages on two axons as the environment for ions undergoing spatial superposition, we argue that evolution in the presence of metric perturbations will differ from that in the absence of these waves. This differential state evolution will then encode the information being processed by the tract due to the interaction of the quantum state of the ions at the nodes with the “controlling’ potential. Upon decoherence, which is equal to a measurement, the final spatial state of the ions is decided and it also gets reset by the next impulse initiation time. Under synchronization, several tracts undergo such processes in synchrony and therefore the picture of a quantum computing circuit is complete. Under this model, based on the number of axons in the corpus callosum alone, we estimate that upwards of 50 million quantum states might be prepared and evolved every second in this white matter tract, far greater processing than any present quantum computer can accomplish.展开更多
This paper derives rigorous statements concerning the propagation velocity of action potentials in axons. The authors use the Green’s function approach to approximate the action potential and find a relation between ...This paper derives rigorous statements concerning the propagation velocity of action potentials in axons. The authors use the Green’s function approach to approximate the action potential and find a relation between conduction velocity and the impulse profile. Computer simulations are used to bolster the analysis.展开更多
BACKGROUND Immunotherapy have demonstrated promising outcomes in patients with high microsatellite instability(MSI)(MSI-H)metastatic colorectal cancer.However,the comparative effectiveness of Immunotherapy and chemoth...BACKGROUND Immunotherapy have demonstrated promising outcomes in patients with high microsatellite instability(MSI)(MSI-H)metastatic colorectal cancer.However,the comparative effectiveness of Immunotherapy and chemotherapy for patients with low MSI(MSI-L),and microsatellite stable(MSS)metastatic colorectal cancer remains unclear.AIM To investigate immunotherapy vs chemotherapy for treatment of MSI-L/MSS metastatic colorectal cancer,and to evaluate the success of immunotherapy against chemotherapy in managing MSI-H metastatic colorectal cancer during a follow-up of 50 months.METHODS We conducted a retrospective cohort study using the National Cancer Database(NCDB)to evaluate the overall survival(OS)of patients with metastatic colorectal cancer treated with immunotherapy or chemotherapy.The study population was stratified by MSI status(MSI-H,MSI-L,and MSS).Multivariable Cox proportional hazard models were used to assess the association between treatment modality and OS,adjusting for potential confounders.RESULTS A total of 21951 patients with metastatic colorectal cancer were included in the analysis,of which 2358 were MSI-H,and 19593 were MSI-L/MSS.In the MSI-H cohort,immunotherapy treatment(n=142)was associated with a significantly improved median OS compared to chemotherapy(n=860).After adjusting for potential confounders,immunotherapy treatment remained significantly associated with better OS in the MSI-H cohort[adjusted hazard ratio(aHR):0.57,95%confidence interval(95%CI):0.43-0.77,P<0.001].In the MSS cohort,no significant difference in median OS was observed between immunotherapy treatment and chemotherapy(aHR:0.94,95%CI:0.69-1.29,P=0.715).CONCLUSION In this population-based study using the NCDB,immunotherapy treatment was associated with significantly improved OS compared to chemotherapy in patients with MSI-H metastatic colorectal cancer,but not in those with MSI-L/MSS metastatic colorectal cancer.Further studies are warranted to determine the optimal therapeutic approach for patients with MSI-L/MSS metastatic colorectal cancer.展开更多
The need for higher data rate and higher systems capacity leads to several solutions including higher constellation size, spatial multiplexing, adaptive modulation and Non-Orthogonal Multiple Access (NOMA). Adaptive M...The need for higher data rate and higher systems capacity leads to several solutions including higher constellation size, spatial multiplexing, adaptive modulation and Non-Orthogonal Multiple Access (NOMA). Adaptive Modulation makes use of the user’s location from his base station, such that, closer users get bigger constellation size and hence higher data rate. A similar idea of adaptive modulation that makes use of the user’s locations is the NOMA technique. Here the base station transmits composite signals each for a different user at a different distance from the base station. The transmitted signal is formed by summing different user’s constellations with different weights. The closer the users the less average power constellation is used. This will allow the closer user to the base station to distinguish his constellation and others constellation. The far user will only distinguish his constellation and other user’s data will appear as a small interference added to his signal. In this paper, it is shown that the Adaptive modulation and the NOMA are special cases of the more general Cluster Modulation technique. Therefore, a general frame can be set to design both modulation schemes and better understanding is achieved. This leads to designing a multi-level NOMA and/or flexible adaptive modulation with combined channel coding.展开更多
We present an eight component integrable Hamiltonian hierarchy, based on a reduced seventh order matrix spectral problem, with the aim of aiding the study and classification of multicomponent integrable models and the...We present an eight component integrable Hamiltonian hierarchy, based on a reduced seventh order matrix spectral problem, with the aim of aiding the study and classification of multicomponent integrable models and their underlying mathematical structures. The zero-curvature formulation is the tool to construct a recursion operator from the spatial matrix problem. The second and third set of integrable equations present integrable nonlinear Schrödinger and modified Korteweg-de Vries type equations, respectively. The trace identity is used to construct Hamiltonian structures, and the first three Hamiltonian functionals so generated are computed.展开更多
Type 2 diabetes(T2D)is a multifaceted and heterogeneous syndrome associated with complications such as hypertension,coronary artery disease,and notably,breast cancer(BC).The connection between T2D and BC is establishe...Type 2 diabetes(T2D)is a multifaceted and heterogeneous syndrome associated with complications such as hypertension,coronary artery disease,and notably,breast cancer(BC).The connection between T2D and BC is established through processes that involve insulin resistance,inflammation and other factors.Despite this comprehension the specific cellular and molecular mechanisms linking T2D to BC,especially through microRNAs(miRNAs),remain elusive.miRNAs are regulators of gene expression at the post-transcriptional level and have the function of regulating target genes by modulating various signaling pathways and biological processes.However,the signaling pathways and biological processes regulated by miRNAs that are associated with T2D and BC have not yet been elucidated.This review aims to identify dysregulated miRNAs in both T2D and BC,exploring potential signaling pathways and biological processes that collectively contribute to the development of BC.展开更多
Green supplier selection is an important debate in green supply chain management(GSCM),attracting global attention from scholars,especially companies and policymakers.Companies frequently search for new ideas and stra...Green supplier selection is an important debate in green supply chain management(GSCM),attracting global attention from scholars,especially companies and policymakers.Companies frequently search for new ideas and strategies to assist them in realizing sustainable development.Because of the speculative character of human opinions,supplier selection frequently includes unreliable data,and the interval-valued Pythagorean fuzzy soft set(IVPFSS)provides an exceptional capacity to cope with excessive fuzziness,inconsistency,and inexactness through the decision-making procedure.The main goal of this study is to come up with new operational laws for interval-valued Pythagorean fuzzy soft numbers(IVPFSNs)and create two interaction operators-the intervalvalued Pythagorean fuzzy soft interaction weighted average(IVPFSIWA)and the interval-valued Pythagorean fuzzy soft interaction weighted geometric(IVPFSIWG)operators,and analyze their properties.These operators are highly advantageous in addressing uncertain problems by considering membership and non-membership values within intervals,providing a superior solution to other methods.Moreover,specialist judgments were calculated by the MCGDM technique,supporting the use of interaction AOs to regulate the interdependence and fundamental partiality of green supplier assessment aspects.Lastly,a statistical clarification of the planned method for green supplier selection is presented.展开更多
We consider matrix integrable fifth-order mKdV equations via a kind of group reductions of the Ablowitz–Kaup–Newell–Segur matrix spectral problems. Based on properties of eigenvalue and adjoint eigenvalue problems,...We consider matrix integrable fifth-order mKdV equations via a kind of group reductions of the Ablowitz–Kaup–Newell–Segur matrix spectral problems. Based on properties of eigenvalue and adjoint eigenvalue problems, we solve the corresponding Riemann–Hilbert problems, where eigenvalues could equal adjoint eigenvalues, and construct their soliton solutions, when there are zero reflection coefficients. Illustrative examples of scalar and two-component integrable fifthorder mKdV equations are given.展开更多
基金Field work for this project was conducted under State of Florida Special Activities License Number 05SR-902provided in part by the Tampa Bay Estuary Program+2 种基金Delo Research Professor Grant (University of Tampa)the Dana Award Program (University of Tampa)the Biology Department (University of Tampa)
文摘Seagrass ecosystems worldwide have been declining, leading to a decrease in associated fish populations, especiallythose with low mobility such as syngnathids (pipefish and seahorses). This two-year pilot study investigated seasonal patterns indensity, growth, site fidelity, and population dynamics of Tampa Bay (FL) syngnathid fishes at a site adjacent to two marinas underconstruction. Using a modified mark-recapture technique, fish were collected periodically from three closely located sites thatvaried in seagrass species (Thalassia spp., Syringodium spp., and mixed-grass sites) and their distance from open water, but hadconsistent physical/chemical environmental characteristics. Fish were marked, photographed for body size and gender measurements,and released the same day at the capture site. Of the 5695 individuals surveyed, 49 individuals were recaptured, indicatinga large, flexible population. Population density peaks were observed in July of both years, with low densities in late winter andlate summer. Spatially, syngnathid densities were highest closest to the mouth of the bay and lowest near the shoreline. Sevenspecies of syngnathid fishes were observed, and species-specific patterns of seagrass use emerged during the study. However,only two species, Syngnathus scovelli and Hippocampus zosterae, were observed at high frequencies. For these two species, bodysize decreased across the study period, but while S. scovelli's population density decreased, H. zosterae's increased. Across six ofthe seven species, population size declined over the course of this preliminary study; however, seasonal shifts were impossible todistinguish from potential anthropogenic effects of
文摘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.
文摘Introduction:Traumatic brain injury(TBI)is a common diagnosis among veterans secondary to combat experiences.TBI is also rampant among those experiencing homelessness,possibly due to veterans making up 12.3%of the homeless population(Tsai and Rosenheck,2015),or due to the high risk of violence or trauma among those experiencing homelessness.TBI is up to 10×more prevalent among those experiencing homelessness(Stubbs et al.,2020;Dell et al.,2021).
文摘BACKGROUND Cervical cancer is a rare primary tumor resulting in metastases to the breast with few cases reported in literature.Breast metastases are associated with poor prognosis.The following case highlights the diagnostic challenges associated with metastatic cervical cancer to the breast along with individualized treatment.CASE SUMMARY A 44-year-old G7P5025 with no significant past medical or surgical history presented with heavy vaginal to an outside emergency department where an exam and a pelvic magnetic resonance imaging showed a 4.5 cm heterogenous lobulated cervical mass involving upper two thirds of vagina,parametria and lymph node metastases.Cervical biopsies confirmed high grade adenocarcinoma with mucinous features.A positron emission tomography/computed tomography(PET/CT)did not show evidence of metastatic disease.She received concurrent cisplatin with external beam radiation therapy.Follow up PET/CT scan three months later showed no suspicious fluorodeoxyglucose uptake in the cervix and no evidence of metastatic disease.Patient was lost to follow up for six months.She was re-imaged on re-presentation and found to have widely metastatic disease including breast disease.Breast biopsy confirmed programmed death-ligand 1 positive metastatic cervical cancer.The patient received six cycles of carboplatin and paclitaxel with pembrolizumab.Restaging imaging demonstrated response.Patient continued on pembrolizumab with disease control.CONCLUSION Metastatic cervical cancer to the breast is uncommon with nonspecific clinical findings that can make diagnosis challenging.Clinical history and immunohistochemical evaluation of breast lesion,and comparison to primary tumor can support diagnosis of metastatic cervical cancer to the breast.Overall,the prognosis is poor,but immunotherapy can be considered in select patients and may result in good disease response.
文摘This perspective focuses on the recent literature regarding the role of the gut-brain axis(GBA) in fecal microbiota transplantation(FMT) and stem cell therapy(SCT) in Parkinson's disease(PD).PD is the second most common neurodegenerative disease in the United States,yet therapies remain limited.Current research suggests that the GBA may play a role in the pathogenesis of PD.GBAbased FMT as well as SCT offer promising new avenues for PD treatment.Pro bing the interactions between FMT and SCT with the GBA may reveal novel therapeutics for PD.
文摘1.Introduction For decades,substantial disagreement has persisted as to whether dynamic knee valgus is the cause of the majority of anterior cruciate ligament(ACL)injuries or rather the result of the ACL rupture.1 Consequently,great effort and expense has gone into capturing 3-dimensional kinetics and kinematics from live athletes to drive in vitro and in silico models of ACL injury in order to elucidate the actual mechanism of injury,as these factors have been demonstrated to be surrogates of intraarticular structural loading on the ACL.2,3 The elucidation of injury mechanisms for non-contact ACL injuries is of great medical value as such knowledge consequently permits quantified examination and validation of interventions and their respective effectiveness in both prevention and rehabilitation of these traumatic knee injuries.
基金support via the University of Maryland School of Medicinesupport of the University of Maryland,Baltimore,Institute for Clinical&Translational Research(ICTR)the National Center for Advancing Translational Sciences(NCATS)Clinical Translational Science Award(CTSA)grant number 1UL1TR003098.
文摘The focus of outcome-based education has shifted from the process of training to the end“product”of education.This has necessitated a reframing of the teaching,learning,and assessment.Therefore,in 2013,the Accreditation Council for Graduate Medical Education(ACGME)implemented the educational milestones for all accredited residencies and fellowship programs.[1]The milestones have been described as“developmentally based,specialty-specific achievements that residents are expected to demonstrate at established intervals as they progress through training.”[1]Milestones are based on the six core competencies established by the ACGME and American Board of Medical Specialties(ABMS),which consist of medical knowledge(MK),patient care(PC),interpersonal and communication skills(ICS),practice-based learning and improvement(PBLI),professionalism(PROF),and systems-based practice(SBP).[2,3]ACGME,in conjunction with the American Board of Emergency Medicine(ABEM),drafted 23 detailed subcompetencies relevant to emergency medicine(EM).[4]
文摘We have previously evaluated asbestos exposure associated with various maintenance procedures on light aircraft. The purpose of this study was to evaluate asbestos exposure during engine maintenance on light aircraft. This test was designed to evaluate the potential for asbestos exposure to mechanics and others who remove asbestos-containing engine gaskets from reciprocating style aircraft engines. Utilized in this test was an air cooled, horizontally opposed, aviation gasoline burning engine, assembled during 1986 and operated intermittently up into 2015, having accumulated 1680 hours run time. Nearly 75% of the asbestos-containing gaskets installed during 1986 were still in place at the time of testing. Chrysotile asbestos contents of such gaskets ranged from 55% to 60% by area, for those of sheet style and 5% by area, for the spiral wound metal/asbestos style. Despite the levels of effort required to effect gasket removals, the professional aircraft mechanic was not exposed to airborne asbestos fibers at the lower limits of sampling and analytical detection achieved;all of which were substantially less than the current Occupational Safety and Health Administration Permissible Exposure Limits for asbestos. The results of this testing indicate an absence of gasket related asbestos exposure risk to mechanics who work with light aircraft engines, including those having asbestos-containing gaskets. These results are consistent with the findings of Mlyarek and Van Orden who studied the asbestos exposure risk occasioned during overhaul of larger radial style reciprocating aircraft engines [1].
文摘Dystonia characterizes a group of neurological movement disorders characterized by abnormal muscle movements,often with repetitive or sustained contraction resulting in abnormal posturing.Different types of dystonia present based on the affected body regions and play a prominent role in determining the potential efficacy of a given intervention.For most patients afflicted with these disorders,an exact cause is rarely identified,so treatment mainly focuses on symptomatic alleviation.Pharmacological agents,such as oral anticholinergic administration and botulinum toxin injection,play a major role in the initial treatment of patients.In more severe and/or refractory cases,focal areas for neurosurgical intervention are identified and targeted to improve quality of life.Deep brain stimulation(DBS)targets these anatomical locations to minimize dystonia symptoms.Surgical ablation procedures and peripheral denervation surgeries also offer potential treatment to patients who do not respond to DBS.These management options grant providers and patients the ability to weigh the benefits and risks for each individual patient profile.This review article explores these pharmacological and neurosurgical management modalities for dystonia,providing a comprehensive assessment of each of their benefits and shortcomings.
文摘Blastomas,characterized by a mixture of mesenchymal,epithelial,and undifferentiated blastematous components,are rare malignant neoplasms originating from precursor blast cells.This review focuses on digestive system blastomas in adult patients,including gastroblastoma,hepatoblastoma,and pancreatoblastoma.Gastroblastoma is a biphasic,epitheliomesenchymal tumor,with only sixteen cases reported to date.In addition to the characteristic histology,metastasisassociated lung adenocarcinoma transcript 1-glioma-associated oncogene homolog 1 gene fusion is typical,although recently novel ewing sarcoma breakpoint region 1-c-terminal binding protein 1 and patched 1-glioma-associated oncogene homolog 2 fusions have been described.Hepatoblastoma is exceptionally rare in adults and can show a variety of histologic patterns which may cause diagnostic difficulty.Pancreatoblastoma,primarily a pediatric tumor,displays acinar differentiation and squamoid nests with other lines of differentiation also present,especially neuroendocrine.Diagnostic approaches for these blastomas include a combination of imaging modalities,histopathological examination,and molecular profiling.The treatment generally involves surgical resection,which may be supplemented by chemotherapy or radiotherapy in some cases.Prognoses vary with gastroblastoma generally showing favorable outcomes post-surgery whereas hepatoblastoma and pancreatoblastoma often have poorer outcomes,particularly in the setting of metastases.This review highlights the complexity of diagnosing and managing these rare adult blastomas as well as the need for ongoing research to better understand their pathogenesis and improve treatment strategies.
文摘In this paper, the authors extend [1] and provide more details of how the brain may act like a quantum computer. In particular, positing the difference between voltages on two axons as the environment for ions undergoing spatial superposition, we argue that evolution in the presence of metric perturbations will differ from that in the absence of these waves. This differential state evolution will then encode the information being processed by the tract due to the interaction of the quantum state of the ions at the nodes with the “controlling’ potential. Upon decoherence, which is equal to a measurement, the final spatial state of the ions is decided and it also gets reset by the next impulse initiation time. Under synchronization, several tracts undergo such processes in synchrony and therefore the picture of a quantum computing circuit is complete. Under this model, based on the number of axons in the corpus callosum alone, we estimate that upwards of 50 million quantum states might be prepared and evolved every second in this white matter tract, far greater processing than any present quantum computer can accomplish.
文摘This paper derives rigorous statements concerning the propagation velocity of action potentials in axons. The authors use the Green’s function approach to approximate the action potential and find a relation between conduction velocity and the impulse profile. Computer simulations are used to bolster the analysis.
文摘BACKGROUND Immunotherapy have demonstrated promising outcomes in patients with high microsatellite instability(MSI)(MSI-H)metastatic colorectal cancer.However,the comparative effectiveness of Immunotherapy and chemotherapy for patients with low MSI(MSI-L),and microsatellite stable(MSS)metastatic colorectal cancer remains unclear.AIM To investigate immunotherapy vs chemotherapy for treatment of MSI-L/MSS metastatic colorectal cancer,and to evaluate the success of immunotherapy against chemotherapy in managing MSI-H metastatic colorectal cancer during a follow-up of 50 months.METHODS We conducted a retrospective cohort study using the National Cancer Database(NCDB)to evaluate the overall survival(OS)of patients with metastatic colorectal cancer treated with immunotherapy or chemotherapy.The study population was stratified by MSI status(MSI-H,MSI-L,and MSS).Multivariable Cox proportional hazard models were used to assess the association between treatment modality and OS,adjusting for potential confounders.RESULTS A total of 21951 patients with metastatic colorectal cancer were included in the analysis,of which 2358 were MSI-H,and 19593 were MSI-L/MSS.In the MSI-H cohort,immunotherapy treatment(n=142)was associated with a significantly improved median OS compared to chemotherapy(n=860).After adjusting for potential confounders,immunotherapy treatment remained significantly associated with better OS in the MSI-H cohort[adjusted hazard ratio(aHR):0.57,95%confidence interval(95%CI):0.43-0.77,P<0.001].In the MSS cohort,no significant difference in median OS was observed between immunotherapy treatment and chemotherapy(aHR:0.94,95%CI:0.69-1.29,P=0.715).CONCLUSION In this population-based study using the NCDB,immunotherapy treatment was associated with significantly improved OS compared to chemotherapy in patients with MSI-H metastatic colorectal cancer,but not in those with MSI-L/MSS metastatic colorectal cancer.Further studies are warranted to determine the optimal therapeutic approach for patients with MSI-L/MSS metastatic colorectal cancer.
文摘The need for higher data rate and higher systems capacity leads to several solutions including higher constellation size, spatial multiplexing, adaptive modulation and Non-Orthogonal Multiple Access (NOMA). Adaptive Modulation makes use of the user’s location from his base station, such that, closer users get bigger constellation size and hence higher data rate. A similar idea of adaptive modulation that makes use of the user’s locations is the NOMA technique. Here the base station transmits composite signals each for a different user at a different distance from the base station. The transmitted signal is formed by summing different user’s constellations with different weights. The closer the users the less average power constellation is used. This will allow the closer user to the base station to distinguish his constellation and others constellation. The far user will only distinguish his constellation and other user’s data will appear as a small interference added to his signal. In this paper, it is shown that the Adaptive modulation and the NOMA are special cases of the more general Cluster Modulation technique. Therefore, a general frame can be set to design both modulation schemes and better understanding is achieved. This leads to designing a multi-level NOMA and/or flexible adaptive modulation with combined channel coding.
文摘We present an eight component integrable Hamiltonian hierarchy, based on a reduced seventh order matrix spectral problem, with the aim of aiding the study and classification of multicomponent integrable models and their underlying mathematical structures. The zero-curvature formulation is the tool to construct a recursion operator from the spatial matrix problem. The second and third set of integrable equations present integrable nonlinear Schrödinger and modified Korteweg-de Vries type equations, respectively. The trace identity is used to construct Hamiltonian structures, and the first three Hamiltonian functionals so generated are computed.
基金Supported by Sao Paulo Research Foundation,No.2022/02339-4Conselho Nacional de Desenvolvimento Científico e Tecnológico,No.313376/2021-2 and No.313479/2017-8.
文摘Type 2 diabetes(T2D)is a multifaceted and heterogeneous syndrome associated with complications such as hypertension,coronary artery disease,and notably,breast cancer(BC).The connection between T2D and BC is established through processes that involve insulin resistance,inflammation and other factors.Despite this comprehension the specific cellular and molecular mechanisms linking T2D to BC,especially through microRNAs(miRNAs),remain elusive.miRNAs are regulators of gene expression at the post-transcriptional level and have the function of regulating target genes by modulating various signaling pathways and biological processes.However,the signaling pathways and biological processes regulated by miRNAs that are associated with T2D and BC have not yet been elucidated.This review aims to identify dysregulated miRNAs in both T2D and BC,exploring potential signaling pathways and biological processes that collectively contribute to the development of BC.
基金funded by King Saud University,Riyadh,Saudi Arabia.
文摘Green supplier selection is an important debate in green supply chain management(GSCM),attracting global attention from scholars,especially companies and policymakers.Companies frequently search for new ideas and strategies to assist them in realizing sustainable development.Because of the speculative character of human opinions,supplier selection frequently includes unreliable data,and the interval-valued Pythagorean fuzzy soft set(IVPFSS)provides an exceptional capacity to cope with excessive fuzziness,inconsistency,and inexactness through the decision-making procedure.The main goal of this study is to come up with new operational laws for interval-valued Pythagorean fuzzy soft numbers(IVPFSNs)and create two interaction operators-the intervalvalued Pythagorean fuzzy soft interaction weighted average(IVPFSIWA)and the interval-valued Pythagorean fuzzy soft interaction weighted geometric(IVPFSIWG)operators,and analyze their properties.These operators are highly advantageous in addressing uncertain problems by considering membership and non-membership values within intervals,providing a superior solution to other methods.Moreover,specialist judgments were calculated by the MCGDM technique,supporting the use of interaction AOs to regulate the interdependence and fundamental partiality of green supplier assessment aspects.Lastly,a statistical clarification of the planned method for green supplier selection is presented.
基金the Scientific and Technological Innovation Team Project of the Shaanxi Innovation Capability Support Plan,China(2022TD-30)the Youth Innovation Team of Shaanxi Universities(2019-2022)+2 种基金the Top Young Talents Project of“Special support program for high-level talents”in the Shaanxi Province(2018-2023)the International Science and Technology Cooperation Program of the Shaanxi Province(2022KW-39)Xi’an Science and Technology Planning Project(2022JH-RYFW-0196).
基金supported in part by the National Natural Science Foundation of China (Grant Nos. 11975145, 11972291, and 51771083)the Ministry of Science and Technology of China (Grant No. G2021016032L)the Natural Science Foundation for Colleges and Universities in Jiangsu Province, China (Grant No. 17 KJB 110020)。
文摘We consider matrix integrable fifth-order mKdV equations via a kind of group reductions of the Ablowitz–Kaup–Newell–Segur matrix spectral problems. Based on properties of eigenvalue and adjoint eigenvalue problems, we solve the corresponding Riemann–Hilbert problems, where eigenvalues could equal adjoint eigenvalues, and construct their soliton solutions, when there are zero reflection coefficients. Illustrative examples of scalar and two-component integrable fifthorder mKdV equations are given.
