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Abstract Standard-of-care (SoC) imaging for assessing colorectal polyps during colonoscopy, based on white-light colonoscopy (WLC) and narrow-band imaging (NBI), does not have sufficient accuracy to assess the invasion depth of complex polyps non-invasively during colonoscopy. We aimed to evaluate the feasibility of a custom endoscopic optical coherence tomography (OCT) probe for assessing colorectal polyps during routine colonoscopy. Patients referred for endoscopic treatment of large colorectal polyps were enrolled in this pilot clinical study, which used a side-viewing OCT catheter developed for use with an adult colonoscope. OCT images of polyps were captured during colonoscopy immediately before SoC treatment. A deep learning model was trained to differentiate benign from deeply invasive lesions for real-time diagnosis. 35 polyps from 32 patients were included. OCT imaging added on average 3:40 min (range 1:54–8:20) to the total procedure time. No complications due to OCT were observed. OCT revealed distinct subsurface tissue structures that correlated with histological findings, including tubular adenoma (n = 20), tubulovillous adenoma (n = 10), sessile serrated polyps (n = 3), and invasive cancer (n = 2). The deep learning model achieved an area under the receiver operating characteristic curve (AUROC) of 0.984 (95%CI 0.972–0.996) and Cohen’s kappa of 0.845 (95%CI 0.774–0.915) when compared to gold standard histopathology. OCT is feasible and safe for polyp assessment during routine colonoscopy. When combined with deep learning, OCT offers clinicians increase confidence in identifying deeply invasive cancers, potentially improving clinical decision-making. Compared to previous studies, ours offers a nuanced comparison between not just benign and malignant lesions, but across multiple histological subtypes of polyps.

Abstract This study aimed to elucidate the regression process of ostium granulomas under the usage of intranasal steroid after primary endoscopic dacryocystorhinostomy (DCR). The authors retrospectively reviewed 57 patients (a total of 72 ostia) who had ostium granulomas after primary endoscopic DCR between 2011 and 2015. Topical intranasal steroid spray was applied in all the patients since postoperative day 1. Adjunctive intralesional triamcinolone acetonide injections were administered for extensive and large-sized granulomas that caused impending ostium blockage. Sequential regression of the ostium granulomas and success rates of DCR were assessed using endoscopic photos. The granulomas completely disappeared in 69 (95.8%) ostia, and the average time interval from the surgery to the disappearance was 6.9 ± 2.8 months. Anatomical and functional surgical success rates were 90.3% and 84.7%, respectively. Intralesional steroid injections for ostium granulomas did not alter the outcomes compared to topical intranasal steroid usage significantly (p = 0.445). In conclusion, we observed that, by continuing the usage of intranasal steroids, ostium granulomas disappear gradually at postoperative 6 months. The intranasal surgical manipulation of granulomas, which results in more mucosal cicatricial change and impedes patient satisfaction, can be successfully avoided.

BackgroundCommunity health center (CHC) patients experience a disproportionately high prevalence of chronic conditions and barriers to accessing technologies that might support the management of these conditions. One such technology includes tools used for remote patient monitoring (RPM), the use of which surged during the COVID-19 pandemic. ObjectiveThe aim of this study was to assess how a CHC implemented an RPM program during the COVID-19 pandemic. MethodsThis retrospective case study used a mixed methods explanatory sequential design to evaluate a CHC’s implementation of a suite of RPM tools during the COVID-19 pandemic. Analyses used electronic health record–extracted health outcomes data and semistructured interviews with the CHC’s staff and patients participating in the RPM program. ResultsThe CHC enrolled 147 patients in a hypertension RPM program. After 6 months of RPM use, mean systolic blood pressure (BP) was 13.4 mm Hg lower and mean diastolic BP 6.4 mm Hg lower, corresponding with an increase in hypertension control (BP

COVID-19 infected individuals with type 2 diabetes mellitus are at higher risk of COVID-19 related complications. Previous studies have yielded varying results regarding the effect of metformin, an antidiabetic drug, on the clinical outcomes of COVID-19 patients. In this retrospective observational study, we aim to assess the impact of pre-existing oral antidiabetic treatment on the clinical outcomes of COVID-19. We analyzed in-patient data from hospital records, enrolling 150 COVID-19 patients with pre-existing diabetes mellitus. Among them, 75 were treated with metformin, while the remaining 75 were not. Exclusion criteria included patients with type I diabetes mellitus and those above 85 years of age. Fisher's exact test, Chi square test and unpaired t-test were used to analyze the data. There were no significant differences between the two groups in terms of age, gender, or drugs prescribed, aside from metformin. However, the metformin-treated group exhibited a significantly higher proportion of moderately ill patients compared to the non-metformin-treated group (P = 0.0011). Nonetheless, no statistically significant differences were observed between the groups regarding oxygen support requirement or duration of hospital stay. Notably, the metformin group showed distinct variations in haematological parameters, including lower serum creatinine levels (P = 0.0049), platelet count (P = 0.02) and HbA1c levels (P = 0.01). In conclusion, pre-existing metformin treatment did not impact the duration of hospital stay or the need for oxygen support in COVID-19 patients. However, the treatment did exert influence on other essential parameters.

Abstract Primary liver cancer arises either from hepatocytic or biliary lineage cells, giving rise to hepatocellular carcinoma (HCC) or intrahepatic cholangiocarcinoma (ICCA). Combined hepatocellular- cholangiocarcinomas (cHCC-CCA) exhibit equivocal or mixed features of both, causing diagnostic uncertainty and difficulty in determining proper management. Here, we perform a comprehensive deep learning-based phenotyping of multiple cohorts of patients. We show that deep learning can reproduce the diagnosis of HCC vs. CCA with a high performance. We analyze a series of 405 cHCC-CCA patients and demonstrate that the model can reclassify the tumors as HCC or ICCA, and that the predictions are consistent with clinical outcomes, genetic alterations and in situ spatial gene expression profiling. This type of approach could improve treatment decisions and ultimately clinical outcome for patients with rare and biphenotypic cancers such as cHCC-CCA.

La problématique de la gestion des déchets urbains, particulièrement des déchets plastiques, qui préoccupe largement les chercheurs, les responsables sur l’aménagement des villes à travers le monde en vue de la gestion durable de l’environnement, est au centre de cet article. En effet, l’objectif de tous étant de trouver des pistes de solution aux problèmes de pollution physique des eaux et des villes ; il s’est avéré important dans le cadre de cette étude sur la ville de Kinshasa de découvrir avant tout les causes de la non-performance dans la gestion des déchets comme point de départ de l’analyse stratégique. Pour y parvenir, une enquête de terrain a été effectuée sur 11 structures de recyclages de déchets, soit 50% de ces entreprises et la méthode AHP développée par Saaty a été utilisée pour tester et hiérarchiser les facteurs critiques de succès défaillants dans la chaine logistique du recyclage à Kinshasa. Les résultats démontrent que les facteurs les plus défaillants dans le management des déchets et de leur recyclage sont dans un ordre décroissant : le financement, la législation, la logistique & les produits et enfin le marketing.

There are a wide range of benign and malignant pathologies that the radiologist may encounter in the adrenal glands and kidneys, often incidentally when imaging is performed for other indications. Many imaging modalities including CT, MR, and US are often used in an attempt to characterize these lesions. A definitive radiological diagnosis, however, is not always possible. This is at times due to atypical presentations of typical lesions which may be mistaken for more aggressive or concerning pathologic conditions. Adrenal lesions that do not demonstrate characteristic benign imaging features might require surgical excision. Similarly, cystic renal lesions that demonstrate nodular enhancement are concerning for Bosniak IV lesions and require surgical management. We report 3 cases in 3 different patients of incidentally discovered hematomas with peripheral enhancement, 2 involving the adrenal gland and 1 involving the kidney. All 3 of these histologically proven hematomas demonstrated similar radiological manifestations of peripheral nodular progressive enhancement, mimicking neoplastic conditions, and necessitating surgical removal.

This work studies the response of a 2 x 2 pile group near a slope subjected to lateral load. Three-dimensional, non-linear finite element analysis is carried out. The entire code is developed in FORTRAN 90. Bending-dominated pile and pile caps are represented by 20 node elements with quadratic shape function, and shear-dominated soil elements are represented by eight-node elements with linear shape function. Sixteen node interface element of zero thickness is used for stress transfer between pile and soil. The outcome highlights the influence of slope parameters like slope angle and edge distance on the response of the 2 x 2 pile group near a slope. The lateral displacement and maximum bending moments are increased with an increase in slope. However, its effect reduces with an increase in slope distance. The point of zero-shear along the pile's depth shifts deeper with an increase in slope.

Abstract Over the past 4 years, the authors have participated as members of the Mobilizing Computable Biomedical Knowledge Technical Infrastructure working group and focused on conceptualizing the infrastructure required to use computable biomedical knowledge. Here, we summarize our thoughts and lay the foundation for future work in the development of CBK infrastructure, including: explaining the difference between computable knowledge and data, and contextualizing the conversation with the Learning Health Systems and the FAIR principles. Specifically, we provide three guiding principles to advance the development of CBK infrastructure: (a) Promote interoperable systems for data and knowledge to be findable, accessible, interoperable, and reusable. (b) Enable stable, trustworthy knowledge representations that are human and machine readable. (c) Computable knowledge resources should, when possible, be open. Standards supporting computable knowledge infrastructures must be open.

Tropical cyclone (TC) Gulab originated in the Bay of Bengal during the post-monsoon season of 2021. Following an unusual westward trajectory, TC Gulab made landfall on the east coast of India, traversed central India, and reintensified over the Arabian Sea into TC Shaheen. This study employed an online Eulerian water vapor tracer (WVT) tool embedded within the Weather Research and Forecasting model to investigate the role of land in terms of soil moisture (SM) and land use land cover (LULC) in persistence of TC Gulab over central India. We quantified the contributions of sub-regions and dominant LULC types within the Indian subcontinent to the precipitation associated with TC Gulab. Our findings indicate that evapotranspiration across the entire Indian subcontinent contributed approximately 30% to the post-landfall precipitation associated with TC Gulab. The highest contribution originated from the northwestern region, followed by the northeast. Croplands, the dominant LULC type, were the primary contributors, followed by forests. Despite changing the dominant land cover from cropland to forest, the low-pressure system persisted over land while altering the spatial patterns of precipitation. Sensitivity experiments demonstrated a linear decrease in precipitation originating from land with decreasing SM. Notably, there is a disproportionate decline in total precipitation with decreasing SM. Further analysis separating atmospheric vapor sources into land and ocean contributions using WVT revealed a compensatory mechanism. The contribution of oceanic vapor to atmospheric vapor over land increased when SM decreased due to increase in the latent heat over ocean. However, the total atmospheric vapor remained low, ultimately leading to a lower total precipitation. Although SM plays a role, our results highlight the importance of oceanic and atmospheric processes in determining TC persistence over land. This study offers valuable insights into the dynamics of land–atmosphere interactions during low-pressure systems of TCs.