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Differences in presenting symptoms of primary hyperparathyroidism and outcomes of parathyroidectomy between sexes have been described, but whether these can be assessed by perioperative use of a validated tool, such as the Pasieka Parathyroidectomy Assessment Score, is unknown. All patients with primary hyperparathyroidism were asked to complete symptom assessment at the preoperative and postoperative visits. The assessment included a query for 13 Pasieka Parathyroidectomy Assessment Score parameters evaluated using a visual analog scale as described by Pasieka (summative score 0–1,300), and general quality of life and wellness. A review of a prospectively maintained database of primary hyperparathyroidism patients (January 2016–December 2019) was performed, and those who had a 6-month cure after initial parathyroidectomy were included. The study cohort was mostly women (77%, 541/701). The median preoperative Pasieka Parathyroidectomy Assessment Score was higher in women (155, 0–1,190) than in men (80.5, 0–855, P <.001), although there were similar rates of asymptomatic primary hyperparathyroidism (Pasieka Parathyroidectomy Assessment Score = 0, 12.5% vs 7%, P =.042). After curative parathyroidectomy, women reported a substantial reduction in symptomatology, with Pasieka Parathyroidectomy Assessment Score declining by 35% at initial postoperative visit (median, 155 vs 100, P <.001), further decreasing to 48% by 6 months (155 vs 80, P <.001). The Pasieka Parathyroidectomy Assessment Score in men did change but to a much smaller degree at both the initial postoperative visit (80.5 vs 70; P =.036) and at 6 months (80.5 vs 57.5; P =.048). When assessed with the Pasieka Parathyroidectomy Assessment Score, improvement in symptoms was clearly demonstrated for women after curative parathyroidectomy. Whether symptom improvement also occurs in men is less apparent but may be due to disparities in the development and validation of outcomes tools in general. [ABSTRACT FROM AUTHOR]

The American College of Radiology Thyroid Imaging Reporting and Data System for ultrasound classification of malignancy risk was developed to better triage thyroid nodules for fine-needle aspiration biopsy. To examine further, we compared thyroid cytologic classification rates in nodules before and after institutional Thyroid Imaging Reporting and Data System implementation. Cytology diagnoses by Bethesda criteria (categories I–VI) from January 2014 to October 2021 were retrieved; observed changes in yearly category frequency were analyzed by linear regression; and pooled cohorts of pre– (2014–2018) and post–Thyroid Imaging Reporting and Data System (2019–2021) cytology call rates were compared. Overall, 7,413 cytologic specimens were included (range/year 715–1,444). From 2014 to 2021, the proportion of benign (Bethesda category II) diagnosis per year declined stepwise from 49.7% to 19.4%, and atypia of undetermined significance/follicular lesion of undetermined significance (Bethesda category III) increased sequentially from 21.3% to 51.5%. Between 2014 and 2021, Bethesda category III diagnosis increased on average by 4.8% per year (95% confidence internal, 3.29–5.54; P <.001) and Bethesda category II results decreased on average by 4.4% per year (95% confidence interval, 6.29–3.42; P <.001). When comparing pre– and post–Thyroid Imaging Reporting and Data System, the proportion of Bethesda category II cytology results decreased (43.1% vs 21%; P =.001) while Bethesda category III (28.3% vs 47.7%; P =.002) and Bethesda category V (1.1% vs 1.7%; P =.015) results increased. After implementation of American College of Radiology Thyroid Imaging Reporting and Data System ultrasound criteria, we observed a 2.5-fold decline in the rate of benign cytology and an increase in the proportion of atypia of undetermined significance/follicular lesion of undetermined significance results. [ABSTRACT FROM AUTHOR]

Molecular testing improves the diagnostic accuracy of thyroid cancer. Whether specific molecular testing results are associated with tumor phenotype or provide prognostic information needs further delineation. Consecutive thyroid cancer patients after index thyroidectomy with ThyroSeq version 3 (Rye Brook, NY) molecular testing obtained on preoperative fine-needle aspiration or thyroidectomy specimens from patients with thyroid cancer were categorized into 3 molecular risk groups based on detected mutations, fusions, copy number alterations, and/or gene expression alterations and correlated with histopathology and recurrence, defined as biochemical or structural. Of 578 patients, 49.9%, 37.5%, and 12.6% had molecular risk group–low, molecular risk group–intermediate, and molecular risk group–high cancers, respectively. With a median 19-month follow-up, 9.1% patients recurred. Compared with molecular risk group–low, molecular risk group–intermediate cancers were diagnosed in younger patients and more often had microscopic extrathyroidal extension, involved margins, and nodal disease. Compared with molecular risk group–intermediate, molecular risk group–high cancers were diagnosed in older patients and more often had gross extrathyroidal extension and vascular invasion. In multivariable analysis, recurrence was more likely in molecular risk group–high cancers than in molecular risk group–intermediate (hazard ratio = 4.0; 95% confidence interval, 1.9–8.6; P <.001) and more likely in molecular risk group–intermediate than in molecular risk group–low (hazard ratio = 5.0; 95% confidence interval, 2.0–12.5; P <.001). Using modern comprehensive genotyping, the genetic profile of thyroid cancers can be categorized into 3 novel molecular risk groups that were associated with histopathologic phenotype and recurrence in short-term follow-up. [ABSTRACT FROM AUTHOR]

Robotic-assisted pancreatectomy continues to proliferate despite limited evidence supporting its benefits from the patient's perspective. We compared patient-reported outcomes (PROs) between patients undergoing robotic and open pancreatectomies. PROs, measured with the FACT-Hep, FACT-G, and HCS, were assessed in the immediate postoperative (i.e., preoperative to discharge) and recovery (i.e., discharge to three months postoperative) periods. Linear mixed models estimated the association of operative approach on PROs. Minimally important differences (MIDs) were also considered. Among 139 patients, 105 (75.5%) underwent robotic pancreatectomies. Compared to those who underwent open operations, those who underwent robotic operations experienced worse FACT-Hep scores that were both statistically and clinically significant (mean difference [MD] 8.6 points, 95% CI 1.0–16.3). Declines in FACT-G (MD 4.3, 95% CI −1.0 to 9.6) and HCS (MD 4.3, 95% CI 0.8–7.9) scores appeared to contribute equally in both operative approaches to the decline in total FACT-Hep score. Patients who underwent robotic versus open operations both statistically and clinically significantly improved due to improvements in HCS (MD 6.1, 95% CI 2.3–9.9) but not in FACT-G (MD 1.2, 95% CI − 5.1-7.4). The robotic approach to pancreas surgery might offer, from the patient's perspective, greater improvement in symptoms over the open approach by three months postoperatively. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to sample the opinions of radiation oncologists and trainees in the United States regarding residency expansion, what action(s) should be taken to limit residency supply, if any, and the proposed Accreditation Council for Graduate Medical Education (ACGME) changes.Methods and Materials: An online survey was distributed to 1048 attending radiation oncologists by e-mail and approximately 800 residents through their program coordinators. The survey asked respondents to rank how strongly they agreed with certain statements regarding residency supply, possible solutions to address any perceived oversupply, and the proposed ACGME changes on a 1-to-10 disagreement-to-agreement scale. The 16% response rate yielded 294 responses for analysis.Results: Of the respondents, 90 (30%) were residents, and 204 (70%) were attendings, of whom 117 (57%) were academic and 87 (43%) were nonacademic. Eighty-six percent agreed that there is a residency oversupply issue, and 91% agreed that actions should be taken to limit residency expansion. On χ2 test, residents and attendings were similarly likely to agree that there is a residency oversupply issue (93% and 89%, P = .27), although residents were more likely to agree that this oversupply should be acted upon compared with attendings (100% and 88%, P < .01). Regarding possible solutions, respondents were most likely to agree that further expansion should be limited (90%), program requirements should be made more stringent (76%), and the use of the Supplemental Offer and Acceptance Program should be limited (69%). Proposed ACGME changes that respondents were most likely to agree with included requiring that programs have modern image guidance, stereotactic radiation therapy, and brachytherapy techniques (98%) and have 4+ faculty members and maintain a faculty-to-resident ratio of >1.5:1 (86%). Case log minimums most supported to be increased were 4 uterus (65%) and 11 postmastectomy breast (61%) simulations.Conclusions: The majority of respondents agree that there is a residency oversupply issue and that actions should be taken to limit residency expansion and make program requirements more stringent. [ABSTRACT FROM AUTHOR]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jss.2008.08.015 Byline: Jason Liu, Yue Li, Nathanael Van Vorst, Scott Mann, Keith Hellman Keywords: Network simulation; Network emulation; Real-time simulation; Virtual private network Abstract: We present an open and flexible software infrastructure that embeds physical hosts in a simulated network. In real-time network simulation, where real-world implementations of distributed applications and network services can run together with the network simulator that operates in real-time, real network packets are injected into the simulation system and subject to the simulated network conditions computed as a result of both real and virtual traffic traversing the network and competing for network resources. Our real-time simulation infrastructure has been implemented based on Open Virtual Private Network (OpenVPN), modified and customized to bridges traffic between the physical hosts and the simulated network. We identify the performance advantages and limitations of our approach via a set of experiments. We also present two interesting application scenarios to show the capabilities of the real-time simulation infrastructure. Author Affiliation: School of Computing and Information Sciences, Florida International University, Miami, 11200 SW 8th Street, ECS 261B, FL 33199, USA Department of Mathematical and Computer Sciences, Colorado School of Mines, Golden, CO 80401, USA Article History: Received 6 February 2008; Revised 4 August 2008; Accepted 4 August 2008 Article Note: (footnote) [star] This article is an extended version of early work published at the 2007 INFOCOM MiniSymposium (). Part of this work was done when Dr. Jason Liu was at the Colorado School of Mines.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ydbio.2006.11.029 Byline: Minke van Tuyl (a)(b), Freek Groenman (a)(b), Jinxia Wang (a), Maciek Kuliszewski (a), Jason Liu (a), Dick Tibboel (b), Martin Post (a) Keywords: Angiogenesis; Vasculogenesis; Vegf; Angiopoietins; Fgf2; Lung development Abstract: Sonic Hedgehog (Shh)-deficient mice have a severe lung branching defect. Recent studies have shown that hedgehog signaling is involved in vascular development and it is possible that the diminished airway branching in Shh-deficient mice is due to abnormal pulmonary vasculature formation. Therefore, we investigated the role of Shh in pulmonary vascular development using Shh/Tie2lacZ compound mice, which exhibit endothelial cell-specific LacZ expression, and Pecam-1 immunohistochemistry. In E11.5-13.5 Shh-deficient mice, the pulmonary vascular bed is decreased, but appropriate to the decrease in airway branching. However, when E12.5 Shh-deficient lungs were cultured for 4-6 days, the vascular network deteriorated compared to wild-type lungs. The expression of vascular endothelial growth factor (Vegf) or its receptor Vegfr2 (KDR/Flk-1) was not different between E12.5-13.5 Shh-deficient and wild-type lungs. In contrast, angiopoietin-1 (Ang1), but not Ang2 or the angiopoietin receptor Tie2, mRNA expression was downregulated in E12.5-E13.5 lungs of Shh null mutants. Recombinant Ang1 alone was unable to restore in vitro branching morphogenesis in Shh-deficient lungs. Conversely, the angiogenic factor fibroblast growth factor (Fgf)-2 alone or in combination with Ang1, increased vascularization and tubular growth and branching of Shh-deficient lungs in vitro. The angiogenic factors did not overcome the reduced smooth muscle cell differentiation in the Shh null lungs. These data indicate that early vascular development, mediated by Vegf/Vegfr2 signaling proceeds normally in Shh-deficient mice, while later vascular development and stabilization of the primitive network mediated by the Ang/Tie2 signaling pathway are defective, resulting in an abnormal vascular network. Stimulation of vascularization with angiogenic factors such as Fgf2 and Ang1 partially restored tubular growth and branching in Shh-deficient lungs, suggesting that vascularization is required for branching morphogenesis. Author Affiliation: (a) Canadian Institutes of Health Research (CIHR) Group in Lung Development, Hospital for Sick Children Research Institute, and Departments of Pediatrics and Physiology, University of Toronto, Toronto, Canada (b) Department of Pediatric Surgery, Sophia Children's Hospital, Erasmus MC, Rotterdam, The Netherlands Article History: Received 31 May 2005; Revised 23 October 2006; Accepted 17 November 2006

The purpose of this study was to evaluate for age, racial, and ethnic disparities among clinical studies where patients can potentially receive brachytherapy treatment. Trials involving brachytherapy for breast, cervical, prostate, and uterine cancers were identified using ClinicalTrials.gov. The age, racial, and ethnic breakdown of the identified trials were compared to US population-estimates derived from the Surveillance, Epidemiology, and End Results (SEER) Program. Primary outcomes were gaps between gaps between mean age and race and ethnic proportions in trials and the US population. Secondary outcomes included proportions of racial and ethnic data reporting. Descriptive statistics, t-tests, χ2 tests, and univariate analysis were used to analyze the data. A total of 77 trials with reported data were identified, representing 13,580 patients. The overall difference in mean age in the identified trials compared to US population estimates was -2.29 years (p < 0.001), with the largest difference occurring in prostate cancer at -2.72 years (p < 0.001). With the exception of ethnicity in cervical cancer (p = 0.18), all racial and ethnic distributions were statistically significantly different. Overall, the largest disparity was among Asian (-2.65%) and Hispanic patients (-1.05%). Of the 77 trials, 76 (98.7%) reported age, 36 (46.8%) reported race, and 24 (31.2%) reported ethnicity. Diversity data is underreported among clinical studies where brachytherapy is a potential treatment component. However, among reported trials, disparities are present albeit relatively small compared to previous studies reporting on disparities in clinical trials. Future efforts should emphasize increased reporting of racial and ethnicity data as well as ensuring inclusion of older patients and minorities. [ABSTRACT FROM AUTHOR]

• APBI use is stable since 2008, but with a drop in brachytherapy and a rise in IORT. • There is a steady rise in patients considered "suitable" by ASTRO APBI guidelines. • Trends in APBI modality utilization appears to be influenced by available literature. To examine recent modality utilization trends in accelerated partial breast irradiation (APBI) in the National Cancer Database (NCDB) based on the American Society for Radiation Oncology (ASTRO) guidelines. A total of 58,194 patients treated with APBI were identified. Patients were segregated by APBI modality (brachytherapy, external beam radiotherapy [EBRT], and intraoperative radiotherapy ([IORT]). These patients were then further classified by suitability to receive APBI based on ASTRO guidelines. Temporal trends in utilization were evaluated using linear regression. Logistic regression was applied to study factors contributing to APBI modality choice and treatment within the ASTRO suitability groups. Patients treated with brachytherapy, EBRT, and IORT comprised 70.5%, 17.5%, and 12.0% of patients treated with APBI. From 2008 to 2017, total APBI cases remained relatively stable (−54.1 cases/year, p = 0.161) while brachytherapy cases decreased by 258.7 cases/year (p < 0.001). EBRT and IORT increased by 51.5 cases/year (p = 0.019) and 153.1 cases/year (p < 0.001), respectively. 40.0% of patients treated with APBI were classified as "suitable", which increased from 2010 to 2017 from 35.3% to 45.3% (slope = 1.51%/year, r 2 = 0.61, p = 0.022). In comparison, 36.0% (36.1% in 2010 to 33.1% in 2017) of patients were classified as "cautionary" (slope = −0.33%/year, r 2 = 0.63, p = 0.019) and 23.9% (28.6% in 2010 to 21.6% in 2017) of patients were classified as "unsuitable" (slope = −1.18%/year, r 2 = 0.67, p = 0.012). While overall APBI utilization has remained stable since 2008, this has been accompanied by a decline in brachytherapy and a rise in IORT. The causes of these trends should be the topic of future research. [ABSTRACT FROM AUTHOR]

Endoscopic biliary stenting (EBS) and percutaneous transhepatic biliary drainage (PTBD) are two techniques used for preoperative biliary drainage prior to hepatobiliary resection. The objectives of this study were to determine predictors of the drainage technique selection and to evaluate the association between drainage technique and postoperative outcomes. Using ACS NSQIP data (2014–2017), patients who underwent preoperative biliary drainage prior to hepatobiliary resection for malignancy were identified. Separate multivariable-adjusted, propensity score (PS) adjusted, and PS matched logistic regression models were constructed to evaluate the association between drainage technique and postoperative outcomes. Of 527 patients identified, 431 (81.8%) received EBS and 96 (18.2%) received PTBD. Patients who underwent PTBD had more preoperative co-morbidities, including higher ASA class, recent weight loss, and hypoalbuminemia (all p < 0.05). After multivariable adjustment, PTBD was significantly associated with 30-day DSM (OR 1.92, 95% CI 1.24–2.97, p = 0.004), overall SSI (OR 1.74, 95% CI 1.10–2.76, p = 0.019), and superficial SSI (OR 2.08, 95% CI 1.20–3.60, p = 0.010). These findings remained significant for both PS-adjusted and PS-matched models. Patients undergoing hepatobiliary resection selected for PTBD had significantly more preoperative co-morbidities and nutritional deficits. Compared to EBS, PTBD was associated with significantly higher odds of postoperative morbidity and mortality. [ABSTRACT FROM AUTHOR]

The association between higher surgical volume and better perioperative outcomes after pancreatectomy has been extensively demonstrated. However, how different notions of experience impact outcomes of surgeons operating within high-quality scenarios remains unclear. Self-reported experience parameters from ACS-NSQIP HPB-Collaborative surgeons were merged with 2014–2016 ACS-NSQIP clinical data. The association of various experience parameters with outcomes was investigated through uni- and multivariable analyses. Hierarchical regression assessed surgeon performance. 111/151 HPB-Collaborative surgeons provided responses (73.5%). Compared to the other 532 ACS-NSQIP surgeons performing pancreatectomy, HPB-Collaborative surgeons performed 7692/16,239 of the overall pancreatectomies (47.3%), with improved outcomes of serious morbidity, pancreatic fistula, reoperation, duration of stay and readmissions. Median age of respondents was 49 years and 92.8% were fellowship-trained. Median career and annual pancreatectomy volume were 400 and 35, respectively; median annual institutional volume was 100 resections. On unadjusted analyses, several aspects of experience were associated with the outcomes studied, especially for pancreatoduodenectomy; however, none remained significant after multivariable adjustment. Surgeons' profiling showed substantial homogeneity in performance for both pancreatoduodenectomy and distal pancreatectomy. Contemporary data shows that for surgeons operating in high quality settings clinical outcomes are largely independent of indicators of greater experience. [ABSTRACT FROM AUTHOR]

Apolipoprotein M (ApoM) is a lipocalin produced by the liver that binds to high-density lipoprotein and sphingosine-1-phosphate in circulation. Reduced ApoM in plasma is associated with death and hospitalizations in patients with heart failure (HF). The syndrome of right heart failure (RHF) is also associated with increased level of inflammatory cytokines, in part due to liver and splanchnic congestion. To date, the relationship between ApoM and inflammation in RHF has not been investigated. In this study, we evaluated the impact of RHF on ApoM levels and assessed the correlation between ApoM and multiple circulating cytokines and growth factors. We hypothesized that ApoM levels would be significantly decreased in patients with RHF and would inversely correlate with markers of inflammation. We recruited adult patients undergoing right heart catheterization and excluded those with history of transplant, inflammatory disease, or malignancy. Patients underwent simultaneous blood sampling from hepatic vein and IVC and were classified into normal, HF, and RHF cohorts based on established hemodynamic criteria a priori. ApoM levels in serum were quantified by a validated ELISA and cytokines and growth factors were assessed using multiplex protein assay. A mouse model of RHF was established using pulmonary artery banding (PAB) and circulating ApoM levels were measured at 2 months after PAB. A total of 61 patients were recruited. HF and RHF patients had similar cardiac indices, although RHF patients had higher right atrial pressure (RAP) and higher RAP/pulmonary capillary wedge pressure ratio. ApoM was decreased in HF and RHF patients in a stepwise manner compared to normal controls (p=0.02 and 0.05 respectively, Figure). Using a multiplex protein assay, we identified a distinct inflammatory profile in the RHF population, including elevation of novel factors such as VEGF-A, soluble CD163 (sCD163), and CXCL12. Correlational analysis showed that ApoM was inversely correlated with several inflammatory biomarkers, with the strongest association seen with sCD163 (R=-0.53, p<0.001). Moreover, we found that PAB in mice reduced ApoM levels by 60% compared to controls (p=0.05) and tissue analysis showed upregulation of inflammatory and profibrotic pathways. RHF is associated with a profound reduction in ApoM levels when compared to both normal patients and those with HF and preserved right ventricular function. Circulating ApoM was found to be inversely correlated with multiple inflammatory biomarkers. In a mouse model of RHF, ApoM levels were decreased early in the disease process suggesting this response may be an initiating event. Future studies will investigate the mechanisms and consequences of reduced levels of ApoM in patients with RHF. [ABSTRACT FROM AUTHOR]

Background: Assessments of surgical quality should consider both surgeon and patient perspectives simultaneously. Focusing on patients undergoing major gastrointestinal cancer surgery, we sought to characterize hospitals, and their patients, on both these axes of quality.Methods: Using the American College of Surgeons' National Surgical Quality Improvement Program registry, hospitals were profiled on a risk-adjusted composite measure of death or serious morbidity (DSM) generated from patients who underwent colectomy, esophagectomy, hepatectomy, pancreatectomy, or proctectomy for cancer between January 1, 2015 and December 31, 2016. These hospitals were also profiled using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Highest-performing hospitals on both quality axes, and their respective patients, were compared to the lowest-performing hospitals.Results: Overall, 60,526 patients underwent their cancer operation at 530 hospitals. There were 38 highest- and 48 lowest-performing hospitals. The correlation between quality axes was poor (ρ = 0.10). Compared to the lowest-performing hospitals, the highest-performing hospitals were more often NCI-designated cancer centers (29.0% vs. 4.2%, p = 0.002) and cared for a lower proportion of Medicaid patients (0.14 vs. 0.23, p < 0.001). Patients who had their operations at the lowest- versus highest-performing hospitals were more often black (17.2% vs. 8.4%, p < 0.001), Hispanic (8.3% vs. 3.5%, p < 0.001), functionally dependent (3.8% vs. 0.9%, p < 0.001), and not admitted from home (4.4% vs. 2.4%, p < 0.001).Conclusions: Hospital performance varied when assessed by both risk-adjusted surgical outcomes and patient experiences. In this study, poor-performing hospitals appeared to be disproportionately serving disadvantaged and minority cancer patients. [ABSTRACT FROM AUTHOR]

Abstract Background Whether the choice of antibiotic prophylaxis, the type of incision, or the use of wound protectors decreases surgical site infections (SSIs) in patients undergoing pancreatoduodenectomy (PD) remains unknown. Methods Patients undergoing open, elective PD between January 1, 2016 and June 30, 2017 were identified from the American College of Surgeons' National Surgical Quality Improvement Program registry. Multivariable logistic regression models were constructed to determine the association of antibiotic prophylaxis type, incision type, and wound protector use on the incidence of any, superficial, and organ/space SSIs, and to profile hospitals. Results Overall, 5969 patients were included from 140 hospitals. The overall rate of SSI was 20.3% (n = 1213). Superficial SSIs occurred in 432 (7.2%) patients and organ/space SSIs in 841 (14.1%). Wound protector use was associated with 23% lower odds of experiencing any SSIs (OR 0.77, 95% CI 0.60–0.98), reflective of the decreased odds associated with superficial SSIs (OR 0.65, 95% CI 0.44–0.97), but not organ/space SSIs (OR 0.89, 95% CI 0.68–1.17). Highest-performing hospitals frequently utilized broad-spectrum antibiotics, midline incisions, and wound protectors. Conclusion Wound protectors reduced superficial, but not organ/space, infections in patients undergoing pancreatoduodenectomy. Routine use of wound protectors in patients undergoing proximal pancreatectomy is recommended. [ABSTRACT FROM AUTHOR]

• The PD controller design problem of positive discrete-time systems with constant delay is tackled in this work. • A systematic formulation is proposed to design non-fragile PD controllers for such kind of systems. • Based on the necessary and sufficient conditions derived, two tractable linear-programming-based and semi-definite-programming-based algorithms are developed for calculating the solution. This paper addresses the issue of proportional-derivative (PD) controllers design for positive linear systems in the discrete-time domain, which still remains a challenging problem in positive systems theory. The specific aim is to design a PD controller for a system with constant time delay, which simultaneously ensures closed-loop system stability and preserves positivity. Moreover, additive gain variation of the controller is considered in the synthesis process. Systematic formulation and tractable algorithms are developed to find the PD controller gains for positive stabilization. The performance of such methods is validated by numerical examples. [ABSTRACT FROM AUTHOR]

With the recent success of immunotherapy, there is a growing interest in combining radiation with immunotherapy to boost abscopal response rates. Several challenges exist in determining how to synergize these two modalities in the treatment of metastatic NSCLC. References for this review were identified through searches of MEDLINE/PubMed and Clinicaltrials.gov databases with the search terms "abscopal", "radiation OR radiotherapy," "NSCLC", and "lung" on the index date of July 2022 from 2000-2022. This systematic review focuses primarily on clinical papers. Early work combining radiotherapy with immunotherapy show promise in unlocking the abscopal effect. Preliminary evidence suggests that radiotherapy regimens with <5 fractions and smaller fields may be superior to regimens with 15 fractions and larger fields. There does not appear to be enough evidence to draw conclusions about the optimal timing of radiotherapy in relation to immunotherapy or the optimal anatomical location of radiation to induce the abscopal effect. Several studies suggest selecting patients with a higher absolute lymphocyte count (ALC) and lower neutrophil-to-lymphocyte ratio (NLR) may help to further boost abscopal response rates. Furthermore, selecting tumors with programmed death ligand-1 (PD-L1) expression, mismatch repair deficiency, and higher tumor mutational burden may similarly achieve this goal. Lastly, additional work is needed to minimize and predict for severe toxicity associated with combination therapy. [ABSTRACT FROM AUTHOR]

Highlights • We proposed a novel method for predicting the power consumption of a complete workload or application. • The model extrapolate the power consumption of only a few code segments of the same application obtained from measurement. • Our method employs a set of code analysis tools to capture the program's phase behavior and then adopts a multi-variable linear regression method to estimate the power consumption of the entire program. • Our method is compatible with both serial programs and parallel programs which can be widely used among personal computer or supercomputers. Abstract Power profiling tools based on fast and accurate workload analysis can be useful for job scheduling and resource allocation aiming to optimize the power consumption of large-scale, high-performance computer systems. In this article, we propose a novel method for predicting the power consumption of a complete workload or application by extrapolating the power consumption of only a few code segments of the same application obtained from measurements. As such, it provides a fast and yet effective way for predicting the power consumption of the execution of both single and multi-threaded programs on arbitrary architectures without having to profile the entire program's execution. The latter would be costly to obtain, especially if it is a long-running program. Our method employs a set of code analysis tools to capture the program's phase behavior and then uses a multi-variable linear regression method to estimate the power consumption of the entire program. For validation, we select the SPEC 2006 benchmark suite and the NAS parallel benchmarks to evaluate the accuracy and effectiveness of our method. Experimental results on three generations of multicore processors show that our power profiling method achieves good accuracy in predicting program's energy use with relatively small errors. [ABSTRACT FROM AUTHOR]

Two experiments were conducted with growing and finishing swine to determine the effect of phytase supplementation of sorghum-canola meal diets without added inorganic phosphorus ( iP ) on growth performance, apparent total-tract P, calcium ( Ca ), nitrogen ( N ), and energy utilization, bone strength, bone ash, serum Ca and P concentrations, and serum phosphatase activity. For Exp. 1, 42 crossbred barrows in individual metabolism cages were fed a P-deficient diet for 7 d before starting a 28-d experiment at 24.8 kg body weight ( BW ). Experiment 1 had 7 treatments that were a negative control ( NC ) diet supplemented with 0, 400, 800, 1200, or 1600 U of Aspergillus niger ( AN ) phytase / kg, a positive control ( PC ) diet, and the PC diet supplemented with 1200 U of AN phytase / kg. Fecal and urine collections were made from d 21–26. Blood samples were collected on d 0, 14, and 28. For Exp. 2, 126 growing-finishing crossbred swine with an initial BW of 21.6 kg were group-fed (3 pigs/pen) in 3 phases (grower, early-finisher, and late-finisher). Experiment 2 had 6 treatments that were a NC diet for each phase supplemented with 0, 200, 400, 600, or 800 U of AN phytase / kg and a PC diet. Fecal collections were made from d 49–54. Blood samples were collected on d 35, 63, and 91. For both experiments, 400 U of AN phytase / kg of diet was adequate ( P  ≤ 0.05) for growth performance compared with the PC treatment groups. For Exp. 1, apparent total-tract P absorption and retention plateaued at 1200 U of AN phytase / kg of diet ( P  < 0.01), with fecal Ca and P excretion reduced 22.4% and 28.6%, respectively, compared with the PC treatment group. However, pigs fed the PC + 1200 U of AN phytase / kg absorbed and retained more P (g / d, P  < 0.01) than any other treatment group. For Exp. 2, apparent total-tract P absorption, bone strength, and bone ash weight plateaued at 600 U of AN phytase / kg of diet ( P  < 0.01), with fecal P excretion reduced 29.4% compared with the PC treatment group. For both experiments, the AN phytase treatments did not increase Ca, N, or energy absorption (amount / d or % of intake), and had no effect on serum Ca and P concentrations, or the serum activity of alkaline phosphatase, total acid phosphatase, or tartrate-resistant acid phosphatase. [ABSTRACT FROM AUTHOR]

Background Prior studies comparing the efficacy of orthotopic liver transplantation to resection in patients with hepatocellular carcinoma have not controlled for underlying severity of liver disease. Methods Patients with stage I to III hepatocellular carcinoma and preserved liver function (model for end-stage liver disease <12) who underwent resection or orthotopic liver transplantation between 2010 and 2013 were identified from the National Cancer Database. Short-term (30- and 90-day) and overall survival were assessed from 1:1 propensity score-matched cohorts based on patient and tumor characteristics. Results During the period studied, 689 (28%) underwent orthotopic liver transplantation, and 1,774 (72%) patients underwent resection. Propensity score matching yielded 374 undergoing orthotopic liver transplantation matched to 374 patients undergoing resection. Rates of 30-day mortality (01.9% vs 0.8%, respectively; P = .34) and 90-day mortality (3.5% vs 2.1%, P = .38) were not different between matched cohorts. Orthotopic liver transplantation did, however, result in a greater overall survival compared with resection (median overall survival not reached versus 4.5 years; P = .01). On multivariable Cox regression, resection was associated with a 67% greater likelihood of overall mortality compared with orthotopic liver transplantation (hazard ratio 1.67; 95% confidence interval, 1.15–2.43). Conclusion For patients diagnosed with hepatocellular carcinoma in the context of preserved liver function, orthotopic liver transplantation was associated with a significant improvement in overall survival relative to resection. [ABSTRACT FROM AUTHOR]

Background Although strong volume-outcome relationships exist for many cancer operations, patients continue to undergo these operations at low-volume hospitals. Methods Patients were identified from the National Cancer Data Base from 2010–2013 who underwent resection for bladder, breast, esophagus, lung, pancreas, rectum, and stomach cancers. Low-volume hospitals were defined as those in the bottom quartile by surgical volume for each cancer type separately. Logistic regression models were constructed to assess patient-level factors associated with undergoing cancer surgery at low-volume hospitals across cancer types while controlling for tumor characteristics. Survival outcomes (30- and 90-day mortality; overall survival) were also assessed. Results Low volume thresholds were 4, 84, 4, 18, 8, 7, and 4 resections per year for bladder, breast, esophagus, lung, pancreas, rectum, and stomach cancers, respectively, resulting in 772 (74.1%), 828 (57.5%), 664 (77.5%), 830 (64.7%), 716 (79.2%), 898 (65.1%), and 888 (68.5%) hospitals classified as low-volume hospitals, respectively. For all the cancers examined, patients were more likely to undergo operation at low-volume hospitals if they traveled shorter distances (home to surgical facility), resided in rural locations, or had not received neoadjuvant therapy. Other patient and tumor factors were not associated consistently with undergoing operation at low-volume hospitals. Patients who went to low-volume hospitals had poorer outcomes among the studied cancers. Conclusion Patients continue to undergo operation at low-volume hospitals due to where they live and how far they have to travel. Regionalization policy initiatives will remain challenging in this population. Efforts should therefore continue to emphasize quality improvement locally at each facility caring for patients with cancer. [ABSTRACT FROM AUTHOR]

Background: Coffee is an important source of antioxidants, and consumption of this beverage is associated with many health conditions and a lower mortality risk. However, no study, to our knowledge, has examined whether varying coffee or caffeine consumption levels are associated with telomere length, a biomarker of aging whose shortening can be accelerated by oxidative stress.Objective: We performed a large comprehensive study on how coffee consumption is associated with telomere length.Methods: We used data from the Nurses' Health Study (NHS), a prospective cohort study of female nurses that began in 1976. We examined the cross-sectional association between coffee consumption and telomere length in 4780 women from the NHS. Coffee consumption information was obtained from validated food-frequency questionnaires, and relative telomere length was measured in peripheral blood leukocytes by the quantitative real-time polymerase chain reaction. Unconditional logistic regression was used to obtain ORs when the telomere length outcome was dichotomized at the median. Linear regression was used for tests of trend with coffee consumption and telomere length as continuous variables.Results: Higher total coffee consumption was significantly associated with longer telomeres after potential confounding adjustment. Compared with non-coffee drinkers, multivariable ORs for those drinking 2 to <3 and ≥3 cups of coffee/d were, respectively, 1.29 (95% CI: 0.99, 1.68) and 1.36 (95% CI: 1.04, 1.78) (P-trend = 0.02). We found a significant linear association between caffeine consumption from all dietary sources and telomere length (P-trend = 0.02) after adjusting for potential confounders, but not after additionally adjusting for total coffee consumption (P-trend = 0.37).Conclusions: We found that higher coffee consumption is associated with longer telomeres among female nurses. Future studies are needed to better understand the influence of coffee consumption on telomeres, which may uncover new knowledge of how coffee consumption affects health and longevity. [ABSTRACT FROM AUTHOR]

Lignocellulose is an abundant waste product of agricultural and processing industries that can be utilized as a renewable fuel substitute for petroleum-based fuels. Saprophytic filamentous fungi are an important source of plant cell wall degrading enzymes necessary to break down the complex carbohydrates found in plant cell walls into simple sugars. Zinc binuclear cluster transcription factors activate the transcription of plant cell wall degrading enzymes when fungal cells are exposed to plant biomass. Nutrient sensing pathways that prioritize the use of preferred carbon sources act upstream of these transcription factors to inhibit the energy intensive production of cell wall degrading enzymes when unnecessary, while downstream feedback from the fungal secretory system also acts to regulate the production of these enzymes. Understanding the regulation of the fungal lignocellulolytic response will be important as we strive to increase the efficiency of production of these enzymes. [ABSTRACT FROM AUTHOR]

Calcium phosphate (CaP) cements are highly applicable and valuable materials for filling bone defects by minimally invasive procedures. The chitosan (CS) biopolymer is also considered as one of the promising biomaterial candidates in bone tissue engineering. In the present study, some key features of CaP–CS were significantly improved by developing a novel CaP–CS composite. For this purpose, CS was the first cross-linked with tripolyphosphate (TPP) and then mixed with CaP matrix. A group of CaP–CS samples without cross-linking was also prepared. Samples were fabricated and tested based on the known standards. Additionally, the effect of different powder (P) to liquid (L) ratios was also investigated. Both cross-linked and uncross-linked CaP–CS samples showed excellent washout resistance. The most significant effects were observed on Young's modulus and compressive strength in wet condition as well as surface hardness. In dry conditions, the Young's modulus of cross-linked samples was slightly improved. Based on the presented results, cross-linking does not have a significant effect on porosity. As expected, by increasing the P/L ratio of a sample, ductility and injectability were decreased. However, in the most cases, mechanical properties were enhanced. The results have shown that cross-linking can improve the mechanical properties of CaP–CS and hence it can be used for bone tissue engineering applications. [ABSTRACT FROM AUTHOR]

The effectiveness of a direct quantification assay is essential to the adoption of the combined direct quantification/direct STR workflow. In this paper, the feasibility of using the Quantifiler ® Trio DNA quantification kit for the direct quantification of forensic casework samples was investigated. Both low-level touch DNA samples and blood samples were collected on PE swabs and quantified directly. The increased sensitivity of the Quantifiler ® Trio kit enabled the detection of less than 10 pg of DNA in unprocessed touch samples and also minimizes the stochastic effect experienced by different targets in the same sample. The DNA quantity information obtained from a direct quantification assay using the Quantifiler ® Trio kit can also be used to accurately estimate the optimal input DNA quantity for a direct STR amplification reaction. The correlation between the direct quantification results (Quantifiler ® Trio kit) and the direct STR results (GlobalFiler™ PCR amplification kit * ) for low-level touch DNA samples indicates that direct quantification using the Quantifiler ® Trio DNA quantification kit is more reliable than the Quantifiler ® Duo DNA quantification kit for predicting the STR results of unprocessed touch DNA samples containing less than 10 pg of DNA. [ABSTRACT FROM AUTHOR]

Abstract: The current short tandem repeat (STR) typing workflow for forensic casework samples involves sample collection, sample screening, DNA extraction, DNA qPCR quantification and STR amplification. Although very effective and powerful, this workflow still has room for improvements. For example, the screening assays in practice do not provide DNA related information and also do not work with touch DNA samples, which make up of the majority of the property crime samples. It is known that not all DNA samples have equal probative values. Considering the DNA backlog situation crime laboratories face today, an effective screening tool would be highly desirable. It would allow forensic scientists to prioritize the DNA samples so that the limited resources would be first spent on samples that would have better chances of producing informative STR profiles. qPCR assay does provide DNA quantity and gender information and would be an ideal screening tool. However, prior to quantification, sample extraction and purification are required. By the time a DNA sample is ready for qPCR quantification, time and resources have already been spent on samples that should have been given low priority or excluded from further processing if DNA quantity and gender information were known. To overcome this problem, a direct quantification technology is developed to allow qPCR quantification of casework samples without the need for DNA extraction and purification. The key to a direct qPCR assay is the PE-Swab, a novel sample collection device. A small sample punch can be generated from a PE-Swab and placed in a qPCR reaction for quantification. After optimizing the punch size and the quantification software baseline setting, accurate DNA quantification can be obtained from a sample without the need to carry out DNA extraction and purification. Proof of concept studies were done with low lever touch samples as well as blood samples. The PE-Swab also allows direct STR amplification of casework samples without the need for DNA extraction. Besides its potential as a screening tool, the direct qPCR assay can also be used to normalize the DNA input for a direct STR amplification reaction. The feasibility of the direct qPCR/direct STR amplification workflow was demonstrated with touch DNA samples and blood stain samples. [Copyright &y& Elsevier]

Purpose: To conduct an updated and comprehensive study on the risks of subsequent primary urogenital cancers for childhood and adolescent cancer survivors.Methods: This longitudinal study was conducted using 9 cancer registries from the Surveillance, Epidemiology and End Results (SEER) Program with follow-up from 1975 to 2017. There were 43,991 patients diagnosed with first primary cancer from 1975 to 2016 before the age of 20 years who subsequently survived for at least 1 year. Standardized incidence ratios (SIRs) and absolute excess risks (AERs) for urogenital cancers were calculated.Results: Compared with the general population, the risk of urinary system cancer was significantly higher in both female (SIR = 5.18, 95% CI: 3.65-7.14) and male (SIR = 2.80, 95% CI: 1.94-3.92) survivors of any first cancer, with shorter median interval length between first cancer and subsequent urinary system cancer for male survivors (19.9 years) than female survivors (29.3 years). Females also had significantly higher SIR than males for subsequent urinary system cancer (SIRfemale:male=1.86, 95% CI: 1.13-3.03) and kidney cancer (SIRfemale:male = 1.97, 95% CI: 1.11-3.53). Compared with the general population, females with any first cancer had significantly higher risks for cancers of the corpus uteri (SIR = 2.32, 95% CI: 1.49-3.45) and vulva (SIR = 4.27, 95% CI: 1.38-9.95).Conclusions: Childhood and adolescent cancer survivors may have greater female susceptibility for developing subsequent urinary system and kidney cancers, and these survivors may have higher risks for specific types of reproductive system cancers. Our findings may lead to better awareness and surveillance for urogenital cancer by these cancer survivors and their physicians. [ABSTRACT FROM AUTHOR]

Background: Dietary and genetic factors involved in the one-carbon metabolism pathway may affect telomere length through DNA methylation and synthesis, but this has not been comprehensively investigated in epidemiologic studies. Objective: We cross-sectionally examined associations between dietary and genetic factors in the one-carbon metabolism pathway and relative peripheral blood leukocyte telomere length. Design: A total of 1715 participants from the Nurses' Health Study (NHS) had measurements of relative telomere length and plasma concentrations of folate, vitamin B-6, vitamin B-12, cysteine, and homocysteine. Food-frequency questionnaire (FFQ) measurements were also used for the assessment of folate, choline, methionine, riboflavin, vitamin B-6, vitamin B-12, and alcohol intakes. Genotyping was performed on 475 participants with telomere measurements on 29 mostly nonsynonymous single-nucleotide polymorphisms (SNPs) involved in one-carbon metabolism. Unconditional logistic and linear regression models were used. Results: There were no significant dose-response relations between any plasma- or FFQ-measured dietary factors and relative telomere length in multivariate analyses. For folate, vitamin B-6, and vitamin B-12, results from the use of FFQ data were consistent with plasma-biomarker findings. We showed no significant associations that involved SNPs and relative telomere length after we accounted for the false discovery rate. Conclusion: Our analyses involving plasma and questionnaire measurements of one-carbon metabolism factors show that some key dietary and genetic factors in this metabolic network are not associated with relative peripheral blood leukocyte telomere length. [ABSTRACT FROM AUTHOR]

The HID EVOlution—qPCR/STR Setup System enables automation of DNA quantitative real-time polymerase chain reaction (PCR) setup, normalization of DNA sample, and PCR setup for short tandem repeat (STR) analysis. The HID EVOlution System tracks sample and reagent information and facilitates data transfer of DNA quantification, normalization, and PCR setup for STR analysis steps, eliminating the need for manual processing and repetitive data entry. Instruments for the automated system include a Tecan Freedom EVO 150 robot for liquid handling, the 7500 Real-Time PCR System for DNA quantification, the GeneAmp PCR System 9700 for STR amplification, and the 3130xl Genetic Analyzer for the detection of amplified STR fragments. Validation studies including reproducibility, accuracy, correlation, and contamination studies were performed. Results demonstrated clean liquid-handling capabilities and maintenance of sample integrity. Variation in average allele peak height obtained using automated protocol was similar to that obtained using the manual protocol. [Copyright &y& Elsevier]

An abstract for the article "A systematic evaluation of left ventricular (LV) models for estimating LV volumes in children using cardiac cine (MRI)," by Jiming Zhang, Carlo Uribe, Jason Liu, Benjamin Cheong, Amol Pednekar, Paolo Angelini and Raja Muthupillai is presented.

This paper addresses the reachable set problem on nonlinear switched singular systems with impulsive performance and time-delay under bounded disturbance. The goal is to provide a real-time bounding set containing all reachable states. Originally, a real-time bounding criterion is developed by analyzing the variation of subinterval piecewise function and combining the definition of the average impulsive interval. Additionally, a lower bound on the Lyapunov function is provided by introducing an inequality scaling technique to avoid acquiring state bounds based on system decomposition techniques. Subsequently, the real-time bounding closed set, including all reachable states of the system, is estimated by calculating the Dini derivative of the Lyapunov function and using the real-time bounding criterion and the integral inequality technique. Finally, several numerical examples are given to illustrate the validity of the results obtained in this study. • o acquire the bounding of the piecewise Lyapunov function, a new R-T bounding criterion is presented using the definition of average impulsive interval and analyzing the relationship between the piecewise functions before and after switching. • Most results almost always choose the system decomposition method in order to obtain the state bound. The new method proposed in this paper does not need to consider the relationship between the rank of the singular matrix and the other matrices in the system. • Based on Lyapunov theory, a sufficient condition of R-TRS is given in the form of LMIs by applying the proposed new method and integral inequality technique. So far, no relevant results have been found on nonlinear SSS with impulsive performance. [ABSTRACT FROM AUTHOR]