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Abstract Objectives This study aimed to analyse the value of pre-operative 18F-fluorodeoxyglucose positron emission tomography (PET)-computed tomography that can predict tumour pathological complete response, tumour histology grade, overall survival, and recurrence-free survival in patients with locally advanced oesophageal squamous cell carcinoma who underwent neoadjuvant chemoradiotherapy (NCRT) followed by surgery. Methods We retrospectively reviewed the cases of patients with locally advanced oesophageal squamous cell carcinoma undergoing NCRT followed by surgery. Patients who did not undergo PET within 3 months of surgery were excluded. We set a pre-operative PET maximum standardised uptake value (SUVmax) of > 5 as the threshold and classified the patients into two groups. We analysed the tumour response and histology grade, and compared the overall survival and recurrence-free survival between the two groups. Results This cohort included 92 patients with oesophageal squamous cell carcinoma who underwent NCRT followed by surgery; 49 patients had a pre-operative PET SUVmax 5. The patients’ pre-operative PET SUVmax correlated with tumour histology, ypT stage, and tumour response. Patients with a pre-operative SUVmax 5. Conclusions Pre-operative SUVmax may be useful to predict tumour response, survival, and recurrence in patients with locally advanced oesophageal squamous cell carcinoma who undergo NCRT followed by surgery.

Background: Lymphadenectomy plays a crucial role in the surgical management of early- stage esophageal cancer. However, few studies have examined lymphadenectomy outcomes in advanced stages, particularly in patients who initially underwent concurrent chemoradiation therapy. This retrospective study investigates the effect of lymphadenectomy in patients diagnosed with AJCC 8th-edition clinical stage III esophageal squamous cell carcinoma who received concurrent preoperative chemoradiation. Methods: Data from 1994 to 2023 were retrieved from our retrospective database. All patients underwent a uniform evaluation and treatment protocol, including preoperative concurrent chemoradiation therapy comprising cisplatin and 5-fluorouracil, followed by esophagectomy. The analysis encompassed clinical T and N stages, tumor location, tumor grade, pathological T and N stages, pathological stage, and the extent of lymph node dissection. Overall survival, “Free-To-Recurrence”, and disease-free survival were assessed via Kaplan–Meier survival curves and the Cox regression model for multivariate analysis. Results: The dataset was stratified into two groups according to extent of lymph node dissection, with one group having Conclusions: The quantity of lymphadenectomy is a crucial determinant for patients with AJCC 8th-edition clinical stage III esophageal squamous cell carcinoma receiving preoperative concurrent chemoradiation.

Abstract Purpose The present study aimed to propose a modified intra-articular transtendinous looped biceps tenodesis (mTLBT) using a suture anchor and to compare the functional outcomes and incidence of Popeye deformities between biceps tenotomy and mTLBT. Methods Medical records of patients who underwent either tenotomy or mTLBT for the long head of the biceps tendon (LHBT) lesion between January 2016 and April 2021 were retrospectively reviewed. The inclusion criteria were patients aged 40–70 years with LHBT pathologies, such as superior labrum anterior to posterior (SLAP) lesions > type II, LHBT pulley system rupture with bicipital instability, and intra-articular LHBT tear. The exclusion criteria were full-thickness supraspinatus tears, frozen shoulder, shoulder fracture, and postoperative traumatic events that affected the operated shoulder. All patients were followed up for at least 1 year. Popeye deformity, bicipital cramping pain, visual analog scale (VAS) pain score, and functional outcome scores (University of California at Los Angeles [UCLA] and American Shoulder and Elbow Surgeons [ASES] scores) were recorded. Fisher’s exact test and Chi-square test were used for categorical variables, whereas the Mann–Whitney U test was used for nonparametric variables. Results The mTLBT and tenotomy groups included 15 and 40 patients, respectively. The incidence of Popeye deformity and biceps cramping pain in the tenotomy group (52.5% and 50%, respectively) was significantly higher than that in the mTLBT group (13.3% and 20%, respectively) (p = 0.009 and p = 0.045, respectively). The postoperative VAS, UCLA, and ASES scores were not significantly different between the two groups. One patient in the tenodesis group experienced metallic-anchor pullout. Conclusion mTLBT is an arthroscopic intra-articular top of the groove tenodesis that can be performed completely in the intra-articular space and is especially suitable for patients with an intact or partially torn rotator cuff. This technique is reliable for treating biceps pathologies as it results in similar functional outcome scores, lesser biceps cramping pain, and less frequent Popeye deformity compared to biceps tenotomy. Level of Evidence III.

IntroductionEsophageal stenoses are frequent complications after esophageal atresia surgery as well as after acid, alkali and battery ingestion. Worldwide, repeated balloon dilatations are the most frequently performed procedures for these stenoses. In most cases the stenoses can be dilated sufficiently to allow adequate enteral nutrition. Until recently, age dependent esophageal lumen size has not been established; which was aim of the current study.MethodsAll children in whom an esophageal contrast imaging was performed between 1/2011 and 5/2021 were included. The width was measured by two investigators at two measuring points in two planes, the diameter was calculated and plotted against the respective weight of the child. Bland-Altmann plots have confirmed the validity of the measurements of both investigators.ResultsEsophagus diameter was measured in more than 100 children. The resulting curves show a very good correlation with weight (upper measuring point: r = 0.86743, p < 0.0001; lower measuring point: r = 0.80593, p < 0.0001).ConclusionThese results are the first to define the esophageal diameter in children. The results of this study may guide physicians performing esophageal interventions including dilatations in future.

Case: A 45-year-old woman sustained a unique lateral tibia plateau fracture pattern with a vertically rotated fragment composed of an intact articular surface and subchondral bone. During open reduction and internal fixation (ORIF), a full thickness radial tear of the lateral meniscus was found, which was repaired under direct visualization through arthrotomy. At final follow-up, the patient regained pain-free activity with good meniscus healing, as confirmed with a second-look arthroscopic examination. Conclusion: This case represents an undescribed fracture pattern that indicates an associated meniscus injury. A thorough evaluation, including Magnetic Resonance Imaging should be considered. One-stage ORIF followed with meniscus repair represents a good treatment option.

We study moduli spaces of lattice-polarized K3 surfaces in terms of orbits of representations of algebraic groups. In particular, over an algebraically closed field of characteristic 0, we show that in many cases, the nondegenerate orbits of a representation are in bijection with K3 surfaces (up to suitable equivalence) whose Néron–Severi lattice contains a given lattice. An immediate consequence is that the corresponding moduli spaces of these lattice-polarized K3 surfaces are all unirational. Our constructions also produce many fixed-point-free automorphisms of positive entropy on K3 surfaces in various families associated to these representations, giving a natural extension of recent work of Oguiso.

Abstract Background An eye injury that causes no light perception (NLP) typically carries an unfavorable prognosis, and NLP because of trauma is a common indication for enucleation. With advances in vitreoretinal surgical techniques, however, the indication for enucleation is no longer determined by posttrauma NLP vision alone. There are limited studies in the literature to analyse the outcome of NLP eyes following open globe injury. The current study was aimed to evaluate the outcome of surgical repair of severely traumatized eyes with no light perception vision as preoperative visual acuity. Secondary objective was to possibly predict the factors affecting the final vision outcome in this eyes. Methods Retrospective case analysis of patients with surgical repair of open globe injury over last ten years at a tertiary referral eye care centre in Singapore. Results Out of one hundred and seventy two eyes with open globe injury 27 (15.7%) eyes had no light perception (NLP). After surgical repair, final visual acuity remained NLP in 18 (66.7%) eyes. Final vision improved to Light perception/ Hand movement (LP/HM) in 2(7.4%) eyes, 1/200 to 19/200(11.1%) in 3 eyes and 20/50-20/200(14.8%) in 4 eyes. The median follow up was 18.9 months (range: 4–60 months). The factors contributing to poor postoperative outcome were presence of RAPD (p = 0.014), wound extending into zone III (p = 0.023) and associated vitreoretinal trauma (p = 0.008). Conclusions One third of eyes had ambulatory vision or better though two third of eyes still remained NLP. Pre-operative visual acuity of NLP should not be an indication for primary enucleation or evisceration for severely traumatized eyes. Presence of afferent papillary defect, wound extending posterior to rectus insertion and associated vitreoretinal trauma can adversely affect the outcome in severely traumatized eyes with NLP. Timely intervention and state of art surgery may restore useful vision in severely traumatized eyes.

Purpose: Helicobacter pylori infections differ between children and adults. The Pediatric society practice guidelines recommend against a test-and-treat approach, characterized by the use of non-invasive tests for diagnosis (e.g. urea breath test [UBT] or stool antigen test). However, significant variations exist in clinical practice. This study examined the use of non-invasive testing for the screening and diagnosis of H. pylori infection in children at a tertiary pediatric hospital in Singapore, reviewing both management decisions and patient outcomes. Methods: A retrospective review was conducted on children between the ages of 0 and 18 years who were tested for H. pylori infection using either a stool antigen test or UBT between January 2018 and June 2020. Results: Among the 1,397 children tested, 117 (8.4%) had a positive stool H. pylori antigen result, and 5 out of 85 tested (5.9%) had a positive UBT. Abdominal pain was the predominant symptom (n=98; 80.3%). Only 7 treatment-naïve children had biopsy-proven disease. Tissue biopsies for H. pylori culture were sent to 2 children, with 1 negative result. A total of 111 children (91.0%) received treatment, wherein proton pump inhibitor, amoxicillin, and clarithromycin for 14 days was the most common therapeutic regimen. Symptom resolution was observed in 62 children (50.8%). Conclusion: A test-and-treat strategy was more widely utilized than endoscopy-based testing, showing a low compliance to existing guidelines for the management of H. pylori infections in children at our center and significant false-positive rates. [ABSTRACT FROM AUTHOR]

The article "Stemming the tide of chronic kidney disease: A focus on primary care prevention" published in the Annals of the Academy of Medicine, Singapore discusses the rise in chronic kidney disease (CKD) prevalence in Singapore and the importance of primary care in prevention and management. The study evaluates the outcomes of CKD patients enrolled in the HALT-CKD program, emphasizing the significance of maintaining ACEi/ARB therapy. The study also highlights the limited impact of SGLT2i and counseling on CKD progression, suggesting areas for improvement in primary care practices. The article concludes by introducing the HSG CKD Care Protocol to empower primary care in managing CKD stages G1-G3A effectively. [Extracted from the article]

The emerging demand for a variety of novel Location-based Services (LBS) by consumers and industrial users is driven by the rapid and extensive proliferation of mobile smart devices. Sensors embedded in smart devices or machines provide wireless connectivity and Global Positioning System (GPS) capability, and are co-utilized to acquire location-linked data which are algorithmically transformed into reliable and accurate location estimates. GPS is a mature and reliable technology for outdoor localization but indoor localization in a complex multi-storey building environment remains challenging due to fluctuations in wireless signal strength arising from multipath fading. Location-linked data from wireless access points (WAPs) such as received signal strength (RSS) are acquired as numerical sequences. By conceptualizing a fixed order sequence of WAP measurements as a sentence where the RSS from each WAP are words, we may leverage on recent advances in artificial intelligence for natural language processing (NLP) to enhance localization accuracy and improve robustness against signal fluctuations. We propose the hyper-class Transformer (HyTra), an encoder-only Transformer neural network which learns the relative positions of wireless access points (WAPs) through multiple learnable embeddings. We propose a second network, HyTra-HF, which improves upon HyTra by applying a hierarchical relationship between location classes. We test our proposed networks on public and private datasets varying in sizes. HyTra-HF outperforms existing deep learning solutions by obtaining 96.7% accuracy for the floor classification task on the UJIIndoorloc dataset. HyTra-HF is amenable to deep model compression and achieves accuracy of 95.95% with over ten-fold reduction in model size using Sparsity Aware Orthogonal (SAO) initialization and has the best-in-class accuracy for the sparse model. [ABSTRACT FROM AUTHOR]

Abstract Insider threats pose a critical risk to organisations, impacting their data, processes, resources, and overall security. Such significant risks arise from individuals with authorised access and familiarity with internal systems, emphasising the potential for insider threats to compromise the integrity of organisations. Previous research has addressed the challenge by pinpointing malicious actions that have already occurred but provided limited assistance in preventing those risks. In this research, we introduce a novel approach based on bidirectional long short-term memory (BiLSTM) networks that effectively captures and analyses the patterns of individual actions and their sequential dependencies. The focus is on predicting whether an individual would be a malicious insider in a future day based on their daily behavioural records over the previous several days. We analyse the performance of the four supervised learning algorithms on manual features, sequential features, and the ground truth of the day with different combinations. In addition, we investigate the performance of different RNN models, such as RNN, LSTM, and BiLSTM, in incorporating these features. Moreover, we explore the performance of different predictive lengths on the ground truth of the day and different embedded lengths for the sequential features. All the experiments are conducted on the CERT r4.2 dataset. Experiment results show that BiLSTM has the highest performance in combining these features.

Abstract Nicotinamide adenine dinucleotide phosphate-diaphorase (NADPH-d) was used to detect neurodegenerations in aged monkeys. Our previous studies have shown that aging-related NADPH-d positive bodies (ANBs) and megaloneurites appeared in the lumbosacral spinal cord of aged rats and dogs, respectively. To determine the occurrence of megaloneurites and ANBs in non-human primates, we used NADPH-d histochemistry to perform an advanced study of aging-related alterations in aged male monkeys. We identified two distinct abnormal NADPH-d positive alterations, which were expressed as ANBs and megaloneurites, mainly distributed in the superficial dorsal horn, dorsal gray commissure, lateral collateral pathway (LCP) and sacral parasympathetic nucleus of the sacral spinal cord in aged monkeys. Meanwhile, large diameter punctate NADPH-d abnormalities occurred and scattered in the lateral white matter of the LCP and dorsal root entry zone at the same level of megaloneurites in the gray matter. Immunohistochemical results showed that megaloneurites and ANBs are two distinct abnormal alterations, with megaloneurites co-localizing with vasoactive intestinal peptide immunoreactivity, whereas ANBs were not co-localized. Both ANBs and megaloneurites provide consistent evidence that the anomalous NADPH-d alterations in the aged sacral spinal cord are referred to as a specialized aging marker in the pelvic visceral organs in non-human primates.

Understanding the impact of mining disturbances and creep deformation on the macroscopic deformation and the microscopic pore and fracture structures (MPFS) of coal is paramount for ensuring the secure extraction of coal resources. This study conducts cyclic loading-unloading and creep experiments on coal using a low-field nuclear magnetic resonance (NMR) experimental apparatus which is equipped with mechanical loading units, enabling real-time monitoring the T2 spectrum. The experiments indicated that cyclic loading-unloading stress paths initiate internal damage within coal samples. Under identical creep stress conditions, coal samples with more initial damages had more substantial instantaneous deformation and creep deformation during the creep process. After undergoing nearly 35 h of staged creep, the total strains for coal samples CC01, CC02, and CC03 reach 2.160%, 2.261%, and 2.282%, respectively. In the creep stage, the peak area ratio of seepage pores and microfractures (SPM) gradually diminishes. A higher degree of initial damage leads to a more pronounced compaction trend in the SPM of coal samples. Considering the porosity evolution of SPM during the creep process, this study proposes a novel fractional derivative model for the porosity evolution of SPM. The efficacy of the proposed model in predicting porosity evolution of SPM is substantiated through experimental validation. Furthermore, an analysis of the impact mechanisms on key parameters in the model was carried out.

Abstract Introduction Intestinal obstruction is a common complication in patients with advanced malignancies, often attributed to the disease itself or as a side effect of opioid analgesics used for pain management. However, the occurrence of intestinal obstruction following antituberculosis therapy is rare. Case presentation We report a unique case of a 58-year-old Asian male diagnosed with stage IV pancreatic carcinoma and pulmonary tuberculosis. The patient was initiated on a regimen of ethambutol hydrochloride, pyrazinamide, rifampicin, and isoniazid tablets (II) for tuberculosis, alongside morphine for the management of severe cancer-related pain. Subsequently, he developed symptoms indicative of intestinal obstruction. Despite discontinuation of morphine, the patient’s symptoms persisted until he autonomously ceased all medications, leading to a rapid improvement in his condition. This unexpected resolution highlighted the antituberculosis drugs as the probable cause of his intestinal obstruction. Conclusions This case underscores the importance of considering antituberculosis drugs as a potential cause of intestinal obstruction, especially in patients who do not respond to conventional management strategies for drug-induced gastrointestinal side effects. It also emphasizes the need for heightened vigilance and monitoring when prescribing these medications to patients with advanced malignancies, to promptly identify and address rare but significant side effects.

In this article, a single-board integrated millimeter-wave (mm-Wave) asymmetric full-digital beamforming (AFDBF) array is developed for beyond-fifth-generation (B5G) and sixth-generation (6G) communications. The proposed integrated array effectively addresses the challenge of arranging a large number of ports in a full-digital array by designing vertical connections in a three-dimensional space and successfully integrating full-digital transmitting (Tx) and receiving (Rx) arrays independently in a single board. Unlike the traditional symmetric array, the proposed asymmetric array is composed of an 8 × 8 Tx array arranged in a square shape and an 8 + 8 Rx array arranged in an L shape. The center-to-center distance between two adjacent elements is 0.54λ0 for both the Tx and Rx arrays, where λ0 is the free-space wavelength at 27 GHz. The proposed AFDBF array possesses a more compact structure and lower system hardware cost and power consumption compared with conventional brick-type full-digital arrays. In addition, the energy efficiency of the proposed AFDBF array outperforms that of a hybrid beamforming array. The measurement results indicate that the operating frequency band of the proposed array is 24.25–29.50 GHz. An eight-element linear array within the Tx array can achieve a scanning angle ranging from −47° to +47° in both the azimuth and the elevation planes, and the measured scanning range of each eight-element Rx array is –45° to +45°. The measured maximum effective isotropic radiated power (EIRP) of the eight-element Tx array is 43.2 dBm at 28.0 GHz (considering the saturation point). Furthermore, the measured error vector magnitude (EVM) is less than 3% when 64-quadrature amplitude modulation (QAM) waveforms are used.