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Inflammatory bowel diseases (IBD) are affected by dietary factors, including nondigestible carbohydrates (fibers), which are fermented by colonic microbes. Fibers are overall beneficial, but not all fibers are alike, and some patients with IBD report intolerance to fiber consumption. Given reproducible evidence of reduced fiber-fermenting microbes in patients with IBD, we hypothesized that fibers remain intact in select patients with reduced fiber-fermenting microbes and can then bind host cell receptors, subsequently promoting gut inflammation.Colonic biopsies cultured ex vivo and cell lines in vitro were incubated with oligofructose (5 g/L), or fermentation supernatants (24-hour anaerobic fermentation) and immune responses (cytokine secretion [enzyme-linked immunosorbent assay/meso scale discovery] and expression [quantitative polymerase chain reaction]) were assessed. Influence of microbiota in mediating host response was examined and taxonomic classification of microbiota was conducted with Kraken2 and metabolic profiling by HUMAnN2, using R software.Unfermented dietary β-fructan fibers induced proinflammatory cytokines in a subset of IBD intestinal biopsies cultured ex vivo, and immune cells (including peripheral blood mononuclear cells). Results were validated in an adult IBD randomized controlled trial examining β-fructan supplementation. The proinflammatory response to intact β-fructan required activation of the NLRP3 and TLR2 pathways. Fermentation of β-fructans by human gut whole microbiota cultures reduced the proinflammatory response, but only when microbes were collected from patients without IBD or patients with inactive IBD. Fiber-induced immune responses correlated with microbe functions, luminal metabolites, and dietary fiber avoidance.Although fibers are typically beneficial in individuals with normal microbial fermentative potential, some dietary fibers have detrimental effects in select patients with active IBD who lack fermentative microbe activities. The study is publicly accessible at the U.S. National Institutes of Health database (clinicaltrials.gov identification number NCT02865707).

Industry funding in medicine enhances physician training but can create bias influencing accurate reporting of outcomes. High rates of conflict of interest (COI) disclosure have been found in orthopaedic surgery. However, industry-specific disclosures have not been investigated and small-value compensations previously excluded. Using the nerve allograft industry as a proxy to examine specific patterns of COI between physicians and industries relevant to their publications, we sought to evaluate patterns in industry-specific COI disclosure within the hand and upper extremity surgery literature.Literature search for primary studies using nerve allografts in the hand and upper extremity from 2013 to 2021 was conducted. Authors were cross-referenced with their publication's COI statement and payments recorded in the Open Payments Database (OPD). Only payments relevant to the topic or product presented in the publication were included. Payments in all OPD subdivisions were compared.Fourteen studies with 14 first, 72 middle, and 14 senior authors were included. Disclosed and undisclosed payments totaled $2,848,196 and $2,509,397. Only 28% of the authors had completely accurate COI statements. Research and food and beverage comprised the highest and lowest average rates of accurate disclosure (93.8% and 24.9%). The value of accurately disclosed payments was significantly greater on a per-author basis among senior authors ( P0.001). Neither the value of undisclosed payments nor the rate of accurate disclosure differed by authorship position ( P = 0.904 and P = 0.350).When examined in the context of industries specific to publication, the rate of correct COI disclosure is lower than previously reported with small-value compensation a major contributor. Areas of improvement include the following: (1) All authors should be held accountable for correct disclosure; (2) all forms of financial support should be reported; and (3) journals should independently verify disclosures to the OPD. OPD utilization may help verify correct reporting, especially when the industry is related to the area of study, in the interest of maintaining the highest editorial integrity.

Introduction. The presence and influence of physician review websites (PRW) have increased significantly in the field of medicine. This study aims to better understand determinants of patient satisfaction and the sentiment of ophthalmologists using natural language processing of Healthgrades reviews. Methods. Healthgrades is a PRW where patients submit verified reviews, containing a star rating and a narrative review, of US-based ophthalmologists. This was a quantitative observational study conducted on May 23, 2022. We identified associations between physician demographics and both the sentiment analysis scores of narrative reviews and star ratings using the Student’s t-tests and one-way ANOVA tests. After natural language processing the reviews, a logistic regression explored the impacts of the most frequent words on the positivity of a given review. Results. This study examined a total of 16700 reviews of 1125 ophthalmologists. Ophthalmologists of younger age and male gender received statistically significantly higher star ratings and sentiment analysis scores; analysis of location of practice did not affect scores. Textual analysis revealed that words describing the physician’s personality, such as “friendly” and “caring,” increased the likelihood of reviews being positive more than descriptors of the visit’s effectiveness, such as “results” and “efficient.” Conclusion. Younger and male ophthalmologists received higher star ratings and sentiment analysis scores. Additionally, results indicated that words describing the ophthalmologist’s pleasant personality and the visit’s effectiveness most positively impacted a review, whereas descriptors of a wait or an unpleasant personality most negatively impacted a review.

A child’s day in the garden with their Gran and Pa leads to a wonderful exploration of pollination. Join them in discovering how pollination happens in our gardens and backyards, and the importance it has for our environment. Meet the animals involved in pollination and the plants that depend on pollination to produce our fruit, vegetables and even our clothes! Reading level varies from child to child, but we recommend this book for ages 5 to 9.

Lateral patellar inclination (LPI) measures patellar tilt and is historically described on axial X-ray or a single magnetic resonance image (MRI). Given the variability in patellar height, LPI may be better represented by performing this measurement on two separate axial MRI images. We hypothesized that a two-image LPI measurement would be different from the current single-image LPI and have similar, if not superior reliability. Sixty-five patients treated for patellar instability (PI) between 2014 and 2017 were identified. Single image and two-image LPI were measured on axial MRI images. All measurements were performed by two independent observers. Reliability analysis was based on three observers' measurements of 30 randomly selected patients. Both the one image and two image LPI showed good inter-rater reliability (intraclass correlation coefficient [ICC] = 0.71 and 0.89, respectively), although the two image LPI had less variability. Both single image and two image LPI had near perfect intra-rater reliability (ICC = 0.98 and 0.98, respectively). Average single image LPI (14.6 ± 9.9 degrees) was 6.1 ± 3.4 degrees less than the average two image LPI (19.6 ± 9.4 degrees) (p = 0.037). Referencing a previously described 13.5 degrees maximum threshold, 54% of the patients had excessive patellar tilt based on single image LPI, while 73% had pathologic patellar tilt based on two image LPI. Two image LPI has similar reliability with less inter-rater variability compared with the historical single image LPI measurement. Significantly greater patellar tilt was identified with two image LPI that was found with single image LPI. A larger percentage of patients were classified as having pathologic patellar tilt based on two image LPI than single image LPI. The two image LPI provides more consistent and representative measurements of patellar tilt. Previously described threshold values for patellar tilt should be re-examined using this new measurement technique to appropriately risk stratify patients with PI and patellofemoral pain.

Background: Given global population growth and aging, it is imperative to prioritize early eye disease detection and treatment. However, the current eye specialist workforce capacity is not bridging the growing gap, making it important to consider alternative solutions for increasing eye screening capabilities. This study compared virtual reality (VR) vision screening exams that help evaluate retinal health, such as 24-2 perimetry, Ishihara color blindness, and Amsler grid tests, against their in-clinic counterparts. Methods: 86 subjects were recruited from Mount Sinai’s ophthalmology clinic for a head-to-head comparison trial that was internally controlled across healthy controls and eyes with glaucoma and retinal disease. Results: Perimetry results from Humphrey Visual Field Analyzer (HVFA) and VR suprathreshold testing demonstrated a good sensitivity both overall (80% OD, 84% OS) and across control (86% OD, 89% OS), glaucoma (69% OD, 78% OS), and retinal disease (76% OD, 80% OS) groups. A Garway-Heath anatomical map showed an overall 70-80% agreement. Ishihara plate tests did not show a significant difference between the two testing modalities (p = 0.12; Mann-Whitney U test), which remained true across groups. Amsler grid testing differences were also non-significant (p = 0.81; Mann-Whitney U test), including each subgroup. Patient time required to complete VR exams was significantly improved (p

We develop new methods of quantifying the impact of photon detector imperfections on achievable secret key rates in Time-Entanglement based Quantum Key Distribution (QKD). We address photon detection timing jitter, detector downtime, and photon dark counts and show how each may decrease the maximum achievable secret key rate in different ways. We begin with a standard Discrete Memoryless Channel (DMC) model to get a good bound on the mutual information lost due to the timing jitter, then introduce a novel Markov Chain (MC) based model to characterize the effect of detector downtime and show how it introduces memory to the key generation process. Finally, we propose a new method of including dark counts in the analysis that shows how dark counts can be especially detrimental when using the common Pulse Position Modulation (PPM) for key generation. Our results show that these three imperfections can significantly reduce the achievable secret key rate when using PPM for QKD. Additionally, one of our main results is providing tooling for experimentalists to predict their systems' achievable secret key rate given the detector specifications., Corrections and revisions were made to plots and formulas in section IV, with smaller revisions to sections III.E and VII, and with cosmetic improvements to most plots. Clarification has been added regarding mutual consideration of jitter and down time

Introduction Narcolepsy type 1 (NT1) is characterized by pathologic hypersomnolence, REM intrusion phenomena, including cataplexy, and orexin deficiency. The diagnosis of NT1 is established based on the presence of bone fide cataplexy and supportive PSG and MSLT testing which requires patients to achieve sufficient sleep duration and regularity and discontinue centrally acting medications that might alter REM sleep. In cases where there is a high index of suspicion for NT1, CSF orexin deficiency is helpful to support the diagnosis of NT1. This is particularly true when PSG-MSLT are not feasible, CNS medication cannot be discontinued, or cataplexy cannot be validated. Report of case(s) A 16 year old girl presented for evaluation of excessive daytime sleepiness in the setting of suprasellar germinoma which was resected and treated with chemoradiation at age 11. She subsequently developed panhypopituitarism and severe hypersomnolence in the setting of sleep-wake schedule irregularities, variability of sleep duration, refractory delayed sleep phase disorder, and snoring. She reported episodic weakness in the setting of negative triggers, which was atypical for cataplexy. Her medications included modafinil, amphetamine-dextroamphetamine, and the SSRI fluoxetine. Physical examination depicted normal airways. Epworth Sleepiness Scale score was 18. Screening polysomnography showed a sleep efficiency of 78%, sleep latency of 46.5 minutes, REM latency 2 hours, AHI of 0/hr, and periodic limb movements of 35/hr without arousals. While the REM latency on polysomnography was inconsistent with NT1, the clinical history of a diencephalic mass and chemoradiation was suggestive of secondary NT1. She was unable to proceed with PSG-MSLT due to her psychiatrist's advice against discontinuing her SSRI and her difficulty in maintaining sleep-wake regularity. An evaluation for CSF orexin was performed establishing a normal level of 337 pg/mL (reference level of 200 pg/mL in healthy individuals), ruling out orexin deficiency /narcolepsy type 1. The patient was subsequently improved with wake-promoting antidepressants and light therapy in the AM. Conclusion This case illustrates the value of CSF orexin testing in the setting of diencephalic lesions in patients unable to undergo formal narcolepsy testing. Support (if any)

Objectives To evaluate the impact of intralesional heterogeneity on the performance of multiparametric magnetic resonance imaging (mpMRI) in determining cancer extent and treatment margins for focal therapy (FT) of prostate cancer. Patients and Methods We identified men who underwent primary radical prostatectomy for organ‐ confined prostate cancer over a 3‐year period. Cancer foci on whole‐mount histology were marked out, coding low‐grade (LG; Gleason 3) and high‐grade (HG; Gleason 4–5) components separately. Measurements of entire tumours were grouped according to intralesional proportion of HG cancer: 0%, 12 mm vs 26% for ≤12 mm) and those containing HG cancer (44%, vs 20% for LG only). Size discrepancy analysis suggests an optimal tumour size of ≤12 mm and treatment margins of 5–6 mm for FT. For tumours ≤12 mm in diameter, applying 5‐ and 6‐mm treatment margins would achieve 98.6% and 100% complete tumour ablation, respectively. For tumours of all sizes, using the same margins would ablate >95% of the HG cancer components. Conclusions Multiparametric MRI performance in estimating prostate cancer size, and consequently the treatment margin for FT, is impacted by tumour size and the intralesional heterogeneity of cancer grades.

Background: Lipomas are a rare cause of posterior interosseous nerve (PIN) compression. A systematic review of predictors for motor recovery has not been performed. This study sought to evaluate whether patient or lipoma characteristics are associated with motor recovery and could be used to determine when immediate tendon transfers at the time of excision should be performed. Methods: Articles describing patients with forearm lipomas resulting in PIN compression with motor weakness were included. Patient age, gender, symptom duration, laterality and largest dimension of lipoma, surgical intervention, and motor recovery were identified. Article quality was assessed via the Methodological Index for Non-Randomized Studies criteria. Results: Thirty articles reporting on 34 patients were identified. Average age was 58.2 years. Average largest lipoma dimension was 5.7 cm. All patients underwent lipoma removal, and 2 had concomitant tendon transfers. In all, 73.5% of patients had complete motor recovery at an average of 9.7 months. Patient age and largest dimension of lipoma, and duration of symptoms were not significant predictors of motor recovery. Symptom duration was a significant predictor of motor recovery in binary regression, particularly if < 18 months. Conclusions: The majority of patients with PIN weakness secondary to lipoma are likely to have complete motor recovery after excision alone. Concomitant tendon transfers should be considered for patients symptomatic for greater than 18 months. Further, adequately powered, studies are required to stratify risk factors and evaluate other modalities to identify the minority of patients who would benefit from immediate tendon transfer.

OBJECTIVE To compare the detection rates of prostate cancer between systematic biopsy and targeted biopsy using a stereotactic robot-assisted transperineal prostate platform. MATERIALS AND METHODS We identified consecutive patients with suspicious lesion(s) on multiparametric magnetic resonance imaging (mpMRI), who underwent both systematic and MRI-transrectal ultrasonography (US) fusion targeted biopsy using our proprietary transperineal robot-assisted prostate biopsy platform between January 2015 and January 2019 at our institution, for retrospective analysis. Comparative analysis was performed between systematic and targeted biopsy using McNemar's test, and the cohort was further stratified by prior biopsy status and Prostate Imaging Reporting and Data System (PI-RADS) v2.0 score. International Society of Urological Pathology (ISUP) grade group (GG) ≥2 cancers (previously known as Gleason grade ≥7) were considered to be clinically significant. RESULTS A total of 500 patients were included in our final analysis, of whom 67 (13%) were patients with low-risk cancer on active surveillance. Of the 433 patients without prior diagnosis of cancer, 288 (67%) were biopsy-naive. A total of 248 (57%) were diagnosed with prostate cancer, with 199 (46%) having clinically significant prostate cancer (ISUP GG ≥2). There were no statistically significant differences in the overall prostate cancer and clinically significant prostate cancer detection rate between systematic and targeted biopsy (51% vs 49% and 40% vs 38% respectively; P = 0.306 and P = 0.609). Of the 248 prostate cancers detected, 75% (187/248) were detected on both systematic and targeted biopsy, 14% (35/248) were detected on systematic biopsy alone and 11% (26/248) were detected on targeted biopsy alone. Of the 199 clinically significant cancers detected, 69% (138/199) were detected on both systematic and targeted biopsy, 17% (33/199) on systematic biopsy alone and 14% (28/199) on targeted biopsy alone. There were no statistically significant differences in the detection rate between systematic and targeted biopsy for both overall and clinically significant prostate cancer, even when the cohort was stratified by prior biopsy status and PI-RADS score. Targeted biopsy has greater sampling efficiency compared to systematic biopsy for both overall and clinically significant prostate cancer (23.2% vs 9.8%, P < 0.001 and 14.8% vs 5.6%, P < 0.001). CONCLUSIONS Using our robot-assisted transperineal prostate platform, combined MRI-US targeted biopsy with concurrent systematic prostate systematic biopsy probably represents the optimal method for the detection of clinically significant prostate cancer.

In the early 20th century, modern school curricula and new-style schools mushroomed in the Chinese remittance landscape of southern China. Breaking away from the two-and-a-half millennia of Confucian tradition, their creation marked a pivotal point of departure between the nation’s past and future. Since overseas migration and modern education both provide a fruitful context for the circulation of new objects and a cross-fertilization of ideas, new schools serve as barometers of social-material change. Research in the present-day cities of Zhongshan and Zhuhai (formerly Heung San County) suggests that diaspora-funded schools were beacons of modern learning within the China–Australia corridor. Both their physical structures and material manifestations invited a new engagement with the modern world.

Cannabis has consistently been the third most commonly abused drug among drug arrestees in Singapore over the past few years. Accordingly, this study aimed to understand the profile of cannabis users in Singapore and explore the effects of cannabis use on drug progression.A total of 450 participants who had used cannabis at least once in their lifetime were recruited from the National Addictions Management Service, prisons, the Community Rehabilitation Centre and halfway houses from August 2017 to May 2018. A face-to-face questionnaire was administered and descriptive analyses were conducted.The mean participant age was 40.9 ± 14.51 years, and 93.1% of them were male. The participants generally initiated cannabis use during adolescence, at a mean onset age of 16.5 ± 4.46 years. Most (89.6%) were introduced to cannabis by peers. Approximately half of them (46.9%) had used cannabis before other illicit drugs and 42.1% of them had used heroin as the succeeding drug.In Singapore, cannabis use is often initiated during adolescence, largely under peer influence. Cannabis users may progress to other illicit drugs, particularly heroin, later in life.

Introduction: Despite the uptake of focal therapy for prostate cancer in recent years, challenges remain in the identification of all tumor foci and adequacy of ablative modalities, accoun...

Summary:. Injectable drug use in the upper extremity often leads to chronic wounds complicated by osteomyelitis. Conventional reconstructive options are often not feasible and/or are contraindicated in this patient population. We have started using a synthetic, biodegradable temporizing matrix (BTM) for the treatment of these patients. We hypothesize that BTM is a safe, low-risk, and low-morbidity alternative reconstructive option. We report outcomes after staged debridement and BTM application followed by split-thickness skin grafting for two patients with large, chronic bilateral forearm wounds with concomitant osteomyelitis confirmed by MRI and biopsy. No acute surgical complications were encountered and at a mean follow-up of 13 months, both patients had maintained stable soft-tissue coverage. Reconstruction using BTM is a novel treatment option that can simplify the reconstruction, reduce donor-site morbidity, and optimize success for patients with chronic wounds resulting from injectable drug use. Initial outcomes are promising; however, further comparative studies are needed to better evaluate long-term outcomes of this technique.

Many qiaoxiang in southern Fujian and Guangdong appear derelict, but documenting the material heritage and interviewing people about its social significance reveals another image. The homeland of Overseas Chinese was not only found to be significant for the diaspora but serves as an enduring reminder of a grassroots-based modernity in rural China. The qiaoxiang effectively became a transnational legacy of migration from southern China that has undergone the following stages of transformation: exodus-led emergence of a remittance landscape, sudden abandonment, and sometimes revival. Today, it has become a “repository” or “living museum” where tourists and scholars alike can visit and ponder how humans adapted to post-rural life.

Objective: To evaluate the efficacy of multiparametric magnetic resonance imaging (mp-MRI) using Prostate Imaging Reporting and Data System version 2.0 (PI-RADSv2) definitions in detecting organ-confined prostate cancer. Methods: All patients who underwent radical prostatectomy between January 1, 2014 and December 30, 2014 were identified. All underwent mp-MRI within 180 days before surgery. Those with prior pelvic irradiation or androgen deprivation therapy were excluded. Fully embedded, whole-mount histopathology was centrally reviewed and correlated with imaging for tumour location, Gleason score (GS) and stage. Results: There were 39 patients included, of which 35 (90%) had mp-MRI done post-biopsy. A total of 93 cancer foci were identified on whole-mount pathology, of which mp-MRI detected 63 (68%). Of those detected by mp-MRI, 14 were PI-RADS 3 (n = 6 for GS 6, n = 8 for GS 7, no GS ≥ 8) and 49 were PI-RADS 4–5 (n = 7 for GS 6, n = 33 for GS 7, and n = 9 for GS ≥ 8). There were 30 (32%) cancer foci missed by mp-MRI (n = 15 for GS 6, n = 13 for GS 7 and n = 2 for GS ≥ 8). A lesion classified as PI-RADS 4–5 predicted a higher grade cancer on pathology as compared to PI-RADS 3 (for GS 7 lesions, odds ratio [OR] = 3.53, 95% CI: 0.93–13.45, p = 0.064). The mp-MRI size detection limit was 20 mm2 and 100 mm2 for 50% and 75% probability of cancer, respectively. In associating with radiological and pathologic stage, the weighted Kappa value was 0.69 (p

OBJECTIVES To investigate the trends in the presentation and surgical management of renal tumors at Singapore General Hospital, Singapore. METHODS We accessed our uro-oncological registry to extract the clinicopathological data of patients with renal tumors who underwent nephrectomy from 2000 to 2015. Binary logistic regression was used to identify predictors of nephron-sparing surgery utilization, Clavien-Dindo grade ≥III complications and progression to stage ≥3 chronic kidney disease. Cox regression models were created to evaluate the proportional hazards of the risk factors for overall survival and cancer-specific survival. RESULTS A total of 1208 cases of nephrectomy were carried out between 2000 and 2015. The proportion of cT1a tumors increased from 2000-2004 to 2010-2015, which was accompanied by the doubling of utilization rates of nephron-sparing surgery and minimally invasive surgery. Charlson Comorbidity Index score

The existence and dilemmas of metropolitan fisheries have been overlooked in research on the resilience of coastal marine socio-ecological systems. Yet, they could produce a model of sustainable fisheries with significant global impact. To fill that research gap, this study investigates an inshore fishery population that has sustained itself within Hong Kong's rapid urban development, seeking to understand the reasons for its survival. The results indicate that the values of self-reliance and entrepreneurialism exacted by fishing enabled the fishers to make necessary adaptations and reposition themselves in mariculture and service industries. These new ventures, while retaining marine-based livelihoods, draw the fishers away from fishing activities. The paradox of this value-based resilience of a metropolitan fishery is discussed for its potential to generate policies to strengthen linkages among the fishers’ business activities and to create a sustainable fishery model useful in other contexts.