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Abstract Reducing the risk of urethral strictures after transurethral surgery for patients with bladder cancer requires effective strategies. We compared the clinical outcomes of a novel drug-injectable urethral catheter set (NIUS) with hyaluronic acid (HA) with those of the conventional intraurethral HA injection method. This six-center, prospective, randomized, single-blind trial included 192 male patients aged ≥ 20 years scheduled to undergo transurethral surgery. The primary outcome was patient-reported satisfaction. Secondary outcomes were patient-reported pain intensity, clinician-reported convenience, and urethral strictures. Cystourethroscopy was performed under direct visualization. Outcomes of the experimental (NIUS with HA) and control (HA) groups were compared using the chi-square test and t-test. The post-transurethral surgery rate was significantly higher in the experimental group than in the control group (p

Purpose To analyze adenoma detection rate (ADR) and related quality indicators of colonoscopy among trainees and make recommendations for appropriate colonoscopy training. Methods ADR and related indicators of colonoscopies performed by 3 trainees and 5 colonoscopy experts between March and November 2022 were analyzed. These indicators were analyzed in both the entire patients and the screening/surveillance group. In addition, the training period of the 3 trainees was divided into 3 sections, and the changes in these indicators were examined. Results The mean ADR of the 3 trainees was 50.6%. In the screening/surveillance group, the mean ADR of the 3 trainees was 51.8%, showing no significant difference from the experts' ADR (53.4%). When the training period was divided into 3 sections and analyzed in the screening/surveillance group, the mean ADR of the trainees gradually increased to 49.4%, 52.6%, and 53.6%, respectively; however, the difference was insignificant. Analyzing each trainee’s ADR, there was a significant difference among the 3 trainees (58.5% vs. 44.7% vs. 50.2%, P=0.008). However, in the third section of the training period, the 3 trainees’ ADRs were 53.0%, 49.2%, and 57.3%, respectively, showing no significant difference (P=0.606). Conclusion In the early stages of training, the ADR was higher than recommended; however, there were variances in ADR between individuals. As the training period passed, the ADR became similar at the expert level, whereas the difference in ADR between trainees decreased. Therefore, efforts to increase ADR should be made actively from the beginning of training and continued during the training period.

SA508 Gr.1A low-alloy steel is being considered as a candidate material for main steam line piping in nuclear power plants. Therefore, improving its strength and toughness is essential for enhancing the leak-before-break (LBB) margin. In this study, six types of model alloys were fabricated by varying the contents of microalloying elements (C, Cu, B, Ti, and Nb) to enhance the mechanical properties of the specimens. The addition of a few ppm of B led to the formation of a fine-grained low-temperature transformation microstructure, resulting in the highest strength among the model alloys. However, the addition of Nb and Ti increased the formation of coarse ferrite, significantly decreasing the strength of the alloys. Reducing the C content while adding a small amount of B simultaneously maintained strength and enhanced toughness. Furthermore, the LBB margins of model alloys and commercial steel were evaluated to validate the influence of varying microalloying content. The model alloys exhibited a substantial increase in yield strength and fracture resistance, resulting in a more than 10% increase in the LBB margin. Notably, the LBB margin of the alloy with 15 ppm B was 1.39, approximately 25% higher than that of commercial steels.

Mesozooplankton are critical components of marine ecosystems, acting as key intermediaries between primary producers and higher trophic levels by grazing on phytoplankton and influencing fish populations. They play pivotal roles in the pelagic food web and export production, affecting the biogeochemical cycling of carbon and nutrients. Therefore, accurately modeling and visualizing mesozooplankton community dynamics is essential for understanding marine ecosystem patterns and informing effective management strategies. However, modeling these dynamics remains challenging due to the complex interplay among physical, chemical, and biological factors, and the detailed parameterization and feedback mechanisms are not fully understood in theory-driven models. Graph neural network (GNN) models offer a promising approach to forecast multivariate features and define correlations among input variables. The high interpretive power of GNNs provides deep insights into the structural relationships among variables, serving as a connection matrix in deep learning algorithms. However, there is insufficient understanding of how interactions between input variables affect model outputs during training. Here we investigate how the graph structure of ecosystem dynamics used to train GNN models affects their forecasting accuracy for mesozooplankton species. We find that forecasting accuracy is closely related to interactions within ecosystem dynamics. Notably, increasing the number of nodes does not always enhance model performance; closely connected species tend to produce similar forecasting outputs in terms of trend and peak timing. Therefore, we demonstrate that incorporating the graph structure of ecosystem dynamics can improve the accuracy of mesozooplankton modeling by providing influential information about species of interest. These findings will provide insights into the influential factors affecting mesozooplankton species and emphasize the importance of constructing appropriate graphs for forecasting these species.

Acute myeloid leukemia (AML) remains challenging to treat, which in part relates to genetic heterogeneity of the disease, to the protective tumor microenvironment driving resistance to therapy, and also to immune evasion characteristics of leukemic cells. Targeting epigenetic programs in AML provides an attractive opportunity to impair long-term proliferation and induce differentiation. The novel inhibitor JNJ- 75276617 (bleximenib) targets the menin-KMT2A interaction and provides preclinical efficacy in AML (Kwon et al1). Here, we provide mechanistic insight in how JNJ- 75276617 impairs proliferation and drives differentiation of primary AML patient cells. A large-scale drug screen was set up in which genetic alterations and quantitative proteomics were compared with drug sensitivity in a preclinical setting, which revealed that granulocyte macrophage progenitor (GMP)-like AMLs display the greatest sensitivity. Furthermore, we identified that NPM1c/DNMT3Amut AMLs are sensitive, and some NPM1wt AML subtypes without KMT2A-MLLT3 rearrangements benefit from menin-KMT2A inhibition. Genome-wide ChIP-seq studies revealed patient-specific epigenetic alterations upon JNJ-75276617 treatment, uncovering a striking upregulation of MHC class I and class II expression as a consequence of epigenetic changes upon menin-KMT2A inhibition, independent of MEIS1 loss but involving CIITA activation. Functionally, this results in enhanced sensitivity of leukemic blasts to T cell-mediated cytotoxicity in allogeneic and autologous settings. Our data indicate that JNJ-75276617 provides a potential therapeutic approach whereby not only proliferation is impaired and differentiation is induced, but whereby therapeutic benefit might also be achieved by reactivating the antigen presentation machinery.

Background and objectivesThe optimal timing for complete revascularization (CR) in patients with acute myocardial infarction (AMI) and multivessel disease (MVD) remain uncertain.MethodsThis post-hoc analysis of the FRAME-AMI trial included AMI patients with MVD (n = 549). They were classified into immediate (n = 329) and staged CR (n = 220) groups. All percutaneous coronary interventions were performed during inex hospitalization. The primary endpoint was a composite of all-cause death, acute myocardial infarction, and repeated revascularization. Secondary endpoints included each component of the primary endpoint. Additional comparisons for the outcomes in ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) were also performed.ResultsThe incidence of the primary endpoint was not significantly different in any of the AMI patients [12.7% [immediate CR] vs. 17.4% [staged CR], p = 0.905, adjusted hazard ratio [HR] of staged CR = 0.81, 95% confidence interval = 0.43–1.53, p = 0.528]. Other secondary endpoints were also not significantly different. Analyses of STEMI and Neither the primary or secondary endpoints of NSTEMI patients were significantly different.ConclusionsIn this post-hoc analysis of the FRAME-AMI trial, no significant difference in clinical outcomes was observed between the immediate and staged CR strategies for AMI with MVD and the subgroups, such as STEMI or NSTEMI. However, the results should be interpreted carefully because of the many limitations, including a limited sample size and a lack of statistical power. Trial Registration: FRAME-AMI clinicaltrials.gov, identifier (NCT02715518).

Background Bronchiectasis is a chronic respiratory disease that leads to airway inflammation, destruction, and airflow limitation, which reflects its severity. Impulse oscillometry (IOS) is a non-invasive method that uses sound waves to estimate lung function and airway resistance. The aim of this study was to assess the usefulness of IOS in predicting the severity of bronchiectasis. Methods We retrospectively reviewed the IOS parameters and clinical characteristics in 145 patients diagnosed with bronchiectasis between March 2020 and May 2021. Disease severity was evaluated using the FACED score, and patients were divided into mild and moderate/severe groups. Results Forty-four patients (30.3%) were in the moderate/severe group, and 101 (69.7%) were in the mild group. Patients with moderate/severe bronchiectasis had a higher airway resistance at 5 Hz (R5), a higher difference between the resistance at 5 and 20 Hz (R5−R20), a higher resonant frequency (Fres), and a higher area of reactance (AX) than patients with mild bronchiectasis. R5 ≥0.43, resistance at 20 Hz (R20) ≥0.234, R5−R20 ≥28.3, AX ≥1.02, reactance at 5 Hz (X5) ≤−0.238, and Fres ≥20.88 revealed significant univariable relationships with bronchiectasis severity (p

Purpose: To evaluate the efficacy and safety of holmium laser enucleation of the prostate (HoLEP) in a large prospective cohort of patients with benign prostatic hyperplasia (BPH) through systematic follow-up at a single institution. Materials and Methods: Clinical outcomes were analyzed between August 2008 and June 2022. Patients were followed-up at 2 weeks, 3 months and 6 months postoperatively. Results: A total of 3,000 patients (mean age, 69.6±7.7 years) underwent HoLEP. Baseline total International Prostate Symptom Score (IPSS) was 19.3±7.7 and maximum flow rate (Qmax) was 9.4±4.8 mL/s. Mean total prostate volume was 67.7±3.4 mL. Total operation time was 60.7±31.5 minutes, and catheterization time was 1.0 days (range, 1.0–1.0 days). At 6 months postoperatively, the total IPSS decreased to 6.6±5.8 and Qmax increased to 22.2±11.3 mL/s. Complications at 6 months postoperatively included stress urinary incontinence (SUI) in 36 patients (1.9%), urgency urinary incontinence (UUI) in 25 (1.3%), bladder neck contracture (BNC) requiring transurethral incision (TUI) in 16 (0.5%), and urethral stricture in 29 (1.0%). Eleven patients (0.4%) with prostatic fossa stones required stone removal. Sixty-one patients (2.0%) required secondary surgery (transurethral coagulation, 16 [0.5%]; TUI for BNC, 16 [0.5%]; stone removal for prostatic fossa stones, 11 [0.4%]; and endoscopic internal urethrotomy for urethral stricture, 18 [0.6%]). Conclusions: Mid-term follow-up results after HoLEP in BPH patients showed excellent efficacy and low complication rates. Unlike previous reports, the incidence of SUI and UUI after HoLEP was low, but the occurrence of de novo stone formation in prostatic fossa was notable.

This study was conducted to determine the effect of traffic stress by soil compaction on zoysiagrass by analyzing the aerial and underground parts and hyperspectral analysis. Zoysiagrass plants were subjected to a compaction strength gradient from 35 to 80 kgf/cm2 to confirm the compaction resistance and recoverable limit and measure the physiological change during stress. Changes in leaf color, photosynthesis, and hyperspectral reflectance due to continuous weak and strong traffic stress were measured, and vegetation indices were evaluated for the critical traffic stress injury assessment. As a result, the stem of the zoysiagrass was severely damaged up to 70 kgf/cm2 based on soil hardness. The recoverable limit strength of soil compaction was 55 kgf/cm2 under weak response pressure conditions. Collectively, our results show that the damage of weak compaction strength on the zoysiagrass was quickly recovered after the stop of traffic stress, especially since the growth of the underground part was increased by weak traffic stress. However, if the compaction strength above 65 kgf/cm2 lasted for a long time, the growth of the underground part is limited by lowering the energy supply for the recovery occurred, in turn, the recovery occurred slowly after the compaction was stopped. Among the vegetation indices obtained from hyperspectral data, pigment specific simple ratio for chlorophyll a (PSSRa), pigment specific simple ratio for chlorophyll b (PSSRb), and pigment specific simple ratio for carotenoids (PSSRc) were effective in evaluating the damage of traffic stress.

Objective. The TOol for PArticle Simulation (TOPAS) is a Geant4-based Monte Carlo software application that has been used for both research and clinical studies in medical physics. So far, most users of TOPAS have focused on radiotherapy-related studies, such as modeling radiation therapy delivery systems or patient dose calculation. Here, we present the first set of TOPAS extensions to make it easier for TOPAS users to model medical imaging systems.Approach. We used the extension system of TOPAS to implement pre-built, user-configurable geometry components such as detectors (e.g. flat-panel and multi-planar detectors) for various imaging modalities and pre-built, user-configurable scorers for medical imaging systems (e.g. digitizer chain).Main results. We developed a flexible set of extensions that can be adapted to solve research questions for a variety of imaging modalities. We then utilized these extensions to model specific examples of cone-beam CT (CBCT), positron emission tomography (PET), and prompt gamma (PG) systems. The first of these new geometry components, the FlatImager, was used to model example CBCT and PG systems. Detected signals were accumulated in each detector pixel to obtain the intensity of x-rays penetrating objects or prompt gammas from proton-nuclear interaction. The second of these new geometry components, the RingImager, was used to model an example PET system. Positron-electron annihilation signals were recorded in crystals of the RingImager and coincidences were detected. The simulated data were processed using corresponding post-processing algorithms for each modality and obtained results in good agreement with the expected true signals or experimental measurement.Significance. The newly developed extension is a first step to making it easier for TOPAS users to build and simulate medical imaging systems. Together with existing TOPAS tools, this extension can help integrate medical imaging systems with radiotherapy simulations for image-guided radiotherapy.

In this paper, we propose a new method for three-dimensional (3D) visualization that proportionally estimates the number of photons in the background and the object under photon-starved conditions. Photon-counting integral imaging is one of the techniques for 3D image visualization under photon-starved conditions. However, conventional photon-counting integral imaging has the problem that a random noise is generated in the background of the image by estimating the same number of photons in entire areas of images. On the other hand, our proposed method reduces the random noise by estimating the proportional number of photons in the background and the object. In addition, the spatial overlaps have been applied to the space where photons overlap to obtain the enhanced 3D images. To demonstrate the feasibility of our proposed method, we conducted optical experiments and calculated the performance metrics such as normalized cross-correlation, peak signal-to-noise ratio (PSNR), and structural similarity index measure (SSIM). For SSIM of 3D visualization results by our proposed method and conventional method, our proposed method achieves about 3.42 times higher SSIM than conventional method. Therefore, our proposed method can obtain better 3D visualization of objects than conventional photon-counting integral imaging methods under photon-starved conditions.

The widespread resistance of enterococci to many commonly used antimicrobial agents is a growing concern. Given that the current treatment options for enterococcal infections are limited, the discovery of new therapies, including combination therapies, is necessary. We evaluated double-drug combinations of lefamulin with doxycycline, rifampin, and quinupristin/dalfopristin for in vitro synergy against strains of Enterococcus faecium (E. faecium) and Enterococcus faecalis (E. faecalis) by using checkerboard and time-kill assays. In the checkerboard assay, the synergistic effect of lefamulin with doxycycline and rifampin was observed in 29 (85.3%) and 33 (97.1%) of the 34 different E. faecium strains tested, respectively. These combinations also showed synergistic effects against 17 (94.4%) of the 18 different vancomycin-resistant E. faecium strains. Among the 33 different E. faecalis strains, the combination of lefamulin with doxycycline, quinupristin/dalfopristin, and rifampin displayed synergistic effects in 31 (93.9%), 26 (78.8%), and 20 (60.6%) strains, respectively. No antagonism was observed in any of the combinations. The time-kill assay confirmed the synergistic effects of all these combinations. These synergistic combinations exhibited bacteriostatic activity. Although lefamulin is not currently used to treat enterococcal infections, we suggest that these combinations may serve as alternative drug regimens.