Complementary Modalities Research Articles

Clinical, Pathologic, and Imaging Variables Associated with Prostate Cancer Detection by PSMA PET/CT and Multiparametric MRI.

Multiparametric MRI (mpMRI) and prostate-specific membrane antigen (PSMA) PET/CT are complementary imaging modalities used in the presurgical evaluation of patients with prostate cancer (PCa). The purpose of this study was to characterize clinically significant PCa (csPCa) detected and not detected by PSMA PET/CT and mpMRI, focusing on tumors detected solely by PSMA PET/CT and overlooked by mpMRI. Methods: We conducted a single-center, retrospective analysis of patients who underwent both PSMA PET/CT and mpMRI within 3 mo of each other and before radical prostatectomy. Two nuclear medicine physicians and 2 radiologists, in a masked manner, independently contoured PCa lesions on PSMA PET/CT and mpMRI, respectively. A consensus read was done with a third reader for each modality, and a majority rule was applied (2:1). After centralized imaging, a pathologic review was done by a genitourinary pathologist. We assessed agreement between imaging modalities and correlation with pathology. Logistic regression models explored associations between clinicopathologic variables and tumor detection on imaging. Results: In total, 132 csPCa tumors from 100 patients were identified on surgical pathology. PSMA PET/CT showed higher lesion-level (87% vs. 80%) and patient-level (98% vs. 94%) sensitivity than mpMRI. Tumors detected on both imaging modalities were larger and had higher grade groups than those not detected by one or both imaging modalities. On multivariable analysis, csPCa tumors undetected by mpMRI but detected by PSMA PET/CT were smaller than those detected by both modalities. Most tumors showing aggressive pathologic features, such as the large cribriform pattern (94.7%) and the intraductal carcinoma (96%), were correctly detected by both imaging modalities. Limitations included selection bias in a surgical cohort. Conclusion: PSMA PET/CT tends to detect smaller csPCa not detected by mpMRI. Larger tumors on pathology with higher grade groups are more likely to be correctly detected by both imaging modalities. These findings provide insights for refining presurgical evaluation strategies in PCa.

Natural Language Generation for Visualizations: State of the Art, Challenges and Future Directions

AbstractNatural language and visualization are two complementary modalities of human communication that play a crucial role in conveying information effectively. While visualizations help people discover trends, patterns and anomalies in data, natural language descriptions help explain these insights. Thus, combining text with visualizations is a prevalent technique for effectively delivering the core message of the data. Given the rise of natural language generation (NLG), there is a growing interest in automatically creating natural language descriptions for visualizations, which can be used as chart captions, answering questions about charts or telling data‐driven stories. In this survey, we systematically review the state of the art on NLG for visualizations and introduce a taxonomy of the problem. The NLG tasks fall within the domain of natural language interfaces (NLIs) for visualization, an area that has garnered significant attention from both the research community and industry. To narrow down the scope of the survey, we primarily concentrate on the research works that focus on text generation for visualizations. To characterize the NLG problem and the design space of proposed solutions, we pose five Wh‐questions, why and how NLG tasks are performed for visualizations, what the task inputs and outputs are, as well as where and when the generated texts are integrated with visualizations. We categorize the solutions used in the surveyed papers based on these ‘five Wh‐questions’. Finally, we discuss the key challenges and potential avenues for future research in this domain.

IDEEA: information diffusion model for integrating gene expression and EEG data in identifying Alzheimer’s disease markers

Abstract Understanding the genetic components of Alzheimer’s disease (AD) via transcriptome analysis often necessitates the use of invasive methods. This work focuses on overcoming the difficulties associated with the invasive process of collecting brain tissue samples in order to measure and investigate the transcriptome behavior of AD. Our approach called IDEEA (Information Diffusion model for integrating gene Expression and EEG data in identifying Alzheimer’s disease markers) involves systematically linking two different but complementary modalities: transcriptomics and EEG data. We preprocess these two data types by calculating the spectral and transcriptional sample distances, over 11 brain regions encompassing 6 distinct frequency bands. Subsequently, we employ a genetic algorithm approach to integrate the distinct features of the preprocessed data. Our experimental results show that
IDEEA converges rapidly to local optima gene subsets, in fewer than 250 iterations. Our algorithm identifies novel genes along with genes that have previously been linked to AD. It is also capable of detecting genes with transcription patterns specific to individual EEG bands as well as those with common patterns among bands. In particular, the alpha2 (10-13 Hz) frequency band yielded 8 AD associated genes out of the top 100 most frequently selected genes by our algorithm, with a p-value of
0.05. Our method not only identifies AD-related genes but also genes that interact with AD genes in terms of transcription regulation. We evaluated various aspects of our approach, including the genetic algorithm performance, band-pair association and gene interaction topology. Our approach reveals AD-relevant genes with transcription patterns inferred from EEG alone, across various frequency bands, avoiding the risky brain tissue collection process. This is a significant advancement toward the early identification of AD using non-invasive EEG recordings.

Homoeopathy vs. conventional primary care in children during the first 24 months of life—a pragmatic randomised controlled trial

To compare the difference between primary homoeopathic and conventional paediatric care in treating acute illnesses in children in their first 24 months of life. One hundred eight Indian singleton newborns delivered at 37 to 42 weeks gestation were randomised at birth (1:1) to receive either homoeopathic or conventional primary care for any acute illness over the study period. In the homoeopathic group, conventional medical treatment was added when medically indicated. Clinicians and parents were unblinded. Children in the homoeopathic group experienced significantly fewer sick days than those in the conventional group (RR: 0.37, 95% CI: 0.24–0.58; p < 0.001), with correspondingly fewer sickness episodes (RR: 0.53, 95% CI: 0.32–0.87; p = .013), as well as fewer respiratory illnesses over the 24-month period. They were taller (F (1, 97) = 8.92, p = .004, partial eta squared = 0.84) but not heavier than their conventionally treated counterparts. They required fewer antibiotics, and their treatment cost was lower.Conclusion: Homoeopathy, using conventional medicine as a safety backdrop, was more effective than conventional treatment in preventing sick days, sickness episodes, and respiratory illnesses in the first 24 months of life. It necessitated fewer antibiotics and its overall cost was lower. This study supports homoeopathy, using conventional medicine as a safety backdrop, as a safe and cost-effective primary care modality during the first 2 years of life.Trial registration: Clinical Trial Registry-India (2018/09/015641). https://ctri.nic.in/Clinicaltrials/login.phpWhat is Known:• Due to their holistic nature, many Complementary and Alternative Medical (CAM) modalities are not readily amenable to assessment by head-to-head RCT for a given Indication.• We propose a pragmatic, RCT comparing homoeopathic with conventional medicine as a system.What is New:• Homoeopathic was apparently superior to conventional primary care in preventing sick days, sickness episodes, and respiratory illness episodes and was significantly associated with growth in height but not weight and required fewer antibiotics in children from birth to 24 months of age.

Multimodal investigation of dynamic brain network alterations in autism spectrum disorder: Linking connectivity dynamics to symptoms and developmental trajectories

BackgroundAutism spectrum disorder (ASD) has been associated with disrupted brain connectivity, yet a comprehensive understanding of the dynamic neural underpinnings remains lacking. This study employed concurrent electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS) techniques to investigate dynamic functional connectivity (dFC) patterns and neurovascular characteristics in children with ASD. We also explored associations between neurovascular characteristics and the developmental trajectory of adaptive behavior in individuals with ASD. MethodsResting-state EEG and fNIRS data were simultaneously recorded from 58 ASD and 63 TD children. We implemented a k-means clustering approach to extract the dFC states for each modality. In addition, a multimodal covariance network (MCN) was constructed from the EEG and fNIRS dFC features to capture the neurovascular characteristics linked to ASD. ResultsEEG analyses revealed atypical properties of dFC states in the beta and gamma bands in children with ASD compared to TD children. For fNIRS, the ASD group exhibited atypical properties of dFC states such as duration and transitions relative to the TD group. The MCN analysis revealed significantly suppressed functional covariance between right superior temporal and left Broca's areas, alongside enhanced right dorsolateral prefrontal-left Broca covariance in ASD. Notably, we found that early neurovascular characteristics can predict the developmental progress of adaptive functioning in ASD. ConclusionThe multimodal investigation revealed distinct dFC patterns and neurovascular characteristics associated with ASD, elucidating potential neural mechanisms underlying core symptoms and their developmental trajectories. Our study highlights that integrating complementary neuroimaging modalities may aid in unraveling the complex neurobiology of ASD.

The Microneedle Revolution: Transforming Vitiligo Treatment Landscapes-A Comprehensive Review of the Literature.

Vitiligo is characterized by the emergence of depigmented patches on the skin, posing significant therapeutic challenges. Microneedling, a novel treatment strategy, capitalizes on its potential to invigorate skin regeneration and facilitate melanocyte migration. This review critically evaluates the efficacy, safety, and patient satisfaction associated with microneedling for vitiligo treatment, juxtaposing it with traditional therapies to elucidate its viability as either a standalone or complementary treatment modality. A comprehensive literature review was conducted across major databases, including PubMed and Cochrane Library, using keywords like "microneedling" and "vitiligo," encompassing studies up to January 2024. This review focused on microneedling's effectiveness, safety, and patient satisfaction, including both solo and combined treatments. Data synthesis emphasized repigmentation rates, side effects, and patient feedback. An exhaustive review of studies pertaining to microneedling for vitiligo, especially focusing on outcomes when administered alone or in conjunction with agents such as tacrolimus and 5-fluorouracil, was undertaken. Key evaluation metrics included repigmentation success rates, adverse effects, and patient-reported outcomes. Microneedling demonstrates a favourable safety profile, with mild and manageable side effects such as pain, erythema, and temporary hyperpigmentation. Severe adverse events are rare, further supporting its safety as a treatment option for vitiligo. The evidence amassed suggests that microneedling significantly augments repigmentation rates, particularly in synergy with topical treatments. It is generally well-tolerated, manifests minimal adverse effects, and has garnered high patient satisfaction levels. Nonetheless, the absence of standardized treatment protocols and paucity of long-term efficacy data underscore the imperative for further empirical inquiry. Microneedling emerges as a propitious treatment alternative for vitiligo, demonstrating both safety and efficacy, notably when used in tandem with topical agents. Future investigations should aim at protocol standardization and long-term efficacy evaluation to firmly establish its therapeutic stature within vitiligo management paradigms.

Fish behavior recognition based on an audio-visual multimodal interactive fusion network

In light of the challenges imposed by fish behavior recognition, which arise from environmental noise and dim lighting in aquaculture environments and adversely affect the effectiveness of unimodal recognition methods based on either sound or visual cues, this paper proposes a fish behavior recognition model, Mul-SEResNet50, based on the fusion of audio and visual information. To address issues such as image blurring and indistinct sounds in aquaculture environments, which hinder the effectiveness of multimodal fusion and complementary modalities, a multimodal interaction fusion (MIF) module is introduced. This module integrates audio-visual modalities at multiple stages to achieve a more comprehensive joint feature representation. To enhance complementarity during the fusion process, we designed a U-shaped bilinear fusion structure to fully utilize multimodal information, capture cross-modal associations, and extract high-level features. Furthermore, to address the potential loss of key features, a temporal aggregation and pooling (TAP) layer is introduced to preserve more fine-grained features by extracting both the maximum and average values within pooling regions. To validate the effectiveness of the proposed model, both ablation experiments and comparative experiments are conducted. The results demonstrate that Mul-SEResNet50 achieves a 5.04 % accuracy improvement over SEResNet50 without sacrificing detection speed. Compared to the state-of-the-art U-FusionNet-ResNet50 +SENet model, Mul-SEResNet50 achieves accuracy and F1 score improvements of 0.47 % and 1.32 %, respectively. These findings confirm the efficacy of the proposed model in terms of accurately recognizing fish behavior, facilitating the precise monitoring of fish behavior.

Non-Invasive Bio-Impedance Imaging and Sensing for Medical Diagnostics and Industrial Applications

Bio-impedance-based imaging technique stands at the intersection of medical/industrial imaging techniques and is also known as electrical impedance tomography (EIT), imparting a non-invasive, value-powerful approach for imaging biological tissues and procedures. We begin by elucidating the essential standards underlying EIT, focusing on the size of impedance variations inside an object (plastic pipe) to reconstruct its inner conductivity distribution. Subsequently, we delve into the numerous programs of EIT across numerous fields and discuss recent experimental strategies and advancements aimed at mitigating these boundaries, such as novel electrode configurations, advanced reconstruction algorithms, and incorporation of complementary imaging modalities. Finally, we underscore the importance of experimental research in advancing the capabilities and packages of EIT as a valuable device in industrial monitoring, specifically in bedside tracking, process pipelines, tank monitoring and also used for other medical or industrial detection, even as additionally exploring its rising roles in commercial and environmental applications.

Cupping Therapy for the Treatment of Migraine Headache: a systematic review and meta-analysis of clinical trials.

Cupping therapy is a widely used complementary medicine for the treatment of migraine headaches globally. However, conflicting evidence exists on its effectiveness. To evaluate the safety and efficacy of cupping therapy in treating migraine headache disorder. Seven databases were systematically searched PubMed/MEDLINE, Clinicaltrials.gov, Cochrane CENTRAL, ScienceDirect, ProQuest, SinoMed, and the National Science and Technology Library. The primary endpoints are the treatment success and the pain intensity reduction. The secondary endpoints were adverse events (AEs) risk and improvement in quality of life (QoL), which was based on the Migraine Disability Scale (MIDAS). Subgroup analyses were performed based on the cupping techniques (wet and dry cupping) and adjunctive complementary treatments (i.e. acupuncture and/or collateral pricking). Eighteen trials out of 348 records were included, pooling 1,446 participants (n = 797 received cupping therapy). Treatment success was significantly higher among those with cupping therapy (risk ratio [RR] [95% CI] = 1.83 [1.52-2.21]); with significant improvement observed only with wet cupping (RR [95% CI] = 1.88 [1.53-2.30]). The adjunctive complementary therapy did not achieve a greater amplitude of treatment success compared to cupping therapy alone. Furthermore, cupping therapy showed significant pain reduction compared to baseline (standardized mean difference [SMD] [95% CI] = 0.55 [0.39-0.70]) and achieved fewer risks of AEs (RR [95% CI] = 1.88 [1.53-2.30]). However, cupping did not improve the overall QoL (MIDAS SMD [95% CI] = -0.79 [-3.55-1.98]). Cupping therapy was an effective complementary modality to treat migraine headaches. However, it did not demonstrate improvement in QoL (PROSPERO CRD42024514509).

Electrochemical impedance spectroscopy unmasks high-risk atherosclerotic features in human coronary artery disease.

Coronary plaque rupture remains the prominent mechanism of myocardial infarction. Accurate identification of rupture-prone plaque may improve clinical management. This study assessed the discriminatory performance of electrochemical impedance spectroscopy (EIS) in human cardiac explants to detect high-risk atherosclerotic features that portend rupture risk. In this single-center, prospective study, n = 26 cardiac explants were collected for EIS interrogation of the three major coronary arteries. Vessels in which advancement of the EIS catheter without iatrogenic plaque disruption was rendered impossible were not assessed. N = 61 vessels underwent EIS measurement and histological analyses. Plaques were dichotomized according to previously established high rupture-risk parameter thresholds. Diagnostic performance was determined via receiver operating characteristic areas-under-the-curve (AUC). Necrotic cores were identified in n = 19 vessels (median area 1.53 mm2) with a median fibrous cap thickness of 62 μm. Impedance was significantly greater in plaques with necrotic core area ≥1.75 mm2 versus <1.75 mm2 (19.8 ± 4.4 kΩ vs. 7.2 ± 1.0 kΩ, p = .019), fibrous cap thickness ≤65 μm versus >65 μm (19.1 ± 3.5 kΩ vs. 6.5 ± 0.9 kΩ, p = .004), and ≥20 macrophages per 0.3 mm-diameter high-power field (HPF) versus <20 macrophages per HPF (19.8 ± 4.1 kΩ vs. 10.2 ± 0.9 kΩ, p = .002). Impedance identified necrotic core area ≥1.75 mm2, fibrous cap thickness ≤65 μm, and ≥20 macrophages per HPF with AUCs of 0.889 (95% CI: 0.716-1.000) (p = .013), 0.852 (0.646-1.000) (p = .025), and 0.835 (0.577-1.000) (p = .028), respectively. Further, phase delay discriminated severe stenosis (≥70%) with an AUC of 0.767 (0.573-0.962) (p = .035). EIS discriminates high-risk atherosclerotic features that portend plaque rupture in human coronary artery disease and may serve as a complementary modality for angiography-guided atherosclerosis evaluation.

Identifying genetic variants associated with chromatin looping and genome function

Here we present a comprehensive HiChIP dataset on naïve CD4 T cells (nCD4) from 30 donors and identify QTLs that associate with genotype-dependent and/or allele-specific variation of HiChIP contacts defining loops between active regulatory regions (iQTLs). We observe a substantial overlap between iQTLs and previously defined eQTLs and histone QTLs, and an enrichment for fine-mapped QTLs and GWAS variants. Furthermore, we describe a distinct subset of nCD4 iQTLs, for which the significant variation of chromatin contacts in nCD4 are translated into significant eQTL trends in CD4 T cell memory subsets. Finally, we define connectivity-QTLs as iQTLs that are significantly associated with concordant genotype-dependent changes in chromatin contacts over a broad genomic region (e.g., GWAS SNP in the RNASET2 locus). Our results demonstrate the importance of chromatin contacts as a complementary modality for QTL mapping and their power in identifying previously uncharacterized QTLs linked to cell-specific gene expression and connectivity.

Multimodal registration network with multi-scale feature-crossing.

A critical piece of information for prostate intervention and cancer treatment is provided by the complementary medical imaging modalities of ultrasound (US) and magnetic resonance imaging (MRI). Therefore, MRI-US image fusion is often required during prostate examination to provide contrast-enhanced TRUS, in which image registration is a key step in multimodal image fusion. We propose a novel multi-scale feature-crossing network for the prostate MRI-US image registration task. We designed a feature-crossing module to enhance information flow in the hidden layer by integrating intermediate features between adjacent scales. Additionally, an attention block utilizing three-dimensional convolution interacts information between channels, improving the correlation between different modal features. We used 100 cases randomly selected from The Cancer Imaging Archive (TCIA) for our experiments. A fivefold cross-validation method was applied, dividing the dataset into five subsets. Four subsets were used for training, and one for testing, repeating this process five times to ensure each subset served as the test set once. We test and evaluate our technique using fivefold cross-validation. The cross-validation trials result in a median target registration error of 2.20 mm on landmark centroids and a median Dice of 0.87 on prostate glands, both of which were better than the baseline model. In addition, the standard deviation of the dice similarity coefficient is 0.06, which suggests that the model is stable. We propose a novel multi-scale feature-crossing network for the prostate MRI-US image registration task. A random selection of 100 cases from The Cancer Imaging Archive (TCIA) was used to test and evaluate our approach using fivefold cross-validation. The experimental results showed that our method improves the registration accuracy. After registration, MRI and TURS images were more similar in structure and morphology, and the location and morphology of cancer were more accurately reflected in the images.

Evaluating the Perceived Value of Holistic Certification Among Nurses: A Descriptive Survey Study.

Purpose: Specialty nursing certifications serve as a validation of nursing knowledge in specific areas. Holistic nursing emphasizes comprehensive patient care and incorporates complementary alternative modalities (CAM) into daily care. Despite its significance, limited research has evaluated the perceived value of holistic nursing certification among nurses. Study Design: Descriptive survey design. Methods: The Likert-scale survey Perceived Value of Certification (PVCT)-12 Tool was given to holistic certified and non-certified nurses at a large, academic Magnet hospital in the northeast United States from 10/2022 to 2/2023. Additionally, non-certified nurses were asked to select the top three barriers to certification from a list of nine. The responses between certified and non-certified nurses were compared using the Chi-square test, Fisher's exact test, or Student's t-test as appropriate. Findings: A total of 59 nurses (25 certified, 34 non-certified) met inclusion criteria. Ninety-six percent of certified nurses versus 64.7% of non-certified nurses agreed that certification demonstrates a commitment to the nursing profession, p = 0.004, but, otherwise, responses to the PVCT-12 Tool were similar. Both groups felt certification was more strongly associated with intrinsic factors (e.g., sense of accomplishment) than extrinsic factors (e.g., salary). Conclusion: Nurses were consistent in their perceived value of holistic certification, regardless of their certification status.

Turning to digital: Examining the relationship between offline healthcare barriers and U.S. older adults’ emotional well-being via online patient–provider communication and perceived quality of care (2017–2020)

PurposeTo examine the association between offline healthcare barriers and emotional well-being and assess the mediation roles of online patient–provider communication (OPPC) and perceived quality of care. This study also investigates the trends in offline healthcare barriers, OPPC, perceived quality of care, and emotional well-being over four years among the old population in the U.S. MethodsData from the Health Information National Trends Survey (HINTS) 5 Cycles 1, 2, and 4 were used. Mediation analysis and comparison analysis were employed. ResultsThe results indicated an increment in OPPC and a decline in patient’s perceived quality of care between 2017 and 2020. Across the three years, offline healthcare barriers were consistently negatively associated with emotional well-being, and perceived quality of care remained a mediator in such a relationship. Moreover, the serial mediating roles of OPPC and perceived quality of care between offline healthcare barriers and emotional well-being turned from statistically non-significant (2017) to significant (2018, 2020). ConclusionOur results witness the growing adoption of OPPC among older adults and the evolution of OPPC as a complementary communication modality. The findings can support interventions to augment OPPC utilization and enhance the perception of quality care of older adults, contributing to their increased emotional well-being.

How does the role of complementary and alternative medicine in general practice differ between countries? Interviews with doctors who have worked both in Germany and elsewhere in Europe

BackgroundAvailable data suggest that general practitioners (GPs) in Germany use complementary and alternative medicine (CAM) modalities more frequently than GPs in many other countries. We investigated the country differences perceived by general practitioners who have worked in Germany and in one of four other European countries with regard to the role of complementary and alternative treatments in primary care.MethodsIn this qualitative study we conducted semi-structured interviews with 12 GPs who had worked both in Germany and Italy, the Netherlands, Norway or the United Kingdom (UK; n = 3 for each of the four countries). Participants were asked how they perceived and experienced country differences regarding health system, relevance of CAM modalities, the role of evidence-based medicine (EBM) and science, and how they handle so-called indeterminate situations. For the analysis, we followed a thematic analysis approach according to Braun and Clarke with focus on themes that cover CAM.ResultsParticipants unanimously reported that they perceived CAM to be more relevant in general practice in Germany compared to the other countries. We identified four overarching themes in relation to the perceived reasons for these differences. Firstly, physicians with experiences in countries with a strong EBM and science orientation (Netherlands, Norway and the UK) considered the deeply ingrained view in national healthcare systems and GP communities that CAM modalities are not evidence-based as the main reason for the lower use of CAM by GPs. Secondly, extensive training of communication skills was cited as a reason that reduced the need for CAM in the Netherlands, Norway and the UK. Thirdly, differences in patient expectations and demands were perceived as a factor contributing to greater utilisation of CAM by German GPs compared to the other countries. Finally, country-specific reimbursement mechanisms were considered as a factor influencing the role of CAM in general practice.ConclusionsThe study results point to major differences between countries with regard to the role of CAM in GP care. Differences in basic attitudes in the discipline of general practice, patient expectations and system conditions appear to play an important role here.

EarSpeech: Exploring In-Ear Occlusion Effect on Earphones for Data-efficient Airborne Speech Enhancement

Earphones have become a popular voice input and interaction device. However, airborne speech is susceptible to ambient noise, making it necessary to improve the quality and intelligibility of speech on earphones in noisy conditions. As the dual-microphone structure (i.e., outer and in-ear microphones) has been widely adopted in earphones (especially ANC earphones), we design EarSpeech which exploits in-ear acoustic sensory as the complementary modality to enable airborne speech enhancement. The key idea of EarSpeech is that in-ear speech is less sensitive to ambient noise and exhibits a correlation with airborne speech. However, due to the occlusion effect, in-ear speech has limited bandwidth, making it challenging to directly correlate with full-band airborne speech. Therefore, we exploit the occlusion effect to carry out theoretical modeling and quantitative analysis of this cross-channel correlation and study how to leverage such cross-channel correlation for speech enhancement. Specifically, we design a series of methodologies including data augmentation, deep learning-based fusion, and noise mixture scheme, to improve the generalization, effectiveness, and robustness of EarSpeech, respectively. Lastly, we conduct real-world experiments to evaluate the performance of our system. Specifically, EarSpeech achieves an average improvement ratio of 27.23% and 13.92% in terms of PESQ and STOI, respectively, and significantly improves SI-SDR by 8.91 dB. Benefiting from data augmentation, EarSpeech can achieve comparable performance with a small-scale dataset that is 40 times less than the original dataset. In addition, we validate the generalization of different users, speech content, and language types, respectively, as well as robustness in the real world via comprehensive experiments. The audio demo of EarSpeech is available on https://github.com/EarSpeech/earspeech.github.io/.

Near-infrared photoimmunotherapy as a complementary modality to in situ vaccine in a preclinical pancreatic cancer model

Pancreatic cancer is one of the most refractory malignancies. In situ vaccines (ISV), in which intratumorally injected immunostimulatory adjuvants activate innate immunity at the tumor site, utilize tumor-derived patient-specific antigens, thereby allowing for the development of vaccines in patients themselves. Near-infrared photoimmunotherapy (NIR-PIT) is a novel therapy that selectively kills cancer cells exclusively in the NIR-irradiated region. Extending our previous research showing that ISV using the unique nanoparticulate Toll-like receptor 9 (TLR9) ligand K3-SPG induced effective antitumor immunity, here we incorporated NIR-PIT into K3-SPG-ISV so that local tumor destruction by NIR-PIT augments the antitumor effect of ISV. In the mouse model of pancreatic cancer, the combination of K3-SPG-ISV and CD44-targeting NIR-PIT showed synergistic systemic antitumor effects and enhanced anti-programmed cell death-1 (PD-1) blockade. Mechanistically, strong intratumoral upregulation of interferon-related genes and dependency on CD8+ T cells were observed, suggesting the possible role of interferon and cytotoxic T cell responses in the induction of antitumor immunity. Importantly, this combination induced immunological memory in therapeutic and neoadjuvant settings. This study represents the first attempt to integrate NIR-PIT with ISV, offering a promising new direction for cancer immunotherapy, particularly for pancreatic cancer.

Barriers and Facilitators to Integrating Acupuncture into the U.S. Health Care System: A Scoping Review.

Background: Acupuncture is a widely practiced complementary and integrative health modality that has multiple clinical applications. The use of acupuncture in the United States is rapidly increasing. Although studies have shown the efficacy and effectiveness of acupuncture for various ailments, the integration of acupuncture into the U.S. health care system remains a challenge. Little is known about the factors affecting this integration. Objective: To provide a systematic review of the barriers and facilitators affecting the integration of acupuncture into the U.S. health care system. Methods: Four electronic databases were searched. Three independent reviewers were involved in the screening and data charting processes. Findings were synthesized and categorized into four levels based on the Social Ecological Model. Results: A total of 22 studies were included in the final review. The barriers and facilitators affecting the integration of acupuncture were mapped into four levels (individual, interpersonal, organizational, and policy). The most frequently reported barriers and facilitators were mapped into the Social Ecological Model constructs within the "Individual" level (i.e., beliefs and attitudes of acupuncture, and practical issues) and the "Organizational" level (i.e., credentialing, space and facility, referral system). Conclusion: This review has identified and synthesized the breadth of evidence on the barriers and facilitators to the integration of acupuncture into the U.S. health care system. Results of this review will guide future implementation studies to develop and test implementation strategies to integrate acupuncture into the U.S. health care system.

Herbal and Non-Herbal Dietary Supplements for Psychiatric Indications: Considerations in Liver Transplantation.

Traditional, complementary, and integrative medicine (TCIM) modalities are widely employed. However, TCIM, specifically herbal and non-herbal dietary supplements, can pose challenges in the context of organ transplantation. In this review, we discuss common supplements used for psychiatric purposes and highlight important considerations for candidates and recipients of liver transplants. Ashwagandha, kava kava, green tea extract, skullcap, turmeric, and valerian have known idiosyncratic hepatotoxic potential and may complicate the liver transplantation course. Multiple supplements reportedly carry a lower risk of hepatotoxicity, though evidence for widespread use in those at risk for or with hepatic impairment is limited. Psychiatrists caring for candidates and recipients of liver transplants must recognize that patients may find supplements helpful in alleviating psychiatric symptoms, despite an overall limited evidence base. Evaluating benefit versus risk ratios and reviewing drug-drug interactions is essential to promote transplant candidacy and mitigate the possibility of native or graft liver dysfunction.

Combining Cyproheptadine Hydrochloride With Targeted Muscle Activation Training to Treat Upper Extremity Stroke: A Randomized, Placebo-Controlled Trial

ObjectiveTo examine a treatment for upper extremity impairment in stroke survivors that combines administration of cyproheptadine hydrochloride with repetitive practice focused on control of muscle activation patterns. DesignDouble-blind, randomized controlled trial. SettingsLaboratory within a free-standing rehabilitation hospital. ParticipantsA total of 94 stroke survivors with severe, chronic hand impairment were randomly assigned to 1 of 4 treatment groups. InterventionsParticipants received either a placebo or cyproheptadine hydrochloride in identical pill form. The daily dosage of cyproheptadine/placebo was gradually increased from 8 to 24 mg/d over 3 weeks and then maintained over the next 6 weeks while participants completed 18 therapy sessions. Therapy consisted of either (1) active practice of muscle activation patterns to play “serious” computer games or control a custom hand exoskeleton or (2) passive, cyclical finger stretching imposed by the exoskeleton. Main Outcome MeasuresHand control was evaluated with the primary outcome measure of time to complete the Graded Wolf Motor Function Test (GWMFT) and secondary outcome measures including finger strength and spasticity. ResultsAcross the 88 participants who completed the study, a repeated-measures analysis of variance revealed a significant effect of GroupxEvaluation interaction on GWMFT (F=1.996, P=.026). The 3 groups receiving cyproheptadine and/or actively practicing muscle activation pattern control exhibited significant reduction in mean time to complete the GWMFT tasks; roughly one-third of these participants experienced at least a 10% reduction in completion time. Gains were maintained at the 1-month follow-up evaluation. The group receiving placebo and passive stretching did not show improvement. No significant differences among groups were observed in terms of changes in strength or spasticity. ConclusionsDespite chronic, severe impairment, stroke survivors were able to complete the therapy focused on muscle activations and achieved statistically significant improvement in hand motor control. Cyproheptadine hydrochloride is a potential complementary treatment modality for stroke survivors with hand impairment.