Continuous Variables Research Articles

Continuous-variable quantum passive optical network

To establish a scalable and secure quantum network, a critical milestone is advancing from basic point-to-point quantum key distribution (QKD) systems to the development of inherently multi-user protocols designed to maximize network capacity. Here, we propose a quantum passive optical network (QPON) protocol based on continuous-variable (CV) systems, particularly the quadrature of the coherent state, which enables deterministic, simultaneous, and high-rate secret key generation among all network users. We implement two protocols with different trust levels assigned to the network users and experimentally demonstrate key generation in a quantum access network with 8 users, each with an 11 km span of access link. Depending on the trust assumptions about the users, we reach 1.5 and 2.1 Mbits/s of total network key generation (or 0.4 and 1.0 Mbits/s with finite-size channels estimation). Demonstrating the potential to expand the network’s capacity to accommodate tens of users at a high rate, our CV-QPON protocols open up new possibilities in establishing low-cost, high-rate, and scalable secure quantum access networks serving as a stepping stone towards a quantum internet.

Cerebral emboli detection and autonomous neuromonitoring using robotic transcranial Doppler with artificial intelligence for transcatheter aortic valve replacement with and without embolic protection devices: a pilot study

BackgroundPeriprocedural ischemic stroke remains a serious complication in patients undergoing transcatheter aortic valve replacement (TAVR). We used a novel robotic transcranial Doppler (TCD) system equipped with artificial intelligence (AI) for...

Association between Body Fat Percentage and Cardiometabolic Diseases in General Population.

The body fat percentage is an indicator of overall body fat related to metabolism and inflammation. Our study aims to analyze the association between body fat percentage and the risk of cardiometabolic diseases in the general population. This was a retrospectively cross-sectional study. A total of 5084 participants enrolled from the National Health and Nutrition Examination Survey cycle of 1999-2004 were divided into quartiles according to their body fat percent levels. The body fat percentage was measured from bioelectrical impedance analysis. A history of cardiometabolic diseases, including cardiovascular disease, hypertension and diabetes mellitus, was ascertained from questionnaire, physical or laboratory examination. The association between body fat percentage and cardiometabolic diseases was investigated using multivariate logistic regression. Compared with the lowest quartile of body fat percentage, the multivariate-adjusted odds ratio and 95% confidence interval of the highest quartile was 3.99 (1.58-10.88) for cardiovascular disease, 1.08 (1.04-1.13) for hypertension and 3.08 (1.89-5.11) for diabetes. Body fat percentage independently increased the risk of cardiometabolic diseases as a continuous variable. Higher body fat percentage level was associated with a higher likelihood of cardiometabolic diseases, which could be a powerful predictive factor.

The Prevalence of Tobacco Product Use Among Students in the Faculty of Medicine at Pamukkale University and Their Views on the Smoke-Free Campus Implementation.

Tobacco use is an important risk factor for more than 20 types of cancer, especially cardiovascular and respiratory diseases, and many other health problems. Cigarettes are one of the most commonly used tobacco products in the world, and they can cause both physical and mental addiction. Adolescence is known to be the highest-risk period in terms of addiction among all age groups. As a result, smoke-free campus practices have become even more important in universities. This study investigates the prevalence of smoking among Pamukkale Medical School students and their views and behaviors regarding smoke-free campus practices. This cross-sectional study was conducted with 548 medical students at Pamukkale Universıty Faculty of Medicine during the academic year 2021-2022, between April 1-29, 2022. A face-to-face interview was conducted. Students' smoking status and their views about a smoke-free campus were assessed. In the questionnaire, the independent variables were socio-demographic characteristics, duration of staying in a smoke-free environment, smoking status in the place of residence, areas where smoking is most common, Fagerström nicotine dependence level, knowledge about smoke-free campus applications and campuses with the smokefree application. The Statistical Package for the Social Sciences version 21.0 package program was used to analyze the data. Descriptive statistics are presented with numbers and percentages for categorical variables, while the arithmetic mean and standard deviation are used for continuous variables. The chi-square test was used to compare categorical variables,and the Kolmogorov-Smirnov analysis was used to test the compatibility of data to normal distribution. The student smoking rate increased significantly as the number of semesters increased (P = .021). The smoking rate of male students was higher than that of female students (P = .001). The smoking rate of students living with their family or relatives was lower (P = .020). Smokers (14.7%) were more likely to have heard about the introduction of smoke-free zones on campus than nonsmokers (11%) (P = .280). 81.4% of students affirmed the statement, "The number of smoke-free rooms should be increased," and 84.3% responded, "I support the existence of smoke-free spaces." Nonsmoking students (90.8%) are more likely to agree that smoke-free spaces should be increased than those who smoke (57.7%) (P < .001). Among the students, 17.6% of nonsmokers and 37.8% of smokers find the information about smoke-free spaces sufficient (P < .001). The rate of those who consider smoke-free space inspections to be sufficient is lower for nonsmoking students than for nonsmokers (P = .017). Nonsmokers (89.5%) support the existence of smoke-free spaces to a higher degree than smokers (71.2%) (P < .001). One-third of Pamukkale University Faculty of Medicine students smoke, and smoking rates are higher among men and those who do not live with family or relatives. All participants strongly support the existence of smoke-free zones (84.3%), while a proportion of tobacco users (31.4%) support the implementation of a smoke-free campus. Student opinions of the smoke-free zones and the smoke-free campus application are more positive among nonsmokers than smokers.

Fault-Tolerant Quantum Computation by Hybrid Qubits with Bosonic Cat Code and Single Photons

Hybridizing different degrees of freedom or physical platforms potentially offers various advantages in building scalable quantum architectures. Here, we introduce a fault-tolerant hybrid quantum computation by building on the advantages of both discrete-variable (DV) and continuous-variable (CV) systems. In particular, we define a CV-DV hybrid qubit with a bosonic cat code and a single photon, which is implementable in current photonic platforms. Due to the cat code encoded in the CV part, the predominant loss errors are readily correctable without multiqubit encoding, while the logical basis is inherently orthogonal due to the DV part. We design fault-tolerant architectures by concatenating hybrid qubits and an outer DV quantum error-correction code such as a topological code, exploring their potential merit in developing scalable quantum computation. We demonstrate by numerical simulations that our scheme is at least an order of magnitude more resource efficient compared to all previous proposals in photonic platforms, allowing us to achieve a record-high loss threshold among existing CV and hybrid approaches. We discuss the realization of our approach not only in all-photonic platforms but also in other hybrid platforms including superconducting and trapped-ion systems, which allows us to find various efficient routes toward fault-tolerant quantum computing. Published by the American Physical Society 2024

Assessment of Clinical Reasoning in Undergraduate Medical Education: A Pragmatic Approach to Programmatic Assessment.

Clinical reasoning, a complex construct integral to the practice of medicine, has been challenging to define, teach, and assess. Programmatic assessment purports to overcome validity limitations of judgments made from individual assessments through proportionality and triangulation processes. This study explored a pragmatic approach to the programmatic assessment of clinical reasoning. The study analyzed data from 2 student cohorts from the University of Utah School of Medicine (UUSOM) (n = 113 in cohort 1 and 119 in cohort 2) and 1 cohort from the University of Colorado School of Medicine (CUSOM) using assessment data that spanned from 2017 to 2021 (n = 199). The study methods included the following: (1) asking faculty judges to categorize student clinical reasoning skills, (2) selecting institution-specific assessment data conceptually aligned with clinical reasoning, (3) calculating correlations between assessment data and faculty judgments, and (4) developing regression models between assessment data and faculty judgments. Faculty judgments of student clinical reasoning skills were converted to a continuous variable of clinical reasoning struggles, with mean (SD) ratings of 2.93 (0.27) for the 232 UUSOM students and 2.96 (0.17) for the 199 CUSOM students. A total of 67 and 32 discrete assessment variables were included from the UUSOM and CUSOM, respectively. Pearson r correlations were moderate to strong between many individual and composite assessment variables and faculty judgments. Regression models demonstrated an overall adjusted R2 (standard error of the estimate) of 0.50 (0.19) for UUSOM cohort 1, 0.28 (0.15) for UUSOM cohort 2, and 0.30 (0.14) for CUSOM. This study represents an early pragmatic exploration of regression analysis as a potential tool for operationalizing the proportionality and triangulation principles of programmatic assessment. The study found that programmatic assessment may be a useful framework for longitudinal assessment of complicated constructs, such as clinical reasoning.

Joint inference of discrete cell types and continuous type-specific variability in single-cell datasets with MMIDAS.

Reproducible definition and identification of cell types is essential to enable investigations into their biological function, and understanding their relevance in the context of development, disease and evolution. Current approaches model variability in data as continuous latent factors, followed by clustering as a separate step, or immediately apply clustering on the data. We show that such approaches can suffer from qualitative mistakes in identifying cell types robustly, particularly when the number of such cell types is in the hundreds or even thousands. Here, we propose an unsupervised method, MMIDAS, which combines a generalized mixture model with a multi-armed deep neural network, to jointly infer the discrete type and continuous type-specific variability. Using four recent datasets of brain cells spanning different technologies, species, and conditions, we demonstrate that MMIDAS can identify reproducible cell types and infer cell type-dependent continuous variability in both uni-modal and multi-modal datasets.

Improved composable key rates for CV-QKD

Modern security proofs of quantum key distribution (QKD) must take finite-size effects and composable aspects into consideration. This is also the case for continuous-variable (CV) protocols, which are based on the transmission and detection of bosonic coherent states. In this paper, we refine and advance the previous theory in this area providing a more rigorous formulation for the composable key rate of a generic CV-QKD protocol. Thanks to these theoretical refinements, our general formulas allow us to prove more optimistic key rates with respect to previous literature. Published by the American Physical Society 2024

Analog quantum simulation of partial differential equations

Quantum simulators were originally proposed for simulating one partial differential equation (PDE) in particular—Schrödinger’s equation. Can quantum simulators also efficiently simulate other PDEs? While most computational methods for PDEs—both classical and quantum—are digital (they must be discretised first), PDEs have continuous degrees of freedom. This suggests that an analog representation can be more natural. While digital quantum degrees of freedom are usually described by qubits, the analog or continuous quantum degrees of freedom can be captured by qumodes. Based on a method called Schrödingerisation, we show how to directly map D-dimensional linear PDEs onto a (D+1) -qumode quantum system where analog or continuous-variable (CV) Hamiltonian simulation on D + 1 qumodes can be used. This very simple methodology does not require one to discretise PDEs first, and it is not only applicable to linear PDEs but also to some nonlinear PDEs and systems of nonlinear ordinary differential equations. We show some examples using this method, including the Liouville equation, heat equation, Fokker–Planck equation, Black–Scholes equations, wave equation and Maxwell’s equations. We also devise new protocols for linear PDEs with random coefficients, important in uncertainty quantification, where it is clear how the analog or CV framework is most natural. This also raises the possibility that some PDEs may be simulated directly on analog quantum systems by using Hamiltonians natural for those quantum systems.

Association of carotid endarterectomy at low-volume centers with higher likelihood of major complications and nonroutine discharge.

Carotid artery stenosis (CAS) is associated with an annual stroke risk of 2%-5%, and revascularization with carotid endarterectomy (CEA) can reduce this risk. While studies have demonstrated that hospital CEA volume is associated with mortality and myocardial infarction, CEA volume cutoffs in studies are relatively arbitrary, and no specific analyses on broad complications and discharge disposition have been performed. In this study, the authors systematically set out to identify a cutoff at which CEA procedural volume was significantly associated with major complications and nonroutine discharge. Asymptomatic and symptomatic CAS patients undergoing CEA were retrospectively identified in the Nationwide Readmissions Database (2010-2018). The association of CEA volume with outcomes was explored as a continuous variable using locally estimated scatterplot smoothing. The identified volume cutoff was used to generate dichotomous volume cohorts, and multivariate analyses of patient and hospital characteristics were conducted to evaluate the association of CEA volume with major complications and discharge disposition. Between 2010 and 2018, 308,933 asymptomatic and 32,877 symptomatic patients underwent CEA. Analysis of CEA volume with outcomes as a continuous variable demonstrated that an increase in volume was associated with a lower risk until a volume of approximately 7 cases per year (20th percentile). A total of 6702 (2.2%) asymptomatic and 1040 (3.2%) symptomatic patients were treated at the bottom 20% of hospital procedure volume. Increased rates of complications were seen at low-volume centers among asymptomatic (3.66% vs 2.77%) and symptomatic (7.4% vs 6.87%) patients. Asymptomatic patients treated at low-volume centers had an increased likelihood of major complications (OR 1.26, 95% CI 1.07-1.49; p = 0.007) and nonroutine discharge (OR 1.36, 95% CI 1.24-1.50; p < 0.0001). Symptomatic patients treated at low-volume centers were also more likely to experience major complications (OR 1.47, 95% CI 1.07-2.02; p = 0.02) and nonroutine discharge (OR 1.26, 95% CI 1.07-1.47; p = 0.005). Mortality rates were similar between low- and high-volume hospitals among asymptomatic (0.36% and 0.32%, respectively) and symptomatic (1.06% and 1.49%, respectively) patients, while volume was not significantly associated with mortality among asymptomatic (OR 1.06, 95% CI 0.67-1.65; p = 0.81) and symptomatic (OR 0.81, 95% CI 0.43-1.54; p = 0.52) patients in multivariate analysis. CEA patients, asymptomatic or symptomatic, are at a higher risk of major complications and nonroutine discharge at low-volume centers. Analysis of CEA as a continuous variable demonstrated a cutoff at 7 cases per year, and further study may identify factors associated with improved outcome at the lowest-volume centers.

Attenuation of ventriculomegaly and iron overload after intraventricular hemorrhage by membrane attack complex inhibition.

The pathophysiology of posthemorrhagic hydrocephalus (PHH) is not well understood, but recent data suggest blood components play a significant role. This study aimed to understand the timing of membrane attack complex (MAC) activation after intraventricular hemorrhage (IVH) and the effect of MAC inhibition on PHH development. This study was composed of four parts. First, 24 young adult male rats underwent stereotactic intraventricular injection of autologous blood or saline and MRI on day 1, 3, or 7 after hemorrhage. Second, 18 rats underwent intraventricular injection of saline, autologous blood with aurin tricarboxylic acid (ATA) in vehicle, or autologous blood with vehicle and underwent serial MRI studies on days 1 and 3 after hemorrhage. Third, 12 rats underwent intraventricular injections as above and MRI 2 hours after hemorrhage. Finally, 24 rats underwent the intraventricular injections as above, as well as serial MRI studies on days 1, 7, 14, and 28 after hemorrhage. The MR images were used to calculate ventricular volume and iron deposition. Open field testing was performed to assess functional outcomes. Outcomes on day 28 were reported as a ratio to the animal's baseline values and normalized via log-transformation. Statistical analysis included the Shapiro-Wilk tests for normality and t-tests and 1-way analysis of variance for 2 and 3 groups of continuous variables, respectively. MAC was found within the hematoma 1 day after hemorrhage and persisted until day 7. Administration of ATA resulted in similar intraventricular hematoma volumes compared to vehicle 2 hours after hemorrhage. At 1 and 3 days after hemorrhage, ATA administration resulted in significantly smaller ventricular volumes and less hemolysis within the hematoma than in the vehicle animals. Administration of ATA also resulted in significantly smaller ventriculomegaly and less iron deposition in the periventricular area than in the vehicle rats 28 days after hemorrhage. Functionally, ATA rats were significantly faster, traveled longer distances, and spent less time resting than vehicle rats at 28 days. MAC was activated early and persisted within the hematoma until day 7 after IVH. MAC inhibition attenuated hemolysis in the clot and ventriculomegaly acutely after IVH. One month after hemorrhage, MAC inhibition attenuated ventriculomegaly and iron accumulation and improved functional outcomes.

Feasibility of Weight-based Tube Voltage and Iodine Delivery Rate for Coronary Artery CT Angiography.

The objective of this study was to evaluate the feasibility of weight-based tube voltage and iodine delivery rate (IDR) for coronary artery CT angiography (CCTA). A total of 193 patients (mean age: 58 ± 12 years) with suspected coronary heart disease indicated for CCTA between May and October 2022 were prospectively enrolled. The subjects were divided into five groups according to body weight: < 60 kg, 60 - 69 kg, 70 - 79 kg, 80 - 89 kg, and ≥ 90 kg. The tube voltage and IDR settings of each group were as follows: 70 kVp/0.8 gI/s, 80 kVp/1.0 gI/s, 80 kVp/1.1 gI/s, 100 kVp/1.5 gI/s, and 100 kVp/1.5 gI/s, respectively. Objective image quality data included the CT value and standard deviation (noise) of the aortic root (AR), the proximal left anterior descending branch (LAD), and the distal right coronary artery (RCA), as well as the signal-to-noise ratio and contrast-to-noise ratio of the LAD and RCA. Subjective image quality assessment was performed based on the 18-segment model. Contrast and radiation doses, as well as effective dose (ED), were recorded. All continuous variables were compared using either the one-way ANOVA or the Kruskal-Wallis rank sum test. No significant differences were observed in all objective and subjective parameters of image quality between the groups (P > 0.05). However, significant differences in contrast and radiation doses were observed (P < 0.05). The contrast doses across the weight groups were 27 mL, 35 mL, 38 mL, 53 mL, and 53 mL, respectively, while the ED were 1.567 (1.30, 2.197) mSv, 1.53 (1.373, 1.78) mSv, 2.113 (1.963, 2.256) mSv, 4.22 (3.771, 4.483) mSv, and 4.786 (4.339, 5.536) mSv, respectively. Weight-based tube voltage and IDR yielded consistently high image quality, and allowed for further reduction in contrast and radiation exposure during CCTA for coronary artery diseases.

Tunable Continuous‐Variable Tripartite Entanglement via Simultaneous and Ordinal Cascaded Nonlinear Processes

AbstractMultipartite quantum entanglement plays a vital role in both fundamental science and quantum applications. The cascaded four‐wave mixing (FWM) process is an effective method to prepare multipartite entanglement, however, the physical nature of entanglement based on different cascading paths, i.e., simultaneous cascaded FWM (SC‐FWM) and ordinal cascaded FWM (OC‐FWM), has not yet been conclusively determined. In this article, tunable continuous‐variable (CV) triple‐mode entanglement is proposed to be generated by using both the SC‐FWM and OC‐FWM schemes. The simulation results reveal that the absorption/dispersion properties of the two nonlinear processes can be efficiently tuned by varying the optical parameters (i.e., the photon detuning and the nonlinear susceptibility), resulting in triple‐mode CV entanglement with tunable properties. Compared with the OC‐FWM scheme, the SC‐FWM scheme has a broader entanglement bandwidth and a higher degree of entanglement, where the tripartite entanglement region is 4.38% larger than that of the OC‐FWM scheme. Furthermore, these results indicate that the SC‐FWM scheme has a more compact and stable mode structure with better entanglement performance. Such tunable optical triple‐mode entanglement may find applications in specific quantum communication protocols and pave the way for implementing and manipulating multichannel quantum networks.

Comparison of Transcatheter Edge-to-Edge Mitral Valve Repair for Primary Mitral Regurgitation Outcomes to Hospital Volumes of Surgical Mitral Valve Repair.

Transcatheter edge-to-edge mitral valve (MV) repair (TEER) is an effective treatment for patients with primary mitral regurgitation at prohibitive risk for surgical MV repair (MVr). High-volume MVr centers and high-volume TEER centers have better outcomes than low-volume centers, respectively. However, whether MVr volume predicts TEER outcomes remains unknown. We hypothesized that high-volume MV surgical centers would have superior risk-adjusted outcomes for TEER than low-volume centers. We combined data from the American College of Cardiology/Society of Thoracic Surgeons Transcatheter Valve Therapy registry and the Society of Thoracic Surgeons adult cardiac surgery database. MVr was defined as leaflet resection or artificial chords with or without annuloplasty and was evaluated as a continuous variable and as predefined categories (<25, 25-49, and ≥50 MV repairs/year). A generalized linear mixed model was used to evaluate risk-adjusted in-hospital/30-day mortality, 30-day heart failure readmission, and TEER success (mitral regurgitation ≤2+ and gradient <5 mm Hg). The study comprised 41 834 patients from 500 sites of which 332 (66.4%) were low, 102 (20.4%) intermediate, and 66 (13.2%) high-volume surgical centers (P<0.001). TEER success was 54.6% and was not statistically significantly different across MV surgical site volumes (P=0.4271). TEER mortality at 30 days was 3.5% with no significant difference across MVr volume on unadjusted (P=0.141) or adjusted (P=0.071) analysis of volume as a continuous variable. One-year mortality was 15.0% and was lower for higher MVr volume centers when adjusted for clinical and demographic variables (P=0.027). Heart failure readmission at 1 year was 9.4% and was statistically significantly lower in high-volume centers on both unadjusted (P=0.017) or adjusted (P=0.015) analysis. TEER can be safely performed in centers with low volumes of MV repair. However, 1-year mortality and heart failure readmission are superior at centers with higher MVr volume.

Output Formation Containment for Multiagent Systems Under Multipoint Multipattern FDI Attacks: A Resilient Impulsive Compensation Control Approach.

The increasing number of devices and frequent interactions of agents from networked multiagent systems (MASs) exacerbate the risks of potential cyber attacks, especially the different point attacks and multiple pattern attacks. This article considers the output formation-containment problem for MASs under multipoint multipattern false data injection (FDI) attacks. The multipoint describes the attacks simultaneously occurring on the sensors, actuators, and communication channels; the multipattern captures that sensor and actuator attack signals are both continuous deterministic variables, and the communication channel attack signals are intermittent random variables, obeying the Bernoulli distribution. For such compromised MASs, a novel hybrid protocol is proposed, which integrates a state observer, an attack estimator, an impulsive interactor and a compensation controller. Thereinto, the state observer and the attack estimator are constructed to recover the unmeasured system states and the unknown FDI attack signals, respectively; the impulsive interactor is designed to guarantee that the neighbor's signals are transmitted only at impulsive instants, and meanwhile the channel attacks are randomly launched; using the recovered signals, the compensation controller is devised to alleviate the effect of attacks. A sufficient condition is identified, under which the output formation containment is achieved with cooperative uniform ultimate boundedness (UUB). Finally, simulation results are carried out to validate the effectiveness and advantages of the proposed approach.

Assessing measurement invariance with moderated nonlinear factor analysis using the R package OpenMx.

Assessing measurement invariance is an important step in establishing a meaningful comparison of measurements of a latent construct across individuals or groups. Most recently, moderated nonlinear factor analysis (MNLFA) has been proposed as a method to assess measurement invariance. In MNLFA models, measurement invariance is examined in a single-group confirmatory factor analysis model by means of parameter moderation. The advantages of MNLFA over other methods is that it (a) accommodates the assessment of measurement invariance across multiple continuous and categorical background variables and (b) accounts for heteroskedasticity by allowing the factor and residual variances to differ as a function of the background variables. In this article, we aim to make MNLFA more accessible to researchers without access to commercial structural equation modeling software by demonstrating how this method can be applied with the open-source R package OpenMx. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Smoking characteristics and years since quitting smoking of US adults diagnosed with lung and bladder cancer: A national health and nutrition examination survey analysis.

Smoking is a recognized risk factor for bladder BC and lung cancer LC. We investigated the enduring risk of BC after smoking cessation using U.S. national survey data. Our analysis focused on comparing characteristics of LC and BC patients, emphasizing smoking status and the latency period from smoking cessation to cancer diagnosis in former smokers. We analyzed data from the National Health and Examination Survey (2003-2016), identifying adults with LC or BC history. Smoking status (never, active, former) and the interval between quitting smoking and cancer diagnosis for former smokers were assessed. We reported descriptive statistics using frequencies and percentages for categorical variables and median with interquartile ranges (IQR) for continuous variables. Among LC patients, 8.9% never smoked, 18.9% active smokers, and 72.2% former smokers. Former smokers had a median interval of 8 years (IQR 2-12) between quitting and LC diagnosis, with 88.3% quitting within 0-19 years before diagnosis. For BC patients, 26.8% never smoked, 22.4% were active smokers, and 50.8% former smokers. Former smokers had a median interval of 21 years (IQR 14-33) between quitting and BC diagnosis, with 49.3% quitting within 0-19 years before diagnosis. BC patients exhibit a prolonged latency period between smoking cessation and cancer diagnosis compared to LC patients. Despite smoking status evaluation in microhematuria, current risk stratification models for urothelial cancer do not incorporate it. Our findings emphasize the significance of long-term post-smoking cessation surveillance and advocate for integrating smoking history into future risk stratification guidelines.

Single Institution Evaluation of Electromagnetic Navigation Bronchoscopy for Diagnosis of Pulmonary Lesions.

Electromagnetic navigation bronchoscopy (ENB) utilizes three-dimensional reconstructions based on computed tomography to guide the biopsy of pulmonary lesions. Various limitations have been described; however, supporting data have been limited by small sample sizes. Cases of ENB for evaluation of a pulmonary lesion at a single institution during a 1-year span were reviewed for demographics, lesion location, procedural details, and final tissue diagnosis. ENB was performed by 3 pulmonologists using the Veran platform with rapid on-site evaluation. T test or Mann-Whitney U test compared continuous variables and χ 2 or Fisher exact test compared categorical variables as appropriate. A patient with a negative or inconclusive biopsy was followed for 1 year postprocedure. A total of 107 pulmonary lesions were evaluated. The population studied had a mean age of 67 and a median pulmonary lesion size of 26.0 mm. For malignant lesions, the pathologic diagnostic yield from ENB was 52.1% (37/71). The diagnostic yield of benign lesions was much lower at 16.7% (6/36). The overall procedural complication rate was 8.4% (9/107). Complications were more likely to occur in patients with malignant lesions. The most common complication was pneumothorax, occurring in 5.6% of all biopsies and 7.0% of patients with malignant lesions. This study demonstrates significant differences in diagnostic accuracy between lesions found to be malignant versus benign. Our observed complication rate was slightly higher than other groups have reported, with a greater frequency occurring in patients with malignant lesions; however, the rate of pneumothorax was still lower than computed tomography-guided transcutaneous biopsies.

Clinical Effectiveness of Continuous Glucose Monitoring in Pregnancies Affected by Type 1 Diabetes.

Background: Continuous glucose monitoring (CGM) improves neonatal outcomes in type 1 diabetes pregnancies; however, its effectiveness has not been assessed in a real-world setting in the United States. Objective: The Triple C Study aimed to examine the clinical effectiveness, assessed through maternal glucose control and gestational health outcomes, of CGM use compared with self-monitoring of blood glucose (SMBG) in pregnancies associated with type 1 diabetes in a real-world setting. Research Design and Methods: We retrospectively identified 160 type 1 diabetes pregnancies at the Barbara Davis Center for Diabetes managed with CGM therapy (n = 109) or SMBG (n = 51) over a 6.5-year period (2014-2020). Obstetric care was provided at multiple practices. CGM use was defined as ≥60% wear in the second and third trimesters of pregnancy. Data were obtained from the electronic medical record system, hospital records, and vital statistics departments (Colorado and Wyoming). We used Student's t-test for continuous variables and chi-square test for categorical variables to compare outcomes between groups. Results: The CGM group had more participants meeting trimester-specific hemoglobin A1C (HbA1c) goals throughout pregnancy and postpartum (P < 0.01 in each time period). The CGM group had fewer participants never meeting HbA1c goals in any trimester than the SMBG group (P < 0.001). There were no significant differences in neonatal outcomes between groups, other than for macrosomia (12.8% CGM vs. 29.4% SMBG, P = 0.01). Infants of CGM users required a neonatal intensive care unit admission less often (52.9% CGM vs. 68.3% SMBG, P = 0.0989). Conclusions: CGM use was associated with improved maternal glucose levels in a diverse real-world cohort.

Abstract 4442: Associations between pre-diagnostic plasma metabolites and biliary tract cancer risk in the prospective UK Biobank cohort

Abstract Background Annually, approximately 200,000 people are diagnosed with biliary tract cancer (BTC). Most present with metastatic disease which encompasses a 5-year survival rate of &amp;lt;5%. Etiology is poorly understood though some studies suggest metabolic dysregulation may contribute to development. Previous evaluations of metabolites and BTC risk have primarily been limited to case-control studies, few metabolites, or post-diagnostic blood samples. Methods We evaluated 248,285 adult participants with metabolite data in the UK Biobank, a prospective cohort study. Participants were excluded (6.2%) primarily due to a baseline history of cancer. To reduce potential influences of reverse causation, those who developed cancer or died within one year after baseline blood collection were also removed. Metabolites were trimmed to two standard deviations, log-transformed (ln[x+0.5]), z-scored, and evenly divided into tertiles. Cox proportional hazards regression was implemented to evaluate associations of BTC risk per 1-standard deviation (SD) and across tertiles with hazard ratios (HR) and 95% confidence intervals (95% CI). Models were adjusted for age, sex, education, income, fasting time, and statin use. A p-value of 0.001 was considered statistically significant after multiple comparison adjustment (0.05 divided by 50, the number of independent tests). Results The analyzed cohort includes 232,781 UKB participants with a median age of 58, a median follow-up time of 11.8 years, and 268 first primary incident BTC cases. Multiple metabolites were significantly associated with BTC risk using continuous variables (per 1-SD increment). High triglyceride to total lipid ratios were associated with higher BTC risk, and the strongest association was for intermediate-density lipoproteins (the HR (95% CI) was 1.33 (1.15-1.54), p=0.0001). On the other hand, high cholesterol to total lipid ratios were associated with lower BTC risk, and the strongest association was for the free cholesterol to total lipids in small very-low-density lipoproteins (VLDL) (0.76 (0.66-0.88), p =0.0002). High glutamine was associated with lower BTC risk (0.68 (0.69-0.89), p =0.0003) as was the phospholipid to total lipid ratio in small VLDL (0.75 (0.65-0.87), p =0.0002). Analysis by tertile identified additional significant associations, including a higher polyunsaturated fatty acid to total fatty acid ratio being associated with lower BTC risk (the HR (95% CI) comparing the highest to lowest tertile, 0.50 (0.35-0.71), p-trend=0.0001). Notably, within polyunsaturated fatty acids, a higher omega-6 to omega-3 ratio trended toward higher risk (1.32 (0.94-1.85), p-trend=0.11). Conclusion These findings indicate circulating metabolites may be biomarkers for BTC and suggest that triglycerides, cholesterols, fatty acids, phospholipids, and glutamine may be involved in BTC etiology. Citation Format: Valerie Gunchick, Guochong Gia, Wei Zheng. Associations between pre-diagnostic plasma metabolites and biliary tract cancer risk in the prospective UK Biobank cohort [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4442.