Fusion Type Research Articles

Impact of Antidepressant use on Intraoperative Blood Loss and Transfusion Rates in Lumbar Fusion Surgery

A quarter of spine surgery patients take antidepressants. Basic science research has suggested serotonergic antidepressants impair platelet function. This has been supported by only a small number of works in the setting of spine surgery. The purpose of this study is to investigate the impact of antidepressants on intraoperative bleeding risk during lumbar fusion. Patients who underwent elective 1-3 level lumbar fusion at a single, academic, tertiary center (2017-2021) were identified. Antidepressant use and class, demographic and surgical data were evaluated. Bleeding risk was assessed by total intraoperative blood loss (mL), calculated using the formula by Gross et al, and by postoperative transfusion. Patients prescribed versus not prescribed an antidepressant were matched 1:1 by age, sex, BMI, Elixhauser, smoking status, and levels fused. Appropriate statistical analysis was performed (Alpha was set at 0.05). 420 patients with, and 420 patients without an antidepressant prescription at the time of lumbar fusion were identified. Patients without an antidepressant prescription had a higher Charlson Comorbidity Index (0.91 ± 1.09 vs. 0.76 ± 1.1; p = 0.048), but otherwise the groups were demographically similar, and underwent similar surgeries. Antidepressant use was not associated with increased intraoperative bleeding or postoperative transfusion rate, regardless of sub-analysis by procedure type or antidepressant class. Antidepressant use was not associated with increased intraoperative blood loss or increased postoperative transfusion requirement, regardless of sub-analysis by fusion type or antidepressant class. The current findings do not support discontinuing antidepressants prior to lumbar fusion.

Heterogeneous functional regression for subgroup analysis

With ever increasing number of features of modern datasets, data heterogeneity is gradually becoming the norm rather than the exception. Whereas classical regressions usually assume all the samples follow a common model, it becomes imperative to identify the heterogeneous relationship in different subsamples. In this article, we propose a new approach to model heterogeneous functional regression relations. We target at the association between a response and a predictor, whose relationship can vary across underlying subgroups and is modeled as an unknown functional of an auxiliary predictor. We introduce a procedure which performs simultaneous parameter estimation and subgroup identification through a fusion type group-wise penalization. We establish the statistical guarantees in terms of non-asymptotic convergence of the parameter estimation. We also establish the oracle property and asymptotic normality of the estimators. We carry out intensive simulations, and illustrate with a new dataset from an Alzheimer’s disease study.

Actin dynamics switches two distinct modes of endosomal fusion in yolk sac visceral endoderm cells

Membranes undergo various patterns of deformation during vesicle fusion, but how this membrane deformation is regulated and contributes to fusion remains unknown. In this study, we developed a new method of observing the fusion of individual late endosomes and lysosomes by using mouse yolk sac visceral endoderm cells that have huge endocytic vesicles. We found that there were two distinct fusion modes that were differently regulated. In homotypic fusion, two late endosomes fused quickly, whereas in heterotypic fusion they fused to lysosomes slowly. Mathematical modeling showed that vesicle size is a critical determinant of these fusion types and that membrane fluctuation forces can overcome the vesicle size effects. We found that actin filaments were bound to late endosomes and forces derived from dynamic actin remodeling were necessary for quick fusion during homotypic fusion. Furthermore, cofilin played a role in endocytic fusion by regulating actin turnover. These data suggest that actin promotes vesicle fusion for efficient membrane trafficking in visceral endoderm cells.

Actin dynamics switches two distinct modes of endosomal fusion in yolk sac visceral endoderm cells.

Membranes undergo various patterns of deformation during vesicle fusion, but how this membrane deformation is regulated and contributes to fusion remains unknown. In this study, we developed a new method of observing the fusion of individual late endosomes and lysosomes by using mouse yolk sac visceral endoderm cells that have huge endocytic vesicles. We found that there were two distinct fusion modes that were differently regulated. In homotypic fusion, two late endosomes fused quickly, whereas in heterotypic fusion they fused to lysosomes slowly. Mathematical modeling showed that vesicle size is a critical determinant of these fusion types and that membrane fluctuation forces can overcome the vesicle size effects. We found that actin filaments were bound to late endosomes and forces derived from dynamic actin remodeling were necessary for quick fusion during homotypic fusion. Furthermore, cofilin played a role in endocytic fusion by regulating actin turnover. These data suggest that actin promotes vesicle fusion for efficient membrane trafficking in visceral endoderm cells.

Effect of aortic valve phenotype and sex on aorta dilation in patients with aortic stenosis

BackgroundBicuspid aortic valve (BAV) is often associated with a concomitant aortopathy. However, few studies have evaluated the effect of the aortic valve (AV) phenotype on the rate of dilation of...

Lysine (K)-specific methyltransferase 2A (KMT2A) rearrangements among Iraqi de novo acute myeloid leukemia

Abstract: BACKGROUND: The classification of acute myeloid leukemia (AML) has evolved extensively over the last 20 years significantly, impacting the diagnosis and prognosis of the patients. The lysine (K)-specific methyltransferase 2A (KMT2A) gene, which has more than 80 gene fusions, is present in approximately 10% of all leukemias. Most KMT2A rearrangements are associated with adverse prognosis and need heavy chemotherapy protocol upfront. OBJECTIVE: This study aims to study the prevalence of KMT2A gene fusion among Iraqi patients with AML and its association with clinical and hematological parameters and patients’ outcomes. PATIENTS, MATERIALS, AND METHODS: A prospective cohort study conducted between December 2020 and May 2022 enrolled 115 Iraqi adults newly diagnosed with AML at the Hematology Unit of Baghdad Teaching Hospital. The patients were also monitored at this facility during the study period. Genetic rearrangements were detected using the Leukemia Q-Fusion Screening Kit through Real-Time Quantitative Reverse Transcription PCR (RT-qPCR) analysis. RESULTS: KMT2A rearrangements were identified in 23 (20%) patients. The most common was t(10;11) which presented in 15 (13%) patients, followed by t(9;11) in 5 (4.3%) patients and t(11;17) in 3 (2.6%) patients. Patients with KMT2A rearrangements were significantly older and more likely to have splenomegaly. At 1-month posttreatment, they had significantly lower red blood cell counts and hemoglobin levels and higher blast percentages. Only 4.3% achieved complete remission (CR) compared to 76.1% without KMT2A rearrangements, with a significantly higher mortality rate (30.4% vs. 5.4%, P = 0.0001). Regarding the treatment response, no significant differences were observed among the different fusion types of KMT2A rearrangements. CONCLUSION: KMT2A rearrangements are more prevalent among Iraqi AML patients compared to the global trend and are associated with older age, higher rates of splenomegaly, poorer hematological recovery, and worse outcomes, regardless of the KMT2A rearrangement fusion type.

IPCT-Net: Parallel information bottleneck modality fusion network for obstructive sleep apnea diagnosis

Obstructive sleep apnea (OSA) is a common sleep breathing disorder and timely diagnosis helps to avoid the serious medical expenses caused by related complications. Existing deep learning (DL)-based methods primarily focus on single-modal models, which cannot fully mine task-related representations. This paper develops a modality fusion representation enhancement (MFRE) framework adaptable to flexible modality fusion types with the objective of improving OSA diagnostic performance, and providing quantitative evidence for clinical diagnostic modality selection. The proposed parallel information bottleneck modality fusion network (IPCT-Net) can extract local-global multi-view representations and eliminate redundant information in modality fusion representations through branch sharing mechanisms. We utilize large-scale real-world home sleep apnea test (HSAT) multimodal data to comprehensively evaluate relevant modality fusion types. Extensive experiments demonstrate that the proposed method significantly outperforms existing methods in terms of participant numbers and OSA diagnostic performance. The proposed MFRE framework delves into modality fusion in OSA diagnosis and contributes to enhancing the screening performance of artificial intelligence (AI)-assisted diagnosis for OSA.

Clinicopathological Features of CCDC6-RET and NCOA4-RET Fusions in Thyroid Cancer: A Single-Center Retrospective Cohort Study in a Chinese Population.

Background: The rearranged during transfection (RET) proto-oncogene fusion is common in papillary thyroid cancer (PTC), varying across ethnic groups. However, comprehensive comparisons of RET fusion types are limited. This study aims to identify predominant RET fusions and analyze their clinicopathological characteristics in a cohort of Chinese thyroid cancer cases. Methods: This single-center retrospective cohort study analyzed thyroid cancer data, utilizing next-generation sequencing on formalin-fixed, paraffin-embedded tissue samples. Detailed clinicopathological data of thyroid cancer cases with RET fusions were collected. Results: Among 2300 thyroid cancer cases, RET fusions were exclusively found in PTC or differentiated high-grade thyroid carcinoma (DHGTC) cases (2234 cases), absent in other types (66 cases). Of the 2234 PTC or DHGTC cases, 113 (5.06%) exhibited RET fusions, including 100 primary cases. Coiled-coil domain containing 6 (CCDC6)-RET fusions predominated (78.0%, 78/100), with nuclear receptor coactivator 4 (NCOA4)-RET fusions representing 22.0% (22/100). NCOA4-RET fusions were more prevalent in patients aged 45 years and older (54.5% vs. 28.2%, p = 0.021) and DHGTC cases (p < 0.05) and associated with higher rates of lymph node metastases (90.9% vs. 67.9%, p = 0.032). CCDC6-RET fusion exhibited a higher prevalence of Hashimoto's thyroiditis (HT) (67.9% vs. 22.7%, p < 0.001) and elevated thyroglobulin antibody levels (14.11 [1.86-174.32] IU/mL vs. 2.01 [1.14-15.41] IU/mL, p = 0.018). Moreover, CCDC6-RET fusion predominantly occurred in classical PTC (56.4%, 44/78) and infiltrative follicular PTC (17.9%, 14/78), whereas NCOA4-RET fusion was more frequent in classical PTC (36.4%, 8/22), solid PTC (27.3%, 6/22), and DHGTC (27.3%, 6/22). RET fusions with compound mutations were associated with older age (≥45 years) and bilateral thyroid involvement. Follow-up data showed a higher recurrence rate in the RET fusion group compared with the BRAFV600E mutation group (5.0% vs. 0.0%, p = 0.018). Although the NCOA4-RET group showed a numerically higher recurrence rate compared with CCDC6-RET (9.1% vs. 3.8%), this difference was not statistically significant (p = 0.559). Conclusions: RET fusions are specific to PTC or DHGTC cases among Chinese thyroid cancer cases. CCDC6-RET and NCOA4-RET fusions exhibited distinct clinicopathological features, with NCOA4-RET being more aggressive.

An hetero-modal deep learning framework for medical image synthesis applied to contrast and non-contrast MRI

Some pathologies such as cancer and dementia require multiple imaging modalities to fully diagnose and assess the extent of the disease. Magnetic resonance imaging offers this kind of polyvalence, but examinations take time and can require contrast agent injection. The flexible synthesis of these imaging sequences based on the available ones for a given patient could help reduce scan times or circumvent the need for contrast agent injection. In this work, we propose a deep learning architecture that can perform the synthesis of all missing imaging sequences from any subset of available images. The network is trained adversarially, with the generator consisting of parallel 3D U-Net encoders and decoders that optimally combines their multi-resolution representations with a fusion operation learned by an attention network trained conjointly with the generator network. We compare our synthesis performance with 3D networks using other types of fusion and a comparable number of trainable parameters, such as the mean/variance fusion. In all synthesis scenarios except one, the synthesis performance of the network using attention-guided fusion was better than the other fusion schemes. We also inspect the encoded representations and the attention network outputs to gain insights into the synthesis process, and uncover desirable behaviors such as prioritization of specific modalities, flexible construction of the representation when important modalities are missing, and modalities being selected in regions where they carry sequence-specific information. This work suggests that a better construction of the latent representation space in hetero-modal networks can be achieved by using an attention network.

Using physics-informed neural networks to predict the lifetime of laser powder bed fusion processed 316L stainless steel under multiaxial low-cycle fatigue loading

Axial-torsional Low-Cycle Fatigue (LCF) tests were conducted under strain control on Additively Manufactured (AM) 316L stainless steel using laser powder bed fusion. The tests covered various strain amplitudes under tension-compression, proportional, and pure shear loading paths. The AM 316L stainless steel exhibited cyclic softening and transgranular cracking under all the investigated loading conditions. The presence of deposition defects, predominantly the lack of fusion type, was identified as the main factor influencing the crack initiation and propagation, as well as the scatter in the fatigue lifetime. Therefore, to account for the damaging effects of these deposition related defects on fatigue lifetime, a novel physics-informed neural network was proposed. Subsequently, this neural network was combined with the critical plane approach, based on the tensile mode of failure, in order to predict the lifetime of AM 316L stainless steel. The predicted data exhibited a good correlation with the experimental results.

Epigenomic and Transcriptomic Profiling of Solitary Fibrous Tumors Identifies Site-Specific Patterns and Candidate Genes Regulated by DNA Methylation

A solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm that can arise at any anatomical site and is characterized by recurrent NAB2::STAT6 fusions and metastatic progression in 10% to 30%. The cell of origin has not been identified. Despite some progress in understanding the contribution of heterogeneous fusion types and secondary mutations to SFT biology, epigenetic alterations in extrameningeal SFT remain largely unexplored, and most sarcoma research to date has focused on the use of methylation profiling for tumor classification. We interrogated genome-wide DNA methylation in 79 SFTs to identify informative epigenetic changes. RNA-seq data from targeted panels and data from the Cancer Genome Atlas (TCGA) were used for orthogonal validation of selected findings. In unsupervised clustering analysis, the top 500 most variable CpGs segregated SFTs by primary anatomical site. Differentially methylated genes associated with the primary SFT site included EGFR; TBX15; multiple HOX genes; and their cofactors EBF1, EBF3, and PBX1; as well as RUNX1 and MEIS1. Of the 20 DMGs interrogated on the RNA-seq panel, 12 were significantly differentially expressed according to site. However, except TBX15, most of these also showed differential expression according to NAB2::STAT6 fusion type, suggesting that the fusion oncogene contributes to the transcriptional regulation of these genes. Transcriptomic data confirmed an inverse correlation between gene methylation and the expression of TBX15 in both SFT and TCGA sarcomas. TBX15 also showed differential mRNA expression and 5′ UTR methylation between tumors in different anatomical sites in TCGA data. In all analyses, TBX15 methylation and mRNA expression retained the strongest association with tissue of origin in SFT and other sarcomas, suggesting a possible marker to distinguish metastatic tumors from new primaries without genomic profiling. Epigenetic signatures may further help to identify SFT progenitor cells at different anatomical sites.

Space Traffic Management: Data Fusion

This article provides an overview of and terminology associated with the topic of data fusion, especially as it relates to, and for the purposes of promoting space sustainability and enabling Space Traffic Coordination (STC) and Space Traffic Management (STM). First, the terminology and organizations (data contributors and aggregators) associated with data fusion is discussed. Next, the various “levels” of data fusion are delineated, and a detailed breakdown of the data levels associated with STC and STM (and indeed all space operations) is provided. The taxonomy of data required for safe collaborative space activities are detailed. And finally, data fusion is explored in the context of STC and STM, including the levels, techniques, data sources, and state representations used. And finally, the benefits and limitations of the various data fusion types and levels are outlined with practical examples provided.

BERTOLOTTI'S SYNDROME: DIAGNOSIS AND TREATMENT

IntroductionLumbosacral transitional vertebrae (LSTV) are increasingly recognized as a common anatomical variant and is the most common congenital anomaly of the lumbosacral spine. Patients can have symptomatic LSTV, known as Bertolotti's Syndrome, where transitional anatomy can cause back, L5 distribution leg, hip, and groin pain. We propose an outline for diagnosis and treatment of Bertolotti's Syndrome.MethodsWe retrospectively reviewed over 500 patients presenting to the primary author with low back, buttock, hip, groin and/or leg pain from April 2009 through April 2024. Patients with radiographic findings of an LSTV and clinical presentation underwent diagnostic injections to confirm diagnosis of Bertolotti's syndrome. Treatment was determined based on patient's LSTV classification. 157 patients with confirmed Bertolotti's syndrome underwent surgical treatment.ResultsOver 500 patients presented with an appropriate clinical presentation and radiographic findings of an LSTV. Diagnostic injections were targeted into the transitional anatomy confirming the LSTV as the primary pain generator to make the diagnosis of Bertolotti's syndrome. The decision in the type of surgical intervention, resection or fusion, was made based on patient's LSTV anatomy. 157 patients with confirmed Bertolotti's Syndrome underwent surgical treatment (121 fusions (77%), 36 resections (23%)). The classification system and surgical outcomes, in part, have been previously published in World Neurosurgery.ConclusionWe have outlined the best practice of diagnosis and treatment selection for Bertolotti's syndrome. We have shown significant improvement in outcomes based on this method. We hope to aid in both patient education and provide an outline on how clinicians can become knowledgeable on Bertolotti's syndrome.Conflicts of interestNo conflicts of interestSources of fundingNo funding obtained

Capitolunate versus Four-Corner Arthrodesis for Midcarpal Arthrosis

Abstract Background Midcarpal fusion is a procedure indicated for midcarpal arthrosis or instability, though the merits of fusing the triquetrohamate joint in addition to the capitolunate joint are not known. The purpose of this study was to compare capitolunate fusion with four-corner fusion with a null hypothesis that no differences would exist in outcomes. Methods A retrospective chart review of patients with midcarpal arthrosis who underwent midcarpal fusion between the years 2013 and 2023 was conducted. Patients were separated into groups according to fusion type. Demographics and methods of fixation were recorded. Outcomes evaluated included subjective outcomes, radiographic alignment, success of fusion, range of motion, strength, and complications. Results In total, 51 patients met inclusion criteria. Of these, 20 had capitolunate fusions and 31 had four-corner fusions. Staples were the most common form of fixation. Postoperative strength and range of motion were relatively preserved from preoperative levels in both groups. Both groups also had similar improvements in Disabilities of Arm, Shoulder, and Hand score. Capitolunate angles were not significantly different between groups; however, ulnar translocation was greater in the four-corner fusion group. Revision surgery was required in 10% of capitolunate fusions versus 29% of four-corner fusions, although this difference was not calculated to be significantly different. Conclusion Capitolunate fusion and four-corner fusion yielded comparable improvements with respect to clinical and radiographic outcomes. Fusing the triquetrohamate joint does not appear to enhance outcomes.

ETMR-23. CNS SARCOMAS WITHCIC- ORATXN1-ALTERATIONS — A META-ANALYSIS OF CLINICAL AND MOLECULAR FEATURES IN A LARGE SERIES OF PATIENTS

Abstract BACKGROUND In 2021, the 5th WHO classification of central nervous system (CNS) tumors acknowledged CNS sarcomas with CIC alterations as a distinct tumor type, which may also expand to non-CIC alterations including ATXN1. To tackle the lack of treatment protocols for these highly aggressive tumors, we conducted a meta-analysis to provide an overview of clinical and molecular characteristics, define clinically relevant subtypes, and ultimately advise on treatment guidelines. METHODS We collected molecular and clinical data for &amp;gt;200 patients with CIC- or ATXN1-altered CNS sarcomas by screening our in-house DNA methylation database (581 potential patients initially identified), publication databases (50 patients), and contacting centers worldwide (60 patients). Tumor tissue (FFPE and fresh frozen) for further molecular characterization was obtained from a subset of patients. DNA methylation-based clustering analyses (t-SNE, UMAP, consensus partitioning) were performed, integrating gene fusion details (RNAseq, FISH), copy-number variations, and clinical patient data to identify associations between (epi-)genetic and clinical parameters. RESULTS Most prominent fusion partners for CIC (n=47) and ATXN1 (n=9) were NUTM1 (n=18), LEUTX (n=17) and DUX4 (n=15). Clustering analyses of DNA methylation patterns indicated several epigenetic subtypes associated with different fusion types. Potential clinical implications are still under evaluation. Age distribution of patients at diagnosis in this cohort ranged from two months to 71 years (median=7.5 years). We observed no gender bias. Survival analyses are currently being performed, first results on survival and follow-up studies will be shown at the symposium. CONCLUSION We show first-of-its-kind data describing a large cohort of CNS sarcomas with CIC or ATXN1 alterations, outlining molecular and clinical characteristics, which may facilitate the development of guidelines for optimal treatment of these tumors based on retrospective response data. New molecular insights may also open up an avenue for targeted therapeutic approaches.

HGG-13. INFANT-TYPE HEMISPHERIC GLIOMA (IHG): AN INDIVIDUAL PATIENT DATA META-ANALYSIS

Abstract BACKGROUND Infant-type hemispheric gliomas (IHG) are epigenetically distinct pediatric high-grade gliomas characterized by fusions in receptor tyrosine kinase (RTK) genes. METHODS We performed a methodical literature search, including 30 publications (22 case reports), to identify patients who met the diagnostic criteria of IHG based on the 2021 WHO Classification of CNS Tumors. Individual patient data were obtained from published literature and/or via the authors of the publications. Survival analysis was conducted using the Kaplan-Meier method, and multivariate analysis was performed to investigate the effect of clinical and molecular variables on outcomes. RESULTS Hundred-fifty-five previously reported and one unpublished IHG were identified: 131 (84%) had fusions in RTK genes, of which ALK was most prevalent (62/131), followed by NTRK1/2/3 (30/131), ROS1 (30/131), and MET (9/131). Twenty-five patients, with either no identified RTK fusion (6/156) or not assessable fusion (19/156), had methylation scores ≥ 0.9 for IHG (using the Molecular Neuropathology brain tumor classifier versions ≥ 11b4). Surgery followed by adjuvant chemotherapy in 69% (67/97) was the most common primary treatment used in our cohort. The 3-year EFS and OS were 55% (95%CI: 45-67) and 81 % (95%CI: 73-89). 41 patients with relapsed or progressive tumors received various second-line treatments including surgery, chemotherapy, radiotherapy, and targeted therapy. Based on multivariate analysis, complete resection resulted in better EFS (p = 0.05) and OS (p = 0.009), and the presence and type of RTK gene fusion were not associated with clinical outcomes. CONCLUSION Our results show that despite favorable OS, patients with IHG often show early progression, indicating that the primary optimal treatment for IHG is yet to be established. Our analysis further indicates that achieving a safe, complete resection may play an important role in treating these patients. A comprehensive analysis of the salvage regimen is required to understand their role in OS.

Targeted sequencing of DNA/RNA combined with radiomics predicts lymph node metastasis of papillary thyroid carcinoma

ObjectiveThe aim of our study is to find a better way to identify a group of papillary thyroid carcinoma (PTC) with more aggressive behaviors and to provide a prediction model for lymph node metastasis to assist in clinic practice.MethodsTargeted sequencing of DNA/RNA was used to detect genetic alterations. Gene expression level was measured by quantitative real-time PCR, western blotting or immunohistochemistry. CCK8, transwell assay and flow cytometry were used to investigate the effects of concomitant gene alterations in PTC. LASSO-logistics regression algorithm was used to construct a nomogram model integrating radiomic features, mutated genes and clinical characteristics.Results172 high-risk variants and 7 fusion types were detected. The mutation frequencies in BRAF, TERT, RET, ATM and GGT1 were significantly higher in cancer tissues than benign nodules. Gene fusions were detected in 16 samples (2 at the DNA level and 14 at the RNA level). ATM mutation (ATMMUT) was frequently accompanied by BRAFMUT, TERTMUT or gene fusions. ATMMUT alone or ATM co-mutations were significantly positively correlated with lymph node metastasis. Accordingly, ATM knock-down PTC cells bearing BRAFV600E, KRASG12R or CCDC6-RET had higher proliferative ability and more aggressive potency than cells without ATM knock-down in vitro. Furthermore, combining gene alterations and clinical features significantly improved the predictive efficacy for lymph node metastasis of radiomic features, from 71.5 to 87.0%.ConclusionsTargeted sequencing of comprehensive genetic alterations in PTC has high prognostic value. These alterations, in combination with clinical and radiomic features, may aid in predicting invasive PTC with higher accuracy.

Noncanonical RET fusions in Chinese patients with non-small cell lung cancer from DNA-based next-generation sequencing.

e20000 Background: The FDA has approved selpercatinib and pralsetinib for the treatment of metastatic RET fusion-positive non-small cell lung cancer in adult patients. Although the overall response rate is high and the response is durable, the outcomes may vary due to different fusion types of the same driver gene. Methods: We retrospectively collected and analyzed 14062 samples (tumour tissue or plasma) from Chinese lung cancer patients who underwent tissue-based or ctDNA-based next-generation sequencing (NGS) assays at HaploX Genomic Sequencing Center from May 18, 2020, to January 11, 2024. All samples with a RET gene fusion were included and classified based on the fusion partner gene and breakpoint position. Results: A total of 157 (1.1%) samples with DNA-based NGS harbored a RET gene fusion. Among the samples with a RET gene fusion, the most common RET fusion partners at the DNA level were KIF5B (73.2%) and CCDC6 (21.0%). We categorized RET fusions into canonical fusions and noncanonical fusions based on fusion partner and breakpoint position, and the proportions of canonical fusions and noncanonical fusions were 88.5% (139/157) and 11.5% (18/157) respectively. Among the samples with a noncanonical RET fusion, 5 samples harbored a RET fusion with an uncommon fusion partner, it remains unclear whether these fusions lead to RET activation. Conclusions: In this retrospective study, we identify different types of RET fusions in Chinese lung cancer patients. The majority are canonical fusions, which can benefit from tyrosine kinase inhibitors in clinical, the rest are noncanonical fusions, and their role in precision therapy needs further verification by RNA-based NGS or other assays. All in all, our research helps guide precision therapy in clinical settings. [Table: see text]

Spinal catheter revision in pediatric intrathecal baclofen pumps: risk factors and postoperative outcomes.

Intrathecal baclofen (ITB) pumps are commonly used in pediatric patients with cerebral palsy (CP) and medically refractory spasticity. However, catheter malfunction and associated risk factors are not well understood. The aim of this study was to examine potential risk factors for spinal catheter malfunction and characterize postoperative follow-up to understand the clinical consequences. Patients who received ITB pump replacement or revision at Boston Children's Hospital between 2010 and 2023 were retrospectively reviewed. The spinal catheter revision cohort (SCRC) included patients whose spinal catheter was occluded requiring lumbar catheter revision. The second cohort included abdominal pump replacements only (APRC). Between-group comparisons and multivariable regression identified factors associated with catheter revision and postoperative outcomes. Forty-one (33.6%) patients underwent spinal catheter revision and were compared with 81 patients (66.4%) who underwent abdominal pump replacement only. Younger age at surgery and an elevated preoperative lower-extremity modified Ashworth scale grade were associated with spinal catheter revision (p < 0.05). Catheter model type, tip location, and history of spinal fusion were not associated with obstruction. Postoperatively, SCRC patients experienced a higher rate of infection (17.1%) relative to APRC patients (0%) within 30 days from their ITB pump replacement procedure (p < 0.05) and greater likelihood of subsequent ITB system removal compared with the APRC (24.4% vs 7.4%, p < 0.05). Although not differing preoperatively, SCRC patients had lower postoperative ITB doses when compared with the APRC group (median dose 143 vs 350 µg/day, p < 0.05) at hospital discharge and remained statistically different at the 6-month and 1-year follow-ups (p < 0.05). There were no postoperative differences in baclofen overdose, withdrawal, or median number of hospital readmissions within 30 days. Overall, 31.7% of spinal catheter revisions were unanticipated by the clinical team at time of surgery. Younger age at surgery and increased preoperative lower-extremity tone may be risk factors for catheter obstruction, resulting in a higher rate of postoperative infection and subsequent ITB pump removal compared with pump replacement alone. Spinal catheter occlusion can complicate revision or replacement procedures, especially when unanticipated. Routine clinical assessment may be inadequate for diagnosing insidious catheter malfunction. Catheter occlusion deserves further study, and routine assessment of catheter patency may be warranted to prevent suboptimal tone therapy.

Hakka Blues and Jazz: The Inspiration of Black Music in the Hakka Taiwanese Musical Revitalization Movement in Postdictatorial Taiwan

Abstract: This article discusses the influence of African American blues and jazz on the Hakka Taiwanese musical revitalization movement since the late 1990s. Case studies examine the discourse and materialization of two types of musical fusion, namely Hakka blues and Hakka jazz, by Sanguetai (1997–2007) and Sanguetaihousheng (2008– present). Their performances express appreciation for Black music and advance diversity and inclusion in Taiwan; furthermore, they allow the musicians to articulate their resistance against the status quo and elevate the social status of sango . Black music has a decisive position in the development of neotraditional Hakka Taiwanese music .