Median Size Research Articles

Jet cavitation-enhanced hydration method for the preparation of magnesium hydroxide

During the preparation of magnesium hydroxide via the hydration method, in-situ growth and agglomeration often inhibit the reaction. This study used active magnesium oxide as the raw material and employed jet cavitation technology to enhance the hydration process. Based on the growth process of magnesium hydroxide, the mechanism of jet-enhanced hydration was analyzed. The effects of reaction temperature (T), reaction time (t), solid-liquid ratio (s), and cavitation number (σ) on the hydration rate were investigated. An L25(54) orthogonal experiment explored the significance of each factor's impact on the hydration rate. The hydration products were characterized using scanning electron microscopy (SEM), X-ray diffraction (XRD), and a specific surface area analyzer. Results indicate that the factors affecting the hydration rate, in order of significance, are cavitation number > reaction temperature > solid-liquid ratio > reaction time. The optimal process parameters were determined to be a reaction temperature of 70 °C, reaction time of 80 min, solid-liquid ratio of 1:12, and cavitation number of 0.42. Under these conditions, the hydration rate reached 94.87 %, producing well-dispersed lamellar magnesium hydroxide with a narrow particle size distribution (median particle size D50 = 4.511 μm) and a BET specific surface area of 11.345 m²/g.

Laboratory Study of Interface Friction between Sand and Steel Surfaces

Abstract In this study, results have been reported from a series of laboratory tests to determine the interface friction angle of steel surfaces with sand through modified direct shear testing. For completion, steel surfaces with different surface geometry to replicate the roughness have been slid against various sands compacted at different relative densities under both dry and wet conditions. The standard square shape direct shear box has been modified into circular and rectangular boxes to sufficiently enhance the contact area and to subsequently quantify its effect on interface friction angle. A mild steel interface of smooth and rough texture with a groove depth of 0.2 mm and tipping at an angle of 90° has been used in this study. The analysis of results revealed that the interface friction angles obtained from the standard direct shear box agree closely with those obtained from both modified rectangular and circular shear boxes. However, the ratio of the interface friction angle from the modified apparatus and soil’s angle of internal friction significantly depends upon the roughness of the surface in contact with the sand, its median particle size, and is independent of the effects of box size, soil’s relative density, and dry or wet condition. A comparison between existing well-accepted guidelines and current observations has been presented for use by the practicing engineers dealing with soil-structure interaction.

Late outcomes of Fontan operation from the EUROFONTAN experience

Abstract Background Fifty years after the first Fontan operation, the persisting challenges and evolving landscape of post-Fontan complications are explored in the EUROFONTAN experience. Aim of the study is the evaluation of long term outcomes of a large cohort of Fontan patients, focusing on age at Fontan and onset of Fontan-associated liver disease (FALD). Methods A retrospective clinical study across 21 european congenital cardiac centers across Europe. Clinical and operative data of patients who underwent Fontan operation between January 1990 and December 2022 were gathered through a RedCap online database. Results 2606 patients were included in this analysis (M/F: 59%/41%, median age and median weight at Fontan of 4.3 y.o (IQR 3.3-6.4), and 16kg (IQR 14-20), respectively. Most frequent cardiac anomaly were tricuspid atresia and pulmonary atresia with intact ventricular septum (781, 30%). Ventricular morphology was left in 1379 patients (53%), and right in 1029 patients (40%). Extra cardiac conduit (ECC) was performed in the majority of patients (2335, 90%), with a median conduit size of 20mm (IQR 18-20). Early post-operative complications were present in 52% (1340), with an early reintervention in 349 patients (249 surgical , 99 catheter driven) At a median follow-up median of 10 years (IQR 4-15), there were 79 late deaths (3%). Adverse events occurred in 49% (1288 , non-surgical in 962 , surgical in 249). The clinical status was stage A in 60% (1288 patients), while only a minority (1.3%) was in status D. Systemic Ventricular function was normal in 1898 patients (73%), while absent or mild Atrioventricular Valve regurgitation was presnet in 86% (1816). Of note, FALD was detected in 388 (15 %) , and sinus rhythm was present in 99%. Statistical analysis shows that late death and adverse events are significantly associated right ventricular morphology of the systemic ventricle (p-value 0.019). Of note, when compared to lateral tunnel, TCPC extracardiac conduit demonstrated lower late mortality (2.3% vs 8.2%, p-value <0.001) and complication rates (60% vs 48%, p-value 0.001). Analyzing age at Fontan, a linear relationship exists between age and late mortality, whereby mortality increases with advancing age (graph 1). However, concerning the development of late adverse events, the risk decreases with age at Fontan up to 7 years; beyond 7 years, the risk increases with advancing age (graph 2). The analysis demonstrated growing FALD-prevalence with increasing time from Fontan completion (significant especially after 10 years). Conclusion current long term outcomes of Fontan operation are highly satisfactory. However, the longer survival is associated to an increasing incidence of late term extracardiac complications (namely FALD) which are more evident if Fontan is performed at older age.Data of Fontan PatientsCorrelation between age at Fontan and AE

A 16-year evaluation of opportunistic lung cancer screening with low-dose CT in China: comparative findings between non-smokers and smokers

BackgroundAlthough low-dose computed tomography (LDCT) screening effectively reduces LC mortality in high-risk individuals with a history of smoking in China, the feasibility and efficacy of lung cancer screening (LCS) in individuals who never smoked versus individuals who smoked remains unclear.MethodsWe conducted a retrospective analysis of prospective cohort studies at the National Cancer Center (NCC) in China from January 2006 to December 2022. A comprehensive LCS initiative was undertaken, involving 30,468 participants (54.5% male). Participants underwent LCS using LDCT. Potential malignancies were managed through joint consensus between patients and their physicians. Epidemiology, screening eligibility criteria, and LC detection rates and survival outcomes were compared between individuals who smoked and individuals who never smoked.ResultsAmong 30,468 participants, 339 LCs were pathologically confirmed in 289 patients. The LC detection rate was 0.9% (289/30,468) overall, 0.8% in individuals who smoked (71/9,042), and 1.0% in individuals who never smoked (218/21,426). In individuals who smoked, LC detection rates were 0.5% (21/4516) and 1.1% (50/4526) in the < 20 and ≥ 20 pack-year subgroups, respectively (P = 0.001). Early-stage LC (stage 0 or I) was detected in 73.8% of the individuals who smoked and in 78.8% of individuals who never smoked, while advanced LC (stage III–IV) was found 8.8% of individuals who smoked and 4.2% of individuals who never smoked, respectively. Significant differences in histologic types were found between individuals who smoked and individuals who never smoked (P = 0.01), although adenocarcinoma was the most prevalent in both groups, at 83.0% and 78.8%, respectively. The median nodule size was 9.9 mm (IQR, 8.0–13.8) in individuals who smoked and 9.2 mm (IQR, 6.8–13.6) in individuals who never smoked (P = 0.228). Individuals who never smoked tended to favour surgical treatment alone (88.0%) more than individuals who smoked (81.3%). The 10-year survival rate was higher in individuals who never smoked (92.6%) than in individuals who smoked (88.8%). Only 15.6% (45/289) of patients with LC met the United States Preventive Services Task Force (USPSTF) criteria for LDCT eligibility, while 29.0% (84/289) met the China guideline for the screening and early detection of lung cancer (CGSL) criteria. Median follow-up for those followed was 25.4 (IQR, 13.7–43.3) months.ConclusionsLDCT screening improves early LC detection and treatment outcomes for both individuals who smoked and individuals who never smoked. Significant differences exist in epidemiology, histologic type, and survival between these groups. The USPSTF and CGSL criteria miss a significant number of LC cases, particularly among individuals who never smoked. Integrating individuals who never smoked into LCS programs is essential, yet it comes with its own challenges, such as managing radiation risks, allocating resources effectively, and considering financial aspects. Consequently, there is an urgent need for LCS programs in China to better identify the “high-risk” non-smoker population susceptible to LC and to ensure that potential risks associated with screening are reduced.

TAVI-related vascular access complications: are Viabahn stents a good option?

Abstract Background Vascular access complications (VACs) remain one of the biggest challenges when performing transcatheter aortic valve implantation (TAVI). Historically, concerns regarding stent placement in flexing points have been a deterrent to the percutaneous treatment of VACs, due to the potential development of claudication over time. The Viabahn stent, being a covered stent that offers flexibility and conformability, may be well-suited for deployment in these anatomies. Purpose This study aimed to evaluate the safety and efficacy of the iliofemoral Viabahn stenting for treating TAVI-related VACs. Methods Retrospective analysis of patients submitted to Viabahn stenting in the iliofemoral sector for TAVI-related VACs in a single tertiary centre between January 2017 and October 2023. Baseline characteristics, procedure data and complications were noted according to the Valve Academic Research Consortium-2. Results A total of 722 patients were submitted to transfemoral TAVI during the study period. Of these, 25 (3.6%) underwent Viabahn stenting to treat TAVI-related VACs and were included in this study. Patient mean age was 82.1±6.13 years, 61.2% were male. At the baseline, patients had a mean Euroscore II of 2.73±1.91. A unilateral access approach was used in 40% of cases. The median size of the main access sheath was 14 Fr [IQ 14-16], and the closure devices deployed were Manta® in 72%, and Perclose® in 28%. The Viabahn stent treated different types of VACS, including vessel rupture in 56%, acute dissection in 28% (12% with no antegrade flow), and failed sealing in 16%. The complicated artery was the common femoral in 82%, and the external iliac in 18%. Percutaneous treatment with Viabahn stenting was successful in 92% of cases. In two cases (8%), one of acute occlusion and one of vessel rupture, vascular surgery was required. During the hospital stay, there were no further vascular or hemorrhagic complications. After a mean follow-up of 15 months, 20% of patients were evaluated by Doppler which showed no signs of restenosis or stent complications. Only one patient experienced lower limb claudication at 1 year due to stent restenosis detected in the CT scan, which was managed with medical therapy. There were no other adverse vascular events during follow-up. Conclusion Our study suggests that Viabahn stenting emerges as a valuable therapeutic option, ensuring long-term safety and efficacy, in the complex realm of TAVI-related vascular complications.

Evaluating the Availability and Accessibility of Agricultural Extension Services Under the Single Spine System in Uganda. A Case of Smallholder Crop Farmers in Buhweju District

Purpose: This study evaluated the availability and accessibility of agricultural extension services under the Single Spine System, with a specific focus on smallholder crop farmers in Buhweju District. Methodology: The study adopted a mixed-methods approach, employing both quantitative and qualitative data collection techniques. Structured questionnaires were administered to a sample of 393 smallholder crop farmers and key informant interviews with district agricultural officers and extension workers provided in-depth insights into the delivery of services. Findings: The results indicate that education was positively and significantly (P&lt;0.01) associated with knowledge about the availability of extension services. Farmers with more years of schooling had a greater likelihood of being aware of extension providers. Similarly, larger households with more labor resources (median size = 4) had better access to extension services. Moreover, household land size (median = 3 acres) and income (median = UGX 250,000) were significantly correlated with both availability and access to extension services, with wealthier farmers seeking more information to improve agricultural productivity. The study also revealed that proximity to extension service centers was a critical factor; households closer to sub-county offices (median distance = 1.5 km) had higher knowledge of available services. Access to credit and group membership were also major determinants of both awareness and access to extension services. Challenges were also identified, including limited outreach by extension officers, inadequate allowances, and insufficient logistical support for field officers. Unique Contribution to Theory, Policy and Practice: The study recommends increased sensitization efforts using local leaders, social media, and community networks, alongside greater support for sub-county agricultural officers to ensure effective service delivery.

Streamlined surgical approach for coexistent urethral stricture and benign prostatic enlargement: feasibility, safety and patency results.

To evaluate the technical feasibility, safety, and patency results of a simultaneous surgical approach to repair urethral stricture and treat benign prostatic enlargement endoscopically in a highly selected group of patients at a tertiary referral center. We hypothesize that this is technically feasible, safe, and does not affect urethroplasty outcomes. A retrospective review of adult men who underwent simultaneous urethroplasty and endoscopic prostatic surgery between May 2017 and May 2024 at our institution was conducted. Patients with strictures < 15 French and prostates with adverse prognostic features of response to medical treatment were included. The primary outcome was technical feasibility and safety. The secondary outcome was stricture-free survival. Twenty men were treated during the study period. The median length of the urethral stricture was 3.0cm (IQR 2.0-5.0), and the median size of the prostate was 95.0cc (IQR 63.3-128.3). All patients were treated successfully with a median operative time of 194.5min (IQR 180.0-246.8), and no procedures required conversion to a staged procedure or open prostatectomy. There were seven Clavien-Dindo I-II complications and one Clavien-Dindo IIIb complication (hematuria requiring endoscopic clot evacuation). At 22months follow-up, two cases of urethral re-stricture were diagnosed, with one case requiring redo urethroplasty, though none had previous major complications. The combination of urethroplasty and endoscopic surgery for benign prostatic enlargement at the same stage appears to be technically viable and safe, and it does not compromise medium-term urethral patency results in a carefully selected group of patients.

Flow Diversion for Intracranial Aneurysms With Incorporated Branch: A Subanalysis From the SEASE International Registry

BACKGROUND The presence of an incorporated branch as well as its anatomical relationship to the intracranial aneurysms (IAs) and the parent artery may affect the occlusion outcome following flow diversion. This study evaluated the safety and effectiveness of the cobalt‐chromium Surpass Evolve (Stryker), a 64‐wire flow diversion device for the treatment of IAs with incorporated branches. METHODS This subanalysis uses data from the SEASE (Safety and Effectiveness Assessment of Surpass Evolve) registry to retrieve data related to IAs with incorporated branches. Those IAs were classified by a core lab into 4 categories based on their anatomical relationship to the parent artery and branch: (A) sidewall anatomic, (B) sidewall hemodynamic, (C) neck branch, and (D) dome branch. We compared the outcomes based on their incorporated branch's relation to the dome (A–C versus D). RESULTS This study included 67 patients and IAs. Most IAs were in the posterior communicating artery (46.3%), with a median size of 4.35 mm. Age, sex, comorbidities, baseline functional‐status, and IA features were similar between the 2 groups. Among those, 53 (79.1%) had branches emerging from the dome, and 14 (20.9%) had branches originating from other locations (A = 7, B = 2, and C = 5). At a median imaging follow‐up of 10.5 months, complete occlusion was lower in IAs with a branch from the sac compared with those with the neck (60.8% versus 92.9%; P = 0.026), with an overall occlusion of 67.7%. Thromboembolic and hemorrhagic complications, as well as retreatment, were reported in 1.6% and 3.1% of cases, respectively, with no significant differences between groups. CONCLUSION Our analysis underscores the influence of branch origin on occlusion rates, with the neck‐originating branch demonstrating higher occlusion rates. These insights emphasize the role of anatomical considerations in treatment strategies, follow‐up timelines, and designing future clinical trials. Further studies are warranted to explore these variations across different flow diversion technologies.

Clinical usefulness of C-reactive protein-albumin-lymphocyte (CALLY) index as a prognostic biomarker in patients undergoing surgical resection of pancreatic cancer.

The C-reactive protein-albumin-lymphocyte (CALLY) index, which simultaneously evaluates the nutritional, immunological, and inflammatory statuses, is a new prognostic biomarker in patients with various cancers; however, no study has reported the clinical significance of the CALLY index in patients with pancreatic cancer. This study aimed to investigate whether the preoperative CALLY index is a prognostic biomarker in patients undergoing surgical resection of pancreatic cancer. We retrospectively enrolled 461 patients with pancreatic cancer who underwent surgical resection between January 2013 and December 2022. The overall survival (OS) and relapse-free survival (RFS) rates were calculated using the Kaplan-Meier method. Univariate and multivariate analyses were performed using Cox proportional hazards regression models. The optimal cut-off value for the preoperative CALLY index was 1.9. In the low CALLY group, patients were older (p = 0.012), more patients underwent pancreaticoduodenectomy (p = 0.002), the median tumor size was larger (p < 0.001), more patients had pathologically confirmed metastatic lymph nodes (p = 0.015) and worse pathological stage (p = 0.015), and fewer patients received adjuvant chemotherapy (p = 0.003). A low CALLY index was associated with decreased OS (22.1 vs. 37.9months) and RFS (12.4 vs. 16.4months). Univariate and multivariate analyses showed that the preoperative CALLY index was an independent prognostic factor for OS (p < 0.001) and RFS (p = 0.045). The preoperative CALLY index is a prognostic biomarker for both OS and RFS in patients undergoing surgery for pancreatic cancer.

Patterns of Dynamic Adaptability of the Circle of Willis in Response to Major Branch Artery Coverage with a Flow Diverter

The plasticity of the Circle of Willis represents an underexplored yet intriguing dimension of vascular anatomy in cerebrovascular disorders. We outline distinct patterns of change in response to aneurysm treatment using flow diversion (FD) after covering major branches. Retrospective analysis of digital subtraction angiographies (DSA) from intracranial aneurysms treated with FD from 2013 to 2023. Vessel diameters, including those covered by the stent and adjacent arteries, were measured. Angiographic changes were evaluated at last imaging follow-up. Of the 622 patients, 49 had angiographic follow-up for pattern assessment. The median age was 62 years; females represented 71.4%. The median size of the treated aneurysms was 4.7mm. Four patterns of angiographic change were identified: (1)Patients with supraclinoid aneurysms, A1-ACA caliber increased (hypoplastic: 1.05 to 2.00 mm; non-hypoplastic: 2.45 to 2.75 mm) after FD coverage of the contralateral ACA. (2)Patients with paraclinoid aneurysms and hypoplastic-fetal P1-PCA, the diameter increased from 0.80 to 1.7 mm (p<0.01) after covering the ipsilateral PComA origin. (3)Patients with basilar-tip and proximal PCA aneurysms showed increased ipsilateral PComA size from 1.2 to 2 mm (p<0.01) after PCA origin coverage. (4)Patients with anterior communicating aneurysms, the diameter of the contralateral hypoplastic A1 segment increased from 1.0 to 1.35 mm (p=0.39) or non-hypoplastic A1-ACA from 2.75 to 3.05 mm (p=0.10) after FD coverage. The circle of Willis displays both hemodynamic and anatomic plasticity after major branch coverage with a flow diverter. This phenomenon is aimed at preserving blood flow in the distal territory of the covered vessel.

Prognostic value of the advanced lung cancer inflammation index in intrahepatic cholangiocarcinoma

IntroductionThe advanced lung cancer inflammation index (ALI), which combines inflammation and nutrition data, was recently proposed as a prognostic biomarker. We assessed the impact of ALI on overall survival (OS) among patients undergoing surgery for intrahepatic cholangiocarcinoma (ICC). MethodsPatients who underwent surgery for ICC were identified from an international cohort. ALI was calculated as body-mass index (BMI)∗albumin/neutrophil-to-lymphocyte ratio; patients were categorized into “low-” and “high-ALI” using log-rank statistics. The impact of ALI on OS was compared against other inflammatory markers (i.e., neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], systemic immune inflammation index [SII = platelets∗NLR]) using Harrell's Concordance index (C-index) and the Akaike Information Criterion (AIC). To minimize intergroup differences, propensity score matching was employed. ResultsAmong 1045 patients, more than one-half of individuals underwent major hepatectomy (n = 582, 55.7 %), median tumor size was 5.5 cm (IQR, 3.8–7.8), and median ALI was 38.9 (IQR 26.5–57.2). On multivariate analysis, low ALI was an independent risk factor for worse OS (HR 1.21, 95 % CI 1.01–1.46; p = 0.04). Patients with low ALI had worse 5-year OS (36.9 % vs. 49.9 %; p < 0.001), which remained significant after PSM (36.9 % vs. 41.3 %; p = 0.039). ALI had a comparable discriminatory ability compared with NLR, PLR, and SII (C-index: 0.646 vs. 0.644 vs. 0.640 vs. 0.641, respectively), yet had a lower AIC (5475.31 vs. 5546.80 vs. 5550.45 vs. 5548.62, respectively) suggesting slightly better model fit and accuracy. ConclusionsALI was an independent predictor of OS among patients undergoing surgery for ICC. Nutritional and inflammatory markers should be incorporated into predictive models to improve prognostic stratification.

Evaluation of colorectal liver metastases using virtual monoenergetic images obtained from dual-layer spectral computed tomography.

To assess the potential of virtual monoenergetic images in assessing colorectal liver metastasis (CRLM) compared with conventional CT images. This single-center, retrospective study included 173 consecutive patients (mean age, 65.5 ± 10.6years; 106 men) who underwent dual-layer spectral CT (DLSCT) between November 2016 and April 2021. Portal venous phase images were reconstructed using hybrid iterative reconstruction (iDose) and virtual monoenergetic imaging at 50keV. Four radiologists independently and randomly reviewed the de-identified iDose and 50keV images. Lesion detection, CRLM conspicuity, and CRLM diagnosis were compared between these images using a generalized estimating equation analysis. The reference standards used were histopathology and follow-up imaging findings. The study included 797 focal liver lesions, including 463 CRLMs (median size, 18.1mm [interquartile range, 10.9-37.7mm]). Lesion detection was better with 50keV images than with iDose images (45.0% [95% confidence interval [CI]: 39-50] vs 40.0% [95% CI: 34-46], P = 0.003). CRLM conspicuity was higher in the 50keV images than in the iDose images (3.27 [95% CI: 3.09-3.46] vs 3.09 [95% CI: 2.90-3.28], P < 0.001). However, the specificity for diagnosing CRLM was lower with 50keV images than with iDose images (94.5% [95% CI: 91.6-96.4] vs 96.0% [95% CI: 93.2-98.1], P = 0.022), whereas sensitivity did not differ significantly (77.6% [95% CI: 70.3-83.5] vs 76.9% [95% CI: 70.0-82.7], P = 0.736). Indeterminate lesions were more frequently noted in 50keV images than in iDose images (13% [445/3188] vs 9% [313/3188], P = 0.005), and 56% (247/445) of the indeterminate lesions at 50keV were not CRLMs. The 50keV images obtained from DLSCT were better than the iDose images in terms of CRLM conspicuity and lesion detection. However, 50keV images did not improve CRLM diagnosis but slightly increased the reporting of indeterminate focal liver lesions associated with CRLMs.

Clinicopathological Characteristics of Small Cell Carcinoma of the Ovary, Hypercalcemic Type – a case Series

Abstract Introduction/Objective Small cell carcinoma of the ovary hypercalcemic type (SCCOHT) is a rare (&amp;lt;0.01%) and aggressive ovarian tumor primarily affecting young women (median of approximately 24 years), characterized by rapid growth, early metastasis, and association with hypercalcemia in two-thirds of cases. The diagnosis of SCCOHT is challenging due to its rarity and lack of specific clinical symptoms or biomarkers. Our study aims to delineate the clinicopathologic characteristics of SCCOHT based on our case series and add to the existing knowledge. Methods/Case Report A retrospective review of University of Pennsylvania Health system pathology database was conducted from 2012 to 2024. Our study identified four patients diagnosed with SCCOHT. Clinical information and histopathologic characteristics were reviewed. Results (if a Case Study enter NA) Among the four patients identified, the median age was 24 years, with a median tumor size of 14.5 cm, and all patients presented with weight loss, abdomen bloating, and elevated CA125 levels. Notably, two patients exhibited hypercalcemia, while one initially presented with normal calcium levels but developed hypercalcemia during disease recurrence. One patient maintained normal calcium levels throughout. Surgical intervention involved bilateral salpingo-oophorectomy in all cases, with pathological staging revealing two patients at pT1a, one at pT1c, and one at pT3c. Histopathological analysis consistently revealed similar morphology, including solid and cystic necrotic neoplasms with diffuse growth or nests/cords of undifferentiated small cells, which displaying vesicular chromatin and prominent nucleoli. Immunohistochemical staining demonstrated loss of BRG1 (SMARCA4) expression in two patients and diffuse positivity for WT1 in all patietns, while negative for cytokeratin, germ cell markers, and melanocytic markers. Genetic test revealed SMARCA4 mutation (p.E 717*, c.3169-1G&amp;gt;A) in one patient. Conclusion Small cell carcinoma of the ovary, hypercalcemic type, presents a diagnostic and therapeutic challenge due to its rarity and aggressive nature. Adequate treatment options are currently limited, highlighting the critical need for further research and development of targeted therapies in SCCOHT. Testing for mutations in the SMARCA4 gene is essential for accurate diagnosis of SCCOHT and may uncover new avenues for treatment and management strategies.

Factors affecting radiation exposure in patients undergoing endoscopic treatment for urolithiasis.

Imaging techniques, such as computed tomography (CT) and fluoroscopy, are essential for the diagnosis and treatment of urolithiasis. There is increasing concern regarding the cumulative radiation dose associated with medical imaging and its adverse effects. This study aimed to assess radiation exposure in patients undergoing endoscopic management of urolithiasis and to identify factors associated with increased exposure.A retrospective analysis of all consecutive symptomatic urolithiasis cases who underwent endoscopic surgery over a two-year period at a tertiary referral center was performed. The cumulative radiation dose was recorded per stone episode, and the effective dose (ED) then calculated. Multivariable regression analysis was performed to determine the association between ED and patient, stone, and procedural characteristics.Between January 2020 and December 2021, 250 patients underwent endoscopic intervention for urolithiasis; 71% (n = 178) were male with a median age of 48 years (IQR 35-59). The median stone size was 6mm (IQR, 5-8mm) and the median stone volume was 110 mm3 (IQR, 60-206 mm3). Most stones were located in the distal ureter (46%, n = 114). The median ED received per stone episode was 3.99 mSv (IQR 2.9-7 mSv). On multivariable analysis, BMI, number of CT scans performed, CT protocol used, and repeat procedures strongly predicted increased radiation dose (p < 0.01).It is important for urologists to consider the cumulative radiation dosage in patients with urolithiasis. Strategies to minimize exposure, such as avoiding re-imaging, low-dose CTs, and collimation of the region of interest with judicious magnification, should be considered during treatment.

Cas9-targeted-based long-read sequencing for genetic screening of RPE65 locus.

Long-read sequencing (LRS) enables accurate structural variant detection and variant phasing. When a molecular diagnosis is suspected, target enrichment can reduce the cost and duration of sequencing. LRS was conducted in five inherited retinal dystrophy (IRD) patients harboring a monoallelic variant in RPE65 that remained uncharacterized after clinical exome sequencing (CES). CRISPR-Cas9 guide RNA probes were designed to target a 31kb region, including the entire RPE65 locus. The DNA was sequenced on a MinION platform. Short-read ×30 whole-genome sequencing (WGS) was performed for five patients to validate nanopore results. The nanopore sequencing process yielded a median of 271 reads within the targeted region, with a mean depth of 109 and a median read size of 8kb. All variants identified by CES have been detected using this approach, and no additional RPE65 gene causative variants were found. Nanopore variant detection demonstrated performance akin to short-read WGS at similar coverage levels, although exhibiting increased false positive calls at lower coverage. In this study, we explore the advantages of using a targeted approach together with long-read sequencing to identify variants associated with IRD. The results underscore the utility of targeted long reads for characterizing patients affected by rare diseases when first-tier diagnostic tests are non-conclusive.

Are Clinically Node-Negative Patients with a Positive Preoperative Axillary Lymph Node Biopsy Appropriate Candidates for Sentinel Lymph Node Biopsy?

Whether cN0 patients with image-detected nodal metastases are appropriate for sentinel lymph node biopsy (SLNB) or should proceed directly to axillary lymph node dissection (ALND) or neoadjuvant chemotherapy (NAC) is controversial. We sought to determine how often ALND is needed with upfront surgery and to identify factors associated with ≥ 3 positive SLNs after a positive preoperative lymph node (LN) biopsy. Patients with cT1-2N0 breast cancer and a positive LN biopsy treated from 2014 to 2022 were identified from a prospective database. Patients who received NAC were excluded. Clinicopathologic characteristics were compared between women with 1-2 positive SLNs and ≥ 3 positive SLNs. Of 90 eligible patients, 66 (73%) had 1-2 positive SLNs and 24 (27%) had ≥ 3 positive SLNs. The median patient age was 62 years, median tumor size was 2.2 cm, and 16 women (18%) received a mastectomy. There was no difference in body mass index, tumor size, histology, grade, multifocality, presence of lymphovascular invasion, and receptor status between groups. On multivariable analysis, having ≥ 3 positive SLNs was associated with > 1 abnormal LN on preoperative imaging (odds ratio [OR] 4.36, 95% confidence interval [CI] 1.47-14.0; p = 0.01), microscopic extracapsular extension in the SLNs (OR 3.83, 95% CI 1.25-13.7; p = 0.025), and a higher median number of SLNs removed (OR 1.42, 95% CI 1.10-1.88; p = 0.01). More than 70% of women with cT1-2 breast cancer with image-detected nodal metastases had < 3 positive SLNs and did not require ALND. To avoid multiple trips to the operating room, frozen section can be considered in women with multiple abnormal LNs on imaging.

CFD-DEM study on the blocking conformation of pre-filled sand control screen by layering method

Preventing screen blockage due to sand poses a significant challenge. The article combines computational fluid dynamics (CFD) and discrete element method (DEM) to establish a fully coupled four-way interaction model. A sophisticated size particle injection model was established, taking into account the particle size distribution (PSD) characteristics of the formation. A layering method was used to study the sand control behavior of a high-performance pre-filled screen. The study also quantitatively investigated the impact of factors such as median sand size (D50), screen structure, and fluid velocity on both wellbore-screen annulus and internal screen plugging patterns. The findings reveal that the sand retention rate within the wellbore-screen annulus exceeds 93.8 %. The risk of pre-filled screen blockage is minimized when the ratio of gravel diameter to sand diameter falls within the range of 3.3–5. At a gravel filling rate of 97 %, fine sand predominantly moves radially, resulting in a low risk of blockage at the screen's entrance layer, thereby favoring oil and gas production. In cases with elevated fine sand content, it is advisable to maintain a production flow rate below 3 m/s to mitigate localized erosion damage caused by increased pressure resulting from screen blockage. This model holds significant importance in optimizing completion tools and production parameters.

Constitutive Pleiotrophin Deletion Results in a Phenotype with an Altered Pancreatic Morphology and Function in Old Mice.

Pleiotrophin (PTN) is crucial for embryonic development and pancreas organogenesis as it regulates metainflammation, metabolic homeostasis, thermogenesis, and glucose tolerance. Pleiotrophin deletion is associated with a lipodystrophic phenotype in which adipose tissue plasticity is altered in late life. This study explored the impact of pleiotrophin deletion on pancreatic morphology and function in later life. We analyzed glucose tolerance and circulating parameters on female wild-type (Ptn+/+) and knock-out (Ptn-/-) mice. At 9 and 15 months, we conducted morphometric analyses of pancreatic islets and evaluated the levels of insulin, glucagon, somatostatin, glucose transporter 2 (GLUT2), vesicle-associated membrane protein 2 (VAMP2), and synaptosome-associated protein 25 (SNAP25) via immunofluorescence. The effect of PTN on glucose-stimulated insulin secretion (GSIS) was evaluated in INS1E cells and isolated islets. Ptn-/- mice showed hyperinsulinemia, impaired glucose tolerance, and increased homeostatic model assessment for insulin resistance (HOMA-IR) with age. While Ptn+/+ islets enlarge with age, in Ptn-/- mice, the median size decreased, and insulin content increased. Vesicle transport and exocytosis proteins were significantly increased in 9-month-old Ptn-/- islets. Islets from Ptn-/- mice showed impaired GSIS and decreased cell membrane localization of GLUT2 whereas, PTN increased GSIS in INS1E cells. Ptn deletion accelerated age-related changes in the endocrine pancreas, affecting islet number and size, and altering VAMP2 and SNAP25 levels and GLUT2 localization leading to impaired GSIS and insulin accumulation in islets.

Initial Patient Characteristics of TSOG 102: A Multicenter Prospective Registry of Active Surveillance in Patients with Multiple Ground Glass Opacities

ObjectivePresentation with multiple ground glass opacities (GGOs) is an increasingly common occurrence, and the optimal management of these lesions is unclear. Active surveillance has been increasingly adopted as a management strategy for other low-grade malignancies. We hypothesized that active surveillance could be a feasible and safe option for patients with multiple GGOs. MethodsPatients with ≥2 GGOs (ground glass predominant, <50% solid, ≤3 cm) were enrolled in a multi-institutional registry and prospectively followed up on active surveillance with computed tomography scans every 6 to 12 months. Each GGO was catalogued and measured individually at each follow-up visit. ResultsTarget accrual was met, with 337 patients from 23 institutions. The mean age was 70 years (interquartile range, 65-77 years), and 74% were women. Most were former (70%) or current (9%) smokers, with a mean exposure of 30 pack-years (interquartile range [IQR], 15-44 pack-years). Half of the patients (51%) had a previous lung cancer, and the majority (86%) were already under surveillance at the time of study entry. The median number of GGOs per patient was 3 (IQR, 2-5), with a total of 1467 GGOs under surveillance. The median GGO size was 0.9 cm (IQR, 0.7-1.3 cm). Most GGOs were 0.5 to 1 cm in size. ConclusionsActive surveillance, rather than immediate intervention, was an acceptable option to patients, and accrual to this registry trial was feasible. Safety endpoints and long-term outcomes will be assessed in the planned 5-year follow-up in accordance with the protocol.

Safety and feasibility of transcatheter closure of atrial septal defects in small children weighing less than 10 kg.

When young patients with an oval fossa defect present early with symptoms of heart failure and pulmonary hypertension, surgical treatment is recommended in small bodyweight rather than transcatheter closure. Outcomes of device closure in consecutive symptomatic children weighing under 10 kg were compared with young children aged below 4 years but weighing above 10 kg. Transthoracic echocardiography under conscious sedation guided the procedure in all without need for balloon sizing, transesophageal echocardiogram, and intubation anaesthesia. Symptoms, anthropometry, shunt ratio, pulmonary pressures, defect and device size, percentage oversizing, device/body weight ratio, complications, and post-procedural growth spurt were compared. Ninety-six patients weighing under 10 kg were compared with 160 patients weighing above 10 kg. In total, 83.3% of patients in the study group and 25% of controls were severely malnourished. The median indexed defect size was 35.2 mm/sq.m and 27.4 mm/sq.m, and the device was oversized by 8.7% and 14.2% in the study group and controls, respectively. The device/body weight ratio was 1.93 in study group and 1.4 in controls. Procedure was successful in all except one patient weighing under 10 kg who had a device embolisation. Both groups showed significant growth spurts and proportion, with severe malnutrition reduced to 42% and 11% in the two groups. Device closure was feasible and safe in patients under 10 kg. Transthoracic echocardiographic imaging on conscious sedation provided adequate guidance. Symptoms and growth significantly improved after intervention. Despite a larger defect size, smaller patients had comparable outcomes. In symptomatic children under 10 kg needing early closure, transcatheter intervention should not be deferred.