Median Speed Research Articles

Promoting application of enhanced recovery after surgery protocols during perioperative localized abdominal and thoracic neuroblastomas.

To investigate the safety and efficacy of the application of enhanced recovery after surgery (ERAS) protocols in the perioperative period of abdominal and thoracic localized neuroblastomas (NBs). In this retrospective study, 68 children with NBs who underwent surgical resection of the tumor were enrolled. The ERAS protocols for NB excision were implemented in the ERAS group (n = 39) and the consequences were compared with children treated with traditional care (n = 29, TRAD group). The main outcomes of our interest included the incidence of surgery-related complications, the postoperative length of stay (LOS), and the Face/Legs/Activity/Cry/Consolability (FLACC) quantitative table from postoperative days (POD) 1-5. We also evaluated the median intraoperative fluid volume and anesthesia recovery time; blood glucose levels at the beginning of anesthesia, POD1, and 3; WBC counts, CRP values, and the concentration of plasma nutritional indicators on POD1 and 3; time of early ambulation, first anal exhaust, total enteral nutrition (TEN), and discontinue intravenous infusion postoperatively; usage proportion and duration of abdominal and thoracic drainages, nasogastric decompression tubes and urinary catheters; cost of hospitalization, parental satisfaction rate, and readmission rate of surgery ward within 30days. Compared to the TRAD group, the ERAS group had lower surgery-related complications, albeit not significantly (P > 0.05); the median postoperative LOS decreased from 11.0 to 8.0days (P < 0.001), the LOS of abdominal NB was significantly shortened (P < 0.001) compared to thoracic NB (P = 0.07) between the two groups; the FLACC scores decreased significantly from POD1-5 (all P < 0.01). The ERAS group had an improved median intraoperative infusion speed (5.0mL/kg/h vs 8.0mL/kg/h), time of early ambulation (1.0days vs 3.0days), first anal exhaust (2.0days vs 2.0days), TEN (5.0 vs 7.0days), discontinuation of intravenous infusion (5.0days vs 8.0days), and total cost of hospitalization (33,897.2 Yuan vs 38,876.3 Yuan); (all P < 0.01). The usage proportion and duration of surgical drainages and tubes were apparently reduced. The mean blood glucose level was higher at the beginning of anesthesia but lower on POD1 and 3 in the ERAS group (P < 0.01). No statistically significant difference was detected in WBC counts and concentrations of hemoglobin and albumin between the two groups of patients (P > 0.05), while the concentrations of prealbumin on POD3 were higher and the CRP level on POD1 was lower in the ERAS group than the TRAD group (P < 0.01). The satisfaction rate of parents was only slightly higher, but the difference was not statistically significant (P = 0.730). No obvious differences were observed in the aspects of NB resection (P = 0.462) and 30-day readmissions of surgery ward (P = 1.000). The application of ERAS protocols has a significant potential to accelerate perioperative rehabilitation in children undergoing abdominal and thoracic NBs' surgical resection.

The efficacy and safety of per-nasal "GTS partner" assisted traction technique for gastric endoscopic submucosal dissection: a prospective single-center randomized clinical trial.

Since the snare traction-assisted ESD has been proven effective in treating flat lesions of the digestive tract, we modified and innovated the process and path of the traditional snare entering the digestive tract, aiming to investigate the efficacy and safety of using the per-nasal "GTS partner" assisted traction technology in gastric ESD. Patients with superficial gastric neoplasms were prospectively enrolled between November 2022 and May 2024 and randomly assigned to a conventional ESD (C-ESD) group or per-nasal "GTS partner" traction-assisted ESD (GTS-ESD) group. The primary outcomes were procedure time and dissection speed. The GTS-ESD and C-ESD groups included 40 patients each, and all the enrolled patients underwent the assigned treatment. The median procedure time in the GTS-ESD group was shorter than that in the C-ESD group (38min vs. 48min; P < 0.001), and the mean resection speed of the GTS-ESD group was faster than that of the C-ESD group (17.95 mm2/min vs. 11.86 mm2/min; P = 0.033). The median resection speed of lesions ≥ 20mm was faster by GTS-ESD than by C-ESD (21.21 mm2/min vs. 12.83 mm2/min, P = 0.002). The en bloc resection rate (100% vs 100%) and R0 resection rate (100% vs. 97.5%) were similar between the two groups. There were no adverse events related to the per-nasal "GTS partner" assisted traction technology, and the traction technology had little interference with the endoscopist. The per-nasal "GTS partner" assisted traction technique can significantly shorten the gastric ESD procedure time and has the advantages of no damage to normal mucosa and adjustable traction direction, especially in the lower 1/3 of the stomach or lesions with a diameter of ≥ 20mm.

Thermodynamic Evolution of Plumes

Plumes are considered to play an important role in the origin of the solar wind. However, an understanding of their thermodynamic evolution is not complete. Here, we perform a detailed study of a plume inside a coronal hole throughout its lifetime, using the observations from the Atmospheric Imaging Assembly and the Helioseismic and Magnetic Imager. We find that the plume’s formation is preceded by frequent occurrences of small-scale jets and jetlets at its base, leading to the gradual development of plume haze. The plume rapidly developed within the first 6 hr into its well-known morphology. Light curves from all extreme ultraviolet channels exhibit a similar profile, suggesting its multithermal nature and intensity modulation over its lifespan. Moreover, the photospheric magnetic field dynamics at the plume’s base are highly correlated with its light curve in 171 Å. We calculate outflow velocities, observed prominently in the 171 Å passband and mildly in the 193 and 211 Å passbands, with median speeds lower in higher temperature bands but occasionally comparable to the respective sound speeds. When data are averaged over larger spatial scales, the plume appears isothermal along its length, with constant temperature throughout its lifetime. However, an analysis of the differential emission measure at full resolution reveals the presence of higher-temperature plasma, indicating internal temperature structures within the plume. These results provide new insights into the formation, dynamics, and thermal properties of coronal plumes, placing tighter constraints on models to understand their thermodynamic evolution and potential role in the solar wind.

Role of Walking Energetics and Perceived Fatigability Differs by Gait Speed: The Study of Muscle, Mobility and Aging (SOMMA).

Slower gait speed may be driven by greater energy deficits and fatigability among older adults. We examined associations of walking energetics and perceived physical fatigability with gait speed among slower and faster walkers. Additionally, we used statistical mediation to examine the role of fatigability in the associations of walking energetics and gait speed using the Study of Muscle, Mobility and Aging (SOMMA). Perceived physical fatigability was assessed using the Pittsburgh Fatigability Scale (PFS) Physical score (range 0-50, higher = greater). A 3-phase cardiopulmonary exercise treadmill test collected peak oxygen consumption (VO2peak, mL/kg/min), energetic cost of walking (ECW, mL/kg/m), and cost-capacity ratio (VO2/VO2peak*100, %). Slower (<1.01 m/s) versus faster (≥1.01 m/s) walkers were classified using median 4-m gait speed. Linear regressions and statistical mediation analyses were conducted. Slower walkers had lower VO2peak, higher ECW at preferred walking speed (PWS), and greater PFS Physical score compared to faster walkers (all p < .05; N = 849). One standard deviation (1-SD) higher VO2peak was associated with 0.1 m/s faster gait speed, while 1-SD higher ECW PWS, cost-capacity ratio at PWS and slow walking speed (SWS), and PFS Physical score were associated with 0.02-0.23 m/s slower gait speed. PFS Physical score was a significant statistical mediator in the associations between VO2peak (15.2%), SWScost-capacity ratio (15.9%), and ECW PWS (10.7%) with gait speed and was stronger among slower walkers. Slower walkers may be more influenced by perceptions of fatigue in addition to walking energetics. Our work highlights the importance of targeting both energetics and perceived fatigability to prevent mobility decline.

Artificial intelligence model for automated surgical instrument detection and counting: an experimental proof-of-concept study

BackgroundRetained surgical items (RSI) are preventable events that pose a significant risk to patient safety. Current strategies for preventing RSIs rely heavily on manual instrument counting methods, which are prone to human error. This study evaluates the feasibility and performance of a deep learning-based computer vision model for automated surgical tool detection and counting.MethodsA novel dataset of 1,004 images containing 13,213 surgical tools across 11 categories was developed. The dataset was split into training, validation, and test sets at a 60:20:20 ratio. An artificial intelligence (AI) model was trained on the dataset, and the model’s performance was evaluated using standard object detection metrics, including precision and recall. To simulate a real-world surgical setting, model performance was also evaluated in a dynamic surgical video of instruments being moved in real-time.ResultsThe model demonstrated high precision (98.5%) and recall (99.9%) in distinguishing surgical tools from the background. It also exhibited excellent performance in differentiating between various surgical tools, with precision ranging from 94.0 to 100% and recall ranging from 97.1 to 100% across 11 tool categories. The model maintained strong performance on a subset of test images containing overlapping tools (precision range: 89.6–100%, and recall range 97.2–98.2%). In a real-time surgical video analysis, the model maintained a correct surgical tool count in all non-transition frames, with a median inference speed of 40.4 frames per second (interquartile range: 4.9).ConclusionThis study demonstrates that using a deep learning-based computer vision model for automated surgical tool detection and counting is feasible. The model’s high precision and real-time inference capabilities highlight its potential to serve as an AI safeguard to potentially improve patient safety and reduce manual burden on surgical staff. Further validation in clinical settings is warranted.

Solar Eruptive Phenomena Associated with Solar Energetic Electron Spectral Types

The energy spectral shape of solar energetic electron events carries important information on the energetic electron source/acceleration at the Sun. We investigate the association of six newly identified solar energetic electron spectral types with solar eruptive phenomena, including the downward double-power-law (DDPL) spectrum with break energy E B above 20 keV (DDPL EB≥20keV ), DDPL with E B below 20 keV (DDPL EB<20keV ), upward double-power law (UDPL), single-power-law (SPL), Ellision–Ramaty–like (ER), and logarithmic-parabola (LP). We find that the SPL type shows (the other five types show) an association with hard X-ray flares of ∼38% (∼55%–82%) and an association with west-limb coronal mass ejections (CMEs) of ∼76% (∼85%–93%). Among the other five types, the DDPL EB<20keV and ER (LP and DDPL EB≥20keV ) types only have an association with type II radio bursts of ∼7%–8% (∼16%–20%) and an association with halo CMEs of ∼5%–9% (∼11%–21%); however, the UDPL type exhibits a significant (∼47% and ∼50%) association with type II bursts and halo CMEs, with a significantly faster median CME speed of 1000−120+550 km s−1. For DDPL EB≥20keV (DDPL EB<20keV ) with a positive (no) correlation between spectral indexes and no (a positive) correlation between the spectral index and break energy, the spectrum appears to be flatter as the associated CME (flare) becomes faster (stronger). These results suggest that the SPL type can result from the initial acceleration process that likely occurs high in the corona, and then provide seed populations for further acceleration processes to form the other five types: the DDPL EB<20keV and ER types via flare-related processes, the LP and DDPL EB≥20keV types via CME-related processes, and the UDPL type via CME-driven shocks.

Successful treatment of staghorn stones with flexible ureteroscopy and thulium fiber laser (TFL) lithotripsy: initial experience with 32 cases

PurposeTo investigate the efficacy and safety of flexible ureteroscopy with thulium fiber laser lithotripsy for management of renal staghorn stones.Materials and MethodsThirty-two patients with staghorn stones were recruited. Stone characteristics including: width, length, volume and density were analyzed. Ablation speed, laser efficacy and laser activity were recorded. The primary outcome was to assess stone free rate after the procedure using spiral CT scan.ResultsThe median stone volume was 7339 (3183–53838) mm3. Median operative and lasing time were 135 (70–200) and 117 (50–180) minutes, respectively. The mean total energy delivered was 63.9 ± 30 KJ with a median ablation speed of 1.3 (0.5–4.9) mm3/sec. Mean laser efficacy was 7.5 ± 3.6 Joules/mm3. A total of 12 complications occurred in 8 patients (25%). The median hospital stay was 7 (3.5–48) hours and 30 patients (93.7%) were discharged on the same day of surgery. After the first session, seventeen patients (53%) were stone free with no residual fragments while six (19%) patients had residuals £ 2 mm. Nine patients (28%) had residuals > 2 mm with median residual size of 4 (3–9) mm. A second intervention was required in 4 cases.The overall stone free rate after completion of treatment was 65.6%.ConclusionFlexible ureteroscopy with thulium fiber laser lithotripsy is a safe and effective treatment option for staghorn stones with stone free rate comparable to standard PCNL with advantages of minimal morbidity, minimal blood loss and shorter hospital stay.

Reference Values for Habitual and Fast Gait Speed in Singapore Adults Aged 21 to 80.

Objectives: Gait speed indicates the individual's functional status and predicts overall health. This study aims to determine (1) the intra- and inter-rater and test-retest reliability of the dynamic 4 m gait speed test protocol; (2) establish the normative reference values of habitual and fast gait speeds in community-dwelling healthy Singaporean adults aged 21 to 80; and (3) explore the association of age, gender, height, weight, and body mass index (BMI) on gait speed. Methods: This prospective cross-sectional study recruited healthy ambulatory community-dwelling Singaporeans aged 21 to 80 who could ambulate independently without aid. Participants were excluded if they required walking aids; were pregnant; or had physical, medical, or cognitive conditions that may affect gait. Each participant completed at least two habitual and fast gait speed test trials via a 4 m walkway with a dynamic start. The data were analysed by descriptive statistics, the Mann-Whitney test, the Spearman coefficient, and the interclass correlation coefficient (ICC). Results: In total, 178 males and 201 females were included in the data analysis. The median age was 45.0 years [interquartile range (IQR) 26.2-59.0], and the median height was 1.64 metres (m) (IQR 1.58-1.70). The median habitual gait speed was 1.08 metre/second (m/s) (IQR 0.97-1.22), and the fast gait speed was 1.55 m/s (IQR 1.40-1.70). The ICC for reliability ranged from 0.84 to 0.99, indicating that the 4 m gait speed test had good-to-excellent reliability. Conclusions: Gait speeds were not influenced by gender but declined with age advancement. Age and height and age and BMI were weakly correlated to habitual and fast gait speed, respectively. We established the norm values for the 4 m gait speeds in Singapore and proved it to be a reliable gait speed assessment ready for immediate community applications.

A multicenter, retrospective study of a through-the-needle injection–capable electrosurgical knife for endoscopic submucosal dissection

Endoscopic submucosal dissection (ESD) is a technically challenging resection technique for en bloc removal of dysplastic and early cancerous GI lesions. We conducted a single-arm retrospective study evaluating the safety and efficacy of a new through-the-needle injection-capable electrosurgical knife used in upper and lower ESD procedures performed at 6 U.S. academic centers. Data were retrospectively collected on consecutive cases in which the new ESD knife was used. The primary efficacy endpoint was successful ESD (en bloc resection with negative margins). Secondary efficacy endpoints included en bloc resection rate, curative resection rate, median ESD time, and median dissection speed. The safety endpoint was device- or procedure-related serious adverse events. ESD procedures of 581 lesions in 579 patients were reviewed, including 187 (32.2%) upper GI and 394 (67.8%) lower GI lesions. Prior treatment was reported in 283 (48.9%) patients. Successful ESD was achieved in 477 (82.1% of 581) lesions-lower for patients with versus without submucosal fibrosis (73.6% vs 87.0%, respectively; P< .001) but similar for those with versus without previous treatment (81.7% vs 82.3%, respectively; P= .848). A total of 443 (76.2% of 581) lesions met criteria for curative resection. Median ESD time was 1.0 (range, 0.1-4.5) hour. Median dissection speed was 17.1 (interquartile range, 5.3-29.8) cm2/h. Related serious adverse events were reported in 15 (2.6%) patients, including delayed hemorrhage (1.9%), perforation (0.5%), or postpolypectomy syndrome (0.2%). A newly developed through-the-needle injection-capable ESD knife showed a good success rate and excellent safety at U.S. (Clinical trial registration number: NCT04580940.).

Dome-type extracorporeal manual morcellation during laparoscopic uterine surgery: Two years’ experience in a teaching hospital

ObjectiveThis study aims to describe the dome-type manual morcellation technique, a modified form of C-type incision, its comparative advantages over existing morcellation methods, the perioperative outcomes of trainees with varying experience levels, and the variables influencing morcellation speed based on our two years of experience. MethodsThis retrospective cohort study included women who underwent laparoscopic myomectomy or hysterectomy using dome-type morcellation for tissue extraction at a tertiary teaching hospital between May 2020 and September 2022. Morcellation was performed by either a single surgeon or a trainee (resident). Basic patient characteristics, perioperative outcomes, and morcellation time and speed were compared between the surgeon and trainee group. Regression models were employed to analyze variables influencing morcellation speed. ResultsA total of 41 women were enrolled. Among them, 20 procedures were performed by a surgeon alone, while the remaining 21 procedures were completed by trainees under the surgeon's supervision. The median weight of the specimens was 378 g (range 91–1345 g), and the median time for morcellation was 10 min (range 1–55 min). The median morcellation speed of surgeon and trainees was 70.25 and 31.7 g/min, respectively. Trainees' level of experience was found to be associated with morcellation speed, particularly for soft specimens. Additionally, both incision size and specimen stiffness were significantly associated with morcellation speed. No morcellation-related complications or bag ruptures were observed. ConclusionDome-type manual morcellation is an intuitive, efficient and safe method for specimen removal and is easy to learn for beginners.

A study on the design of a deep learning model for classroom based on user participation and game chemistry processes

In gamified learning, user engagement has always been an important concern in the field of education. For mass learning, the integration of classroom learning and gamification can make users well-stimulated and help them to improve and cultivate their comprehensive abilities. With the characteristics of efficiency, fairness, and objectivity, online assessment systems (OJ systems) have become an important tool for learning. However, the following limitations still exist in current OJ systems: First, most OJ systems cannot perceive and quantify the user’s learning level at the knowledge point level. This can lead to a mismatch between the difficulty of study questions adapted by the system to the user and the user’s learning ability; second, most OJ systems lack research and design of motivation methods. These limitations can negatively affect the enhancement of students’ motivation and the consolidation and improvement of their learning ability. Given this, the article designs and implements a gamified online assessment system (Game_OJ) based on user participation and the game chemistry process. The online assessment system uses a modified Bayesian knowledge tracking model (CC-BKT). The application of the Bayesian knowledge tracking model can accurately perceive and quantify students’ learning of each knowledge point. The online assessment system introduces the gamification idea to design the motivation methods in the OJ system, including the design of gamification elements and the design of the challenge process of gamified learning, aiming to enhance students’ motivation to learn. It promotes students’ deep learning in the classroom and outside the classroom. The CC-KPT model proposed in this paper has an average increase of 2.15 % in AUG value and an average increase of 3.25 % in accuracy compared to the same type of model, and the speed of response and the median speed of processing demand of this system is within 1 s when 500 users use the system at the same time, which meets the needs of on-campus teaching scenarios.

Tropical cyclone low-level wind speed, shear, and veer: sensitivity to the boundary layer parametrization in the Weather Research and Forecasting model

Abstract. Mesoscale modeling can be used to analyze key parameters for wind turbine load assessment in a large variety of tropical cyclones. However, the modeled wind structure of tropical cyclones is known to be sensitive to the boundary layer scheme. We analyze modeled wind speed, shear, and wind veer across a wind turbine rotor plane in the eyewall and outer cyclone. We further assess the sensitivity of wind speed, shear, and veer to the boundary layer parametrization. Three model realizations of Typhoon Megi are analyzed over the open ocean using three frequently used boundary layer schemes in the Weather Research and Forecasting (WRF) model. All three typhoon simulations reasonably reproduce the cyclone track and structure. The boundary layer parametrization causes up to 15 % differences in median wind speed at hub height between the simulations. The simulated wind speed variability also depends on the boundary layer scheme. The modeled median wind shear is smaller than or equal to 0.11 used in the current IEC (International Electrotechnical Commission) standard regardless of the boundary layer scheme for the eyewall and outer cyclone region. However, up to 43.6 % of the simulated wind profiles in the eyewall region exceed 0.11. While the surface inflow angle is sensitive to the boundary layer scheme, wind veer in the lowest 400 m of the atmospheric boundary layer is less affected by the boundary layer scheme. Simulated median wind veer reaches values up to 1.7×10-2° m−1 (1.2×10-2° m−1) in the eyewall region (outer cyclone region) and is relatively small compared to moderate-wind-speed regimes. On average, simulated wind speed shear and wind veer are highest in the eyewall region. Yet strong spatial organization of wind shear and veer along the rainbands may increase wind turbine loads due to rapid changes in the wind profile at the turbine location.

A prospective multicenter feasibility study of a miniaturized implantable continuous flow ventricular assist device in smaller children with heart failure

There is no FDA-approved left ventricular assist device (LVAD) for smaller children permitting routine hospital discharge. Smaller children supported with LVADs typically remain hospitalized for months awaiting heart transplant-a major burden for families and a challenge for hospitals. We describe the initial outcomes of the Jarvik 2015, a miniaturized implantable continuous flow LVAD, in the NHLBI-funded Pumps for Kids, Infants, and Neonates (PumpKIN) study, for bridge-to-heart transplant. Children weighing 8 to 30 kg with severe systolic heart failure and failing optimal medical therapy were recruited at 7 centers in the United States. Patients with severe right heart failure and single-ventricle congenital heart disease were excluded. The primary feasibility endpoint was survival to 30 days without severe stroke or non-operational device failure. Of 7 children implanted, the median age was 2.2 (range 0.7, 7.1) years, median weight 10 (8.2 to 20.7) kilograms; 86% had dilated cardiomyopathy; 29% were INTERMACS profile 1. The median duration of Jarvik 2015 support was 149 (range 5 to 188) days where all 7 children survived including 5 to heart transplant, 1 to recovery, and 1 to conversion to a paracorporeal device. One patient experienced an ischemic stroke on day 53 of device support in the setting of myocardial recovery. One patient required ECMO support for intractable ventricular arrhythmias and was eventually transplanted from paracorporeal biventricular VAD support. The median pump speed was 1600 RPM with power ranging from 1-4 Watts. The median plasma free hemoglobin was 19, 30, 19 and 30 mg/dL at 7, 30, 90 and 180 days or time of explant, respectively. All patients reached the primary feasibility endpoint. Patient-reported outcomes with the device were favorable with respect to participation in a full range of activities. Due to financial issues with the manufacturer, the study was suspended after consent of the eighth patient. The Jarvik 2015 LVAD appears to hold important promise as an implantable continuous flow device for smaller children that may support hospital discharge. The FDA has approved the device to proceed to a 22-subject pivotal trial. Whether this device will survive to commercialization remains unclear because of the financial challenges faced by industry seeking to develop pediatric medical devices. (Supported by NIH/NHLBI HHS Contract N268201200001I, clinicaltrials.gov 02954497).

Tidal current power in Capalulu strait, North Maluku: A feasibility study

The Indonesian government has set goals for increasing the use of renewable energy in the coming years. Currently, Indonesia relies heavily on non-renewable energy sources, which poses a threat to the environment due to the country's growing energy needs. This study aims to assess the potential for developing a tidal power plant in Capalulu Strait, North Maluku. Using hydrodynamic modelling, the study identified two potential locations at coordinates 1.877°S – 125.328°E (Capa-2) and 1.863°S – 125.323°E (Capa-4) which were selected for having median current speeds exceeding 1.8 m/s and maximum current speeds exceeding 3.5 m/s. The study tested a hypothetical implementation of KHPS Gen5 instrument(s) by Verdant Power, a 5 m diameter turbine with a rated nominal power of 37 kW and a maximum rated power of 56 kW. A power plant layout was designed to be placed at Capa-2 and Capa-4, each location accommodating 45 turbines. The development of this power plant is estimated to produce up to 22 GWh per year. Financial analysis resulted in a LCOE of IDR 5,930/kWh. However, this price is still high compared to the national electricity tariff of IDR 1,027.70/kWh. Variations in the number of turbines also may not result in a lower LCOE than the national tariff. Nevertheless, the estimated cost of generating electricity is still competitive compared to diesel, which is around IDR 5,804/kWh.

Fast and accurate variant identification tool for sequencing-based studies

BackgroundAccurate identification of genetic variants, such as point mutations and insertions/deletions (indels), is crucial for various genetic studies into epidemic tracking, population genetics, and disease diagnosis. Genetic studies into microbiomes often require processing numerous sequencing datasets, necessitating variant identifiers with high speed, accuracy, and robustness.ResultsWe present QuickVariants, a bioinformatics tool that effectively summarizes variant information from read alignments and identifies variants. When tested on diverse bacterial sequencing data, QuickVariants demonstrates a ninefold higher median speed than bcftools, a widely used variant identifier, with higher accuracy in identifying both point mutations and indels. This accuracy extends to variant identification in virus samples, including SARS-CoV-2, particularly with significantly fewer false negative indels than bcftools. The high accuracy of QuickVariants is further demonstrated by its detection of a greater number of Omicron-specific indels (5 versus 0) and point mutations (61 versus 48–54) than bcftools in sewage metagenomes predominated by Omicron variants. Much of the reduced accuracy of bcftools was attributable to its misinterpretation of indels, often producing false negative indels and false positive point mutations at the same locations.ConclusionsWe introduce QuickVariants, a fast, accurate, and robust bioinformatics tool designed for identifying genetic variants for microbial studies. QuickVariants is available at https://github.com/caozhichongchong/QuickVariants.

Structural performance and fragility assessment of elevated residential buildings during 2017–2018 hurricanes in Texas and Florida

Elevating coastal houses on columns or piles is recognized as an effective technique for reducing the risks of flooding and storm surges. However, recent hurricanes have exposed a potential vulnerability in this approach, as many elevated residential structures sustained significant wind damage even at wind speeds below the current design level. Elevating a structure increases its exposure to stronger winds and leads to potential changes in the wind effects due to the air gap beneath the floor. However, there has been limited research comparing the performance of actual constructed elevated and slab-on-grade residential structures during realistic wind events. To fill this gap, authors utilized publicly available building performance datasets, collected by the Structural Extreme Events Reconnaissance (StEER) Network and others, to extract data on the performance of 851 elevated and 1536 slab-on-grade residential houses impacted by Hurricanes Irma, Harvey, and Michael. Effects of several key parameters were analyzed in terms of the intensity and distribution of the damage experienced by the different components. Furthermore, empirical fragility functions were developed for different roof shapes and cladding materials by combining the estimated wind speed that affected each structure and the assigned damage ratios for the roof and wall claddings. Analysis using the Wilcoxon rank-sum test demonstrated a statistically significant difference in the median wind speeds of various damage states of the components in both elevated and slab-on-grade houses. Additionally, a significant difference was observed in Texas slab-on-grade houses which experienced either no, minor, moderate, or severe damage, compared to their Florida counterparts. Results showed that elevated houses experience more damage than their slab-on-grade counterparts regardless of the roof shape, cladding materials, and construction age. Additionally, results showed that the elevated houses built in Texas exhibit the highest level of vulnerability among the various housing groups studied. Specifically, the percentage of elevated houses in Texas that experienced destroyed damage state surpassed those of slab-on-grade houses in Texas and elevated houses in Florida by 343 % and 166 %, respectively. The paper identified several knowledge gaps, and it emphasized the need for further experimental tests of building components and different building geometries to improve existing risk models.

Novel gastric endoscopic submucosal dissection training model enhances the endoscopic submucosal dissection skills of trainees: a multicenter comparative study.

Endoscopic submucosal dissection (ESD) requires high endoscopic technical skills, and trainees should develop effective training methods. In collaboration with KOTOBUKI Medical, we developed the G-Master, which is a non-animal training model that can simulate various parts of gastric ESD. We aimed to clarify the usefulness of the G-Master for inexperienced ESD trainees. We collected data from the first 5 gastric ESD cases conducted by 15 inexperienced ESD trainees at 5 participating centers between 2018 and 2022. The participants were divided into two groups: the G-Master training and non-G-Master training groups. Outcome measurements, such as procedural speed, perforation rate, self-completion rate, and en bloc resection rate, were compared between the two groups retrospectively. A total of 75 gastric ESD cases were included in this study. The G-Master training group included 25 cases performed by 5 trainees, whereas the non-G-Master training group included 50 cases performed by 10 trainees. The median procedural speed for all cases was significantly faster in the G-Master training group than in the non-G-Master training group. Moreover, the procedural speed was linearly improved from the initial to the last cases in the lower location in the G-Master training group compared with the non-G-Master training group. In addition, although there was no significant difference, the G-Master training group showed lower rates of perforation and a lesser need to transition to expert operators than the non-G-Master training group. The G-Master could improve the ESD skills of inexperienced ESD trainees.

Plasma metabolites and physical function in patients undergoing hemodialysis

Impaired physical function contributes to falls, fractures, and mortality among patients undergoing dialysis. Using a metabolomic approach, we identified metabolite alterations and effect size-based composite scores for constructs of impaired gait speed and grip strength. 108 participants incident to dialysis had targeted plasma metabolomics via liquid chromatography-mass spectrometry and physical function assessed (i.e., 4 m walk, handgrip strength). Physical function measures were categorized as above/ below median, with grip utilizing sex-based medians. To develop composite scores, metabolites were identified via Wilcoxon uncorrected p < 0.05 and effect size > 0.40. Receiver operating characteristic analyses tested whether scores differentiated between above/below function groups. Participants were 54% male, 77% Black and 53 ± 14 y with dialysis vintage of 101 ± 50 days. Median (IQR) grip strength was 35.5 (11.1) kg (males) and 20 (8.4) kg (females); median gait speed was 0.82 (0.34) m/s. Of 246 measured metabolites, composite scores were composed of 22 and 12 metabolites for grip strength and gait speed, respectively. Area under the curve for metabolite composite was 0.88 (gait) and 0.911 (grip). Composite scores of physical function performed better than clinical parameters alone in patients on dialysis. These results provide potential pathways for interventions and needed validation in an independent cohort.

A prospective randomized trial comparing the pocket-creation method and conventional method of endoscopic submucosal dissection in early gastric cancers and precancerous lesions

BackgroundEndoscopic submucosal dissection (ESD) is widely used as a standard treatment regimen for early gastric cancers (EGCs). However, such an approach is time consuming and has a high risk of perforation and bleeding in some corner-site lesions because of the obscured view and difficulty in submucosal lifting. The newly developed pocket-creation method (PCM) provides a clearer view and better traction of the submucosal layer than conventional ESD (c-ESD). Nevertheless, no prospective randomized study has evaluated the efficacy of the PCM in EGCs and precancerous lesions. MethodsThis was a prospective randomized controlled trial. Patients with superficial gastric neoplastic lesions ≥ 20 mm were randomly assigned to the PCM-ESD group or c-ESD group. The primary outcome was dissection speed. ResultsThere were 28 patients in the PCM-ESD group and 27 in the c-ESD group. The median dissection speed was significantly higher in the PCM-ESD group than in the c-ESD group (21.5 mm2/min vs 14.3 mm2/min, P < .001). Meanwhile, the operation time in the PCM-ESD group was significantly shorter than that in the c-ESD group (30 vs 40 min, P = .047). In multiple linear regression analysis, the treatment method was independently associated with the resection speed of ESD. ConclusionPCM-ESD was an effective and safe treatment for EGCs and precancerous lesions.

Association between peripheral and respiratory muscle strength and gait speed in the elderly is not mediated by peripheral muscle blood flow

BackgroundThe aging process affects different systems, including the musculoskeletal and respiratory systems. Both systems seem to be interconnected in relation to functional capacity deterioration in the elderly. Therefore, this study aimed to evaluate the association between peripheral and respiratory muscle strength with gait speed and its possible mediation by leg muscle blood flow (LBF) in the elderly. MethodsPeople aged over 65 years, of both sexes and clinically stable were evaluated. Gait speed was evaluated by the 4.6 m walking test. Maximal inspiratory pressure (MIP) and expiratory pressure (MEP) by manuvacuometry, Handgrip strength by a dynamometer (Jamar®) and LBF by venous occlusion plethysmography. ResultsWe included 110 patients with mean age 76.9 ± 7.2 years, 56 (50.9 %) were women, 72 (67.9 %) were classified as frail by Fried criteria and 22 (20.0 %) reported the regular practice of exercise. Baseline mean values of MIP was 59.5 ± 23.8 and MEP 68.2 ± 23.8. The median gait speed was 0.88 m/s, handgrip strength 19.5 Kg/f and LBF 2.7 ml/min/100 ml. Further analysis showed a significant association between gait speed and handgrip strength with MIP (p = 0.005, p = 0.013, respectively). However, no mediation by LBF were found. ConclusionThere is a strong association between gait speed and handgrip strength with MIP without mediation by LBF.