Initial Pattern Research Articles

Exploratory data analysis of physicochemical parameters of natural antimicrobial and anticancer peptides: Unraveling the patterns and trends for the rational design of novel peptides.

Peptide-based research has attained new avenues in the antibiotics and cancer drug resistance era. The basis of peptide design research lies in playing with or altering physicochemical parameters. Here in this work, we have done exploratory data analysis (EDA) of physicochemical parameters of antimicrobial peptides (AMPs) and anticancer peptides (ACPs), two promising therapeutics for microbial and cancer drug resistance to deduce patterns and trends. Briefly, we have captured the natural AMPs and ACPs data from the APD3 database. After cleaning the data manually and by CD-HIT web server, further data analysis has been done using Python-based packages, modlAMP and Pandas. We have extracted the descriptive statistics of 10 physicochemical parameters of AMPs and ACPs to build a comprehensive dataset containing all major parameters. The global analysis of datasets has been done using modlAMP to find the initial patterns in global data. The subsets of AMPs and ACPs were curated based on the length of the peptides and were analyzed by Pandas package to deduce the graphical profile of AMPs and ACPs. EDA of AMPs and ACPs shows selectivity in the length and amino acid compositions. The distribution of physicochemical parameters in defined quartile ranges was observed in the descriptive statistical and graphical analysis. The preferred length range of AMPs and ACPs was found to be 21-30 amino acids, whereas few outliers in each parameter were evident after EDA analysis. The derived patterns from natural AMPs and ACPs can be used for the rational design of novel peptides. The statistical and graphical data distribution findings will help in combining the different parameters for potent design of novel AMPs and ACPs.

Climatological features of future MCSs over the Canadian Prairies using convection-permitting climate models

This study explores the potential effects of global warming on Mesoscale Convective Systems (MCSs) initiation and duration in the Canadian Prairies. By utilizing high-resolution convection-permitting climate models (CPCMs), the study examines 15 parameters to identify the most significant factor for predicting future changes, using the Pseudo Global Warming (PGW) approach. The results suggest that the frequency of MCSs will significantly increase in the future, with varying initiation and duration patterns between daytime and nighttime. The study highlights Preciptable Water (PW), Isentropic Potential Vorticity (IPV), and Most Unstable Convective Potential Energy (MUCAPE) as the most significant parameters for long-lived nighttime MCSs, while Relative Humidity at 850 hPa (RH850), PW, and Storm Relative Helicity 0-1 km (SRH1km) are identified as the most significant parameters for long-lived daytime MCSs. The findings are supported by violin plots that show the differences in the distribution of the 15 parameters in the initiation regions of short- and long-lived MCSs. Additionally, this study partially confirms previous research findings, such as the Mountain-plains solenoids, which suggest that increased PW and RH850 in the future are in agreement with increased total precipitation in the northern region. The study emphasizes the importance of utilizing newly released forcing datasets to investigate the potential impact of global warming on MCSs initiation and duration in the Canadian Prairies.

Extended dialogues in establishing children-teacher play: The pattern of initiation–challenge–extension (ICE)

In studies of classroom discourse in early childhood education and care (ECEC), a dominance of the communicative pattern of initiation, response, follow-up (IRF) is shown, and a need of knowledge about extensive dialogue for meaning making is argued. In the present study, communication between children and teacher(s) in play is consider as a form educational discourse mediating language learning. The study, informed by a sociocultural perspective aims to contribute to the knowledge of pattern of establishing a pedagogical dialogue in play activities. What characterizes the communication establishing a joint play in which children come to participate in extensive dialogues is clarified through reanalyzing video-documented data from a project concerning play, learning and teaching in ECEC. The analysis implies a pattern of ICE: children initiating a play (I)—a teacher challenging the initiative (C)—children expanding the content (E). The function of challenging is understood as the critical contribution for opening for and expanding the children’s verbal participation. A conclusion of changing the follow-up from evaluating to expanding in a pedagogical dialogue is recommended to study further in different contexts.

Alteration of Postural Reactions in Rats with Different Levels of Dopamine Depletion.

Dopamine (DA) is the critical neurotransmitter involved in the unconscious control of muscle tone and body posture. We evaluated the general motor capacities and muscle responses to postural disturbance in three conditions: normal DA level (wild-type rats, WT), mild DA deficiency (WT after administration of α-methyl-p-tyrosine-AMPT, that blocks DA synthesis), and severe DA depletion (DAT-KO rats after AMPT). The horizontal displacements in WT rats elicited a multi-component EMG corrective response in the flexor and extensor muscles. Similar to the gradual progression of DA-related diseases, we observed different degrees of bradykinesia, rigidity, and postural instability after AMPT. The mild DA deficiency impaired the initiation pattern of corrective responses, specifically delaying the extensor muscles' activity ipsilaterally to displacement direction and earlier extensor activity from the opposite side. DA depletion in DAT-KO rats after AMPT elicited tremors, general stiffness, and akinesia, and caused earlier response to horizontal displacements in the coactivated flexor and extensor muscles bilaterally. The data obtained show the specific role of DA in postural reactions and suggest that this experimental approach can be used to investigate sensorimotor control in different dopamine-deficient states and to model DA-related diseases.

Initiation Patterns of Disease-Modifying Therapies for Multiple Sclerosis Among US Adults and Children, 2001 Through 2020

Many disease-modifying therapies (DMTs) have been approved for multiple sclerosis (MS) in the past 2 decades. Research evaluating how these approvals have changed real-world prescribing patterns is scarce. To evaluate patterns in DMT initiations between 2001 and 2020 among commercially insured US adults and children with MS. This serial cross-sectional study was conducted from 2001 through 2020 (mean patient enrollment duration, 4.8 years) and used US commercial claims data (MarketScan). Analysis took place between January 2022 and March 2023. Of 287 084 patients with MS identified, 113 583 patients (113 095 adults and 488 children) with MS newly initiated at least 1 DMT. New initiation episode of a DMT, defined as no claim for the same DMT in the previous year. The proportion of total DMT initiations per year attributable to each DMT. Trends in initiations were evaluated annually. The study team identified 153 846 DMT initiation episodes among adults (median age, 46 [IQR, 38-53) years]; 86 133 female [76.2%]) and 583 among children (median age, 16 (IQR, 14-17) years; 346 female [70.9%]). Among adults, use of platform injectables showed an absolute decline of 73.8% over the study period, driven by a 61.2% reduction in interferon β initiations (P < .001 for trend). In contrast, the 2010 introduction of oral DMTs led to a rise in their use from 1.1% (2010) to 62.3% (2020) of all DMT initiations (P = .002 for trend). Infusion therapy initiations remained relatively low, accounting for 3.2% of all initiations since their introduction in 2004 but increased modestly annually after ocrelizumab was introduced (2017), reaching 8.2% of all initiations in 2020 (P < .001 for trend). Children showed similar initiation patterns, except for preferred oral therapy. Between 2019 and 2020, dimethyl fumarate was the most commonly initiated DMT in adults (23.3% to 27.2% of all initiations), while in children fingolimod was the most commonly initiated (34.8% to 68.8%). Current MS treatment guidelines emphasize shared decision-making between patients and clinicians to balance treatment efficacy, safety, cost, and convenience. This study found that oral DMTs were the predominant DMT type initiated by 2020. The cause of this shift cannot be determined from this study, but may reflect several factors, including convenience of administration, direct-to-consumer advertising, or insurance restrictions.

Initial core loading pattern optimization studies using estimation of distribution algorithm for VVER type cores

Innovative fuel management schemes based on evolutionary algorithms (EAs) now form an integral part of design and operation for nuclear reactors. In the present study, Estimation of Distribution Algorithm (EDA) has been developed for light water reactors (LWRs) and as a case study EDA has been applied to optimize the core loading pattern of VVER X2 benchmark’s initial core. EDA belongs to class of EAs where the optimization solution evolves through progress of generations and in each generation sampling of best candidates of previous generation is done. The main objectives of this study is firstly to develop and test EDA to optimize core loading pattern (LP) for VVER type cores and secondly to generate new optimized LPs having same safety features but with improved fuel utilization with respect to reference benchmark case. The most suitable values for internal parameters for EDA like population size (N), percentage best candidates (M) and weighting factor ‘α’ were evaluated for reaching a reasonable optimized solution in computationally efficient way. During this study, a number of optimized initial core loading patterns were generated, where the target parameters and safety limits are met. A comprehensive analysis for selected LPs has been carried out for full cycle and a comparison has been done for the reported safety and operational characteristics. It is observed that a few of the optimized LPs have better fuel economy than the benchmark LP.

Combining TSS-MPRA and sensitive TSS profile dissimilarity scoring to study the sequence determinants of transcription initiation.

Cis-regulatory elements (CREs) can be classified by the shapes of their transcription start site (TSS) profiles, which are indicative of distinct regulatory mechanisms. Massively parallel reporter assays (MPRAs) are increasingly being used to study CRE regulatory mechanisms, yet the degree to which MPRAs replicate individual endogenous TSS profiles has not been determined. Here, we present a new low-input MPRA protocol (TSS-MPRA) that enables measuring TSS profiles of episomal reporters as well as after lentiviral reporter chromatinization. To sensitively compare MPRA and endogenous TSS profiles, we developed a novel dissimilarity scoring algorithm (WIP score) that outperforms the frequently used earth mover's distance on experimental data. Using TSS-MPRA and WIP scoring on 500 unique reporter inserts, we found that short (153 bp) MPRA promoter inserts replicate the endogenous TSS patterns of ∼60% of promoters. Lentiviral reporter chromatinization did not improve fidelity of TSS-MPRA initiation patterns, and increasing insert size frequently led to activation of extraneous TSS in the MPRA that are not active in vivo. We discuss the implications of our findings, which highlight important caveats when using MPRAs to study transcription mechanisms. Finally, we illustrate how TSS-MPRA and WIP scoring can provide novel insights into the impact of transcription factor motif mutations and genetic variants on TSS patterns and transcription levels.

Transcriptional response of Cu-deficient barley (Hordeum vulgare L.) to foliar-applied nano-Cu: Molecular crosstalk between Cu loading into plants and changes in Cu homeostasis genes

For safe and effective nutrient management, the cutting-edge approaches to plant fertilization are continuously developed. The aim of the study was to analyze the transcriptional response of barley suffering from Cu deficiency to foliar application of nanoparticulate Cu (nano-Cu) and its ionic form (CuSO4) at 100 and 1000 mg L−1 for the examination of their supplementing effect. The initial interactions of Cu-compounds with barley leaves were analyzed with spectroscopic (ICP-OES) and microscopic (SEM-EDS) methods. To determine Cu cellular status, the impact of Cu-compounds on the expression of genes involved in regulating Cu homeostasis (PAA1, PAA2, RAN1, COPT5), aquaporins (NIP2.1, PIP1.1, TIP1.1, TIP1.2) and antioxidant defense response (SOD CuZn, SOD Fe, SOD Mn, CAT) after 1 and 7 days of exposure was analyzed. Although Cu accumulation in plant leaves was detected overtime, the Cu content in leaves exposed to nano-Cu for 7 days was 44.5% lower than in CuSO4 at 100 mg L−1. However, nano-Cu aggregates remaining on the leaf surface indicated a potential difference between measured Cu content and the real Cu pool present in the plant. Our study revealed significant changes in the pattern of gene expression overtime depending on Cu-compound type and dose. Despite the initial puzzling patterns of gene expression, after 7 days all Cu transporters showed significant down-regulation under Cu-compounds exposure to prevent Cu excess in plant cells. Conversely, aquaporin gene expression was induced after 7 days, especially by nano-Cu and CuSO4 at 100 mg L−1 due to the stimulatory effect of low Cu doses. Our study revealed that the gradual release of Cu ions from nano-Cu at a lower rate provided a milder molecular response than CuSO4. It might indicate that nano-Cu maintained better metal balance in plants than the conventional compounds, thus may be considered as a long-term supplier of Cu.

(058) Attention to Genital Cues Scale - Principal Components Analysis and Correlational Validity

Abstract Introduction The Attention to Genital Cues (AGC) scale was developed to characterize respondents’ usual experience observing genital sensations by capturing perceived prevalence, ease, and value of being aware of genital cues (Handy &amp; Meston, 2016, 2018). The scale has been predominantly used in the literature as a descriptive measure (A. Handy, personal communication, October 13, 2020). However, there appears to be no published data for using it in quantitative statistical analyses. Quantitative information about genital cue observation may be useful, as it has been reported that awareness of these sensations is salient for some women’s sexual arousal (Meston &amp; Stanton, 2018). Objectives The objective of this investigation was to explore the psychometric properties of the AGC scale. Methods This was a secondary data analysis of 2018 data collected from student and community participants regarding genital arousal sensations. The current investigation focused on responses to the AGC scale, which consists of an initial skip pattern question followed by four scored items and a free-text response (Handy &amp; Meston, n.d.). The sample was limited to women who endorsed usually paying attention to genital cues when sexually engaged and/or aroused (N = 491). A principal components analysis was performed on the four scored items to determine whether the items comprised a single factor; bivariate correlations were calculated to determine convergent and discriminant validity as well as to explore other potential associations of interest. Variables used for the latter analysis were subscales of the Multidimensional Assessment of Interoceptive Awareness scale (Mehling et al., 2012), which measures bodily mindfulness (noticing, not-distracting, not-worrying, attention regulation, emotional awareness, self-regulation, body listening, and trusting); the arousal subscale of the Female Sexual Function Index (Rosen et al., 2000); and the tiredness and negative arousal subscales of the Four Dimensional Mood Scale (Huelsman et al., 1998). Results A principal components analysis produced a .62 Kaiser-Meyer-Olkin measure of sampling adequacy, which surpassed the value of .50 suggested as adequate by Kaiser (1970), and a significant Bartlett’s test of sphericity (χ2 (6) = 311.15, p &amp;lt; .00) (Barlett, 1950). All of the item loadings were above .40 (.56 - .82) on a single factor for genital attending; therefore, rotation was not necessary. Reliability for the measure was adequate (α = .64), especially given the relatively small number of items. There was some support for the measure’s convergent validity: the AGC was positively associated with attention regulation (r = .12, p &amp;lt; .01), noticing (r =.19, p &amp;lt; .00), and sexual arousal (r = .198, p &amp;lt; .009). However, a significant association was not found between AGC and body listening (r = .03, p &amp;lt; .47). AGC scores were not significantly related to dispositional tiredness (r = .03, p &amp;lt; .54) or negative affect (r = -.12, p &amp;lt; .01), demonstrating discriminant validity. Additionally, age (r = .18, p &amp;lt; .00), self-regulation (r = .11, p &amp;lt; .02), and trusting (r = .10, p &amp;lt; .02) were significantly correlated with AGC scores. Conclusions The AGC scale has adequate psychometric properties to function as a single factor scale. This measure may be useful in future quantitative investigations focused on sexual psychophysiology, sexual functioning, or bodily mindfulness. Disclosure No.

Video characteristics for remote recognition of agonal respiration: A pilot study

AimThe mobile network quality in ambulances can be variable and limited. This pilot study aimed to identify a suitable network setting for recognizing agonal respiration under limited network conditions. MethodsWe recruited five emergency medical technicians, and each participant viewed 30 real-life videos with different resolutions, frame rates, and network scenarios. Thereafter, they reported the respiration pattern of the patient and identified agonal respiration cases. The time at which agonal respiration was identified was also recorded. The answers provided by the five participants were compared with those of two emergency physicians to compare the accuracy and time delay in breathing pattern recognition. ResultsThe overall accuracy for initial respiratory pattern recognition was 80.7% (121/150). The accuracy for normal breathing was 93.3% (28/30), for not breathing was 96% (48/50), and for agonal breathing was 64.3% (45/70). There was no significant difference in successful recognition between video resolutions. However, the rate of time delay in recognizing agonal respiration less than 10 seconds between 15-fps group and 30-fps group had statistical significance (21% vs 52%, p = 0.041). ConclusionThe frame rate emerges as one of critical factors in agonal respiration recognition through telemedicine, outweighing the significance of video resolution.

The predictive role of early childhood dysregulation profile on the parallel growth trajectories of reading and math performance across elementary and middle school

This study examined the heterogeneity in the co-developmental trajectories of reading and math performance (i.e., parallel changes in the initial scores and growth patterns) and identified the number, size and shape of the co-developmental trajectory across elementary and middle schools. In addition, this investigation focused on how an early childhood dysregulation profile (DP; indexed by a high co-occurrence of emotional, behavior, and attention problems) was associated with distinct co-developmental trajectories of reading and math performance. Specifically, we examined whether early childhood DP level can predict (a) membership assignment into each distinct co-development group and (b) variability in initial scores and changes in growth with each distinct co-development group. Participants were 784 academically at-risk students (47 % girls) predominantly from low socioeconomic status families who were recruited in first grade (Mean age = 6.57 years) and followed annually through the final year of middle school (ninth grade). Results revealed two distinct co-developmental trajectories of reading and math performance, including (a) a lower initial reading (higher increasing) and higher initial math (lower increasing) class (85.3 %) and (b) a lower initial math (higher increasing) and higher initial reading (lower increasing) class (14.7 %). Our results provided evidence for the compensatory pattern of co-developmental trajectories, indicating initial lower skills grow at a faster rate than the initial high. Further, early childhood DP was not associated with the membership assignment for these two distinct classes, which means that regardless of children’s early DP level, they have equal chances to be assigned to each of the classes. However, children with higher parent and teacher-reported DP in first grade demonstrated lower initial scores and a slower improvement rate in both classes after controlling for kindergarten literacy skills, gender, ethnicity, intelligence, socioeconomic status, and grade retention. Our study findings demonstrated (a) substantial heterogeneity in the co-developmental trajectories of reading and math performance across elementary and middle school ages; and (b) the importance of promoting self-regulation beginning in early childhood, especially for academically at-risk children in families facing economic challenges.

Molecules that Generate Fingerprints: A New Class of Fluorescent Sensors for Chemical Biology, Medical Diagnosis, and Cryptography.

ConspectusFluorescent molecular sensors, often referred to as "turn-on" or "turn-off" fluorescent probes, are synthetic agents that change their fluorescence signal in response to analyte binding. Although these sensors have become powerful analytical tools in a wide range of research fields, they are generally limited to detecting only one or a few analytes. Pattern-generating fluorescent probes, which can generate unique identification (ID) fingerprints for different analytes, have recently emerged as a new class of luminescent sensors that can address this limitation. A unique characteristic of these probes, termed ID-probes, is that they integrate the qualities of conventional small-molecule-based fluorescent sensors and cross-reactive sensor arrays (often referred to as chemical, optical, or electronic noses/tongues). On the one hand, ID-probes can discriminate between various analytes and their combinations, akin to array-based analytical devices. On the other hand, their minute size enables them to analyze small-volume samples, track dynamic changes in a single solution, and operate in the microscopic world, which the macroscopic arrays cannot access.Here, we describe the principles underlying the ID-probe technology, as well as provide an overview of different ID-probes that have been developed to date and the ways they can be applied to a wide range of research fields. We describe, for example, ID-probes that can identify combinations of protein biomarkers in biofluids and in living cells, screen for several protein inhibitors simultaneously, analyze the content of Aβ aggregates, as well as ensure the quality of small-molecule and biological drugs. These examples highlight the relevance of this technology to medical diagnosis, bioassay development, cell and chemical biology, and pharmaceutical quality assurance, among others. ID-probes that can authorize users and protect secret data are also presented and the mechanisms that enable them to hide (steganography), encrypt (cryptography), and prevent access to (password protection) information are discussed.The versatility of this technology is further demonstrated by describing two types of probes: unimolecular ID-probes and self-assembled ID-probes. Probes from the first type can operate inside living cells, be recycled, and their initial patterns can be more easily obtained in a reproducible manner. The second type of probes can be readily modified and optimized, allowing one to prepare various different probes from a much wider range of fluorescent reporters and supramolecular recognition elements. Taken together, these developments indicate that the ID-probe sensing methodology is generally applicable, and that such probes can better characterize analyte mixtures or process chemically encoded information than can the conventional fluorescent molecular sensors. We therefore hope that this review will inspire the development of new types of pattern-generating probes, which would extend the fluorescence molecular toolbox currently used in the analytical sciences.

Adjacent Fracture Rates Following Balloon Kyphoplasty in Osteoporotic Vertebral Compression Fractures: A Case Series.

Background Osteoporotic vertebral compression fractures (OVCF) represent a substantial concern, as they are associated with significant increases in morbidity and mortality. One option for the management of these patients is balloon kyphoplasty, in which a balloon is inflated within the collapsed vertebral body. Following this, the cavity is filled with polymethyl methacrylate (PMMA) cement to restore height and strength. Although this procedure has been shown to have great effectiveness, one complication that has been documented is an adjacent level refracture. This is thought to be due to the increased relative strength of the repaired vertebral body. Our study aims to quantify the rates of adjacent level refracture following balloon kyphoplastyas well as identify factors that may be associated with this event. Methods We reviewed the electronic medical records (EMR) of patients that underwent balloon kyphoplasty between January 1, 2017 and August 1, 2020. A single surgeon performed all procedures. Only adult patients who received a diagnosis of osteoporosis based on a history of fragility fracture or bone mineral density measurement were included. Patients with additional or confounding bone conditions, such as malignancy or other lytic lesions, were excluded. Data were analyzed in SPSS(IBM Corp., Armonk, NY, United States). Results We included 89 patients in our study. We observed an adjacent level refracture prevalence of 13.5% (n=12). We observed a significant increase in refracture rates among patients with unsatisfactory resolution of symptoms following initial balloon kyphoplasty, from 8.2% for satisfactory resolution of symptoms to 43.8% for those with unsatisfactory resolution. (p-value 0.011). Additionally, all 12 patients with adjacent level refractures occurred among patients with complex, multiple-level initial fracture patterns. Conclusions The treatment of OVCF with balloon kyphoplasty is a well-documented and effective method. The prevalence of adjacent-level refracture may be linked to several variables such as the initial fracture pattern. More research is needed to better predict refracture and improve patient outcomes.

Riding a Mechanical Scooter from the Inconvenient Side Promotes Muscular Balance Development in Children

Mechanical scooter riding is a popular physical activity among children, but little is known about the differences in muscle loading between the dominant and non-dominant sides during this activity. The objective of this study was to identify the muscle activation patterns in children’s dominant and non-dominant legs as they rode scooters on the convenient and inconvenient sides. The study included nine healthy children aged 6–8. The participants rode 20 m on a mechanical scooter at a self-selected pace using both the convenient and inconvenient sides. Electromyography was used to measure the muscle activity in the dominant and non-dominant legs during the pushing and gliding phases. A 20 m sprint run was used as a control exercise to estimate the typical differences in muscle activation between the dominant and non-dominant legs. In the pushing phase, the symmetry index for five of the eight analyzed muscles exceeded 50% (p &lt; 0.05); four of these muscles were more active in the pushing leg, and one was more active in the standing leg. In the gliding phase, four muscles were more active in the standing leg, and one was more active in the pushing leg (p &lt; 0.05). Upon observing children who changed sides while riding a scooter, it was found that the pattern of muscle activation displayed a reverse trend that resembled the initial pattern. Our study indicated notable differences in muscle activity patterns between the dominant and non-dominant sides of individual leg muscles during children’s scooter riding. These patterns were reversed when children switched sides on the scooter. These findings suggest that using both legs and switching sides while riding a scooter may be a viable strategy for promoting balanced muscular development.

How to find the perfect application pattern for adhesively bonded joints?

Adhesive bonding has become increasingly popular in the manufacturing industry due to its many advantages. However, the need to completely fill the joint gap with adhesive for optimum force transfer remains a significant challenge. To ensure full gap filling and therefore joint integrity, safety critical applications often require the adhesive to flow beyond the bonded edges. Due to inadequate design of this process, the adhesive volume that escapes is often more than 30–50% of the adhesive volume. This current practice represents a suboptimal way of proceeding, which the current paper may mitigate.As a result, excessive amounts of adhesive are typically applied due to the lack of suitable models for predicting the flow and final distribution of the adhesive, including the excess amount. This limitation has hindered progress in adhesive bonding technology, and urgent action is needed to address this issue.This paper offers a solution to the significant challenge of predicting adhesive flow and distribution in manufacturing applications. The authors have developed and validated a model that allows the simulation of these complex processes. The paper goes further to present initial application patterns aimed at minimising adhesive waste while ensuring the full filling of the overlap. To achieve this, the authors employ a procedure that involves an advanced reverse squeeze flow simulation to derive an optimal application pattern from a simple initial design. It turns out that a wide range of different final distributions can be produced by a variety of initial star-shaped forms. This paper represents a significant contribution to adhesive bonding technology for anyone interested in manufacturing efficiency.

Use of nongynecologic cytologic-histologic correlation to identify patterns of error: An institutional experience.

Quality management practices empower cytology laboratories to deliver consistent, high-quality patient care. Monitoring of key performance indicators is one way by which laboratories can identify patterns of error and focus their improvement activities. Cytologic-histologic correlation (CHC) identifies error by retrospectively reviewing cytology cases when discordant surgical pathology diagnoses are reported. Analysis of CHC data can elucidate patterns of error and direct quality improvement initiatives. CHC data of nongynecologic cytology specimens were reviewed over a 3-year period (2018-2021). Errors were separated by anatomic site and classified as either sampling or interpretive errors. A total of 364 discordant cases were identified out of 4422 cytologic-histologic pairs (a discordant rate of 8%). The majority (272; 75%) were sampling errors, with fewer interpretive errors (92; 25%). Sampling errors were found to occur most commonly in lower urinary tract and lung. Interpretive errors were most commonly found in lower urinary tract and thyroid. Nongynecologic CHC data can be a valuable resource for cytology laboratories. By studying the types of errors, quality improvement activities can be targeted toward problem areas.

Transverse posterior wall acetabular fracture pattern is associated with increased risk of periprosthetic joint infection after conversion total hip arthroplasty

IntroductionAcetabular fracture subtypes are associated with varying rates of subsequent conversion total hip arthroplasty (THA) after open reduction internal fixation (ORIF) with transverse posterior wall (TPW) patterns having a higher risk for early conversion. Conversion THA is fraught with complications including increased rates of revision and periprosthetic joint infections (PJI). We aimed to determine if TPW pattern is associated with higher rates of readmissions and complications including PJI after conversion compared to other subtypes. MethodsWe retrospectively reviewed 1,938 acetabular fractures treated with ORIF at our institution from 2005 to 2019, of which 170 underwent conversion that met inclusion criteria, including 80 TPW fracture pattern. Conversion THA outcomes were compared by initial fracture pattern. There was no difference between the TPW and other fracture patterns in age, BMI, comorbidities, surgical variables, length of stay, ICU stay, discharge disposition, or hospital acquired complications related to their initial ORIF procedure. Multivariable analysis was performed to identify independent risk factors for PJI at both 90-days and 1-year after conversion. ResultsTPW fracture had higher risk of PJI after conversion THA at 1-year (16.3% vs 5.6%, p = 0.027). Multivariable analysis revealed TPW independently carried increased risk of 90-day (OR 4.89; 95% CI 1.16–20.52; p = 0.03) and 1-year PJI (OR 6.51; 95% CI 1.56–27.16; p = 0.01) compared to the other acetabular fracture patterns. There was no difference between the fracture cohorts in 90-day or 1-year mechanical complications including dislocation, periprosthetic fracture and revision THA for aseptic etiologies, or 90-day all-cause readmission after the conversion procedure. ConclusionAlthough conversion THA after acetabular ORIF carry high rates of PJI overall, TPW fractures are associated with increased risk for PJI after conversion compared to other fracture patterns at 1-year follow-up. Novel management/treatment of these patients either at the time of ORIF and/or conversion THA procedure are needed to reduce PJI rates. Level of evidenceTherapeutic Level III (retrospective study of consecutive patients undergoing an intervention with analyses of outcomes).

Clinical characteristics and initial treatment patterns of patients with HCC in Korea: A multi-center real-world database analysis from the LINK research network.

e16116 Background: In Korea, liver cancer is the fifth most frequently diagnosed cancer and has the second highest cancer mortality rate. Despite recent advances in systemic therapy, patients with Hepatocellular carcinoma (HCC) continue to have poor prognoses as many are diagnosed at an advanced disease stage. To better understand the current treatment landscape and contribute to improved patient outcomes, the LINK (Liver Cancer in Korea) research network was established as a longitudinal real-world HCC database with annual data refresh. The aim was to provide current and up-to-date real-world insights into HCC patient characteristics, treatment patterns, and outcomes. Methods: LINK’s data sources are the electronic medical records of three leading academic hospitals (Asan Medical Center, Samsung Medical Center, Severance Hospital). Extracted data are standardized using a study-specific common data model to ensure comparability across hospitals. Adult patients with primary diagnosis of HCC (ICD-10: C22.0) in 2015-2020 were included and followed until death, loss to follow-up, or June 2021, whichever occurred first. Patients without valid treatment records or morphology codes or with other primary cancer diagnosis were excluded. Data on key patient and clinical characteristics, treatments, such as systemic anti-cancer therapy (SACT) regimens, and real-world outcomes were collected. Rule-based algorithms were developed to define initial treatments and lines of therapy in palliative SACT. Results: Of 25,480 HCC patients identified, 10,298 (40%) met eligibility criteria and were included in the analysis. The median age was 60 years and 19% were female. There were 74% of patients classified as Child-Pugh (CP) class A, 16% as B, 1% as C, and 9% with unknown CP at diagnosis. For albumin-bilirubin (ALBI) grade at diagnosis, 49% of patients were classified as grade 1, 45% as 2, 5% as 3, and 1% unknown. Loco-regional therapy was the most common initial treatment, with 54% and 13% of patients receiving transarterial therapy and local ablation therapy, respectively. A total of 628 patients (6%) undergone liver transplantation regardless of preceding treatments and 15% of patients were initially treated with hepatectomy. Only 2% received radiation therapy (RT) or RT in combination with cytotoxic chemotherapy as initial treatment. Among 3,026 patients who received SACT either as an initial (10%) or subsequent treatment, 67%, 20%, and 13% received 1 line, 2 lines, and 3 lines of therapy. The most common first-line SACT was sorafenib, followed by lenvatinib. Conclusions: The LINK database can serve as a multi-center research platform to facilitate fast and reliable real-world evidence generation for HCC patients. Future updates and subgroup analyses of interest can further evaluate the impact of new therapies and changes to HCC treatment guidelines in Korea.

Borderzone Infarcts and Recurrent Cerebrovascular Events in Symptomatic Intracranial Arterial Stenosis: A Systematic Review and Meta-Analysis.

Intracranial arterial stenosis (ICAS)-related stroke occurs due to three primary mechanisms with distinct infarct patterns: (1) borderzone infarcts (BZI) due to impaired distal perfusion, (2) territorial infarcts due to distal plaque/thrombus embolization, and (3) plaque progression occluding perforators. The objective of the systematic review is to determine whether BZI secondary to ICAS is associated with a higher risk of recurrent stroke or neurological deterioration. As part of this registered systematic review (CRD42021265230), a comprehensive search was performed to identify relevant papers and conference abstracts (with ≥20 patients) reporting initial infarct patterns and recurrence rates in patients with symptomatic ICAS. Subgroup analyses were performed for studies including any BZI versus isolated BZI and those excluding posterior circulation stroke. The study outcome included neurological deterioration or recurrent stroke during follow-up. For all outcome events, corresponding risk ratios (RRs) and 95% confidence intervals (95% CI) were calculated. A literature search yielded 4,478 records with 32 selected during the title/abstract triage for full text; 11 met inclusion criteria and 8 studies were included in the analysis (n=1,219 patients; 341 with BZI). The meta-analysis demonstrated that the RR of outcome in the BZI group compared to the no BZI group was 2.10 (95% CI 1.52-2.90). Limiting the analysis to studies including any BZI, the RR was 2.10 (95% CI 1.38-3.18). For isolated BZI, RR was 2.59 (95% CI 1.24-5.41). RR was 2.96 (95% CI 1.71-5.12) for studies only including anterior circulation stroke patients. This systematic review and meta-analysis suggests that the presence of BZI secondary to ICAS may be an imaging biomarker that predicts neurological deterioration and/or stroke recurrence.

The Impact of Midodrine Tapering Versus Nontapering Regimens on the Clinical Outcomes of Critically Ill Patients: A Retrospective Cohort Study.

Midodrine has been used in the intensive care unit (ICU) setting to reduce the time to vasopressor discontinuation. The limited data supporting midodrine use have led to variability in the pattern of initiation and discontinuation of midodrine. To compare the effectiveness and safety of 2 midodrine discontinuation regimens during weaning vasopressors in critically ill patients. A retrospective cohort study was conducted at King Abdulaziz Medical City. Included patients were adults admitted to ICU who received midodrine after being unable to be weaned from intravenous vasopressors for more than 24 hours. Patients were categorized into two subgroups depending on the pattern of midodrine discontinuation (tapered dosing regimen vs. nontapered regimen). The primary endpoint was the incidence of inotropes and vasopressors re-initiation after midodrine discontinuation. The incidence of inotropes or vasopressors' re-initiation after discontinuation of midodrine was lower in the tapering group (15.4%) compared with the non-tapering group (40.7%) in the crude analysis as well as regression analysis (odd ratio [OR] = 0.15; 95% CI = 0.03, 0.73, P = 0.02). The time required for the antihypertensive medication(s) initiation after midodrine discontinuation was longer in patients who had dose tapering (beta coefficient (95% CI): 3.11 (0.95, 5.28), P = 0.005). Moreover, inotrope or vasopressor requirement was lower 24 hours post midodrine initiation. In contrast, the two groups had no statistically significant differences in 30-day mortality, in-hospital mortality, or ICU length of stay. These real-life data showed that tapering midodrine dosage before discontinuation in critically ill patients during weaning from vasopressor aids in reducing the frequency of inotrope or vasopressor re-initiation. Application of such a strategy might be a reasonable approach among ICU patients unless contraindicated.