American Society Research Articles

Award-winning Fruit Publication in ASHS Journals across the Decades (1986–2023)

Established in 1903, the American Society for Horticultural Science (ASHS) is a leading professional organization that serves a diverse horticultural community. With influence spanning both national and global domains, ASHS makes substantial contributions to various branches of horticulture. In 1985, ASHS introduced the annual Fruit Publication Award to honor exceptional research articles related to fruit. Reflecting on these awarded articles, especially in light of ASHS’s 120-year history, not only serves as a congratulatory gesture to the recipients but also provides insight into the evolutionary progression of fruit science.

Twenty-five Years of Award-winning Education Publication Excellence in ASHS Journals

The American Society for Horticultural Science Education Publication Excellence award was established in 1997 to recognize the most outstanding publication in ASHS journals related to education and teaching. This article reviews the award history, authors, and topics of the awarded papers. The award was recognized annually from 1998 to 2023 except for 3 years when no award was given. The majority of awarded papers were published in HortTechnology. Awards were presented to 70 authors from 23 institutions in 20 states and two other countries. Of the awarded papers, three had single authors, and 20 had multiple authors. Several awarded authors have been recognized in other ASHS publication awards or professional career awards. The majority of awarded papers focused on undergraduate students, teaching methods, and floriculture or ornamental topics.

Thirty-six Years of Award-winning Vegetable Publication Excellence in ASHS Journals

The American Society for Horticultural Science (ASHS) Vegetable Publication Award, established in 1985, recognizes the author(s) of the outstanding paper on vegetable crops each year published in ASHS journals by an ASHS member. The goal is to encourage better quality research and more effective communication through writing and publication. Manuscripts published in any of the three ASHS journals are eligible to receive the award. To date, of the 36 awarded papers, 86.5% of the awarded papers were published in the Journal of the American Society for Horticultural Science and 13.5% in HortScience, and no publications in HortTechnology have received the award. Authors from 25 states have received the Vegetable Publication Award, with Florida having the most recipients (eight), followed by California (four), Wisconsin (four), Michigan (three), and Illinois (three). In addition, the Vegetable Publication Award has been presented to papers with authors from Israel (two), Canada (two), and one each from Belgium, Brazil, China, Italy, Japan, and the Netherlands. There is some association between commodities that were the subject of the awarded papers and the highest value vegetable commodities in the United States. Eight of the awarded papers reported studies on tomato (ranked first for value in the United States), four on lettuce (ranked second), and three each on broccoli, (ranked fifth) and sweet corn (ranked seventh). Most of the awarded papers covered topics related to plant physiology and response to stress (18 papers), followed by breeding and genetic resources (eight papers); nutraceuticals, aroma, and volatiles (five papers); genetics and gene mapping (three papers); postharvest (two papers); and only one winning paper focused on production systems.

The Most Outstanding—Recognizing Achievements through ASHS Publication Awards: A Brief History of Publications and an Introduction to Publication Awards

The American Society for Horticultural Science (ASHS) has since its inception published annual serial monographs or journals to achieve its mission of communicating horticultural science. To recognize the accomplishments of the membership, a series of professional awards was created. After the individual awards, the ASHS created publication awards. This paper, and the papers that follow, document the publication awards of the ASHS. The papers were based on presentations at the 2023 annual conference and serve as additional recognition of the contributions of member authors and as a historical record of achievements of the ASHS.

Investigation of Mechanical Properties of Natural Fiber Reinforced Hybrid Composite

Abstract: Hybrid composite is a material composed of matrix and two or more reinforcements. Two or more reinforcements in hybrid composite replace the limitation of conventional composites by providing uniform strength to thematerial. Recently, natural fibers reinforced hybrid composites are gaining increased interest due to the encouraging properties of natural fibers such as high strength to weight ratio, low cost, no harm to environment etc. Many studies dealt with natural fibers based composite reported that the hybrid composites has the potential to replace glass fiber based composites and to reduce the weight of conventional composite. This project reports on the manufacturing of the Indian elm and Acacia fibre reinforced epoxy composite laminate as per the ASTM (American Society for Testing and Materials) Standards. This laminate consists of matrix and reinforcement. Epoxy is used as a structural matrix material which is then reinforced by Indian elm fiber, combining Acacia fibres with resin matrix results in composites that are strong, lightweight, corrosion-resistant and dimensionally stable. They also provide good design flexibility, high dielectric strength and act as inflammable materials. Their tremendous strength-to-weight and design flexibility make them ideal in structural components for the aerospace industry. In this project the Indian elm and Acacia fibre reinforced epoxy composite is manufactured into two different parts each having ratios of Indian elm and Acacia fibre to epoxy resin as 60:40, 40:60 respectively and are compared for ultimate tensile strength, impact strength, hardness strength and flexural strength of the material by conducting experiment such as tensile test, flexural test, hardness test and impact test.

Double Half Purse-String Sutures Plus "8" Pattern of Stitching for Prevention of Duodenal Stump Fistula after Laparoscopic Gastrectomy.

Background: Duodenal stump fistula represents an infrequent but serious complication after laparoscopic radical gastrectomy with Billroth II or Roux-en-Y reconstruction for gastric cancer. The present study was designed to evaluate the effectiveness of laparoscopic double half purse-string sutures plus "8" pattern of stitching for reinforcement of duodenal stump. Methods: The data of patients undergoing laparoscopic radical gastrectomy with Billroth II or Roux-en-Y reconstruction were retrospectively analyzed between August 2022 and June 2023. According to the different reinforcement methods of duodenal stump, included patients were subdivided into three groups as follows: Group A, duodenal stump was treated with double half purse-string sutures plus "8" pattern of stitching; Group B, duodenal stump was reinforced by continuous suture using a barbed suture; and Group C, duodenal stump without any additional processing. The incidences of duodenal stump fistula between three groups were documented and compared. Moreover, the independent risk factors associated with duodenal stump fistula were analyzed using the logistic regression analysis. Results: No postoperative duodenal stump fistula occurred in Group A, which was significantly different from Group B and Group C (P = .007). In the multivariate analysis, age (odds ratio [OR], 1.191; 95% confidence interval [CI], 1.088-1.303), body mass index (OR, 0.824; 95% CI, 0.727-0.935), and American Society of Anesthesiologists score (OR, 4.495; 95% CI, 1.264-15.992) were the risk factors for duodenal stump fistula. Conclusion: Double half purse-string sutures plus "8" pattern of suture can be conducted in a relatively short operation period and could prevent the incidence of duodenal stump fistula to some extent.

Experimental investigation of 3D printed polylactic acid and polylactic acid – hydroxyapatite composite through material extrusion technique for biomedical application

In biomedical industries, composite additive manufacturing are employed for customization, quicker production, efficient use and capital reduction. This experimental work focuses on the development of poly lactic acid (PLA) and novel extruded hydroxyapatite (HA) reinforced poly lactic acid (HPLA) by material extrusion (ME) technique and their properties were compared with that of standard 3D printed PLA. The extruded composite filaments were subjected to thermal characterization (DSC, TGA) and chemical characterization (FTIR) to ensure filament quality and its implementation in ME technique for 3D printing process. In addition, the melt compounded composite filaments were subjected to annealing to observe the influence of heat treatment upon their mechanical properties and thereby to validate their potential to resist breakage during ME process. Taguchi orthogonal array method using MiniTab software is employed to execute the parameter optimization for the 3D printing process. The 3D printed tensile, flexural and impact specimens, using pure PLA and extruded composite filaments, as per American Society for Testing and Materials (ASTM) standards were subjected to a comparative experimental study which showed that 3D printed specimens using PLA and HPLA performed better than that of standard PLA specimens due to the improvement in their crystalline nature. The ruptured specimens were subjected to microstructural characterization (optical microscopy, SEM) to observe failure modes and ash content test was conducted to validate the homogenous distribution HA filler particles in PLA matrix. In addition, mechanical characterization was also performed on 3D printed bone plate/bone scaffold application using extruded filaments of PLA and HPLA, as per ASTM F543 standards, to validate incorporation of the composite filaments in real-time application in biomedical industry.

Clinical networking results in continuous improvement of the outcome of patients with acute promyelocytic leukemia.

The introduction of all-trans retinoic acid (ATRA) combined with anthracyclines has significantly improved the outcomes for patients with acute promyelocytic leukemia (APL), and this strategy remains the standard of care in countries where arsenic trioxide is not affordable. However, data from national registries and real-world databases indicate that low- and middle-income countries (LMIC) still face disappointing results, mainly due to high induction mortality and suboptimal management of complications. The American Society of Hematology established the International Consortium on Acute Leukemias (ICAL) to address this challenge through international clinical networking. Here, we present the findings from the ICAPL study involving 806 patients with APL recruited in Brazil, Chile, Paraguay, Peru, and Uruguay. The induction mortality rate has decreased to 14.6% compared to the pre-ICAL rate of 32%. Multivariable logistic regression analysis revealed as factors associated with induction death: age ≥ 40 years, ECOG = 3, high-risk status based on the PETHEMA/GIMEMA classification, albumin level ≤ 3.5 g/dL, bcr3 PML/RARA isoform, the interval between presenting symptoms to diagnosis exceeding 48 hours, and the occurrence of central nervous system and pulmonary bleeding. With a median follow-up of 53 months, the estimated 4-year overall survival (OS) rate is 81%, the 4-year disease-free survival (DFS) rate is 80%, and the 4-year cumulative incidence of relapse (CIR) rate is 15%. These results parallel those observed in studies conducted in high-income countries, highlighting the long-term effectiveness of developing clinical networks to improve clinical care and infrastructure in LMIC.

Technical Aspects and Outcome of Multi-Staged and Single-Staged Thoracoabdominal Fenestrated Endovascular Aortic Repair.

In some cases of endovascular thoracoabdominal or juxtarenal aortic aneurysm repair, a thoracic endograft in combination with a fenestrated renovisceral device may be needed in order to create a sufficient proximal landing zone. This study aimed to evaluate the technical aspects and postoperative morbidity of a single- or 2-stage approach. Eighty-seven consecutive patients undergoing thoracic endovascular aortic repair (TEVAR) in combination with elective fenestrated repair (fenestrated endovascular aortic repair [FEVAR]; fenestrated Anaconda device) from 2015 to 2022 were included in this retrospective bicentric study. Underlying pathologies, aortic morphology, technical details, and postoperative morbidity were recorded. Single-staged ("1S," n=61) and 2-staged ("2S," n=26) interventions were compared. Indications were thoracoabdominal aneurysms (TAAAs) (Crawford I-IV) (n=56, 64%) and juxtarenal aneurysms (n=31, 36%). In 2S, the proportion of TAAA was higher than in 1S (2S: 77%, 1S: 59%; p=0.001). In 2S, the covered length of the descending aorta was longer (1S: 128±60 mm, 2S: 202±64 mm; p=0.003). Temporary aneurysm sack perfusion (TASP) was established in 11 (18%) of 1S and 1 (4%) of 2S patients (p=0.079), as well as cerebrospinal fluid (CSF) drainage catheter in 48 (79%) of 1S and 19 (73%) of 2S. The rate of spinal cord ischemia (SCI) and the severity of SCI were not different in both groups, with a total of 3 cases of persisting paraplegia. The rate of access complications was higher in 2S (n=6, 23%) than in 1S (n=4, 7%; p=0.027). Postoperative 30 day morbidity did not significantly differ in both groups and neither did 30 day mortality (4.6% in 1S vs 3.8% in 2S; p=0.083). The combination of TEVAR and FEVAR using a fenestrated endograft is feasible and safe. Aortic morphology does not change significantly after endovascular repair. A single-staged strategy is feasible with excellent results, especially in Crawford IV, Crawford V, or juxtarenal aneurysms. Two-staged repair is recommended in cases with long aortic coverage and a higher American Society of Anesthesiologists (ASA) class. Follow-up data are needed to evaluate the long-term stability of the TEVAR/FEVAR interconnection. Our study has revealed the safety and efficacy of the combination of TEVAR and FEVAR in the treatment of TAAAs and juxtarenal aneurysms with compromised supravisceral landing zones. A single-staged concept is not necessary in all cases. Staged procedures may reduce postoperative morbidity in cases with long aortic coverage and higher ASA class.

HER2 quantitative continuous scoring for accurate patient selection in HER2 negative trastuzumab deruxtecan treated breast cancer

Many targeted cancer therapies rely on biomarkers assessed by scoring of immunohistochemically (IHC)-stained tissue, which is subjective, semiquantitative, and does not account for expression heterogeneity. We describe an image analysis-based method for quantitative continuous scoring (QCS) of digital whole-slide images acquired from baseline human epidermal growth factor receptor 2 (HER2) IHC-stained breast cancer tissue. Candidate signatures for patient stratification using QCS of HER2 expression on subcellular compartments were identified, addressing the spatial distribution of tumor cells and tumor-infiltrating lymphocytes. Using data from trastuzumab deruxtecan-treated patients with HER2-positive and HER2-negative breast cancer from a phase 1 study (NCT02564900; DS8201-A-J101; N = 151), QCS-based patient stratification showed longer progression-free survival (14.8 vs 8.6 months) with higher prevalence of patient selection (76.4 vs 56.9%) and a better cross-validated log-rank p value (0.026 vs 0.26) than manual scoring based on the American Society of Clinical Oncology / College of American Pathologists guidelines. QCS-based features enriched the HER2-negative subgroup by correctly predicting 20 of 26 responders.

High-flow nasal cannula oxygen reduced hypoxemia in patients undergoing gastroscopy under general anesthesia at ultra-high altitude: a randomized controlled trial.

Hypoxemia can occur in people at ultra-high altitude (above 3500m) even at rest, and patients undergoing gastroscopy under general anesthesia have higher risk of hypoxemia. Supplementary oxygen via standard nasal cannula (SNC) is the standard of care for most patients who undergo gastroscopy under general anesthesia, which provides oxygen flow up to 15L/min. High-flow nasal cannula (HFNC) could deliver oxygen at a rate up to 60L/min, which is recommended by the American Society of Anesthesiologists Practice Guidelines. We speculated that the benefit with HFNC is more prominent in high-altitude areas, and aimed to compare the incidence of hypoxemia during gastroscopy under general anesthesia at ultra-high altitude with oxygen supply via either HFNC or SNC. The trial was registered at at Chinese Clinical Trial Registry (ChiCTR2100045513; date of registration on 18/04/2021). Adult patients undergoing gastroscopy with anesthesia (estimated duration of anesthesia at ≥ 15min) were randomized at a 1:1 ratio to receive HFNC oxygen or SNC oxygen. The primary outcome was hypoxemia (SpO2 < 90% for any duration). Secondary outcomes included severe hypoxemia (SpO2 < 75% for any duration or SpO2 < 90% but ≥ 75% for ≥ 60s) and hypotension, as defined by reduction of mean arterial blood pressure by ≥ 25% from the baseline. A total of 262 patients were enrolled: 129 in the HFNC group and 133 in the SNC group. All patients received the designated intervention. Student's t-test, Mann-Whitney U test and χ2 test were employed in the study. The rate of hypoxemia was 9.3% (12/129) in the HFNC group versus 36.8% (49/133) in the SNC group [risk ratio (95% confidence interval): 0.25(0.14-0.45); P < 0.001). The HFNC group also had lower rate of severe hypoxemia [0.0% (0/129) versus 11.3% (15/133); risk ratio (95% confidence interval): 0.03(0.00-0.55); P < 0.001, respectively]. The rate of hypotension did not differ between the 2 groups [22.5% (29/129) in HFNC group versus 21.1% (28/133) in SNC group; risk ratio (95% confidence interval): 1.07(0.67-1.69) ; P = 0.779]. HFNC oxygen reduced the incidence of hypoxemia during anesthesia in adult patients undergoing gastroscopy at ultra-high altitude.

Initial Experience with Single Port Robotic Right Colectomies: Results of an Investigator-Initiated Investigational Device Exemption Study Using a Novel Single Port Robotic Platform

BACKGROUND: Minimally invasive surgical techniques have been widely adopted in colorectal surgery. New technological breakthroughs have led to even less invasive alternatives like single-port surgery, but this has been hindered by technical challenges such as collision of the robotic arms within a limited space. The Intuitive da Vinci single port robotic platform is a novel system that overcomes some of these challenges. IMPACT OF INNOVATION: The aim of this study was to assess the safety and feasibility of the Intuitive da Vinci Single Port robotic platform in right segmental colectomies among adult patients. These findings may set the stage for more widespread use of single port robotic surgery. TECHNOLOGY MATERIALS AND METHODS: The Intuitive da Vinci Single-Port SP robot is a system designed specifically for single port robotic surgery. This platform enables flexible port location and efficient internal and external range of motion by utilizing a single C-shaped arm. In our study, right colectomies were performed in adult patients using this platform between May 2022 and November 2022 and compared to right colectomies in adult patients done using the standard multiport platform between Jan 2019- December 2022. The main outcome measure was safety and quality event rate. PRELIMINARY RESULTS: Among 5 patients who underwent single port robotic right colectomy, and 83.3% (n=25) underwent multiport right colectomy. In the single port group, 40% (n = 2) developed a safety/quality event (postoperative portal vein thrombosis and excessive postoperative pain). Of the multiport group, 32% (n = 8) had one safety/quality event, and 8% (n = 2) had more than one event. CONCLUSIONS AND FUTURE DIRECTIONS: This preliminary study, one of the first FDA-approved, investigator-initiated uses of this platform in colorectal surgeries, shows that this platform is a safe and feasible option for right colectomies and on preliminary evaluation appears comparable in terms of relevant safety/quality events to the multiport platform. Trial Registration: Clinicaltrials.gov NCT05321134 Trial Funding: American Society of Colon &amp; Rectal Surgeons (ASCRS) Research Foundation.

Reproducibility of MRI Diagnosis of Female Genital Anomalies.

Purpose: To assess and compare intrareader and interreader reproducibility of magnetic resonance imaging (MRI) diagnosis of female genital anomalies (FGAs) using the American Society for Reproductive Medicine-Mullerian anomalies classification 2021 (ASRM-MAC 2021) and European Society of Human Reproduction and Embryology-European Society for Gynecological Endoscopy (ESHRE-ESGE) 2016 classification. Methods: In this retrospective study, we searched our electronic MRI database from April 2021 to September 2023, selecting MRI studies with FGAs. Seventy-six consecutive studies were included and reviewed by 4 independent radiologists using both classifications. Studies were re-evaluated after 1 month. Reproducibility was assessed using kappa (κ) scores with 95% confidence intervals (CI). Results: Intrareader agreement for MRI diagnosis of FGAs was substantial to excellent, with κ scores ranging from 0.684 (95% CI, 0.534-0.834) to 0.985 (95% CI, 0.963-1.01) using the ASRM-MAC 2021 and from 0.743 (95% CI, 0.621-0.865) to 0.846 (95% CI, 0.719-0.973) using the ESHRE-ESGE 2016 classification. Pairwise interreader agreement was higher with the ASRM-MAC 2021, ranging from moderate (κ = 0.491; 95% CI, 0.341-0.642) to substantial (κ = 0.709; 95% CI, 0.597-0.821), compared to the ESHRE-ESGE 2016 classification, with weak (κ = 0.080; 95% CI, 0.068-0.228) to moderate (κ = 0.511; 95% CI, 0.344-0.678) agreement. Overall interreader agreement was moderate for both classifications (κ = 0.599; 95% CI, 0.562-0.638 for ASRM-MAC 2021 and κ = 0.429; 95% CI, 0.396-0.463 for ESHRE-ESGE 2016 classification), but with significant differences (non-overlapping CIs). Conclusion: The intrareader reproducibility was high for both classifications, whereas the interreader reproducibility was higher using the ASRM-MAC 2021, highlighting the impact of classification criteria on the reproducibility of MRI diagnosis of FGAs.

Effect of distal ischemic preconditioning on cardiovascular events in adult patients with hip fracture one year after operation

To investigate the effect of remote ischemic preconditioning (RIPC) on major adverse cardiovascular events (MACE) in elderly patients with hip fracture 1 year after operation. Total of 314 elderly patients with hip fracture of gradeⅡand Ⅲ for American Society of Anesthesiologists (ASA) were treated by surgical operation from April 2015 to May 2020 including 116 males and 198 females, the age ranged from 60 to 76 years old. The subjects were divided into intervention group and control group according to whether received RIPC. Among them, 157 cases in intervention group included 56 males and 101 females with an average age of (68.12±7.13) years old and 157 cases in control group included 60 males and 97 females with an average age of (68.24±7.05) years old. Both groups were given routine anesthesia. The intervention group was treated with RIPC on the basis of routine anesthesia. The MACE events 1 year after operation in two groups were compared and analyzed. The OR values of RIPC for myocardial infarction, heart failure, stroke, nonfatal cardiac arrest, coronary revascularization, severe arrhythmia, peripheral artery thrombosis, readmission of cardiovascular disease, and all-cause death in patients with hip fracture one year after operation were 1.269, 1.304, 0.977, 1.089, 1.315, 1.335, 0.896, 0.774, 1.191, respectively, but there was no significant difference (P>0.05). RIPC did not significantly affect and change the occurrence of major cardiovascular adverse events within 1 year after hip fracture surgery. The long term impact of RIPC on clinical cardiovascular outcomes in non cardiac surgery needs to be confirmed in appropriate randomized clinical trials.

Erector spinae plane block for pain management in blunt chest trauma in military prehospital medicine, an interventional study

ABSTRACT Background Erector spinae plane block (ESPB) was presented in previous studies as a simple and safe technique with an excellent analgesic profile and improvement in respiratory function in multiple rib fractures. The purpose of this study was to investigate the efficiency of performing ESPB in the primary care unit for pain alleviation for individuals with blunt chest traumas. Methods This prospective interventional work was performed on 54 patients ranging in age from 20 to 50 years old, both sexes, American society of anesthesiology class I and II diagnosed with multiple rib fracture following blunt chest trauma. ESPB were performed using 20 mL of 0.25% levo-bupivacaine. Results The median (IQR) numeric rate scale was 9 (8–9) before block application and was significantly reduced to 1 (0–1) till it was 0 (0–1) in the 12th hour. After 24th hour, the median pain score was 2 (1–2), (p < 0.00). The mean arterial blood pressure and heart rate have significantly decreased following the block. Regarding complications of morphine, two patients only experienced mild vomiting. There were no other complications (local anesthetic toxicity, hematoma formation and pneumothorax). Conclusion Prehospital administration of ESPB for blunt chest trauma improved the pain scores, decreased the opioid administration without negative consequences on the hemodynamic state or occurrence of complications among participants.

Manufacturers perceptions of the barriers and facilitators of designing and producing accessible fitness equipment: A qualitative study

ABSTRACT A descriptive qualitative study was conducted to learn manufacturer perceptions of the barriers and facilitators of designing and producing accessible fitness equipment. Eight participants familiar with the ASTM International (formally the American Society for Testing and Materials) Universal Design of Fitness Equipment standards were interviewed via a virtual platform. Audio recorded interviews were transcribed verbatim and independently coded by two investigators using thematic analysis. Two primary themes emerged from the data, 1) Challenges and 2) Tipping the Scale. Challenges included a humanitarian versus a business model view, application of the ASTM International standards, lack of a market analysis, and safety and liability. Facilitators deemed appropriate to tip the scale include consideration of a carrot (reward) versus a stick (punitive measures), availability of a market analysis, ASTM International standard modifications and enlisting activism for cultural change and development of laws and policies to mandate inclusion of accessible fitness space and equipment. Legislative action appears to be a primary facilitator to increase the design, development, and availability of accessible equipment in fitness centers.

Concomitant extragenital malformations of female reproductive tract anomalies: analysis of 444 cases in Peking Union Medical College Hospital

Objective: To analyze the incidence and clinical phenotype of the concomitant extragenital malformations in the patients with female reproductive tract anomalies. Methods: A retrospective study was conducted using clinical data of hospitalized patients diagnosed with uterine, cervical, or vaginal malformations from January 2003 to December 2022 in Peking Union Medical College Hospital. The malformations were classified according to American Society for Reproductive Medicine müllerian anomalies classification 2021, and in each type, the incidence and specific manifestations of concomitant extragnital malformations were analyzed. Results: A total of 444 patients were included. The overall incidence of concomitant extragenital malformations was 43.5% (193/444), including urinary system, skeletal system, and other system malformations. Renal malformations on the obstructed side were present in all patients with oblique vaginal septum syndrome (100.0%, 78/78). The total incidence of concomitant extragnital malformations was as high as 8/11 in uterus didelphys, 43.5% (10/23) in unicornuate uterus, 33.6% (79/235) in Mayer-Rokitansky-Küster-Hauser syndrome, 18.8% (6/32) in septate uterus and 18.5% (12/65) in cervical agenesis. Urinary system malformations (30.6%, 136/444) and skeletal system malformations (13.5%, 60/444) were the most common concomitant malformations in all types, in which, unilateral renal agenesis and scoliosis were the most common. Conclusions: Urinary and skeletal system malformations are important features of female reproductive tract anomalies. Urologic ultrasonography and spinal roentgenogram are recommended for all patients with female reproductive tract anomalies.

“How Many Black Hippies Do You See?” The Counterculture in Black and White

Historians have treated the counterculture largely as a white phenomenon and drawn sharp boundaries between its escapism and the political engagement of the Black freedom struggle. A look at the counterculture's origins and growth in the late 1950s and the 1960s reveals that the counterculture intersected with Black culture in many ways. White beats, hipsters, and hippies generally admired the civil rights movement's support for equality and nonviolence, but sometimes scoffed at its effort to gain integration into American society. Hippies considered themselves outsiders from society and imagined that they shared affinity with Black Americans. Blacks’ responses to the counterculture ranged from contempt to curiosity to embrace. Some Blacks despised the hippies’ lifestyle and political apathy, but others considered the counterculture an important challenge to “the System.” American culture, style, literature, and music were all affected by the counterculture's experimentalism. The counterculture changed white culture, Black culture, and American culture. Drawing boundaries between cultural forms proves less instructive than focussing on the connections between them.

The Evolving Role of Genomic Testing in Early Breast Cancer: Implications for Diagnosis, Prognosis, and Therapy

Multigene prognostic genomic assays have become indispensable in managing early breast cancer (EBC), offering crucial information for risk stratification and guiding adjuvant treatment strategies in conjunction with traditional clinicopathological parameters. The American Society of Clinical Oncology (ASCO) guidelines endorse these assays, though some clinical contexts still lack definitive recommendations. The dynamic landscape of EBC management demands further refinement and optimization of genomic assays to streamline their incorporation into clinical practice. The breast cancer community is poised at the brink of transformative advances in enhancing the clinical utility of genomic assays, aiming to significantly improve the precision and effectiveness of both diagnosis and treatment for women with EBC. This article methodically examines the testing methodologies, clinical validity and utility, costs, diagnostic frameworks, and methodologies of the established genomic tests, including the Oncotype Dx Breast Recurrence Score®, MammaPrint, Prosigna®, EndoPredict®, and Breast Cancer Index (BCI). Among these tests, Prosigna and EndoPredict® have at present been validated only on a prognostic level, while Oncotype Dx, MammaPrint, and BCI hold both a prognostic and predictive role. Oncologists and pathologists engaged in the management of EBC will find in this review a thorough comparison of available genomic assays, as well as strategies to optimize the utilization of the information derived from them.

Assessment of the Educational and Training Modalities in Point-of-Care Ultrasound (POCUS) for Anesthesiologists.

Point-of-care ultrasound (POCUS) has been developed as a critical tool for diagnostic patient evaluation and clinical management. Its transcendence into anesthesiology necessitates appropriate and effective educational strategies to assist in the development of anesthesia POCUS learners. Several professional societies, including the American Society of Anesthesiologists (ASA), American Society of Regional Anesthesia (ASRA), and Accreditation Council for Graduate Medical Education (ACGME) for anesthesiology have established minimum training standards for POCUS education for anesthesiologists, residents, and fellows.1,4 The article at hand aims to summarize and provide insight into the various educational modalities utilized in POCUS training, incorporate these strategies in the established "Indication, Acquisition, Interpretation, and Medical decision-making" (I-AIM) framework, and include recommendations on the minimum number of POCUS exams to aid in achieving competency.3.