Early external fixation of tibial plateau fractures is associated with an increased risk of compartment syndrome.

INTRODUCTION: Tibial plateau fractures are often associated with high-energy trauma necessitating external fixation as a means of temporization. There is evidence that pin placement and fracture distraction may result in transient increases in compartment pressures, and the optimal timing of external fixator placement is unknown. This study sought to determine the effect of early versus late external fixator placement on the risk of compartment syndrome after a tibial plateau fracture. METHODS: The Trauma Quality Improvement Program was retrospectively queried between 2015 and 2019 for adult patients with a tibial plateau fracture who underwent external fixator placement. Patients with concomitant tibial shaft and/or distal femur fractures, requiring lower extremity fasciotomy before external fixation, or external fixation >7 days after admission were excluded. The primary study outcome was inpatient compartment syndrome. Secondary outcomes were inpatient acute respiratory failure/unplanned intubation, surgical site infection, and venous thromboembolism (VTE). A time threshold of delayed external fixation was identified at which the odds of compartment syndrome no longer significantly decreased with increasing time using a Markov Chain Monte Carlo simulation of a restricted cubic spline model. The odds of each outcome were compared between patients who underwent early versus delayed external fixation on or after the time threshold, adjusting for potential confounding by patients, injury, and hospital characteristics. Significance was defined as p < 0.05. RESULTS: A threshold for delayed external fixation was identified at 28.8 h from admission. Of the 3,185 eligible patients, 2,656 (83.4 %) were classified as early external fixation and 529 (16.6 %) were classified as delayed external fixation. Delayed external fixation was associated with lower adjusted odds (aOR) of compartment syndrome (aOR: 0.31, 95 % Confidence Interval (CI): 0.13-0.74, p = 0.008) and higher aOR of acute respiratory failure/unplanned intubation (aOR: 2.13, 95 % CI: 1.13-4.0.2, p = 0.019), however no significant differences in adjusted odds of surgical site infection or VTE were observed. CONCLUSION: Patients with tibial plateau fractures who underwent closed reduction and external fixation within 28.8 h of admission were associated with greater odds of compartment syndrome than those undergoing external fixation after this time threshold.

Arrival-breeding interval is flexible in a songbird and is not constrained by migration carry-over effects.

As spring phenology advances with climate change, so too must the timing of life cycle events. Breeding at the right time is critical in many species as it maximizes fitness. For long-distance migratory birds, flexibility in the duration of the arrival-breeding interval (pre-breeding period) may allow populations to adjust their timing of breeding. However, whether first egg-lay dates are flexible to local environmental conditions after arrival, and if they are constrained by the time needed to replenish energy lost during migration, remains unclear. We investigated the regional flexibility of the arrival-breeding interval in an avian migrant, the purple martin, Progne subis, across their breeding range. We evaluated whether the duration of the arrival-breeding interval was flexible to temperature and precipitation at breeding sites, and if timing was limited by migration rate and stopover duration. We also tested if longer interval durations were associated with higher fledging success. To address our hypotheses, we used a combination of migration tracking, weather and breeding data collected from four regions across eastern North America (26.1° N to 52.4° N latitude). We found the arrival-breeding interval to be shortest in the north and longest in the south. Across all regions, warmer temperatures encountered at breeding grounds were associated with shorter intervals, and faster migration rates led to longer intervals. The length of the interval was not influenced by precipitation or stopover duration. Finally, longer intervals were not associated with higher fledge success. Currently, the longer arrival-breeding intervals in this study system, on average 28.3 days, may provide both early and late-arriving birds with ample time for recovery so birds can lay eggs according to temperature. Any negative effects of faster migration may have been buffered by longer arrival-breeding intervals, as interval length did not determine fledge success. With ongoing climate change, further research is needed to examine if arrival-breeding intervals become constrained by migration timing, which may limit opportunities for migrants to match the timing of breeding with key resources.

Individual timing consistency across long-distance songbird migrations.

Migration timing in long-distance migratory birds plays an essential role in individual survival and fitness and is thought to be driven by circannual routines cued by photoperiod with some plasticity to environmental conditions. We examined the individual order of migration timing in purple martins (Progne subis), a neotropical migratory songbird that travels between breeding sites throughout eastern North America and nonbreeding sites in Brazil. Migration timing data were collected for 295 different individual purple martins over 9 years using light-level geolocators deployed at breeding sites across the range. We used linear mixed-effect models to examine the influence of the rank order of individual departure dates in one season on the rank order of four subsequent migration events while controlling for the effects of breeding latitude, sex, and age. Overall, we found evidence for consistent individual timing that can extend across 8 months and 12,000-24,000 km of migration. Individual rank order of migration timing in purple martins was generally conserved across migrations with consistent timings between fall departure dates from, and spring arrival dates to the breeding site the following year (0.28 ± 0.03, 95% CI 0.22-0.34), as well as at a finer scale across fall migration (0.33 ± 0.05, 95% CI 0.23-0.43), over the stationary nonbreeding period (0.39 ± 0.04, 95% CI 0.31-0.47), and across spring migration (0.03 ± 0.001, 95% CI 0.028-0.032). These results demonstrate that purple martins exhibit consistency in individual migration timing throughout the annual cycle that is likely driven by inherent individual circannual schedules. We additionally found that migration distance played a significant role, as the consistency of individual timing lessened over longer distances. Understanding how individual birds time migrations and if individuals are consistent between events can provide insight into how birds respond to shifts in their environment with climate change.

Next day sentinel node biopsy for melanoma after lymphoscintigraphy using 99mTc-labelled nanocolloid does not adversely affect long-term outcomes.

OBJECTIVE: Sentinel Lymph Node Biopsy (SLNB) is an important management tool for early-stage melanoma. Different radiopharmaceuticals are used internationally to localise the sentinel node using lymphoscintigraphy (LSG) before surgery. Recent reports have suggested that a delayed interval between LSG and SLNB using 99mTc-labelled nanocolloid tracer has an adverse survival impact, but not with 99mTc-labelled antimony sulphide colloid. This study aims to analyse survival outcome in a prospective cohort of melanoma patients undergoing same day or next day SLNB after LSG using 99mTc-labelled nanocolloid. METHODS: Outcome data were reviewed for patients undergoing SLNB, stratified by time interval between LSG and SLNB at a single UK academic centre. Kaplan-Meier survival analysis was used to assess overall survival (OS), melanoma-specific survival (MSS) and progression-free survival (PFS). Cox multivariable regression analysis identified independent risk factors. RESULTS: 925 patients had LSG using the 99mTc-nanocolloid tracer between 2009 and 2019, with a median follow-up of 6.36 years. No difference was seen on univariate analysis in OS, MSS, PFS, or nodal recurrence between patients undergoing same day or next day SLNB (Log-rank P = 0.437, 0.293, 0.587, 0.342 respectively). In addition, nodal recurrence as first site or anytime site of recurrence in SLNB negative patients was similar between the groups (Log-rank P = 0.093 and 0.457 respectively). Stratified analysis of time did not demonstrate an outcome difference (MSS Log-rank P = 0.938). Cox multivariable regression did not show time interval to independently influence OS, MSS or PFS. CONCLUSIONS: We do not find a significant effect on long-term outcomes when SLNB is performed the day after LSG with 99mTc-labelled nanocolloid tracer. We infer that tracer migration is not clinically significant within 24 h of injection based on long term clinical outcome data.

Design of an Electronic Interface for Single-Photon Avalanche Diodes.

Single-photon avalanche diodes (SPADs) belong to a family of avalanche photodiodes (APDs) with single-photon detection capability that operate above the breakdown voltage (i.e., Geiger mode). Design and technology constraints, such as dark current, photon detection probability, and power dissipation, impose inherent device limitations on avalanche photodiodes. Moreover, after the detection of a photon, SPADs require dead time for avalanche quenching and recharge before they can detect another photon. The reduction in dead time results in higher efficiency for photon detection in high-frequency applications. In this work, an electronic interface, based on the pole-zero compensation technique for reducing dead time, was investigated. A nanosecond pulse generator was designed and fabricated to generate pulses of comparable voltage to an avalanche transistor. The quenching time constant (τq) is not affected by the compensation capacitance variation, while an increase of about 30% in the τq is related to the properties of the specific op-amp used in the design. Conversely, the recovery time was observed to be strongly influenced by the compensation capacitance. Reductions in the recovery time, from 927.3 ns down to 57.6 ns and 9.8 ns, were observed when varying the compensation capacitance in the range of 5-0.1 pF. The experimental results from an SPAD combined with an electronic interface based on an avalanche transistor are in strong accordance, providing similar output pulses to those of an illuminated SPAD.

The impact on users of an unfamiliar AED following a recent training experience: A randomized cross over simulation study.

Objective: This study examined the impact of prior familiarity with automated external defibrillator (AED) models on the time of defibrillation and the emotional experiences of laypersons. Methods: We conducted a randomized cross over simulation study with 123 participants to assess their reactions to both familiar and unfamiliar AED models. The time to first defibrillation was measured using three different AED training models, two of which were previously unknown to the participants. Additionally, semi-structured interviews were held with the participants to gather further insights. Results: Participants took longer to initiate defibrillation with unfamiliar (M = 34 s) AEDs compared to familiar (M = 27 s) ones. This delay was accompanied by feelings of confusion, nervousness, and anxiety. Factors such as the design of the AED covers, electrodes, and buttons were identified as sources of confusion. Nonetheless, clear instructions and similarities between devices helped facilitate their use. Conclusion: The findings suggest that AED design and familiarity with different AED designs may affect performance by laypersons. To improve user confidence, it would be useful to familiarize users with a variety of AED models as part of training initiatives. Understanding the impact of AED familiarity on rescuer's response can guide CPR training strategies and improve outcomes for OHCA. As more AED models become available to the public, the user-friendliness of AEDs may also be improved. It is beneficial for AED manufacturers to consider the results of research when developing new models.

Effect of postsurgical adjuvant chemotherapy timing on outcomes in patients with pancreatic cancer - a systematic review and meta-analysis.

To assess the association between the timing of postsurgical adjuvant chemotherapy and overall survival (OS) and disease-free survival (DFS) in patients with pancreatic cancer (PC). Literature search of PubMed, EMBASE, and Scopus databases was done for randomized controlled trials (RCTs) or observational studies (cohort studies, case-control studies), reporting outcomes of adult PC patients (aged 18 and above) who underwent surgery and received adjuvant chemotherapy at different time points after the operation. Pooled effect sizes were quantified and reported as hazard ratio (HR). The primary outcomes were OS and DFS. A random effects model to was used account for potential variability across studies. Sixteen studies were included. There was no significant difference between early and delayed initiation of adjuvant chemotherapy in terms of OS (HR 1.03, 95% CI: 0.98, 1.08) and DFS (HR 1.09, 95% CI: 0.91, 1.31). Subgroup analyses based on tumour stage, sample size, and the number of chemotherapeutic agents used did not reveal significant associations. Delayed initiation was associated with reduced OS in patients with well- to moderately differentiated tumours, with the confidence intervals approaching statistical significance (HR 1.12, 95% CI: 1.00,1.25). There was no significant association between the timing of postoperative adjuvant chemotherapy initiation and OS and DFS in patients with pancreatic cancer. These findings underscore the importance of optimizing treatment strategies and suggest that clinicians need to focus on other critical aspects such as drug selection, dosage, and patient-specific factors that might substantially impact treatment efficacy.

Timing of coronary artery bypass grafting after myocardial infarction influences late survival.

Objectives: The role of timing of coronary artery bypass grafting after acute myocardial infarction on early and late outcomes remains uncertain. Methods: We reviewed 1631 consecutive adult patients who underwent isolated coronary artery bypass grafting with information on timing of acute myocardial infarction. Early and late mortality were compared between patients receiving coronary artery bypass grafting within 24 hours after acute myocardial infarction, between 1 and 7 days after acute myocardial infarction, and more than 7 days after acute myocardial infarction. Sensitivity analyses were performed in subgroups of patients with ST-segment elevation myocardial infarction or non-ST-segment elevation myocardial infarction, and other high-risk groups. Results: A total of 124 patients (5.7%) underwent coronary artery bypass grafting within 24 hours, 972 patients (51.2%) received coronary artery bypass grafting between 1 and 7 days after acute myocardial infarction, and 535 patients (43.2%) underwent coronary artery bypass grafting more than 7 days after acute myocardial infarction. Overall operative mortality was 2.7% with comparable adjusted early mortality among 3 groups. Over a median follow-up of 13.5 years (interquartile range, 8.9-17.1), compared with patients receiving coronary artery bypass grafting between 1 and 7 days after acute myocardial infarction, those receiving coronary artery bypass grafting at 7 days had greater adjusted risk for late overall mortality (hazard ratio, 1.39, 95% CI, 1.16-1.67; P < .001), whereas those receiving coronary artery bypass grafting within 24 hours had comparable risk of late overall mortality (hazard ratio, 1.12, 95% CI, 0.86-1.47; P = .39). Timing of coronary artery bypass grafting was associated with late mortality in patients with non-ST-segment elevation myocardial infarction (patients receiving coronary artery bypass grafting at >7 days had a higher risk of late mortality [hazard ratio, 1.38, 95% CI, 1.14-1.67, P < .001] compared with those receiving coronary artery bypass grafting between 1 and 7 days), but not in patients with ST-segment elevation myocardial infarction. Conclusions: Early revascularization through coronary artery bypass grafting within 7 days during the same hospitalization appears beneficial, especially for patients presenting with non-ST-segment elevation myocardial infarction.

Timing of percutaneous coronary intervention and risk of new-onset acute ischemic stroke in non-ST elevation myocardial infarction: A retrospective cohort study insight into the National Inpatient Sample Database (2016-2019).

Background and Aims: For patients with high-risk non-ST elevation myocardial infarction (NSTEMI), current guidelines recommend an early invasive strategy within 24 h. New-onset acute ischemic stroke (NAIS) is a rare but fatal complication of percutaneous coronary intervention (PCI). However, the effect of the timing of PCI and the risk of NAIS in NSTEMI is poorly defined. Methods: Patients with NSTEMI who underwent PCI were queried from the National Inpatient Sample Database (2016-2019) and stratified into three groups: early (<24 h), medium (24-72 h), and late (>72 h) PCI. Multivariate logistic regression models were used to determine the association between timing of PCI and NAIS. Results: Among 633,115 weighted hospitalizations, patients in the late PCI group had a higher incidence of NAIS (1.3%) than those in the early (0.67%) and medium (0.71%) PCI groups. Patients undergoing late PCI were older, more likely to be female, and had a greater incidence of comorbidities (e.g., diabetes mellitus, chronic pulmonary and renal illness, and atrial fibrillation) than those undergoing early or medium PCI. After adjustment, only late PCI was significantly associated with a 54% increased NAIS risk (adjusted odds ratio: 1.54 [95% confidence interval: 1.29-1.84]). Additionally, there was heterogeneity in the magnitude of risk by age and sex. Younger people (<65 years) (p for interaction <0.001) and men (interaction-value p = 0.040) were more likely to encounter NAIS. Conclusion: Late PCI was associated with a higher risk of NAIS than early PCI, particularly among men and those aged <65 years.

Child maltreatment in a high adversity context: Associations of age, type and timing of exposure with psychopathology in middle childhood.

BACKGROUND: While cumulative childhood maltreatment (CM) has been linked to psychopathological outcomes, recent studies point to the relevance of the type and timing of exposure. The aim of the current study was to better understand their importance beyond the cumulative burden of CM for psychopathological symptoms in middle childhood. METHODS: A total of N = 341 children (M = 9.92, SD = 1.51) were interviewed to assess trauma load (UCLA - University of California at Los Angeles Event List), exposure to CM (pediMACE - Maltreatment and Abuse Chronology of Exposure - Pediatric Interview) and different outcomes of psychopathology (UCLA Posttraumatic Stress Disorder Reaction Index, Children's Depression Inventory (CDI), Strengths and Difficulties Questionnaire (SDQ). We employed conditioned random forest regression, incorporating type, timing, and cumulative indicators of CM, to assess the importance of each predictor simultaneously. RESULTS: Exposure to CM (abuse, neglect and cumulative indicators) exhibited a robust association with psychopathological outcomes. Recent abuse and recent neglect showed most robust associations with outcomes, neglect was stronger related to internalizing problems and timing of exposure showed clear associations with diverse pathological outcomes. CONCLUSION: Beyond the cumulative burden, type and timing of CM show direct and diverse associations to pathological outcomes in middle childhood. Our results highlight the critical importance of early and detailed identification of CM, particularly recent exposure. This finding is valuable for researchers and clinicians, as it can refine diagnostic assessments and pave the way for effective early intervention strategies for affected children.

A critical assessment of time-to-antibiotics recommendations in pediatric sepsis.

The Pediatric Surviving Sepsis Campaign (SSC) Guidelines recommend delivery of antibiotics within one hour for children with septic shock and, for those without shock but with sepsis-related organ dysfunction, as soon as feasible within three hours. In this review, we summarize the available adult and pediatric literature supporting these recommendations. We also explore the implications of implementing time-to-antibiotic goals at the point of antibiotic initiation in clinical practice, as well as the potential downstream impacts of these goals on antibiotic de-escalation.

Eating frequency, timing of meals, and sleep duration before and after a randomized controlled weight loss trial for breast cancer survivors.

PURPOSE: To examine eating frequency, timing of meals, and sleep duration before and after a weight loss intervention for breast cancer survivors. METHODS: Female breast cancer survivors (n = 159; 55 ± 9 years; 31.4 ± 5.0 kg/m2; stage I-III, median [IQR] 9.5 [5.5] months post-diagnosis) participated in a randomized controlled trial of a 12-month weight loss intervention versus usual care. Eating frequency, proportion of daily calories consumed after 5 PM, eating after 8 PM, nightly fasting duration, and sleep duration were estimated and categorized based on existing associations with factors influencing breast cancer prognosis and breast cancer outcomes. These behaviors at baseline were compared to women from an Australian national survey with similar age and BMI range. Mixed-effects linear regression models were used to examine the changes in health behaviors from baseline to 18 months between intervention and usual care groups. RESULTS: Before the trial, eating after 8 PM (67%) was higher, and short nightly fasting duration (< 13 h, 83%) and long sleep duration (> 9 h/day, 26%) were marginally higher, in breast cancer survivors than women in the national survey (52%, 75%, and 17%, respectively). "Less optimal" eating behaviors and sleep duration tended to co-occur. Behaviors remained unchanged over the 18-month follow-up, irrespective of the study group (p > 0.05; Cohen's effect sizes < 0.3). CONCLUSIONS: Later timing of eating and long sleep duration were prevalent in breast cancer survivors and continued following a weight loss intervention. IMPLICATIONS FOR CANCER SURVIVORS: Future multi-behavior interventions in breast cancer survivors should consider specific messages to target eating timing behaviors and sleep.

The influence of spatial frequency information on temporal synchrony perception on audiovisual stimuli.

Previous studies have shown that the spatial frequency (SF) of visual stimuli alters the perceived timing of subjective simultaneity. However, these studies have been limited to the effects of a single SF component. In this study, I measured and compared the points of subjective simultaneity (PSS) for audiovisual stimuli among low, high, and composited SF components. This experiment comprised a dual-presentation timing task and a ternary response format to eliminate response bias. The results indicated that the PSS value of the composition-SF stimuli was more toward visual-lead timing than the low-SF stimuli and did not differ significantly from that of the high-SF stimuli. The correlation coefficients showed that the PSS in composition-SF stimuli marginally approximated that of high-SF stimuli higher than that of low-SF stimuli. Future studies are needed to confirm these findings using visual stimuli with a wider range of SF components and with a modulated contrast.

Functional magnetic resonance imaging signal has sub-second temporal accuracy.

Neuronal activation sequence information is essential for understanding brain functions. Extracting such timing information from blood-oxygenation-level-dependent functional magnetic resonance imaging (fMRI) signals is confounded by local cerebral vascular reactivity (CVR), which varies across brain locations. Thus, detecting neuronal synchrony as well as inferring inter-regional causal modulation using fMRI signals can be biased. Here we used fast fMRI measurements sampled at 10 Hz to measure the fMRI latency difference between visual and sensorimotor areas when participants engaged in a visuomotor task. The regional fMRI timing was calibrated by subtracting the CVR latency measured by a breath-holding task. After CVR calibration, the fMRI signal at the lateral geniculate nucleus (LGN) preceded that at the visual cortex by 496 ms, followed by the fMRI signal at the sensorimotor cortex with a latency of 464 ms. Sequential LGN, visual, and sensorimotor cortex activations were found in each participant after the CVR calibration. These inter-regional fMRI timing differences across and within participants were more closely related to the reaction time after the CVR calibration. Our results suggested the feasibility of mapping brain activity using fMRI with accuracy in hundreds of milliseconds.

Association of late eating with colorectal adenomas: a cross-sectional study.

PURPOSE: Colorectal cancer (CRC) is linked to lifestyle exposures. However, changes in the CRC rates among younger populations remain poorly understood and suggest the existence of yet unidentified factor(s) that may contribute to colon carcinogenesis. Here, we investigated the potential role of time of eating in the risk of pre-cancerous colonic neoplasms (tubular adenoma: TA). METHODS: We enrolled 663 participants undergoing screening colonoscopies. Data on food timing, dietary intake, sleep/wake patterns, and chronotype were collected through structured questionnaires. Late eating was defined as the consumption of food or snack within a 3-hour window of sleep onset for at least four days a week. Pathology reports confirmed the histology of colonic polyps, and adenomas were further classified into risk categories. RESULTS: A total of 644 patients met criteria for our study. There were 270 (42.2%) participants classified as late eaters. Compared to non-late eaters, the odds of TA were higher in late eaters (OR = 1.46, 95% CI = 1.05-2.03, p = 0.023), an association which was strengthened after adjusting for multiple confounders (OR 1.98, 95% CI 1.19-3.28, p = 0.008). Late eating remained an independent risk factor for high-risk as well as multiple TAs. CONCLUSION: This study proposes late eating as a risk factor for colon tubular adenomas and underscores the potential role of less studied forms of circadian disruption imposed by time of eating in the development of colon neoplastic formation.

A systematic review of the timing of therapeutic anticoagulation in adult patients with acute traumatic brain injury: narrative synthesis of observational studies.

Traumatic brain injury (TBI) presents complex management scenarios, particularly in patients requiring anticoagulation for concurrent conditions such as venous thromboembolism (VTE) or atrial fibrillation (AF). A systematic search of PubMed/MEDLINE, Embase, and the Cochrane Library databases was conducted to identify relevant studies. Inclusion criteria encompassed studies assessing the effects of anticoagulation therapy on outcomes such as re-hemorrhage, hematoma expansion, thrombotic events, and hemorrhagic events in TBI patients with subdural hematomas (SDH). This systematic review critically addresses two key questions: the optimal timing for initiating anticoagulation therapy and the differential impact of this timing based on the type of intracranial bleed, with a specific focus on subdural hematomas (SDH) compared to other types. Initially screening 508 articles, 7 studies met inclusion criteria, which varied in design and quality, precluding meta-analysis. The review highlights a significant knowledge gap, underscoring the lack of consensus on when to initiate anticoagulation therapy in TBI patients, exacerbated by the need for anticoagulation in the presence of VTE or AF. Early anticoagulation, particularly in patients with SDH, may elevate the risk of re-hemorrhage, posing a clinical dilemma. Evidence on whether the type of intracranial hemorrhage influences outcomes with early anticoagulation remains inconclusive, indicating a need for further research to tailor management strategies effectively. This review underscores the scarcity of high-quality evidence regarding anticoagulation therapy in TBI patients with concurrent conditions, emphasizing the necessity for well-designed prospective studies to elucidate optimal management strategies for this complex patient population.

The impact of histological subtype on postoperative recurrence pattern and timing in locally advanced esophagogastric junction cancer.

PURPOSE: The differences in tumor behavior between adenocarcinoma (AC) and squamous cell carcinoma (SCC) of the esophagogastric junction (EGJ) have yet to be well investigated. The purpose of this study was to gain insights that can contribute to tailored treatments and follow-up strategies by analyzing the correlation between histological subtypes and oncological outcomes. METHODS: A retrospective analysis was used to determine the characteristics of the histological subtypes of EGJ cancer by comparing the appearance of postoperative recurrence. A total of 102 consecutive patients with pathological stage IIA to IVA EGJ cancer, who underwent R0 surgery in our department from 2004 to 2020, were enrolled. The recurrence pattern, timing, survival, and potential prognostic factors were compared. RESULTS: After a median follow-up time of 70.1 months, the AC group demonstrated comparable lymph node failure-free survival (P = 0.291) and significantly worse non-lymphogenous recurrence-free survival (P = 0.035) than did the SCC group. A significantly longer period from surgery to recurrence was also observed in the AC group (P = 0.029). Multivariate analysis indicated that histological subtype (P = 0.015, 95% CI 1.24-7.28) was significantly correlated with the incidence of non-lymphogenous recurrence. CONCLUSIONS: The pattern and timing of postoperative recurrence were significantly different between the histological subtypes of EGJ cancer. Compared with EGJ SCC, EGJ AC may have a greater tendency toward non-lymphogenous progression and a greater propensity for longer surgery-to-recurrence periods.

SimpleTrackV2: Rethinking the Timing Characteristics for Multi-Object Tracking.

Multi-object tracking tasks aim to assign unique trajectory codes to targets in video frames. Most detection-based tracking methods use Kalman filtering algorithms for trajectory prediction, directly utilizing associated target features for trajectory updates. However, this approach often fails, with camera jitter and transient target loss in real-world scenarios. This paper rethinks state prediction and fusion based on target temporal features to address these issues and proposes the SimpleTrackV2 algorithm, building on the previously designed SimpleTrack. Firstly, to address the poor prediction performance of linear motion models in complex scenes, we designed a target state prediction algorithm called LSTM-MP, based on long short-term memory (LSTM). This algorithm encodes the target's historical motion information using LSTM and decodes it with a multilayer perceptron (MLP) to achieve target state prediction. Secondly, to mitigate the effect of occlusion on target state saliency, we designed a spatiotemporal attention-based target appearance feature fusion (TSA-FF) target state fusion algorithm based on the attention mechanism. TSA-FF calculates adaptive fusion coefficients to enhance target state fusion, thereby improving the accuracy of subsequent data association. To demonstrate the effectiveness of the proposed method, we compared SimpleTrackV2 with the baseline model SimpleTrack on the MOT17 dataset. We also conducted ablation experiments on TSA-FF and LSTM-MP for SimpleTrackV2, exploring the optimal number of fusion frames and the impact of different loss functions on model performance. The experimental results show that SimpleTrackV2 handles camera jitter and target occlusion better, achieving improvements of 1.6%, 3.2%, and 6.1% in MOTA, IDF1, and HOTA, respectively, compared to the SimpleTrack algorithm.

A Mixed Approach for Clock Synchronization in Distributed Data Acquisition Systems.

Proper timing synchronization is important when data from sensors are acquired by different devices. This paper proposes a simple but effective solution for System on Chip (SoC) architectures that integrates a general-purpose Field Programmable Gate Array (FPGA) with a CPU. The proposed approach relies on a network synchronization protocol implemented in software, such as Network Time Protocol (NTP) or Precision Time Protocol (PTP), and uses the FPGA to generate a clock reference that is maintained in step with the synchronized system clock. The clock generated by the FPGA is obtained from the FPGA oscillator via appropriate fractional clock division. Clock drift is avoided via a software program that periodically compares the FPGA and the system counters, respectively, and adjusts the fractional clock divider in order to slightly adjust the FPGA clock frequency using a Proportional Integral controller. A specific implementation is presented on the RedPitaya platform, generating a 1 MHz clock in step with the NTP synchronized system clock. The presented system has been used in a distributed data acquisition system for fast transient recording in the neutral beam test facility for the ITER nuclear fusion experiment.

Determining the optimal timing of adjuvant chemotherapy initiation after concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma.

BACKGROUND: Studies on several malignancies have suggested that the time to commencement of adjuvant chemotherapy (AC) is associated with survival outcomes. There have, however, been no relevant reports of nasopharyngeal carcinoma (NPC). PATIENTS AND METHODS: This clinical study examined newly diagnosed patients between April 2017 and December 2020. The primary endpoint was progression-free survival (PFS). Inverse probability of treatment weighting was used to control for confounding factors. Cox models with restricted cubic splines, Kaplan-Meier method and log-rank tests were used to evaluate the relationship between AC timing and survival. RESULTS: A total of 551 patients were identified [median age, 45 years (interquartile range 36-52 years); 383 (69.5%) male]. Restricted cubic splines demonstrated that the timing of AC initiation had a U-shaped association with PFS. The risk of disease progression decreased within 37 days and subsequently increased. From 37 to 90 days, each additional 7-day delay conferred worse PFS of 1.32 months {hazard ratio (HR): 1.14 [95% confidence interval (CI) 1.01-1.28], P = 0.04}. The cut-off value of the receiver operating characteristic curve for initiation was 69.5 days. At a median follow-up of 48 months, the PFS was significantly better in patients initiated within 69.5 days [HR: 2.18 (95% CI 1.17-4.06), log-rank P = 0.009], with a higher 3-year rate [78.8% (95% CI 75.1% to 82.7%) versus 59.0% (95% CI 42.2% to 82.5%)] than beyond 69.5 days. Positive results were also observed in secondary endpoints. The initiation group was an independent prognostic factor [HR: 2.28 (95% CI 1.42-3.66), P < 0.001]. CONCLUSIONS: The optimal timing of AC initiation is ∼37 days after concurrent chemoradiotherapy in patients with locoregionally advanced nasopharyngeal carcinoma. A delay beyond 69.5 days is associated with compromised survival. Efforts should be made to address the reasons for delays and ensure the timely initiation of AC.