Distinguishing methicillin-resistant Staphylococcus aureus from methicillin-sensitive strains by combining Fe3O4 magnetic nanoparticle-based affinity mass spectrometry with a machine learning strategy.

Pathogenic bacteria, including drug-resistant variants such as methicillin-resistant Staphylococcus aureus (MRSA), can cause severe infections in the human body. Early detection of MRSA is essential for clinical diagnosis and proper treatment, considering the distinct therapeutic strategies for methicillin-sensitive S. aureus (MSSA) and MRSA infections. However, the similarities between MRSA and MSSA properties present a challenge in promptly and accurately distinguishing between them. This work introduces an approach to differentiate MRSA from MSSA utilizing matrix-assisted laser desorption ionization mass spectrometry (MALDI-MS) in conjunction with a neural network-based classification model. Four distinct strains of S. aureus were utilized, comprising three MSSA strains and one MRSA strain. The classification accuracy of our model ranges from ~ 92 to ~ 97% for each strain. We used deep SHapley Additive exPlanations to reveal the unique feature peaks for each bacterial strain. Furthermore, Fe3O4 MNPs were used as affinity probes for sample enrichment to eliminate the overnight culture and reduce the time in sample preparation. The limit of detection of the MNP-based affinity approach toward S. aureus combined with our machine learning strategy was as low as ~ 8 × 103 CFU mL-1. The feasibility of using the current approach for the identification of S. aureus in juice samples was also demonstrated.

Pitching Biomechanics and Shoulder Function in Baseball Pitchers with Scapular Dyskinesis.

The primary purpose was to investigate the influence of scapular dyskinesis (SD) on pitching biomechanics and shoulder function in high school baseball pitchers. The secondary purpose was to identify possible factors associated with shoulder function in pitchers with SD. Thirty-eight pitchers were classified into the SD group (n=26) or the non-SD group (n=12). They were evaluated with the Kerlan-Jobe Orthopaedic Clinic shoulder and elbow (KJOC) scale and clinical measurements of shoulder characteristics, and with measurements of scapular kinematics, muscle activation, and ball speed during fastball pitching. Compared to the controls, the pitchers with SD had less scapular external rotation (difference=11.3 degrees, ES=0.92, p=0.012) during overall pitching and less upper trapezius (UT) activation during the late cocking (difference=7.1%, ES=0.79, p=0.019) and acceleration phases (difference=12.5%, ES=0.75, p=0.035). Higher UT activation during the late cocking phase was significantly associated with higher KJOC scores (standardized ß=0.415, p=0.039). In conclusion, deficits in scapular external rotation and decreased UT activation during pitching were found in pitchers with SD. Higher UT activation may be important for shoulder function in pitchers with SD.

Assessment of incident frailty hazard associated with depressive symptoms in a Taiwanese longitudinal study.

OBJECTIVES: To estimate the risks of depressive symptoms for developing frailty, accounting for baseline robust or pre-frailty status. DESIGN: An incident cohort study design. SETTING: Community dwellers aged 55 years and above from urban and rural areas in seven regions in Taiwan. PARTICIPANTS: A total of 2,717 participants from the Healthy Aging Longitudinal Study in Taiwan (HALST) were included. Subjects with frailty at baseline were excluded. The average follow-up period was 5.9 years. MEASUREMENTS: Depressive symptoms were measured by the 20-item Center for Epidemiological Studies Depression (CES-D) Scale. Frailty was assessed using the Fried frailty measurement. Participants were stratified by baseline robust or pre-frailty status to reduce the confounding effects of the shared criteria between depressive symptoms and frailty. Overall and stratified survival analyses were conducted to assess risks of developing frailty as a result of baseline depressive symptoms. RESULTS: One hundred individuals (3.7%) had depressive symptoms at baseline. Twenty-seven individuals (27.0%) with depressive symptoms developed frailty, whereas only 305 out of the 2,617 participants (11.7%) without depressive symptoms developed frailty during the follow-up period. After adjusting for covariates, depressive symptoms were associated with a 2.6-fold (95% CI 1.6, 4.2) increased hazard of incident frailty. The patterns of increased hazard were also observed when further stratified by baseline robust or pre-frailty status. CONCLUSIONS: Depressive symptoms increased the risk of developing frailty among the older Asian population. The impact of late-life depressive symptoms on physical health was notable. These findings also replicated results from Western populations. Future policies on geriatric public health need to focus more on treatment and intervention against geriatric depressive symptoms to prevent incident frailty among older population.

Developing screening services for colorectal cancer on Android smartphones.

INTRODUCTION: Colorectal cancer (CRC) is an important health problem in Western countries and also in Asia. It is the third leading cause of cancer deaths in both men and women in Taiwan. According to the well-known adenoma-to-carcinoma sequence, the majority of CRC develops from colorectal adenomatous polyps. This concept provides the rationale for screening and prevention of CRC. Removal of colorectal adenoma could reduce the mortality and incidence of CRC. Mobile phones are now playing an ever more crucial role in people's daily lives. The latest generation of smartphones is increasingly viewed as hand-held computers rather than as phones, because of their powerful on-board computing capability, capacious memories, large screens, and open operating systems that encourage development of applications (apps). SUBJECTS AND METHODS: If we can detect the potential CRC patients early and offer them appropriate treatments and services, this would not only promote the quality of life, but also reduce the possible serious complications and medical costs. In this study, an intelligent CRC screening app on Android™ (Google™, Mountain View, CA) smartphones has been developed based on a data mining approach using decision tree algorithms. For comparison, the stepwise backward multivariate logistic regression model and the fecal occult blood test were also used. RESULTS: Compared with the stepwise backward multivariate logistic regression model and the fecal occult blood test, the proposed app system not only provides an easy and efficient way to quickly detect high-risk groups of potential CRC patients, but also brings more information about CRC to customer-oriented services. CONCLUSIONS: We developed and implemented an app system on Android platforms for ubiquitous healthcare services for CRC screening. It can assist people in achieving early screening, diagnosis, and treatment purposes, prevent the occurrence of complications, and thus reach the goal of preventive medicine.

Shoe choice may affect fencing lunge attack performance.

The purpose of this study was to investigate the differences in attack time and lower limb biomechanics when performing fencing lunge with fencing shoes (FS) and commonly used court shoes (CS). Additionally, the study aimed to evaluate whether fencing shoes with a heel cup (FSH) could reduce lower limb impact. Thirteen female collegiate fencers who had participated in national-level competitions were recruited for this study. Participants performed the lunge on a human-shaped target while wearing FS, FSH, or CS in a randomized order. Biomechanical data were collected using a 3D motion analysis system synchronized with a force plate. A signal light, and an accelerometer were attached to the target's head to initiate lunge movement and detect hit moment for calculating attack time. Attack time was significantly shorter when wearing FS (0.92 ± 0.05 s) and FSH (0.93 ± 0.07 s) compared to CS (0.96 ± 0.06 s). The maximum angular velocity of ankle plantarflexion in rear foot push-off phase was significantly slower when wearing FS and FSH than when wearing CS. The maximum knee posterior shear force, maximum knee flexion moment, and maximum ankle medial shear force during the front foot step phase were significantly greater when wearing FS than when wearing CS. These forces were significantly reduced or nearly significantly reduced when wearing FSH, and there were no significant differences compared to wearing CS. The maximum ankle medial shear force during the push-off phase in rear foot was the greatest when wearing FS but decreased significantly when using FSH. However, this force was still greater than when wearing CS. Wearing FS resulted in a higher loading rate (LR) on the front foot. This LR was reduced when a heel cup was used but still remained higher than when wearing CS. There were no significant differences in the forward extension of body, maximum ground reaction force, or center of pressure displacement during front foot step and rear foot push-off phases among the three shoe conditions. Wearing FS can enhance lunge performance, and the use of a heel cup can effectively reduce lower limb impact.

Risk Factors for Unplanned Early Implantable Port Catheter Removal in Adult Hematology Cancer Patients Receiving Chemotherapy: A Propensity Score Matching Study.

Purpose: Implantable port catheter is a reliable vascular access for chemotherapy infusion in cancer patients. However, patients with hematology malignancies usually present with a myriad of blood cell abnormalities that put them at risk of infection and mechanical problems requiring catheter removal. This study aims to determine the risk factors associated with unplanned (catheter removal other than completion of treatment plan) early (within 90 days of catheter implantation) implantable port catheter removal. Patients and Methods: A retrospective, propensity score-matched study of 386 patients with hematology malignancies who received implantable venous access ports between January 2015 and December 2022. We conducted a univariate analysis to select the variables for propensity score matching. Patients with unplanned early implantable port catheter removal (early group) were matched 1:1 to patients without unplanned early removal (non-early group). Results: Univariate analysis demonstrated a statistically significant difference between early and non-early groups for age (p = 0.048), hemoglobin level (p = 0.028), thrombocytopenia (p = 0.025), and PG-SGA (p < 0.001). Thrombocytopenia was the only independent risk factor with a statistically significant difference in Cox proportional hazard analysis, HR 2.823, 95 CI 1.050-7.589, p = 0.040. The median catheter survival for patients with thrombocytopenia was 61 days (95% CI 28.58-93.42) compared to 150 days (95% CI 9.81-290.19) for patients without thrombocytopenia, p = 0.015. Patient survival is not affected by early catheter removal. The median survival for patients in the early group was 28.28 months (95% CI 27.43-29.15) compared to 32.39 months (95% CI 24.11-40.68), for the non-early group, p = 0.709. Conclusion: Hematology malignancy patients with thrombocytopenia are at high risk for unplanned early port catheter removal without survival difference.

The effects of different iron shaft weights on golf swing performance.

This study examined the effects of three 7-iron shaft weights on golf swing performance among golfers of varying skill levels. The study included 10 low-handicap (LH; 4.3 ± 2.4) and 10 high-handicap (HH; 29.1 ± 5.4) right-handed golfers as participants. The participants were randomly assigned 7-iron clubs with shaft weights categorized as light (77 g), medium (98 g), or heavy (114 g), and they performed test shots. Kinematic data were captured using a motion analysis system with nine infra-red high speed cameras; a force platform connected to this system was used to record weight transfer patterns. Performance variables were assessed using a FlightScope launch monitor. A two-way mixed-design analysis of variance was used to determine the significance of the performance differences among both participant groups and golf shaft weights. The results indicated that during the backswing, the LH group exhibited significantly greater maximum rightward upper torso rotation, maximum X-factor, and maximum right wrist hinge rotation than did the HH group. During the downswing, the LH group exhibited significantly greater maximum upper torso angular velocity and maximum right wrist angular velocity than did the HH group. Moreover, the LH group produced significantly higher ball speeds, longer shot distances, and lower launch angles than did the HH group. The shaft weight neither greatly altered the golf swing nor displaced the center of gravity of the golfers. The lighter shafts were observed to facilitate faster clubhead speeds and initial ball velocities, thereby resulting in longer shot distances, especially among LH golfers. Although significant differences in swing mechanics and performance exist between HH and LH golfers, lighter shafts can contribute to increased shot distances for all golfers.

Invasive pulmonary aspergillosis among patients with severe community-acquired pneumonia and influenza in ICUs: a retrospective cohort study.

RATIONALE: The prevalence, clinical characteristics, and outcomes of invasive pulmonary aspergillosis in patients with severe community-acquired pneumonia (CAP) in intensive care units remain underestimated because of the lack of a disease-recognition scheme and the inadequacy of diagnostic tests. OBJECTIVES: To identify the prevalence, risk factors, and outcomes of severe CAP complicated with invasive pulmonary aspergillosis (IPA) in intensive care units (ICUs). METHODS: We conducted a retrospective cohort study including recruited 311 ICU-hospitalized patients with severe CAP without influenza or with influenza. Bronchoalveolar lavage fluid (BALF) samples were from all patients and subjected to mycological testing. Patients were categorized as having proven or probable Aspergillus infection using a modified form of the AspICU algorithm comprising clinical, radiological, and mycological criteria. MEASUREMENTS AND MAIN RESULTS: Of the 252 patients with severe CAP and 59 influenza patients evaluated, 24 met the diagnostic criteria for proven or probable Aspergillus infection in the CAP group and 9 patients in the influenza group, giving estimated prevalence values of 9.5% and 15.3%, respectively. COPD and the use of inhaled corticosteroids were independent risk factors for IPA. IPA in patients with severe CAP was significantly associated with the duration of mechanical support, the length of ICU stay, and the 28-day mortality. CONCLUSIONS: An aggressive diagnostic approach for IPA patients with severe CAP and not only influenza or COVID-19 should be pursued. Further randomized controlled trials need to evaluate the timing, safety, and efficacy of antifungal therapy in reducing IPA incidence and improving clinical outcomes.

Extensive spinal cord ischemia following endovascular repair of an infrarenal abdominal aortic aneurysm: a rare complication.

Postoperative paraplegia secondary to spinal cord ischemia (SCI) is an extremely rare and devastating complication of endovascular repair in abdominal aortic aneurysm (AAA) surgery. The reported incidence is only 0.21 % worldwide. This case of postoperative paraplegia occurred in a 60-year-old man immediately following endovascular repair of an infrarenal AAA. Postoperative magnetic resonance imaging showed multiple foci of SCI involvement from C5 to L1. However, neither cerebral spinal fluid drainage nor steroid therapy was effective; he was eventually admitted with no improvement in his neurological status. The mechanism remains multifactorial until now and needs more attention in perioperative management. We report the first case involved in the most significantly extensive SCI after endovascular repair of an infrarenal AAA.

Analysis and classification of coffee beans using single coffee bean mass spectrometry with machine learning strategy.

Coffee is a daily essential, with prices varying based on taste, aroma, and chemical composition. However, distinguishing between different coffee beans is challenging due to time-consuming and destructive sample pretreatment. This study presents a novel approach for directly analyzing single coffee beans through mass spectrometry (MS) without the need for sample pretreatment. Using a single coffee bean deposited with a solvent droplet containing methanol and deionized water, we generated electrospray to extract the main species for MS analysis. Mass spectra of single coffee beans were obtained in just a few seconds. To showcase the effectiveness of the developed method, we used palm civet coffee beans (kopi luwak), one of the most expensive coffee types, as model samples. Our approach distinguished palm civet coffee beans from regular ones with high accuracy, sensitivity, and selectivity. Moreover, we employed a machine learning strategy to rapidly classify coffee beans based on their mass spectra, achieving 99.58% accuracy, 98.75% sensitivity, and 100% selectivity in cross-validation. Our study highlights the potential of combining the single-bean MS method with machine learning for the rapid and non-destructive classification of coffee beans. This approach can help to detect low-priced coffee beans mixed with high-priced ones, benefiting both consumers and the coffee industry.

Serum vascular endothelial growth factor affects tissue fluid accumulation and is associated with deteriorating tissue perfusion and oxygenation in severe sepsis: a prospective observational study.

BACKGROUND: Positive fluid balance and tissue fluid accumulation are associated with adverse outcomes in sepsis. Vascular endothelial growth factor (VEGF) increases in sepsis, promotes vascular permeability, and may affect tissue fluid accumulation and oxygenation. We used near-infrared spectroscopy (NIRS) to estimate tissue hemoglobin (Hb) oxygenation and water (H2O) levels to investigate their relationship with serum VEGF levels. MATERIAL AND METHODS: New-onset severe sepsis patients admitted to the intensive care unit were enrolled. Relative tissue concentrations of oxy-Hb ([HbO2]), deoxy-Hb ([HbR]), total Hb ([HbT]), and H2O ([H2O]) were estimated by near-infrared spectroscopy (NIRS) for three consecutive days and serum VEGF levels were measured. Comparisons between oliguric and non-oliguric patients were conducted and the correlations between variables were analyzed. RESULTS: Among 75 eligible patients, compared with non-oliguric patients, oliguric patients were administrated more intravascular fluids (median [IQR], 1926.00 [1348.50-3092.00] mL/day vs. 1069.00 [722.00-1486.75] mL/day, p < 0.001) and had more positive daily net intake and output (mean [SD], 1,235.06 [1303.14] mL/day vs. 313.17 [744.75] mL/day, p = 0.012), lower [HbO2] and [HbT] over the three-day measurement (analyzed by GEE p = 0.01 and 0.043, respectively) and significantly higher [H2O] on the third day than on the first two days (analyzed by GEE p = 0.034 and 0.018, respectively). Overall, serum VEGF levels were significantly negatively correlated with [HbO2] and [HbT] (rho = - 0.246 and - 0.266, p = 0.042 and 0.027, respectively) but positively correlated with [H2O] (rho = 0.449, p < 0.001). Subgroup analysis revealed a significant correlation between serum VEGF and [H2O] in oliguric patients (rho = 0.532, p = 0.003). Multiple regression analysis determined the independent effect of serum VEGF on [H2O] (standardized coefficient = 0.281, p = 0.038). CONCLUSIONS: In severe sepsis, oliguria relates to higher positive fluid balance, lower tissue perfusion and oxygenation, and progressive tissue fluid accumulation. Elevated serum VEGF is associated with worsening tissue perfusion and oxygenation and independently affects tissue fluid accumulation.

The impacts of bacterial co-infections and secondary bacterial infections on patients with severe influenza pneumonitis admitted to the intensive care units.

PURPOSES: This study investigated the prevalence and clinical outcomes of pulmonary bacterial co-infections and secondary bacterial infections in patients with severe influenza pneumonitis. METHODS: We retrospectively analyzed the data of adult patients with severe influenza pneumonitis admitted to medical ICUs. Bacterial co-infections and secondary bacterial infections were identified. The risk factors of bacterial infection were evaluated. The outcomes of patients regarding co-infection or secondary bacterial infection were analyzed. RESULTS: We identified 117 critically ill patients with laboratory-confirmed influenza pneumonitis admitted to the medical ICUs. Klebsiella pneumoniae (31.4%) and Staphylococcus aureus (22.8%) were the most identified bacteria in patients with bacterial co-infection. A high proportion of methicillin-resistant Staphylococcus aureus (17.1%) was noted. Liver cirrhosis and diabetes mellitus were the independent risk factors for bacterial co-infection. Acinetobacter baumannii (30.7%) and S. aureus (23.1%) were the most often identified bacteria in patients with secondary bacterial pneumonia. Patients with secondary bacterial infections had a longer duration of mechanical ventilation, and longer ICU and hospital stay. CONCLUSIONS: High rates of drug-resistant bacterial co-infections and secondary bacterial infections were identified in patients with severe influenza pneumonitis requiring ICU care and were associated with more morbidity in these patients.

Increased tissue water in patients with severe sepsis affects tissue oxygenation measured by near-infrared spectroscopy: a prospective, observational case-control study.

Background: Tissue oedema affects tissue perfusion and interferes with the monitoring of tissue oxygenation in patients with severe sepsis. However, the underlying mechanisms remain unclear. We used a wireless near-infrared spectroscopy (NIRS) device that transmits tri-wavelength light to quantify tissue haemoglobin (Hb) and water (H2O) content. We estimated tissue H2O in severe sepsis patients and healthy controls, compared their difference, and investigated the correlation of tissue H2O with systemic haemodynamics and its impact on tissue oxygenation. Methods: Seventy-seven adult patients with new-onset severe sepsis admitted to the intensive care unit within 72 h and 30 healthy volunteers (controls) were enrolled. The NIRS device was placed on the participant's leg to estimate the relative tissue concentrations of oxy-Hb ([HbO2]), deoxy-Hb ([HbR]), total Hb ([HbT]), and H2O ([H2O]) at rest for three consecutive days. Two-sample t-test or Mann-Whitney U test, chi-square test, and generalised estimating equations (GEEs) were used for comparisons. Results: In severe sepsis patients, the [H2O] in the anterior tibia was higher [mean (standard deviation, 95% confidence interval), 10.57 (3.37, 9.81-11.34) vs. 7.40 (1.89, 6.70-8.11)] and the [HbO2], [HbT], and tissue Hb oxygen saturation (StO2) were lower [0.20 (0.01, 0.20-0.20) vs. 0.22 (0.01, 0.22-0.23), 0.42 (0.02, 0.42-0.43) vs. 0.44 (0.02, 0.44-0.45), and 47.25% (1.97%, 46.80-47.70%) vs. 49.88% (1.26%, 49.41-50.35%), respectively] than in healthy controls in first-day measurements. GEE analysis revealed significant differences in [H2O], [HbO2], [HbT], and StO2 between groups over three consecutive days (all P≤0.001). In addition, [HbO2] and StO2 levels gradually decreased over time in the patient group. A negative correlation was observed between [H2O] and [HbO2] and StO2, which became more obvious over time (day 1: r=-0.51 and r=-0.42, respectively; both P<0.01; day 3: r=-0.67 and r=-0.63, respectively, both P<0.01). Systolic arterial pressure was positively related to [H2O] (r=0.51, P<0.05, on day 1) but was not associated with tissue oxygenation parameters. Conclusions: NIRS can be used to quantify tissue H2O. Severe sepsis patients have increased tissue H2O, which responds to changes in arterial blood pressure and affects tissue oxygenation.

A Preliminary Study of Pre-Season Taekwondo Preparation Strategy: Personal Isolation Training Effect for Elite Athletes.

BACKGROUND: The global coronavirus disease pandemic (COVID-19) has had a considerable impact on athletic competition and team sports training. Athletes have been forced to train alone at home. However, the isolation training model effects are still unknown. PURPOSE: This study compared the effects of personal isolation training (PIT) and detraining (DT) on specific sport performances (flexibility, power, reaction time, acceleration, and aerobic capacity) and body composition in elite taekwondo athletes. METHODS: Eleven elite taekwondo athletes were recruited as voluntary subjects. Athletes were randomly paired by weight into the personal isolation training group (PIT group: N = 5, age: 21.2 ± 0.4 years, BMI: 22.2 ± 0.8 kg/m2) or detraining group (DT group: N = 6, age: 19.8 ± 0.3 years, BMI: 23.1 ± 1.0 kg/m2). All subjects performed the same training content prior to the pre-test (T1). When the pre-test was completed, all subjects underwent 12 weeks of PIT or DT. Athletes were then administrated the post-test (T2). The athlete's sport performances and body composition were measured to compare the differences between the two groups (PIT and DT) and two phases (T1 and T2). RESULTS: There were no significant differences in kicking reaction time and flexibility in both groups (p > 0.05). The PIT showed significant improvements in 10 m (10M) sprint performance (p < 0.05), and displayed a progress trend in Abalakov jump performance. In addition, the PIT resulted in a better change response in 10M sprint performance (PIT: -4.2%, DT: +2.1%), aerobic endurance performance (PIT: -10.2%, DT: -18.4%), right arm muscle mass (PIT: +2.9%, DT: -3.8%), and trunk muscle mass (PIT: +2.2%, DT: -1.9%) than DT (p < 0.05). The fat mass percentage showed a negative change from T1 to T2 in both groups (p < 0.05). CONCLUSIONS: PIT showed a trend toward better body composition (arm and trunk muscle) and sport performances (10M sprint and aerobic capacity) compared to DT. This finding may provide information on the effectiveness of a personal isolation training model for optimal preparation for taekwondo athletes and coaches. It may also serve as a useful and safe guideline for training recommendations during the coronavirus disease (COVID-19).

Survival after multiple nail gun injuries to the brain, lung, and heart: a case report and a review of the literature.

Most nail gun injuries involve the extremities and result from work-related accidents. Injuries to the brain or thorax are relatively rare, and cases with injuries to both regions are even rarer and often lethal. Initial evaluation, resuscitation, and surgical planning can be challenging for emergency physicians and surgeons. We present the details of a man with multiple nail gun injuries to the brain, lung, and heart following a suicide attempt. The patient presented to the emergency department in shock. After immediate resuscitation, emergent sternotomy, and subsequent craniotomy, he was discharged without significant morbidity. According to the literature, this is the only reported case involving multiple nail gun injuries to the brain, lungs, and heart. The mortality rate of multiple nail gun injuries involving the head and chest is approximately 20%. Rapid evaluation, immediate resuscitation, and appropriate imaging and surgery are crucial for increasing survival and achieving a good prognosis. Emergency sternotomy for cardiac injury is the foremost priority, and the timing of craniotomy depends on the patient's vital sign status and whether brain injury is evident.A preprint of this article is available online: DOI: 10.21203/rs.3.rs-35448/v1.

Survival of Patients with Lung Cancer in the Setting of Liver Cirrhosis: A Multicenter Propensity Score Matching Study.

PURPOSE: The survival outcome of lung cancer patients with coexisting liver cirrhosis has thus far received limited attention in the literature. In this study, we evaluated whether liver cirrhosis is an independent risk factor for the survival of patients with lung cancer. MATERIALS AND METHODS: We conducted a retrospective, multicenter, propensity-matched study of lung cancer patients with and without liver cirrhosis. To determine differences in survival, we sought to identify risk factors associated with poor outcomes using Kaplan-Meier survival analysis and Cox proportional hazards regression. RESULTS: There were no statistically significant differences in the baseline clinical characteristics of patients between the cirrhosis and non-cirrhosis groups. The median overall survival of patients with and without cirrhosis was 13.07 months (95% confidence interval [CI]: 10.56-16.84) and 13.67 months (95% CI: 10.42-16.91), respectively (p=0.76). Cox proportional hazards regression analysis revealed that liver cirrhosis was not an independent risk factor for poor outcome (hazard ratio [HR]: 1.057, 95% CI: 0.805-1.388, p=0.690). In patients with cirrhosis, lower serum albumin levels, higher Charlson Comorbidity Index score, advanced-stage lung cancer, and treatment modality were factors associated with poor outcome. Increase in serum albumin by 1 g was associated with a 30% reduction in the risk of mortality (HR: 0.700, 95% CI: 0.494-0.993, p=0.045). While every point increase in the Charlson Comorbidity Index score by 1 point was linked to a 9% higher risk of mortality (HR: 1.090, 95% CI: 1.023-1.161, p=0.007). CONCLUSION: The survival rates of lung cancer patients with and without cirrhosis did not differ significantly. Higher serum albumin levels and lower Charlson Comorbidity Index scores were associated with improved survival.

SLIM: Simultaneous Logic-in-Memory Computing Exploiting Bilayer Analog OxRAM Devices.

von Neumann architecture based computers isolate computation and storage (i.e. data is shuttled between computation blocks (processor) and memory blocks). The to-and-fro movement of data leads to a fundamental limitation of modern computers, known as the Memory wall. Logic in-Memory (LIM)/In-Memory Computing (IMC) approaches aim to address this bottleneck by directly computing inside memory units thereby eliminating energy-intensive and time-consuming data movement. Several recent works in literature, propose realization of logic function(s) directly using arrays of emerging resistive memory devices (example- memristors, RRAM/ReRAM, PCM, CBRAM, OxRAM, STT-MRAM etc.), rather than using conventional transistors for computing. The logic/embedded-side of digital systems (like processors, micro-controllers) can greatly benefit from such LIM realizations. However, the pure storage-side of digital systems (example SSDs, enterprise storage etc.) will not benefit much from such LIM approaches as when memory arrays are used for logic they lose their core functionality of storage. Thus, there is the need for an approach complementary to existing LIM techniques, that's more beneficial for the storage-side of digital systems; one that gives compute capability to memory arrays not at the cost of their existing stored states. Fundamentally, this would require memory nanodevice arrays that are capable of storing and computing simultaneously. In this paper, we propose a novel 'Simultaneous Logic in-Memory' (SLIM) methodology which is complementary to existing LIM approaches in literature. Through extensive experiments we demonstrate novel SLIM bitcells (1T-1R/2T-1R) comprising non-filamentary bilayer analog OxRAM devices with NMOS transistors. Proposed bitcells are capable of implementing both Memory and Logic operations simultaneously. Detailed programming scheme, array level implementation, and controller architecture are also proposed. Furthermore, to study the impact of proposed SLIM approach for real-world implementations, we performed analysis for two applications: (i) Sobel Edge Detection, and (ii) Binary Neural Network- Multi layer Perceptron (BNN-MLP). By performing all computations in SLIM bitcell array, huge Energy Delay Product (EDP) savings of ≈75× for 1T-1R (≈40× for 2T-1R) SLIM bitcell were observed for edge-detection application while EDP savings of ≈3.5× for 1T-1R (≈1.6× for 2T-1R) SLIM bitcell were observed for BNN-MLP application respectively, in comparison to conventional computing. EDP savings owing to reduction in data transfer between CPU ↔ memory is observed to be ≈780× (for both SLIM bitcells).

Feasibility of transumbilical anatomic "Lung" segmentectomy in a canine model.

BACKGROUND: Transumbilical approach has been shown to be feasible to perform lung wedge resection and anatomic lobectomy. This study uses a canine model to assess the feasibility of transumbilical segmentectomy. METHODS: Transumbilical segmentectomy was performed in 10 beagle dogs using a 3-cm umbilical incision combined with a 2.5-cm diaphragmatic incision. We evaluated the surgical outcomes, operative complications, physiologic changes, hemodynamic changes, and inflammatory changes of the procedures. RESULTS: Transumbilical segmentectomy was successfully completed in eight of ten animals. There was one mortality complication related to lung injury causing hemodynamic collapse. Another animal required conventional thoracotomy to complete the surgery due to limited working space. There were no notable events in the postoperative period for all eight dogs that completed the segmentectomy via the transumbilical approach. CONCLUSION: This animal study demonstrates that the pulmonary segmentectomy can be performed with current standard endoscopic instruments via a single transumbilical incision.We believe that advancing surgical innovation and good collaboration between multi-disciplinary research teams will further establish clearer roles for transumbilical segmentectomy in thoracic surgery.

Comparison of Clinical Manifestation, Diagnosis, and Outcomes of Invasive Pulmonary Aspergillosis and Pulmonary Mucormycosis.

OBJECTS: Invasive pulmonary mold infection usually has devastating outcomes. Timely differentiation between invasive pulmonary aspergillosis (IPA) from pulmonary mucormycosis (PM) is critical for treatment decision-making. However, information on IPA and PM differentiation is limited. METHODS: We conducted a retrospective, multicenter, observational study, with proven and probable IPA and PM patients from January 2004 to December 2017. Demographics, clinical manifestations, image reports, histopathological findings, and outcomes were analyzed. RESULTS: A total of 46 IPA (33 proven and 13 probable) and 19 PM (18 proven and one probable) cases were analyzed. The majority of tissues (81% in IPA and 61% in PM) were obtained using bronchoscopy. Prior influenza infection was a predisposing factor for IPA, and abscess formation in CT scan was associated with PM (p = 0.0491, p = 0.0454, respectively). The positive culture rate for PM was lower than that for IPA (37% vs. 67%, p = 0.0294). The galactomannan (GM) level from serum and bronchoalveolar lavage (BAL) fluid was significantly higher in IPA than in PM (3.3 ± 0.5 vs. 0.8 ± 0.6, p = 0.0361; 4.0 ± 0.6 vs. 0.59 ± 0.1, p = 0.0473, respectively). The overall mortality rate was 65%, which was similar among IPA and PM groups. Systemic steroid exposure and high Acute Physiology and Chronic Health Evaluation II (APACHE II) scores on admission were independently correlated to mortality in IPA (p = 0.027, p = 0.026, respectively). However, there was no predictor for mortality found in PM patients. CONCLUSIONS: Influenza infection, abscess formation in CT scan, and GM level may help physicians to differentiate IPA and PM. Bronchoscopy-guided biopsy and lavage specimen provide timely and definite diagnosis. The prognosis of IPA is associated with systemic steroid exposure and higher APACHE II scores on admission.