Axonal remodeling is a critical aspect of ischemic brain repair processes and contributes to spontaneous functional recovery.Our previous in vitro study demonstrated that exosomes/small extracellular vesicles(sEVs)iso...Axonal remodeling is a critical aspect of ischemic brain repair processes and contributes to spontaneous functional recovery.Our previous in vitro study demonstrated that exosomes/small extracellular vesicles(sEVs)isolated from cerebral endothelial cells(CEC-sEVs)of ischemic brain promote axonal growth of embryonic cortical neurons and that microRNA 27a(miR-27a)is an elevated miRNA in ischemic CEC-sEVs.In the present study,we investigated whether normal CEC-sEVs engineered to enrich their levels of miR-27a(27a-sEVs)further enhance axonal growth and improve neurological outcomes after ischemic stroke when compared with treatment with non-engineered CEC-sEVs.27a-sEVs were isolated from the conditioned medium of healthy mouse CECs transfected with a lentiviral miR-27a expression vector.Small EVs isolated from CECs transfected with a scramble vector(Scra-sEVs)were used as a control.Adult male mice were subjected to permanent middle cerebral artery occlusion and then were randomly treated with 27a-sEVs or Scra-sEVs.An array of behavior assays was used to measure neurological function.Compared with treatment of ischemic stroke with Scra-sEVs,treatment with 27a-sEVs significantly augmented axons and spines in the peri-infarct zone and in the corticospinal tract of the spinal grey matter of the denervated side,and significantly improved neurological outcomes.In vitro studies demonstrated that CEC-sEVs carrying reduced miR-27a abolished 27a-sEV-augmented axonal growth.Ultrastructural analysis revealed that 27a-sEVs systemically administered preferentially localized to the pre-synaptic active zone,while quantitative reverse transcription-polymerase chain reaction and Western Blot analysis showed elevated miR-27a,and reduced axonal inhibitory proteins Semaphorin 6A and Ras Homolog Family Member A in the peri-infarct zone.Blockage of the Clathrin-dependent endocytosis pathway substantially reduced neuronal internalization of 27a-sEVs.Our data provide evidence that 27a-sEVs have a therapeutic effect on stroke recovery by promoting axonal remodeling and improving neurological outcomes.Our findings also suggest that suppression of axonal inhibitory proteins such as Semaphorin 6A may contribute to the beneficial effect of 27a-sEVs on axonal remodeling.展开更多
Understanding the neural underpinning of human gait and balance is one of the most pertinent challenges for 21st-century translational neuroscience due to the profound impact that falls and mobility disturbances have ...Understanding the neural underpinning of human gait and balance is one of the most pertinent challenges for 21st-century translational neuroscience due to the profound impact that falls and mobility disturbances have on our aging population.Posture and gait control does not happen automatically,as previously believed,but rather requires continuous involvement of central nervous mechanisms.To effectively exert control over the body,the brain must integrate multiple streams of sensory information,including visual,vestibular,and somatosensory signals.The mechanisms which underpin the integration of these multisensory signals are the principal topic of the present work.Existing multisensory integration theories focus on how failure of cognitive processes thought to be involved in multisensory integration leads to falls in older adults.Insufficient emphasis,however,has been placed on specific contributions of individual sensory modalities to multisensory integration processes and cross-modal interactions that occur between the sensory modalities in relation to gait and balance.In the present work,we review the contributions of somatosensory,visual,and vestibular modalities,along with their multisensory intersections to gait and balance in older adults and patients with Parkinson’s disease.We also review evidence of vestibular contributions to multisensory temporal binding windows,previously shown to be highly pertinent to fall risk in older adults.Lastly,we relate multisensory vestibular mechanisms to potential neural substrates,both at the level of neurobiology(concerning positron emission tomography imaging)and at the level of electrophysiology(concerning electroencephalography).We hope that this integrative review,drawing influence across multiple subdisciplines of neuroscience,paves the way for novel research directions and therapeutic neuromodulatory approaches,to improve the lives of older adults and patients with neurodegenerative diseases.展开更多
This study shows that sulfide solid-state electrolytes,β-Li_(3)PS_(4)and Li_(6)PS_(5)Cl,are flammable solids.Both solid-state electrolytes release sulfur vapor in a dry,oxidizing environment at elevated temperature&l...This study shows that sulfide solid-state electrolytes,β-Li_(3)PS_(4)and Li_(6)PS_(5)Cl,are flammable solids.Both solid-state electrolytes release sulfur vapor in a dry,oxidizing environment at elevated temperature<300℃.Sulfur vapor is a highly flammable gas,which then auto-ignites to produce a flame.This behavior suggests that an O_(2)-S gas-gas reaction mechanism may contribute to all-solid-state battery thermal runaway.To improve all-solid-state battery safety,current work focuses on eliminating the O_(2)source by changing the cathode active material.The conclusion of this study suggests that all-solidstate battery safety can also be realized by the development of solid-state electrolytes with less susceptibility to sulfur volatilization.展开更多
Transformer models have emerged as pivotal tools within the realm of drug discovery,distinguished by their unique architectural features and exceptional performance in managing intricate data landscapes.Leveraging the...Transformer models have emerged as pivotal tools within the realm of drug discovery,distinguished by their unique architectural features and exceptional performance in managing intricate data landscapes.Leveraging the innate capabilities of transformer architectures to comprehend intricate hierarchical dependencies inherent in sequential data,these models showcase remarkable efficacy across various tasks,including new drug design and drug target identification.The adaptability of pre-trained trans-former-based models renders them indispensable assets for driving data-centric advancements in drug discovery,chemistry,and biology,furnishing a robust framework that expedites innovation and dis-covery within these domains.Beyond their technical prowess,the success of transformer-based models in drug discovery,chemistry,and biology extends to their interdisciplinary potential,seamlessly combining biological,physical,chemical,and pharmacological insights to bridge gaps across diverse disciplines.This integrative approach not only enhances the depth and breadth of research endeavors but also fosters synergistic collaborations and exchange of ideas among disparate fields.In our review,we elucidate the myriad applications of transformers in drug discovery,as well as chemistry and biology,spanning from protein design and protein engineering,to molecular dynamics(MD),drug target iden-tification,transformer-enabled drug virtual screening(VS),drug lead optimization,drug addiction,small data set challenges,chemical and biological image analysis,chemical language understanding,and single cell data.Finally,we conclude the survey by deliberating on promising trends in transformer models within the context of drug discovery and other sciences.展开更多
CD47 is a ubiquitous and pleiotropic cell-surface receptor.Disrupting CD47 enhances injury repair in various tissues but the role of CD47 has not been studied in bone injuries.In a murine closed-fracture model,CD47-nu...CD47 is a ubiquitous and pleiotropic cell-surface receptor.Disrupting CD47 enhances injury repair in various tissues but the role of CD47 has not been studied in bone injuries.In a murine closed-fracture model,CD47-null mice showed decreased callus bone formation as assessed by microcomputed tomography 10 days post-fracture and increased fibrous volume as determined by histology.To understand the cellular basis for this phenotype,mesenchymal progenitors(MSC)were harvested from bone marrow.CD47-null MSC showed decreased large fibroblast colony formation(CFU-F),significantly less proliferation,and fewer cells in Sphase,although osteoblast differentiation was unaffected.However,consistent with prior research,CD47-null endothelial cells showed increased proliferation relative to WT cells.Similarly,in a murine ischemic fracture model,CD47-null mice showed reduced fracture callus size due to a reduction in bone relative to WT 15 days-post fracture.Consistent with our in vitro results,in vivo EdU labeling showed decreased cell proliferation in the callus of CD47-null mice,while staining for CD31 and endomucin demonstrated increased endothelial cell density.Finally,WT mice with ischemic fracture that were administered a CD47 morpholino,which blocks CD47 protein production,showed a callus phenotype similar to that of ischemic fractures in CD47-null mice,suggesting the phenotype was not due to developmental changes in the knockout mice.Thus,inhibition of CD47 during bone healing reduces both non-ischemic and ischemic fracture healing,in part,by decreasing MSC proliferation.Furthermore,the increase in endothelial cell proliferation and early blood vessel density caused by CD47 disruption is not sufficient to overcome MSC dysfunction.展开更多
Bone morphogenetic proteins are essential for bone regeneration/fracture healing but can also induce heterotopic ossification(HO).Understanding accessory factors modulating BMP signaling would provide both a means of ...Bone morphogenetic proteins are essential for bone regeneration/fracture healing but can also induce heterotopic ossification(HO).Understanding accessory factors modulating BMP signaling would provide both a means of enhancing BMP-dependent regeneration while preventing HO.This study focuses on the ability of the collagen receptor,discoidin domain receptor 2(DDR2),to regulate BMP activity.As will be shown,induction of bone formation by subcutaneous BMP2 implants is severely compromised in Ddr2-deficient mice.In addition,Ddr2 deficiency attenuates HO in mice expressing the ACVR1 mutation associated with human fibrodysplasia ossificans progressiva.In cells migrating into BMP2 implants,DDR2 is co-expressed with GLI1,a skeletal stem cell marker,and DDR2/GLI1-positive cells participate in BMP2-induced bone formation where they contribute to chondrogenic and osteogenic lineages.Consistent with this distribution,conditional knockout of Ddr2 in Gli1-expressing cells inhibited bone formation to the same extent seen in globally Ddr2-deficient animals.This response was explained by selective inhibition of Gli1+cell proliferation without changes in apoptosis.The basis for this DDR2 requirement was explored further using bone marrow stromal cells.Although Ddr2 deficiency inhibited BMP2-dependent chondrocyte and osteoblast differentiation and in vivo,bone formation,early BMP responses including SMAD phosphorylation remained largely intact.Instead,Ddr2 deficiency reduced the nuclear/cytoplasmic ratio of the Hippo pathway intermediates,YAP and TAZ.This suggests that DDR2 regulates Hippo pathway-mediated responses to the collagen matrix,which subsequently affect BMP responsiveness.In summary,DDR2 is an important modulator of BMP signaling and a potential therapeutic target both for enhancing regeneration and treating HO.展开更多
This review focuses on the diagnostic algorithm for nonobstructive azoospermia(NOA),a significant male factor contributing to infertility.NOA,characterized by the absence of sperm in the ejaculate,requires a systemati...This review focuses on the diagnostic algorithm for nonobstructive azoospermia(NOA),a significant male factor contributing to infertility.NOA,characterized by the absence of sperm in the ejaculate,requires a systematic diagnostic approach to identify reversible conditions,genetic factors,and prognosis for achieving pregnancy.The diagnostic pathway involves semen analysis and a comprehensive evaluation for hormonal deficiencies,anatomical abnormalities,and genetic factors.The importance of medical history,physical examination,endocrine evaluation,imaging,and genetic testing is emphasized.This review highlights the significance of differentiating NOA from obstructive azoospermia(OA)and outlines key considerations for effective management,including surgical sperm retrieval and assisted reproductive techniques.Testicular biopsy is discussed as a definitive method to distinguish obstructive cases from nonobstructive cases,providing valuable prognostic information.Overall,a thorough and systematic diagnostic approach is essential for the effective management of men suspected with NOA,offering insights into potential treatment options and reproductive outcomes.展开更多
In computer vision and artificial intelligence,automatic facial expression-based emotion identification of humans has become a popular research and industry problem.Recent demonstrations and applications in several fi...In computer vision and artificial intelligence,automatic facial expression-based emotion identification of humans has become a popular research and industry problem.Recent demonstrations and applications in several fields,including computer games,smart homes,expression analysis,gesture recognition,surveillance films,depression therapy,patientmonitoring,anxiety,and others,have brought attention to its significant academic and commercial importance.This study emphasizes research that has only employed facial images for face expression recognition(FER),because facial expressions are a basic way that people communicate meaning to each other.The immense achievement of deep learning has resulted in a growing use of its much architecture to enhance efficiency.This review is on machine learning,deep learning,and hybrid methods’use of preprocessing,augmentation techniques,and feature extraction for temporal properties of successive frames of data.The following section gives a brief summary of assessment criteria that are accessible to the public and then compares them with benchmark results the most trustworthy way to assess FER-related research topics statistically.In this review,a brief synopsis of the subject matter may be beneficial for novices in the field of FER as well as seasoned scholars seeking fruitful avenues for further investigation.The information conveys fundamental knowledge and provides a comprehensive understanding of the most recent state-of-the-art research.展开更多
Conducting predictability studies is essential for tracing the source of forecast errors,which not only leads to the improvement of observation and forecasting systems,but also enhances the understanding of weather an...Conducting predictability studies is essential for tracing the source of forecast errors,which not only leads to the improvement of observation and forecasting systems,but also enhances the understanding of weather and climate phenomena.In the past few decades,dynamical numerical models have been the primary tools for predictability studies,achieving significant progress.Nowadays,with the advances in artificial intelligence(AI)techniques and accumulations of vast meteorological data,modeling weather and climate events using modern data-driven approaches is becoming trendy,where FourCastNet,Pangu-Weather,and GraphCast are successful pioneers.In this perspective article,we suggest AI models should not be limited to forecasting but be expanded to predictability studies,leveraging AI's advantages of high efficiency and self-contained optimization modules.To this end,we first remark that AI models should possess high simulation capability with fine spatiotemporal resolution for two kinds of predictability studies.AI models with high simulation capabilities comparable to numerical models can be considered to provide solutions to partial differential equations in a data-driven way.Then,we highlight several specific predictability issues with well-determined nonlinear optimization formulizations,which can be well-studied using AI models,holding significant scientific value.In addition,we advocate for the incorporation of AI models into the synergistic cycle of the cognition–observation–model paradigm.Comprehensive predictability studies have the potential to transform“big data”to“big and better data”and shift the focus from“AI for forecasts”to“AI for science”,ultimately advancing the development of the atmospheric and oceanic sciences.展开更多
BACKGROUND Coronavirus disease 2019(COVID-19)disrupted healthcare and led to increased telehealth use.We explored the impact of COVID-19 on liver transplant evaluation(LTE).AIM To understand the impact of telehealth o...BACKGROUND Coronavirus disease 2019(COVID-19)disrupted healthcare and led to increased telehealth use.We explored the impact of COVID-19 on liver transplant evaluation(LTE).AIM To understand the impact of telehealth on LTE during COVID-19 and to identify disparities in outcomes disaggregated by sociodemographic factors.METHODS This was a retrospective study of patients who initiated LTE at our center from 3/16/20-3/16/21(“COVID-19 era”)and the year prior(3/16/19-3/15/20,“pre-COVID-19 era”).We compared LTE duration times between eras and explored the effects of telehealth and inpatient evaluations on LTE duration,listing,and pretransplant mortality.RESULTS One hundred and seventy-eight patients were included in the pre-COVID-19 era cohort and one hundred and ninety-nine in the COVID-19 era cohort.Twentynine percent(58/199)of COVID-19 era initial LTE were telehealth,compared to 0%(0/178)pre-COVID-19.There were more inpatient evaluations during COVID-19 era(40%vs 28%,P<0.01).Among outpatient encounters,telehealth use for initial LTE during COVID-19 era did not impact likelihood of listing,pretransplant mortality,or time to LTE and listing.Median times to LTE and listing during COVID-19 were shorter than pre-COVID-19,driven by increased inpatient evaluations.Sociodemographic factors were not predictive of telehealth.CONCLUSION COVID-19 demonstrates a shift to telehealth and inpatient LTE.Telehealth does not impact LTE or listing duration,likelihood of listing,or mortality,suggesting telehealth may facilitate LTE without negative outcomes.展开更多
This study investigates trends in extreme precipitation events(EPEs)across Antarctica from 1979 to 2023,analyzing changes in EPE frequency,intensity,and the proportion of extreme to total precipitation.Using Self-Orga...This study investigates trends in extreme precipitation events(EPEs)across Antarctica from 1979 to 2023,analyzing changes in EPE frequency,intensity,and the proportion of extreme to total precipitation.Using Self-Organizing Map(SOM)techniques,the study distinguishes the contributions from thermodynamic,dynamic,and interaction components in explaining these trends.Positive EPE occurrence trends are observed across the Bellingshausen and Weddell Seas,Dronning Maud Land,and parts of the Southern Ocean,with declines limited to Queen Mary Land.Thermodynamic factors,responsible for 96.0%of the overall trend,are driven by increased water vapor content in polar air masses.Dynamic contributions,representing 10.8%,are linked to a strengthened Amundsen Sea Low(ASL)associated with the Southern Annular Mode(SAM)and Pacific South American(PSA)trends.Interaction effects make a slightly negative contribution(-6.8%)to the overall trend.Variations in water vapor transport and vertical velocity tied to annual 500-hPa geopotential height anomalies further explain EPE trends.These findings provide insight into the atmospheric processes that influence Antarctic EPEs,with implications for understanding the climatic impact on the polar environment.展开更多
A previous paper showed that the real numbers between 0 and 1 could be represented by an infinite tree structure, called the ‘infinity tree’, which contains only a countably infinite number of nodes and arcs. This p...A previous paper showed that the real numbers between 0 and 1 could be represented by an infinite tree structure, called the ‘infinity tree’, which contains only a countably infinite number of nodes and arcs. This paper discusses how a finite-state Turing machine could, in a countably infinite number of state transitions, write all the infinite paths in the infinity tree to a countably infinite tape. Hence it is argued that the real numbers in the interval [0, 1] are countably infinite in a non-Cantorian theory of infinity based on Turing machines using countably infinite space and time. In this theory, Cantor’s Continuum Hypothesis can also be proved. And in this theory, it follows that the power set of the natural numbers P(ℕ) is countably infinite, which contradicts the claim of Cantor’s Theorem for the natural numbers. However, this paper does not claim there is an error in Cantor’s arguments that [0, 1] is uncountably infinite. Rather, this paper considers the situation as a paradox, resulting from different choices about how to represent and count the continuum of real numbers.展开更多
The field of gastroenterology has experienced revolutionary advances over the past years,as flexible endoscopes have become widely accessible.In addition to enabling faster,less invasive,and more affordable treatment,...The field of gastroenterology has experienced revolutionary advances over the past years,as flexible endoscopes have become widely accessible.In addition to enabling faster,less invasive,and more affordable treatment,flexible endoscopes have greatly improved the detection and endoscopic screening of malignancies and prevented many cancer-related deaths.The development and clinical application of new diagnostic endoscopic technologies,such as magnification endoscopy,narrow-band imaging,endoscopic ultrasound with biopsy,and more recently,artificial intelligence enhanced technologies,have made the recognition and detection of various neoplasms and sub-epithelial tumors more possible.This review demonstrates the latest advancements in endoscopic procedures,techniques,and devices applied in the diagnosis and management of gastrointestinal cancer.展开更多
Dental implants have restored masticatory function to over 100000000 individuals,yet almost 1000000 implants fail each year due to peri-implantitis,a disease triggered by peri-implant microbial dysbiosis.Our ability t...Dental implants have restored masticatory function to over 100000000 individuals,yet almost 1000000 implants fail each year due to peri-implantitis,a disease triggered by peri-implant microbial dysbiosis.Our ability to prevent and treat peri-implantitis is hampered by a paucity of knowledge of how these biomes are acquired and the factors that engender normobiosis.Therefore,we combined a 3-month interventional study of 15 systemically and periodontally healthy adults with whole genome sequencing,finescale enumeration and graph theoretics to interrogate colonization dynamics in the pristine peri-implant sulcus.We discovered that colonization trajectories of implants differ substantially from adjoining teeth in acquisition of new members and development of functional synergies.Source-tracking algorithms revealed that this niche is initially seeded by bacteria trapped within the coverscrew chamber during implant placement.These pioneer species stably colonize the microbiome and exert a sustained influence on the ecosystem by serving as anchors of influential hubs and by providing functions that enable cell replication and biofilm maturation.Unlike the periodontal microbiome,recruitment of new members to the peri-implant community occurs on nepotistic principles.Maturation is accompanied by a progressive increase in anaerobiosis,however,the predominant functionalities are oxygen-dependent over the 12-weeks.The peri-implant community is easily perturbed following crown placement,but demonstrates remarkable resilience;returning to pre-perturbation states within three weeks.This study highlights important differences in the development of the periodontal and peri-implant ecosystems,and signposts the importance of placing implants in periodontally healthy individuals or following the successful resolution of periodontal disease.展开更多
This article constructs statistical selection procedures for exponential populations that may differ in only the threshold parameters. The scale parameters of the populations are assumed common and known. The independ...This article constructs statistical selection procedures for exponential populations that may differ in only the threshold parameters. The scale parameters of the populations are assumed common and known. The independent samples drawn from the populations are taken to be of the same size. The best population is defined as the one associated with the largest threshold parameter. In case more than one population share the largest threshold, one of these is tagged at random and denoted the best. Two procedures are developed for choosing a subset of the populations having the property that the chosen subset contains the best population with a prescribed probability. One procedure is based on the sample minimum values drawn from the populations, and another is based on the sample means from the populations. An “Indifference Zone” (IZ) selection procedure is also developed based on the sample minimum values. The IZ procedure asserts that the population with the largest test statistic (e.g., the sample minimum) is the best population. With this approach, the sample size is chosen so as to guarantee that the probability of a correct selection is no less than a prescribed probability in the parameter region where the largest threshold is at least a prescribed amount larger than the remaining thresholds. Numerical examples are given, and the computer R-codes for all calculations are given in the Appendices.展开更多
Understanding microbial-host interactions in the oral cavity is essential for elucidating oral disease pathogenesis and its systemic implications.In vitro bacteria-host cell coculture models have enabled fundamental s...Understanding microbial-host interactions in the oral cavity is essential for elucidating oral disease pathogenesis and its systemic implications.In vitro bacteria-host cell coculture models have enabled fundamental studies to characterize bacterial infection and host responses in a reductionist yet reproducible manner.However,existing in vitro coculture models fail to establish conditions that are suitable for the growth of both mammalian cells and anaerobes,thereby hindering a comprehensive understanding of their interactions.Here,we present an asymmetric gas coculture system that simulates the oral microenvironment by maintaining distinct normoxic and anaerobic conditions for gingival epithelial cells and anaerobic bacteria,respectively.Using a key oral pathobiont,Fusobacterium nucleatum,as the primary test bed,we demonstrate that the system preserves bacterial viability and supports the integrity of telomerase-immortalized gingival keratinocytes.Compared to conventional models,this system enhanced bacterial invasion,elevated intracellular bacterial loads,and elicited more robust host pro-inflammatory responses,including increased secretion of CXCL10,IL-6,and IL-8.In addition,the model enabled precise evaluation of antibiotic efficacy against intracellular pathogens.Finally,we validate the ability of the asymmetric system to support the proliferation of a more oxygen-sensitive oral pathobiont,Porphyromonas gingivalis.These results underscore the utility of this coculture platform for studying oral microbial pathogenesis and screening therapeutics,offering a physiologically relevant approach to advance oral and systemic health research.展开更多
Obstructed defecation syndrome(ODS)is a complex defecatory disorder asso-ciated with pelvic floor dysfunction.It affects approximately 50%of women over the age of 50 and significantly impacts their quality of life.The...Obstructed defecation syndrome(ODS)is a complex defecatory disorder asso-ciated with pelvic floor dysfunction.It affects approximately 50%of women over the age of 50 and significantly impacts their quality of life.The causes of ODS include structural abnormalities such as rectocele,enterocele,intussusception,and pelvic floor descent,as well as functional disorders like anismus.Accurate diagnosis is crucial for effective management due to the high risk of treatment failure associated with inaccurate findings.Various imaging modalities are used to assess pelvic floor disorders,including fluoroscopic defecography(FD),mag-netic resonance defecography(MRD),pelvic floor ultrasound(PFUS),and echode-fecography(EDF).FD is the most commonly performed test worldwide,offering high accuracy in diagnosing pelvic floor disorders.It provides dynamic visual-ization of defecation mechanics but involves radiation exposure.MRD offers ex-cellent soft tissue detail and multiplanar imaging without radiation,making it particularly useful for multicompartment disorders;however,it is associated with high procedural costs and limited availability.Both PFUS and EDF are minimally invasive and avoid radiation exposure.PFUS shows promise as a valuable screening tool that could help minimize the need for advanced imaging if findings are normal.EDF is also promising but requires specialized training and remains less widely available.This review evaluates the accuracy,advantages,and limitations of various diagnostic modalities for pelvic floor disorders,aiming to guide optimal clinical decision-making.展开更多
BACKGROUND Urologists are commonly consulted regarding difficult and traumatic urethral catheterizations.Complications surrounding Foley catheterizations represent a significant burden to the healthcare system.AIM To ...BACKGROUND Urologists are commonly consulted regarding difficult and traumatic urethral catheterizations.Complications surrounding Foley catheterizations represent a significant burden to the healthcare system.AIM To assess the demographic and patient characteristics surrounding urological consultation for difficult and traumatic Foley catheterizations at our institution across multiple hospitals.METHODS This is a single-institution,multi-hospital,263 patient,retrospective chart review from Jan 2020–December 2023.RESULTS The majority of consultations(80.2%)did not require heroic measures by the urology service.A Foley catheter placement was determined not difficult in the majority 191(72.6%)of patients.Sub-group analysis of“difficult by urology”vs“not difficult by urology”,showed a significant difference between those with zero attempts,one attempt,and greater than one attempts(P=0.004).Those patients specifically with greater than one attempts were more likely to be seen as a difficult insertion by urology assessment(60.6%)compared to not difficult(38.6%).Likewise,those patients with a history of difficult urethral catheter(DUC)/traumatic urethral catheterization(TUC)(25.8%)were more likely to be difficult compared to those without a history of DUC/TUC(14.2%)(P=0.038).CONCLUSION The study found that majority of consultations received did not require heroic measures by the urology service to place a catheter.Patients who had a history of DUC/TUC and those who had greater than one catheter attempts were statistically more likely to be a DUC based on urology assessment.At our institution we hope to propose a protocol in which nursing staff and non-urologic clinicians will utilize a troubleshooting checklist and an algorithm when difficult or traumatic urethral catheters are encountered in order to improve patient care and decrease healthcare costs.For example,this protocol would ideally address complications of multiple catheter attempts such as urethral trauma,development of urethral strictures,and infection risk.Additionally,future trainings and availability of additional resources will be provided and assessed with a goal of reducing healthcare cost surrounding these complications.展开更多
As a rare earth solute element in Mg alloys,Y has the beneficial effects of increasing both the strength and the ductility as well as weakening the crystallographic texture.To achieve a more fundamental understanding ...As a rare earth solute element in Mg alloys,Y has the beneficial effects of increasing both the strength and the ductility as well as weakening the crystallographic texture.To achieve a more fundamental understanding on how Y addition affects the microstructural evolution and mechanical properties,the Y segregation behavior at grain boundaries was investigated in Mg-1wt.%Y and Mg-7wt.%Y alloys at different conditions.The segregation intensity and its dependence on the grain boundary misorientation angle were experimentally characterized and computationally predicted.Strong segregation at grain boundaries was observed in both low and high Y-containing alloys.Y segregation was found to remain in alloy Mg-7Y after high-temperature annealing heat treatment at 540℃.No direct correlation between the Y segregation intensity and the grain boundary misorientation angle could be established based on either the experimental characterization or the atomistic simulation with a spectral model.We thus conclude that grain boundary segregation of Y is independent of grain boundary misorientation angle.展开更多
基金supported by the NIH grants,R01 NS111801(to ZGZ)American Heart Association 16SDG29860003(to YZ)。
文摘Axonal remodeling is a critical aspect of ischemic brain repair processes and contributes to spontaneous functional recovery.Our previous in vitro study demonstrated that exosomes/small extracellular vesicles(sEVs)isolated from cerebral endothelial cells(CEC-sEVs)of ischemic brain promote axonal growth of embryonic cortical neurons and that microRNA 27a(miR-27a)is an elevated miRNA in ischemic CEC-sEVs.In the present study,we investigated whether normal CEC-sEVs engineered to enrich their levels of miR-27a(27a-sEVs)further enhance axonal growth and improve neurological outcomes after ischemic stroke when compared with treatment with non-engineered CEC-sEVs.27a-sEVs were isolated from the conditioned medium of healthy mouse CECs transfected with a lentiviral miR-27a expression vector.Small EVs isolated from CECs transfected with a scramble vector(Scra-sEVs)were used as a control.Adult male mice were subjected to permanent middle cerebral artery occlusion and then were randomly treated with 27a-sEVs or Scra-sEVs.An array of behavior assays was used to measure neurological function.Compared with treatment of ischemic stroke with Scra-sEVs,treatment with 27a-sEVs significantly augmented axons and spines in the peri-infarct zone and in the corticospinal tract of the spinal grey matter of the denervated side,and significantly improved neurological outcomes.In vitro studies demonstrated that CEC-sEVs carrying reduced miR-27a abolished 27a-sEV-augmented axonal growth.Ultrastructural analysis revealed that 27a-sEVs systemically administered preferentially localized to the pre-synaptic active zone,while quantitative reverse transcription-polymerase chain reaction and Western Blot analysis showed elevated miR-27a,and reduced axonal inhibitory proteins Semaphorin 6A and Ras Homolog Family Member A in the peri-infarct zone.Blockage of the Clathrin-dependent endocytosis pathway substantially reduced neuronal internalization of 27a-sEVs.Our data provide evidence that 27a-sEVs have a therapeutic effect on stroke recovery by promoting axonal remodeling and improving neurological outcomes.Our findings also suggest that suppression of axonal inhibitory proteins such as Semaphorin 6A may contribute to the beneficial effect of 27a-sEVs on axonal remodeling.
文摘Understanding the neural underpinning of human gait and balance is one of the most pertinent challenges for 21st-century translational neuroscience due to the profound impact that falls and mobility disturbances have on our aging population.Posture and gait control does not happen automatically,as previously believed,but rather requires continuous involvement of central nervous mechanisms.To effectively exert control over the body,the brain must integrate multiple streams of sensory information,including visual,vestibular,and somatosensory signals.The mechanisms which underpin the integration of these multisensory signals are the principal topic of the present work.Existing multisensory integration theories focus on how failure of cognitive processes thought to be involved in multisensory integration leads to falls in older adults.Insufficient emphasis,however,has been placed on specific contributions of individual sensory modalities to multisensory integration processes and cross-modal interactions that occur between the sensory modalities in relation to gait and balance.In the present work,we review the contributions of somatosensory,visual,and vestibular modalities,along with their multisensory intersections to gait and balance in older adults and patients with Parkinson’s disease.We also review evidence of vestibular contributions to multisensory temporal binding windows,previously shown to be highly pertinent to fall risk in older adults.Lastly,we relate multisensory vestibular mechanisms to potential neural substrates,both at the level of neurobiology(concerning positron emission tomography imaging)and at the level of electrophysiology(concerning electroencephalography).We hope that this integrative review,drawing influence across multiple subdisciplines of neuroscience,paves the way for novel research directions and therapeutic neuromodulatory approaches,to improve the lives of older adults and patients with neurodegenerative diseases.
文摘This study shows that sulfide solid-state electrolytes,β-Li_(3)PS_(4)and Li_(6)PS_(5)Cl,are flammable solids.Both solid-state electrolytes release sulfur vapor in a dry,oxidizing environment at elevated temperature<300℃.Sulfur vapor is a highly flammable gas,which then auto-ignites to produce a flame.This behavior suggests that an O_(2)-S gas-gas reaction mechanism may contribute to all-solid-state battery thermal runaway.To improve all-solid-state battery safety,current work focuses on eliminating the O_(2)source by changing the cathode active material.The conclusion of this study suggests that all-solidstate battery safety can also be realized by the development of solid-state electrolytes with less susceptibility to sulfur volatilization.
基金supported in part by National Institute of Health(NIH),USA(Grant Nos.:R01GM126189,R01AI164266,and R35GM148196)the National Science Foundation,USA(Grant Nos.DMS2052983,DMS-1761320,and IIS-1900473)+3 种基金National Aero-nautics and Space Administration(NASA),USA(Grant No.:80NSSC21M0023)Michigan State University(MSU)Foundation,USA,Bristol-Myers Squibb(Grant No.:65109)USA,and Pfizer,USAsupported by the National Natural Science Foundation of China(Grant Nos.:11971367,12271416,and 11972266).
文摘Transformer models have emerged as pivotal tools within the realm of drug discovery,distinguished by their unique architectural features and exceptional performance in managing intricate data landscapes.Leveraging the innate capabilities of transformer architectures to comprehend intricate hierarchical dependencies inherent in sequential data,these models showcase remarkable efficacy across various tasks,including new drug design and drug target identification.The adaptability of pre-trained trans-former-based models renders them indispensable assets for driving data-centric advancements in drug discovery,chemistry,and biology,furnishing a robust framework that expedites innovation and dis-covery within these domains.Beyond their technical prowess,the success of transformer-based models in drug discovery,chemistry,and biology extends to their interdisciplinary potential,seamlessly combining biological,physical,chemical,and pharmacological insights to bridge gaps across diverse disciplines.This integrative approach not only enhances the depth and breadth of research endeavors but also fosters synergistic collaborations and exchange of ideas among disparate fields.In our review,we elucidate the myriad applications of transformers in drug discovery,as well as chemistry and biology,spanning from protein design and protein engineering,to molecular dynamics(MD),drug target iden-tification,transformer-enabled drug virtual screening(VS),drug lead optimization,drug addiction,small data set challenges,chemical and biological image analysis,chemical language understanding,and single cell data.Finally,we conclude the survey by deliberating on promising trends in transformer models within the context of drug discovery and other sciences.
基金supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases(NIAMS)of the National Institutes of Health(NIH)under award numbers F30AR071201(R.L.Z.)and R01 AR066028(K.D.H.)Additional research support is provided by the NIH under a training award T32TR004371(C.A.C.).
文摘CD47 is a ubiquitous and pleiotropic cell-surface receptor.Disrupting CD47 enhances injury repair in various tissues but the role of CD47 has not been studied in bone injuries.In a murine closed-fracture model,CD47-null mice showed decreased callus bone formation as assessed by microcomputed tomography 10 days post-fracture and increased fibrous volume as determined by histology.To understand the cellular basis for this phenotype,mesenchymal progenitors(MSC)were harvested from bone marrow.CD47-null MSC showed decreased large fibroblast colony formation(CFU-F),significantly less proliferation,and fewer cells in Sphase,although osteoblast differentiation was unaffected.However,consistent with prior research,CD47-null endothelial cells showed increased proliferation relative to WT cells.Similarly,in a murine ischemic fracture model,CD47-null mice showed reduced fracture callus size due to a reduction in bone relative to WT 15 days-post fracture.Consistent with our in vitro results,in vivo EdU labeling showed decreased cell proliferation in the callus of CD47-null mice,while staining for CD31 and endomucin demonstrated increased endothelial cell density.Finally,WT mice with ischemic fracture that were administered a CD47 morpholino,which blocks CD47 protein production,showed a callus phenotype similar to that of ischemic fractures in CD47-null mice,suggesting the phenotype was not due to developmental changes in the knockout mice.Thus,inhibition of CD47 during bone healing reduces both non-ischemic and ischemic fracture healing,in part,by decreasing MSC proliferation.Furthermore,the increase in endothelial cell proliferation and early blood vessel density caused by CD47 disruption is not sufficient to overcome MSC dysfunction.
基金Scientific Research Training Program for Young Talents of Union Hospital,Tongji Medical College,Huazhong University of Science and Technology(F.W.),NIH/NIDCR grants DE029012 and DE029465Department of Defense Grant PR190899(R.T.F.)Michigan Musculoskeletal Health Core Center(NIH/NIAMS P30 AR069620)。
文摘Bone morphogenetic proteins are essential for bone regeneration/fracture healing but can also induce heterotopic ossification(HO).Understanding accessory factors modulating BMP signaling would provide both a means of enhancing BMP-dependent regeneration while preventing HO.This study focuses on the ability of the collagen receptor,discoidin domain receptor 2(DDR2),to regulate BMP activity.As will be shown,induction of bone formation by subcutaneous BMP2 implants is severely compromised in Ddr2-deficient mice.In addition,Ddr2 deficiency attenuates HO in mice expressing the ACVR1 mutation associated with human fibrodysplasia ossificans progressiva.In cells migrating into BMP2 implants,DDR2 is co-expressed with GLI1,a skeletal stem cell marker,and DDR2/GLI1-positive cells participate in BMP2-induced bone formation where they contribute to chondrogenic and osteogenic lineages.Consistent with this distribution,conditional knockout of Ddr2 in Gli1-expressing cells inhibited bone formation to the same extent seen in globally Ddr2-deficient animals.This response was explained by selective inhibition of Gli1+cell proliferation without changes in apoptosis.The basis for this DDR2 requirement was explored further using bone marrow stromal cells.Although Ddr2 deficiency inhibited BMP2-dependent chondrocyte and osteoblast differentiation and in vivo,bone formation,early BMP responses including SMAD phosphorylation remained largely intact.Instead,Ddr2 deficiency reduced the nuclear/cytoplasmic ratio of the Hippo pathway intermediates,YAP and TAZ.This suggests that DDR2 regulates Hippo pathway-mediated responses to the collagen matrix,which subsequently affect BMP responsiveness.In summary,DDR2 is an important modulator of BMP signaling and a potential therapeutic target both for enhancing regeneration and treating HO.
文摘This review focuses on the diagnostic algorithm for nonobstructive azoospermia(NOA),a significant male factor contributing to infertility.NOA,characterized by the absence of sperm in the ejaculate,requires a systematic diagnostic approach to identify reversible conditions,genetic factors,and prognosis for achieving pregnancy.The diagnostic pathway involves semen analysis and a comprehensive evaluation for hormonal deficiencies,anatomical abnormalities,and genetic factors.The importance of medical history,physical examination,endocrine evaluation,imaging,and genetic testing is emphasized.This review highlights the significance of differentiating NOA from obstructive azoospermia(OA)and outlines key considerations for effective management,including surgical sperm retrieval and assisted reproductive techniques.Testicular biopsy is discussed as a definitive method to distinguish obstructive cases from nonobstructive cases,providing valuable prognostic information.Overall,a thorough and systematic diagnostic approach is essential for the effective management of men suspected with NOA,offering insights into potential treatment options and reproductive outcomes.
文摘In computer vision and artificial intelligence,automatic facial expression-based emotion identification of humans has become a popular research and industry problem.Recent demonstrations and applications in several fields,including computer games,smart homes,expression analysis,gesture recognition,surveillance films,depression therapy,patientmonitoring,anxiety,and others,have brought attention to its significant academic and commercial importance.This study emphasizes research that has only employed facial images for face expression recognition(FER),because facial expressions are a basic way that people communicate meaning to each other.The immense achievement of deep learning has resulted in a growing use of its much architecture to enhance efficiency.This review is on machine learning,deep learning,and hybrid methods’use of preprocessing,augmentation techniques,and feature extraction for temporal properties of successive frames of data.The following section gives a brief summary of assessment criteria that are accessible to the public and then compares them with benchmark results the most trustworthy way to assess FER-related research topics statistically.In this review,a brief synopsis of the subject matter may be beneficial for novices in the field of FER as well as seasoned scholars seeking fruitful avenues for further investigation.The information conveys fundamental knowledge and provides a comprehensive understanding of the most recent state-of-the-art research.
基金in part supported by the National Natural Science Foundation of China(Grant Nos.42288101,42405147 and 42475054)in part by the China National Postdoctoral Program for Innovative Talents(Grant No.BX20230071)。
文摘Conducting predictability studies is essential for tracing the source of forecast errors,which not only leads to the improvement of observation and forecasting systems,but also enhances the understanding of weather and climate phenomena.In the past few decades,dynamical numerical models have been the primary tools for predictability studies,achieving significant progress.Nowadays,with the advances in artificial intelligence(AI)techniques and accumulations of vast meteorological data,modeling weather and climate events using modern data-driven approaches is becoming trendy,where FourCastNet,Pangu-Weather,and GraphCast are successful pioneers.In this perspective article,we suggest AI models should not be limited to forecasting but be expanded to predictability studies,leveraging AI's advantages of high efficiency and self-contained optimization modules.To this end,we first remark that AI models should possess high simulation capability with fine spatiotemporal resolution for two kinds of predictability studies.AI models with high simulation capabilities comparable to numerical models can be considered to provide solutions to partial differential equations in a data-driven way.Then,we highlight several specific predictability issues with well-determined nonlinear optimization formulizations,which can be well-studied using AI models,holding significant scientific value.In addition,we advocate for the incorporation of AI models into the synergistic cycle of the cognition–observation–model paradigm.Comprehensive predictability studies have the potential to transform“big data”to“big and better data”and shift the focus from“AI for forecasts”to“AI for science”,ultimately advancing the development of the atmospheric and oceanic sciences.
文摘BACKGROUND Coronavirus disease 2019(COVID-19)disrupted healthcare and led to increased telehealth use.We explored the impact of COVID-19 on liver transplant evaluation(LTE).AIM To understand the impact of telehealth on LTE during COVID-19 and to identify disparities in outcomes disaggregated by sociodemographic factors.METHODS This was a retrospective study of patients who initiated LTE at our center from 3/16/20-3/16/21(“COVID-19 era”)and the year prior(3/16/19-3/15/20,“pre-COVID-19 era”).We compared LTE duration times between eras and explored the effects of telehealth and inpatient evaluations on LTE duration,listing,and pretransplant mortality.RESULTS One hundred and seventy-eight patients were included in the pre-COVID-19 era cohort and one hundred and ninety-nine in the COVID-19 era cohort.Twentynine percent(58/199)of COVID-19 era initial LTE were telehealth,compared to 0%(0/178)pre-COVID-19.There were more inpatient evaluations during COVID-19 era(40%vs 28%,P<0.01).Among outpatient encounters,telehealth use for initial LTE during COVID-19 era did not impact likelihood of listing,pretransplant mortality,or time to LTE and listing.Median times to LTE and listing during COVID-19 were shorter than pre-COVID-19,driven by increased inpatient evaluations.Sociodemographic factors were not predictive of telehealth.CONCLUSION COVID-19 demonstrates a shift to telehealth and inpatient LTE.Telehealth does not impact LTE or listing duration,likelihood of listing,or mortality,suggesting telehealth may facilitate LTE without negative outcomes.
基金supported by the National Key R&D Program of China(2022YFE0106300)Norges Forskningsråd(328886).
文摘This study investigates trends in extreme precipitation events(EPEs)across Antarctica from 1979 to 2023,analyzing changes in EPE frequency,intensity,and the proportion of extreme to total precipitation.Using Self-Organizing Map(SOM)techniques,the study distinguishes the contributions from thermodynamic,dynamic,and interaction components in explaining these trends.Positive EPE occurrence trends are observed across the Bellingshausen and Weddell Seas,Dronning Maud Land,and parts of the Southern Ocean,with declines limited to Queen Mary Land.Thermodynamic factors,responsible for 96.0%of the overall trend,are driven by increased water vapor content in polar air masses.Dynamic contributions,representing 10.8%,are linked to a strengthened Amundsen Sea Low(ASL)associated with the Southern Annular Mode(SAM)and Pacific South American(PSA)trends.Interaction effects make a slightly negative contribution(-6.8%)to the overall trend.Variations in water vapor transport and vertical velocity tied to annual 500-hPa geopotential height anomalies further explain EPE trends.These findings provide insight into the atmospheric processes that influence Antarctic EPEs,with implications for understanding the climatic impact on the polar environment.
文摘A previous paper showed that the real numbers between 0 and 1 could be represented by an infinite tree structure, called the ‘infinity tree’, which contains only a countably infinite number of nodes and arcs. This paper discusses how a finite-state Turing machine could, in a countably infinite number of state transitions, write all the infinite paths in the infinity tree to a countably infinite tape. Hence it is argued that the real numbers in the interval [0, 1] are countably infinite in a non-Cantorian theory of infinity based on Turing machines using countably infinite space and time. In this theory, Cantor’s Continuum Hypothesis can also be proved. And in this theory, it follows that the power set of the natural numbers P(ℕ) is countably infinite, which contradicts the claim of Cantor’s Theorem for the natural numbers. However, this paper does not claim there is an error in Cantor’s arguments that [0, 1] is uncountably infinite. Rather, this paper considers the situation as a paradox, resulting from different choices about how to represent and count the continuum of real numbers.
文摘The field of gastroenterology has experienced revolutionary advances over the past years,as flexible endoscopes have become widely accessible.In addition to enabling faster,less invasive,and more affordable treatment,flexible endoscopes have greatly improved the detection and endoscopic screening of malignancies and prevented many cancer-related deaths.The development and clinical application of new diagnostic endoscopic technologies,such as magnification endoscopy,narrow-band imaging,endoscopic ultrasound with biopsy,and more recently,artificial intelligence enhanced technologies,have made the recognition and detection of various neoplasms and sub-epithelial tumors more possible.This review demonstrates the latest advancements in endoscopic procedures,techniques,and devices applied in the diagnosis and management of gastrointestinal cancer.
基金supported by National Institutes of Health R03DE027492 to Shareef Dabdoubsupported by National Institutes of Health,project number 7R01DE027857-06supported by National Institutes of Health R56DE033913 awarded to Purnima Kumar.
文摘Dental implants have restored masticatory function to over 100000000 individuals,yet almost 1000000 implants fail each year due to peri-implantitis,a disease triggered by peri-implant microbial dysbiosis.Our ability to prevent and treat peri-implantitis is hampered by a paucity of knowledge of how these biomes are acquired and the factors that engender normobiosis.Therefore,we combined a 3-month interventional study of 15 systemically and periodontally healthy adults with whole genome sequencing,finescale enumeration and graph theoretics to interrogate colonization dynamics in the pristine peri-implant sulcus.We discovered that colonization trajectories of implants differ substantially from adjoining teeth in acquisition of new members and development of functional synergies.Source-tracking algorithms revealed that this niche is initially seeded by bacteria trapped within the coverscrew chamber during implant placement.These pioneer species stably colonize the microbiome and exert a sustained influence on the ecosystem by serving as anchors of influential hubs and by providing functions that enable cell replication and biofilm maturation.Unlike the periodontal microbiome,recruitment of new members to the peri-implant community occurs on nepotistic principles.Maturation is accompanied by a progressive increase in anaerobiosis,however,the predominant functionalities are oxygen-dependent over the 12-weeks.The peri-implant community is easily perturbed following crown placement,but demonstrates remarkable resilience;returning to pre-perturbation states within three weeks.This study highlights important differences in the development of the periodontal and peri-implant ecosystems,and signposts the importance of placing implants in periodontally healthy individuals or following the successful resolution of periodontal disease.
文摘This article constructs statistical selection procedures for exponential populations that may differ in only the threshold parameters. The scale parameters of the populations are assumed common and known. The independent samples drawn from the populations are taken to be of the same size. The best population is defined as the one associated with the largest threshold parameter. In case more than one population share the largest threshold, one of these is tagged at random and denoted the best. Two procedures are developed for choosing a subset of the populations having the property that the chosen subset contains the best population with a prescribed probability. One procedure is based on the sample minimum values drawn from the populations, and another is based on the sample means from the populations. An “Indifference Zone” (IZ) selection procedure is also developed based on the sample minimum values. The IZ procedure asserts that the population with the largest test statistic (e.g., the sample minimum) is the best population. With this approach, the sample size is chosen so as to guarantee that the probability of a correct selection is no less than a prescribed probability in the parameter region where the largest threshold is at least a prescribed amount larger than the remaining thresholds. Numerical examples are given, and the computer R-codes for all calculations are given in the Appendices.
基金supported by National Science Foundation CAREER (2238972)National Institute of Dental and Craniofacial Research awards (R03DE031329 and R01DE030943)The Translational Tissue Modeling Laboratory is supported by the University of Michigan (Center for Gastrointestinal Research,Office of the Dean, Comprehensive Cancer Center, and the Departments of Pathology, Pharmacology, and Internal Medicine) with additional funding from the Endowment for Basic Sciences
文摘Understanding microbial-host interactions in the oral cavity is essential for elucidating oral disease pathogenesis and its systemic implications.In vitro bacteria-host cell coculture models have enabled fundamental studies to characterize bacterial infection and host responses in a reductionist yet reproducible manner.However,existing in vitro coculture models fail to establish conditions that are suitable for the growth of both mammalian cells and anaerobes,thereby hindering a comprehensive understanding of their interactions.Here,we present an asymmetric gas coculture system that simulates the oral microenvironment by maintaining distinct normoxic and anaerobic conditions for gingival epithelial cells and anaerobic bacteria,respectively.Using a key oral pathobiont,Fusobacterium nucleatum,as the primary test bed,we demonstrate that the system preserves bacterial viability and supports the integrity of telomerase-immortalized gingival keratinocytes.Compared to conventional models,this system enhanced bacterial invasion,elevated intracellular bacterial loads,and elicited more robust host pro-inflammatory responses,including increased secretion of CXCL10,IL-6,and IL-8.In addition,the model enabled precise evaluation of antibiotic efficacy against intracellular pathogens.Finally,we validate the ability of the asymmetric system to support the proliferation of a more oxygen-sensitive oral pathobiont,Porphyromonas gingivalis.These results underscore the utility of this coculture platform for studying oral microbial pathogenesis and screening therapeutics,offering a physiologically relevant approach to advance oral and systemic health research.
文摘Obstructed defecation syndrome(ODS)is a complex defecatory disorder asso-ciated with pelvic floor dysfunction.It affects approximately 50%of women over the age of 50 and significantly impacts their quality of life.The causes of ODS include structural abnormalities such as rectocele,enterocele,intussusception,and pelvic floor descent,as well as functional disorders like anismus.Accurate diagnosis is crucial for effective management due to the high risk of treatment failure associated with inaccurate findings.Various imaging modalities are used to assess pelvic floor disorders,including fluoroscopic defecography(FD),mag-netic resonance defecography(MRD),pelvic floor ultrasound(PFUS),and echode-fecography(EDF).FD is the most commonly performed test worldwide,offering high accuracy in diagnosing pelvic floor disorders.It provides dynamic visual-ization of defecation mechanics but involves radiation exposure.MRD offers ex-cellent soft tissue detail and multiplanar imaging without radiation,making it particularly useful for multicompartment disorders;however,it is associated with high procedural costs and limited availability.Both PFUS and EDF are minimally invasive and avoid radiation exposure.PFUS shows promise as a valuable screening tool that could help minimize the need for advanced imaging if findings are normal.EDF is also promising but requires specialized training and remains less widely available.This review evaluates the accuracy,advantages,and limitations of various diagnostic modalities for pelvic floor disorders,aiming to guide optimal clinical decision-making.
文摘BACKGROUND Urologists are commonly consulted regarding difficult and traumatic urethral catheterizations.Complications surrounding Foley catheterizations represent a significant burden to the healthcare system.AIM To assess the demographic and patient characteristics surrounding urological consultation for difficult and traumatic Foley catheterizations at our institution across multiple hospitals.METHODS This is a single-institution,multi-hospital,263 patient,retrospective chart review from Jan 2020–December 2023.RESULTS The majority of consultations(80.2%)did not require heroic measures by the urology service.A Foley catheter placement was determined not difficult in the majority 191(72.6%)of patients.Sub-group analysis of“difficult by urology”vs“not difficult by urology”,showed a significant difference between those with zero attempts,one attempt,and greater than one attempts(P=0.004).Those patients specifically with greater than one attempts were more likely to be seen as a difficult insertion by urology assessment(60.6%)compared to not difficult(38.6%).Likewise,those patients with a history of difficult urethral catheter(DUC)/traumatic urethral catheterization(TUC)(25.8%)were more likely to be difficult compared to those without a history of DUC/TUC(14.2%)(P=0.038).CONCLUSION The study found that majority of consultations received did not require heroic measures by the urology service to place a catheter.Patients who had a history of DUC/TUC and those who had greater than one catheter attempts were statistically more likely to be a DUC based on urology assessment.At our institution we hope to propose a protocol in which nursing staff and non-urologic clinicians will utilize a troubleshooting checklist and an algorithm when difficult or traumatic urethral catheters are encountered in order to improve patient care and decrease healthcare costs.For example,this protocol would ideally address complications of multiple catheter attempts such as urethral trauma,development of urethral strictures,and infection risk.Additionally,future trainings and availability of additional resources will be provided and assessed with a goal of reducing healthcare cost surrounding these complications.
基金supported by PRISMS(PRedictive Integrated Structural Materials Science)center which is located at University of Michigan and funded by U.S.Department of Energy,Office of Basic Energy Science,Division of Materials Science and Engineering(Grant award number DE-SC0008637)support from Michigan Center for Materials Characterization(MC2)at University of Michigan and Canmet MATERIALS,Natural Resources Canada+1 种基金the Extreme Science and Engineering Discovery Environment(XSEDE)Stampede2 at the TACC through allocation TG-MSS160003the National Energy Research Scientific Computing Center(NERSC),a U.S.Department of Energy Office of Science User Facility operated under Contract No.DE-AC02-05CH11231。
文摘As a rare earth solute element in Mg alloys,Y has the beneficial effects of increasing both the strength and the ductility as well as weakening the crystallographic texture.To achieve a more fundamental understanding on how Y addition affects the microstructural evolution and mechanical properties,the Y segregation behavior at grain boundaries was investigated in Mg-1wt.%Y and Mg-7wt.%Y alloys at different conditions.The segregation intensity and its dependence on the grain boundary misorientation angle were experimentally characterized and computationally predicted.Strong segregation at grain boundaries was observed in both low and high Y-containing alloys.Y segregation was found to remain in alloy Mg-7Y after high-temperature annealing heat treatment at 540℃.No direct correlation between the Y segregation intensity and the grain boundary misorientation angle could be established based on either the experimental characterization or the atomistic simulation with a spectral model.We thus conclude that grain boundary segregation of Y is independent of grain boundary misorientation angle.
