Stent-Graft Placement for Hepatic Arterial Hemorrhage after Pancreaticobiliary Surgery: Long-Term Clinical Outcomes.

PURPOSE: To evaluate the safety and long-term clinical outcomes of stent-graft placement to treat hepatic arterial hemorrhageafter pancreaticobiliary surgery. MATERIALS AND METHODS: Outcomes were retrospectively evaluated in 61 patients (50 men and 11 women; mean age, 63 years) who underwent stent-graft placement for delayed arterial hemorrhage (after 24 hours) after pancreaticobiliary surgery from 2006 to 2023. Bleeding sites included the gastroduodenal artery stump (n = 54), common or proper hepatic artery (n = 5), and right hepatic artery (n = 2). The stent-grafts used were Viabahn (n = 27), Comvi (n = 11), Jostent (n = 3), Covera (n = 11), and Lifestream (n = 7). Technical and clinical success and adverse events (AE) were evaluated. After stent-graft placement, overall survival (OS), hemorrhage-free survival (HFS), and stent patency were evaluated. RESULTS: The technical and clinical success rates of stent-graft placement were 97% and 93%, respectively. The severe AE rate was 12% and was significantly higher in patients who underwent pylorus-sacrificing rather than pylorus-preserving surgery (P = .001). None of the severe AEs were associated with patient mortality. Median OS after stent-graft placement was 854 days, and median HFS was 822 days. The 1-, 3-, 5-, and 10-year stent patency rates were 87%, 84%, 79%, and 72%, respectively. CONCLUSIONS: Stent-graft placement was safe and provided long-term control of hepatic arterial hemorrhage after pancreaticobiliary surgery.

Academic Promotions in Medicine: An Appraisal of Fairness.

OBJECTIVE: To investigate whether the process of conferring academic rank or components of the promotion packet contribute to the lack of parity in academic advancement for women and individuals underrepresented in medicine (URMs). PATIENTS AND METHODS: We retrospectively reviewed prospective promotion applications to the position of associate professor or professor at Mayo Clinic from January 2, 2015, through July 1, 2019. Individuals with doctorate degrees who applied for either rank were included in the study. Data collected included demographic characteristics, curriculum vitae at time of application, committee score sheets, and deferral and approval decisions. Deferral rates for women compared with men and for URMs compared with non-URMs was the primary outcome. RESULTS: Of 462 people who applied for associate professor, 10% (n=46) were deferred. Those promoted had worked longer at Mayo Clinic (median, 6 years vs 2 years; P=.01), had more mentees (median, 6 vs 4; P=.02), authored more publications (median [interquartile range (IQR)], 39 [32-52] vs 30 [24-35]; P<.001), and were more likely to be on a National Institutes of Health or institutional grant (P<.05). Of the 320 people who applied for professor, 8.8% (n=28) were deferred. Those promoted had authored more publications (median [IQR], 77 [60-99] vs 56 [44-66]; P<.001) and were less likely to hold an elected office to a professional society (22.6% vs 39.3%; P=.05). There was no significant association between deferral status and sex (P>.4) or race/ethnicity (P>.9) for either rank. CONCLUSION: The process for academic advancement for professorships does not contribute to the gap in promotion rates for women and URMs.

A Mixed-Method Approach to Explore Successful Recruitment and Treatment of Minority Patients on Therapeutic Cancer Clinical Trials at a Tertiary Referral Center Using Photo-Elicitation Interviews.

Introduction: Under-represented minority patients (URM) enroll in cancer clinical trials (CCT) at low rates. To gain insight into barriers and facilitators to CCT enrollment, we conducted a mixed method study of URM patients who were successfully treated on a therapeutic CCT from 2018-2021 at all institutional sites. Methods: A retrospective chart review of 270 minority patients was conducted to identify patient demographics and characteristics. All living URM patients were requested to participate in a survey and qualitative interview using a photo elicitation technique. Results: Most patients who participated in a CCT were patients with solid tumors, metastatic disease, and did not live in a rural area. Survey data showed that the two most significant drivers of CCT enrollment were potential of benefit to self and to others (altruism). Direct recommendation from a healthcare provider to participate in CCT was critical. URM patients enrolled on a CCT experience a significant burden of symptoms and financial distress. Key themes identified from the interviews that motivated patients to participate included chance for cure, staying positive, altruism and advancement of science, and having diverse representation in research. Patient-level facilitators to participation included social support, cost coverage, and limited treatment options. Sytematic facilitators identified included minimizing logistical barriers, decentralizing cancer clinical trials, increasing awareness via patient narratives, diversifying research staff, minimizing cost, and being clear on puropose and benefit of the trial. Conclusion: Success stories of minority recruitment can provide useful information to enhance minority accrual. Photo elicitation interviews provide rich narratives of patient experience.

Integrated Identification and Genetic Diversity of Potentially Invasive Clearwing Moths (Lepidoptera: Cossoidea: Sesiidae) in Korea.

The populations of clearwing moth borers in Korea have recently caused extensive and severe damage to pin oaks (Quercus palustris Munchh.). We conducted field monitoring and molecular analyses to identify them in an integrated manner. Morphological examination and molecular analyses of the COI gene, based on intra- and interspecific genetic divergences (GDs), revealed that the borers were identified as two invasive species, Sphecodoptera sheni and Paranthrenella pinoakula sp. nov. The maximum intraspecific GD was found to be 1.9%, whereas the minimum interspecific GD was confirmed as 8.1%, indicating a distinct barcoding gap. Both the MJ network and NJ tree also showed that 18 haplotypes (Hs) were detected from the 52 COI sequences. The borers revealed a total of 17 Hs: (i) H1-H7 were detected in all seven regions with S. sheni; (ii) Wonju and Goyang populations of S. sheni revealed more than three Hs; (iii) H7 was closely connected with H8 of the Chinese population of S. sheni; (iv) H9-H10 were detected in other samples from the Wonju population with P. pinoakula sp. n. and were closely located with congeneric species. A maximum likelihood tree also revealed that P. pinoacula sp. n. nested within the congeneric species, genetically separating from S. sheni.

Integrated Logic Circuits Based on Wafer-Scale 2D-MoS2 FETs Using Buried-Gate Structures.

Two-dimensional (2D) transition-metal dichalcogenides (TMDs) materials, such as molybdenum disulfide (MoS2), stand out due to their atomically thin layered structure and exceptional electrical properties. Consequently, they could potentially become one of the main materials for future integrated high-performance logic circuits. However, the local back-gate-based MoS2 transistors on a silicon substrate can lead to the degradation of electrical characteristics. This degradation is caused by the abnormal effect of gate sidewalls, leading to non-uniform field controllability. Therefore, the buried-gate-based MoS2 transistors where the gate electrodes are embedded into the silicon substrate are fabricated. The several device parameters such as field-effect mobility, on/off current ratio, and breakdown voltage of gate dielectric are dramatically enhanced by field-effect mobility (from 0.166 to 1.08 cm2/V·s), on/off current ratio (from 4.90 × 105 to 1.52 × 107), and breakdown voltage (from 15.73 to 27.48 V) compared with a local back-gate-based MoS2 transistor, respectively. Integrated logic circuits, including inverters, NAND, NOR, AND, and OR gates, were successfully fabricated by 2-inch wafer-scale through the integration of a buried-gate MoS2 transistor array.

Monolithic Integration of Semi-Transparent and Flexible Integrated Image Sensor Array with a-IGZO Thin-Film Transistors (TFTs) and p-i-n Hydrogenated Amorphous Silicon Photodiodes.

A novel approach to fabricating a transparent and flexible one-transistor-one-diode (1T-1D) image sensor array on a flexible colorless polyimide (CPI) film substrate is successfully demonstrated with laser lift-off (LLO) techniques. Leveraging transparent indium tin oxide (ITO) electrodes and amorphous indium gallium zinc oxide (a-IGZO) channel-based thin-film transistor (TFT) backplanes, vertically stacked p-i-n hydrogenated amorphous silicon (a-Si:H) photodiodes (PDs) utilizing a low-temperature (<90 °C) deposition process are integrated with a densely packed 14 × 14 pixel array. The low-temperature-processed a-Si:H photodiodes show reasonable performance with responsivity and detectivity for 31.43 mA/W and 3.0 × 1010 Jones (biased at -1 V) at a wavelength of 470 nm, respectively. The good mechanical durability and robustness of the flexible image sensor arrays enable them to be attached to a curved surface with bending radii of 20, 15, 10, and 5 mm and 1000 bending cycles, respectively. These studies show the significant promise of utilizing highly flexible and rollable active-matrix technology for the purpose of dynamically sensing optical signals in spatial applications.

Preoperative Balloon-Occluded Transcatheter Arterial Chemoembolization Followed by Surgical Resection: Pathological Evaluation of Necrosis.

This study investigates the clinical and pathological outcomes of preoperative balloon-occluded transcatheter arterial chemoembolization (B-TACE) in patients with single hepatocellular carcinoma (HCC). The data are from 25 consecutive patients who underwent sequential treatment of subsegmental B-TACE and hepatic surgery for single HCC. Radiological and pathological evaluation of oily subsegmentectomy, defined as the iodized oil-laden necrotic area that includes the entire HCC and surrounding liver parenchyma, were performed. Subsegmental B-TACE was technically successful in all patients. The major and minor complication rates were 8% and 24%, respectively. On the first follow-up computed tomography (CT), oily subsegmentectomy was observed in 18 (72%) out of 25 patients. Apart from one patient showing a partial response, the remaining 24 (96%) patients showed a complete response. Pathological complete necrosis of the HCC was observed in 18 (72%) out of 25 patients with complete or extensive necrosis of the peritumoral liver parenchyma. The remaining seven patients without peritumoral parenchymal necrosis had extensive necrosis of the HCCs. In conclusion, preoperative B-TACE can be a safe and effective method for the treatment of single HCC and a good bridge treatment for subsequent surgical resection. In addition, oily subsegmentectomy itself on the CT can be a good predictor of pathological complete necrosis of the HCC. The findings obtained from this study would provide a potential role of B-TACE in the treatment strategy for single HCC.

Nanostructured Vanadium Dioxide Materials for Optical Sensing Applications.

Vanadium dioxide (VO2) is one of the strongly correlated materials exhibiting a reversible insulator-metal phase transition accompanied by a structural transition from a low-temperature monoclinic phase to high-temperature rutile phase near room temperature. Due to the dramatic change in electrical resistance and optical transmittance of VO2, it has attracted considerable attention towards the electronic and optical device applications, such as switching devices, memory devices, memristors, smart windows, sensors, actuators, etc. The present review provides an overview of several methods for the synthesis of nanostructured VO2, such as solution-based chemical approaches (sol-gel process and hydrothermal synthesis) and gas or vapor phase synthesis techniques (pulsed laser deposition, sputtering method, and chemical vapor deposition). This review also presents stoichiometry, strain, and doping engineering as modulation strategies of physical properties for nanostructured VO2. In particular, this review describes ultraviolet-visible-near infrared photodetectors, optical switches, and color modulators as optical sensing applications associated with nanostructured VO2 materials. Finally, current research trends and perspectives are also discussed.

Transarterial chemoembolization for advanced hepatocellular carcinoma without macrovascular invasion or extrahepatic metastasis: analysis of factors prognostic of clinical outcomes.

Objectives: To evaluate the safety and efficacy of TACE and factors predicting survival in patients with advanced hepatocellular carcinoma (HCC) without macrovascular invasion (MVI) or extrahepatic spread (EHS). Methods: This single-center retrospective study included 236 treatment-naïve patients who underwent TACE as first-line treatment for advanced HCC without MVI or EHS between January 2007 and December 2021. Results: Following TACE, the median overall survival (OS) was 24 months. Multivariate Cox regression analyses revealed that tumor number ≥4 (risk point: 3), maximal tumor size >10 cm (risk point: 2), Child-Pugh class B (risk point: 2), alpha-fetoprotein (AFP) concentration ≥400 ng/mL (risk point: 2), and presence of HCC rupture (risk point: 2) were risk factors significantly associated with OS. The expected median OS among patients with <2, 2-4, and 5-9 risk points were 72, 29, and 12 months respectively. The major complication rates were significantly lower in patients with maximal tumor size ≤10 cm than in those with maximal tumor size >10 cm (4% [5/138] vs 21% [21/98], p = 0.001). Conclusion: TACE may be safe and effective in selected patients with advanced HCC without MVI or EHS, with a median OS of 24 months. Patients with limited tumor burden, compensated liver function, absence of HCC rupture, and favorable biologic markers may benefit the most from TACE. TACE is not recommended for patients with huge HCCs (>10 cm) because of its high rate of major complications (21%).

Artificial intelligence for automatic detection of basal cell carcinoma from frozen tissue tangential biopsies.

Evaluation of basal cell carcinoma (BCC) involves tangential biopsies of a suspicious lesion that is sent for frozen sections and evaluated by a Mohs micrographic surgeon. Advances in artificial intelligence (AI) have made possible the development of sophisticated clinical decision support systems to provide real-time feedback to clinicians which could have a role in optimizing the diagnostic workup of BCC. There were 287 annotated whole-slide images of frozen sections from tangential biopsies, of which 121 contained BCC, that were used to train and test an AI pipeline to recognize BCC. Regions of interest were annotated by a senior dermatology resident, experienced dermatopathologist, and experienced Mohs surgeon, with concordance of annotations noted on final review. Final performance metrics included a sensitivity and specificity of 0.73 and 0.88, respectively. Our results on a relatively small dataset suggest the feasibility of developing an AI system to aid in the workup and management of BCC.

Artificial intelligence in medicine - dermatology compared to other medical specialties in FDA-cleared software as medical device.

Artificial intelligence (AI) and machine learning (ML) have occupied the center stage in healthcare as research groups and institutions investigate their capabilities and risks. Dermatology is often cited as one of the medical specialties most ripe for disruption with AI technology due to the heavy incorporation of visual information into clinical decisions and treatments. Although the literature on AI in dermatology is rapidly growing, there has been a noticeable absence of mature AI solutions utilized by dermatology departments or patients. This commentary provides insight into the regulatory challenges facing AI solutions for the specialty of dermatology and the unique considerations that should be factored into AI development and deployment.

Delayed Diagnosis of Retronychia: How Ultrasound Can Nail the Diagnosis in Clinically Subtle Patients.

A 47-year-old man presented to the dermatologic surgery clinic with a 7-month history of a painful, swollen left great toe after minor trauma. Intermittently, the toe became exquisitely tender such that even weight of a blanket exacerbated pain. The patient initially presented to primary care with purulence and pain, but the culture of expressed purulence revealed normal flora. Condition of the patient did not improve despite evaluation by several medical specialists and multiple rounds of topical antifungal and steroid creams, vinegar soaks, and oral antibiotics.

A Bioinspired Ultra Flexible Artificial van der Waals 2D-MoS2 Channel/LiSiOx Solid Electrolyte Synapse Arrays via Laser-Lift Off Process for Wearable Adaptive Neuromorphic Computing.

Wearable electronic devices with next-generation biocompatible, mechanical, ultraflexible, and portable sensors are a fast-growing technology. Hardware systems enabling artificial neural networks while consuming low power and processing massive in situ personal data are essential for adaptive wearable neuromorphic edging computing. Herein, the development of an ultraflexible artificial-synaptic array device with concrete-mechanical cyclic endurance consisting of a novel heterostructure with an all-solid-state 2D MoS2 channel and LiSiOx (lithium silicate) is demonstrated. Enabled by the sequential fabrication process of all layers, by excluding the transfer process, artificial van der Waals devices combined with the 2D-MoS2 channel and LiSiOx solid electrolyte exhibit excellent neuromorphic synaptic characteristics with a nonlinearity of 0.55 and asymmetry ratio of 0.22. Based on the excellent flexibility of colorless polyimide substrates and thin-layered structures, the fabricated flexible neuromorphic synaptic devices exhibit superior long-term potentiation and long-term depression cyclic endurance performance, even when bent over 700 times or on curved surfaces with a diameter of 10 mm. Thus, a high classification accuracy of 95% is achieved without any noticeable performance degradation in the Modified National Institute of Standards and Technology. These results are promising for the development of personalized wearable artificial neural systems in the future.

Scoping review of medical students' perceptions of the field of dermatology.

Background: Although perceived barriers to applying to dermatology have been researched among medical students, there remains a dearth of literature dedicated to understanding perceptions that medical students have of the field of dermatology and dermatologists. Methods: A review of the literature in Embase, Pubmed, Scopus, Web of Science, and ScienceDirect were carried out to identify articles and abstracts between 2016 and 2021 relating to medical student perceptions of the field of dermatology. Peer-reviewed English studies measuring attitudes/level of interest in dermatology or other specialities, understanding of dermatologic topics, procedures, and/or scope of practice were included. Duplicate studies and conference abstracts were excluded. All publications were screened using the PRISMA-Sc guidelines. Findings were summarised and tabulated accordingly. Results: A total of nine articles met inclusion criteria and eight are included in this review since one was not accessible online. Notable findings include non-US medical students perceiving dermatology as monotonous, stigmatized, unfamiliar, and difficult to access with a misunderstanding of the diversity and severity of the conditions dermatologists treat. No data on US medical student perceptions was found. Perceptions were found to be influential in career planning: medical students may reject specialities after exposure to negative comments on the field. Factors attracting students to dermatology include the appeal of being a dermatologist, media portrayal, and dermatologists' influence on patients' lives. Completion of dermatology-related activities improved medical student interest, comfort, and understanding of the field. Early dermatology exposure in US undergraduate premedical students led to heightened interest in the field, more confidence in ability to find dermatology mentors, and increased perception that dermatology serves the needs of underserved communities. Conclusions: This review demonstrates the need to further investigate medical student perceptions of dermatology, particularly in the United States. Perceptions of medical specialities can impact medical student career choices. Understanding which misconceptions may be preventing students from exploring dermatology can inform efforts towards improving diversity, equity, and inclusion: translating to an equitable match and improving patient outcomes. Limitations include exclusion of articles published before 2016, geographic variability in studies, and limited data on evolving student perceptions over time.

Socioeconomic predictors of cost and length of stay for erythroderma: a cross-sectional analysis of the national inpatient sample.

Erythroderma is an uncommon but serious dermatologic disorder that often requires hospitalization for diagnosis and treatment. However, little is known about predictors influencing cost and patient outcomes. The present study sought to characterize the sociodemographic factors that predict patient outcomes and hospital cost. Data were obtained from the 2016-2018 National Inpatient Sample (NIS) provided by the Healthcare Cost and Utilization Project from the Agency for Healthcare Research and Quality for patients of any age with a primary or secondary diagnosis of exfoliative dermatitis. Regression analyses were performed to find predictors for hospital costs and patient outcomes, represented by the length of stay (LOS). Univariate analysis of LOS revealed urban teaching hospitals were associated with prolonged LOS (p = 0.023). Univariate analysis of hospital cost yielded the following factors associated with increased hospital cost: Black and Asian patients (p = .045), urban teaching hospitals (p = .035), and northeast or south geographic location (p = .004). Multivariable regression analysis revealed prolonged LOS was associated with female sex (p = .043) and large bed capacity (p = .044) while shorter LOS was associated with increased age (p = .025); lower hospital costs were associated with private-owned hospitals -  (p = .025). In patients diagnosed with erythroderma, there appear to be racial, economic, and geographic disparities for patients that lead to greater hospital costs and longer LOS.

ChatGPT offers an editorial on the opportunities for chatbots in dermatologic research and patient care.

ChatGPT is a chatbot developed by OpenAI, an artificial intelligence research laboratory, that is trained on massive-scale internet text data to understand a broad range of language styles and topics. As a mature, conversational chatbot, ChatGPT can respond to follow-up questions and produce coherent primary texts based on the user's request. We explore the opportunities and risks of integrating chatbots into dermatologic patient care and research while presenting ChatGPT's response to the same question.

Comparing Whole Slide Imaging and Light Microscopy to Identify Tumor in en face Frozen Sections.

OBJECTIVE: To assess accuracy of whole slide imaging (WSI) in the interpretation of permanent and frozen sections in surgical pathology and the identification of tumors in cutaneous en face frozen sections. METHODS: Twenty glass slides containing cutaneous en face frozen sections were selected from twenty cases of keratinocyte carcinomas treated with Mohs micrographic surgery. Ten slides contained tumor and ten did not. A blinded dermatologic surgeon used traditional light microscopy (LM) to assess physical slides for tumor presence and type, while noting the confidence (scale 1-10) and time (min) in making the determination. After a seven-day washout period, the surgeon repeated this process using WSI of the same slides, each de-identified and scanned at 20x using the Aperio AT2 (Leica Biosystems). RESULTS: Percent agreement between LM and WSI was 100%, with Cohen's kappa of 1.0. The average time taken to determine tumor presence was significantly greater using WSI than LM. Similarly, the surgeon was significantly more confident using LM than WSI. CONCLUSION: This proof-of-concept study suggests that diagnostic concordance is excellent between LM and WSI in the evaluation of Mohs frozen sections. However, WSI was cumbersome to use, not ergonomic, and required significantly more time.

A woman with recurrent umbilical bleeding: a case report.

BACKGROUND: Umbilical discharge in an adult is rare and generates broad diagnostic considerations. Umbilical anatomy is variable owing to congenital abnormalities and acquired pathology such as umbilical hernias. The umbilicus can be a site of primary or metastatic malignancy or endometriosis. CASE PRESENTATION: A 40-year-old white American woman came to the clinic with a 2-day history of spontaneous umbilical bleeding. She reported periumbilical pain associated with nausea and emesis. There were no visible skin abnormalities, but deep palpation of the abdomen produced a thin, watery, serosanguineous fluid from the umbilicus. She experienced a similar episode of umbilical bleeding 5 years prior without clear cause. Laboratory workup was notable for mildly elevated C-reactive protein . Computed tomography imaging revealed a fat-containing umbilical hernia with fat necrosis, necessitating complete surgical resection of the umbilicus. CONCLUSIONS: Umbilical hernia with fat necrosis is a rare condition that should be considered in adults with umbilical discharge. Additional diagnostic considerations in adults with spontaneous umbilical bleeding/discharge include embryonal remnants, omphalitis, and metastasis. If the cause is not readily apparent on physical exam, imaging with computed tomography should be considered to assess for hernia and embryonal anomalies.

Robust 2D MoS2 Artificial Synapse Device Based on a Lithium Silicate Solid Electrolyte for High-Precision Analogue Neuromorphic Computing.

High-precision artificial synaptic devices compatible with existing CMOS technology are essential for realizing robust neuromorphic hardware systems with reliable parallel analogue computation beyond the von Neumann serial digital computing architecture. However, critical issues related to reliability and variability, such as nonlinearity and asymmetric weight updates, have been great challenges in the implementation of artificial synaptic devices in practical neuromorphic hardware systems. Herein, a robust three-terminal two-dimensional (2D) MoS2 artificial synaptic device combined with a lithium silicate (LSO) solid-state electrolyte thin film is proposed. The rationally designed synaptic device exhibits excellent linearity and symmetry upon electrical potentiation and depression, benefiting from the reversible intercalation of Li ions into the MoS2 channel. In particular, extremely low cycle-to-cycle variations (3.01%) during long-term potentiation and depression processes over 500 pulses are achieved, causing statistical analogue discrete states. Thus, a high classification accuracy of 96.77% (close to the software baseline of 98%) is demonstrated in the Modified National Institute of Standards and Technology (MNIST) simulations. These results provide a future perspective for robust synaptic device architecture of lithium solid-state electrolytes stacked with 2D van der Waals layered channels for high-precision analogue neuromorphic computing systems.