Tree-level almond yield estimation from high resolution aerial imagery with convolutional neural network.

Introduction: Estimating and understanding the yield variability within an individual field is critical for precision agriculture resource management of high value tree crops. Recent advancements in sensor technologies and machine learning make it possible to monitor orchards at very high spatial resolution and estimate yield at individual tree level. Methods: This study evaluates the potential of utilizing deep learning methods to predict tree-level almond yield with multi-spectral imagery. We focused on an almond orchard with the 'Independence' cultivar in California, where individual tree harvesting and yield monitoring was conducted for ~2,000 trees and summer aerial imagery at 30cm was acquired for four spectral bands in 2021. We developed a Convolutional Neural Network (CNN) model with a spatial attention module to take the multi-spectral reflectance imagery directly for almond fresh weight estimation at the tree level. Results: The deep learning model was shown to predict the tree level yield very well, with a R2 of 0.96 (±0.002) and Normalized Root Mean Square Error (NRMSE) of 6.6% (±0.2%), based on 5-fold cross validation. The CNN estimation captured well the patterns of yield variation between orchard rows, along the transects, and from tree to tree, when compared to the harvest data. The reflectance at the red edge band was found to play the most important role in the CNN yield estimation. Discussion: This study demonstrates the significant improvement of deep learning over traditional linear regression and machine learning methods for accurate and robust tree level yield estimation, highlighting the potential for data-driven site-specific resource management to ensure agriculture sustainability.

Safe and effective treatment of venous Thromboembolism associated with Cancer: focus on direct Oral Anticoagulants in Asian patients.

Cancer-associated thrombosis (CAT) poses a significant disease burden and the incidence in Asian populations is increasing. Anticoagulation is the cornerstone of treatment, but can be challenging due to the high bleeding risk in some cancers and the high risk of recurrent venous thromboembolism (VTE) in patients with malignancies. Direct oral anticoagulants (DOACs) are well established as first-choice treatments for VTE in non-cancer patients, offering a more convenient and less invasive treatment option than low-molecular-weight heparin (LMWH). Asian patients have exhibited comparable efficacy and safety outcomes with other races in trials of DOACs for VTE in the general population. Although no specific data are available in Asian patients with CAT, results from randomized controlled trials of apixaban, edoxaban, or rivaroxaban versus the LMWH, dalteparin, indicate that DOACs are a reasonable alternative to LMWH for anticoagulation in Asian patients with CAT. This is further supported by analyses of real-world data in Asian populations demonstrating the efficacy and safety of DOACs in Asian patients with CAT. Apixaban, edoxaban, or rivaroxaban are recommended in the most recently updated international guidelines as first-line therapy for CAT in patients without gastrointestinal or genitourinary cancers and at low risk of bleeding. An increased risk of major gastrointestinal bleeding was evident with edoxaban or rivaroxaban, but not apixaban, versus dalteparin in the clinical trials, suggesting that apixaban could be a safe alternative to LMWH in patients with gastrointestinal malignancies. Determining the optimal anticoagulant therapy for patients with CAT requires careful consideration of bleeding risk, tumor type, renal function, drug-drug interactions, financial costs, and patients' needs and preferences.

Jejunocolic fistula presenting as chronic diarrhoea from advanced lymphoma.

Jejunocolic fistula, a late complication of intestinal lymphoma, is a rare entity with only five reported cases in the literature. We report a young male presenting with a left lateral neck mass 5 years ago which then progressed to superior vena cava syndrome. Despite receiving radiotherapy and two cycles of chemotherapy, there was still tumour progression. He presented with a 2-week history of diarrhoea, haematochezia and weight loss for which antibiotics provided no relief. Esophagogastroduodenoscopy and colonoscopy showed a jejunocolic fistula. After discussion with the multidisciplinary team, nutritional upbuilding was initiated followed by exploratory laparotomy with segmental resection and anastomosis. On histopathology, diffuse large B-cell lymphoma involving the jejunum and colon was noted. Despite receiving palliative chemotherapy, he still succumbed to disease progression. This case highlights the importance of early recognition of jejunocolic fistulas among patients with intestinal lymphomas to facilitate early multidisciplinary intervention.

The Impact of Malnutrition on the Quality of Life of Colorectal Cancer Patients in a Tertiary Hospital.

Malnutrition among colorectal cancer patients can impair quality of life and decrease survival. This study evaluated the nutritional status of colorectal cancer patients and its association with quality of life among Filipino colorectal cancer patients seen in a tertiary hospital. A cross-sectional study was conducted among colorectal cancer patients seen at the Philippine General Hospital between December 1, 2019 and February 28, 2020. Nutritional status was evaluated using the Subjective Global Assessment, while quality of life was assessed using the EORTC QLQ-C30. Descriptive statistics, ANOVA and logistic regression were employed for analysis. Among 292 patients, malnutrition was noted in 76.4%. Stage III cancer had a higher odds for malnutrition (OR (odds ratio) = 6.22, 95% confidence interval (CI): 1.59, 24.42). Patients who received or were currently receiving chemotherapy were less likely to develop malnutrition (OR = 0.35, 95% CI: 0.18-0.69). Global health status and all functional subscale scores for the severely malnourished group were lower while the scores for symptom scales increased with the degree of malnutrition. There was a high prevalence of malnutrition among colorectal cancer patients and this was associated with poor quality of life. Future directions emphasizing early nutritional screening and assessment are recommended.

The role of the medical oncologist in the holistic care of patients with cancer in the Philippines.

In the past decade, cancer care in the Philippines has advanced in response to the complex heterogeneity inherent to the disease and the constantly increasing number of patients. Central to this development is the increased awareness and universal acceptance of the multidisciplinary team (MDT) approach in providing cancer care to optimize outcomes where medical oncologists play a vital role. This position paper summarizes the unique and multifaceted roles of the medical oncologist in ensuring that the best possible care is given to patients with cancer by actively participating in the whole spectrum of the patient's journey-from diagnosis, treatment, supportive care, until providing palliative care and addressing end-of-life issues.

Clinicopathologic Factors Associated with Mismatch Repair Status Among Filipino Patients with Young-Onset Colorectal Cancer.

INTRODUCTION: Young-onset colorectal cancer is recognized as a distinct disease that may be sporadic or hereditary in nature. Microsatellite instability testing is recommended as a routine procedure in evaluating colorectal cancer specimens, especially in young-onset disease, because of implications in management. Immunohistochemistry of mismatch repair proteins serves as an inexpensive alternative to microsatellite instability testing with the added advantage of monitoring protein expression levels that may suggest underlying genetic or epigenetic alterations. This descriptive study aimed to determine the frequencies of proficient and deficient mismatch repair status among Filipino young-onset colorectal cancer patients, and to investigate their clinicopathologic profile. METHODS: Tumor tissues were prospectively collected from patients from two tertiary hospitals in the Philippines. Patients of age ≤45 years with resected adenocarcinoma of the colon or rectum were recruited. RESULTS: Seventy-seven out of 124 patients had tumor samples sent for immunohistochemistry. Of these, 61 samples (79%) were found to have proficient status while 16 samples (21%) had deficient status. Mismatch repair protein deficiencies, when present, more commonly involved MSH2 and MSH6 (9%) rather than MLH1 and PMS2 (5%). The deficient group had a mean age of 37.1 years and a female preponderance (56.25%), presenting as locally advanced ascending or descending colon tumors with mucinous histology in half of the population. The mismatch repair proficient group presented as locally advanced rectal and sigmoid tumors but with fewer mucinous adenocarcinomas (26.2%) compared to the deficient group. In both the mismatch repair proficient and deficient patients with family history reports, most did not have any known relative with cancer (75.4% and 68.75%, respectively). CONCLUSION: This is the first attempt to perform mismatch repair testing among young-onset colorectal cancer patients in the Philippines and to gather data on their clinicopathologic characteristics. However, the limited sample size precludes conclusive results for the associations of mismatch repair with clinicopathologic features.

What Will Keep Me Coming Back to the Clinic: Factors Identified by Filipino Colorectal Cancer Patients Seen at a National Academic Referral Center.

Health-care decisions in the Philippines are widely affected by various factors such as family, community, health-care access, and educational attainment. We designed a questionnaire to evaluate patient views at the University of the Philippines-Philippine General Hospital colorectal multidisciplinary clinic to identify factors that contribute to continued follow-up at the colorectal multidisciplinary clinic. A total of 128 patients, 62% of whom were being treated with curative intent participated in the study. We found that trust in their physicians, presence of family support, and affordability of treatment were factors highly valued by patients consulting at the clinic.

Measuring Transverse Displacements Using Unmanned Aerial Systems Laser Doppler Vibrometer (UAS-LDV): Development and Field Validation.

Measurement of bridge displacements is important for ensuring the safe operation of railway bridges. Traditionally, contact sensors such as Linear Variable Displacement Transducers (LVDT) and accelerometers have been used to measure the displacement of the railway bridges. However, these sensors need significant effort in installation and maintenance. Therefore, railroad management agencies are interested in new means to measure bridge displacements. This research focuses on mounting Laser Doppler Vibrometer (LDV) on an Unmanned Aerial System (UAS) to enable contact-free transverse dynamic displacement of railroad bridges. Researchers conducted three field tests by flying the Unmanned Aerial Systems Laser Doppler Vibrometer (UAS-LDV) 1.5 m away from the ground and measured the displacement of a moving target at various distances. The accuracy of the UAS-LDV measurements was compared to the Linear Variable Differential Transducer (LVDT) measurements. The results of the three field tests showed that the proposed system could measure non-contact, reference-free dynamic displacement with an average peak and root mean square (RMS) error for the three experiments of 10% and 8% compared to LVDT, respectively. Such errors are acceptable for field measurements in railroads, as the interest prior to bridge monitoring implementation of a new approach is to demonstrate similar success for different flights, as reported in the three results. This study also identified barriers for industrial adoption of this technology and proposed operational development practices for both technical and cost-effective implementation.

Bevacizumab in metastatic small-bowel adenocarcinoma: A systematic review and meta-analysis.

Cancers of the small bowel could account for less than 5% of all gastrointestinal malignancies. Of these tumors, adenocarcinomas were the major histologic subtype and generally carried a poor prognosis. High expression of vascular epithelial growth factor (VEGF) could be seen in small bowel adenocarcinomas. A systematic review was conducted here to determine if bevacizumab, a recombinant humanized antibody against VEGF, could offer clinical benefit among patients with metastatic small bowel adenocarcinoma when combined with chemotherapy. A search for relevant published and unpublished studies was performed using PubMed, ScienceDirect, Google Scholar, the American Society of Clinical Oncology meetings library, ClinicalTrials.gov, and ISRCTN registry. Information on study design, methods, intervention, and outcomes were extracted from selected eligible studies. Methodological quality was then assessed using the Newcastle-Ottawa Scale. There was a significant improvement in mean overall survival with the addition of bevacizumab with chemotherapy versus chemotherapy alone. The use of bevacizumab with chemotherapy, likewise improved progression-free survival and objective response rate compared to chemotherapy alone. Continued use of bevacizumab beyond first progression also appeared to show benefit. The conduct of prospective controlled studies by consortia to offset the rarity of small bowel adenocarcinomas could further elucidate the efficacy of bevacizumab in the treatment of this disease.

Prognostic utility of baseline neutrophil-to-lymphocyte ratio in patients receiving immune checkpoint inhibitors: a review and meta-analysis.

INTRODUCTION: Systemic inflammation is associated with prognosis in solid tumors. The neutrophil-to-lymphocyte ratio (NLR) is a marker for the general immune response to various stress stimuli. Studies have shown correlation of NLR to outcomes in immune checkpoint blockade, peripheral neutrophil count to intratumor neutrophil population, and NLR to intratumoral levels of myeloid-derived suppressor cells. Studies have shown elevated peripheral blood regulator T cells accompanied by elevated NLR are associated with poor outcomes further highlighting the importance of inflammation in the prognosis of cancer patients. METHODS: We performed a meta-analysis of published articles on the utility of baseline NLR in predicting outcomes in patients treated with immune checkpoint inhibitors (ICIs) using Review Manager, version 5.3. Seven studies on the prognostic utility of NLR in ICI treatment were included in this analysis. For outcomes of interest, the hazard ratios (HRs) were computed. Subgroup analyses were planned based on type of malignancy and type of immune checkpoint inhibitor. RESULTS/DISCUSSION: A high NLR resulted in worse overall survival (OS) (HR, 1.92; 95% CI, 1.29-2.87; p=0.001) and progression-free survival (PFS; HR, 1.66; 95% CI, 1.38-2.01; p<0.00001) across types of malignancies studied (melanoma, non-small-cell lung cancer, and genitourinary cancer). Subgroup analysis across different types of malignancies treated with ICI showed similar results for OS and PFS. The single study on genitourinary cancers also showed worse OS and PFS (OS: HR, 1.82; 95% CI, 1.29-2.87; p=0.001 and PFS: HR, 1.83; 95% CI, 0.97-3.44; p=0.06). A high NLR also showed worse OS and PFS across all ICIs (ipilimumab, nivolumab, and unspecified or pooled pembrolizumab and nivolumab; OS: HR, 1.92; 95% CI, 1.29-2.87; p=0.001 and PFS: HR, 1.66; 95% CI, 1.38-2.01; p<0.00001). Subgroup analysis by type of ICI showed similar results. CONCLUSION: A high NLR is associated with poorer outcomes across studies. This shows that NLR has the potential as a readily available prognostic indicator for patients receiving ICI based on available studies. Studies utilizing more stringent design may serve to better determine the utility of this tool.

A practical, single-view alternative to Stenver's for plain radiographic unilateral and bilateral post-cochlear implant position check.

INTRODUCTION: 'Stenver's' is the standard plain radiograph view to check the electrode position after cochlear implantation. However, a reproducible alignment for intra-individual comparison of electrode position using a true Stenver's alignment is not always straightforward to achieve, particularly for inexperienced radiographers, or on non-compliant children. In addition, two ionizing exposures in two different positions are required for bilateral cochlear implants. AIMS: To assess the efficacy of other, more simple, single-exposure radiographs for the assessment of electrode position. METHODS: Dummy electrodes and receiver units were bilaterally implanted into a cadaver. Plain radiographs in Stenver's views, and plain antero-posterior (AP) midline radiographic single views incorporating both implants were obtained with the tube at a range of angles tilted caudal and cranial to the perpendicular. Five internationally renowned cochlear implant surgeons were each asked if each radiograph gave adequate information for unilateral and for bilateral implants and they were asked to list in order of their favoured top three views. RESULTS: No surgeon thought that a single-exposure Stenver's view was adequate for assessment of the contra-lateral side. Consensus was that all AP views were fit for the purpose, with no preference given between each of the AP views. The ipsi-lateral Stenver's was considered to give better depth of insertion information. CONCLUSION: There is no apparent advantage of caudal and cranial tilt angles over a straight perpendicular AP. A single-view AP radiograph is an alternative to Stenver's view for a post-unilateral and post-simultaneous bilateral cochlear implant check.

Microbiota-stimulated immune mechanisms to maintain gut homeostasis.

In recent years there has been an explosion of interest to identify microbial inhabitants of human and understand their beneficial role in health. In the gut, a symbiotic host-microbial interaction has coevolved as bacteria make essential contributions to human metabolism and bacteria in turn benefits from the nutrient-rich niche in the intestine. To maintain host-microbe coexistence, the host must protect itself against microbial invasion, injury, and overreactions to foreign food antigens, and gut microbes need protection against competing microbes and the host immune system. Perturbation of this homeostatic coexistence has been strongly associated with human disease. This review discusses how gut bacteria regulate host innate and adaptive immunity, with emphasis on how this regulation contributes to host-microbe homeostasis in the gut.

Dissection of soft-preserved cadavers in the training of gynaecological oncologists: report of the first UK workshop.

OBJECTIVE: To assess the surgical anatomy knowledge of gynaecological oncology (GO) trainees and to evaluate the impact of a cadaveric dissection course on postgraduate surgical training. METHODS: An intensive 3-day cadaveric dissection course with illustrated lectures and supervised dissection, with a multiple-choice questionnaire (MCQ) on surgical anatomy at the beginning and end of the course was organised in the Anatomy Facility of a London Medical School. Each cadaver was embalmed with a mixture of alcohol, phenol and glycerol ("soft-preserved") rather than fixed in formalin, to more closely preserve in vivo conditions of the body. There were ten dissecting delegates, two per cadaver. The delegates dissected the abdomen and pelvis with the emphasis on surgical approaches rather than the classical descriptive anatomy approaches. Delegates also completed a course evaluation. RESULTS: Without negative marking, the mean initial MCQ score was 57%, and final mean score 64%. With negative marking, the mean initial score was 43%, and mean final score 53%. Delegates rated the course highly, would recommend it to other trainees and considered that such a course should be incorporated into subspecialty training. CONCLUSION: The surgical anatomy knowledge of subspecialty trainees was weak but improved as a result of the dissection course. The most positive finding was the course evaluation. Postgraduate surgical training in GO would likely be enhanced by, and arguably requires, cadaveric dissection. "Soft-preserved" rather than formalin-fixed cadavers should be used.

Region- and cell-specific differences in the distribution of carbonic anhydrases II, III, XII, and XIV in the adult rat epididymis.

We employed RT-PCR followed by light microscope immunocytochemistry on St. Marie's- and Bouin's-fixed tissues to define the distribution of carbonic anhydrase (CA) isoforms in the male reproductive tract. The data revealed that CA II, III, IV, XII, and XIV were expressed in rat epididymis. Whereas CA III was found in principal cells of all epididymal regions, CA II was localized in narrow cells of the initial segment and principal cells of all regions. CA XII expression was most intense in the corpus and proximal cauda regions, where it appeared over the basolateral plasma membranes of principal cells. Narrow cells of the initial segment also revealed intense reactions, as did basal cells of the corpus and proximal cauda regions. Principal cells of the initial segment and proximal caput regions showed diffuse apical cytosolic reactions and occasional basolateral staining for CA XIV, whereas principal cells of distal regions showed more diffuse cytosolic reactions highlighting both apical and basal regions of the cell, with basal cells also being reactive. These data suggest subtle differences in cell type and subcellular- and region-specific distributions for CAs in their role of fine-tuning pH in the lumen, cell cytosol, and intervening intercellular spaces of the epididymis.

Mineral acquisition rates in developing enamel on maxillary and mandibular incisors of rats and mice: implications to extracellular acid loading as apatite crystals mature.

UNLABELLED: The formation rates of mineral in developing enamel were determined by microweighing of incisors of mice and rats. Computations indicated that a large excess of hydrogen ions would result from creating apatite at the calculated rates. Enamel organ cells (ameloblasts), therefore, likely excrete bicarbonate ions to prevent pH in fluid bathing enamel from becoming too acidic. INTRODUCTION: Protons (H+) are generated whenever calcium and phosphate ions combine directly from aqueous solutions to form hydroxyapatite. Enamel is susceptible to potential acid loading during development because the amount of fluid bathing this tissue is small and its buffering capacity is low. The epithelial cells covering this tissue are also believed to form permeability barriers at times during the maturation stage when crystals grow at their fastest rates. The goal of this study was to measure the bulk weight of mineral present in rodent enamel at specific times in development and estimate the amount of acid potentially formed as the apatite crystals mature. MATERIALS AND METHODS: Upper and lower jaws of mice and rats were freeze-dried, and the enamel layers on the incisors were partitioned into a series of 0.5 mm (mouse) or 1.0 mm (rat) strips along the length of each tooth. The strips were weighed on a microbalance, ashed at 575 degrees C for 18-24 h to remove organic material, and reweighed to determine the actual mineral weight for each strip. RESULTS AND CONCLUSIONS: The data indicated that, despite differences in gross sizes and shapes of maxillary and mandibular incisors in rats and mice, the overall pattern and rates of mineral acquisition were remarkably similar. This included sharply increasing rates of mineral acquisition between the secretory and maturation stages, with peak levels approaching 40 microg/mm tooth length. Computer modeling indicated that quantities of H+ ions potentially generated as apatite crystals grew during the maturation stage greatly exceeded local buffering capacity of enamel fluid and matrix proteins. In other systems, bicarbonate ions are excreted to neutralize highly acidic materials generated extracellularly. Data from this study indicate that ameloblasts, and perhaps cells in other apatite-based hard tissues, use similar bicarbonate release mechanisms to control excess acid arising from mineral formation.

Inversion of the direction of stereoinduction in the coupling of chiral gamma,delta-unsaturated Fischer carbene complexes with o-ethynylbenzaldehyde.

[reaction: see text] A variety of gamma,delta-unsaturated carbene complexes that feature a stereogenic center at the beta-carbon couple with 2-ethynylbenzaldehyde to afford hydrophenanthrene derivatives with a high degree of stereoinduction. The direction of stereoinduction is opposite for examples where the stereogenic center is acyclic vs examples where it is within a ring.