摘要： Internal medicine (IM) residents frequently perform invasive bedside procedures during residency training. Bedside procedure training in IM programs may compromise patient safety. Current evidence suggests that IM training programs rely heavily on the number of procedures completed during training as a proxy for resident competence instead of using objective postprocedure patient outcomes. The authors posit that the results of procedural training effectiveness should be reframed with outcome metrics rather than process measures alone. This article introduces the as low as reasonably achievable (ALARA) approach, which originated in the nuclear industry to increase safety margins, to help assess and reduce bedside procedural risks. Training program directors are encouraged to use ALARA calculations to define the risk trade-offs inherent in current procedural training and assess how best to reliably improve patient outcomes. The authors describe 5 options to consider: training all residents in bedside procedures, training only select residents in bedside procedures, training no residents in bedside procedures, deploying 24-hour procedure teams supervised by IM faculty, and deploying 24-hour procedure teams supervised by non-IM faculty. The authors explore how quality improvement approaches using process maps, fishbone diagrams, failure mode effects and analyses, and risk matrices can be effectively implemented to assess training resources, choices, and aims. Future research should address the drivers behind developing optimal training programs that support independent practice, correlations with patient outcomes, and methods that enable faculty to justify their supervisory decisions while adhering to ALARA risk management standards.

摘要： Pathogen transmission into zebrafish colonies is controlled through vigilant biosecurity practices. One such practice is embryo surface disinfection, which often uses sodium hypochlorite. However, if sodium hypochlorite is used at an inappropriate pH, concentration, or exposure time, zebrafish embryos can experience significant mortality and morbidity. Reagent-grade sodium hypochlorite is often used for embryo surface disinfection because commercial-grade sodium hypochlorite has additional ingredients that may have deleterious effects on the embryo. In addition, chlorine dioxide and the combination of sodium chloride and potassium peroxymonosulfate (SCPP) are effective equipment disinfectants;however, the effects of these chemical agents on zebrafish embryos during surface disinfection are unknown. In this study, we exposed strain 5D zebrafish embryos (ages, 6 and 24 h postfertilization) to 4 chlorine-containing agents (reagent-grade sodium hypochlorite [bleach], commercial-grade sodium hypochlorite [bleach], SCPP, and chlorine dioxide) at either 50- or 100- ppm for 5 or 10 min. All groups were evaluated at 5 d postfertilization for survival, hatching rate, and morphologic defect rate. The experimental group with the highest survival and hatching rates and the lowest morphologic defect rate was the 24-h postfertilization embryos exposed to 50 ppm SCPP for 5 min. The survival, hatching rate, and defect rate did not differ significantly among age-matched controls;however, the hatching rate after exposure to 50 ppm SCPP was significantly higher than that of embryos exposed to 50 ppm reagent-grade sodium hypochlorite for 5 min (100% compared with 23% respectively). SCPP solution may provide an alternative surface disinfectant for zebrafish embryos because it maximizes survival and hatching rates and minimizes morphologic defect rates. However, in vivo efficacy against common zebrafish pathogens requires further testing. Use of chlorine dioxide at 50 ppm or greater is no

关键词： cystitis   interstitial cystitis   recurrence  

摘要： Purpose: We aimed to investigate the impact of various bladder lesions on the clinical symptoms and recurrence of interstitial cystitis (IC). Materials and Methods: Patients with IC who underwent transurethral resection and cauterization for Hunner lesions (HLs) were enrolled. Features of HLs-noninflamed, inflamed, and gradually inflamed-and associated cystoscopic findings, including waterfall bleeding (none, focal or extensive), submucosal hemorrhage, and mucosal streak, were analyzed to investigate their association with preoperative symptoms and recurrence. Results: We included 272 procedures from 141 patients (male:female ratio 37:104) with a mean +/- SD age of 61.4 +/- 10.5 years. Recurrence was observed in 160 procedures after a mean of 15.6 months (range 0.7-91.7);repeat transurethral resection and cauterization was performed in 131 cases. The number of HLs observed at each procedure was variable, and sufficient bladder filling revealed hidden lesions in 10.7% of cases. Waterfall bleeding was frequently accompanied with inflamed/gradually inflamed HLs. Inflammatory HLs were associated with smaller functional bladder capacity and preoperative urgency (p=0.007). Extensive waterfall bleeding was associated with smaller functional bladder capacity (p=0.006). On multivariate analysis, initially inflamed HLs (HR: 1.675, 95% CI: 1.022-2.746, p=0.041) and gradual inflammatory changes in HLs (HR: 1.893, 95% CI: 1.050-3.410, p=0.034) were found to be risk factors for recurrence. Conclusions: Sufficient bladder filling revealed hidden HLs. The features of HLs were not associated with subjective symptoms;inflamed changes were a predictive factor for IC recurrence, and associated with frequent urgency episodes and smaller bladder capacity.

关键词： Zea mays   Brachiaria spp   Food production   Cover crop   Nitrogen supply   Tropical agriculture  

摘要： Optimizing agronomic efficiency (AE) of nitrogen (N) fertilizer use by crops and enhancing crop yields are challenges for tropical no-tillage systems since maintaining crop residues on the soil surface alters the nutrient supply to the system. Cover crops receiving N fertilizer can provide superior biomass, N cycling to the soil and plant residue mineralization. The aims of this study were to (i) investigate N application on forage cover crops or cover crop residues as a substitute for N sidedressing (conventional method) for maize and (ii) investigate the supply of mineral N in the soil and the rates of biomass decomposition and N release. The treatments comprised two species, i.e., palisade grass [Urochloa brizantha (Hochst. Ex A. Rich.) R.D. Webster] and ruzigrass [Urochloa ruziziensis (R. Germ. and C.M. Evrard) Crins], and four N applications: (i) control (no N application), (ii) on live cover crops 35 days before maize seeding (35 DBS), (iii) on cover crop residues 1 DBS, and (iv) conventional method (N sidedressing of maize). The maximum rates of biomass decomposition and N release were in palisade grass. The biomass of palisade grass and ruzigrass were 81 and 47% higher in N application at 35 DBS compared with control in ruzigrass (7 Mg ha(-1)), and N release followed the pattern observed of biomass in palisade and ruzigrass receiving N 35 DBS (249 and 189 kg N ha(-1)). Mineral N in the soil increased with N application regardless of cover crop species. Maize grain yields and AE were not affected when N was applied on palisade grass 35 DBS or 1 DBS (average 13 Mg ha(-1) and 54 kg N kg(-1) maize grain yield) compared to conventional method. However, N applied on ruzigrass 35 DBS decreased maize grain yields. Overall, N fertilizer can be applied on palisade grass 35 DBS or its residues 1 DBS as a substitute for conventional sidedressing application for maize.

关键词： RNA   urinary bladder neoplasms   ureteral neoplasms   genome  

摘要： Purpose: We compared upper tract urothelial carcinoma (UTUC) and bladder urothelial carcinoma (BUC) in same-patient metachronous UTUC and synchronous UTUC and BUC using next-generation sequencing. Materials and Methods: Consecutive untreated same-patient samples of UTUC and BUC were macrodissected from unstained formalin-fixed, paraffin-embedded slides after quality control. Samples were divided into 4 groups: 1) UTUC-metachronous BUC, 2) BUC-metachronous UTUC, 3) synchronous UTUC-BUC, 4) UTUC without BUC. Exclusions were inadequate clinical data or histological tumor purity <30%. Whole transcriptome RNA sequencing was performed. After quality assessment, gene expression clusters using unsupervised hierarchical consensus clustering and correlation with pertinent clinicopathologic variables, a prior RNASeq data set and other published data were performed. Results: RNAseq was performed on 95 samples (UTUC=61, BUC=34) from 40 untreated patients. Unsupervised consensus clustering segregated the tumors into 2 clusters that were enriched with BASE47 basal-like or luminal-like gene expression. Almost two-thirds (61.9%) of Group 2 tumors were basal-like, while the majority of Groups 1, 3, 4 (80.6%, 70.0% and 69.6%, respectively) were luminal-like (p=0.017). Further analyses revealed that the differences in basal-like and luminal-like gene expression were associated with differential fibroblast and immune cell gene expression signatures. In all, 87.5% of metachronous tumors maintained subtype membership. Conclusions: Gene expression analysis of same-patient metachronous UTUC-BUC suggests that the majority of mUTUC developing after BUC appear more basal-like, while synchronous and initial UTUC tumors appear luminal-like. Metachronous tumors largely maintain molecular subtype membership of the initial tumor regardless of chronologic development or anatomical origin.

关键词： alternative algebra   generalized Lie derivation  

摘要： In this paper we intend to describe generalized Lie-type derivations using, among other things, a generalization for alternative algebras of the result: "If F : A -> A is a generalized Lie n-derivation associated with a Lie n-derivation D, then a linear map H = F - D satisfies H(p(n)(x(1), x(2),..., x(n))) = p(n)(H(x(1)), x(2),..., x(n)) for all x(1), x(2),..., x(n) is an element of A". Thus, if A is a unital alternative algebra with a nontrivial idempotent e1 satisfying certain conditions, then a generalized Lie-type derivation F : A -> A is of the form F(x) = lambda x+Xi(x) for all x is an element of A, where lambda is an element of Z(A) and Xi : A -> A is a Lie-type derivation.

关键词： Multiple scattering   Wave interaction   PolarGreen's function   Finite water depth   Wave energy converters  

摘要： The interaction theory presented by Kagemoto and Yue (1986) significantly reduces the computational burden in the wave interaction problem of multiple surface-piercing bodies, particularly arrays of wave energy converters in recent years. Two essential operators of the theory are the so-called Diffraction Transfer Matrix and Radiation Characteristics. Many subsequent researchers (Goo and Yoshida, 1990;Flavi`a et al., 2018) have implemented the theory using the source distribution method in evaluating the two linear operators of a single unique geometry. However, nowadays, a great majority of boundary element method codes have been written by virtue of the hybrid source-dipole distribution method on account of its high accuracy. In this regard, the present work aims to introduce a full set of mathematical formulations, as well as a complete derivation process of evaluating the two operators based on the hybrid source-dipole distribution method. The proposed formulations are then applied to two benchmark geometries, as given by McNatt et al. (2015) and Flavi`a et al. (2018). Good agreement is found between the present results and those from the literature. Moreover, two alternative approaches to solve the diffraction problem have been compared to assess both their accuracy and efficiency. It is found that the two methods present similar levels of accuracy but very different computational burden.

关键词： macrophage   mechanotransduction   MSC   osteogenesis   YAP   BMP2 axis  

摘要： For reconstructive surgeons, critically skeletal damage represents a major challenge. Growing evidence indicate that bone repair is dynamically regulated by the mesenchymal stem cell (MSC)-macrophage interaction. Mechanical strain plays a fundamental role in bone repair and regeneration by influencing MSCs differentiation. Recently, a few findings indicate that macrophages may be mechanically sensitive and their phenotype can be regulated, in part, by mechanical cues. However, how macrophages subjected mechanical stretch influence the osteogenic differentiation of MSCs remain unclear. Thus, the purpose of this study is to explore the effect of macrophages stimulated with mechanical stretch on MSCs osteogenesis. By using a coculture system, we discover that macrophages efficiently induce osteogenic differentiation of MSCs under specific stretch conditions. A synergy mechanism between M2 polarization and YAP/BMP2 axis are identified through molecular and genetic analyses. Macrophages are activated by cyclic stretch and polarized to M2 phenotype that produce anti-inflammatory cytokines such as IL-10 and TGF-beta to regulate the local inflammatory microenvironment. Furthermore, mechanical stretch induces YAP activation and nuclear translocation, subsequently regulates downstream BMP2 expression to facilitate MSCs osteogenesis. These findings not only advance our understanding of the complex influence among the mechanical strain, macrophage inflammatory response as well as the osteogenic differentiation of MSCs, but also reveal a control system from mechanical signals to chemical response then to cell behaviors during bone repair and regeneration.