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Background: Development of pancreatic necroses or pseudocysts are typical complications of pancreatitis and may require endoscopic drainage therapy using metal or plastic stents. Microbial infection of these lesions poses a major challenge. So far, the composition and significance of the microbial colonization on drainage stents are largely unknown although it may impact outcomes during endoscopic drainage therapy., Methods: A total of 26 stents used for drainage of pancreatic lesions were retrieved and the stent microbiome was determined by 16S rRNA gene sequencing. Additional analysis included comparison of the stent microbiome to the intracavitary necrosis microbiome as well as scanning electron microscopy (SEM) and micro-computed tomography (μCT) imaging of selected metal or plastic stents., Results: The stent microbiome comprises a large proportion of opportunistic enteric pathogens such as Enterococcus (14.4%) or Escherichia (6.1%) as well as oral bacteria like Streptococcus (13.1%). Increased levels of opportunistic enteric pathogens were associated with a prolonged hospital stay ( r  = 0.77, p  = 3e-06) and the occurrence of adverse events during drainage therapy ( p  = 0.011). Higher levels of oral bacteria were associated ( r  = -0.62, p  = 8e-04) with shorter durations of inpatient treatment. SEM and μCT investigations revealed complex biofilm networks on the stent surface., Conclusion: The composition of the stent microbiome is associated with prolonged hospital stays and adverse events during endoscopic drainage therapy, highlighting the need for effective infection control to improve patient outcomes. In addition to systemic antibiotic therapy, antimicrobial stent coatings could be a conceivable option to influence the stent microbiome and possibly enhance control of the necrotic microflora., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Frost, Khaimov, Senz, Weiss, Klußmann-Fricke, Rühlemann, Bang, Franke, Pickartz, Budde, Aghdassi, Siewert, Weiss, Grabow, Lerch and Sendler.)

Residential homes and light commercial buildings usually require substantial heat and electricity simultaneously. A combined heat and power system enables more efficient and environmentally friendly energy usage than that achieved when heat and electricity are produced in separate processes. However, due to financial and space constraints, residential and light commercial buildings often limit the use of traditional large-scale industrial equipment. Here we develop a micro-combined heat and power system powered by an opposed-piston engine to simultaneously generate electricity and provide heat to residential homes or light commercial buildings. The developed prototype attains the maximum AC electrical efficiency of 35.2%. The electrical efficiency breaks the typical upper boundary of 30% for micro-combined heat and power systems using small internal combustion engines (i.e., <10 kW). Moreover, the developed prototype enables maximum combined electrical and thermal efficiencies greater than 93%. The prototype is optimally designed for natural gas but can also run renewable biogas and hydrogen, supporting the transition from current conventional fossil fuels to zero carbon emissions in the future. The analysis of the unit's decarbonization and cost-saving potential indicate that, except for specific locations, the developed prototype might excel in achieving decarbonization and cost savings primarily in US northern and middle climate zones., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

In the context of the COVID-19 pandemic, there has been a scarcity of resources with various effects on the care of cancer patients. This paper provides an English summary of a German guideline on prioritization and resource allocation for colorectal and pancreatic cancer in the context of the pandemic. Based on a selective literature review as well as empirical and ethical analyses, the research team of the CancerCOVID Consortium drafted recommendations for prioritizing diagnostic and treatment measures for both entities. The final version of the guideline received consent from the executive boards of nine societies of the Association of Scientific Medical Societies in Germany (AWMF), 20 further professional organizations and 22 other experts from various disciplines as well as patient representatives. The guiding principle for the prioritization of decisions is the minimization of harm. Prioritization decisions to fulfill this overall goal should be guided by (1) the urgency relevant to avoid or reduce harm, (2) the likelihood of success of the diagnostic or therapeutic measure advised, and (3) the availability of alternative treatment options. In the event of a relevant risk of harm as a result of prioritization, these decisions should be made by means of a team approach. Gender, age, disability, ethnicity, origin, and other social characteristics, such as social or insurance status, as well as the vehemence of a patient's treatment request and SARS-CoV-2 vaccination status should not be used as prioritization criteria. The guideline provides concrete recommendations for (1) diagnostic procedures, (2) surgical procedures for cancer, and (3) systemic treatment and radiotherapy in patients with colorectal or pancreatic cancer within the context of the German healthcare system., (© 2024 S. Karger AG, Basel.)

Background and Objective: Hepatocellular carcinoma (HCC) is a leading cause of cancer deaths. Patients with HCC are often significantly affected by sarcopenia and cancer cachexia. Prehabilitation, a multimodal pre-operative exercise and nutritional intervention, has been implemented with varying degrees of success in enhancing outcomes among other gastrointestinal (GI) malignancies. However, remarkably little is described how prehabilitation may be beneficial in improving outcomes among those with HCC. Thus, a narrative review is warranted to examine previously developed prehabilitation models and determine how interventions affected sarcopenia as a prognosticator in HCC and other GI malignancies. This article seeks to offer guidance on how prehabilitation may be implemented for those with HCC based on available data published on other GI malignancies and serve as a call for additional research specific to the value of prehabilitation in HCC., Methods: Independent key-term searches were conducted by all authors of various databases (PubMed, ScienceDirect, Google Scholar) for relevant articles examining role, safety, and efficacy of prehabilitation in HCC and/or other GI malignancies. Relevant articles pertaining to sarcopenia, Enhanced Recovery After Surgery (ERAS) guidelines, and prehabilitation models were collected and analyzed. Review authors held multiple meetings to ensure coherence of narrative review process and final product., Key Content and Findings: Patients with HCC often suffer from sarcopenia and/or cachexia, which are known to be associated with poorer outcomes. The benefits of a prehab program in patients with HCC are not well described in current literature, but in referencing the benefits of prehab programs in other GI malignancies and ERAS protocols on patients undergoing liver resection and liver transplant, there is potential for a similar multimodal program to yield similar benefits and healthcare cost-savings. However, further investigation is needed as HCC has multiple etiologies and affects a wide variety of people., Conclusions: A multimodal prehabilitation program emphasizing regular aerobic and resistance exercise, nutritional optimization, lifestyle modifications, mental health and wellness practices, with a nurse and rehabilitation physician's oversight may improve outcomes in patients undergoing treatment for HCC. However further investigation into specific exercise models, optimal nutrition regimens and benefit/cost analysis of a multimodal prehabilitation program within this complex patient population is needed.

Cortico-spinal fMRI acquisitions aim to investigate direct interactions between brain and spinal cord, e.g. during motor output or pain processing, by covering both regions in a single measurement. Due to their large distance and location in the body, a dynamic shim update of constant and linear shim terms is required when using echo-planar imaging (EPI) to achieve reasonable image quality in both target regions. A previously presented approach with region-wise shim settings is based on a standard single-region shim algorithm and suffers from (i) non-optimal shim settings because it combines linear and second-order shim terms optimized for different volumes, and (ii) significant user interactions making it rather cumbersome, time consuming, and error-prone. Here, a dedicated ("CoSpi") shim algorithm for cortico-spinal fMRI is presented that performs joint optimization of static second-order shim terms and one set of linear and constant shim terms for each region in a single run and with minimal user interaction. Field map and T2*-weighted EPI measurements were performed on a clinical 3 T whole-body MR system in water phantoms and five healthy volunteers using the conventional region-wise and CoSpi shim settings as well as "gold standard" shim settings optimized for one of the target regions only. With CoSpi shim settings, (i) overall field inhomogeneity was reduced by about 65% / 75% (brain / spinal cord volume) compared to the conventional region-wise approach and in vivo was within 5% of the values obtained with the single-volume shim settings, (ii) geometric distortions derived from voxel displacement maps were reduced on average by about 35% / 70%, (iii) the temporal SNR determined from an EPI time series that may reflect the impact of through-slice dephasing, was increased by about 17% / 10%, and (iv) the variation of the mean field between slices, a measure targeting the predisposition to insufficient fat saturation and GRAPPA-related ghosting artifacts, was reduced by about 90% / 45%. Thus, the presented algorithm not only speeds up and simplifies the shim procedure considerably, but also provides a better field homogeneity and image quality, which both could help to significantly improve the applicability of cortico-spinal fMRI., Competing Interests: Declarations of Competing Interest None., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Non-invasive assessment of axon radii via MRI bears great potential for clinical and neuroscience research as it is a main determinant of the neuronal conduction velocity. However, there is a lack of representative histological reference data at the scale of the cross-section of MRI voxels for validating the MRI-visible, effective radius (r eff ). Because the current gold standard stems from neuroanatomical studies designed to estimate the bulk-determined arithmetic mean radius (r arith ) on small ensembles of axons, it is unsuited to estimate the tail-weighted r eff . We propose CNN-based segmentation on high-resolution, large-scale light microscopy (lsLM) data to generate a representative reference for r eff . In a human corpus callosum, we assessed estimation accuracy and bias of r arith and r eff . Furthermore, we investigated whether mapping anatomy-related variation of r arith and r eff is confounded by low-frequency variation of the image intensity, e.g., due to staining heterogeneity. Finally, we analyzed the error due to outstandingly large axons in r eff . Compared to r arith , r eff was estimated with higher accuracy (maximum normalized-root-mean-square-error of r eff : 8.5 %; r arith : 19.5 %) and lower bias (maximum absolute normalized-mean-bias-error of r eff : 4.8 %; r arith : 13.4 %). While r arith was confounded by variation of the image intensity, variation of r eff seemed anatomy-related. The largest axons contributed between 0.8 % and 2.9 % to r eff . In conclusion, the proposed method is a step towards representatively estimating r eff at MRI voxel resolution. Further investigations are required to assess generalization to other brains and brain areas with different axon radii distributions., Competing Interests: Declaration of Competing Interest The Max Planck Institute for Human Cognitive and Brain Sciences has an institutional research agreement with Siemens Healthcare. NW was a speaker at an event organized by Siemens Healthcare and was reimbursed for the travel expenses., (Copyright © 2022. Published by Elsevier Inc.)

Most COVID-19 vaccines require temperature control for transportation and storage. Two types of vaccine have been developed by manufacturers (Pfizer and Moderna). Both vaccines are based on mRNA and lipid nanoparticles requiring low temperature storage. The Pfizer vaccine requires ultra-low temperature storage (-80 °C to -60 °C), while the Moderna vaccine requires -30 °C storage. However, the last stage of distribution is quite challenging, especially for rural or suburban areas, where local towns, pharmacy chains and hospitals may not have the infrastructure required to store the vaccine at the required temperature. In addition, there is limited data available to address ancillary challenges of the distribution framework for both transportation and storage stages, including safety concerns due to human exposure to large amounts of CO 2 from dry-ice sublimation, issues due to the pressure increase caused by dry-ice sublimation, and the potential issue caused by non-uniform cryogenic temperatures. As such, there is a need for test dataset to assist the development of a quick, effective, secure, and safe solution to mitigate the challenges faced by vaccine distribution logistics., (© 2022. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.)