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Complex storage stacks providing data compression, indexing, and analytics help leverage the massive amounts of data generated today to derive insights. It is challenging to perform this computation, however, while fully utilizing the underlying storage media. This is because, while storage servers with large core counts are widely available, single-core performance and memory bandwidth per core grow slower than the core count per die. Computational storage offers a promising solution to this problem by utilizing dedicated compute resources along the storage processing path. We present DeltaFS Indexed Massive Directories (IMDs), a new approach to computational storage. DeltaFS IMDs harvest available (i.e., not dedicated) compute, memory, and network resources on the compute nodes of an application to perform computation on data. We demonstrate the efficiency of DeltaFS IMDs by using them to dynamically reorganize the output of a real-world simulation application across 131,072 CPU cores. DeltaFS IMDs speed up reads by 1,740× while only slightly slowing down the writing of data during simulation I/O for in situ data processing.

Deep learning accelerators efficiently train over vast and growing amounts of data, placing a newfound burden on commodity networks and storage devices. A common approach to conserve bandwidth involves resizing or compressing data prior to training. We introduce Progressive Compressed Records (PCRs), a data format that uses compression to reduce the overhead of fetching and transporting data, effectively reducing the training time required to achieve a target accuracy. PCRs deviate from previous storage formats by combining progressive compression with an efficient storage layout to view a single dataset at multiple fidelities---all without adding to the total dataset size. We implement PCRs and evaluate them on a range of datasets, training tasks, and hardware architectures. Our work shows that: (i) the amount of compression a dataset can tolerate exceeds 50% of the original encoding for many DL training tasks; (ii) it is possible to automatically and efficiently select appropriate compression levels for a given task; and (iii) PCRs enable tasks to readily access compressed data at runtime--- utilizing as little as half the training bandwidth and thus potentially doubling training speed.

Background. The superior mesenteric artery (SMA) syndrome is a rare entity presenting with upper gastrointestinal tract obstruction and weight loss. Studies to determine the optimal methods of diagnosis and treatment are required. Aims and Methods. This study aims at analyzing the clinical presentation, diagnosis, and management of SMA syndrome. Ten cases of SMA syndrome out of 2074 esophagogastroduodenoscopies were suspected. A contrast-enhanced computed tomography (CECT) scan was performed to confirm the diagnosis. After, a gastroenterologist and a nutritionist personalized the therapy. Furthermore, we compared the demographical, clinical, endoscopic, and radiological parameters of these cases with a control group consisting of 10 cases out of 2380 EGDS of initially suspected (but not radiologically confirmed) SMA over a follow-up 2-year period (2015-2016). Results. The prevalence of SMA syndrome was 0.005%. Median age and body mass index were 23.5 years and 21.5 kg/m2, respectively. Symptoms developed between 6 and 24 months. Median aortomesenteric angle and aorta-SMA distance were 22 and 6 mm, respectively. All patients improved on conservative treatment. In our series, a marked (>5 kg) weight loss (p=0.006) and a long-standing presentation (more than six months in 80% of patients) (p=0.002) are significantly related to a diagnosis of confirmed SMA syndrome at CECT after an endoscopic suspicion. A “resembling postprandial distress syndrome dyspepsia” presentation may be helpful to the endoscopist in suspecting a latent SMA syndrome (p=0.02). The narrowing of both the aortomesenteric angle (p=0.001) and the aortomesenteric distance (p<0.001) was significantly associated with the diagnosis of SMA after an endoscopic suspicion; however, the narrowing of the aortomesenteric distance seemed to be more accurate, rather than the narrowing of the aortomesenteric angle. Conclusion. SMA syndrome represents a diagnostic and therapeutic challenge. Our results show the following findings: the importance of the endoscopic suspicion of SMA syndrome; the preponderance of a long-standing and chronic onset; a female preponderance; the importance of the nutritional counseling for the treatment; no need of surgical intervention; and better diagnostic accuracy of the narrowing of the aorta-SMA distance. Larger prospective studies are needed to clarify the best diagnosis and management of the SMA syndrome.

We are approaching a point in time when it will be infeasible to catalog and query data after it has been generated. This trend has fueled research on in-situ data processing (i.e. operating on data as it is streamed to storage). One important example of this approach is in-situ data indexing. Prior work has shown the feasibility of indexing at scale as a two-step process. First, one partitions data by key across the CPU cores of a parallel job. Then each core indexes its subset as data is persisted. Online partitioning requires transferring data over the network so that it can be indexed and stored by the core responsible for the data. This approach is becoming increasingly costly as new computing platforms emphasize parallelism instead of individual core performance that is crucial for communication libraries and systems software in general. In addition to indexing, scalable online data partitioning is also useful in other contexts such as load balancing and efficient compression.We present FilterKV, an efficient data management scheme for fast online data partitioning of key-value (KV) pairs. FilterKV reduces the total amount of data sent over the network and to storage. We achieve this by: (a) partitioning pointers to KV pairs instead of the KV pairs themselves and (b) using a compact format to represent and store KV pointers. Results from LANL show that FilterKV can reduce total write slowdown (including partitioning overhead) by up to 3x across 4096 CPU cores.

Irritable bowel syndrome (IBS) is a chronic, recurring, and remitting functional disorder of the gastrointestinal tract characterized by abdominal pain, distention, and changes in bowel habits. Although there are several drugs for IBS, effective and approved treatments for one or more of the symptoms for various IBS subtypes are needed. Improved understanding of pathophysiological mechanisms such as the role of impaired bile acid metabolism, neurohormonal regulation, immune, dysfunction, the epithelial barrier and the secretory properties of the gut has led to advancements in the treatment of IBS. With regards to therapies for restoring intestinal permeability, multiple studies with prebiotics and probiotics are ongoing, even if to date their efficacy has been limited. In parallel, much progress has been made in targeting low-grade inflammation, especially through the introduction of drugs such as mesalazine and rifaximin, even if a better knowledge of the mechanisms underlying the low-grade inflammation in IBS may allow the design of clinical trials that test the efficacy and safety of such drugs. This literature review aims to summarize the findings related to new and investigational therapeutic agents for IBS, most recently developed in preclinical as well as Phase 1 and Phase 2 clinical studies.

Zollinger-Ellison syndrome is an often progressive, persistent and frequently life-threatening disease, described for the first time as characterized by ulceration of the upper jejunum, hypersecretion of gastric acid and non-beta islet cell tumors of the pancreas; this syndrome is due to the hypersecretion of gastrin. We report a case of Zollinger-Ellison syndrome presenting as severe esophagitis evolving in stenosis, which demonstrates how a delayed diagnosis may induce risk of disease spreading. In this setting new diagnostic approaches, such as somatostatin receptor scanning and positron emission tomography with 68 Ga-labeled octreotide, could be particularly useful, as well as further new therapeutic options, such as molecular targeted treatments and peptide receptor radionuclide therapy, though surgery is currently the only form of curative treatment, and the role of the therapeutic options mentioned needs to be clarified by forthcoming studies

Low-grade intestinal inflammation plays a key role in the pathophysiology of irritable bowel syndrome (IBS), and this role is likely to be multifactorial. The aim of this review was to summarize the evidence on the spectrum of mucosal inflammation in IBS, highlighting the relationship of this inflammation to the pathophysiology of IBS and its connection to clinical practice. We carried out a bibliographic search in Medline and the Cochrane Library for the period of January 1966 to December 2014, focusing on publications describing an interaction between inflammation and IBS. Several evidences demonstrate microscopic and molecular abnormalities in IBS patients. Understanding the mechanisms underlying low-grade inflammation in IBS may help to design clinical trials to test the efficacy and safety of drugs that target this pathophysiologic mechanism.

Pneumatic dilatation (PD) and Surgical Miotomy (SM) are presently the best treatments for untreated achalasia, with similar efficacy. There is no information on the relative efficacy of PD in younger compared to older patients. Aim of our study was to compare success rate and safety of PD in patients under fifty years old and in those over fifty years old affected by achalasia. Twenty consecutive symptomatic patients were treated in our Unit with graded PD under fluoroscopic view. Five male and 15 female with a median age of 47 years were treated. Twelve patients were less than fifty years old (group I) while 8 were older (group II). Median dysphagia questionnaire score was 14 and13 ingroup I and II respectively. Technical success was achieved in all patients. Seven patients were previously treated through other techniques. In group I all patients achieved a complete remission of symptoms with significant decrease of the dysphagia questionnaire score (3). In group II all patients achieved a complete remission of symptoms with significant decrease of the dysphagia questionnaire score (4.5) but 3 of them repeated the procedure. In boths groups the efficacy of the dilation was radiologically confirmed. Neither early nor late complication were reported in either groups. In our experience PD was an effective and safe procedure both in young and old patients although the older group had more recurrences, all successfully re-dilated.

Background: self-expandable metallic stents (SEMS) are employed as the preferred non surgical palliative treatment for gastric outlet obstruction due to malignancies. Metallic stents are often employed to treat malignant anastomotic obstructions after surgicsl interventions as esophagojejunostomy, gastrojejunostomy and esophagogastrojejunostomy. Methods: this case series reports prospectively the clinical outcomes of SEMS in the palliative care of malignant anastomotic strictures caused by the recurrence gastric cancer follwing gastric surgery as oncological curative treatment, in a series of nine consecutive patients, treated between January 2009 and december 2012 in our center. Results: Nine patients (M:F=8:1) were enrolled in the study. The operation was a total gastrectomy with esophagogastrojejunostomy (n=4), subtotal gastrectomy with Bilroth-II reconstruction (n=4), subtotal gastrectomy with Billroth-II reconstruction (n=3), and subtotal gastrectomy with esophagogastrostomy (n=2). The technical success rate was 88,9%, and the clinical success rate was 88.9%. The reostruction of the stent, due to the ingrowth of the tumor, occurred in 1 patient (11,1%) within 1 month after stent placement. the migration of the stent occurred after the placement of a covered stent in 1 patient who underwent a subtotal gastrectomy (with Billroth-II reconstruction). A case o partial stent dislodgement was treated with the placement of a second stent. The median survival period was 180 days (range, 30-240 days) and the median stent patency was 45 days 8range, 30-90 days). Conclusions: Although the number of the patients treated with SEMS results, in this series, almost small to certainly judge the safety and feasibility of SEMS, we believe that the endoscopic insertion of SEMS seems to be a safe, easily feasible, and effective treatment in the palliative care of malignant anastomotic strictures caused by the recurrence of gastric cancer following gastric surgery. The technical and clinical success, and the onset of complications of this procedure are influenced by several factors, such as the type of anastomosis, the technical features of the stent, and the extent of the underlying tumor.

An association between multiple sclerosis and autoimmune hepatitis has been described. The latter can also be unmasked or exacerbated by a variety of therapies used in multiple sclerosis, such as beta-Interferon or glatiramer acetate. Two cases of hepatitis occurring after exposure to glatiramer acetate are described here: the first, was possibly due to autoimmune hepatitis, rather than glatiramer acetate induced liver injury, the second was definite autoimmune hepatitis. Both occurred in patients who had already experienced hepatitis exacerbations during previous beta-Interferon treatment. We suggest that glatiramer acetate can unmask hepatitis. Thus, liver enzyme monitoring should be undertaken frequently in those patients with multiple sclerosis receiving glatiramer acetate, with a history of hepatitis during treatment with Interferon beta-1a.

The energy consumed by data centers is starting to make up a significant fraction of the world's energy consumption and carbon emissions. A large fraction of the consumed energy is spent on data center cooling, which has motivated a large body of work on temperature management in data centers. Interestingly, a key aspect of temperature management has not been well understood: controlling the setpoint temperature at which to run a data center's cooling system. Most data centers set their thermostat based on (conservative) suggestions by manufacturers, as there is limited understanding of how higher temperatures will affect the system. At the same time, studies suggest that increasing the temperature setpoint by just one degree could save 2-5% of the energy consumption. This paper provides a multi-faceted study of temperature management in data centers. We use a large collection of field data from different production environments to study the impact of temperature on hardware reliability, including the reliability of the storage subsystem, the memory subsystem and server reliability as a whole. We also use an experimental testbed based on a thermal chamber and a large array of benchmarks to study two other potential issues with higher data center temperatures: the effect on server performance and power. Based on our findings, we make recommendations for temperature management in data centers, that create the potential for saving energy, while limiting negative effects on system reliability and performance.

Latent sector errors (LSEs) are a common hard disk failure mode, where disk sectors become inaccessible while the rest of the disk remains unaffected. To protect against LSEs, commercial storage systems use scrubbers: background processes verifying disk data. The efficiency of different scrubbing algorithms in detecting LSEs has been studied in depth; however, no attempts have been made to evaluate or mitigate the impact of scrubbing on application performance. We provide the first known evaluation of the performance impact of different scrubbing policies in implementation, including guidelines on implementing a scrubber. To lessen this impact, we present an approach giving conclusive answers to the questions: when should scrubbing requests be issued, and at what size, to minimize impact and maximize scrubbing throughput for a given workload. Our approach achieves six times more throughput, and up to three orders of magnitude less slowdown than the default Linux I/O scheduler.