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Dynamic mode decomposition (DMD) yields a linear, approximate model of a system’s dynamics that is built from data. This paper seeks to reduce the order of this model by identifying a reduced set o...

Background and Aims Pancreatic ductal adenocarcinoma is an aggressive disease most often diagnosed after local progression or metastatic dissemination, precluding resection and resulting in a high mortality rate. For individuals with elevated personal risk of the development of pancreatic cancer, EUS is a frequently used advanced imaging and diagnostic modality. However, there is variability in the expertise and definition of EUS findings among gastroenterologists, as well as lack of standardized reporting of relevant findings at the time of examination. Adoption of standardized EUS reporting, using a universally accepted and agreed upon terminology, is needed. Methods A consensus statement designed to create a standardized reporting template was authored by a multidisciplinary group of experts in pancreatic diseases that includes gastroenterologists, radiologists, surgeons, oncologists, and geneticists. This statement was developed using a modified Delphi process as part of the Pancreatic Cancer Early Detection Consortium (PRECEDE) and >75% agreement was required to reach consensus. Results We identified reporting elements and present standardized reporting templates for EUS indications, procedural data, EUS image capture, and descriptors of findings, tissue sampling, and for postprocedural assessment of adequacy. Conclusions Adoption of this standardized EUS reporting template should improve consistency in clinical decision making for individuals with elevated risk of pancreatic cancer by providing complete and accurate reporting of pancreatic abnormalities. Standardization will also help to facilitate research and clinical trial design by using clearly defined and consistent imaging descriptions, thus allowing for comparison of results across different centers.

Fibroepithelial polyps (FEPs) are rare benign tumors of mesodermal origin. They are found in the ureters 85% of the time, with the remainder located in the renal pelvis and occasionally the bladder. FEPs can present as flank pain, lower abdominal pain, and/or gross hematuria. Previous literature reports management of these benign lesions using open surgical techniques, laparoscopic techniques, and endoscopic management. In this article, the authors present their pure endoscopic management of a large ureteral polyp and a review of the current literature outlining the etiology, clinical presentations, and management techniques for FEP of the ureter.

Metasurfaces are optical elements with nanoscale dimensions and planar profiles that expand the functionality and usefulness of traditional refractive optics. This has lead to considerable interest in metasurfaces for a variety of applications, including consumer electronics, automotive, and medical devices. Metasurface elements can be manufactured using standard microelectronics process techniques enabling mass production of optical elements in semiconductor foundries. Additionally, being produced at the wafer-scale, metasurfaces enable wafer-scale integration of optical systems. However, most metasurfaces to date have been produced in small-scale research settings using serial patterning techniques such as electron beam lithography. In order for metasurfaces to penetrate high volume applications, scalable production processes must be developed, including lithographic reproduction of metasurface design geometries. In particular, the constituent elements of metasurfaces, nanopillars, have shapes, aspect ratios, and local density variations which diverge from typical microelectronics design rules. After a brief overview of metasurface fundamentals and their applications we will discuss traditional fabrication techniques, device requirements, and the challenges that arise when scaling to manufacturing. We will also discuss future generations of metasurfaces and further challenges in terms of geometry, critical dimensions, and materials compatibility.

Rationale & Objectives Glomerular diseases, including minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, and immunoglobulin A (IgA) nephropathy, share clinical presentations, yet result from multiple biological mechanisms. Challenges to identifying underlying mechanisms, biomarkers, and new therapies include the rarity of each diagnosis and slow progression, often requiring decades to measure the effectiveness of interventions to prevent end-stage kidney disease (ESKD) or death. Study Design Multicenter prospective cohort study. Setting & Participants Cure Glomerulonephropathy (CureGN) will enroll 2,400 children and adults with minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, or IgA nephropathy (including IgA vasculitis) and a first diagnostic kidney biopsy within 5 years. Patients with ESKD and those with secondary causes of glomerular disease are excluded. Exposures Clinical data, including medical history, medications, family history, and patient-reported outcomes, are obtained, along with a digital archive of kidney biopsy images and blood and urine specimens at study visits aligned with clinical care 1 to 4 times per year. Outcomes Patients are followed up for changes in estimated glomerular filtration rate, disease activity, ESKD, and death and for nonrenal complications of disease and treatment, including infection, malignancy, cardiovascular, and thromboembolic events. Analytical Approach The study design supports multiple longitudinal analyses leveraging the diverse data domains of CureGN and its ancillary program. At 2,400 patients and an average of 2 years' initial follow-up, CureGN has 80% power to detect an HR of 1.4 to 1.9 for proteinuria remission and a mean difference of 2.1 to 3.0mL/min/1.73m2 in estimated glomerular filtration rate per year. Limitations Current follow-up can only detect large differences in ESKD and death outcomes. Conclusions Study infrastructure will support a broad range of scientific approaches to identify mechanistically distinct subgroups, identify accurate biomarkers of disease activity and progression, delineate disease-specific treatment targets, and inform future therapeutic trials. CureGN is expected to be among the largest prospective studies of children and adults with glomerular disease, with a broad goal to lessen disease burden and improve outcomes.

There is scant literature describing the effect of glomerular disease on health-related quality of life (HRQOL). The Cure Glomerulonephropathy study (CureGN) is an international longitudinal cohort study of children and adults with four primary glomerular diseases (minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, and IgA nephropathy). HRQOL is systematically assessed using items from the Patient-Reported Outcomes Measurement Informative System (PROMIS). We assessed the relationship between HRQOL and demographic and clinical variables in 478 children and 1115 adults at the time of enrollment into CureGN. Domains measured by PROMIS items included global assessments of health, mobility, anxiety, fatigue, and sleep impairment, as well as a derived composite measure incorporating all measured domains. Multivariable models were created that explained 7 to 32% of variance in HRQOL. Patient-reported edema consistently had the strongest and most robust association with each measured domain of HRQOL in multivariable analysis (adjusted β [95% CI] for composite PROMIS score in children, -5.2 [-7.1 to -3.4]; for composite PROMIS score in adults, -6.1 [-7.4 to -4.9]). Female sex, weight (particularly obesity), and estimated glomerular filtration rate were also associated with some, but not all, domains of HRQOL. Primary diagnosis, disease duration, and exposure to immunosuppression were not associated with HRQOL after adjustment. Sensitivity analyses and interaction testing demonstrated no significant association between disease duration or immunosuppression and any measured domain of HRQOL. Thus, patient-reported edema has a consistent negative association with HRQOL in patients with primary glomerular diseases, with substantially greater impact than other demographic and clinical variables.

Male infertility is a common complaint encountered on an outpatient basis in urology. The initial evaluation and diagnosis of an infertile patient requires a stepwise approach beginning with a thorough history and physical. Infertility can be multifactorial, with many underlying pathologies. One such etiology of infertility is any defect in sperm transport from the testes to the end of the male reproductive tract; this would include a mechanical obstruction such as a prostatic cyst. Case presentation A 28 year old Caucasian male was referred to urology for evaluation of primary infertility. He presented with his wife after being unable to conceive for approximately 1 year with unprotected intercourse. The patient's primary care provider performed an initial semen analysis which revealed low volume ejaculate and virtual azoospermia. Subsequent laboratory analysis included complete blood with differential, complete metabolic panel, serum estradiol, follicle stimulating hormone, luteinizing hormone, prolactin, testosterone, thyroid stimulating hormone, and dehydroepiandrosterone sulfate. Pertinent findings from this workup included a normal follicle stimulating hormone, luteinizing hormone, prolactin, and thyroid stimulating hormone. However, serum testosterone was found to be low at 214.1 ng/mL for which the patient began clomiphene therapy that was titrated to 50 mg in order to normalize serum testosterone levels to 614.8 ng/dL. Repeat semen analysis one month later demonstrated similar findings of low ejaculate volume and virtual azoospermia. On his initial presentation to urology, the patient presented with the aforementioned findings and otherwise had no urogenital complaints. The patient also had an unremarkable past medical history, past surgical history, and family history. The patient endorsed a smoking history and socially drank alcohol. On physical exam, the patient was noted to have a normal genitourinary exam with an orthotopic meatus and no palpable scrotal masses or varicoceles. Retrograde ejaculation analysis was completed 4 weeks following urologic consultation and demonstrated virtual azoospermia with no sperm found on urinalysis. The patient subsequently underwent transrectal ultrasound of the prostate and seminal vesicles one week later which revealed a 2 × 2.3 × 3.0 cm midline prostatic cyst and bilateral seminal vesicle dilation (see Fig. 1). Open in a separate window Fig. 1 Ultrasound images of prostatic cyst.

Prostate cancer is the most common cancer in men in the United States and the second leading cause of mortality in this population. Those diagnosed may undergo a variety of treatments ranging from radiation to chemotherapy to surgery. Although metastases commonly first appear in bone, it is important to consider rare locations of metastasis such as the testicles. We present the case of a 56 year old male who presented with diffusely worsening back pain along with scrotal swelling who was ultimately diagnosed with metastatic prostate cancer to the bilateral testicles. Keywords: Prostate cancer, Testicular metastasis

Many companies are facing the challenge of replacing heavy metal containing pigments in their products because of possible legal restrictions as well as toxicological and environmental considerations. Replacing one pigment in a single formulation is not generally an insurmountable problem, but replacing this pigment in hundreds or perhaps thousands of formulations might generate some anxiety. The purpose of this paper is to review some of the techniques useful for pigment selection. Colorimetric properties and physical characteristics form the basis for logical selection. Chromaticity characteristics, data on relative opacity, migration resistance, hat and light stability of more than thirty pigments will be included. Examples of the use of the techniques illustrating the replacement of chromate pigments in five colors will be presented. Comparative performance data will be included. On the basis of the information presented, limitations in making high chroma yellow will be discussed.

We evaluated the use of an additive Index of Coexisting Diseases (ICED)-based stratification schema to determine subsequent hospitalization and mortality in a hemodialysis population. Patients from five commercial health plans were stratified into low-, medium-, and high-risk groups and followed for up to 1 year. Patients were reassessed and restratified at 90-day intervals and censored when disease management ceased. Outcome measures collected through selfreports and health plan records were captured in an active database. Survival to first hospitalization/ mortality was compared by Kaplan Meier curves, survivor function differences by the Wilcoxon test, and group comparisons by ANOVA and chi square. Population characteristics included mean age of 63.0, 57.7% male, and 58.8% diabetic. Mortality was 13.0% per patient year (standardized mortality ratio 0.43) and the hospitalization rate was 0.59 per patient year (standardized hospitalization ratio 0.24). Survival curves demonstrated differences in mortality and hospitalization between the patients in different initial risk categories (p < 0.01). Mean hospitalizations were 0.81 +/- 1.53 per patient year (high risk), 0.45 +/- 0.99 (medium risk), and 0.15 +/- 0.51 for the low-risk group (p < 0.001). Stratification was dynamic; 47.3% decreased and 4.7% increased risk level between the first and second assessment. These changes were associated with survival differences for initial low (p = 0.06) or medium patients (p < 0.01), and hospital-free survival for initial medium (p = 0.08) or high patients (p < 0.05). In conclusion, this ICED-based stratification schema predicted mortality and hospitalization for hemodialysis patients participating in our disease management program.