Oracle (United States)

Cardiovascular disorders are the leading cause of death worldwide, so it is crucial that we develop innovative, rapid and precise methods of diagnosing them. The hybrid deep learning model proposed in this study combines the most effective elements of sparse autoencoders (SAEs), multilayer perceptrons (MLPs) and convolutional neural networks (CNNs). To properly display the input attributes, this method employs categorical encoding and normalisation on the UCI Heart Disease dataset. This hybrid architecture facilitates the development of an AI system that retains crucial physiological characteristics while handling large amounts of abstract data. Furthermore, it has been demonstrated that the proposed hybrid architecture outperforms the other techniques investigated, including Learning Vector Quantification and Logistic Regression with Boruta feature selection. The hybrid design achieved a recall rate of 93.8%, an accuracy rate of 95.1%, a precision rate of 94.6% and an F1 score of 94.2%. Substantial statistical evidence supports the idea that the CNN–MLP + SAE architecture will be effective as an early detection method for heart disease.

Necrotizing fasciitis (NF) following minor trauma in healthy individuals is rare and poses a considerable diagnostic challenge. Due to its nonspecific early presentation, NF is associated with high rates of misdiagnosis and mortality, underscoring the critical need for early recognition and intervention. A previously healthy 37-year-old male developed rapidly progressive necrotizing fasciitis of the scrotum and right lower extremity following minor bicycle-related abrasions. Upon admission, the patient presented with a high-risk Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score of 8, and imaging studies demonstrated rapid spread of infection from the right inguinal region to the right lower extremity and perineum, with subsequent progression to septic shock and multiple organ dysfunction syndrome. Urgent multidisciplinary team (MDT) collaboration is critical. Through emergency fasciotomy and identification of Group A Streptococcus (GAS) infection, the diagnosis of NF was definitively established. Combined with high-dose penicillin G, and comprehensive supportive measures, he achieved complete recovery without sequelae at 6-month follow-up. Type II NF related with GAS can even occurred in low-risk populations. Early diagnosis relies on LRINEC scoring combined with imaging. Time-critical MDT with immediate coordination for pathogen identificationis crucial for survival. Not applicable.

Senile purpura is characterized by the recurrent ecchymoses following minor trauma [1]. This condition arises due to the weakening of the structural integrity of dermal collagenous tissues and increased fragility of blood vessels. Therapeutic approaches that restore the structural support of the dermal extracellular matrix (ECM) in patients with senile purpura may lead to progressive improvements. Calcium hydroxylapatite (CaHA) has been used as a dermal filler and is known to improve skin quality by inducing mechanotransduction, a process in which mechanical stimuli are converted into biochemical signals [2]. The transcriptional regulator YAP has been highlighted as a key cellular mechanotransducer that exerts influence over collagen synthesis and skin regeneration [3]. A 65-year-old male and a 67-year-old male presented with recurrent bruises on the dorsum of hands (Figure 1a). Despite the regular use of moisturizers and physical protection, purpura continued to worsen. Consequently, 1.5 cc of CaHA (Radiesse; Merz, Raleigh, NC) was diluted in a 1:1 ratio with 0.1% lidocaine and injected subdermally into the dorsum of the hand using a proximal-to-distal fanning technique. The injection was performed on the left hand at baseline, while the right hand remained untreated to serve as a comparison control. After 3 months, gross examination revealed clinical improvements in senile purpura, skin texture, and volume, compared to the baseline (Figure 1a,b). Two punch biopsy specimens were obtained for histopathological examination. The treated side tended to have greater epidermal thickness compared to the control side. Additionally, special stains demonstrated more prominent collagen and elastic fibers in the treated area (Figure 1c–e). Immunohistochemistry analysis also revealed the number of cells exhibiting increased YAP expression after the treatment (Figure 1f,h). The expression of vascular endothelial growth factor is higher in the treated side compared to the control (Figure 1g,i). Given that YAP regulates collagen production in fibroblasts and mediates feedback mechanisms in cellular mechanotransduction, these findings suggest that ECM synthesis following CaHA treatment occurs via a mechanotransduction pathway involving YAP activation. In both patients, CaHA was also administered to the control hand at 3 months, with follow-up for another 3 months post-procedure. Both hands demonstrated sustained improvement in hand volume and skin quality, with favorable clinical results up to 6 months. To address whether CaHA modulates the YAP-mediated mechanotransduction pathway, we performed a 3-dimensional spheroid culture experiment using benign immortalized human dermal fibroblasts and retinal pigment epithelium-1 (RPE1) cells (Supplementary Text, available via Mendeley at https://doi.org/10.17632/b2j2rdxv5n.1), more relevant to the in vivo condition (Figure 2 and Supplementary Figure 1) [4]. Cells exhibiting high levels of nuclear YAP enrichment, indicative of YAP activation, were more frequent in the condition where CaHA was supplemented, compared to the control (Figure 2b,c). Fibroblasts adhering to CaHA microspheres exhibited actin cytoskeletal remodeling (Figure 2c), which is known to strongly influence YAP activity. Our study shows that injecting diluted CaHA into the dorsum of the hand improves senile purpura, accompanied by histological evidence of epidermal and dermal proliferation, increased collagen and elastic fiber density. This dermal ECM reinforcement likely stabilizes fragile vasculature [3]. Notably, we observed a significant increase in YAP-positive cells in the dermis post-CaHA injection, supported by in vitro spheroid culture. Since YAP regulates ECM homeostasis and is suppressed in aged fibroblasts due to reduced mechanical cues, CaHA may restore dermal stiffness and activate YAP-dependent mechanotransduction, promoting neocollagenesis and skin integrity [5]. Nevertheless, this study represents a preliminary and exploratory observation intended to stimulate further controlled trials. Moreover, the clinical inference of our findings is limited by the sample size, male sex homogeneity, and a short follow-up period. While further studies are required to determine whether CaHA can provide long-term improvement for senile purpura, its use may be considered a treatment option for patients unresponsive to conservative therapies. This study was supported by a research grant from Merz Asia Pacific Pte. Ltd. The patient provided written informed consent for the use of clinical images and related data for research and publication purposes. The authors declare no conflicts of interest. The data that supports the findings of this study are available in the supporting information of this article.

Postoperative stiffness is a common complication after total knee arthroplasty (TKA), leading to limited range of motion (ROM), pain, and reduced function. Direct oral anticoagulants (DOACs), such as factor Xa inhibitors, are commonly prescribed for venous thromboembolism (VTE) prophylaxis but may increase the risk of postoperative stiffness due to postoperative bleeding within the knee. This study seeks to evaluate the effect of postoperative VTE prophylaxis (factor Xa inhibitors vs. aspirin) on ROM outcomes in patients undergoing TKA. A total of 1,054 patients who underwent primary TKA by the senior author between November 2021 and May 2023 were retrospectively identified from an institutional database. Records were examined at preoperative, 2-week, 6-week, <1-year, and >1-year postoperative visits. Logistic regression models analyzed ROM outcomes, defining success as 90° flexion and 0° extension at 2 weeks and 125° flexion and 0° extension at 6 weeks. Manipulation under anesthesia (MUA) was recorded as a secondary end point. Factor Xa inhibitors (apixaban or rivaroxaban) did not significantly affect ROM success at 2 weeks (OR = 0.956, 95% confidence interval [CI, 0.866 to 1.054], P = 0.364) or 6 weeks (OR = 0.986, 95% CI [0.892 to 1.089], P = 0.778) postoperatively, compared with aspirin. VTE prophylaxis type was not found to be significantly associated with MUA likelihood. No association was found between postoperative ROM and VTE prophylaxis medication. Previous studies used lower ROM thresholds or focused solely on MUAs. Understanding the effects of DOACs on postoperative stiffness can help guide chemoprophylaxis decisions after TKA.

BackgroundRespiratory syncytial virus (RSV) is a common respiratory illness, with certain populations at higher risk of severe disease including pediatric patients, older adults, and those with compromised immune systems. The current analyses aim to examine the signs and symptoms (S&S) of RSV at time of hospitalization.MethodsA retrospective analysis was conducted using structured electronic health records (EHR) data from Oracle Life Sciences’ nationally representative EHR database. Patients hospitalized with RSV (identified via ICD-9, ICD-10, and/or SNOMED-CT codes) within the two seasons of interest (Season 1 [S1]: 2022Jul01-2023Jun30 and Season 2 [S2]: 2023Jul01-2024Jun30; qualifying once per season) were randomly selected for comprehensive review of S&S. RSV S&S included were on the basis of historic literature, S&S instruments, and expert opinion. Incidence of each S&S was determined via structured (e.g. ICD, SNOMED-CT) and/or manual physician notes review of each S&S text. Descriptive statistics of RSV S&S were reported by age stratification (pediatrics: 0< 5; at-risk adults: 18-64, 65+).ResultsA total of 890 and 661 patients were randomly selected from S1 and S2, respectively. Demographics are presented in Table 1 and S&S are presented in Table 2. Overall S&S incidence in children and adults had overlapping similarities, with common S&S (e.g. cough, altered breathing sounds, hypoxemia) found in all age groups. Certain S&S were higher among pediatric patients (e.g. nasal congestion, fever, appetite loss/feeding problems) while other S&S were higher in older adults (e.g. fatigue). Incidence patterns were similar between both seasons of the predominant S&S found across age groups.ConclusionThis real-world analysis of RSV patients revealed some overlapping similarities of RSV S&S present at the point of hospitalization. Further characterization of RSV signs & symptoms can help inform natural history of the disease and timely interventions.DisclosuresSima S. Toussi, MD, Pfizer: Stocks/Bonds (Private Company) Negar Niki Alami, MD, Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company) Edward Weinstein, MD, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company) Lulu Lee, PhD, Oracle Life Sciences: Employed by Oracle Life Sciences, which received funding from Pfizer to conduct the study. Stacey Purinton, MSN, MPH, Oracle Life Sciences: Employed by Oracle Life Sciences, which received funding from Pfizer to conduct the study. Vicky W. Li, MPH, Oracle Life Sciences: Employed by Oracle Life Sciences, which received funding from Pfizer to conduct the study. Robert J. Taylor, AS, Oracle Life Sciences: Employed by Oracle Life Sciences, which received funding from Pfizer to conduct the study. Neelanzana Paudel, MS, Oracle Life Sciences: Employed by Oracle Life Sciences, which received funding from Pfizer to conduct the study. Wing Yu Tang, MPH, Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company)

Multimodal sensor fusion on resource-constrained microcontrollers (MCUs) is critical for Internet of Things (IoT) applications requiring real-time edge intelligence. While attention mechanisms have revolutionized deep learning, their deployment on ultra-low-power devices with <256KB RAM remains prohibitive due to quadratic memory complexity. We propose TinyFusion-NAS, a hardware-aware neural architecture search framework that discovers lightweight attention-based architectures optimized for multimodal sensor fusion (IMU, audio, environmental sensors) on ARM Cortex-M4/M7 processors using the TinyML framework. Our search space includes linear attention variants, grouped query attention, adaptive sparsity patterns, and hybrid CNN-attention blocks co-optimized with INT8 quantization. Experiments on three embedded platforms (ESP32-S3, STM32H7, nRF52840) demonstrate that TinyFusion- NAS achieves 12.3% higher accuracy than MobileNetV3 while reducing memory by 3.2 × and latency by 2.8 ×, enabling real-time fusion at <2mW power.

IoT deployments generate 79.4 ZB annually across 75B+ devices, yet centralized ML faces insurmountable bandwidth and privacy constraints. While federated learning promises decentralized training, existing frameworks collapse under IoT realities: 1000× resource heterogeneity and 30% Byzantine attacks. We present FaithFL, achieving 95.2% accuracy under 30% Byzantine attacks through: (i) Bayesian Trust Aggregation with O(n) complexity, (ii) Adaptive Gradient Compression reducing communication 45%, and (iii) Differential Privacy with (ϵ=1.0, δ=10<sup xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">−5</sup>)-bounds. Deployed on 50 ESP32 devices, FaithFL converges 67% faster using 60% less energy than FedAvg.

Three endophytic Sphingobium strains, WW5T, 11R-BB, and HT1-2T, were isolated from Salix sitchensis stems, Populus trichocarpa roots, and Pluchea carolinensis shoots, respectively, growing on nutrient-limited rock substrates undergoing primary succession. Cells are Gram-negative, strictly aerobic, rod-shaped, catalase-positive, and motile by a single flagellum. Colonies formed within 2-3days on nitrogen-limited combined carbon medium (NLCCM) and mannitol-glutamate/Luria (MGL) media. Growth occurred at 25-35°C (optimum 30-32.5°C), pH 5-8, and up to 2% NaCl for strains WW5T and 11R-BB and 3% for strain HT1-2T. Cellular fatty acid profiles were dominated by C18:1 ω7c and C16:1 ω7c. The predominant respiratory quinone was ubiquinone-10, and the principal polar lipids were phosphatidylethanolamine, sphingoglycolipids, and phosphatidylglycerol. Hybrid genome assemblies ranged from 5.49-5.72Mb with 64.0-64.2mol% GC, and 5404-5635 coding sequences. The 16S rRNA gene sequences of strains WW5T, 11R-BB, and HT-12T showed 99.5-99.9% identity to S. yanoikuyae JCM 7371T, but formed a separate lineage in neighbor-joining, maximum-likelihood, and maximum-parsimony trees. Pairwise digital DNA-DNA hybridization (dDDH; 99.8%), average nucleotide identity based on BLAST (ANIb; 99.98%), and alignment fraction (AF; 99.5%) indicate that strains WW5T and 11R-BB are conspecific and represent the same subspecies. Strain HT1-2T showed lower relatedness (70% dDDH; 95.05-95.31% ANIb; 76-79% AF) but was more closely related to strains WW5T and 11R-BB than to S. yanoikuyae JCM 7371T, supporting its placement as a subspecies within the same species as strains WW5T and 11R-BB. Based on phylogenomic, genomic, and phenotypic evidence, these strains constitute a novel species, Sphingobium salicis sp. nov., with the strain WW5T (DSM 120182T, NCCB 101075T) designated as the type strain.