from sentence_transformers import SentenceTransformer
# Download from the π€ Hubmodel = SentenceTransformer("sentence-transformers/embeddinggemma-300m-medical")# Run inferencequeries = [ "What are some potential limitations in projecting the future demand for joint replacement surgeries?\n",]documents = [ "We also asked whether current trends are advancing according to earlier expectations [6] .\n\n Our study has several limitations. Our projections are based on the historical growth trajectory of joint replacement surgeries, and do not take into account potential limitations in the availability of surgeons or limited economic resources by private and public payers and hospitals in the future. For example, a shortage in the number of surgeons will have a substantial influence on the actual number of procedures that are performed. We also have not incorporated the potential for future alternative technologies, such as cartilage regeneration or tissue engineering, or drug therapies that limit the progression of joint diseases, which may preempt the need for TJR. We were also unable to account for the potential impact of changes in economy, which may place additional economic burden on patients to pay substantial out-of pocket expenses for these procedures, depending on their insurance coverage. Our study also did not consider potential changes in healthcare policies, such as adoption of volume standards or regionalization of TJR to high volume centers [5] , which could limit the access to care and decrease the future demand. The above economic, policy, and scientific factors cannot be readily incorporated in the statistical model. Our study was also focused on the procedural trends in the U.S.; followup research may include an analysis of trends in other countries, though the availability of historical TJR trends in other countries may be limited. Nonetheless, these limitations in no way diminish the importance of conducting and regularly updating surgical projections to help guide future research, surgeon training, and public health policy decisions. Our study also incorporated a more conservative projection, which relied only on the future changes in population growth, while maintaining current rates of adoption of TJR. Despite these limitations, our current findings are expected to have implications in the private coverage and reimbursement of joint replacement procedures in the future, as patients less than 65 years of age are not typically covered by Medicare, which today funds the majority of total joint replacement procedures in the United States.\n\n We found the relative size of the young patient population for TJR has grown between 1993 and 2006. While 25% to 32% of primary or revision TJRs were performed in patients less than 65 years old in 1993, these proportions have increased to 40% to 46% in the most recent NIS data. The increasing trend in younger patients undergoing TJR has also been reported for different, but partly overlapping, historical periods. For example, Jain et al. reported that the proportion of primary TKA patients aged less than 60 years increased from 12.5% to 19.5% (+56%) between 1990-1993 and 1998-2000 [4] . In addition, for patients aged under 70 years, the proportion increased by 9% from 45.6% to 49.6%. Due to the difference in the stratification by age categories, we were unable to make a direct comparison with the data by Jain et al. [4] . However, our findings that the historical volume of TJR procedures in the younger patient population have been increasing is consistent with these previously reported trends.\n\n While we previously forecasted an increase in demand for primary hip and knee replacement in 2030 by 174% and 673% [6] , respectively, the current study underscores the contribution that young patients are expected to play in the Fig. 2A -B Historical incidence of primary total hip arthroplasty (A) and primary total knee arthroplasty (B) from 1993-2006, superimposed with previous projections [6] , and the updated projections from the current study. The dotted lines represent the 95% CI for the projections.\n\n future utilization of primary TJR surgery, if historical trends in prevalence continue into the future. The statistical modeling approach we have employed in the current and previous study fits a multivariate but linear Poisson regression model to the historical prevalence of TJR procedures. However, because the size of the population subgroups is free to change nonlinearly in the future based on the Census Bureau's projection, the actual projected incidence of surgical demand is therefore not constrained to be a linear function over time. The demand for primary hip and knee arthroplasty between 2004 and 2006 generally exceeded our previous projections, which employed an identical methodology. However, we are unable to judge, based on the limited window of new data for validation, whether a more complex modeling approach would provide a more reliable forecast of demand for surgical procedures.\n\n Our previous methodology provided a reasonable shortterm forecast of the demand for revision hip and knee surgeries between 2004 and 2006. In particular, for 2006, we observed a slight decrease in the estimated number of primary THA and TKA procedures compared to 2005 (Fig. 2 ), but this decrease fell within the uncertainty of the estimates.", '23 In cases of splenic B-cell lymphomas that do not fulfill the World Health Organization 2008 criteria for better established or provisional entities, a diagnosis of splenic B-cell lymphoma/leukemia unclassifiable should be preferred.\n\n Differentiating SMZL from lymphoplasmacytic lymphoma (LPL) may be challenging, particularly on BM biopsy, because SMZL may show a monoclonal serum component and plasmacytic morphology, and both entities lack a distinct phenotype. LPL, which develops primarily in the spleen, homogeneously infiltrates the white pulp without MZ pattern and without monocytoid B cells. MYD88 L265P mutation, present in almost all cases of LPL and rare in SMZL, may be a useful diagnostic tool. 25 A further diagnostic pitfall may be represented by detection of a BM clonal infiltrate in cases of non-CLL monoclonal B lymphocytosis. 26 Finally, secondary splenic localization of EMZL presents a pattern that overlaps with that of SMZL, but clinical dissemination is crucial for differentiation. Splenic involvement virtually excludes a diagnosis of nodal MZL; apart from the differential expression of IRTA1, which is negative in SMZL, 11, 22 clinical correlation is critical for reaching a correct diagnosis when dealing with a BM biopsy.\n\n The cellular origin of SMZL is still debated, and its identification is essential to correctly classify this lymphoma and to elucidate its pathobiology. According to the World Health Organization classification, the postulated normal counterpart of SMZL is a B cell of unknown differentiation stage. 11 According to studies of Ig gene rearrangements, a derivation from antigen-experienced B cells has been postulated in the \n\n -, ,25% of cases; -/1, 25%-50% of cases; 1/-, 50%-75% of cases; 1, .75% of cases.\n\n FL, follicular lymphoma; NMZL, nodal marginal zone lymphoma; SDRPL, splenic diffuse red pulp lymphoma.\n\n *Sporadic cases reported.\n\n vast majority of SMZL. [27] [28] [29] Skewing of the Ig gene repertoire toward the use of the IGHV1-2*04 allele in SMZL suggests that they could derive from a progenitor population adapted in the spleen to particular antigenic challenges, although definitive answers on the issue of the cell of origin of SMZL will admittedly be provided only through multidisciplinary examination of the immune repertoire and transcriptome of normal B-cell populations of the spleen compartments.\n\n The contribution of antigen stimulation to SMZL pathogenesis is suggested by the highly restricted Ig gene repertoire, including stereotyped configuration of the B-cell receptor (BCR) in ;10% of cases 30 and selective usage of the Ig heavy chain variable IGHV1-2*04 allele in ;30%.\n\n 31 Although the epitope recognized by IGHV1-2*04-expressing BCR is unknown, the features of IGHV1-2*04 rearrangements, including minimal somatic mutations and the long complementarity-determining region 3 sequence with common motifs, suggest a possible selection of T-cell-independent MZ B cells by superantigens and thus a role of antigenic drive in lymphomagenesis.\n\n Cytogenetic and genetic lesions SMZL lacks recurrent chromosomal translocations, including translocations that are typical of other lymphoma types such as the t(14;18) translocation affecting BCL2 in follicular lymphoma, the t(11;14) translocation affecting CCND1 in MCL, and the t(11;18), t(14;18), and t(1;14) translocations affecting the BIRC3/MALT1, MALT1, and BCL10 genes, respectively, in EMZL. The lack of these abnormalities may help distinguish SMZL from pathologically mimicking tumors. Approximately 30% of SMZL show hemizygous 7q deletion, which is also frequently seen in splenic B-cell lymphoma/leukemia unclassifiable, but rarely in other lymphoma subtypes.\n\n 32,33 The gene(s) targeted by the 7q deletion remain obscure despite the combined investigation of genomic and transcriptomic profiles and mutation analysis of a number of candidate genes.\n\n Unbiased genomic studies have unraveled the typical coding genome of SMZL. [37] [38] [39] [40] [41] [42] [43] However, because of the limited number of SMZL genomes and/or exomes available so far, the full spectrum of lesions that contribute to the malignant transformation of SMZL remains unknown.', 'The chronic inflammation of rheumatoid arthritis mainly affects the synovial membranes of multiple joints and potentially involves vasculitis and pulmonary, ocular and cardiovascular systems. After the onset of the inflammation, the synovium changes dramatically (Edwards, 1998) . The synovial intima is filled with B-lymphocytes engaged in antibody production against unknown antigens (BlΓ€Γ, Engel, & Burmester, 1999) . Infiltrations of plasma cells into the synovia are highly associated with inflammation of rheumatoid arthritis (Dong, Li, Liu, & Zhu, 2009; Reparon-Schuijt et al., 1998) . The resulting immune complexes activate macrophages and complement and drive a T-cell dependent antibody production in the synovial tissue. The immune complexes are mainly rheumatoid factors that are defined as auto-antibodies against Fc-fragments of IgG (Tighe & Carson, 2001) and occur in about 90% of rheumatoid arthritis patients (DΓΆrner, Egerer, Feist, & Burmester, 2004) . Normally\n\n Rheumatoid arthritis is a desastrous progressive autoimmune disease for which no causative cure is available, simply because the eliciting antigens are unknown despite intesive research efforts. Most patients have also Rheumatiod factor activity where antibodies bind to their own structures within the constant region. Here we considered, wether mutations in the constant regions of immunoglobulins could represent the eliciting antigens.\n\n rheumatoid factors bind to an antibody-antigen complex and facilitate clearance by binding to Fcreceptors, fixation of complement and antigen processing by B-lymphocytes (Carson, Chen, & Kipps, 1991) . The rheumatoid factor binding site resides in CH 2 -CH 3 domain of Fc (Artandi, Calame, Morrison, & Bonagura, 1992; Bonagura et al., 1998; Sutton et al., 1998) . However, rheumatoid factors are also found in other conditions of B-cell hyperreactivity.\n\n The driving force for autoimmune diseases are self-reactive antibodies directed against "altered self" which can be modified proteins (Trouw, Huizinga, & Toes, 2013) . So far posttranslational modifications have been detected in citrullinated antigens that are highly specific for rheumatoid arthritis. Citrulline residues arise from arginine by peptidyl arginine deiminase. However, this posttranslational modification cannot fully explain the pathogenesis of rheumatoid arthritis (Klareskog, Amara, & MalmstrΓΆm, 2014) .\n\n Changes of IgG glycosylation in the IgG were also thought to be involved in rheumatoid arthritis (Parekh et al., 1985) , but recent studies showed that the glycosylation loci are not associated with rheumatoid arthritis (Yarwood et al., 2016) .\n\n Other modifications include oxidized IgG that are recognized by circulating lymphocytes leading to a proliferative response and secrete IL-2 (Grinnell, Yoshida, & Jasin, 2005) . IgG is also covalently cross linked by reactive oxygen and nitric oxide products secreted by inflammatory cells (Uesugi, Hayashi, & Jasin, 1998) .\n\n IgG has long been implicated in the pathogenesis of rheumatoid arthritis. When immune complexes from synovial fluids of patients with rheumatoid arthritis were analyzed for their constituents, mainly IgG and IgM antibodies were found (Male & Roitt, 1981) . They did not contain antibodies with rheumatoid factor specificity and a structural alteration of the IgG was considered as a cause for antigenicity (Carter, Makh, Ponsford, & Elson, 1989) . Sutton, Corper, Bonagura, and Taussig (2000) suggested that rheumatoid factors bind Fc-region and foreign antigen antigens simultaneously and the affinity is potentiated by somatic mutation. Indeed, Fc-binding antibodies from rheumatoid arthritis synovial fluids show imprints of an antigen-dependent process of somatic hypermutation and clonal selection in the variable regions of the L-and H-chains (Van Esch et al., 2003) . It is clear that the synovium of patients with rheumatoid arthritis is prone to mutations (Firestein, 2010) and several multi-evidence genes in genome wide studies have been identified (Whitaker et al., 2015) .',]query_embeddings = model.encode_query(queries)document_embeddings = model.encode_document(documents)print(query_embeddings.shape, document_embeddings.shape)# [1, 768] [3, 768]
# Get the similarity scores for the embeddingssimilarities = model.similarity(query_embeddings, document_embeddings)print(similarities)# tensor([[ 0.7784, -0.0542, 0.0875]])