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Copyright of Anaesthesiologie & Intensivmedizin is the property of DGAI e.V. - Deutsche Gesellschaft fur Anasthesiologie und Intensivmedizin e.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Although often viewed as detrimental, fluctuations carry valuable information about the physical system from which they emerge. Femtosecond noise correlation spectroscopy (FemNoC) has recently been established to probe the ultrafast fluctuation dynamics of thermally populated magnons by measurement of their amplitude autocorrelation. Subharmonic lock-in detection is the key technique in this method, allowing us to extract the pulse-to-pulse polarization fluctuations of two femtosecond optical pulse trains transmitted through a magnetic sample. Here, we present a thorough technical description of the subharmonic demodulation technique and the FemNoC measurement system. We mathematically model the data acquisition process and identify the essential parameters that critically influence the signal-to-noise ratio of the signals. Comparing the model calculations to real datasets allows validating the predicted parameter dependences and provides a means to optimize FemNoC experiments. [ABSTRACT FROM AUTHOR]

Copyright of Laboratory Animals is the property of Sage Publications, Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Owing to their high magnon frequencies, antiferromagnets are key materials for future high-speed spintronics. Picosecond switching of antiferromagnetic spin systems has been viewed a milestone for decades and pursued only by using ultrafast external perturbations. Here, we show that picosecond spin switching occurs spontaneously due to thermal fluctuations in the antiferromagnetic orthoferrite Sm0.7Er0.3FeO3. By analysing the correlation between the pulse-to-pulse polarisation fluctuations of two femtosecond optical probes, we extract the autocorrelation of incoherent magnon fluctuations. We observe a strong enhancement of the magnon fluctuation amplitude and the coherence time around the critical temperature of the spin reorientation transition. The spectrum shows two distinct features, one corresponding to the quasi-ferromagnetic mode and another one which has not been previously reported in pump-probe experiments. Comparison to a stochastic spin dynamics simulation reveals this new mode as smoking gun of ultrafast spontaneous spin switching within the double-well anisotropy potential. Antiferromagnets exhibit high frequency magnons, in the THz regime, a point potentially useful for applications, however, it has meant that detecting spin-fluctuations in antiferromagnets is typically too fast for current experimental approaches. Here Weiss et al use femtosecond noise correlation spectroscopy to observe magnon fluctuations in Sm0.7Er0.3FeO3. [ABSTRACT FROM AUTHOR]

Copyright of Medizinische Klinik: Intensivmedizin & Notfallmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In the spring and summer, high rates of primary production occur in the California Current Ecosystem (CCE) when nutrients are supplied to the euphotic zone. During periods of intense coastal upwelling, a flux of the micronutrient iron comes from nearshore sedimentary sources. In this upwelling region, mesoscale filament features distribute iron laterally, leading to distinct iron‐influenced ecological zones. This study is the first to focus on the biogeochemical links between iron, the macronutrients, and particulates in coastal upwelling filaments. Broad spatial patterns of iron and biogenic silica concentrations, and proxies of iron‐stress of diatoms, support results from microcosm amendment studies conducted during CCE Long Term Ecological Research process cruises in the summers of 2017 and 2019. We found that the benthic boundary layer and shoreward filament endmember supply dissolved and total dissolvable iron to this feature, but rapid assimilation and sinking by biogenic particles (e.g., diatoms) depletes the surface concentrations. Subsequently, diatom blooms which form in recently upwelled water masses become iron limited over time, thereby affecting the ratios of surface macronutrient reservoirs and biogeochemical advective fluxes. The development of Fe‐limitation during lateral advection may lead to efficient carbon export downstream and offshore of the region with the highest phytoplankton growth rates and productivity. Plain Language Summary: Along the western continental margin of the United States, seasonal upwelling filaments appear as fast‐flowing waters with high concentrations of nutrients (e.g., nitrate, silicic acid, iron) and phytoplankton. Diatoms dominate the phytoplankton communities in filaments, and they accumulate particulate matter as organic carbon and dense biogenic silica. During transport offshore, diatoms quickly deplete the surface of the critical micronutrient iron (Fe) and become Fe‐limited. Using shipboard incubation experiments, we show that Fe‐stressed diatom communities become more heavily silicified, and thus denser. Iron‐stress indicators consistently correspond with these phytoplankton community biochemical reconfigurations in two separate studies of filaments, thereby demonstrating a mechanism for enhanced diatom community export out of the surface ocean in later stages of filaments. Key Points: Upwelling filaments become Fe‐limited features in the ocean, as sinking diatoms deplete surface dFe concentrations and are advected offshoreIron‐limitation of diatom blooms is evidenced by in situ geochemical proxies (e.g., negative Siex) and deckboard Fe amendment experimentsGreater biogenic silica‐to‐particulate organic carbon ratios among diatom communities make filaments hotspots of particulate matter export [ABSTRACT FROM AUTHOR]

Antisynthease syndrome (ASSD) is a rare, complex and understudied autoimmune disease. Internet-based studies can overcome barriers of traditional on-site research and are therefore very appealing for rare diseases. The aim of this study was to investigate patient-reported symptoms, diagnostic delay, symptoms, medical care, health status, working status, disease knowledge and willingness to participate in research of ASSD patients by conducting an international web-based survey. The multilingual questionnaire was created by an international group of rheumatologists and patients and distributed online. 236 participants from 22 countries completed the survey. 184/236 (78.0%) were female, mean age (SD) was 49.6 years (11.3) and most common antisynthetase antibody was Jo-1 (169/236, 71.6%). 79/236 (33.5%) reported to work full-time. Median diagnostic delay was one year. The most common symptom at disease onset was fatigue 159/236 (67.4%), followed by myalgia 130/236 (55.1%). The complete triad of myositis, arthritis and lung involvement verified by a clinician was present in 42/236 (17.8%) at disease onset and in 88/236 (37.3%) during the disease course. 36/236 (15.3%) reported to have been diagnosed with fibromyalgia and 40/236 (16.3%) with depression. The most reported immunosuppressive treatments were oral corticosteroids 179/236 (75.9%), followed by rituximab 85/236 (36.0%). 73/236 (30.9%) had received physiotherapy treatment. 71/236 (30.1%) reported to know useful online information sources related to ASSD. 223/236 (94.5%) were willing to share health data for research purposes once a year. Our results reiterate that internet-based research is invaluable for cooperating with patients to foster knowledge in rare diseases. [ABSTRACT FROM AUTHOR]

Background: Physical functioning is a crucial factor for independence and quality of life in old age. The aim of the "bestform—Best function of range of motion" trial is to investigate the effects of a 6 months multimodal machine-based strength, coordination and endurance training on physical function, risk of falls and health parameters in older adults. Methods: Bestform is a cluster-randomised trial including older adults ≥ 65 years living in senior care facilities in Southern Germany. Senior care facilities are randomly allocated to the control group with usual care (n ≥ 10 care facilities) and to the intervention group (n ≥ 10 care facilities), overall including ≥ 400 seniors. Residents belonging to the intervention group are offered a supervised machine-based exercise training programme twice weekly over 45–60 min over six months in small groups, while those in the usual care facilities will not receive active intervention. The primary outcome is the change in Short Physical Performance Battery over six months between groups. Secondary outcomes are change in risk of falling, fear of falling, number of falls and fall-related injuries, physical exercise capacity, handgrip strength, body composition, cardiac function, blood parameters, quality of life, risk of sarcopenia, activities of daily living, and cognition over three and six months. Discussion: The bestform study investigates the change in physical function between seniors performing exercise intervention versus usual care over six months. The results of the study will contribute to the development of effective physical activity concepts in senior care facilities. Trial registration: ClinicalTrials.gov: NCT04207307. Registered December 2019. [ABSTRACT FROM AUTHOR]

Copyright of Forensische Psychiatrie, Psychologie, Kriminologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Fifty-one (61.5%) patients had a single suspect drug, 30 (30.6%) had >=2 drugs, and 2 (2.4%) had none. Dear Editor, Acute generalized exanthematous pustulosis (AGEP) is a cutaneous adverse drug reaction characterized by acute sterile, non-follicular pustules with flexural reinforcement and a short time to onset (TTO) of the reaction.[[1]] The most frequently incriminated drugs are antibiotics, terbinafine, hydroxychloroquine and diltiazem.[3] Systemic involvement has been described.[4] The main differential diagnosis is pustular psoriasis. Twenty-eight patients, including 12 with >=2 suspect drugs, underwent allergological testing (patch tests and intradermal tests in all, drug provocation tests in 13 cases). [Extracted from the article]

Venetoclax based combination therapy does not overcome poor outcomes in BTKi-refractory mantle cell lymphoma: phase 2 trial of umbralisib, ublituximab, and venetoclax Cellular therapies should be prioritized for these patients for whom there is a critical ongoing need for novel treatment options. B Introduction: b Novel agents such as the Bruton's tyrosine kinase inhibitors (BTKi) have improved care for patients with mantle cell lymphoma (MCL), yet progression during BTKi is associated with poor outcomes. [Extracted from the article]

The Earned Income Tax Credit (EITC) provides substantial financial support to low-income workers in the USA, yet around a quarter of EITC payments are estimated to be erroneous or fraudulent. Beginning in 2017, the Protecting Americans from Tax Hikes Act of 2015 requires the Internal Revenue Service to spend additional time processing early EITC claims, delaying the issuance of tax refunds. Leveraging unique data, this paper investigates how delayed tax refunds affected the experience of hardship and unsecured debt among EITC recipients. Results indicate that early filers experienced increased food insecurity relative to later filers after the implementation of the refund delay. [ABSTRACT FROM AUTHOR]

Transition metal diboride-based thin films are promising candidates to replace state-of-the-art protective and functional coating materials due to their unique properties. Here, we focus on hexagonal WB2-z, showing that the AlB2 structure is stabilized by B vacancies exhibiting its energetic minima at sub-stoichiometric WB1.5. Nanoindentation reveals super-hardness of 0001 oriented α-WB2-z coatings, linearly decreasing by more than 15 GPa with predominant 10 1 ¯ 1 orientation. This anisotropy is attributed to differences in the generalized stacking fault energy of basal and pyramidal slip systems, highlighting the feasibility of tuning mechanical properties by crystallographic orientation relations. First report of an anisotropic elastoplastic behaviour in super-hard PVD AlB2 structured WB2-z. Theoretical and experimental verification of thermodynamically most stable sub-stoichiometric α-WB2-z coatings by structural and mechanical analysis. [ABSTRACT FROM AUTHOR]

We report an improved fabrication scheme for carbon based nanospintronic devices and demonstrate the necessity for a careful data analysis to investigate the fundamental physical mechanisms leading to magnetoresistance. The processing with a low-density polymer and an optimised recipe allows us to improve the electrical, magnetic, and structural quality of ferromagnetic Permalloy contacts on lateral carbon nanotube (CNT) quantum dot spin valve devices, with comparable results for thermal and sputter deposition of the material. We show that spintronic nanostructures require an extended data analysis, since the magnetization can affect all characteristic parameters of the conductance features and lead to seemingly anomalous spin transport. In addition, we report measurements on CNT quantum dot spin valves that seem not to be compatible with the orthodox theories for spin transport in such structures. [ABSTRACT FROM AUTHOR]

The present study examines the bending behavior of coarse and fine-grained AZ31 magnesium alloy. The corresponding deformation mechanisms are ascertained via tensile, compression, and bending tests in combination with digital image correlation and electron backscatter diffraction. It is shown that grain refinement from 60 μm to 3 μm significantly improves tensile ductility, while forming limits in compression and bending show no obvious effect of grain size. Analysis of the microstructure revealed a high density of twin bands in the compression zones of the bent samples. Interestingly, the fine-grained material experienced failure in the compression zone. The fracture strain in bending appears limited by the material ductility in both tension and compression. The outcome of this study is that in magnesium alloys grain refinement may not always be an effective method for the improvement of ductility, particularly when bending of the type considered here is dominant. [ABSTRACT FROM AUTHOR]

Surgical treatment of lymphedema with liposuction typically requires subsequent compression therapy. Here we describe an approach where secondary arm lymphedemas are initially treated by autologous lymphatic grafting to bypass the axilla and restore lymphatic flow. In the presence of excess adipose tissue, liposuction is then performed in a second procedure. To assess outcomes, the authors evaluated 28 consecutive adult patients who had undergone secondary liposuction following lymphatic grafting. Arm volumes were measured prior to lymphatic grafting and after the secondary liposuction. The necessity for additional treatment by compression garment and manual lymphatic drainage was assessed prior to lymphatic grafting and after the secondary liposuction following the direct postoperative regimen. The mean arm volumes were reduced significantly (p<0.001) from a mean of 3417±171 (SEM) cm³ prior to lymphatic grafting to 3020±125 cm³ after reconstruction of the lymphatic vascular system and finally to 2516±104 cm³ after the secondary liposuction (SLS). All 28 adult patients underwent continuous compression and manual lymph-drainage (MLD) prior to the reconstructive surgery. All 28 patients were evaluated regarding necessity of any additional therapy more than 6 months after SLS with a median follow up period of 37 months (range, 7-160 months). 18 of 28 patients did not require any supportive therapy beyond 6 months after SLS to maintain the results. Three patients continued to utilize manual lymphatic drainage, 4 used a combination of MLD and compression therapy and 3 used elastic compression therapy (one patient only while at work). These results indicate that microsurgical restoration of lymphatic outflow followed by SLS eliminates the need for additional treatment in more than two thirds of patients. [ABSTRACT FROM AUTHOR]

Copyright of British Journal of Surgery is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Syringe infusion pumps are used for the administration of short-acting drugs in anaesthesia and critical care medicine, but are prone to flow irregularities at low flow rates. A flow-controlled syringe infusion pump using an integrated flow sensor for feedback control represents a new approach to overcoming these limitations. This study compares the performance of a prototype flow-controlled syringe pump both at start-up, and during vertical displacement manoeuvres, with that of a standard infusion syringe pump. The novel pump almost completely eliminated delays at start-up and flow irregularities during hydrostatic pressure changes. Related fluctuations in plasma drug concentration were minimised and the known disadvantages of standard syringe infusion pumps currently used in clinical practice were reduced. Besides providing fast start-up to steady-state flow and precise continuous drug delivery at low flow rates during hydrostatic pressure changes, the new pump offers the potential for the development of target-controlled infusion algorithms for short-acting cardiovascular and other drugs. [ABSTRACT FROM AUTHOR]

Copyright of Best Practice Onkologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: This article investigates the qualities and thermal effects of a novel electrosurgical device (PT) which has been designed by ERBE Elektromedizin GmbH, Germany, for the preparation of critical locations such as in skin-sparing or nipple-sparing techniques and compares it to a standard device (SD) in a porcine ex vivo breast model using an heat map generated by infrared thermography.Methods: In total, 42 abdominal wall specimens of porcine tissue consisting of the skin and the underlying subcutaneous and muscle layer were alternately dissected using one of the devices and pre-settings. During the preparation with the two devices, the epicutaneous temperature was measured by an infrared camera (VarioCam, Jenoptik, Germany) and the maximum temperature as well as the slope of the temperature rise was analysed.Results: The use of PT shows significantly lower values for [Formula: see text] compared to SD. This effect was independent from the chosen mode. Using the same instrument in different modes, the use of AutoCut mode showed a significant reduction of [Formula: see text] at all indicated time points (SD: p < 0.0001 and PT: p < 0.0001). In summary, the combination of AutoCut + PT showed the lowest rise in temperature, whereas the combination of DryCut + SD led to the highest rise in temperature. The temperature difference between these two settings was 13.84 °C, which means a possible temperature reduction of 67% can be achieved by the right choice of device and its tailored mode.Conclusions: The novel PT shows a significant reduction in epicutaneous temperature and a significant reduction of the slope of temperature rise most probably by a more focused application of energy compared to SD. [ABSTRACT FROM AUTHOR]

Summary: The advent of environmental O2 about 2.5 billion years ago forced microbes to metabolically adapt and to develop mechanisms for O2 sensing. Sensing of O2 by [4Fe–4S]2+ to [2Fe–2S]2+ cluster conversion represents an ancient mechanism that is used by FNREc (Escherichia coli), FNRBs (Bacillus subtilis), NreBSa (Staphylococcus aureus) and WhiB3Mt (Mycobacterium tuberculosis). The phylogenetic relationship of these sensors was investigated. FNREc homologues are restricted to the proteobacteria and a few representatives from other phyla. Homologues of FNRBs and NreBSa are located within the bacilli, of WhiB3 within the actinobacteria. Archaea contain no homologues. The data reveal no similarity between the FNREc, FNRBs, NreBSa and WhiB3 sensor families on the sequence and structural levels. These O2 sensor families arose independently in phyla that were already present at the time O2 appeared, their members were subsequently distributed by lateral gene transfer. The chemistry of [4Fe–4S] and [2Fe–2S] cluster formation and interconversion appears to be shared by the sensor protein families. The type of signal output is, however, family specific. The homologues of FNREc and NreBSa vary with regard to the number of Cys residues that coordinate the cluster. It is suggested that the variants derive from lateral gene transfer and gained other functions. [ABSTRACT FROM AUTHOR]

Graft-versus-host disease (GVHD) is an immunological reaction, frequently complicating allogeneic hemopoietic stem cell transplantation, that can involve many organs with a wide range of clinical presentations. We report the case of a dramatic improvement of sclerodermatous cGVHD in a 28-year-old patient after 8 weeks of daily low-dose subcutaneous interleukine-2 treatment. 1b). low-dose interleukine-2 treatment gradually improved skin sclerosis (one-third improvement at 3 months, half improvement at 6 months and complete resolution of skin symptoms at 1 year). [Extracted from the article]

Background: Paediatric emergency tapes provide drug dosing based on the patient's estimated body weight. Unfortunately, published data revealed an unsatisfactory accuracy. A newly developed digital algorithm for weight estimation (CLAWAR) allowing a three-staged habitus adaptation (normal, obese, or cachectic; CLAWAR-3) demonstrated a higher accuracy for weight estimation compared to paediatric emergency tapes. However, the incidence of incorrectly evaluated habitus was 27%. A five-staged habitus adaptation with figural images was suggested by Wells et al to improve habitus and weight estimation. Therefore, CLAWAR was modified with five habitus stages including figural images (CLAWAR-5). We hypothized CLAWAR-5 improves the accuracy of weight estimation.Methods: After obtaining informed written parental consent patients were included in this single centre, prospective clinical observation trial. Body weight estimations by CLAWAR-3 and CLAWAR-5 within ±10% of the actual body weight were compared. Furthermore, the incidence of correct evaluated habitus was calculated. McNemar Tests were used for statistical analysis. Results presented as median (interquartiles), P < .003 considered significant.Results: In total, 312 patients aged 3.3 years (0.7-6.6), with a body length of 95.9 cm (70.0-121.2), weighing 14.8 kg (8.1-22.5), were included. Both CLAWAR-3 and CLAWAR-5 showed equivalent accuracy for weight estimation within the ±10% interval (62.2% vs 60.6%, P = .609). Despite adding figural images, the incidence of correct evaluated habitus with CLAWAR-5 (46.8%) was worse than with CLAWAR-3 (66.7%).Conclusion: The five-staged habitus-adapted method could not improve the accuracy of weight estimation. Furthermore, the error rate of habitus classification was not reduced by the implementation of figural images. [ABSTRACT FROM AUTHOR]

Copyright of Anaesthesist is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: This study sought to develop a clinical risk score for resectable colorectal liver metastasis (CRLM) by combining clinicopathological and clinically available biological indicators, including KRAS. Methods: A cohort of patients who underwent resection for CRLM at the Johns Hopkins Hospital (JHH) was analysed to identify independent predictors of overall survival (OS) that can be assessed before operation; these factors were combined into the Genetic And Morphological Evaluation (GAME) score. The score was compared with the current standard (Fong score) and validated in an external cohort of patients from the Memorial Sloan Kettering Cancer Center (MSKCC). Results: Six preoperative predictors of worse OS were identified on multivariable Cox regression analysis in the JHH cohort (502 patients). The GAME score was calculated by allocating points to each patient according to the presence of these predictive factors: KRAS‐mutated tumours (1 point); carcinoembryonic antigen level 20 ng/ml or more (1 point), primary tumour lymph node metastasis (1 point); Tumour Burden Score between 3 and 8 (1 point) or 9 and over (2 points); and extrahepatic disease (2 points). The high‐risk group in the JHH cohort (GAME score at least 4 points) had a 5‐year OS rate of 11 per cent, compared with 73·4 per cent for those in the low‐risk group (score 0–1 point). Importantly, in cohorts from both the JHH and MSKCC (747 patients), the discriminatory capacity of the GAME score was superior to that of the Fong score, as demonstrated by the C‐index and the Akaike information criterion. Conclusion: The GAME score is a preoperative prognostic tool that can be used to inform treatment selection. [ABSTRACT FROM AUTHOR]

Spirometric monitoring provides precise measurement and delivery of tidal volumes within a narrow range, which is essential for lung-protective strategies that aim to reduce morbidity and mortality in mechanically-ventilated patients. Conventional anaesthesia ventilators include inbuilt spirometry to monitor inspiratory and expiratory tidal volumes. The GE Aisys CS² anaesthesia ventilator allows additional near-patient spirometry via a sensor interposed between the proximal end of the tracheal tube and the respiratory tubing. Near-patient and inbuilt spirometry of two different GE Aisys CS² anaesthesia ventilators were compared in an in-vitro study. Assessments were made of accuracy and variability in inspiratory and expiratory tidal volume measurements during ventilation of six simulated paediatric lung models using the ASL 5000 test lung. A total of 9240 breaths were recorded and analysed. Differences between inspiratory tidal volumes measured with near-patient and inbuilt spirometry were most significant in the newborn setting (p < 0.001), and became less significant with increasing age and weight. During expiration, tidal volume measurements with near-patient spirometry were consistently more accurate than with inbuilt spirometry for all lung models (p < 0.001). Overall, the variability in measured tidal volumes decreased with increasing tidal volumes, and was smaller with near-patient than with inbuilt spirometry. The variability in measured tidal volumes was higher during expiration, especially with inbuilt spirometry. In conclusion, the present in-vitro study shows that measurements with near-patient spirometry are more accurate and less variable than with inbuilt spirometry. Differences between measurement methods were most significant in the smallest patients. We therefore recommend near-patient spirometry, especially for neonatal and paediatric patients. [ABSTRACT FROM AUTHOR]

Background: The objective of this study was to investigate the characteristics, treatment and prognosis of early versus late recurrence of intrahepatic cholangiocarcinoma (ICC) after hepatic resection. Methods: Patients who underwent resection with curative intent for ICC were identified from a multi‐institutional database. Data on clinicopathological characteristics, initial operative details, timing and sites of recurrence, recurrence management and long‐term outcomes were analysed. Results: A total of 933 patients were included. With a median follow‐up of 22 months, 685 patients (73·4 per cent) experienced recurrence of ICC; 406 of these (59·3 per cent) developed only intrahepatic disease recurrence. The optimal cutoff value to differentiate early (540 patients, 78·8 per cent) versus late (145, 21·2 per cent) recurrence was defined as 24 months. Patients with early recurrence had extrahepatic disease more often (44·1 per cent versus 28·3 per cent in those with late recurrence; P < 0·001), whereas late recurrence was more often only intrahepatic (71·7 per cent versus 55·9 per cent for early recurrence; P < 0·001). From time of recurrence, overall survival was worse among patients who had early versus late recurrence (median 10 versus 18 months respectively; P = 0·029). In multivariable analysis, tumour characteristics including tumour size, number of lesions and satellite lesions were associated with an increased risk of early intrahepatic recurrence. In contrast, only the presence of liver cirrhosis was independently associated with an increased likelihood of late intrahepatic recurrence (hazard ratio 1·99, 95 per cent c.i. 1·11 to 3·56; P = 0·019). Conclusion: Early and late recurrence after curative resection for ICC are associated with different risk factors and prognosis. Data on the timing of recurrence may inform decisions about the degree of postoperative surveillance, as well as help counsel patients with regard to their risk of recurrence. [ABSTRACT FROM AUTHOR]

Background: The role of routine lymph node dissection (LND) in the surgical treatment of intrahepatic cholangiocarcinoma (ICC) remains controversial. The objective of this study was to investigate the trends of LND use in the surgical treatment of ICC. Methods: Patients undergoing curative intent resection for ICC in 2000–2015 were identified from an international multi‐institutional database. Use of lymphadenectomy was evaluated over time and by geographical region (West versus East); LND use and final nodal status were analysed relative to AJCC T categories. Results: Among the 1084 patients identified, half (535, 49·4 per cent) underwent concomitant hepatic resection and LND. Between 2000 and 2015, the proportion of patients undergoing LND for ICC nearly doubled: 44·4 per cent in 2000 versus 81·5 per cent in 2015 (P < 0·001). Use of LND increased over time among both Eastern and Western centres. The odds of LND was associated with the time period of surgery and the extent of the tumour/T status (referent T1a: OR 2·43 for T2, P = 0·001; OR 2·13 for T3, P = 0·016). Among the 535 patients who had LND, lymph node metastasis (LNM) was noted in 209 (39·1 per cent). Specifically, the incidence of LNM was 24 per cent in T1a disease, 22 per cent in T1b, 42·9 per cent in T2, 48 per cent in T3 and 66 per cent in T4 (P < 0·001). AJCC T3 and T4 categories, harvesting of six or more lymph nodes, and presence of satellite lesions were independently associated with LNM. Conclusion: The rate of LNM was high across all T categories, with one in five patients with T1 disease having nodal metastasis. The trend in increased use of LND suggests a growing adoption of AJCC recommendations in the treatment of ICC. [ABSTRACT FROM AUTHOR]

A study of preferable deformation modes on strain path and strain level in a TWIP steel sheet was performed. Different strain paths were obtained by stretch forming of specimens with various shapes and tensile tests. TEM analysis was performed on samples cut from various locations in the deformed specimens, which had different strain paths and strain levels and the preferable deformation modes were identified. Stresses caused by various strain paths were considered and an analytical analysis performed to identify the preferable deformation modes for the case of single crystal. For a single crystal, in assumption of the absence of lattice rotation, the strain path and the level of accumulated equivalent strain define the preferable deformation mode. For a polycrystalline material, such analytical analysis is not possible due to the large number of grains and, therefore, numerical simulation was employed. For the polycrystalline material, the role of strain path diminishes due to the presence of a large number of grains with random orientations and the effect of accumulated strain becomes dominant. However, at small strains the strain path still defines the level of twinning activity. TEM analysis experimentally confirmed that various deformation modes lead to different deformation strengthening mechanisms. [ABSTRACT FROM AUTHOR]

Objective: Exposure therapy is an effective treatment for posttraumatic stress disorder (PTSD), but a comprehensive, emotion-focused perspective on how psychotherapy affects brain function is lacking. The authors assessed changes in brain function after prolonged exposure therapy across three emotional reactivity and regulation paradigms.Method: Individuals with PTSD underwent functional MRI (fMRI) at rest and while completing three tasks assessing emotional reactivity and regulation. Individuals were then randomly assigned to immediate prolonged exposure treatment (N=36) or a waiting list condition (N=30) and underwent a second scan approximately 4 weeks after the last treatment session or a comparable waiting period, respectively.Results: Treatment-specific changes were observed only during cognitive reappraisal of negative images. Psychotherapy increased lateral frontopolar cortex activity and connectivity with the ventromedial prefrontal cortex/ventral striatum. Greater increases in frontopolar activation were associated with improvement in hyperarousal symptoms and psychological well-being. The frontopolar cortex also displayed a greater variety of temporal resting-state signal pattern changes after treatment. Concurrent transcranial magnetic stimulation and fMRI in healthy participants demonstrated that the lateral frontopolar cortex exerts downstream influence on the ventromedial prefrontal cortex/ventral striatum.Conclusions: Changes in frontopolar function during deliberate regulation of negative affect is one key mechanism of adaptive psychotherapeutic change in PTSD. Given that frontopolar connectivity with ventromedial regions during emotion regulation is enhanced by psychotherapy and that the frontopolar cortex exerts downstream influence on ventromedial regions in healthy individuals, these findings inform a novel conceptualization of how psychotherapy works, and they identify a promising target for stimulation-based therapeutics. [ABSTRACT FROM AUTHOR]

Objective: Exposure therapy is an effective treatment for posttraumatic stress disorder (PTSD), but many patients do not respond. Brain functions governing treatment outcome are not well characterized. The authors examined brain systems relevant to emotional reactivity and regulation, constructs that are thought to be central to PTSD and exposure therapy effects, to identify the functional traits of individuals most likely to benefit from treatment.Method: Individuals with PTSD underwent functional MRI (fMRI) while completing three tasks assessing emotional reactivity and regulation. Participants were then randomly assigned to immediate prolonged exposure treatment (N=36) or a waiting list condition (N=30). A random subset of the prolonged exposure group (N=17) underwent single-pulse transcranial magnetic stimulation (TMS) concurrent with fMRI to examine whether predictive activation patterns reflect causal influence within circuits. Linear mixed-effects modeling in line with the intent-to-treat principle was used to examine how baseline brain function moderated the effect of treatment on PTSD symptoms.Results: At baseline, individuals with larger treatment-related symptom reductions (compared with the waiting list condition) demonstrated 1) greater dorsal prefrontal activation and 2) less left amygdala activation, both during emotion reactivity; 3) better inhibition of the left amygdala induced by single TMS pulses to the right dorsolateral prefrontal cortex; and 4) greater ventromedial prefrontal/ventral striatal activation during emotional conflict regulation. Reappraisal-related activation was not a significant moderator of the treatment effect.Conclusions: Capacity to benefit from prolonged exposure in PTSD is gated by the degree to which prefrontal resources are spontaneously engaged when superficially processing threat and adaptively mitigating emotional interference, but not when deliberately reducing negative emotionality. [ABSTRACT FROM AUTHOR]

Objective: Gestational diabetes mellitus (GDM) potentially harms the child before birth. We previously found GDM to be associated with developmental changes in the central nervous system. We now hypothesise that GDM may also impact on the fetal autonomic nervous system under metabolic stress like an oral glucose tolerance test (OGTT).Design: We measured heart rate variability (HRV) of mothers and fetuses during a three-point OGTT using fetal magnetocardiography (fMCG).Setting: Measurements were performed in the fMEG Centre in Tübingen.Population: After exclusion of 23 participants, 13 pregnant women with GDM and 36 pregnant women with normal glucose tolerance were examined.Methods: All women underwent the same examination setting with OGTT during which fMCG was recorded three times.Main Outcome Measure(s): Parameters of heart rate variability were measured.Results: Compared with mothers with normal glucose regulation, mothers with GDM showed increased heart rate but no significant differences of maternal HRV. In contrast, HRV in fetuses of mothers with GDM differed from those in the metabolically healthy group regarding standard deviation normal to normal beat (SDNN) (P = 0.012), low-frequency band (P = 0.008) and high-frequency band (P = 0.031). These HRV parameters exhibit a decrease only in GDM fetuses during the second hour of the OGTT.Conclusions: These results show an altered response of the fetal autonomic nervous system to metabolic stress in GDM-complicated pregnancies. Hence, disturbances in maternal glucose metabolism might not only impact on the central nervous system of the fetus but may also affect the fetal autonomic nervous system.Tweetable Abstract: Metabolic stress reveals a different response of fetal autonomic nervous system in GDM-complicated pregnancies. [ABSTRACT FROM AUTHOR]

The article discusses research on arterial to end-tidal carbon dioxide difference in children undergoing mechanical ventilation of the lungs during general anesthesia with tracheal lung intubation and insertion of in-dwelling arterial cannula for blood gas analysis. The study analyzed arterial to end-tidal carbon dioxide differences in using spirometry and side-stream capnography and determined patients' age, weight, physical status, cardiac abnormalities, cardiovascular and pulmonary diseases.

An individual's ecological environment affects their mortality risk, which in turn has fundamental consequences for life-history evolution. In many species, social relationships are likely to be an important component of an individual's environment, and therefore their mortality risk. Here, we examine the relationship between social position and mortality risk in resident killer whales (Orcinus orca) using over three decades of social and demographic data. We find that the social position of male, but not female, killer whales in their social unit predicts their mortality risk. More socially integrated males have a significantly lower risk of mortality than socially peripheral males, particularly in years of low prey abundance, suggesting that social position mediates access to resources. Male killer whales are larger and require more resources than females, increasing their vulnerability to starvation in years of low salmon abundance. More socially integrated males are likely to have better access to social information and food-sharing opportunities which may enhance their survival in years of low salmon abundance. Our results show that observable variation in the social environment is linked to variation in mortality risk, and highlight howsex differences in social effects on survival may be linked to sex differences in life-history evolution. [ABSTRACT FROM AUTHOR]