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Background: The relation between operative time and postoperative complications in liver surgery is unclear. The aim of this study is to assess the impact of operative time on the development of postoperative complications in patients who underwent minimally invasive or open liver resections of various anatomical extent and technical difficulty levels. Methods: In this retrospective cohort study, patients that underwent a right hemihepatectomy (RH), technically major resection (anatomically minor resection in segment 1, 4a, 7 or 8; TMR) or left lateral sectionectomy (LLS) between 2000 and 2022 were extracted from a multicenter database comprising the prospectively maintained databases of 31 centers in 13 countries. Minimally invasive procedures performed during the learning curve were omitted. Logistic regression models, performed separately for 9 different groups based on stratification by procedure type and allocated surgical approach, were used to assess the association between the fourth quartile of operative time (25% of patients with the longest operative time) and postoperative complications. Results: Overall, 5424 patients were included: 1351 underwent RH (865 open, 373 laparoscopic and 113 robotic), 2821 TMR (1398 open, 1225 laparoscopic and 198 robotic), and 1252 LLS (241 open, 822 laparoscopic and 189 robotic). After adjusting for potential confounders (age, BMI, gender, ASA grade, previous abdominal surgery, disease type and extent, blood loss, Pringle, intraoperative transfusions and incidents), the fourth quartile of operative time, compared to the first three quartiles, was associated with an increased risk of postoperative complications after open, laparoscopic and robotic TMR (aOR 1.35, p= 0.031; aOR 1.74, p= 0.001 and aOR 3.11, p= 0.014, respectively), laparoscopic and robotic RH (aOR 1.98, p= 0.018 and aOR 3.28, p= 0.055, respectively) and solely laparoscopic LLS (aOR 1.69, p= 0.019). Conclusions: A prolonged operative time is associated with an increased risk of postoperative complications, although it remains to be defined if this is a causal relationship.

Iatrogenic bile duct injury (BDI) during cholecystectomy is associated with a complex and heterogeneous management owing to the burden of morbidity until their definitive treatment. This study aimed to define the textbook outcomes (TOs) after BDI with the purpose to indicate the ideal treatment and to improve it management.

Aquaporin-4-IgG positive neuromyelitis optica spectrum disorder (AQP4+NMOSD) and myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD) are antibody-associated diseases targeting astrocytes and oligodendrocytes, respectively. Their recognition as distinct entities has led to each having its own diagnostic criteria that require a combination of clinical, serologic, and MRI features. The therapeutic approach to acute attacks in AQP4+NMOSD and MOGAD is similar. There is now class 1 evidence to support attack-prevention medications for AQP4+NMOSD. MOGAD lacks proven treatments although clinical trials are now underway. In this review, we will outline similarities and differences between AQP4+NMOSD and MOGAD in terms of diagnosis and treatment.

IntroductionLimited data exist on brain MRI enhancement in myelin-oligodendrocyte-glycoprotein (MOG) antibody-associated disease (MOGAD) and differences from aquaporin-4-IgG-positive-neuromyelitis-optica-spectrum-disorder (AQP4+NMOSD), and multiple sclerosis (MS).MethodsIn this retrospective observational study, we identified 122 Mayo Clinic MOGAD patients (1 January 1996–1 July 2020) with cerebral attacks. We explored enhancement patterns using a discovery set (n=41). We assessed enhancement frequency and Expanded Disability Status Scale scores at nadir and follow-up in the remainder (n=81). Two raters assessed T1-weighted-postgadolinium MRIs (1.5T/3T) for enhancement patterns in MOGAD, AQP4+NMOSD (n=14) and MS (n=26). Inter-rater agreement was assessed. Leptomeningeal enhancement clinical correlates were analysed.ResultsEnhancement occurred in 59/81 (73%) MOGAD cerebral attacks but did not influence outcome. Enhancement was often patchy/heterogeneous in MOGAD (33/59 (56%)), AQP4+NMOSD (9/14 (64%); p=0.57) and MS (16/26 (62%); p=0.63). Leptomeningeal enhancement favoured MOGAD (27/59 (46%)) over AQP4+NMOSD (1/14 (7%); p=0.01) and MS (1/26 (4%); p<0.001) with headache, fever and seizures frequent clinical correlates. Ring enhancement favoured MS (8/26 (31%); p=0.006) over MOGAD (4/59 (7%)). Linear ependymal enhancement was unique to AQP4+NMOSD (2/14 (14%)) and persistent enhancement (>3 months) was rare (0%–8%) across all groups. Inter-rater agreement for enhancement patterns was moderate.ConclusionsEnhancement is common with MOGAD cerebral attacks and often has a non-specific patchy appearance and rarely persists beyond 3 months. Leptomeningeal enhancement favours MOGAD over AQP4+NMOSD and MS.

Flow-through reactors made of highly porous hierarchical micro/meso/macroporous carbon monoliths (CM) were developed to decontaminate water containing pharmaceutical micropollutants (antibiotics). CM were prepared from hierarchical meso/macroporous silica monoliths as sacrificial templates after impregnation with sucrose as a carbon precursor, hydrothermal carbonization, and subsequent pyrolysis and dissolution of silica by NaOH. CM were fully characterized by nitrogen sorption at 77 K, Hg porosimetry, scanning electron microscopy, transmission electron microscopy, microtomography, permeability measurements, X-ray photoelectron spectroscopy, and chemical analysis. CM exhibit a large surface area (1058 m2g–1), a large pore volume (6.5 mL g–1), high permeability, a homogeneous interconnected macropore network (22 μm), bimodal mesopores (6 and 15 nm), micropores (0.85 nm), and a large number of C═O and COO–groups. They are basic in water (pH 9) and negatively charged. First, adsorption of a single pharmaceutical molecule, tetracycline (TC), was studied. Isotherms of adsorption, kinetics, and diffusion were used to study the mechanism of adsorption on CM, and the process was found to be governed by electrostatic interactions. Then, a mixture of several antibiotics (ciprofloxacin, amoxicillin, sulfamethoxazole, and TC, 20 mg L–1each) was used. The sorption capacity for antibiotics peaked at 815 mg g–1. In a recirculation flow configuration, with a flow rate of 1 mL min–1, CM could remove 93% of the antibiotics. These CM could represent a highly efficient solution for the purification of real wastewater containing pharmaceutical molecules, which are generally found at much lower concentrations (from a few nanograms per liter to micrograms per liter). Regeneration of CM was successfully achieved by washing with HCl (0.1 M).

Aim: This systematic review analysed morbidity and mortality related to the type of technique used to insert gastrojejunal feeding devices in children. Materials and methods: The Healthcare Database Advanced Search, Cochrane and Medline databases were used. PRISMA guidelines were followed by two independent reviewers. Non-English language, mixed report of more of one technique and adult population studies were excluded. Results: Twenty-three papers were selected; overall, 648 patients underwent jejunal tube insertion: 287 received percutaneous gastrojejunal tube (PEG-J), 140 underwent Laparoscopic-Assisted Jejunostomy (LAJ) and 221 received an open surgical jejunostomy (OSJ). Main indications for jejunal feeds were: neurological impairment (NI), inability in establishing gastric feeds, recurrent aspiration pneumonia, severe Gastroesophageal Reflux Disease, and failed fundoplication. 71.5% of patients experienced minor tube-related complications (misplacement, dislodgment, coiling, and breakage). Major complications were volvulus, bowel obstruction and intussusception accounting, respectively, for 7.2% amongst the PEG-J population, 7.6% amongst the LAJ and 10.7% in between the OSJ population. Mortality related to PEG-J placement was 9.3%, in comparison to the LAJ accounting for 14.6% and 7.8% amongst the OSJ group. Conclusion: Mortality and morbidity rate following gastrojejunal feeding tube insertion remains high despite the type of surgical technique used. Careful patient selection, accurate family counselling and multidisciplinary evaluation at decision-making time, is pivotal when considering this enteral feeding route. A clear standardised pathway, also establishing a patient’s inclusion criteria for a more radical approach (such as the Total Esophagogastric Disconnection), should be implemented to improve patient’s quality of life and career’s quality of assistance.

Although assessment for special education services continues to be a primary role of school psychologists, an increased role in behavioral assessment and treatment has been noted over time. This indicates a need for behavior analytic research within the school psychology literature. The purpose of the present study was to investigate the frequency of articles consistent with the theories and practices of applied behavior analysis published in four school psychology journals between 2000 and 2020. A total of 2765 original research articles were reviewed by looking for the presence of ABA focused content within the title or abstract. Results indicate that only 5.5% of articles (n=153) had a primary focus reflective of ABA theory or practice. These data were lower than would have been expected given the current job roles reported by practicing school psychologists.

Background: Several registries focus on patients undergoing minimally invasive liver surgery (MILS). This study compared transatlantic registries focusing on the variables collected and differences in baseline characteristics, indications, and treatment in patients undergoing MILS. Furthermore, key variables were identified. Methods: The five registries for liver surgery from North America (ACS-NSQIP), Italy, Norway, the Netherlands, and Europe were compared. A set of key variables were established by consensus expert opinion and compared between the registries. Anonymized data of all MILS procedures were collected (January 2014–December 2019). To summarize differences for all patient characteristics, treatment, and outcome, the relative and absolute largest differences (RLD, ALD) between the smallest and largest outcome per variable among the registries are presented. Results: In total, 13,571 patients after MILS were included. Both 30- and 90-day mortality after MILS were below 1.1% in all registries. The largest differences in baseline characteristics were seen in ASA grade 3–4 (RLD 3.0, ALD 46.1%) and the presence of liver cirrhosis (RLD 6.4, ALD 21.2%). The largest difference in treatment was the use of neoadjuvant chemotherapy (RLD 4.3, ALD 20.6%). The number of variables collected per registry varied from 28 to 303. From the 46 key variables, 34 were missing in at least one of the registries. Conclusion: Despite considerable variation in baseline characteristics, indications, and treatment of patients undergoing MILS in the five transatlantic registries, overall mortality after MILS was consistently below 1.1%. The registries should be harmonized to facilitate future collaborative research on MILS for which the identified 46 key variables will be instrumental.

We thank Dr. Avasarala for their insightful comments and queries regarding our recent article.1Based on our observations, we agree that in patients with a normal brain MRI, repeat brain MRI after 1–2 weeks should be considered if the clinical suspicion for a myelin oligodendrocyte glycoprotein antibody–associated disease (MOGAD) cerebral attack is high, especially if the CSF is inflammatory.1Indeed, similar radiologic lag has also been reported with 10% of MOGAD myelitis attacks that had an initial normal spine MRI.2Detection of abnormalities on repeat MRI before MOG-immunoglobulin G (IgG) results return can help confirm a core demyelinating event and guide initial acute treatment decisions, but it cannot confirm MOGAD diagnosis because a positive MOG-IgG result is an absolute requirement per 2023 diagnostic criteria.3Radiologic lag in the context of MOGAD optic neuritis has not been evaluated previously, but we believe it is worthy of future investigation. The pathologic basis of radiologic lag is uncertain, but we can hypothesize about potential reasons for this, such as true biological lag from a functional deficit affecting oligodendrocyte electrophysiology before structural damage vs intramyelin edema or inflammation preceding demyelination. Alternatively, it may be due to methodologic/technical reasons. Future studies using more advanced imaging techniques may shed further light on the biology underpinning radiologic lag.

We aimed to investigate abnormal time-varying functional connectivity (FC) for thalamic sub-regions in multiple sclerosis (MS) and their clinical, cognitive and MRI correlates. Eighty-nine MS patients (49 relapsing-remitting [RR] MS; 40 progressive [P] MS) and 53 matched healthy controls underwent neurological, neuropsychological and resting state fMRI assessment. Time-varying connectivity (TVC) was quantified using sliding-window seed-voxel correlation analysis. Standard deviation of FC across windows was taken as measure of TVC, while mean connectivity across windows expressed static FC. MS patients showed reduced TVC vscontrols between most of thalamic sub-regions and fronto-temporo-occipital regions. At the same time, they showed increased static FC between all thalamic sub-regions and structurally connected cortico-subcortical regions. TVC reduction was mainly driven by RRMS; while PMS exhibited a variable pattern of TVC abnormalities, characterized by reduced TVC between frontal/motor thalamic seeds and default-mode network areas and increased TVC vscontrols/RRMS between posterior thalamic sub-regions and occipito-temporo-insular cortices, associated with severity of clinical disability. Compared with controls, both cognitively preserved and impaired patients showed reduced TVC between anterior thalamic sub-regions and frontal cortex. Cognitively impaired patients also showed increased TVC of the right postcentral thalamic sub-region with the cingulate cortex and postcentral gyrus vsboth controls and cognitively preserved patients. Divergent patterns of TVC thalamic abnormalities were found between RRMS and PMS patients. TVC reduction in RRMS may represent the attempt of thalamic network to keep with stable connections. Conversely, increased TVC of posterior thalamic sub-regions characterized PMS and cognitively impaired MS, possibly reflecting maladaptive mechanisms.

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ObjectiveSince astrocytes at the blood–brain barrier are targeted by neuromyelitis optica spectrum disorder (NMOSD), this study aims to assess whether patients with NMOSD have a subclinical accumulation of brain water and if it differs according to disease activity.MethodsSeventy-seven aquaporin-4-positive patients with NMOSD and 105 healthy controls were enrolled at two European centres. Brain dual-echo turbo spin-echo MR images were evaluated and maps of T2 relaxation time (T2rt) in the normal-appearing white matter (NAWM), grey matter and basal ganglia were obtained. Patients with a clinical relapse within 1 month before or after MRI acquisition were defined ‘active’. Differences between patients and controls were assessed using z-scores of T2rt obtained with age-adjusted and sex-adjusted linear models from each site. A stepwise binary logistic regression was run on clinical and MRI variables to identify independent predictors of disease activity.ResultsPatients had increased T2rt in both white and grey matter structures (p range: 0.014 to <0.0001). Twenty patients with NMOSD were defined active. Despite similar clinical and MRI features, active patients had a significantly increased T2rt in the NAWM and grey matter compared with those clinically stable (p range: 0.010–0.002). The stepwise binary logistic regression selected the NAWM as independently associated with disease activity (beta=2.06, SE=0.58, Nagelkerke R2=0.46, p<0.001).ConclusionsIn line with the research hypothesis, patients with NMOSD have increased brain T2rt. The magnitude of this alteration might be useful for identifying those patients with active disease.

ObjectiveTo characterise in vivo the microstructural abnormalities of multiple sclerosis (MS) normal-appearing (NA) cortex and cortical lesions (CLs) and their relations with clinical phenotypes and disability using neurite orientation dispersion and density imaging (NODDI).MethodsOne hundred and seventy-two patients with MS (101 relapsing–remitting multiple sclerosis (RRMS), 71 progressive multiple sclerosis (PMS)) and 62 healthy controls (HCs) underwent a brain 3T MRI. Brain cortex and CLs were segmented from three-dimensional T1-weighted and double inversion recovery sequences. Using NODDI on diffusion-weighted sequence, intracellular volume fraction (ICV_f) and Orientation Dispersion Index (ODI) were assessed in NA cortex and CLs with default or optimised parallel diffusivity for the cortex (D//=1.7 or 1.2 µm2/ms, respectively).ResultsThe NA cortex of patients with MS had significantly lower ICV_f versus HCs’ cortex with both D// values (false discovery rate (FDR)-p <0.001). CLs showed significantly decreased ICV_f and ODI versus NA cortex of both HCs and patients with MS with both D// values (FDR-p ≤0.008). Patients with PMS versus RRMS had significantly decreased NA cortex ICV_f and ODI (FDR-p=0.050 and FDR-p=0.032) with only D//=1.7 µm2/ms. No CL microstructural differences were found between MS clinical phenotypes. MS NA cortex ICV_f and ODI were significantly correlated with disease duration, clinical disability, lesion burden and global and regional brain atrophy (r from −0.51 to 0.71, FDR-p from <0.001 to 0.045).ConclusionsA significant neurite loss occurs in MS NA cortex. CLs show a further neurite density reduction and a reduced ODI suggesting a simplification of neurite complexity. NODDI is relevant to investigate in vivo the heterogeneous pathology affecting the MS cortex.

Background: Although laparoscopic liver resection has become the standard for minor resections, evidence is lacking for more complex resections such as the right posterior sectionectomy (RPS). We aimed to compare surgical outcomes between laparoscopic (LRPS) and open right posterior sectionectomy (ORPS). Methods: An international multicenter retrospective study comparing patients undergoing LRPS or ORPS (January 2007—December 2018) was performed. Patients were matched based on propensity scores in a 1:1 ratio. Primary endpoint was major complication rate defined as Accordion ≥ 3 grade. Secondary endpoints included blood loss, length of hospital stay (LOS) and resection status. A sensitivity analysis was done excluding the first 10 LRPS patients of each center to correct for the learning curve. Additionally, possible risk factors were explored for operative time, blood loss and LOS. Results: Overall, 399 patients were included from 9 centers from 6 European countries of which 150 LRPS could be matched to 150 ORPS. LRPS was associated with a shorter operative time [235 (195–285) vs. 247 min (195–315) p= 0.004], less blood loss [260 (188–400) vs. 400 mL (280–550) p= 0.009] and a shorter LOS [5 (4–7) vs. 8 days (6–10), p= 0.002]. Major complication rate [n= 8 (5.3%) vs. n= 9 (6.0%) p= 1.00] and R0 resection rate [144 (96.0%) vs. 141 (94.0%), p= 0.607] did not differ between LRPS and ORPS, respectively. The sensitivity analysis showed similar findings in the previous mentioned outcomes. In multivariable regression analysis blood loss was significantly associated with the open approach, higher ASA classification and malignancy as diagnosis. For LOS this was the open approach and a malignancy. Conclusion: This international multicenter propensity score-matched study showed an advantage in favor of LRPS in selected patients as compared to ORPS in terms of operative time, blood loss and LOS without differences in major complications and R0 resection rate.

In neuromyelitis optica spectrum disorders, spinal cord lesions at MRI were mainly distributed in the upper cervical cord and in the gray matter, and were spatially associated with atrophy and correlated to disability.

Cervical cord damage assessed with multiparametric MRI explains a substantial proportion of disease course in multiple sclerosis.

The gastrointestinal stromal tumor (GIST) is a digestive neoplasm of mesenchymal lineage. The treatment strategy for receptor tyrosine kinase-mutated GISTs is well defined. Wild-type GISTs (WT-GISTs) respond unsatisfactorily to specific kinase inhibitors. Moreover, evidence shows that repeat surgery has limited benefit. We report the case of a young female patient who was diagnosed with liver metastatic WT-GIST, after initial radical resection and adjuvant therapy with molecular targeted drugs. Due to the disease progression, a two-stage surgery was performed, with the removal of extrahepatic lesions followed by a total hepatectomy. The patient is disease-free after 4 years from liver transplantation (LT), performed under everolimus-based immunosuppression. The treatment of WT-GISTs remains a significant challenge due to the frequent resistance to tyrosine kinase inhibitors (TKIs). Liver transplantation might represent an effective treatment option for such disease.

The gastrointestinal stromal tumor (GIST) is a digestive neoplasm of mesenchymal lineage. The treatment strategy for receptor tyrosine kinase‐mutated GISTs is well defined. Wild‐type GISTs (WT‐GISTs) respond unsatisfactorily to specific kinase inhibitors. Moreover, evidence shows that repeat surgery has limited benefit. We report the case of a young female patient who was diagnosed with liver metastatic WT‐GIST, after initial radical resection and adjuvant therapy with molecular targeted drugs. Due to the disease progression, a two‐stage surgery was performed, with the removal of extrahepatic lesions followed by a total hepatectomy. The patient is disease‐free after 4 years from liver transplantation (LT), performed under everolimus‐based immunosuppression. The treatment of WT‐GISTs remains a significant challenge due to the frequent resistance to tyrosine kinase inhibitors (TKIs). Liver transplantation might represent an effective treatment option for such disease. A young female patient suffering from a liver‐only, recurrent wild‐type gastrointestinal stromal tumor, a condition commonly contraindicating surgery, undergoes successful liver transplantation and remains disease‐free after a long follow‐up, confirming the curative potential of liver transplantation for this indication.

The texture of mesoporous FAU-Y (FAUmes) prepared by surfactant-templating in basic media is a subject of debate. It is proposed that mesoporous FAU-Y consists of: (1) ordered mesoporous zeolite networks formed by a surfactant-assisted zeolite rearrangement process involving local dissolution and reconstruction of the crystalline framework, and (2) ordered mesoporous amorphous phases as Al-MCM-41, which coexist with zeolite nanodomains obtained by a dissolution-reassembly process. By the present systematic study, performed with FAU-Y (Si/Al = 15) in the presence of octadecyltrimethylammonium bromide and 0 < NaOH/Si ratio < 0.25 at 115 °C for 20 h, we demonstrate that mesoporous FAU zeolites consist, in fact, of a complex family of materials with textural features strongly impacted by the experimental conditions. Two main families have been disclosed: (1) for 0.0625 < NaOH/Si < 0.10, FAUmes are ordered mesoporous materials with zeolite walls, which coexist with zeolite nanodomains (100–200 nm) and (2) for 0.125 < NaOH/Si < 0.25, FAUmes are ordered mesoporous materials with amorphous walls as Al-MCM-41, which coexist with zeolite nanodomains (5–100 nm). The zeolite nanodomains decrease in size with the increase of NaOH/Si ratio. Increasing NaOH/Si ratio leads to an increase of mesopore volume, while the total surface area remains constant, and to a decrease of strong acidity in line with the decrease of micropore volume. The ordered mesoporous materials with zeolite walls feature the highest acidity strength. The ordered mesoporous materials with amorphous walls present additional large pores (50–200 nm), which increase in size and amount with the increase of NaOH/Si ratio. This alkaline treatment of FAU-Y represents a way to obtain ordered mesoporous materials with zeolite walls with high mesopore volume for NaOH/Si = 0.10 and a new way to synthesize mesoporous Al-MCM-41 materials containing extralarge pores (50–200 nm) ideal for optimal diffusion (NaOH/Si = 0.25).