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Abstract Background Dorsal approaches to the hindfoot are frequently used. Furthermore, the vascular supply is discussed as a possible cause for ruptures and degeneration of the Achilles tendon. The aim of this study was to evaluate the microperfusion of three possible posterior approaches to the hindfoot and different areas of the Achilles tendon. Methods In 111 subjects, a laser Doppler/white light spectroscopy was used to measure microperfusion in terms of blood flow (Flow) and capillary venous oxygen saturation (SO2) in the hindfoot and Achilles tendon. Measurements were performed at two measurement points (MP, proximal and distal) of three dorsal approaches (medial, lateral and central) and inside the Achilles tendon. Results Microperfusion differed partially between the surgical approaches. The medial and the lateral approaches were significantly superior to the central approach with regard to Flow in both MP (p

Cholecystitis can result in complications if not completely treated. These include gallbladder empyema, perforation and cholecystoenteric fistula.We report the first incidence of cholecystitis resulting in a gallstone fistula with a gastric duplication cyst. A 71 year old patient presented with generalised peritonism that was worst in the epigastric area. Computer tomography (CT) revealed a perforated necrotic gallbladder. Emergency laparotomy, cholecystectomy, partial gastrectomy and Roux-en-Y reconstruction was required. The patient made a slow but full recovery.Pathology results revealed that chronic cholecystitis had resulted in a fistula with a duplication cyst overlying the greater curve of the stomach. Several one centimeter gallstones were found within the cyst cavity.

BackgroundEsophageal atresia (EA) is a rare congenital anomaly characterized by a discontinuity of the esophagus. Following surgical repair, survival rates have improved dramatically the past decenniums and today exceed 90%, but the children commonly present with esophageal and respiratory morbidity. In 2018, a condition-specific quality-of-life questionnaire for children with esophageal atresia (EA) aged 2–7 in Sweden-Germany was finalized (The EA-QOL questionnaire). The study aim was to describe the evaluation of the new translations across 12 new countries in Europe, Asia, Africa, Central-and North America.MethodsFollowing forward-backward translation into the new languages, the 17-item EA-QOL questionnaire was tested in cognitive debriefing interviews with parents of children with EA aged 2–7. Parents rated if each item was easy to understand (clarity) and sensitive to answer (interference with personal integrity). They could skip responding to a non-applicable/problematic item and give open comments. Predefined psychometric criteria were used; item clarity ≥80%/item sensitive to answer ≤20%/item feasibility ≤5% missing item responses. The decision to modify the translation was based on native expert, patient stakeholder, and instrument developer review, and the need for harmonization between translations.ResultsSimilar to findings in the Swedish-German cognitive debriefing, the cross-cultural analysis of input from 116 parents from 12 new countries (4–14 parents, median 9 parents/country) showed that all items in the EA-QOL questionnaire fulfilled the criteria for item clarity ≥80% and sensitive to answer (ranging from 1%-4.5%), although results varied between countries. Four items had missing responses between 5.2% and 13.4%, three within the same domain and were in line with parents’ explanations. Poor translations and feasibility were improved.ConclusionsBased on parent input, the collaboration between native experts, patient stakeholders, and instrument developers, a linguistic version of the EA-QOL questionnaire for children aged 2–7 for use in and across 14 countries has been established. These efforts have set the conditions for a cross-cultural field test of the EA-QOL questionnaire and will open the doors for a new chapter in outcome research, registries, and clinical practice concerning children with EA. In the long-term, this will help increase knowledge of the disease's burden, promote patient-centeredness, exchange of information between nations, and strengthen evidence-based treatments for children born with EA.

The validated 17-gene Oncotype DX Genomic Prostate Score® (GPS™) assay risk-stratifies prostate-cancer patients with localized disease. The assay has primarily been utilized in lower risk patients deciding between active surveillance versus definitive therapy. In this retrospective cohort study, we analyze the association of the GPS result with time to biochemical recurrence post-prostatectomy in patients with National Comprehensive Cancer Network® (NCCN) intermediate and higher risk prostate cancer. The 141 patients included in the study were from the NorthShore University HealthSystem diagnosed 2014-2019 with NCCN intermediate (n = 109) or higher risk (n = 32) prostate cancer, treated with radical prostatectomy 2015-2019. The association of GPS result with time to biochemical recurrence was evaluated using univariable and multivariable Cox proportional hazards models in 120 patients with unfavorable intermediate or higher risk. Median (interquartile range) follow-up time was 28 (20 to 38) months. The GPS result was significantly associated with time to biochemical recurrence as both a continuous and dichotomous variable in univariable (hazard ratio [HR] per 20 GPS units 2.36, 95% CI 1.45-3.80, p < 0.001; HR for GPS result 41-100 vs 0-40 3.28, 95% CI 1.61-7.19, p < 0.001) and in multivariable models accounting for NCCN risk group (HR per 20 GPS units 2.14, 95% CI 1.31-3.46, p = 0.003; HR for GPS result 41-100 vs 0-40 3.00, 95% CI 1.43-6.72, p = 0.003) or biopsy Gleason Score and diagnostic PSA or PSA density. These results indicate that the GPS assay was a strong predictor of biochemical recurrence after radical prostatectomy in this unfavorable intermediate and higher risk prostate cancer patient population.

This paper presents water surface temperature retrieval using Landsat thermal band and meteorological ancillary data. The algorithms were tested using Landsat-5/7/8 imagery acquired at different study sites along the Slave River and Mackenzie River of the Northwest Territories (NWT), Canada. By comparing the retrieved temperatures with in situ water temperatures, in-depth validation of one reliable retrieved technique was successfully demonstrated. The method yielded a mean absolute error (MAE) in the range of 1.00–1.38 °C, over 7 validation locations in a 2-year observation period. This paper also presents a method to estimate suspended sediment concentration (SSC) in the Slave River region using Landsat-8 imagery. The numerical relationships between in situ SSC measurements and water-leaving reflectance in visible and near-infrared (NIR) bands were investigated through regression fitting. The SSC estimation results using the retrieved models were analyzed and validated, the NIR model was found to generate the smallest estimation errors with a MAE of 7.98 mg/L using leave-one-out (LOO) uncertainty assessment. An operational web-based tool for water surface temperature and SSC mapping based on the algorithms validated during this study has been developed to address additional monitoring requirements of the NWT communities. The design and implementation of this tool is also described.

Background: The exponential growth of image-based diagnostic and minimally invasive interventions requires a detailed three-dimensional anatomical knowledge and increases the demand towards the undergraduateanatomical curriculum. This randomized controlled trial investigates whether musculoskeletal ultrasound (MSUS) or arthroscopic methods can increase the anatomical knowledge uptake.Methods: Second-year medical students were randomly allocated to three groups. In addition to the compulsory dissection course, the ultrasound group (MSUS) was taught by eight, didactically and professionally trained,experienced student-teachers and the arthroscopy group (ASK) was taught by eight experienced physicians. The control group (CON) acquired the anatomical knowledge only via the dissection course. Exposure (MSUS and ASK)took place in two separate lessons (75 minutes each, shoulder and knee joint) and introduced standard scan planes using a 10-MHz ultrasound system as well as arthroscopy tutorials at a simulator combined with video tutorials. The theoretical anatomic learning outcomes were tested using a multiple-choice questionnaire (MCQ), and after crossover an objective structured clinical examination (OSCE). Differences in student's perceptions were evaluated using Likert scale-based items.Results: The ASK-group (n = 70, age 23.4 (20-36) yrs.) performed moderately better in the anatomical MC exam in comparison to the MSUS-group (n = 84, age 24.2 (20-53) yrs.) and the CON-group (n = 88, 22.8 (20-33) yrs.; p = 0.019). After an additional arthroscopy teaching 1% of students failed the MC exam, in contrast to 10% in the MSUS- or CON-group, respectively. The benefit of the ASK module was limited to the shoulder area (p < 0.001). The final examination (OSCE) showed no significant differences between any of the groups with good overall performances. In the evaluation, the students certified the arthroscopic tutorial a greater advantage concerning anatomical skills with higher spatial imagination in comparison to the ultrasound tutorial (p = 0.002; p < 0.001).Conclusions: The additional implementation of arthroscopy tutorials to the dissection course during the undergraduate anatomy training is profitable and attractive to students with respect to complex joint anatomy.Simultaneous teaching of basic-skills in musculoskeletal ultrasound should be performed by medical experts, but seems to be inferior to the arthroscopic 2D-3D-transformation, and is regarded by students as more difficult to learn. Although arthroscopy and ultrasound teaching do not have a major effect on learning joint anatomy, they have the potency to raise the interest in surgery. [ABSTRACT FROM AUTHOR]

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Despite huge investment, and the best of intentions, most development projects fail. This is particularly true of Information and Communication Technology for Development (ICTD) projects. We contend that a significant contributor to this failure is the lack of breadth in project design and implementation, and in the training of project implementers. Successful ICTD interventions, in addition to being based on the best computer science research has to offer, must be guided by the relevant social, cultural, political, economic and gender factors that underlie the interaction of the technology with the community into which it is being placed. We therefore argue that efforts to distance computer science from the broader context of ICTD scholarship and practice are misguided. ICTD should be recognized as a truly interdisciplinary area of research and practice. We further argue that ICTD as a discipline has a particular need for academic practitioners. We close with a compilation of current known ICTD academic efforts worldwide.

We examined the responses of doubled-haploid lines (DHLs) of rice (Oryza sativa L.) to drought and rewatering in controlled rainfed lowland conditions, to test the the hypothesis that the DHLs would permit trait comparisons with less confounding by unrelated traits than had been reported previously. IR62266 and four DHLs derived from the cross between IR62266 and CT9993 (DHL-32, 51, 54 and 79) were grown in pot experiments in the greenhouse at the IRRI, Los Baños, Philippines. Genotypic variation in leaf and tiller development, transpiration, water use efficiency, osmotic adjustment and leaf water potential was examined in relation to dry matter production. Results revealed that greater seedling vigor through continued leaf expansion in early drought was associated with greater dry matter production after rewatering. A higher water use efficiency was related to a greater increase in dry matter production during drought. Leaf water potential was correlated strongly with dry weight, not only during drought, but especially on rewatering. Therefore, we found that the ability to continue leaf expansion, higher water use efficiency, and a greater osmotic adjustment for maintenance of leaf water potential as drought progressed were desirable traits for improved performance under drought and improved ability to recover on rewatering. These relationships could be analyzed precisely using such genetically-related materials as DHLs, with less confounding effects of plant size and genetic background.

Doubled haploid lines (DHLs) of rice (Oryza sativa L.) were used to examine responses to drought and rewatering in controlled rainfed lowland conditions, in order to determine whether confounding by unrelated traits would be less than has been reported previously for contrasting cultivars that differ in genetic background. IR62266 and four DHLs derived from the cross between IR62266 and CT9993 (DHL-32, -51, -54 and -79) were grown in pot experiments in the greenhouse during the 2000 dry and wet seasons at IRRI, Los Baños, Philippines. There were two water regimes (well-watered and drought). Estimated water extraction obtained by time domain reflectometry (TDR) was similar to cumulative transpiration estimated from pot weighing for each genotype. Genotypic variation was observed in root traits and water extraction, with extraction slower in DHL-32 and faster in DHL-79, especially in deeper soil layers. An upper bound relationship between water extraction from a soil layer and root length density (RLD) in that layer was readily apparent over DHLs and soil depths, suggesting a critical value of RLD for water extraction of 0.30 cm cm−3 in these conditions. Because soils in the field would not be as homogenous as the puddled soils used in these greenhouse experiments, this critical RLD for water extraction from a soil layer is a reference for ideal conditions, and requires careful validation in the field. Use of DHLs permitted comparisons with reduced confounding by genetic background, with consequent improvements in precision.

El artí­culo presenta de forma general la caracterización del manejo tributario de las cien principales empresas de la ciudad de San Juan de Pasto, identificando para ello el manejo de la obligación impositiva de acuerdo a la actividad que éstas desarrollan, y determinando cómo se aplica las normas tributarias territoriales de acuerdo a su actividad y el establecimiento de las caracterí­sticas tributarias predominantes.

Background: Dorsal approaches to the hindfoot are frequently used. Furthermore, the vascular supply is discussed as a possible cause for ruptures and degeneration of the Achilles tendon. The aim of this study was to evaluate the microperfusion of three possible posterior approaches to the hindfoot and different areas of the Achilles tendon. Methods: In 111 subjects, a laser Doppler/white light spectroscopy was used to measure microperfusion in terms of blood flow (Flow) and capillary venous oxygen saturation (SO2) in the hindfoot and Achilles tendon. Measurements were performed at two measurement points (MP, proximal and distal) of three dorsal approaches (medial, lateral and central) and inside the Achilles tendon. Results: Microperfusion differed partially between the surgical approaches. The medial and the lateral approaches were significantly superior to the central approach with regard to Flow in both MP (p < 0.001), while SO2 was significantly higher at the proximal measurement point (MP 1; p < 0.001). In this area, the lateral approach was significantly superior to the medial approach regarding Flow (MP 1; p = 0.012). The Achilles tendon exhibited a significantly reduced microperfusion 5 cm proximal to the calcaneal tubercle (SO2 p = 0.001; Flow p = 0.048). Demographic factors, such as body mass index and age, had different effects. Microcirculation was partially superior in men and negatively affected by smoking. Conclusions: Soft tissue microcirculation on the lateral and medial side of the healthy Achilles tendon was better than centrally on the tendon. Proximally, the lateral approach was better than the medial approach. These circumstances could provide advantages regarding the surgical approach. The Achilles tendon exhibited significantly reduced microperfusion at the typical side of degeneration and rupture. This circumstance could be a possible cause of degenerative processes. [ABSTRACT FROM AUTHOR]