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Abstract Background The revision knee complexity classification (RKCC) stratifies knee revision operations depending on their level of complexity from simple revisions (R1) to highly complex cases (R3). Current financial codes used for calculation of reimbursement for knee revision services provided at the Trust, rely on patients’ comorbidities. However, previous research has demonstrated that this approach may not yield an accurate financial account of knee revision arthroplasty cost. This is a single centre study from a secondary and tertiary revision unit, with work previously presented by the authors demonstrating that the majority of complex revision knee replacement within the region, take place in this unit. The aims of this study were to illustrate the current cost profile and renumeration service currently in place for revision knee and show the differences in cost based on complexity of the operation. Methods In this retrospective study, 90 cases who underwent revision knee operations in 2019 were analysed. Data was obtained from a tertiary referral centre where the episodes had occurred. Mean cost, tariff, and subsequent deficit were calculated for the R1, R2 and R3 episodes. Results R2 and R3 episodes were significantly more expensive than R1 episodes. The increase in cost between R3 and R2 episodes was not significant. The total cost of the revision operations was £1,162,343. Tariffs received for R2 and R3 revision operations were significantly more expensive than R1 operations. However, the increase in tariffs received for R3 operations was not significant in relation to R2 operations. The total amount of tariffs received by the Trust was £ 770,996 generating a net deficit of - £ 391,347. Conclusion Current financial coding for revision knee does not accurately predict costs associated with revision knee surgery. Net deficit varies depending on the RKCC grade of the knee revision episode with more complex operations resulting in a higher mean net deficit. Implementation of the RKCC could prove to be a useful tool in generating an accurate prediction of the cost associated with knee revision surgery.

Effective wildlife population management requires an understanding of the abundance of the target species. In the United Kingdom, the increase in numbers and range of the non-native invasive grey squirrel Sciurus carolinensis poses a substantial threat to the existence of the native red squirrel S. vulgaris, to tree health, and to the forestry industry. Reducing the number of grey squirrels, is crucial to mitigate their impacts. Camera traps are increasingly used to estimate animal abundance, and methods have been developed that do not require the identification of individual animals. Most of these methods have been focussed on medium to large mammal species with large range sizes and may be unsuitable for measuring local abundances of smaller mammals that have variable detection rates and hard to measure movement behaviour. The aim of this study was to develop a practical and cost-effective method, based on a camera trap index, that could be used by practitioners to estimate target densities of grey squirrels in woodlands to provide guidance on the numbers of traps or contraceptive feeders required for local grey squirrel control. Camera traps were deployed in ten independent woods of between 6 and 28 ha in size. An index, calculated from the number of grey squirrel photographs recorded per camera per day had a strong linear relationship (R2 = 0.90) with the densities of squirrels removed in trap and dispatch operations. From different time filters tested, a 5 min filter was applied, where photographs of squirrels recorded on the same camera within 5 min of a previous photograph were not counted. There were no significant differences between the number of squirrel photographs per camera recorded by three different models of camera, increasing the method’s practical application. This study demonstrated that a camera index could be used to inform the number of feeders or traps required for grey squirrel management through culling or contraception. Results could be obtained within 6 days without requiring expensive equipment or a high level of technical input. This method can easily be adapted to other rodent or small mammal species, making it widely applicable to other wildlife management interventions.

Transverse myelitis is an inflammatory disorder of the spinal cord that can present with a wide array of lower urinary tract symptoms including urinary retention, frequency, urgency, and urge incontinence.We report a case of a 15 year old male with new onset urinary incontinence who initially presented to the urologist and was subsequently diagnosed with transverse myelitis.

Primary tumors of the epididymis are rare and commonly benign in nature. Leiomyoadenomatoid tumors are a rare subvariant of adenomatoid tumors that combines features of leiomyomas. Tumor histology is notable for tubular spaces lined by mesothelial cells with a proliferative spindle cell component. To the best of our knowledge, few cases have been reported in the literature. We report a case of leiomyoadenomatoid tumor in a 58-year-old male.

Background: Achondroplasia is the most common short-limbed skeletal dysplasia resulting from gain-of-function pathogenic variants in fibroblast growth factor receptor 3 ( FGFR3 ) gene, a negative regulator of endochondral bone formation. Most treatment options are symptomatic, targeting medical complications. Infigratinib is an orally bioavailable, FGFR1–3 selective tyrosine kinase inhibitor being investigated as a direct therapeutic strategy to counteract FGFR3 overactivity in achondroplasia. Objectives: The main objective of PROPEL is to collect baseline data of children with achondroplasia being considered for future enrollment in interventional studies sponsored by QED Therapeutics. The objectives of PROPEL 2 are to obtain preliminary evidence of safety and efficacy of oral infigratinib in children with achondroplasia, to identify the infigratinib dose to be explored in future studies, and to characterize the pharmacokinetic (PK) profile of infigratinib and major metabolites. Design: PROPEL (NCT04035811) is a prospective, noninterventional clinical study designed to characterize the natural history and collect baseline data of children with achondroplasia over 6−24 months. PROPEL 2 (NCT04265651), a prospective, phase II, open-label study of infigratinib in children with achondroplasia, consists of a dose-escalation, dose-finding, and dose-expansion phase to confirm the selected dose, and a PK substudy. Methods and analysis: Children aged 3−11 years with achondroplasia who completed ⩾6 months in PROPEL are eligible for PROPEL 2. Primary endpoints include treatment-emergent adverse events and change from baseline in annualized height velocity. Four cohorts at ascending dose levels are planned for dose escalation. The selected dose will be confirmed in the dose-expansion phase. Ethics: PROPEL and PROPEL 2 are being conducted in accordance with the International Conference on Harmonization Good Clinical Practice guidelines, principles of the Declaration of Helsinki, and relevant human clinical research and data privacy regulations. Protocols have been approved by local health authorities, ethics committees, and institutions as applicable. Parents/legally authorized representatives are required to provide signed informed consent; signed informed assent by the child is also required, where applicable. Discussion: PROPEL and PROPEL 2 will provide preliminary evidence of the safety and efficacy of infigratinib as precision treatment of children with achondroplasia and will inform the design of future studies of FGFR-targeted agents in achondroplasia. Registration: ClinicalTrials.gov: NCT04035811; NCT04265651.

Hepatocellular carcinoma (HCC) arises from several different etiologies and carries a poor prognosis. Extrahepatic metastases of HCC are most frequently found in the lungs, lymph nodes, and bones, with adrenal metastases reported in less than 15% of metastatic cases. Herein, we report a case of a 71-year-old man without prior liver disease who presented with a 9-cm right adrenal mass extending into the IVC consistent with HCC on subsequent surgical pathology and immunohistochemical staining. Etiological possibilities for an adrenal tumor as the first presentation of HCC include metastasis from occult primary liver HCC, intra-adrenal hepatic heterotopia, and adrenohepatic fusion.

Abundant evidence supports the presence of at least three distinct types of thalamocortical (TC) neurons in the primate dorsal lateral geniculate nucleus (dLGN) of the thalamus, the brain region that conveys visual information from the retina to the primary visual cortex (V1). Different types of TC neurons in mice, humans, and macaques have distinct morphologies, distinct connectivity patterns, and convey different aspects of visual information to the cortex. To investigate the molecular underpinnings of these cell types, and how these relate to differences in dLGN between human, macaque, and mice, we profiled gene expression in single nuclei and cells using RNA-sequencing. These efforts identified four distinct types of TC neurons in the primate dLGN: magnocellular (M) neurons, parvocellular (P) neurons, and two types of koniocellular (K) neurons. Despite extensively documented morphological and physiological differences between M and P neurons, we identified few genes with significant differential expression between transcriptomic cell types corresponding to these two neuronal populations. Likewise, the dominant feature of TC neurons of the adult mouse dLGN is high transcriptomic similarity, with an axis of heterogeneity that aligns with core vs. shell portions of mouse dLGN. Together, these data show that transcriptomic differences between principal cell types in the mature mammalian dLGN are subtle relative to the observed differences in morphology and cortical projection targets. Finally, alignment of transcriptome profiles across species highlights expanded diversity of GABAergic neurons in primate versus mouse dLGN and homologous types of TC neurons in primates that are distinct from TC neurons in mouse.

Subaqueous dredging is a management activity undertaken globally to improve navigation, remove contaminants, mitigate flood risk and/or generate aggregate. Water Injection Dredging (WID) is a hydrodynamic technique involving the turbation and downstream displacement of fine sediments using vessel-mounted water jets. Despite the technique being widely applied internationally, the environmental and ecological effects of WID are poorly understood. For the first time, this study used a Before-After-Control-Impact (BACI) experimental design to assess the effects of WID on water physicochemistry, and macroinvertebrate and fish communities within a 5.7 km-long reach of tidal river. WID targeted the central channel (thalweg) to avoid disturbance of the channel margins and banks. Mean but not peak turbidity levels were substantially elevated, and dissolved oxygen levels were reduced during periods of WID, although effects were relatively short-lived (≈3 h on average). Dredging resulted in significant reductions in benthic macroinvertebrate community abundance (particularly taxa that burrow into fine sediments), taxonomic richness and diversity. In contrast, minor changes were detected in marginal macroinvertebrate communities within and downstream of the dredged reach following WID. Reductions in fish taxonomic richness and diversity were recorded downstream of the dredged reach most likely due to behavioural avoidance of the sediment plume. No visibly stressed or dead fish were sampled during dredging. Results suggest that mobile organisms and marginal communities were largely unaffected by thalweg WID and that the technique represents a more ecologically sensitive alternative to traditional channel margin mechanical dredging techniques.

41-year-old male presented with significant penile swelling following sexual intercourse. Two years earlier while incarcerated, the patient self-inserted a 1.5 cm subcutaneous penile foreign body (FB) made from a domino piece. An original concern for penile fracture was successfully ruled out by penile ultrasound, and computed tomography ruled out deep infection. Bloodwork otherwise revealed leukocytosis, and the patient was admitted for intravenous antibiotics and observation. Penile cellulitis and hematoma clinically improved, and the FB did not require removal. At 18 month follow up, the patient maintains normal urological and sexual function.

Despite anecdotal reports of the astonishing homing abilities in dogs, their homing strategies are not fully understood. We equipped 27 hunting dogs with GPS collars and action cams, let them freely roam in forested areas, and analyzed components of homing in over 600 trials. When returning to the owner (homewards), dogs either followed their outbound track (‘tracking’) or used a novel route (‘scouting’). The inbound track during scouting started mostly with a short (about 20 m) run along the north-south geomagnetic axis, irrespective of the actual direction homewards. Performing such a ‘compass run’ significantly increased homing efficiency. We propose that this run is instrumental for bringing the mental map into register with the magnetic compass and to establish the heading of the animal.

This is the first study to report the whole match, ball-in-play (BiP), ball-out-of-play (BoP), and Max BiP (worst case scenario phases of play) demands of professional soccer players competing in the English Championship. Effective playing time per soccer game is typically 90 s), providing peak match demands. Whole match demands recorded were compared to BiP and Max BiP, with BiP data excluding all match stoppages, providing a more precise analysis of match demands. Whole match metrics were significantly lower than BiP metrics (p < 0.05), and Max BiP for 30–60 s was significantly higher than periods between 60–90 s and >90 s. No significant differences were found between positions. BiP analysis allows for a more accurate representation of the game and physical demands imposed on professional soccer players. Through having a clearer understanding of maximum game demands in professional soccer, practitioners can design more specific training methods to better prepare players for worst case scenario passages of play.

FIFA World Cup tournements have historically been comprehensively analysed by numerous authors. The present study perpetuates the dissection of the biggest football event in analyzing some of indicators related to success during the 2014 World Cup in Brazil. We sought to identify indicators which best discriminate between winning and losing teams and between qualified and non-qualified teams for the second round. We found that winning teams scored more goals (ES 0.57), had more attempts (ES 0.3), a lower rate of attempt per goal (ES 0.59), a lower rate of attempt on target per goal (ES 0.53), a higher rate of attempts on target per attempt (ES 0.34) and a lower number of yellow cards per game (ES 0.24). Qualified teams differentiated by scoring more goals (ES 0.50), a lower rate of attempts per goal (ES 0.50), a lower rate of attempts on target per goal (ES 0.48) and a higher rate of attempts on target per attempt (ES 0.29). These were the only indicators related to success among a list of 55. Possession, pass efficiency, defensive metrics or patterns of play were not a mark of success. None of the athletic indicators observed had an impact on winning or qualifying during the 2014 World Cup. This study revealed that shooting efficiency was the factor that made the difference during the 2014 FIFA World Cup.

Porphyria is a group of metabolic disorders due to altered enzyme activities within the heme biosynthetic pathway. It is a systemic disease with multiple potential contributions to mitochondrial dysfunction and oxidative stress. Recently, it has become possible to measure mitochondrial function from cells isolated from peripheral blood (cellular bioenergetics) using the XF96 analyzer (Seahorse Bioscience). Mitochondrial respiration in these cells is measured with the addition of activators and inhibitors of respiration. The output is measured as the O2 consumption rate (OCR) at basal conditions, ATP linked, proton leak, maximal, reserve capacity, non-mitochondrial, and oxidative burst. We performed cellular bioenergetics on 22 porphyria (12 porphyria cutanea tarda (PCT), seven acute hepatic porphyria (AHP), and three erythropoietic protoporphyria (EPP)) patients and 18 age and gender matched healthy controls. Of porphyria cases, eight were active (2 PCT, 1 EPP, and 5 AHP) and 14 in biochemical remission. The OCR were decreased in patients compared to healthy controls. The bioenergetic profile was significantly lower when measuring proton leak and the non-mitochondrial associated OCR in the eight active porphyria patients when compared to 18 healthy controls. In conclusion, we demonstrate that the bioenergetic profile and mitochondrial activities assessed in porphyria patients and is different than in healthy control individuals. Further, our novel preliminary findings suggest the existence of a mitochondrial dysfunction in porphyria and this may be used as potential non-invasive biomarker for disease activity. This needs to be assessed with a systematic examination in a larger patient cohort. Studies are also suggested to examine mitochondrial metabolism as basis to understand mechanisms of these findings and deriving mitochondrial based therapies for porphyria. Keywords: PCT, AIP, AHP, Protoporphyria, Mitochondrial

This study's objective was to determine the accuracy of using current computed tomography (CT) scan and software techniques for rapid prototyping by quantifying the margin of error between CT models and laser scans of canine skull specimens. Twenty canine skulls of varying morphology were selected from an anatomy collection at a veterinary school. CT scans (bone and standard algorithms) were performed for each skull, and data segmented (testing two lower threshold settings of 226HU and -650HU) into 3-D CT models. Laser scans were then performed on each skull. The CT models were compared to the corresponding laser scan to determine the error generated from the different types of CT model parameters. This error was then compared between the different types of CT models to determine the most accurate parameters. The mean errors for the 226HU CT models, both bone and standard algorithms, were not significant from zero error (p = 0.1076 and p = 0.0580, respectively). The mean errors for both -650HU CT models were significant from zero error (p < 0.001). Significant differences were detected between CT models for 3 CT model comparisons: Bone (p < 0.0001); Standard (p < 0.0001); and -650HU (p < 0.0001). For 226HU CT models, a significant difference was not detected between CT models (p = 0.2268). Independent of the parameters tested, the 3-D models derived from CT imaging accurately represent the real skull dimensions, with CT models differing less than 0.42 mm from the real skull dimensions. The 226HU threshold was more accurate than the -650HU threshold. For the 226HU CT models, accuracy was not dependent on the CT algorithm. For the -650 CT models, bone was more accurate than standard algorithms. Knowing the inherent error of this procedure is important for use in 3-D printing for surgical planning and medical education.

IntroductionIn the equine racehorse industry, reduced athletic performance due to joint injury and lameness has been extensively reviewed. Intra-articular injections of glucocorticoids are routinely used to relieve pain and inflammation associated with osteoarthritis. Intra-articular injections of pharmaceutical agents require practice for precise needle placement and to minimize complications. Training on simulators or models is a viable alternative for developing these technical skills. The purpose of this study was to compare the qualitative ultrasonographic characteristics of three-dimensional (3D) printed models of equine cervical articular process joints to that of a dissected equine cervical spine (gold standard).MethodsA randomized complete block design study was conducted in which a total of thirteen cervical articular process joint models were printed using several materials, printers, and printing technologies. Ultrasound video clips with the models immersed in water were recorded. Two board certified veterinary radiologists and three veterinary radiology residents reviewed the videos and responded to a survey assessing and comparing the ultrasonographic characteristics of the 3D printed models to those of the gold standard.ResultsSix 3D printed models had ultrasonographic characteristics similar to the gold standard. These six models were (material, printer, printing technology): nylon PA 12, EOS Formiga P100, selective laser sintering (P = 0.99); Onyx nylon with chopped carbon fiber, Markforged Onyx Two, fused deposition modeling (P = 0.48); polycarbonate, Ultimaker 3, fused deposition modeling (P = 0.28); gypsum, ProJet CJP 660 Pro, ColorJet Printing (P = 0.28); polylactic acid, Prusa I3, fused deposition modeling (P = 0.23); and high temperature V1 resin, Form 2, stereolithography (P = 0.22).ConclusionWhen assessed in water, it is possible to replicate the qualitative ultrasonographic characteristics of bone using three dimensional printed models made by combining different materials, printing technologies, and printers. However, not all models share similar qualitative ultrasonographic characteristics with bone. We suggest that the aforementioned six models be used as proxy for simulating bones or joints for use with ultrasound. In order to replicate the resistance and acoustic window provided by soft tissues, further work testing the ability of these models to withstand embedding in material such as ballistic gelatin is required.

Heme-iron recycling from senescent red blood cells (erythrophagocytosis) accounts for the majority of total body iron in humans. Studies in cultured cells have ascribed a role for HRG1/SLC48A1 in heme-iron transport but the in vivo function of this heme transporter is unclear. Here we present genetic evidence in a zebrafish model that Hrg1 is essential for macrophage-mediated heme-iron recycling during erythrophagocytosis in the kidney. Furthermore, we show that zebrafish Hrg1a and its paralog Hrg1b are functional heme transporters, and genetic ablation of both transporters in double knockout (DKO) animals shows lower iron accumulation concomitant with higher amounts of heme sequestered in kidney macrophages. RNA-seq analyses of DKO kidney revealed large-scale perturbation in genes related to heme, iron metabolism and immune functions. Taken together, our results establish the kidney as the major organ for erythrophagocytosis and identify Hrg1 as an important regulator of heme-iron recycling by macrophages in the adult zebrafish.

Generating a comprehensive description of cortical networks requires a large-scale, systematic approach. To that end, we have begun a pipeline project using multipatch electrophysiology, supplemented with two-photon optogenetics, to characterize connectivity and synaptic signaling between classes of neurons in adult mouse primary visual cortex (V1) and human cortex. We focus on producing results detailed enough for the generation of computational models and enabling comparison with future studies. Here, we report our examination of intralaminar connectivity within each of several classes of excitatory neurons. We find that connections are sparse but present among all excitatory cell classes and layers we sampled, and that most mouse synapses exhibited short-term depression with similar dynamics. Synaptic signaling between a subset of layer 2/3 neurons, however, exhibited facilitation. These results contribute to a body of evidence describing recurrent excitatory connectivity as a conserved feature of cortical microcircuits.

Penile and scrotal entrapment from a metal ring placed at the base of the penis is a rare, but important clinical dilemma encountered in urology. Emergent presentation to the urologist, after ring placement far longer than safely practiced, risks ischemic and permanent injury to penile, scrotal, and intrascrotal structures. Treating urologists should be aware of the prevalence of metal ring use, their potential complications, and the surgical approach to their safe removal. We present two patients who were identified at our institution with strangulating injuries of retained penile rings. The first patient was a healthy, 43-year-old male with a metal ring retained for 24 hours that was safely removed with industrial bolt cutters. The second patient, a 74-year-old male, died as a result of sepsis from injuries secondary to penoscrotal ischemia after >48 hour ring retention despite prompt removal at emergent presentation. Although rare, sexual practices may include the use of penoscrotal rings. When retained, ischemic injury and edema may lead to strangulation. Emergent removal may require industrial equipment that is not within the confines of normal operating room tools. Tissue injury may be severe and sepsis life-threatening, even after ring removal.

The Corn Islands are two small Caribbean islands with the richest collection of endemic herpetofaunal taxa in Nicaragua. Despite increasing human population and associated habitat alteration, both islands lack protected areas. The lizard fauna of Great Corn Island consists of 14 species corresponding to nine families, and includes three endemic taxa. We collected three lizard species (Corytophanes cristatus, Gonatodes albogularis, and Hemidactylus frenatus) that were not previously recorded from that island. On Little Corn Island, where there were no previous records of lizards, we found seven species (Ctenosaura similis, Gonatodes albogularis, Hemidactylus frenatus, Holcosus undulatus, Iguana iguana, Lepidodactylus lugubris, and Norops unilobatus), all of which are also present on Great Corn Island.

We examined the efficiency, specificity, and mutational signatures of zinc finger nucleases (ZFNs), transcriptional activator-like effector nucleases (TALENs), and clustered regularly interspaced short palindromic repeat (CRISPR)/Cas9 systems designed to target the gene encoding the transcriptional repressor BCL11A, in human K562 cells and human CD34+ progenitor cells. ZFNs and TALENs were delivered as in vitro transcribed mRNA through electroporation; CRISPR/Cas9 was codelivered by Cas9 mRNA with plasmid-encoded guideRNA (gRNA) (pU6.g1) or in vitro transcribed gRNA (gR.1). Analyses of efficacy revealed that for these specific reagents and the delivery methods used, the ZFNs gave rise to more allelic disruption in the targeted locus compared to the TALENs and CRISPR/Cas9, which was associated with increased levels of fetal hemoglobin in erythroid cells produced in vitro from nuclease-treated CD34+ cells. Genome-wide analysis to evaluate the specificity of the nucleases revealed high specificity of this specific ZFN to the target site, while specific TALENs and CRISPRs evaluated showed off-target cleavage activity. ZFN gene-edited CD34+ cells had the capacity to engraft in NOD-PrkdcSCID-IL2Rγnull mice, while retaining multi-lineage potential, in contrast to TALEN gene-edited CD34+ cells. CRISPR engraftment levels mirrored the increased relative plasmid-mediated toxicity of pU6.g1/Cas9 in hematopoietic stem/progenitor cells (HSPCs), highlighting the value for the further improvements of CRISPR/Cas9 delivery in primary human HSPCs.

After several decades of research we now have evidence that at least six interventions are suitable for immediate use in contemporary clinical practice within high-resource settings and can be expected to safely reduce the rate of preterm birth. These interventions involve strategies to prevent non-medically indicated late preterm birth; use of maternal progesterone supplementation; surgical closure of the cervix with cerclage; prevention of exposure of pregnant women to cigarette smoke; judicious use of fertility treatments; and dedicated preterm birth prevention clinics. Quantification of the extent of success is difficult to predict and will be dependent on other clinical, cultural, societal and economic factors operating in each environment. Further success can be anticipated in the coming years as other research discoveries are translated into clinical practice, including new approaches to treating intra-uterine infection, improvements in maternal nutrition and lifestyle modifications to ameliorate maternal stress. The widespread use of human papillomavirus (HPV) vaccination in girls and young women will decrease the need for surgical interventions on the cervix and can be expected to further reduce the risk of early birth.Together, this array of clinical interventions, each based on a substantial body of evidence, is likely to reduce rates of preterm birth and prevent death and disability in large numbers of children. The process begins with an acceptance that early birth is not an inevitable and natural feature of human reproduction. Preventative strategies are now available and need to be applied. The best outcomes may come from developing integrated strategies designed specifically for each health care environment.

Gene expression profiling is rapidly becoming a mainstay of functional genomic studies. However, there have been relatively few studies of how the data from expression profiles integrate with more classic approaches to examine gene expression. This study used gene expression profiling of a portion of the genome of Saccharomyces cerevisiae to explore the impact of blocks in the isoprenoid biosynthetic pathway on the expression of genes and the regulation of this pathway. Approximately 50% of the genes whose expression was altered by blocks in isoprenoid biosynthesis were genes previously known to participate in the pathway. In contrast to this simple correspondence, the regulatory patterns revealed by different blocks, and in particular by antifungal azoles, was complex in a manner not anticipated by earlier studies.—Dimster-Denk, D., J. Rine, J. Phillips, S. Scherer, P. Cundiff, K. DeBord, D. Gilliland, S. Hickman, A. Jarvis, L. Tong, and M. Ashby. Comprehensive evaluation of isoprenoid biosynthesis regulation in Saccharomyces cerevisiae utilizing the Genome Reproter Matrix™. J. Lipid Res. 1999. 40: 850–860.

We examine the coherence in the spontaneous brain activity of sleeping children as measured by the blood oxygenation level dependent (BOLD) functional magnetic resonance imaging (fMRI) signals. The results are described in terms of resting-state networks (RSN) and their properties. More specifically, in this study we examine the effect of severe prematurity on the spatial location of the visual, temporal, motor, basal ganglia, and the default mode networks, the temporal response properties of each of these networks, and the functional connectivity between them. Our results suggest that the anatomical locations of the RSNs are well developed by 18 months of age and their spatial locations are not distinguishable between premature and term born infants at 18 months or at 36 months, with the exception of small spatial differences noted in the basal ganglia area and the visual cortex. The two major differences between term and preterm children were present at 36 but not 18 months and include: 1) increased spectral energy in the low frequency range (0.01 – 0.06 Hz) for pre-term children in the basal ganglia component, and 2) stronger connectivity between RSNs in term children. We speculate that children born very prematurely are vulnerable to injury resulting in weaker connectivity between resting state networks by 36 months of age. Further work is required to determine whether this could be a clinically useful tool to identify children at risk of developmental delay related to premature birth.

Este artículo hace una revisión del impacto de los sistemas de información en las empresas en general. Muchas de las empresas nacionales e internacionales llevan consigo el trauma de haber tenido problemas serios para la implantación de un sistema de información computadorizado. "Los beneficios de las inversiones en tecnología de información se reducirán si las empresas no consideran los costos del cambio organizacional asociado con un nuevo sistema o no hacen que estos cambios sean efectivos". (Laudon 2004, 426-427). Por esto resulta conveniente de entender la problemática alrededor de los sistemas de información.

Purpose To evaluate a surface conductive radiofrequency (RF) coagulation instrument (Tissuelink FB3.0) in laparoscopic and open partial nephrectomy (PN) in hereditary kidney cancer. The lesion depth and viability in the pathologic specimens from a surgical series and an acute porcine model were characterized under conditions of vascular perfusion and occlusion.Materials and Methods A total of 19 patients underwent 20 laparoscopic and open procedures with the device. Data were acquired on tumor number, size, operative time, blood loss, length of stay, renal function, complications, pathologic diagnosis, and surgical-margin status. Renal lesions were created in pigs with the device, ultrasonic shears, and a standard electrocautery for specified time intervals and operative energy settings. These lesions were analyzed for depth, diameter, and tissue viability.Results In 20 separate (14 laparoscopic; 6 open) procedures in 19 patients, a total of 112 tumors were removed (range 1–31 tumors per procedure). The median operative time, blood loss, and length of stay were 310 minutes, 250 mL, and 4 days, respectively. There were no positive surgical margins. Median preoperative and postoperative creatinine concentrations were similar (1.0 v1.0 mgdL). The average treatment margin depth was 3 mm. In the porcine experiments, the treatment depth in the unclamped vascular model was significantly less in than the clamped model (4.0 ± 1.7 mm v7.0 ± 1.6 mm; P< 0.05). Lesion depth and diameter increased with treatment time. Viability depth correlated well with the depth of the visible thermal lesions (Pearson correlation 0.989).Conclusions This RF energy device can provided adequate and uniform hemostatic control without hilar clamping during laparoscopic and open PN for hereditary renal tumors. Gross measures of renal function after surgery appeared clinically unchanged. Coagulation depth is dependent on both tissue perfusion and time in the porcine model. [ABSTRACT FROM AUTHOR]

Vertical orthogonal joints are a common feature in shallow crustal rocks. There are several competing theories for their formation despite the ubiquity. We examined the exceptional exposures of orthogonal joints in flat-lying Ordovician limestone beds from the Havre-Saint-Pierre Region in Quebec, Canada (north shore of Saint-Lawrence River) to test conceptual models of joint formation in a natural setting. In the region, the spacing of cross-joints is consistently larger than the spacing of systematic joints by a factor of 1.5 approximately. The joint-spacing-to-bed-thickness ratios (s/t) are much larger in these beds (s/t = 4.3 for systematic joints, and 6.4 for cross-joints) than those in higher strained strata along the south shore of the Saint-Lawrence River (s/t = 1), highlighting the effect of tectonic strain in decreasing fracture spacing and block size. The high values of s/t indicate that cross-joint formation was unlikely caused by a switch from compression to tension once a critical s/t ratio for systematic joints was reached (as hypothesized in previous studies). We proposed a new model for the formation of orthogonal joint systems where the principal stress axes locally switch during the formation of systematic fractures. The presence of ladder-shaped orthogonal joints suggests a state of effective stress with σ1∗≫0 > σ2∗>σ3∗ and where σ2∗-σ3∗ is within the range of fracture strength variability at the time of fracture. This research provides a new mechanical model for the formation of orthogonal joint systems and cuboidal blocks.

Examines the problems involved in supplying the Canadian Arctic Expedition of 1913-18 and the personal views of George Phillips, the naval stores officer responsible for organizing supplies, with respect to Vilhjalmur Stefansson, the leader of the expedition, and other members of the party.

ABSTRACT Background: Rapid molecular methods such as the line probe assay (LPA) and Xpert® MTB/RIF assay (Xpert) have been recommended by the World Health Organization for drug-resistant tuberculosis (DR-TB) diagnosis. We conducted an interventional trial in DR-TB reference centers in Brazil to evaluate the impact of the use of LPA and Xpert. Methods: Patients with DR-TB were eligible if their drug susceptibility testing results were available to the treating physician at the time of consultation. The standard reference MGITTM 960 was compared with Xpert (arm 1) and LPA (arm 2). Effectiveness was considered as the start of the appropriate TB regimen that matched drug susceptibility testing (DST) and the proportions of culture conversion and favorable treatment outcomes after 6 months. Results: A higher rate of empirical treatment was observed with MGIT alone than with the Xpert assay (97.0% vs. 45.0%) and LPA (98.2% vs. 67.5%). Patients started appropriate TB treatment more quickly than those in the MGIT group (median 15.0 vs. 40.5 days; p

Cerebral dolichoectasia is an angiopathy involved in a variety of clinical presentations. Patients can rarely present with hydrocephalus as a result of ectatic vessels. We report the case of a 49-year-old male with cerebral dolichoectasia who presented with rare complications of obstructive hydrocephalus, and to our knowledge, a previously unreported cause of fourth ventricular obstruction and cerebellar edema. He represented a diagnostic challenge and after a prolonged admission he was treated successfully with a ventriculoperitoneal shunt. The underlying causes and rarity of diagnosis of cerebral dolichoectasia remain a significant barrier in the optimal treatment of patients as they are often treated for their immediate clinical problem with no definitive treatment for the underlying pathology.

Abstract Field studies have led to several interpretations on the mechanics behind slow earthquake phenomena downdip of the seismogenic zone. To date, field studies have not examined the shallow subduction interface which may also host slow earthquake phenomena. We examine a subduction mélange exhumed from conditions representing the source of shallow slow earthquake phenomena. The mélange consists of a shale matrix containing rigid blocks, including basalt which is altered along the margins. Cataclasite‐bearing faults attest to localized faulting along the altered margins of basaltic blocks, concurrent with distributed shear in the shale matrix. These cataclasite‐bearing faults link individual blocks. Microstructures show mutually crosscutting tensile and shear veins, consistent with failure having occurred at, or near, lithostatic pore fluid pressures. We model the stress concentrations around the altered margins of basaltic blocks during distributed shear and show that frictional failure of the altered basalt is predicted to occur at lower imposed strain rates than frictional failure of the shale, favoring fault development along block margins. Calculations of critical nucleation lengths for the blocks show they would fail dynamically at hydrostatic pore fluid pressures, producing microearthquakes. At near‐lithostatic pore fluid pressures, block lengths are below the critical nucleation length for dynamic failure and may produce slow earthquake phenomena. Mixing of velocity‐weakening blocks into a viscously flowing, velocity‐strengthening matrix may serve as a common mechanism for slow earthquake phenomena updip and downdip of the seismogenic zone.

Renal lymphatics are abundant in the cortex of the normal kidney but have been largely neglected in discussions around renal diseases. They originate in the substance of the renal lobule as blind-ended initial capillaries, and can either follow the main arteries and veins toward the hilum, or penetrate the capsule to join capsular lymphatics. There are no valves present in interlobular lymphatics, which allows lymph formed in the cortex to exit the kidney in either direction. There are very few lymphatics present in the medulla. Lymph is formed from interstitial fluid in the cortex, and is largely composed of capillary filtrate, but also contains fluid reabsorbed from the tubules. The two main factors that contribute to renal lymph formation are interstitial fluid volume and intra-renal venous pressure. Renal lymphatic dysfunction, defined as a failure of renal lymphatics to adequately drain interstitial fluid, can occur by several mechanisms. Renal lymphatic inflow may be overwhelmed in the setting of raised venous pressure (e.g., cardiac failure) or increased capillary permeability (e.g., systemic inflammatory response syndrome). Similarly, renal lymphatic outflow, at the level of the terminal thoracic duct, may be impaired by raised central venous pressures. Renal lymphatic dysfunction, from any cause, results in renal interstitial edema. Beyond a certain point of edema, intra-renal collecting lymphatics may collapse, further impairing lymphatic drainage. Additionally, in an edematous, tense kidney, lymphatic vessels exiting the kidney via the capsule may become blocked at the exit point. The reciprocal negative influences between renal lymphatic dysfunction and renal interstitial edema are expected to decrease renal function due to pressure changes within the encapsulated kidney, and this mechanism may be important in several common renal conditions.

Objective To compare transradial artery access (TRA) to the gold standard of transfemoral artery access (TFA) in mechanical thrombectomy (MT) for stroke caused by anterior circulation large vessel occlusion.Methods The clinical outcomes, procedural speed, angiographic efficacy and safety of both techniques were analysed in 375 consecutive cases over an 18-month period in a high volume statewide neurointerventional service.Results There was no significant difference in patient characteristics, stroke parameters, imaging techniques or intracranial techniques. The median time elapsed between CT scanning and reperfusion was 96.5 min (IQR 68–123) in the TFA group and 95 min (IQR 68–123) in the TRA group (p=0.456). Of 336 patients who were independent at presentation 58% (124/214) of the TFA group and 67% (82/122) of the TRA group had a modified Rankin score of 0–2 at 90-day follow-up (p=0.093). Cross-over from radial to femoral was 4.6% (4/130) compared with 1.6% cross-over from femoral to radial (4/245), but did not meet the predetermined level of statistical significance (OR 2.92, 95% CI 0.81 to 10.52), p=0.088) and did not impact median procedural speed. Adequate angiographic reperfusion, first pass reperfusion, embolisation to new territory and symptomatic intracranial haemorrhage were similar in both groups. There was a significant difference in major access site complications requiring an additional procedure. None of the TRA cases had a major access site complication but 6.5% (16/245) of the TFA cases did (p=0.003).Conclusion This study suggests that using TRA for anterior circulation MT is fast, efficacious, safe and not inferior to the gold standard of TFA.