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The use of fenestrated stent grafts to treat short neck, juxta- and suprarenal aortic aneurysms is increasing worldwide, but midterm outcome reports are scarce. This study aimed to report peri-operative results and midterm outcomes after five years from a single centre. Patients treated with primary fenestrated endovascular aortic aneurysm repair (FEVAR) for short neck, juxta- or suprarenal aortic aneurysms within the period January 2010 to May 2020 with follow up in the centre were included. Early (technical success, operative mortality, spinal cord ischaemia) and five year outcomes (cumulative survival, freedom from aortic related death, target vessel patency, target vessel instability [TVI], re-interventions) were analysed. A total of 349 patients (313 male, mean age 72.3 ± 7.7 years) were included in the study. Technical success was 98% (342/349). The thirty day mortality rate was 0.9% (3/349). Estimated survival at five years was 69.3 ± 3.1%. Freedom from aneurysm related death at five years was 98.8% ± 0.7%. Estimated target vessel patency at five years was 98.7 ± 0.4%. Estimated freedom from TVI at five years was 97.2 ± 0.6%. Estimated freedom from re-intervention at five years was 86.5 ± 2.3%. Survival did not differ significantly between patients with and without re-interventions (p =.088). Midterm results of FEVAR remain good as indicated by sustained target vessel patency and low aortic related mortality rates. An important proportion of patients require re-interventions, which do not have a negative impact on midterm survival. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate potential vertical changes in the position of the maxillary labial frenum (MLF) insertion in growing children and to compare these changes to the vertical growth of the dentoalveolar process and lower facial third. This retrospective longitudinal study investigated records of 33 healthy children. Dental casts, lateral cephalograms, and photographs were evaluated at pretreatment (T0), posttreatment (T1), and 3-5 years into retention (T2). To evaluate the vertical changes of MLF insertion in relation to the vertical growth of the dentoalveolar process, the palatal plane (PP) was used as a reference. These changes were also compared between different MLF typologies (ascribed as thin or fibrous). The distance from MLF to PP only slightly increased from T0 to T2 by 0.6 ± 0.5 mm (P <0.001), whereas the distance between the incisal edge and PP increased significantly from T0 to T2 by 2.6 ± 0.8 mm (P <0.001). A positive correlation was found (r = 0.94; P <0.001) between the changes from the incisal edge to the PP and the MLF to the incisal edge between T0 and T2. No correlation was found between the change from the incisal edge to the PP and MLF to PP between T0 and T2. Thin MLF types showed a larger increase in distance from their insertion to the incisal edge (2.6 ± 0.8 mm) than thick MLF types (1.8 ± 0.7; P <0.03). The MLF remains stable compared with the PP, whereas the maxillary incisal edge moves away from the PP, indicating increased vertical growth of the alveolar process. Dentists should be aware of those changes before performing interventions such as unnecessary frenectomies. • Maxillary labial frenum insertion seems to remain stable in reference to the palatal plane. • This may suggest that performing early frenectomies may not be indicated. • Growth of the dentoalveolar process results in an increased distance of the MLF to the incisal edge. [ABSTRACT FROM AUTHOR]

The benefit of using gelatin solution in cardiac surgery is still controversial. Previous data suggested adverse interactions of gelatin infusion with acute kidney injury (AKI) or coagulopathy. The purpose of this study was to evaluate the association between perioperative gelatin use and fluid overload (FO), hemodynamic stability, and outcomes compared to crystalloid-based fluid management. A retrospective study design. At a single-center tertiary university setting. Propensity score-matched cohort study of 191 pairs of patients scheduled for cardiac surgery. Patients received either gelatin + crystalloid or pure crystalloid-based perioperative fluid management. The primary outcomes were the frequency of FO and hemodynamic stability defined by the vasoactive-inotropic score. Postoperative complications and 3-year survival were analyzed also. Patients who received gelatin experienced more frequent postoperative FO than controls (11.0% v 3.1%, p = 0.006) despite comparable hemodynamic stability in both groups. Gelatin administration was linked with a higher rate of postoperative complications, including blood loss, AKI, and new-onset postoperative atrial fibrillation. Use of gelatin infusion resulted in an adjusted odds ratio of 1.982 (95% CI 1.051-3.736, p = 0.035) for developing early postoperative AKI. This study confirmed a dose-dependent relationship between gelatin infusion and AKI. Thirty-day mortality and 3-year survival were similar in the groups. Gelatin administration versus crystalloid fluid management showed a significant association with a higher rate of FO and an increased risk for early postoperative AKI in a dose-dependent manner. [ABSTRACT FROM AUTHOR]

Hip abductor pathology exists on a spectrum, potentially involving symptoms of pain, weakness, loss of active motion, and disordered movement. Imaging findings may include tendinosis, detachment of a portion of the footprint, fluid imbibition with undersurface tearing at the footprint, or full-thickness detachment of 1 or both tendons with or without evidence of fatty infiltration or atrophy of the associated muscle bellies. Yet, sometimes there are no imaging findings at all. Endoscopic repair of hip abductor tendon tears is growing in popularity and interest. Recent research suggests that with treatment of concomitant pathology, excellent clinical results are durable, even in patients with potentially poor prognoses (eg - older patients with poor preoperative patient reported outcome measures). While techniques have become increasingly refined, surgical indications remain vague and confusing. Future research could consider why some patients are taken to the operating room, while most are not. [ABSTRACT FROM AUTHOR]

Subacromial balloon spacers, a treatment option for massive irreparable rotator cuff tears, have been available in the United States since 2021 and much longer in Europe. The device has been described as a humeral head depressor that increases the subacromial space, centers the humeral head preventing superior migration, and improves deltoid mechanical advantage. This is not convincing. Balloon deflation occurs 3 months after implantation, eliminating the head-depressing effect, and the balloon fully degrades within 15 months. Some propose scarring in the subacromial space smoothes the acromial-humeral articulation; this is also unconvincing. The scar is not thick. Clinical studies largely report unchanged or worsened acromiohumeral interval after surgery. Short-term case series show improvement in pain and function, but comparative studies show mixed results. There may be some advantages over partial rotator cuff repair, but debridement alone may be sufficient treatment, and the generally positive short-term results do not determine whether symptom relief persists over the long term after balloon degradation. A recent clinical study does show mid-term improvement, but the mechanism remains unclear, and, if it is a result of smooth subacromial scarring, tuberoplasty may be an alternative. [ABSTRACT FROM AUTHOR]

To improve outcomes, to decrease the rate of local recurrence and development of distant metastases neoadjuvant and adjuvant therapies are employed in cancer patients in forms of radiation, chemo-, endocrine-, targeted-, and immunotherapy or their combination. Nutrition therapy plays important role in all phases of the cancer journey. From neoadjuvant therapy to prehabilitation, early postoperative nutrition, and long-term nutrition care during the adjuvant phase and survivorship determines the survival and quality of life of cancer patients. During the neoadjuvant phase patients may be in poor nutritional condition which can be aggravated by the applied oncological treatment. Beside this apparent threat this period also gives an excellent opportunity to maintain or even improve the nutritional status of the patients by nutrition therapy. After surgery the burdening effects of the operation may jeopardize the execution of adjuvant therapy. After early postoperative feeding a long-term nutrition strategy should be developed for cancer patients in order to avoid nutritional deterioration during the usually lengthy postoperative therapy. In this narrative review we discuss how preoperative nutritional status and medical nutrition therapy influence the results of surgery and after the operation what is the available evidence about nutritional status and outcome and the potentials to influence them by nutrition therapy. [ABSTRACT FROM AUTHOR]

Modifiable risk factors can impact the surgical outcome after total shoulder arthroplasty (TSA), yet this topic has not been adequately explored. We sought to quantify the effects of common modifiable patient risk factors on the postoperative outcomes and complications in patients who underwent total shoulder arthroplasty (TSA). Data was collected from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) 2006-2016 database for patients undergoing a principle procedure of total shoulder arthroplasty using current procedural terminology (CPT) code 23,472. Modifiable risk factors were defined as patients' smoking status, use of alcohol, diabetes, hypertension, obesity, recent loss of >10% body weight, malnutrition, and anemia. Outcomes of interest included discharge destination, surgical site infection, wound complications, and hematologic complications. There were 14,478 adult patients undergoing total shoulder arthroplasty in the NSQIP database. The majority of patients were Caucasian (83.9%), female (56.2%), and between the ages of 61 and 80 (70.1%). Malnutrition was the only preoperative modifiable variable found to be significantly associated with outcomes. Patients with malnutrition had an increased risk of nonroutine discharge status (OR = 3.12) and hematologic complications (OR = 4.58). Other modifiable risk factors (smoking status, use of alcohol, diabetes, hypertension, obesity, recent loss of >10% body weight, and anemia) analyzed were not significantly associated with outcomes. Malnutrition is associated with an approximately 3-time increased likelihood of nonroutine discharge and 5-time increased likelihood of hematologic complications after TSA. Surgeons should have heightened awareness for potential complications in these patients. While surgeons should continue to counsel their patients on all modifiable risk factors, they may not expect to see differences in the clinical outcomes following TSA. Level IV, prognostic study, retrospective case series. [ABSTRACT FROM AUTHOR]

Adjuvant durvalumab is now recommended for most patients with locally advanced non-small cell lung cancer after concurrent chemoradiotherapy. Herein, we explore the clinical factors that may be associated with the benefit from adjuvant durvalumab. Patients with non-small cell lung cancer who were treated with definitive concurrent chemoradiotherapy at our institution between August 2013 and May 2019 were included in this analysis. Clinical and treatment characteristics were tested for associations with progression-free survival (PFS) in Cox models. Interaction terms were added to the PFS Cox models to explore factors that may modulate the effects of adjuvant durvalumab. PFS and overall survival (OS) rates were estimated using the Kaplan-Meier method, and comparisons between patient subgroups were performed using log rank testing. A total of 105 patients met the eligibility criteria. Thirty-five patients (33%) received adjuvant durvalumab. Treatment with durvalumab was associated with significant improvement in PFS (1-year PFS: 67% vs 39%; log rank P =.006) and OS (1-year OS: 88% vs 76%; log rank P =.041). Exploratory analyses identified the neutrophil-to-lymphocyte ratio (NLR) after radiation therapy (RT) as a factor that may be associated with a benefit from durvalumab. For patients with post-RT NLR exceeding the cohort's median value of 4.3, receipt of adjuvant durvalumab was not associated with a significant PFS improvement (1-year PFS: 45% vs 36%; log rank P =.702). For patients with post-RT NLR <4.3, durvalumab receipt was associated with improved PFS (69% vs 41%; P =.009). High mean RT doses delivered to the heart and esophagus were associated with high post-RT NLR. We identified low NLR after chemoradiotherapy as a factor that may be associated with a benefit from adjuvant durvalumab. Validation studies are warranted. [ABSTRACT FROM AUTHOR]

Esophageal aperistalsis has been considered a relative contraindication for lung transplant because of a higher risk of allograft dysfunction secondary to reflux and aspiration induced by poor esophageal clearance. We previously reported that esophageal motility improves in some patients after lung transplant. We reviewed the clinical course of lung transplant recipients diagnosed with an aperistaltic esophagus on pretransplant testing. We identified patients diagnosed with pretransplant aperistaltic esophagus on high-resolution manometry who underwent lung transplant. Recipients with normal esophageal motility before lung transplant were used as the propensity score–matched control group. High-resolution manometry was repeated after lung transplant, and patients with aperistalsis were further divided into 2 subgroups: improved esophageal peristalsis and nonimproved peristalsis (ie, persistent aperistalsis after lung transplant). Esophageal aperistalsis was seen in 31 patients (mean age, 59.0 years; 21 men). The 1-, 3-, and 5-year post–lung transplant survivals in the aperistalsis group were 80.6%, 51.2%, and 34.9%, respectively, which was significantly lower than in the control group (90.3%, 73.4%, and 58.8%, respectively; P =.038). Post–lung transplant high-resolution manometry was performed for 29 patients in the aperistalsis group, 19 of whom demonstrated improved esophageal motility (65.5%). The 1-, 3-, and 5-year survivals after lung transplant of patients with recovery of peristalsis were similar to those of the control group (89.5%, 65.0%, and 48.8%, respectively; P = 1.000), whereas the nonimproved peristalsis group had lower survival (80.0%, 36.0%, and data unavailable, respectively; P =.012). Esophageal aperistalsis is not necessarily a contraindication for lung transplant. Improved peristalsis can be expected in up to two-thirds of these patients and is associated with good outcomes. [ABSTRACT FROM AUTHOR]

Background: The opioid epidemic is a public health crisis impacting the practice of surgeons performing primary total hip arthroplasty (THA). Seeking to evaluate changes in prescribers' practices, we asked the following questions: (1) Have the initial discharge opioids following THA changed and (2) Have initial total oral morphine milligram equivalents (OME) prescribed following THA decreased since 2014?Methods: We retrospectively reviewed discharge prescriptions for 4233 primary THAs performed between fiscal years (FYs) 2014 and 2018 throughout our healthcare system. Drug, dosing, and total OMEs were recorded. We categorized prescriptions into 3 groups: short-acting narcotics only, short-acting plus long-acting narcotics, and short-acting narcotics plus tramadol. Mean age was 59 and 63% were males.Results: The proportion of patients receiving tramadol increased from 2% (FY14) to 25% (FY18) while long-acting opioid prescriptions decreased from 44% (FY14) to 14% (FY18). Oxycodone (82%) was the most common short-acting narcotic. In total, we observed a 27% decrease in initial OME prescribed to a mean of 683 mg (FY18) (P < .0001). Short-acting only protocols had a 19% OME decrease to 589 mg (FY18). Short plus long-acting protocols haed a 23% OME decrease to 939 mg (FY18). Short-acting plus tramadol had an OME of 849 mg (FY18).Conclusion: Despite a 27% observed decrease in initial OME prescription following THA, the 683 mg mean OME in FY18 was high. Substituting tramadol for a long-acting narcotic failed to have a dramatic clinical impact on decreasing OME. These data suggest that decreasing the number of short-acting narcotic pills is a critical factor in decreasing OME. [ABSTRACT FROM AUTHOR]

An 8-year-old neutered male French Bulldog was presented with a 2-day history of intermittent vomiting, reduced appetite and recent rapid development of multiple cutaneous masses over the head and neck regions. On presentation, the patient had a moderate volume of pericardial and bilateral pleural effusion. Echocardiography demonstrated irregular, heterogeneous thickening of the walls of the right ventricle and right atrium, consistent with infiltrative intramyocardial disease. Cytological examination of fine needle aspirates from one of the cutaneous masses confirmed a mast cell tumour. Pericardial fluid analysis revealed a haemorrhagic neoplastic effusion due to mast cell neoplasia. Histopathological and immunohistochemical examination of tissues obtained post mortem confirmed a high-grade cutaneous mast cell tumour with metastasis to the heart, pericardium, mediastinum and spleen. No metastatic disease was present in the submandibular lymph nodes or liver. Immunohistochemistry demonstrated KIT staining pattern 2. There was strong nuclear Ki67 labelling in an average of 65.0 cells per grid and an average of three positive AgNORs per nucleus in neoplastic cells. Polymerase chain reaction for the activating duplication mutation in exons 8 and 11 of c-Kit were negative. To the authors' knowledge, this is the first report of a canine cutaneous mast cell tumour associated with neoplastic pericardial effusion and widespread intrathoracic metastasis. [ABSTRACT FROM AUTHOR]

Treatment of complex aortic pathologies with customised fenestrated/branched stent grafts (F/BEVAR) is associated with a longer waiting time to the procedure. This study aimed to investigate the prevalence of aneurysm rupture and mortality during the waiting time for a fenestrated/branched stent graft in a single centre. All patients with a pararenal (PAA), thoraco-abdominal (TAAA), or aortic arch aneurysm planned to be treated with a customised F/BEVAR between January 2010 and December 2018 were included. Patients planned for F/BEVAR who in the end did not undergo the procedure were analysed. 906 patients were planned to undergo F/BEVAR during the study period. Of those, 862 (95.1%) underwent the procedure as planned (FEVAR for PAA; n = 494, F/BEVAR for TAAA; n = 348, F/BEVAR for arch aneurysm; n = 20). In 44 (4.9%) patients, the procedure was cancelled. Thirty-seven (4.1%) patients died before the procedure, four (0.4%) patients turned down the procedure, two (0.2%) were cancelled because of worsened general condition, and one (0.1%) ruptured but underwent emergency open repair in another institution. Causes of death during the waiting time were: aneurysm rupture, n = 15 (1.7%); cardiac, n = 7 (0.8%); stroke, n = 3 (0.3%); gastrointestinal, n = 3 (0.3%); death after complete arch debranching, n = 2 (0.2%); infection, n = 2 (0.2%); death after transcatheter aortic valve implantation, n = 1 (0.1%); death after urological surgery, n = 1 (0.1%); unknown, n = 3 (0.3%). Aneurysm diameter was larger in patients who died of aneurysm rupture compared with patients who died as a result of other causes (79.2 ± 13 mm vs. 66.7 ± 12 mm, respectively, p =.005). Aneurysm rupture during the waiting time for F/BEVAR can occur but is rare. Patients with a larger aneurysm diameter may be at higher risk of rupture. Measures to reduce the risk of rupture during the waiting time might include the use of off the shelf devices for larger aneurysms, quicker measurement and graft plan order processes, and quicker graft construction and delivery. [ABSTRACT FROM AUTHOR]

Self-injurious behavior is a frequent phenomenon in adolescence. The present study prospectively examined life events as risk factors for the first onset of direct self-injurious behavior (D-SIB) in the Saving and Empowering Young Lives in Europe school-based multicenter sample. Longitudinal assessments with an interval of 1 year were performed within a sample of 1,933 adolescents (51.47% females; mean age 14.84 ±.9 years) from 10 European countries and Israel. The number of life events during the past 6 months predicted the first onset of D-SIB in the following year. Gender neither predicted the onset of D-SIB nor moderated the association with life events. Moreover, analyses of individual events identified a range of mainly interpersonal events within both family and peer group as proximal risk factors for first episode D-SIB. The results support the critical role of interpersonal life events in the development of D-SIB for both genders and refine the conceptualization of proximal risk factors in terms of accumulated stressors and interpersonal events. [ABSTRACT FROM AUTHOR]

Background Interleukin-15 has become a promising molecule in the context of eliciting an effective, antitumor immune response because it is able to stimulate cells of the innate and adaptive immune system. Methods We generated an interleukin-15-expressing oncolytic influenza A virus for the treatment of an established murine tumor model. Results Our oncolytic influenza A virus produced large amounts of interleukin-15 and induced proliferation and activation of human T cells in vitro. Intraperitoneal administration increased the amount of mouse natural killer cells and effector memory T cells, as well as T cell reactivity in vivo. Moreover, intratumoral injection induced a profound decrease in growth of established tumors in mice and increased the amount of tumor-infiltrating T cells and natural killer cells. Conclusion We established a stable, IL-15-producing oncolytic influenza A virus with promising immunostimulatory and antitumor attributes. [ABSTRACT FROM AUTHOR]

To determine the clinical significance of fluid imbibition at the bone-cartilage interface seen on postoperative MRI scans after osteochondral grafting of chondral lesions of the knee. Retrospective review of patients enrolled in a prospective cartilage repair registry. Included patients underwent osteochondral autografting or allografting of the knee, had minimum one year of clinical follow-up, and underwent at least two postoperative MRI scans. The primary outcome was reoperation for arthroscopic debridement and chondroplasty or graft revision. Secondary outcomes included the radiographic fate of fluid imbibition. A total of 48 knees in 46 patients were analyzed, with mean 39 months clinical follow-up. Nine patients (19%) had fluid imbibition on at least one postoperative MRI scan, all of whom received allograft. Of these, two (22%) required eventual graft revision, four (45%) underwent arthroscopic chondroplasty but did not require revision, and three (33%) did not require any additional surgery by final follow-up. No demographic or surgical variable was associated with the presence of fluid imbibition. Fluid imbibition was significantly associated with need for chondroplasty (p = 0.05), but not graft revision. Fluid imbibition on postoperative MRI following osteochondral allografting of the knee is associated with the need for arthroscopic chondroplasty, but should not be interpreted as a sign of a failing graft. Level IV, Case Series. [ABSTRACT FROM AUTHOR]

Metal pollution has been associated with anthropogenic activities, such as effluents and emissions from mines. Soil could be exposure route of wild rats to metals, especially in mining areas. The aim of this study was to verify whether soil exposure under environmentally relevant circumstances results in metal accumulation and epigenetic modifications. Wistar rats were divided to three groups: 1) control without soil exposure, 2) low-metal exposure group exposed to soil containing low metal levels (Pb: 75 mg/kg; Cd: 0.4), and 3) high-metal exposure group exposed to soil (Pb: 3750; Cd: 6). After 1 year of exposure, the metal levels, Pb isotopic values, and molecular indicators were measured. Rats in the high-group showed significantly greater concentrations of Pb and Cd in tissues. Higher accumulation factors (tissue/soil) of Cd than Pb were observed in the liver, kidney, brain, and lung, while the factor of Pb was higher in the tibia. The obtained results of metal accumulation ratios (lung/liver) and stable Pb isotope ratios in the tissues indicated that the respiratory exposure would account for an important share of metal absorption into the body. Genome-wide methylation status and DNA methyltransferase (Dnmt 3a/3b) mRNA expressions in testis were higher in the high-group, suggesting that exposure to soil caused metal accumulation and epigenetic alterations in rats. Image 1 • Environmentally relevant exposure of metal contaminated soil to rats for 1 year • Cd and Pb were accumulated in the tissues of the Wistar rat • Pb isotope values proposed large share of respiratory exposure for metal absorption • Genome-wide methylation status were altered in the testis. • DNA methyltransferase (Dnmt 3a/3b) mRNA expressions were also elevated. Soil exposure caused metal accumulation and DNA hypermethylation in rats. [ABSTRACT FROM AUTHOR]

• The Precision ID mtDNA Whole Genome Panel was evaluated in a large lineage study using different tissues. • Samples included high quality reference samples and also challenging forensic samples. • The vast majority of samples yielded full mitogenomes from diverse phylogenetic backgrounds. • We observed very high concordance to previous Sanger and other MPS-based analyses. • We observed differences in the display of heteroplasmy that deserve further research. The emergence of Massively Parallel Sequencing technologies enabled the analysis of full mitochondrial (mt)DNA sequences from forensically relevant samples that have, so far, only been typed in the control region or its hypervariable segments. In this study, we evaluated the performance of a commercially available multiplex-PCR-based assay, the Precision ID mtDNA Whole Genome Panel (Thermo Fisher Scientific), for the amplification and sequencing of the entire mitochondrial genome (mitogenome) from even degraded forensic specimens. For this purpose, more than 500 samples from 24 different populations were selected to cover the vast majority of established superhaplogroups. These are known to harbor different signature sequence motifs corresponding to their phylogenetic background that could have an effect on primer binding and, thus, could limit a broad application of this molecular genetic tool. The selected samples derived from various forensically relevant tissue sources and were DNA extracted using different methods. We evaluated sequence concordance and heteroplasmy detection and compared the findings to conventional Sanger sequencing as well as an orthogonal MPS platform. We discuss advantages and limitations of this approach with respect to forensic genetic workflow and analytical requirements. [ABSTRACT FROM AUTHOR]

The effect of thyroid dysfunction on adverse outcomes has been studied in many different patient populations. The objective of this study was to investigate the effect of thyroid hormone supplementation of donors and recipients on postoperative outcomes after orthotopic heart transplantation. Retrospective. Single center, university hospital. Two-hundred and sixty-six consecutive patients undergoing heart transplantation. No interventions. Demographic, hemodynamic, and clinical characteristics; donor and recipient United Network for Organ Sharing scores; and information on thyroid hormone support of donors and recipients were recorded. During the median follow-up of 4.59 years (interquartile range 4.26-4.92 y), 70 patients (26.3%) died. After adjustments were made for the United Network for Organ Sharing score, recipients who were treated preoperatively with l-thyroxine had a lower risk for all-cause mortality (adjusted hazard ratio [HR] 0.24, 95% confidence interval [CI] 0.06-0.98; p = 0.047) compared with recipients who were not treated with l-thyroxine. In addition, l-thyroxine treatment of donors was associated with a better recipient survival (HR 0.31, 95% CI 0.11-0.87; p = 0.025). Pretransplantation thyroid hormone supplementation of donors and recipients was associated with improved long-term survival after heart transplantation. [ABSTRACT FROM AUTHOR]

Thymic epithelial and neuroendocrine carcinomas are rare malignancies, and only a few prognosticators are defined. Surgery is the mainstay of treatment, and complete resection contributes to superior outcome. Systematic lymph node dissection is not routinely performed in thymic malignancies. The aim of this study was to assess the impact of histologically confirmed lymph node metastases on the outcome after thymectomy. We identified 53 patients with thymic epithelial or neuroendocrine carcinomas who underwent surgical resection at our center between 1999 and 2016. The clinical follow-up was retrospectively collected, and the impact of clinicopathologic factors on overall survival was analyzed. Ninety-one percent of the patients were treated taking a multimodal approach. Median overall survival was 11.3 years. Lymph node metastases were identified in 16 patients (30.2%; 11 pN1 and 5 pN2). Lymph node metastasis was associated with inferior overall survival (hazard ratio [HR] 3.03, 95% confidence interval [CI]: 1.03 to 8.87, p = 0.044). Masaoka-Koga stage (4 versus 1 to 3) was another significant prognosticator (HR 7.01, 95% CI: 2.52 to 19.50, p = 0.0002). Organ metastases were present in 18 patients at the time of thymectomy and were associated with inferior outcome (HR 5.8, 95% CI: 2.04 to 16.79, p = 0.001). This retrospective, single-center analysis demonstrates a high rate of lymph node metastasis in resectable thymic neuroendocrine tumors or carcinomas. Positive lymph nodes are associated with an inferior outcome. Prospective studies are warranted to explore whether this outcome can be improved by systematic lymphadenectomy and adjuvant therapies. Nevertheless, lymphadenectomy provides optimal staging and should be a routine part of surgery for patients with thymic malignancies. [ABSTRACT FROM AUTHOR]

Objectives Iliac branch devices (IBD) have become a widespread option to preserve antegrade internal iliac artery (IIA) flow during endovascular aneurysm repair (EVAR). Reported experience with bilateral implantation of IBDs is limited. This study aimed to describe the indications, technical options, and outcomes with the use of bilateral IBDs. Methods All patients undergoing elective implantation of bilateral Cook Zenith IBD between January 2010 and September 2017 in a single centre were included. Bilateral IBD was indicated in physically active, anatomically suitable patients and those with previous or concomitant surgery for a thoraco-abdominal aortic aneurysm or impaired collateral circulation to the IIA. Data were collected prospectively. Results Twenty-nine patients (29 male, mean age 64.1 ± 10 years) were included. Of the 58 IBDs, 48 (83%) were implanted in one procedure and 10 (17%) in two procedures (mean time between procedures 30.4 ± 9 months). Nineteen patients (65%) had a previous or simultaneous EVAR and the remaining 10 (35%) a previous or simultaneous complex aortic repair. Mean CIA diameter was 35.2 ± 8 mm. Technical success was achieved in 55 of the 58 IBDs (95%) with no mortality. Axillary artery access was used in 13 (38%) procedures. During follow up, four (7%) IIA branches occluded (1 bilateral occlusion and 2 unilateral). Estimated IIA branch patency at one and three years was 97.8% ± 2% and 88.5% ± 7%, respectively. All patients with late IIA occlusion remained asymptomatic. Re-intervention was needed in four patients (14%): two bridging stent graft extensions for type Ib endoleak, one relining of the external iliac artery because of mural in-stent thrombus and one femoro-femoral crossover bypass to treat an external iliac limb occlusion. Conclusions Bilateral implantation of IBDs is a safe and effective technique to preserve IIA flow in selected patients with suitable anatomy, showing similar technical success and mid-term outcomes to the unilateral use of the device. [ABSTRACT FROM AUTHOR]

Abstract Mass administration of macrocyclic lactones targets the transmission of the causative agents of lymphatic filariasis to their insect vectors by rapidly clearing microfilariae (Mf) from the circulation. It has been proposed that the anti-filarial action of these drugs may be mediated through the host immune system. We recently developed an in vitro assay for monitoring the attachment to and killing of B. malayi Mf by human neutrophils (PMNs) and monocytes (PBMCs), however, the levels of both cell to worm attachment and leukocyte mediated Mf killing varied greatly between individual experiments. To determine whether differences in an individual's immune cells or the Mf themselves might account for the variability in survival, PMNs and PBMCs were isolated from 12 donors every week for 4 weeks and the cells used for survival assays with a different batch of Mf, thereby keeping donors constant but varying the Mf sample. Results from these experiments indicate that, overall, killing is Mf-rather than donor-dependent. To assess whether ivermectin (IVM) or diethylcarbamazine (DEC) increase killing, Mf were incubated either alone or with immune cells in the presence of IVM or DEC. Neither drug induced a significant difference in the survival of Mf whether cultured with or without cells, with the exception of DEC at 2 h post incubation. In addition, human PBMCs and PMNs were incubated with IVM or DEC for 1 h or 16 h prior to RNA extraction and Illumina sequencing. Although donor-to-donor variation may mask subtle differences in gene expression, principle component analysis of the RNASeq data indicates that there is no significant change in the expression of any genes from the treated cells versus controls. Together these data suggest that IVM and DEC have little direct effect on immune cells involved in the rapid clearance of Mf from the circulation. Graphical abstract Image 1 [ABSTRACT FROM AUTHOR]

Purpose Distal ulnar Hounsfield unit (HU) measurements obtained from computed tomography (CT) scans of the wrist can be used to accurately screen for low bone mineral density. It is unknown whether HU measurements can also predict the risk of future fragility fractures. Therefore, the purpose of this study was to determine if the HU values of the distal ulna correlate to fragility fracture risk. Methods An electronic database of radiographs at a single institution was searched for all wrist CT scans, obtained for any reason, between January 1, 2002, and December 31, 2008, to allow a minimum of 5-year follow-up. Manual measurement of HU on sequential coronal CT slices of the distal ulnar head was taken, and mean values were recorded. Previously determined cutoff values for the diagnosis of low bone mineral density were implemented to stratify patients as at risk or not at risk for future fragility fracture. Medical records were then manually reviewed for the occurrence of any future fragility fracture (hip, spine, proximal humerus, or rib). Results There were 161 CTs in 157 patients and 34 fragility fractures in 21 patients, with a prevalence of 13.4%. The mean HU in the fragility fracture group was significantly lower (134.2 vs 197.1 HU). The percentage of low HU patients with fragility fractures was significantly higher (22.7% vs 3.8%). The odds ratio for fragility fracture in the low HU group was 7.4 (95% confidence interval, 2.1–26.2). Using previously determined cutoff values, the sensitivity and specificity of distal ulna HU values for identifying patients who would sustain at least 1 future fragility fracture were 85.7% and 55.2%, respectively. Conclusions Patients with low distal ulnar HU were significantly more likely to sustain a subsequent fragility fracture. A determination of distal ulnar HUs represents a quick, simple tool to identify patients potentially at risk for fragility fractures. Type of study/level of evidence Prognostic IV. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to compare the accuracy of a smartphone application and a mechanical pedometer for step counting at different walking speeds and mobile phone locations in a laboratory context. Methods: Seventeen adults wore an iPphone6© with Runtastic Pedometer© application (RUN), at 3 different locations (belt, arm, jacket) and a pedometer (YAM) at the waist. They were asked to walk on an instrumented treadmill (reference) at various speeds (2, 4 and 6 km/h). Results: RUN was more accurate than YAM at 2 km/h (p < 0.05) and at 4 km/h (p = 0.03). At 6 km/h the two devices were equally accurate. The precision of YAM increased with speed (p < 0.05), while for RUN, the results were not significant but showed a trend (p = 0.051). Surprisingly, YAM underestimates the number of step by 60.5% at 2 km/h. The best accurate step counting (0.7% mean error) was observed when RUN is attached to the arm and at the highest speed. Conclusions: RUN pedometer application could be recommended mainly for walking sessions even for low walking speed. Moreover, our results confirm that the smartphone should be strapped close to the body to discriminate steps from noise by the accelerometers (particularly at low speed). [ABSTRACT FROM AUTHOR]

Objective Preoperative liver function in heart failure patients is associated with extensive functional, structural, and hemodynamic abnormalities. The authors hypothesized that perioperative liver dysfunction is associated with worse 2-year survival after orthotopic heart transplantation. Design Retrospective study. Setting Single-center, university hospital. Participants The study comprised 209 consecutive patients undergoing heart transplantation. Interventions No interventions. Measurements and Main Results Hepatobiliary markers, hemodynamic parameters, echocardiographic parameters, the need for mechanical cardiac support, demographic parameters, and United Network for Organ Sharing and Model for End-Stage Liver Disease (MELD) scores were investigated. Fifty-five patients (26.3%) died, and the mean survival time was 3.61 years after transplantation. In multivariate Cox regression analysis, in addition to the preoperative modified MELD score, the 4th quartiles of the maximum aspartate transaminase (AST) and alanine transaminase levels on the 4th through 7th postoperative days were independently associated with mortality (odds ratio [OR] 2.46, 95% confidence interval [CI] 1.09-5.55; p = 0.031 and OR 2.41, 95% CI 1.13-5.18; p = 0.024, respectively). By expressing the transaminase values as the multiplier of the sex-specific top normal value, the maximum AST and alanine transaminase levels (OR 1.02, 95% CI 1.01-1.02; p < 0.001 and OR 1.02, 95% CI 1.01-1.03; p = 0.001, respectively) were linked to worse survival. Among the postdischarge parameters, the modified MELD score (OR 1.17, 95% CI 1.09-1.27; p < 0.001) and the AST level were associated with postdischarge mortality (OR 1.002, 95% CI 1.001-1.003; p < 0.001 as a continuous variable; OR 1.07, 95% CI 1.05-1.10; p < 0.001, expressed as the multiplier of the sex-specific normal value, respectively). Conclusions The severity of postoperative liver dysfunction negatively influences survival after heart transplantation, and liver function should be closely assessed in these patients. [ABSTRACT FROM AUTHOR]

As factories become increasingly computerised, and with the increasing interest in Cyber-Physical-Systems and the Internet-of-Things, the issues of software management, deployment, configuration and integration are expected to become increasingly important. This paper reports on the ongoing experiences of using the Docker container technology in a major EU research project targeting smart factories. Docker is used to distribute, deploy and manage the configuration of multiple software modules between multiple teams and demonstrator sites in multiple locations, where each module can use its own mixture of protocols, programming languages and platforms. [ABSTRACT FROM AUTHOR]

Sea turtles are globally endangered and face daily anthropogenic threats, including pollution. However, there is a lack of ecotoxicological information on sea turtles, especially in the Asia-Pacific region. This study aims to determine pollutant levels of foraging green turtles ( Chelonia mydas ) in South China, including Hong Kong, Guangdong and Taiwan, as a basis for their conservation. Scute, liver and muscle tissues of stranded green turtles were analysed for levels of 17 trace elements and methylmercury (MeHg) (n = 86 for scute and n = 14 for liver) and polybrominated diphenyl ethers (PBDEs) (n = 11 for muscle and n = 13 for liver). Ten-fold higher levels of Pb, Ba, V and Tl and 40-fold greater Cd levels were measured in green turtle livers in South China relative to other studies conducted over 10 years ago. Measured PBDE levels were also 27-fold and 50-fold greater than those reported in Australia and Japan. These results warrant further investigation of potential toxicological risks to green turtles in South China and their source rookeries in Malaysia, Micronesia, Indonesia, Marshall Islands, Japan and Taiwan. Research should target monitoring pollutant levels in sea turtles within the West Pacific/Southeast Asia regional management unit spanning East Asia to Southeast Asia to fill in knowledge gaps, in particular in areas such as Thailand, Vietnam, Indonesia, Malaysia and the Philippines where less or no data is available and where foraging grounds of sea turtles have been identified. [ABSTRACT FROM AUTHOR]

Polymer identification of plastic marine debris can help identify its sources, degradation, and fate. We optimized and validated a fast, simple, and accessible technique, attenuated total reflectance Fourier transform infrared spectroscopy (ATR FT-IR), to identify polymers contained in plastic ingested by sea turtles. Spectra of consumer good items with known resin identification codes #1–6 and several #7 plastics were compared to standard and raw manufactured polymers. High temperature size exclusion chromatography measurements confirmed ATR FT-IR could differentiate these polymers. High-density (HDPE) and low-density polyethylene (LDPE) discrimination is challenging but a clear step-by-step guide is provided that identified 78% of ingested PE samples. The optimal cleaning methods consisted of wiping ingested pieces with water or cutting. Of 828 ingested plastics pieces from 50 Pacific sea turtles, 96% were identified by ATR FT-IR as HDPE, LDPE, unknown PE, polypropylene (PP), PE and PP mixtures, polystyrene, polyvinyl chloride, and nylon. [ABSTRACT FROM AUTHOR]

In Hawaii, glyphosate-based herbicides frequently sprayed near shorelines may be affecting non-target marine species. Glyphosate inhibits aromatic amino acid biosynthesis (shikimate pathway), and is toxic to beneficial gut bacteria in cattle and chickens. Effects of glyphosate on gut bacteria in marine herbivorous turtles were assessed in vitro . When cultures of mixed bacterial communities from gastrointestinal tracts of freshly euthanized green turtles ( Chelonia mydas ), were exposed for 24 h to six glyphosate concentrations (plus deionized water control), bacterial density was significantly lower at glyphosate concentrations ≥ 2.2 × 10 − 4 g L − 1 (absorbance measured at 600 nm wavelength). Using a modified Kirby-Bauer disk diffusion assay, the growth of four bacterial isolates ( Pantoea , Proteus , Shigella , and Staphylococcus ) was significantly inhibited by glyphosate concentrations ≥ 1.76 × 10 − 3 g L − 1 . Reduced growth or lower survival of gut bacteria in green turtles exposed to glyphosate could have adverse effects on turtle digestion and overall health. [ABSTRACT FROM AUTHOR]

Background Lead battery repair workers (LBRW) and electronic repair workers (ERW) may be exposed to inorganic components during work. This study aimed at determining essential and non-essential trace elements in male LBRW, ERW, referents and a group of female petty traders (FPT) in Kumasi (Ghana), taking into account iron status and inflammation. Methods Altogether 64 LBRW, 64 ERW, 65 referents and 26 FPT were investigated in this cross-sectional study. Urine, whole blood and serum were collected for determination of trace elements. C-reactive protein and ferritin were determined in serum. Results The LBRW had higher blood concentrations of manganese (B-Mn) and lead (B-Pb) and antimony in urine (U-Sb), and lower concentrations of cobalt in blood (B-Co). Being ERW was associated with higher concentrations of blood cadmium (B-Cd), urinary tin (U-Sn) and serum chromium (S-Cr). Concentrations of selenium (B-Se), Co and mercury (B-Hg) in whole blood and iodine in urine (U-I) were relatively high. Marginal iron status appeared to be a determinant for elevated concentrations of Co in particular, but also Mn and Cd in blood. Systemic inflammation was associated with the concentrations of copper and Se. The concentrations of Hg in whole blood were highly associated with Se and arsenic (As) in whole blood, indicating fish consumption as a common source of intake of these elements. However, Hg in whole blood was only slightly associated with Se in serum. Conclusions The ERW had elevated concentrations of B-Cd, S-Cr, and U-Sn, while B-Mn, B-Pb, and U-Sb concentrations were higher among the LBRW. Iron status and inflammation had substantial impact on some element concentration. This population had high concentrations of B-Se, B-Hg and B-Co and U-I. [ABSTRACT FROM AUTHOR]

Oat β-glucan has been shown to play a positive role in influencing lipid and cholesterol metabolism. However, the mechanisms behind these beneficial effects are not fully understood. The purpose of the current work was to investigate some of the possible mechanisms behind the cholesterol lowering effect of oat β-glucan, and how processing of oat modulates lipolysis. β-Glucan release, and the rate and extent of lipolysis measured in the presence of different sources of oat β-glucan, were investigated during gastrointestinal digestion. Only a fraction of the original β-glucan content was released during digestion. Oat flakes and flour appeared to have a more significant effect on lipolysis than purified β-glucan. These findings show that the positive action of β-glucan is likely to involve complex processes and interactions with the food matrix. This work also highlights the importance of considering the structure and physicochemical properties of foods, and not just the nutrient content. [ABSTRACT FROM AUTHOR]

Humans are exposed to inorganic and organic arsenic. The total arsenic (As) concentration in urine is a commonly used biomarker of exposure. However, little is known about variability of As in biological fluids and the diurnal variation of As excretion. Main objectives were to assess the variability of As in urine, plasma (P-As), whole blood (B-As), and the blood cell fraction (C-As), and to assess diurnal variation of As excretion. Six urine samples were collected at fixed times during 24 h on two different days around one week apart among 29 men and 31 women. Blood samples were collected when the morning urine samples were delivered. The intra-class correlation coefficient (ICC) was calculated as the ratio of the between-individuals variance to the total observed variance. Geometric mean (GM) 24 h urinary excretions of As (U-As 24 h) were 41 and 39 µg/24 h on the two days of sampling. Concentrations of B-As, P-As and C-As were highly correlated with U-As 24 h and As in first void morning urine. No statistically significant differences were observed for the urinary As excretion rate between the different sampling times. A high ICC was observed for As in the cellular blood fraction (0.803), while ICC for first morning urine corrected for creatine was low (0.316). The study suggests that C-As is the most reliable biomarker for use in exposure assessment of individual exposure. Morning urine samples have low reliability for such use. No apparent diurnal variation was observed in the urinary As excretion rate. [ABSTRACT FROM AUTHOR]

Glomerular diseases are common causes of chronic kidney disease in childhood, adolescence, and adulthood. The epidemiology of glomerular diseases differs between different age groups, with minimal change disease being the leading cause of nephrotic syndrome in childhood, while membranous nephropathy and focal segmental glomerulosclerosis are more common in adulthood. IgA vasculitis is also more common in childhood. Moreover, there is a difference in disease severity with more children presenting with a relapsing form of nephrotic syndrome and a more acute presentation of antineutrophil cytoplasmic antibody–associated vasculitis and concomitant glomerulonephritis, as highlighted by the higher percentage of cellular crescents on kidney biopsy specimens in comparison with older patients. There is also a female preponderance in antineutrophil cytoplasmic antibody–associated vasculitis and more children present with tracheobroncholaryngeal disease. This article aims to summarize differences in the presentation of different glomerular diseases that are encountered commonly by pediatric and adult nephrologists and potential differences in the management. [ABSTRACT FROM AUTHOR]