We present WMAP seven-year observations of bright sources which are often used as calibrators at microwave frequencies. Ten objects are studied in five frequency bands (23-94 GHz): the outer planets ...(Mars, Jupiter, Saturn, Uranus, and Neptune) and five fixed celestial sources (Cas A, Tau A, Cyg A, 3C274, and 3C58). The seven-year analysis of Jupiter provides temperatures which are within 1 Delta *s of the previously published WMAP five-year values, with slightly tighter constraints on variability with orbital phase (0.2% ? 0.4%), and limits (but no detections) on linear polarization. Observed temperatures for both Mars and Saturn vary significantly with viewing geometry. Scaling factors are provided which, when multiplied by the Wright Mars thermal model predictions at 350 Delta *mm, reproduce WMAP seasonally averaged observations of Mars within ~2%. An empirical model is described which fits brightness variations of Saturn due to geometrical effects and can be used to predict the WMAP observations to within 3%. Seven-year mean temperatures for Uranus and Neptune are also tabulated. Uncertainties in Uranus temperatures are 3%-4% in the 41, 61, and 94 GHz bands; the smallest uncertainty for Neptune is 8% for the 94 GHz band. Intriguingly, the spectrum of Uranus appears to show a dip at ~30 GHz of unidentified origin, although the feature is not of high statistical significance. Flux densities for the five selected fixed celestial sources are derived from the seven-year WMAP sky maps and are tabulated for Stokes I, Q, and U, along with polarization fraction and position angle. Fractional uncertainties for the Stokes I fluxes are typically 1% to 3%. Source variability over the seven-year baseline is also estimated. Significant secular decrease is seen for Cas A and Tau A: our results are consistent with a frequency-independent decrease of about 0.53% per year for Cas A and 0.22% per year for Tau A. We present WMAP polarization data with uncertainties of a few percent for Tau A. Where appropriate, WMAP results are compared against previous findings in the literature. With an absolute calibration uncertainty of 0.2%, WMAP data are a valuable asset for calibration work.
Background
Oncological outcomes of locally advanced rectal cancer depend on the quality of surgical and oncological management. Enhanced recovery pathways (ERPs) have yet to be assessed for their ...oncological impact when used in combination with minimally invasive surgery. This study assessed outcomes with or without an ERP in patients with rectal cancer.
Methods
This was a retrospective analysis of all consecutive adult patients who underwent elective minimally invasive surgery for primary rectal adenocarcinoma with curative intent between February 2005 and April 2018. Both laparoscopic and robotic procedures were included. Short‐term morbidity and overall survival were compared between patients treated according to the institutional ERP and those who received conventional care.
Results
A total of 600 patients underwent minimally invasive surgery, of whom 320 (53·3 per cent) were treated according to the ERP and 280 (46·7 per cent) received conventional care. ERP was associated with less overall morbidity (34·7 versus 54·3 per cent; P < 0·001). Patients in the ERP group had improved overall survival on univariable (91·4 versus 81·7 per cent at 5 years; hazard ratio (HR) 0·53, 95 per cent c.i. 0·28 to 0·99) but not multivariable (HR 0·78, 0·41 to 1·50) analysis. Multivariable analysis revealed age (HR 1·46, 1·17 to 1·82), male sex (HR 1·98, 1·05 to 3·70) and complications (HR 2·23, 1·30 to 3·83) as independent risk factors for compromised overall survival. Disease‐free survival was comparable for patients who had ERP or conventional treatment (80·5 versus 84·6 per cent at 5 years respectively; P = 0·272).
Conclusion
Treatment within an ERP was associated with a lower morbidity risk that may have had a subtle impact on overall but not disease‐specific survival.
The present investigation aimed to investigate oncological outcomes, comparing enhanced recovery pathway (ERP) versus conventional care by reporting a retrospective analysis of patients undergoing minimally invasive surgery for rectal adenocarcinoma from 2005 to 2018. A total of 600 patients were included in the analysis. The results showed ERP to be associated with a non‐significant improvement in overall survival whereas complications were a main driver for long‐term mortality.
Less complications may reduce cancer risk
We describe a sampling method to estimate the polarized cosmic microwave background (CMB) signal from observed maps of the sky. We use a Metropolis-within-Gibbs algorithm to estimate the polarized ...CMB map, containing Q and U Stokes parameters at each pixel, and its covariance matrix. These can be used as inputs for cosmological analyses. The polarized sky signal is parameterized as the sum of three components: CMB, synchrotron emission, and thermal dust emission. The polarized Galactic components are modeled with spatially varying power-law spectral indices for the synchrotron, and a fixed power law for the dust, and their component maps are estimated as by-products. We apply the method to simulated low-resolution maps with pixels of side 7.2 deg, using diagonal and full noise realizations drawn from the WMAP noise matrices. The CMB maps are recovered with goodness of fit consistent with errors. Computing the likelihood of the E-mode power in the maps as a function of optical depth to reionization, Delta *t, for fixed temperature anisotropy power, we recover Delta *t = 0.091 +/- 0.019 for a simulation with input Delta *t = 0.1, and mean Delta *t = 0.098 averaged over 10 simulations. A 'null'simulation with no polarized CMB signal has maximum likelihood consistent with Delta *t = 0. The method is applied to the five-year WMAP data, using the K, Ka, Q, and V channels. We find Delta *t = 0.090 +/- 0.019, compared to Delta *t = 0.086 +/- 0.016 from the template-cleaned maps used in the primary WMAP analysis. The synchrotron spectral index, Delta *b, averaged over high signal-to-noise pixels with standard deviation Delta *s( Delta *b) < 0.25, but excluding ~6% of the sky masked in the Galactic plane, is -3.03 +/- 0.04. This estimate does not vary significantly with Galactic latitude, although includes an informative prior.
Endothelium-dependent flow-mediated dilation is a homeostatic response to short-term increases in local shear stress. Flow-mediated dilation of the brachial artery in response to postischemic ...reactive hyperemia is impaired in patients with cardiovascular disease risk factors and may reflect local endothelial dysfunction in the brachial artery. However, previous studies have largely neglected the effect of risk factors on evoked shear stress, which is the stimulus for dilation. We evaluated brachial artery percent dilation and evoked diastolic shear stress during reactive hyperemia using high-resolution ultrasound and Doppler in 2045 participants (1107 women, mean age 61 years) in the Framingham Offspring Study. In age- and sex-adjusted models, baseline and hyperemic shear stress were related to brachial artery percent dilation. In stepwise multivariable analyses examining clinical correlates of percent dilation (without shear stress in the model), age, sex, mean arterial pressure, pulse pressure, heart rate, body mass index, lipid medication use, and hormone replacement therapy were related to percent dilation (R =0.189; P <0.001). When hyperemic shear stress was incorporated, the overall R improved (R =0.335; P <0.001), but relationships between risk factors and percent dilation were attenuated (age and mean arterial pressure) or no longer significant (all others). In contrast, risk factors were related to baseline and hyperemic shear stress in multivariable analyses. Evoked hyperemic shear stress is a major correlate of brachial artery flow–mediated dilation. The associations between many risk factors and brachial artery flow–mediated dilation may be attributable to reduced stimulus for dilation rather than impaired local conduit artery response during hyperemia.
A 25 year experience of perineal hernia repair McKenna, N. P.; Habermann, E. B.; Larson, D. W. ...
Hernia : the journal of hernias and abdominal wall surgery,
04/2020, Letnik:
24, Številka:
2
Journal Article
Recenzirano
Purpose
Though perineal hernias remain rare, the incidence is reportedly rising. Secondary to the historical rarity, optimal method of repair and outcomes after repair remain poorly understood. ...Therefore, we reviewed the past 25 years of our institutional experience with perineal hernia repair.
Methods
A retrospective review of an institution-maintained database was conducted from January 1, 1994 to January 31, 2018 for patients undergoing perineal hernia repair. Data were collected on patient characteristics, operative technique, and post-operative outcomes.
Results
Twenty-one patients (
n
= 12 male) underwent perineal hernia repair in the study period with two-thirds of the operations occurring in the most recent 7 years (since January 1, 2011). The median time to repair was 13 months (range 2–127) after index operation. The approach was transabdominal in nine, perineal in nine, and combined in three. Mesh, a tissue flap, or a combination of these was used in 19 of the cases and 6 additional abdominal wall hernias were repaired concurrently. Post-operative complications consisted of superficial surgical-site infection (
n
= 2), infected seroma (
n
= 1), and a missed enterotomy (
n
= 1). Follow-up ranged from 0 to 112 months (median 2 months) and only one recurrence was noted.
Conclusion
Presentation for repair of perineal hernia has increased at our instituion over the past 2 decades. Outcomes did not differ between the three repair approaches and the choice of mesh or tissue-based repair. Surgeons should base these decisions on hernia complexity and local tissue conditions.
CONTEXT Several reports have suggested the usefulness of plasma brain natriuretic
peptide (BNP) as a screening test for left ventricular hypertrophy (LVH) and
systolic dysfunction (LVSD). Prior ...studies were limited by small sample sizes
and selection bias and none compared the diagnostic performance of these peptides
in men and women. OBJECTIVES To examine the usefulness of natriuretic peptides for screening for
elevated LV mass and LVSD in the community. DESIGN, SETTING, AND PARTICIPANTS Community-based prospective cohort study of 3177 participants (1707
women) from the Framingham Study who attended a routine examination in 1995-1998. MAIN OUTCOME MEASURES Receiver operating characteristic (ROC) curves, test sensitivity, specificity,
positive and negative predictive values, and likelihood ratios for identifying
elevated LV mass (sex-specific 90th percentile or higher of LV mass/height2), LVSD (ejection fraction ≤50% and/or fractional shortening <29%),
and moderate to severe LVSD (ejection fraction ≤40% and/or fractional shortening
<22%) at different discrimination limits of plasma BNP and N-terminal proatrial
natriuretic peptide (NT-ANP), with echocardiography as the criterion standard. RESULTS The areas under the ROC curves for elevated LV mass or LVSD were at
or below 0.75 for both peptides, were higher for men compared with women,
and were similar for BNP and NT-ANP. The diagnostic performance of natriuretic
peptides for LVSD improved in women but not in men when select high-risk subgroups
were targeted. Discrimination limits based on high specificity (0.95) yielded
better positive predictive values and likelihood ratios compared with age-
and sex-specific reference limits yet only identified less than one third
of participants who had elevated LV mass or LVSD. CONCLUSION In our large community-based sample, the performance of BNP and NT-ANP
for detection of elevated LV mass and LVSD was suboptimal, suggesting limited
usefulness of natriuretic peptides as mass screening tools.
Background
The prognostic value of pathological lymph node status following neoadjuvant radiotherapy (ypN) remains unclear. This study was designed to determine whether ypN status predicted overall ...survival.
Methods
Patients with locally advanced rectal adenocarcinoma who underwent neoadjuvant long‐course radiation between 2005 and 2014 were identified from the National Cancer Data Base, and divided into ypN0, ypN1 and ypN2 groups. The primary outcome was overall survival. Univariable and multivariable analyses were used to determine factors associated with overall survival.
Results
Of 12 271 patients, 3713 (30·3 per cent) were found to have residual nodal positivity. A majority of patients with ypN1 (1663 of 2562) and ypN2 (878 of 1151) disease had suspected lymph node‐positive disease before neoadjuvant therapy, compared with 3959 of 8558 with ypN0 tumours (P < 0·001). Moreover, ypN1 and ypN2 were significantly associated with ypT3–4 disease (65·7 and 83·0 per cent respectively versus 39·4 per cent for ypN0; P < 0·001). In unadjusted analyses, survival differed significantly between ypN groups (P < 0·001). Five‐year survival rates were 81·6, 71·3 and 55·0 per cent for patients with ypN0, ypN1 and ypN2 disease respectively. After adjustment for confounding variables, ypN1 and ypN2 remained independently associated with overall survival: hazard ratio (HR) 1·61 (95 per cent c.i. 1·46 to 1·77) and 2·63 (2·34 to 2·95) respectively (P < 0·001). Overall survival was significantly longer in patients with ypN1–2 combined with ypT0–2 status than among those with ypT3–4 tumours even with ypN0 status (P = 0·031). Clinical nodal status before neoadjuvant therapy was not significantly associated with overall survival (HR 1·05, 0·97 to 1·13; P = 0·259).
Conclusion
Both ypT and ypN status is of prognostic significance following neoadjuvant therapy for rectal cancer.
Post‐treatment T stage predicts prognosis
Retrorectal tumors are rare tumors that require resection for symptoms, malignancy and potential malignant transformation. Traditional approaches have included laparotomy, perineal excision or a ...combination. Multiple minimally invasive techniques are available which have the potential to minimize morbidity and enhance recovery. We performed a systematic review of the literature to determine the feasibility and surgical outcomes of retrorectal tumors approached using minimally invasive surgical techniques. Publications in which adult patients (≥ 18 years) had a minimally invasive approach (laparoscopic or robotic) for resection of a primary retrorectal tumor were included. Data were collected on approach, preoperative investigation, size and sacral level of the tumor, operating time, length of stay, perioperative complications, margins and recurrence. Thirty-five articles which included a total of 82 patients met the inclusion criteria. The majority of patients were female (
n
= 65; 79.2%), with a mean age of 41.7 years (range 18–89 years). Seventy-three patients (89.0%) underwent laparoscopic or combined laparoscopic–perineal resection, and 9 (10.8%) had a robotic approach. The conversion rate was 5.5%. The overall 30-day morbidity rate was 15.7%, including 1 intraoperative rectal injury (1.2%). Ninety-five percent (
n
= 78) of the retrorectal tumors were benign. Median length of stay was 4 days for both laparoscopic and robotic groups, with ranges of 1–8 and 2–10 days, respectively. No tumor recurrence was noted during follow-up median 28 months (range 5–71 months). A minimally invasive approach for the resection of retrorectal tumors is feasible in selected patients. Careful patient selection is necessary to avoid incomplete resection and higher morbidity than traditional approaches.
Background
Pancreatitis is a common disease in cats that is difficult to diagnose.
Hypothesis/Objectives
To determine the sensitivity and specificity of ultrasonographic changes of the pancreas with ...serum feline pancreatic lipase immunoreactivity (fPLI) as the standard for diagnosis of pancreatitis.
Animals
35 cats with clinical signs consistent with pancreatitis with an abdominal ultrasound examination and serum fPLI concentration measured within 3 days of the ultrasound.
Methods
Retrospective study: Pancreatic thickness, pancreatic margination, pancreatic echogenicity, and peripancreatic fat echogenicity were evaluated. Sensitivity and specificity were calculated with an elevated serum fPLI concentration indicative of pancreatitis as the standard for diagnosis.
Results
Serum fPLI was elevated and diagnostic for pancreatitis in 19 of 35 cats. The single ultrasound characteristic with the highest sensitivity was hyperechoic peripancreatic fat at 68% (95% confidence interval = 44–87%), indicating a moderate probability that cats with pancreatitis will have this abnormality on ultrasonographic examination. Specificity was >90% for each of increased pancreatic thickness, abnormal pancreatic margin, and hyperechoic peripancreatic fat. The sensitivity and specificity of ultrasound were 84% (95% confidence interval = 60–97%) and 75% (95% confidence interval = 48–93%), respectively, in cats with elevated serum fPLI indicative of pancreatitis.
Conclusions and Clinical Importance
The presence of a thick left limb of the pancreas, severely irregular pancreatic margins, and hyperechoic peripancreatic fat in cats with appropriate clinical signs and elevated serum fPLI are highly supportive of pancreatitis.
•We present a one-on-one grant writing Partnership for pre- and post-doctoral trainees.•The rate of funding for participants was 81.0% vs. 42.1% for non-participants.•A Partnership effectively ...supports trainees writing grant proposals.•A school of nursing can invest in a Partnership to increase its research capacity.
The training and mentoring of pre- and post-doctoral trainees in nursing research is essential to feed the pipeline of nurses prepared to launch an independent program of research.
The purpose of this report is to describe a one-on-one grant writing Partnership developed in a school of nursing targeting pre- and post-doctoral trainees and quantify its impact on funding rates.
The Partnership includes four key elements: regular meetings, setting a timeline with milestones, writing and editing support, and attention to administrative documents. Forty grant applications by pre- and post-doctoral trainees were developed and submitted from 2011 to 2020.
Among Partnership participants, 81.0% (17/21) received funding as compared with 42.1% (8/19) who did not participate, p = .02.
Schools of nursing and other disciplines should consider investing in a Partnership to provide grant writing support their pre- and post-doctoral trainees and increase their overall research capacity.
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