Jaundice in the setting of periampullary neoplasms is often treated with biliary stenting. Level 1 data demonstrated an increase in perioperative complications after pancreaticoduodenectomy in ...patients undergoing stent placement. However, the impact of this data on practice patterns in the US remains unknown.
The National Surgical Quality Improvement Program (NSQIP) Pancreatectomy Targeted Participant Use Data File was used to identify patients from 2014 to 2017 undergoing pancreatoduodenectomy. Chi-square test and multivariable logistic regression were used to compare outcomes between those with biliary stent and those without.
Of the 5524 patients, 3321 (60.1%) had biliary stent placement. The stent group was older, had a higher ASA class, and had preoperative weight loss compared to the group without biliary stenting (all p < 0.05). When adjusting for demographic and operative characteristics, the non-stent group had lower associated overall complications and postoperative infections. There was no significant difference in mortality and pancreatic fistula rate between groups.
Preoperative biliary stenting is still common prior to pancreaticoduodenectomy. With a trend toward increased utilization of neoadjuvant chemotherapy, stenting will likely remain a common practice. Recognition of increased rates of complications associated with stent placement allows for appropriate risk-benefit analysis.
A retrospective study was performed by reviewing all
spp. submissions to Northwest ZooPath from 1996 to 2019. Necropsy and biopsy specimens from 106 captive Gila monsters (
) and 49 captive beaded ...lizards (
) were reviewed. Inflammatory diseases were the most frequently diagnosed condition in
spp., and were diagnosed in 72% of all animals examined, including 76% of Gila monsters and 63% of beaded lizards. The most common cause of inflammation was bacterial infection, which was present in 52% of all
spp. with inflammation. Enterocolitis was common in Gila monsters (20%) and beaded lizards (14%), but the underlying causes were different for each species.
spp. was the most common cause of enterocolitis in Gila monsters (36%) but was not identified in beaded lizards. Amoebiasis was a common cause of enterocolitis in Gila monsters (27%) and was the most common cause of enterocolitis in beaded lizards (57%). Deposition diseases were diagnosed in 34% of all
spp. The most frequently diagnosed deposition disease in beaded lizards was urolithiasis-nephrolithiasis (12%). This disease was not diagnosed in Gila monsters. Deposition diseases that were common in Gila monsters and beaded lizards included hepatic lipidosis and renal gout. Neoplasia was diagnosed in 17% of all
spp., including 17% of Gila monsters and 18% of beaded lizards. The most common neoplasm of
spp. was renal adenocarcinoma, which was equally common in Gila monsters and beaded lizards. Less common diagnoses included degenerative diseases, trauma, nutritional disease, nonneoplastic proliferative disease, nondegenerative cardiovascular disease, and congenital malformation.
This article is composed of three independent commentaries about the state of Integrated, Coordinated, Open, Networked (ICON) principles in the American Geophysical Union Biogeosciences section, and ...discussion on the opportunities and challenges of adopting them. Each commentary focuses on a different topic: (a) Global collaboration, technology transfer, and application (Section 2), (b) Community engagement, community science, education, and stakeholder involvement (Section 3), and (c) Field, experimental, remote sensing, and real‐time data research and application (Section 4). We discuss needs and strategies for implementing ICON and outline short‐ and long‐term goals. The inclusion of global data and international community engagement are key to tackling grand challenges in biogeosciences. Although recent technological advances and growing open‐access information across the world have enabled global collaborations to some extent, several barriers, ranging from technical to organizational to cultural, have remained in advancing interoperability and tangible scientific progress in biogeosciences. Overcoming these hurdles is necessary to address pressing large‐scale research questions and applications in the biogeosciences, where ICON principles are essential. Here, we list several opportunities for ICON, including coordinated experimentation and field observations across global sites, that are ripe for implementation in biogeosciences as a means to scientific advancements and social progress.
Plain Language Summary
Biogeosciences is an interdisciplinary field that requires multiscale global data and concerted international community efforts to tackle grand challenges. However, several technical, institutional, and cultural hurdles have remained as major roadblocks toward scientific progress, hindering seamless global data acquisition and international community engagement. To bring a paradigm shift in biogeosciences, there is a need to implement integrated, coordinated, open, and networked efforts, collectively known as the Integrated, Coordinated, Open, Networked (ICON) principles. In this article, we present three related commentaries about the state of ICON, discuss needs to reduce geographical bias in data for enhancing scientific progress, and identify action items. Action items are primarily people‐centric and include but are not limited to: longer‐term funding priorities to institutionalize capacity and reduce entry costs, engagement of local stakeholders across the globe, incentivization of collaborations, and development of training and workshops for capacity building.
Key Points
Biogeosciences needs Integrated, Coordinated, Open, Networked (ICON) principles to address multiscale global problems and reduce geographical bias in scientific progress
Much potential exists for emphasizing people‐centric capacity building, involving relevant stakeholders within an ICON framework
Globally coordinated experimental and field data provide challenges and opportunities for scientific advancement in biogeosciences
Cloud droplet chemical composition is a key observable property that can aid understanding of how aerosols and clouds interact. As part of the Clouds, Aerosols and Monsoon Processes – Philippines ...Experiment (CAMP2Ex), three case studies were analyzed involving collocated airborne sampling of relevant clear and cloudy air masses associated with maritime warm convection. Two of the cases represented a polluted marine background, with signatures of transported East Asian regional pollution, aged over water for several days, while the third case comprised a major smoke transport event from Kalimantan fires.
Sea salt was a dominant component of cloud droplet composition, in spite of fine particulate enhancement from regional anthropogenic sources. Furthermore, the proportion of sea salt was enhanced relative to sulfate in rainwater and may indicate both a propensity for sea salt to aid warm rain production and an increased collection
efficiency of large sea salt particles by rain in subsaturated environments. Amongst cases, as precipitation became more significant, so too did the variability in the sea salt to (non-sea salt) sulfate ratio. Across cases, nitrate and ammonium were fractionally greater in cloud water than fine-mode aerosol particles; however, a strong
covariability in cloud water nitrate and sea salt was suggestive of prior uptake of nitrate on large salt particles.
A mass-based closure analysis of non-sea salt sulfate compared the cloud water air-equivalent mass concentration to the concentration of aerosol particles serving as cloud condensation nuclei for droplet activation. While sulfate found in cloud was generally constrained by the sub-cloud aerosol concentration, there was significant
intra-cloud variability that was attributed to entrainment – causing evaporation of sulfate-containing droplets –and losses due to precipitation. In addition, precipitation tended to promote mesoscale variability in the sub-cloud aerosol through a combination of removal, convective downdrafts, and dynamically driven convergence. Physical
mechanisms exerted such strong control over the cloud water compositional budget that it was not possible to isolate any signature of chemical production/loss using in-cloud observations. The cloud-free environment surrounding the non-precipitating smoke case indicated sulfate enhancement compared to convective mixing quantified by a stable gas tracer; however, this was not observed in the cloud water (either through use of ratios
or the mass closure), perhaps implying that the warm convective cloud timescale was too short for chemical production to be a leading-order budgetary term and because precursors had already been predominantly exhausted.
Closure of other species was truncated by incomplete characterization of coarse aerosol (e.g., it was found that only 10 %–50% of sea salt mass found in cloud was captured during clear-air sampling) and unmeasured gasphase abundances affecting closure of semi-volatile aerosol species (e.g., ammonium, nitrate and organic) and soluble volatile organic compound contributions to total organic carbon in cloud water.
Though complement (C) deposition within the transplant is associated with allograft rejection, the pathways employed have not been established. In addition, evidence suggests that C‐mediated ...cytolysis may be necessary for the tolerance‐inducing activities of mAb therapies. Hence, we assessed the role of the classical C pathway in acute allograft rejection and its requirement for experimental mAb therapies. C1q‐deficient (C1q‐/‐) recipients rejected allografts at a faster rate than wild‐type (WT) recipients. This rejection was associated with exacerbated graft pathology but not with enhanced T‐cell responses in C1q‐/‐ recipients. However, the humoral response to donor alloantigens was accelerated in C1q‐/‐ mice, as an early IgG response and IgG deposition within the graft were observed. Furthermore, deposition of C3d, but not C4d was observed in grafts isolated from C1q‐/‐ recipients. To assess the role of the classical C pathway in inductive mAb therapies, C1q‐/‐ recipients were treated with anti‐CD4 or anti‐CD40L mAb. The protective effects of anti‐CD4 mAb were reduced in C1q‐/‐ recipients, however, this effect did not correlate with ineffective depletion of CD4+ cells. In contrast, the protective effects of anti‐CD40L mAb were less compromised in C1q‐/‐ recipients. Hence, this study reveals unanticipated roles for C1q in the rejection process.
C1q deficient cardiac allograft recipients mount an exacerbated rejection response characterized by decreased numbers of Th1, accelerated alloantibody production, and IgG and C3d deposition within the graft.
ABSTRACT The most stringent local measurement of the Hubble–Lemaître constant from Cepheid-calibrated Type Ia supernovae (SNe Ia) differs from the value inferred via the cosmic microwave background ...radiation (Planck+ΛCDM) by ~5σ. This so-called Hubble tension has been confirmed by other independent methods, and thus does not appear to be a possible consequence of systematic errors. Here, we continue upon our prior work of using Type II supernovae to provide another, largely independent method to measure the Hubble–Lemaître constant. From 13 SNe II with geometric, Cepheid, or tip of the red giant branch (TRGB) host-galaxy distance measurements, we derive H$_0= 75.4^{+3.8}_{-3.7}$ km s-1 Mpc-1 (statistical errors only), consistent with the local measurement but in disagreement by ~2.0σ with the Planck+ΛCDM value. Using only Cepheids (N = 7), we find H$_0 = 77.6^{+5.2}_{-4.8}$ km s-1 Mpc-1, while using only TRGB (N = 5), we derive H$_0 = 73.1^{+5.7}_{-5.3}$ km s-1 Mpc-1. Via 13 variants of our data set, we derive a systematic uncertainty estimate of 1.5 km s-1 Mpc-1. The median value derived from these variants differs by just 0.3 km s-1 Mpc-1 from that produced by our fiducial model. Because we only replace SNe Ia with SNe II – and we do not find statistically significant difference between the Cepheid and TRGB H0 measurements – our work reveals no indication that SNe Ia or Cepheids could be the sources of the ‘H0 tension.’ We caution, however, that our conclusions rest upon a modest calibrator sample; as this sample grows in the future, our results should be verified.
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