To conduct a systematic review and meta-analysis to evaluate the association of a peritoneal interposition flap (PIF) with lymphocele formation following robotic-assisted laparoscopic radical ...prostatectomy (RALP) with pelvic lymph node dissection.
We conducted a systematic search of MEDLINE, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials through August 30, 2023, to identify randomized and nonrandomized studies comparing RALP with pelvic lymph node dissection with and without PIF. A random effects meta-analysis was then performed to evaluate the associations of PIF with 90-day postoperative outcomes.
Five randomized controlled trials (RCTs) and four observational studies, including a total of 2941 patients, were included. The use of PIF was associated with a reduced risk of 90-day symptomatic lymphocele formation after RALP when examining only RCTs (pooled odds ratios OR 0.44, 95% CI 0.28-0.69; I2 =3%) and both RCTs and observational studies (OR 0.35, 95% CI 0.22-0.56; I2 =17%). Similarly, use of PIF was associated with a reduced risk of 90-day any lymphocele formation (OR 0.40, 95% CI 0.28-0.56, I2 =39%). There were no statistically significant differences in postoperative complications between the two groups (OR 0.89; 95% CI 0.69-1.14; I2 =20%).
Use of the PIF is associated with an approximately 50% reduced risk of symptomatic and any lymphocele formation within 90-days of surgery, and it is not associated with an increase in postoperative complications.
The pitch of harmonic complex tones (HCTs) common in speech, music, and animal vocalizations plays a key role in the perceptual organization of sound. Unraveling the neural mechanisms of pitch ...perception requires animal models, but little is known about complex pitch perception by animals, and some species appear to use different pitch mechanisms than humans. Here, we tested rabbits' ability to discriminate the fundamental frequency (F0) of HCTs with missing fundamentals, using a behavioral paradigm inspired by foraging behavior in which rabbits learned to harness a spatial gradient in F0 to find the location of a virtual target within a room for a food reward. Rabbits were initially trained to discriminate HCTs with F0s in the range 400-800 Hz and with harmonics covering a wide frequency range (800-16,000 Hz) and then tested with stimuli differing in spectral composition to test the role of harmonic resolvability (
) or in F0 range (
) or in both F0 and spectral content (
). Together, these experiments show that rabbits can discriminate HCTs over a wide F0 range (200-1,600 Hz) encompassing the range of conspecific vocalizations and can use either the spectral pattern of harmonics resolved by the cochlea for higher F0s or temporal envelope cues resulting from interaction between unresolved harmonics for lower F0s. The qualitative similarity of these results to human performance supports the use of rabbits as an animal model for studies of pitch mechanisms, providing species differences in cochlear frequency selectivity and F0 range of vocalizations are taken into account.
Understanding the neural mechanisms of pitch perception requires experiments in animal models, but little is known about pitch perception by animals. Here we show that rabbits, a popular animal in auditory neuroscience, can discriminate complex sounds differing in pitch using either spectral cues or temporal cues. The results suggest that the role of spectral cues in pitch perception by animals may have been underestimated by predominantly testing low frequencies in the range of human voice.
Many approaches to the transfer problem argue that transfer depends on the recognition of the same or similar abstract structure in 2 different situations. However, mainstream cognitive perspectives ...and contrasting Piagetian constructivist accounts differ in their conceptualizations of structure. These differences, not clearly articulated in the literature, have significant implications for accounts of transfer. Using interview data involving undergraduates learning elementary principles of probability and statistics, and Wagner's (2006) transfer-in-pieces perspective, I extend existing constructivist accounts of transfer in at least 2 ways. First, I show how the notion of a concept projection (diSessa & Wagner, 2005;
Wagner, 2006
) reveals fine-grained mechanisms of transfer that demonstrate how people structure situations and that elaborate on the Piagetian processes of assimilation and accommodation. Second, I examine how what experts consider a single mathematical concept or principle may come to be recognized through a variety of assimilatory cognitive resources whose usefulness is influenced by contextual factors. That is, an individual might structure 2 contextually dissimilar situations differently while perceiving the same mathematical principle at work in both. Similarly, 2 or more individuals may agree on the relevance of a particular mathematical concept in a situation, even though each structures the situation differently.
The symptomatic presentation of seminal vesicle cysts with ipsilateral renal agenesis and ectopic ureter (Zinner syndrome) is rare. Patients are typically diagnosed at the third or the fourth decade ...of life and often present with infertility. Although the diagnosis can generally be made with magnetic resonance imaging, cystography can also be useful in indeterminate cases. We report on the unusual case of an 18-year-old man who presented with pelvic pain that was intensified by ejaculation. Computed tomography and magnetic resonance imaging revealed a cystic structure in the area of the right seminal vesicle that was successfully excised robotically without complications.
We compared pathological and biochemical outcomes after radical prostatectomy in patients at favorable intermediate risk who fulfilled current NCCN® (National Comprehensive Cancer Network®) ...Guidelines® for active surveillance criteria to outcomes in patients who met more traditional criteria for active surveillance.
We queried our institutional review board approved prostate cancer database for patients who met NCCN criteria for very low risk (T1c, Grade Group 1, 3 or fewer of 12 cores, 50% or less core volume and prostate specific antigen density less than 0.15 ng/ml), low risk (T1-T2a, Grade Group 1 and prostate specific antigen less than 10 ng/ml) or favorable intermediate risk (major pattern grade 3 and less than 50% positive biopsy cores) and who had 1 intermediate risk factor, including T2b/c, Grade Group 2 or prostate specific antigen 10 to 20 ng/ml. Men at intermediate risk who did not meet favorable criteria were labeled as being at unfavorable intermediate risk. Patients at favorable intermediate risk were compared to those at very low and low risk, and those at unfavorable intermediate risk to identify differences in rates of adverse pathological findings at radical prostatectomy, including Gleason score Grade Group 3-5, nonorgan confined disease or nodal involvement. Time to biochemical recurrence was compared among the groups using Cox regression.
A total of 3,686 patients underwent radical prostatectomy between January 1, 2014 and December 31, 2015. Of these men 1,454, 250 and 1,362 fulfilled the criteria for low, favorable intermediate and unfavorable intermediate risk, respectively. The rate of adverse pathological findings in favorable intermediate risk cases was significantly higher than in low risk cases and significantly lower than in unfavorable intermediate risk cases (27.4% vs 14.8% and 48.5%, respectively, each p <0.001). Time to biochemical recurrence differed significantly among the risk groups (p <0.001).
Relative to men at low risk those at favorable intermediate risk represent a distinct group. Care should be taken when selecting these patients for active surveillance and monitoring them once they are in an active surveillance program.
Transfer in Pieces Wagner, Joseph F.
Cognition and instruction,
01/2006, Letnik:
24, Številka:
1
Journal Article
Recenzirano
The theoretical perspective outlined here offers an alternative to explanations of knowledge transfer that posit its source in the construction and application of abstract, context-independent ...knowledge structures. A case study analysis of an undergraduate student's attempt to solve a series of problems related to an elementary statistical principle revealed how she came to see problems initially thought to be different as alike, as she slowly came to identify different problems as instances of a single principle. Microgenetic analysis of the data supports diSessa's (1993) knowledge-in-pieces epistemology, which suggests that complex conceptual understanding is supported by the systematization of many different types of knowledge resources, often highly sensitive to context. A "transfer-in-pieces" approach demonstrates how means of attending to (reading out) and coordinating information available in particular instances may vary as a single mathematical principle is perceived as relevant in different contextual circumstances. Transfer is revealed not as rooted in the acquisition of increasingly abstract mental representations, but through the incremental refinement of knowledge resources that account for-rather than overlook-contextual variation.
Students use a variety of resources to make sense of integration, and interpreting the definite integral as a sum of infinitesimal products (rooted in the concept of a Riemann sum) is particularly ...useful in many physical contexts. This study of beginning and upper-level undergraduate physics students examines some obstacles students encounter when trying to make sense of integration, as well as some discomfort and skepticism some students maintain even after constructing useful conceptions of the integral. In particular, many students attempt to explain what integration does by trying to use algebraic sense-making to interpret the symbolic manipulations involved in using the Fundamental Theorem of Calculus. Consequently, students demonstrate a reluctance to use their understanding of "what a Riemann sum does" to interpret "what an integral does." This research suggests an absence of instructional attention to subtle differences between sense-making in algebra and sense-making in calculus, perhaps inhibiting efforts to promote Riemann sum interpretations of the integral during calculus instruction.
Users of cochlear implant (CI) face challenges in everyday situations such as understanding conversations in noise, even with CIs in both ears. These challenges are related to difficulties with tasks ...that require fine temporal processing such as discrimination of pulse rates or interaural time differences (ITD), a major cue for sound localization. The degradation in temporal processing and ITD sensitivity are especially acute in those who lost hearing in early childhood. Here, we characterized temporal coding and ITD sensitivity of single neurons in a novel animal model of early-onset deafness. Rabbits were deafened as neonates and deprived of auditory stimulation until they reached adult age when single-unit recordings from the auditory midbrain were made chronically using an unanesthetized preparation. The results are compared to measurements from adult-deafened rabbits with normal auditory development to understand the effect of early-onset deafness on neural temporal coding and ITD sensitivity. Neurons in the inferior colliculus (IC) of early-deafened rabbits were less likely to show sustained, excitatory responses to pulse train stimulation and more likely to show suppressive responses compared to neurons in adult-deaf animals. Fewer neurons showed synchronized responses to pulse trains at any rate in the early-deaf group. In addition, fewer neurons showed significant ITD sensitivity in their overall firing rate in the early-deaf group compared to adult-deaf animals. Neural ITD discrimination thresholds in the early-deaf group were poorer than thresholds in adult-deaf group, especially at high pulse rates. The overall degradation in neural ITD sensitivity is consistent with the difficulties encountered by human CI users with early-onset hearing loss. These results lay the groundwork for investigating whether the degradations in temporal coding and ITD sensitivity observed in early-deaf animals can be reversed by appropriate CI stimulation during development.
Using case study analysis and a cognitive theoretical orientation, we examine elements of knowledge for teaching needed by a mathematician to orchestrate whole-class discussions in an undergraduate ...mathematics classroom. The instructor, an experienced teacher and mathematics researcher, used an inquiry-oriented curriculum to teach a differential equations course for the first time after teaching it with traditional lecture methods for many years. Examples of classroom teaching and interview data demonstrate that, despite having extensive teaching experience and possessing strong content knowledge, some instructors may still face challenges when trying to provide analytic scaffolding to move whole-class discussions toward a lesson's mathematical goals. We also hypothesize several component practices necessary for the successful use of analytic scaffolding. Our analysis focuses on the relationship between the instructor's pedagogical content knowledge and specialized content knowledge and his capacity to enact these component practices during whole-class discussions.
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