Hepatic resection is one of the mainstays of curative therapy for hepatocellular carcinoma (HCC). The appropriate selection of resectable candidates requires careful consideration of a multitude of ...factors including tumor burden (size and number of nodules, presence of vascular involvement, extrahepatic spread), patient factors (performance status, underlying liver function), and availability of other therapies (access to transplantation, interventional procedures, immunotherapies). Historically, hepatic resection for HCC has been reserved for patients with solitary tumors without vascular invasion. However, in well-selected patients HCC tumors multifocal in nature or with vascular invasion should be considered for hepatic resection.
Rationale
A major challenge in the pharmacological treatment of psychotic disorders is the effective management of the associated cognitive dysfunctions. Novel concepts emphasize a potential benefit ...of partial agonists acting upon dopamine D
2
-like receptors in ameliorating these cognitive deficits, and pre-clinical studies suggest that D
3
-receptor-preferring compounds can exert pro-cognitive effects.
Objective
The objective of the study was to use acute phencyclidine (PCP) treatment to model the cognitive deficits of schizophrenia in mice, and to test the efficacy of the novel, dopamine D
3
-receptor-preferring drug cariprazine in ameliorating the severity of PCP-triggered cognitive deficits.
Methods
One group of wild-type or D
3
-receptor knockout mice was acutely treated with either saline or phencyclidine (PCP, 1 mg/kg). A separate group of mice was treated with cariprazine prior to PCP administration. Both groups were then tested in three cognitive tasks: social interaction/recognition and recognition memory, spatial working memory, and attention-set-shifting.
Results
PCP effectively disrupted social recognition and social recognition memory, spatial working memory, and extradimensional attention set-shifting. Cariprazine pretreatment significantly attenuated the emergence of these cognitive deficits in PCP-treated wild-type mice, but not in PCP-treated D
3
-receptor knockout mice.
Conclusions
In an animal model of PCP-induced cognitive impairment, cariprazine pretreatment significantly diminished PCP-triggered cognitive deficits, and studies on knockout mice show that dopamine D
3
receptors contribute to this effect.
Hepatocellular carcinoma (HCC) is one of the most common causes of cancer-related death worldwide. Partial hepatectomy, one of a few curative therapeutic modalities, is plagued by high recurrence ...rate of up to 70% at 5 years. Throughout the past 3 decades, many clinical trials have attempted to improve HCC recurrence rate following partial hepatectomy using adjuvant and neoadjuvant treatment modalities such as antiviral therapy, brachytherapy, systemic chemotherapy, immunotherapy, transarterial chemoembolization and radioembolization, and radiotherapy. The goal of this review is to discuss the clinical trials pertaining to resectable HCC including surgical technique considerations, adjuvant, and neoadjuvant treatment modalities.
Wearable devices have many applications ranging from health analytics to virtual and mixed reality interaction, to industrial training. For wearable devices to be practical, they must be responsive, ...deformable to fit the wearer, and robust to the user's range of motion. Signals produced by the wearable must also be informative enough to infer the precise physical state or activity of the user. Herein, a fully soft, wearable glove is developed, which is capable of real‐time hand pose reconstruction, environment sensing, and task classification. The design is easy to fabricate using low cost, commercial off‐the‐shelf items in a manner that is amenable to automated manufacturing. To realize such capabilities, resisitive and fluidic sensing technologies with machine learning neural architectures are merged. The glove is formed from a conductive knit which is strain sensitive, providing information through a network of resistance measurements. Fluidic sensing captured via pressure changes in fibrous sewn‐in flexible tubes, measuring interactions with the environment. The system can reconstruct user hand pose and identify sensory inputs such as holding force, object temperature, conductability, material stiffness, and user heart rate, all with high accuracy. The ability to identify complex environmentally dependent tasks, including held object identification and handwriting recognition is demonstrated.
Inspired by human tactile sensing which fuses proprioceptive and contact information, a soft wearable glove is developed, which merges resistive strain and fluidic pressure sensing for accurate intrinsic and environmental data‐driven reasoning. The device is inexpensive, fiber‐based, and simple to manufacture, and can determine hand pose, heart rate, material stiffness, object conductibility, temperature, and stiffness, grasped objects, and written characters.
Purpose
Patients with congenital central hypoventilation syndrome (CCHS) have autonomic dysfunction and lack ventilatory responses to hypoxemia and hypercarbia and thus are prone to adverse events ...during general anesthesia. The objective of this study was to describe the perioperative outcomes of patients with CCHS who were undergoing diaphragm pacer (DP) implantation surgeries under general anesthesia.
Methods
A retrospective cohort study was conducted on patients with CCHS who underwent DP implantation surgeries at CHLA between January 2000 and May 2016. Charts were reviewed for demographics,
PHOX2B
genotype, ventilatory support, comorbidities, anesthesia administered, and perioperative courses.
Results
Of 19 patients with CCHS (58% female) mean age at surgeries was 8.6 ± 5.8 years. Seventeen patients were ventilator-dependent during sleep only; two were ventilator dependent 24 h per day. Mean surgery duration was 3.1 ± 0.5 h. Seventeen patients were extubated to PPV via tracheostomy in the OR. Two patients were extubated to NPPV on postoperative day (POD) 1. Mean transition time to home ventilator or NPPV was 3.0 ± 2.2 days, and mean hospital stay was 5.0 ± 2.1 days. One patient premedicated without ventilatory support developed hypoxemia and hypoventilation. Ten patients (52%) had intraoperative events such as bradycardia, hypotension, significant hypoxemia, and bronchospasm. Fifteen patients had postoperative events. Hypoxemia, pneumonia, and atelectasis accounted for most of perioperative complications. One patient experienced seizure on POD 2 due to hypercarbia.
Conclusion
Patients with CCHS are vulnerable to the cardiorespiratory effects of sedative and anesthetic agents. Therefore, they require vigilant monitoring and optimal ventilatory support in the perioperative period.
Lateral pelvic lymph node (LPLN) involvement occurs in 10%–25% of rectal cancer cases. Total mesorectal excision (TME) with routine LPLN dissection (LPLND) is predominantly applied in Japan whereas ...TME with neoadjuvant treatment are used in the West. LPLND is a morbid procedure and minimally invasive techniques may help reduce its morbidity. Selective lateral pelvic node dissection with TME following neoadjuvant treatment achieves acceptable disease‐free and overall survival.
Military sexual trauma (MST) is a prevalent issue within the U.S. military. Victims are more likely to develop comorbid diseases such as posttraumatic stress disorder (PTSD) and major depressive ...disorder (MDD). Nonetheless, not everyone who suffers from MST develops PTSD and/or MDD. DNA methylation, which can regulate gene expression, might give us insight into the molecular mechanisms behind this discrepancy. Therefore, we sought to identify genomic loci and enriched biological pathways that differ between patients with and without MST, PTSD, and MDD.
Saliva samples were collected from 113 female veterans. Following DNA extraction and processing, DNA methylation levels were measured through the Infinium HumanMethylationEPIC BeadChip array. We used limma and bump hunting methods to generate the differentially methylated positions and differentially methylated regions (DMRs), respectively. Concurrently, we used Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genome to find enriched pathways.
A DMR close to the transcription start site of ZFP57 was differentially methylated between subjects with and without PTSD, replicating previous findings and emphasizing the potential role of ZFP57 in PTSD susceptibility. In the pathway analyses, none survived multiple correction, although top GO terms included some potentially relevant to MST, PTSD, and MDD etiology.
We conducted one of the first DNA methylation analyses investigating MST along with PTSD and MDD. In addition, we found one DMR near ZFP57 to be associated with PTSD. The replication of this finding indicates further investigation of ZFP57 in PTSD may be warranted.
•We investigated the differences in DNA methylation levels between subjects with and without MST, PTSD, and MDD.•This is the first study investigating the epigenetics status associated with MST.•A DMR close to the TSS of the ZFP57 gene was differentially methylated between subjects with and without PTSD.•This finding replicates previous findings and emphasizes the potential role of ZFP57 in PTSD susceptibility.
Background
Surgical management of traumatic duodenal injury remains challenging. While various surgical techniques have been described in the attempt to reduce complications and mortality, recent ...data suggests that surgical approach using less invasive procedures might be associated with improved patient outcomes. The purpose of this study was to determine the recent trend of surgical procedures performed for patients with duodenal injury and their outcome.
Methods
A retrospective analysis of the National Trauma Data Bank (NTDB) from 2002 to 2014 was performed. A total of 2163 patients who sustained a traumatic duodenal injury requiring surgical intervention were included. Patient characteristics, injury data, procedures, and outcomes were examined. Types of duodenal procedures and patient outcomes were compared between two study periods (2002–2006 vs. 2007–2014).
Results
The median age was 27 (IQR 20–39), 78.9% were male, and 63.8% sustained penetrating duodenal injury. The median injury severity score was 18 (IQR 13–26). In patients with isolated duodenal injury, the later study period (2007–2014) was significantly associated with the increased use of primary repair (OR 1.77; 95% CI 1.11–2.83,
p
= 0.017). Overall mortality was 11.7%. Patients in the later study group were significantly associated with lower odds of inhospital mortality (OR 0.47, 95% CI 0.22–0.95,
p
= 0.041).
Conclusions
A progressive trend toward less invasive procedures for duodenal injury was noted in the current study. Inhospital mortality has improved in the late study period.
Abstract only
Mycobacteriophages are viruses that infect bacterial cells of the genus
Mycobacterium
. With more than 400 mycobacteriophage genomes sequenced and available in GenBank, they represent ...the largest collection of sequenced phages that infect a single host (
Mycobacterium smegmatis
). They possess a multitude of unfamiliar or novel genes – genes encoding protein sequences that do not resemble any previously studied proteins – and thus encode products with functions not readily predicted. We hypothesized that some of those genes encode products that interfere with the normal metabolism of the host cell, possibly through specific phage‐host protein‐protein interactions, and thus have a role in enabling phage infection. Further, we predicted that those gene products when expressed alone in host cells would still be toxic and impair cell growth. We have investigated unfamiliar genes in two genetically distinct mycobacteriophages, Pumpkin and Vix, and have identified 4 single genes (Pumpkin_115, Pumpkin_119, Pumpkin_142, Vix_80) and several small genomic regions (Pumpkin gene segment 130–133 and Vix gene segments 65–66, 68–72, 87–88) that are cytotoxic to
M. smegmatis
. We are taking a multi‐prong approach to further identify the specific functions associated with these genes and their products and to determine their roles in the infection process: 1) we have identified mutants of
M. smegmatis
that are resistant to the expression of those genes, 2) we are using
E. coli
‐expressed phage genes to screen for interacting host proteins, 3) we are collecting microscopy data that could identity phage interruption of normal cellular function, and 4) we are in the process of deleting these genes from the phage genome to determine the effect on infection. 24‐hour expression of individual cytotoxic phage genes in M. smegmatis resulted in a significant increase in mean host cell length and some subtle effects on cell shape. Ongoing analysis of the mutants has identified a common mechanism of resistance to distinct phage gene expression, while protein‐protein interaction studies have not yet identified a potential host target involved in translation.
Support or Funding Information
Supported by a Jacob E. Nyenhuis Faculty Development Grant and an HHMI Faculty Research Award
BACKGROUND/OBJECTIVES
Detecting delirium is important to identify patients with a high risk of poor outcomes. Although many different kinds of screening instruments for delirium exist, there is no ...solid consensus about which methods are the most effective. In addition, it is important to find the most useful tools in predicting outcomes such as mortality.
DESIGN
Retrospective cohort study.
SETTING
University of Iowa Hospitals and Clinics.
PARTICIPANTS
A total of 1,125 adult inpatients (mean age = 67.7; median age = 69).
MEASUREMENTS
Post hoc analyses were performed based on existing data from the Confusion Assessment Method for Intensive Care Unit (CAM‐ICU), Delirium Rating Scale‐Revised‐98 (DRS), and the Delirium Observation Screening Scale (DOSS). Correlation among these scales and relationships between 365‐day mortality and each scale were evaluated.
RESULTS
A positive result on the CAM‐ICU (“CAM‐ICU positive”) was associated with higher DRS and DOSS scores. A DRS score = 9/10 was the best cutoff to detect CAM‐ICU positive, and DOSS = 2/3 was the best cutoff to detect CAM‐ICU positive. CAM‐ICU positive was associated with high 365‐day mortality. DRS score = 9/10 and DOSS score = 0/1 were found to differentiate mortality risk the most significantly. Higher DRS and DOSS scores significantly coincided with a decrease in a patient's survival rate at 365 days.
CONCLUSION
The best DRS and DOSS cutoff scores to differentiate 365‐day mortality risk were lower than those commonly used to detect delirium in the literature. New cutoff scores for the DRS and DOSS might be useful in differentiating risk of mortality among hospital patients.
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