Gallbladder reporting and data system (GB-RADS) for risk stratification of gallbladder wall thickening on ultrasonography:an international expert consensus

The Gallbladder Reporting and Data System (GB-RADS) ultrasound (US) risk stratification is proposed to improve consistency in US interpretations, reporting, and assessment of risk of malignancy in gallbladder wall thickening in non-acute setting. It was developed based on a systematic review of the literature and the consensus of an international multidisciplinary committee comprising expert radiologists, gastroenterologists, gastrointestinal surgeons, surgical oncologists, medical oncologists, and pathologists using modified Delphi method. For risk stratification, the GB-RADS system recommends six categories (GB-RADS 0–5) of gallbladder wall thickening with gradually increasing risk of malignancy. GB-RADS is based on gallbladder wall features on US including symmetry and extent (focal vs. circumferential) of involvement, layered appearance, intramural features (including intramural cysts and echogenic foci), and interface with the liver. GB-RADS represents the first collaborative effort at risk stratifying the gallbladder wall thickening. This concept is in line with the other US-based risk stratification systems which have been shown to increase the accuracy of detection of malignant lesions and improve management. Graphical abstract: [Figure not available: see fulltext.]

Rapid and spontaneous recovery in autistic disorder

Recovery in autistic disorder is rare. There are few reports of recovery from autistic disorder after a few years of therapeutic intervention. We report here a case of autistic disorder who recovered spontaneously without any intervention in 13 days

Idiopathic Condylar Resorption: How to Diagnose and When to Treat it?

Idiopathic Condylar Resorption (ICR) has been frequently reported in patients undergoing orthodontic treatment especially in young adolescent females, so as dentists we could be the first ones to diagnose this condition. This condition represents an aggressive and fast-moving form of degenerative disease of the Temporomandibular Joint (TMJ) and the pathognomonic features of this condition include a deficit of condylar volume, furthermore reducing the ramus height and length of mandible and causing a clockwise rotation of the mandible leading to absence of anterior bite. The accurate cause of this condition is not known, however, there are multiple aetiological factors that could be contributing to this disease. ICR is a poorly understood disease and it could be a very difficult condition to treat because of its various expression and the large number of treatment options that are available. Over the past years a number of cases with ICR have been reported in the orthodontic literature. The aim of this review article is to present a compiled data to better understand the pathophysiology and aetiological factors contributing to ICR and provide an insight about the various clinical features and radiographic findings of this condition which will help us diagnose this condition better in our day-to-day practice. Various treatment modalities like splint therapy, orthognathic surgery, joint replacement have also been mentioned and discussed. A case of ICR that reported to our department with a chief complaint of progressive opening of the bite has also been included in this review article

Rapid Polyolefin Plastics Hydrogenolysis Mediated by Single-Site Heterogeneous Electrophilic/Cationic Organo-Group IV Catalysts

: A homologous series of cationic electrophilic group IV metal hydrides (M = Ti, Zr, Hf) created by chemisorption of the corresponding MNp4 precursors on highly Brønsted acidic sulfated alumina (AlS) to yield loosely coordinated surface AlS/MNp2 (Np = neopentyl) species are systematically characterized by ICP, EXAFS/XANES, DRIFTS, and solid-state high-resolution multi-dimensional NMR spectroscopy (SSNMR), as well as by energy span DFT computation. With effective stirring, these complexes readily undergo reaction with H2 to yield AlS/M(alkyl)H species which are highly active for the hydrogenolysis of diverse commercial polyethylenes, α-olefin-ethylene copolymers, isotactic polypropylene, and post-consumer polyolefins including high-density polyethylenes, yielding medium and small linear and branched hydrocar-bons at turnover frequencies as high as 36,300 h-1 at 200 °C/17 atm H2 for M = Zr. For a given polyolefin and reaction conditions, turnover frequencies scale approximately as M = Zr > Hf > Ti, while catalyst thermal stability scales approxi-mately as M = Hf ≈ Zr > Ti, and these trends are qualitatively understandable from the DFT analysis. These catalytic re-sults reveal that the AlS/Hf(R)H- mediated hydrogenolysis favors wax-like and liquid products while the AlS/Zr(R)H-mediated hydrogenolysis can be tuned between gases and liquids. DFT analysis identifies β-alkyl elimination as the turn-over-limiting C-C scission process, which is particularly facile in these cationic d0 complexes, but not so in the neutrally charged analogue

Highly Efficient Polyolefin Hydrogenolysis Enabled by a Single-Site Organo-Tantalum Catalyst on a Super-Acidic Support

The novel electrophilic organo-tantalum catalyst AlS/TaNp () (Np = neopentyl) is prepared by chemisorption of the alkylidene Ta(CHtBu)Np onto highly Brønsted acidic sulfated alumina (AlS). The proposed catalyst structure is supported by EXAFS, XANES, ICP, DRIFTS, and SSNMR measurements and is in good agreement with DFT analysis. Adsorbate is a highly effective catalyst for the hydrogenolysis of linear and branched hydrocarbons, ranging from C2 to polyolefins. To the best of our knowledge, exhibits the highest polyolefin hydrogenolysis activity (9,200 (CH₂ units)·mol(Ta)⁻¹·h⁻¹ at 200 °C/17 atm H₂) reported to date in the peer-reviewed literature. Unlike the AlS/ZrNp₂ analog, the Ta catalyst is more thermally stable and has multiple potential reaction pathways for C-C bond activation. For hydrogenolysis, AlS/TaNp₃ is effective for a wide variety of pre- and post-consumer polyolefin plastics and is not significantly deactivated in the presence of standard polyolefin additives

Risk factors and clinical impact of perioperative neurological deficits following thoracolumbar arthrodesis

Objectives: The rates of arthrodesis performed in the United States and globally have increased tremendously in the last 10–15 years. Amongst the most devastating complications are neurological deficits including spinal cord injury, nerve root irritation, and cauda equine syndrome. The primary purpose of this study is to understand the risk factors for perioperative neurological deficits in patients undergoing thoracolumbar fusion. Patients and methods: Data from the Nationwide Inpatient Sample between the years of 1999–2011 was analyzed. Patients were between the ages of 18 and 80 who had thoracolumbar fusion. Excluded were patients who underwent the procedure as a result of trauma or a malignancy. A list of covariates, including demographic variables, preoperative and postoperative variables that are known to increase the risk of perioperative neurological deficits were compiled. Statistical analysis utilized univariate and multivariate logistic regression for comparisons between these covariates and the proposed outcomes. Results: The analysis of 37,899 patients yielded an overall rate of perioperative neurological deficits and mortality of 1.20% and 0.27%, respectively. Risk factors for perioperative neurological deficits included increasing age (OR 1.023 95% CI 1.018–1.029), Van Walraven 5–14 (OR 1.535 95% CI 1.054–2.235), and preoperative paralysis (OR 2.551 95% CI 1.674–3.886). Furthermore, the data showed that being 65 years old or older doubled the risk for perioperative deficit (OR 1.655, CI 1.248–2.194, p < 0.001). Conclusions: This population based study found that increasing age, higher comorbid burden, and preoperative paralysis increased the risk of perioperative neurological deficits while female gender and hypertension were found to be protective. Keywords: Thoracolumbar fusion, Arthrodesis, Spine, Neurological deficits, Mortality, National Inpatient Sample, Outcomes, Complication

Endoscopic Therapy is Effective for Recurrent Anastomotic Biliary Strictures after Orthotopic Liver Transplantation

Introduction: Orthotopic liver transplantation anastomotic biliary strictures (OLT ABS) are managed with endoscopic biliary stent therapy but the recurrence rate is substantial. Our aims were to retrospectively determine the recurrence rates of OLT ABS after initial successful stent therapy, characterize the management of recurrences and identify associated variables. Materials and Methods: Clinical data from 943 patients receiving non-living donor OLT at our institution from 2005-2012 were reviewed, and 123 OLT ABS patients receiving stent therapy were identified. Features of their endoscopic stent therapy and other pertinent clinical information were evaluated. Results: ABS recurred in 25.5% of patients (24/94) after an initial successful course of stent therapy. Recurrences were received a second course of endoscopic stent therapy and 67% of patients (16/24) achieved long-term remediation of ABS. Six patients underwent a third course of endoscopic stent therapy with 4 patients achieving remediation. Overall remediation rate among ABS recurrences was 83.3% (20/24). A bivariate comparison demonstrated HCV infection, age, median months of maximal stenting and a lower maximum cumulative stent diameter were risk factors for ABS recurrence. Using a Cox regression model, only HCV status proved to be a risk factor for recurrence. Discussion: In conclusion repeat stent therapy achieved high stricture remediation rates. Recurrence after the first or even second course of stenting should not imply failure of endoscopic therapy. A positive HCV status may be associated with higher stricture recurrence rates and this association should be further investigated