6,385 research outputs found
Indocyanine green fluorescence imaging in colorectal surgery: overview, applications, and future directions
Indocyanine green fluorescence imaging is a surgical tool with increasing applications in colorectal surgery. This tool has received acceptance in various surgical disciplines as a potential method to enhance surgical field visualisation, improve lymph node retrieval, and decrease the incidence of anastomotic leaks. In colorectal surgery specifically, small studies have shown that intraoperative fluorescence imaging is a safe and feasible method to assess anastomotic perfusion, and its use might affect the incidence of anastomotic leaks. Controlled trials are ongoing to validate these conclusions. The number of new indications for indocyanine green continues to increase, including innovative options for detecting and guiding management of colorectal metastasis to the liver. These advances could offer great value for surgeons and patients, by improving the accuracy and outcomes of oncological resections
Algorithm Diversity for Resilient Systems
Diversity can significantly increase the resilience of systems, by reducing
the prevalence of shared vulnerabilities and making vulnerabilities harder to
exploit. Work on software diversity for security typically creates variants of
a program using low-level code transformations. This paper is the first to
study algorithm diversity for resilience. We first describe how a method based
on high-level invariants and systematic incrementalization can be used to
create algorithm variants. Executing multiple variants in parallel and
comparing their outputs provides greater resilience than executing one variant.
To prevent different parallel schedules from causing variants' behaviors to
diverge, we present a synchronized execution algorithm for DistAlgo, an
extension of Python for high-level, precise, executable specifications of
distributed algorithms. We propose static and dynamic metrics for measuring
diversity. An experimental evaluation of algorithm diversity combined with
implementation-level diversity for several sequential algorithms and
distributed algorithms shows the benefits of algorithm diversity
A Novel Application of Indocyanine Green Immunofluorescence in Emergent Colorectal Surgery
Here, we report on the feasibility of ICG fluorescence imaging to localize lesions in emergent minimally invasive surgery. A 49-year old female presented to the emergency department with a previously unknown malignant bowel obstruction. She was taken emergently to the operating room for a laparoscopic extended right hemicolectomy, based on tumor location from imaging. With intraoperative difficulty localizing the lesion, an on-table colonoscopy was performed. When the tumor was encountered, peritumoral ICG injections were performed, and the fluorescence lymphoscintigraphy was performed intraoperatively in an attempt to visualize the primary tumor laparoscopically. Intraoperative ICG Immunofluorescence allowed precise, real-time localization of the mass in the descending colon. This information changed the course of the operation, as a laparoscopic left hemicolectomy was then performed instead of the planned extended right hemicolectomy. The patient underwent an end-to-end anastomosis without the need for a defunctioning ileostomy. From this case, we demonstrate the use of ICG fluorescence imaging for tumor localization in the emergent setting is safe, feasible, and effective. This information gained from this technology enables real-time decision making, and can even change the operative plan in the emergent setting for the best patient outcomes. What does this paper add to the existing literature? This paper offers a novel application of an emerging technology- ICG fluorescence- that in this capacity allowed precise, real-time localization of a previously unknown mass in the emergent setting, and changed the course of the operation
Anomalous diffusion in polymers: long-time behaviour
We study the Dirichlet boundary value problem for viscoelastic diffusion in
polymers. We show that its weak solutions generate a dissipative semiflow. We
construct the minimal trajectory attractor and the global attractor for this
problem.Comment: 13 page
A dusty pinwheel nebula around the massive star WR 104
Wolf-Rayet (WR) stars are luminous massive blue stars thought to be immediate
precursors to the supernova terminating their brief lives. The existence of
dust shells around such stars has been enigmatic since their discovery some 30
years ago; the intense radiation field from the star should be inimical to dust
survival. Although dust-creation models, including those involving interacting
stellar winds from a companion star, have been put forward, high-resolution
observations are required to understand this phenomena. Here we present
resolved images of the dust outflow around Wolf-Rayet WR 104, obtained with
novel imaging techniques, revealing detail on scales corresponding to about 40
AU at the star. Our maps show that the dust forms a spatially confined stream
following precisely a linear (or Archimedian) spiral trajectory. Images taken
at two separate epochs show a clear rotation with a period of 220 +/- 30 days.
Taken together, these findings prove that a binary star is responsible for the
creation of the circumstellar dust, while the spiral plume makes WR 104 the
prototype of a new class of circumstellar nebulae unique to interacting wind
systems.Comment: 7 pages, 2 figures, Appearing in Nature (1999 April 08
Ultrasonic Imaging and the Long Wavelength Phase
Elastodynamic and acoustic wave scattering play an essential role in various inspection methods such as sonar and ultrasonic tomography. Recently there has been considerable interest in the implications of long wavelength elastodynamic scattering for the characterization of flaws in elastic solids [1-6]. If the scattering amplitude is expanded as a power series in the frequency, the leading term is real and varies as the frequency squared. The next term varies as the frequency cubed and is purely imaginary. The evaluation of the phase variation in the long wavelength limit requires the ratio of these terms. Most effort to date has been invested in understanding the dependence of the coefficient of the frequency squared term on the size, shape, orientation and material properties of the scatterer. Richardson [3] and Kohn and Rice [4] have shown that, for an anisotropic elastic inclusion in an otherwise isotropic and homogeneous elastic space, the coefficient depends on at most 22 parameters. In addition, efficient numerical programs have been constructed to evaluate this coefficient for ellipsoidal inclusions. Other work has related it to the stress intensity factor for flaws which are crack-like [5]
Chronic psychosocial and financial burden accelerates 5-year telomere shortening: findings from the Coronary Artery Risk Development in Young Adults Study.
Leukocyte telomere length, a marker of immune system function, is sensitive to exposures such as psychosocial stressors and health-maintaining behaviors. Past research has determined that stress experienced in adulthood is associated with shorter telomere length, but is limited to mostly cross-sectional reports. We test whether repeated reports of chronic psychosocial and financial burden is associated with telomere length change over a 5-year period (years 15 and 20) from 969 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) Study, a longitudinal, population-based cohort, ages 18-30 at time of recruitment in 1985. We further examine whether multisystem resiliency, comprised of social connections, health-maintaining behaviors, and psychological resources, mitigates the effects of repeated burden on telomere attrition over 5 years. Our results indicate that adults with high chronic burden do not show decreased telomere length over the 5-year period. However, these effects do vary by level of resiliency, as regression results revealed a significant interaction between chronic burden and multisystem resiliency. For individuals with high repeated chronic burden and low multisystem resiliency (1 SD below the mean), there was a significant 5-year shortening in telomere length, whereas no significant relationships between chronic burden and attrition were evident for those at moderate and higher levels of resiliency. These effects apply similarly across the three components of resiliency. Results imply that interventions should focus on establishing strong social connections, psychological resources, and health-maintaining behaviors when attempting to ameliorate stress-related decline in telomere length among at-risk individuals
Effects of a Single Intra-Articular Injection of a Microsphere-Formulation of Triamcinolone Acetonide on Knee Osteoarthritis Pain: A Double-Blinded, Randomized, Placebo-Controlled, Multinational Study
Background: Intra-articular corticosteroids relieve osteoarthritis pain, but rapid systemic absorption limits efficacy. FX006, a novel, microsphere-based, extended-release triamcinolone acetonide (TA) formulation, prolongs TA joint residence and reduces systemic exposure compared with standard TA crystalline suspension (TAcs). We assessed symptomatic benefits and safety of FX006 compared with saline-solution placebo and TAcs.
Methods: In this Phase-3, multicenter, double-blinded, 24-week study, adults ≥40 years of age with knee osteoarthritis (Kellgren-Lawrence grade 2 or 3) and average-daily-pain (ADP)-intensity scores of ≥5 and ≤9 (0 to 10 numeric rating scale) were centrally randomized (1:1:1) to a single intra-articular injection of FX006 (32 mg), saline-solution placebo, or TAcs (40 mg). The primary end point was change from baseline to week 12 in weekly mean ADP-intensity scores for FX006 compared with saline-solution placebo. Secondary end points were area-under-effect (AUE) curves of the change in weekly mean ADP-intensity scores from baseline to week 12 for FX006 compared with saline-solution placebo, AUE curves of the change in weekly mean ADP-intensity scores from baseline to week 12 for FX006 compared with TAcs, change in weekly mean ADP-intensity scores from baseline to week 12 for FX006 compared with TAcs, and AUE curves of the change in weekly mean ADP-intensity scores from baseline to week 24 for FX006 compared with saline-solution placebo. Exploratory end points included week-12 changes in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Knee Injury and Osteoarthritis Outcome Score Quality of Life (KOOS-QOL) subscale scores for FX006 compared with saline-solution placebo and TAcs. Adverse events were elicited at each inpatient visit.
Results: The primary end point was met. Among 484 treated patients (n = 161 for FX006, n = 162 for saline-solution placebo, and n = 161 for TAcs), FX006 provided significant week-12 improvement in ADP intensity compared with that observed for saline-solution placebo (least-squares mean change from baseline: −3.12 versus −2.14; p < 0.0001) indicating ∼50% improvement. FX006 afforded improvements over saline-solution placebo for all secondary and exploratory end points (p < 0.05). Improvements in osteoarthritis pain were not significant for FX006 compared with TAcs using the ADP-based secondary measures. Exploratory analyses of WOMAC-A, B, and C and KOOS-QOL subscales favored FX006 (p ≤ 0.05). Adverse events were generally mild, occurring at similar frequencies across treatments.
Conclusions: FX006 provided significant, clinically meaningful pain reduction compared with saline-solution placebo at week 12 (primary end point)
Choice biases in no-sample and delay testing in pigeons (Columba livia)
In experimental tasks that involve stimuli that vary along a quantitative continuum, some choice biases are commonly found. Take, for instance, a matching-to-sample task where animals must, following the presentation of sample stimuli (that differ in duration), choose between two or more comparison stimuli. In tests where no sample is presented there is usually a bias towards the comparison that is correct following the shortest sample. To examine some aspects of these choice biases, pigeons were trained in a symbolic matching-to-sample task with two durations of keylight as samples, where key pecking had to be maintained during sample presentation. Firstly, even though animals were required to attend to the sample, a preference for the "short" comparison in no-sample testing was found. This result disproves an account where this effect was hypothesized to happen due to non-programmed learning resulting from the animals failing to attend to some trials. Secondly, even though a bias for "short" was found in both no-sample and delay testing, the extent of the biases differed between tasks, thus suggesting that forgetting the sample presented during a delay does not necessarily land the animal in a state similar to presenting no sample at all to begin with.The present study was supported by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology and Higher Education through national funds. It was also co-financed by the European Regional Development Fund (FEDER)-through COMPETE2020-under the PT2020 Partnership Agreement (POCI-01-0145-FEDER-007653)
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