1,598 research outputs found
Chevalier Jackson, M.D. (1865-1958): Il ne se repose jamais.
In the final year of the American Civil War, 1865, Chevalier Jackson was born on the 4th of November just outside Pittsburgh, Pennsylvania. The eldest of three sons of a poor, livestock-raising family, Jackson was raised in a period of social and political unrest. He was perhaps an even more unrestful boy. The description of his childhood days from his fatherâs fatherâIl ne se repose jamais, ââHe never restsâââwould ultimately reflect the man, doctor, and evangelist Jackson would later become.1 Indeed, he never did rest, Jackson would tirelessly pave the way for modern bronchoscopy and endoscopy as a whole; bringing international renown not only to himself, but also to his specialty
A standardized comparison of peri-operative complications after minimally invasive esophagectomy: Ivor Lewis versus McKeown.
BACKGROUND: While our institutional approach to esophageal resection for cancer has traditionally favored a minimally invasive (MI) 3-hole, McKeown esophagectomy (MIE 3-hole) during the last five years several factors has determined a shift in our practice with an increasing number of minimally invasive Ivor Lewis (MIE IL) resections being performed. We compared peri-operative outcomes of the two procedures, hypothesizing that MIE IL would be less morbid in the peri-operative setting compared to MIE 3-hole.
METHODS: Our institution\u27s IRB-approved esophageal database was queried to identify all patients who underwent totally MI esophagectomy (MIE IL vs. MIE 3-hole) from June 2011 to May 2016. Patient demographics, preoperative and peri-operative data, as well as post-operative complications were compared between the two groups. Post-operative complications were analyzed using the Clavien-Dindo classification system.
RESULTS: There were 110 patients who underwent totally MI esophagectomy (MIE IL n = 49 [45%], MIE 3-hole n = 61 [55%]). The majority of patients were men (n = 91, 83%) with a median age of 62.5 (range 31-83). Preoperative risk stratifiers such as ECOG score, ASA, and Charlson Comorbidity Index were not significantly different between groups. Anastomotic leak rate was 2.0% in the MIE IL group compared to 6.6% in the MIE 3-hole group (p = 0.379). The rate of serious (Clavien-Dindo 3, 4, or 5) post-operative complications was significantly less in the MIE IL group (34.7 vs. 59.0%, p = 0.013). Serious pulmonary complications were not significantly different (16.3 vs. 26.2%, p = 0.251) between the two groups.
CONCLUSIONS: In this cohort, totally MIE IL showed significantly less severe peri-operative morbidity than MIE 3-hole, but similar rates of serious pulmonary complications and anastomotic leaks. These findings confirm the safety of minimally invasive Ivor Lewis esophagectomies for esophageal cancer when oncologically and clinically appropriate. Minimally invasive McKeown esophagectomy remains a satisfactory and appropriate option when clinically indicated
Searching for with Multi-Leptons
The results of a multi-lepton search conducted by the CMS collaboration with
5 fb of data collected from 7 TeV collisions are used to place the
first bound on the rare flavor-changing decay of the top quark to a Higgs boson
and charm quark. Combining results from a number of exclusive three- and
four-lepton search channels yields an estimated upper limit of for a Higgs boson mass of 125 GeV. The sensitivity of future
dedicated searches for could be improved by adding exclusive same
sign di-lepton channels, as well as by sub-dividing channels based on -quark
tagging and partial kinematic top quark and Higgs boson tagging. This bound may
be interpreted more widely within a range of new physics processes that yield
final states with a -boson in association with a Higgs boson. For such
processes with kinematics that are similar to top--anti-top production and
decay, the estimated limit on cross section times branching ratio corresponds
to roughly pb.Comment: 11 pages, 1 table; v2 typo correcte
Development of a Corticosteroid-Immunosuppressed Mouse Model to Study the Pathogenesis and Therapy of Influenza-Associated Pulmonary Aspergillosis
Influenza-associated pulmonary aspergillosis (IAPA) is a feared complication in patients with influenza tracheobronchitis, especially those receiving corticosteroids. Herein, we established a novel IAPA mouse model with low-inoculum Aspergillus infection and compared outcomes in mice with and without cortisone acetate (CA) immunosuppression. CA was an independent predictor of increased morbidity/mortality in mice with IAPA. Early antifungal treatment with liposomal amphotericin B was pivotal to improve IAPA outcomes in CA-immunosuppressed mice, even after prior antiviral therapy with oseltamivir. In summary, our model recapitulates key clinical features of IAPA and provides a robust preclinical platform to study the pathogenesis and treatment of IAPA
Targeted cell imaging properties of a deep red luminescent iridium(III) complex conjugated with a c-Myc signal peptide
A nuclear localisation sequence (NLS) peptide, PAAKRVKLD, derived from the human c-Myc regulator gene, has been functionalised with a long wavelength (λex = 550 nm; λem = 677 nm) cyclometalated organometallic iridium(III) complex to give the conjugate Ir-CMYC. Confocal fluorescence microscopy studies on human fibroblast cells imaged after 18â24 h incubation show that Ir-CMYC concentrations of 80â100 ÎŒM promote good cell uptake and nuclear localisation, which was confirmed though co-localisation studies using Hoechst 33342. In comparison, a structurally related, photophysically analogous iridium(III) complex lacking the peptide sequence, Ir-PYR, showed very different biological behaviour, with no evidence of nuclear, lysosomal or autophagic vesicle localisation and significantly increased toxicity to the cells at concentrations >10 ÎŒM that induced mitochondrial dysfunction. Supporting UV-visible and circular dichroism spectroscopic studies show that Ir-PYR and Ir-CMYC display similarly low affinities for DNA (ca. 103 Mâ1), consistent with electrostatic binding. Therefore the translocation and nuclear uptake properties of Ir-CMYC are attributed to the presence of the PAAKRVKLD nuclear localisation sequence in this complex
A Complete Model of Low-Scale Gauge Mediation
Recent signs of a Standard Model-like Higgs at 125 GeV point towards large
A-terms in the MSSM. This presents special challenges for gauge mediation,
which by itself predicts vanishing A-terms at the messenger scale. In this
paper, we review the general problems that arise when extending gauge mediation
to achieve large A-terms, and the mechanisms that exist to overcome them. Using
these mechanisms, we construct weakly-coupled models of low-scale gauge
mediation with extended Higgs-messenger couplings that generate large A-terms
at the messenger scale and viable mu/B_mu-terms. Our models are simple,
economical, and complete realizations of supersymmetry at the weak scale.Comment: 33 pages; v2: refs added, minor change
National trends in pectus excavatum repair: patient age, facility volume, and outcomes
Background: There is limited data on the adult repair of pectus excavatum (PE). Existing literature is largely limited to single institution experiences and suggests that adults undergoing modified Nuss repair may have worse outcomes than pediatric and adolescent patients. Using a representative national database, this analysis is the first to describe trends in demographics, outcomes, charges, and facility volume for adults undergoing modified Nuss procedure.
Methods: Because of a coding change associated with ICD-10, a retrospective cohort analysis using the National Inpatient Sample (NIS) for patients 12 or older undergoing modified Nuss repair between 2016-2018 was possible. Pearson\u27s Ï2 and Student\u27s t-tests were utilized to compare patient, clinical, and hospital characteristics. Complications were sub-classified into major and minor categories. Facilities performing greater than the mean number of operations were categorized as high-volume.
Results: Of 360 patients, 79.2% were male. There was near gender parity for patients over 30 undergoing repair (55.2% male, 44.8% female). In all age cohorts, patients were predominantly Caucasian. Rates of any postoperative complication differed by age (12-17 years: 30.6%; 18-29 years: 45.2%; 30+ years: 62.1%; P\u3c0.01); older patients had higher rates of all but two subclasses of complication. Age over 30 was associated with higher charges (12-17 years: 57,001; 30+ years: $67,014; P\u3c0.01). High-volume centers operate on older patients, had shorter lengths of stay, and comparable charges to low-volume centers.
Conclusions: Women comprise nearly half of patients undergoing modified Nuss repair after 30 years of age. There are significant differences in complication rates and charges when comparing patients by age. Patients undergoing repair at high-volume facilities benefitted from shorter lengths of stay
(De)Constructing a Natural and Flavorful Supersymmetric Standard Model
Using the framework of deconstruction, we construct simple, weakly-coupled
supersymmetric models that explain the Standard Model flavor hierarchy and
produce a flavorful soft spectrum compatible with precision limits. Electroweak
symmetry breaking is fully natural; the mu-term is dynamically generated with
no B mu-problem and the Higgs mass is easily raised above LEP limits without
reliance on large radiative corrections. These models possess the distinctive
spectrum of superpartners characteristic of "effective supersymmetry": the
third generation superpartners tend to be light, while the rest of the scalars
are heavy.Comment: 36 pages, 4 figures ; v2: references added, expanded discussion of
FCNC
Ultrafast terahertz-field-driven ionic response in ferroelectric BaTiO3
The dynamical processes associated with electric field manipulation of the polarization in a ferroelectric remain largely unknown but fundamentally determine the speed and functionality of ferroelectric materials and devices. Here we apply subpicosecond duration, single-cycle terahertz pulses as an ultrafast electric field bias to prototypical BaTiO[subscript 3] ferroelectric thin films with the atomic-scale response probed by femtosecond x-ray-scattering techniques. We show that electric fields applied perpendicular to the ferroelectric polarization drive large-amplitude displacements of the titanium atoms along the ferroelectric polarization axis, comparable to that of the built-in displacements associated with the intrinsic polarization and incoherent across unit cells. This effect is associated with a dynamic rotation of the ferroelectric polarization switching on and then off on picosecond time scales. These transient polarization modulations are followed by long-lived vibrational heating effects driven by resonant excitation of the ferroelectric soft mode, as reflected in changes in the c-axis tetragonality. The ultrafast structural characterization described here enables a direct comparison with first-principles-based molecular-dynamics simulations, with good agreement obtained
The Association Between Robotic Lung Cancer Resection and Esophagectomy Outcomes: A Facility-Level Analysis
Background: Within the field of robotic thoracic surgery, the association between facility surgical volume, conversion rates, and patient outcomes across multiple procedures has not been explored. This study aims to examine the potential association between robotic lung cancer resection surgical volume and conversion rates for robotic-assisted minimally invasive esophagectomy (RAMIE). Methods: A retrospective analysis of the National Cancer Database, between the years 2010â2018 was conducted. Facility-years were categorized into one of four groups based on a combination of robotic lung cancer resection surgical volume and RAMIE volumes. Cutoffs were based on previously identified surgical volume thresholds. Results: A total of 16,178 patients received robotic lung cancer resections within the included facility-years. The median age was 68 years [interquartile range (IQR): 62â74 years]. A total of 2,153 patients received RAMIEs within the included facility-years. The median age was 65 years (IQR, 58â71 years). RAMIE conversion rate was highest at facilities with high RAMIE and low robotic lung cancer resection volumes and lowest at facilities with high lung cancer resection and RAMIE volume [18 (9.0%) vs. 10 (1.8%); P\u3c0.001]. Higher 30-& 90-day mortality rates were seen among patients who required conversion during robotic lung cancer resection (30-day: 5.8% vs. 1.1%, P\u3c0.001; 90-day: 9.1% vs. 2.1%, P\u3c0.001). Conclusions: Conversion from robotic to open esophagectomy occurs more frequently at centers performing a low volume of robotic lung resections. This finding may imply that robotic operative experience might be transferable between procedures
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