Nonsurgical Approaches to Treat Biliary Tract and Liver Tumors

Endoscopic and percutaneous therapies have been shown to prolong life and reduce morbidity for patients with unresectable advanced stages of primary hepatobiliary malignancies. This article reviews pertinent studies published within the last 5 years that involve locoregional techniques to manage hepatocellular carcinoma, perihilar and distal cholangiocarcinoma. A major emphasis is placed on photodynamic therapy, radiofrequency ablation, irreversible electroporation, and microwave ablation. Technical advances, combinational therapies, and postintervention outcomes are discussed. Despite widespread application, high-quality evidence does not show superiority of any particular locoregional technique for treating advanced hepatobiliary cancers

Structural covariance of the ventral visual stream predicts posttraumatic intrusion and nightmare symptoms: A multivariate data fusion analysis

Visual components of trauma memories are often vividly re-experienced by survivors with deleterious consequences for normal function. Neuroimaging research on trauma has primarily focused on threat-processing circuitry as core to trauma-related dysfunction. Conversely, limited attention has been given to visual circuitry which may be particularly relevant to posttraumatic stress disorder (PTSD). Prior work suggests that the ventral visual stream is directly related to the cognitive and affective disturbances observed in PTSD and may be predictive of later symptom expression. The present study used multimodal magnetic resonance imaging data (n = 278) collected two weeks after trauma exposure from the AURORA study, a longitudinal, multisite investigation of adverse posttraumatic neuropsychiatric sequelae. Indices of gray and white matter were combined using data fusion to identify a structural covariance network (SCN) of the ventral visual stream 2 weeks after trauma. Participant\u27s loadings on the SCN were positively associated with both intrusion symptoms and intensity of nightmares. Further, SCN loadings moderated connectivity between a previously observed amygdala-hippocampal functional covariance network and the inferior temporal gyrus. Follow-up MRI data at 6 months showed an inverse relationship between SCN loadings and negative alterations in cognition in mood. Further, individuals who showed decreased strength of the SCN between 2 weeks and 6 months had generally higher PTSD symptom severity over time. The present findings highlight a role for structural integrity of the ventral visual stream in the development of PTSD. The ventral visual stream may be particularly important for the consolidation or retrieval of trauma memories and may contribute to efficient reactivation of visual components of the trauma memory, thereby exacerbating PTSD symptoms. Potentially chronic engagement of the network may lead to reduced structural integrity which becomes a risk factor for lasting PTSD symptoms

Post-Pancreatoduodenectomy Outcomes and Epidural Analgesia: A 5-Year Single Institution Experience

Introduction Optimal pain control post-pancreatoduodenectomy is a challenge. Epidural analgesia (EDA) is increasingly utilized despite inherent risks and unclear effects on outcomes. Methods All pancreatoduodenectomies (PD) performed from 1/2013-12/2017 were included. Clinical parameters were obtained from retrospective review of a prospective clinical database, the ACS NSQIP prospective institutional database and medical record review. Chi-Square/Fisher’s Exact and Independent-Samples t-Tests were used for univariable analyses; multivariable regression (MVR) was performed. Results 671 consecutive PD from a single institution were included (429 EDA, 242 non-EDA). On univariable analysis, EDA patients experienced significantly less wound disruption (0.2% vs. 2.1%), unplanned intubation (3.0% vs. 7.9%), pulmonary embolism (0.5% vs. 2.5%), mechanical-ventilation >48hrs (2.1% vs. 7.9%), septic shock (2.6% vs. 5.8%), and lower pain scores. On MVR accounting for baseline group differences (gender, hypertension, pre-operative transfusion, labs, approach, pancreatic duct size), EDA was associated with less superficial wound infections (OR 0.34; CI 0.14-0.83; P=0.017), unplanned intubations (OR 0.36; CI 0.14-0.88; P=0.024), mechanical ventilation >48 hrs (OR 0.22; CI 0.08-0.62; P=0.004), and septic shock (OR 0.39; CI 0.15-1.00; P=0.050). EDA improved pain scores post-PD days 1-3 (P<0.001). No differences were seen in cardiac or renal complications; pancreatic fistula (B+C) or delayed gastric emptying; 30/90-day mortality; length of stay, readmission, discharge destination, or unplanned reoperation. Conclusion Based on the largest single institution series published to date, our data support the use of EDA for optimization of pain control. More importantly, our data document that EDA significantly improved infectious and pulmonary complications

Perceptions of knowledge sharing among small family firm leaders: a structural equation model

Small family firms have many unique relational qualities with implications for how knowledge is passed between individuals. Extant literature posits leadership approach as important in explaining differences in knowledge-sharing climate from one firm to another. This study investigates how leadership approaches interact with family influence to inform perceptions of knowledge sharing. We utilize survey data (n = 110) from owner-managers of knowledge-intensive small family firms in Scotland. Our findings present a choice in leadership intention, contrasting organization-focused participation against family-influenced guidance. Insight is offered on the implications of this leadership choice at both organizational and familial level

Transgastric Pancreatic Necrosectomy: How I Do It

Necrotizing pancreatitis is a serious medical problem that often requires intervention to debride necrotic pancreatic and peripancreatic tissue. Recently, minimally invasive approaches have been applied to pancreatic necrosectomy. The purpose of this report is to review the history of transgastric pancreatic debridement, identify appropriate patient selection criteria, and highlight technical “pearls.” We present this subject matter in the context of our own clinical experience, with a primary focus on a “How I Do It” type of technical description

The stellar metallicity distribution of disc galaxies and bulges in cosmological simulations

By means of high-resolution cosmological hydrodynamical simulations of Milky Way-like disc galaxies, we conduct an analysis of the associated stellar metallicity distribution functions (MDFs). After undertaking a kinematic decomposition of each simulation into spheroid and disc sub-components, we compare the predicted MDFs to those observed in the solar neighbourhood and the Galactic bulge. The effects of the star formation density threshold are visible in the star formation histories, which show a modulation in their behaviour driven by the threshold. The derived MDFs show median metallicities lower by 0.2-0.3 dex than the MDF observed locally in the disc and in the Galactic bulge. Possible reasons for this apparent discrepancy include the use of low stellar yields and/or centrally-concentrated star formation. The dispersions are larger than the one of the observed MDF; this could be due to simulated discs being kinematically hotter relative to the Milky Way. The fraction of low metallicity stars is largely overestimated, visible from the more negatively skewed MDF with respect to the observational sample. For our fiducial Milky Way analog, we study the metallicity distribution of the stars born "in situ" relative to those formed via accretion (from disrupted satellites), and demonstrate that this low-metallicity tail to the MDF is populated primarily by accreted stars. Enhanced supernova and stellar radiation energy feedback to the surrounding interstellar media of these pre-disrupted satellites is suggested as an important regulator of the MDF skewness.Comment: 20 pages, 14 figures, MNRAS, accepte

The Zoltar forecast archive, a tool to standardize and store interdisciplinary prediction research

Forecasting has emerged as an important component of informed, data-driven decision-making in a wide array of felds. We introduce a new data model for probabilistic predictions that encompasses a wide range of forecasting settings. This framework clearly defnes the constituent parts of a probabilistic forecast and proposes one approach for representing these data elements. The data model is implemented in Zoltar, a new software application that stores forecasts using the data model and provides standardized API access to the data. In one real-time case study, an instance of the Zoltar web application was used to store, provide access to, and evaluate real-time forecast data on the order of 108 rows, provided by over 40 international research teams from academia and industry making forecasts of the COVID-19 outbreak in the US. Tools and data infrastructure for probabilistic forecasts, such as those introduced here, will play an increasingly important role in ensuring that future forecasting research adheres to a strict set of rigorous and reproducible standards

Root pathogen diversity and composition varies with climate in undisturbed grasslands, but less so in anthropogenically disturbed grasslands

Soil-borne pathogens structure plant communities, shaping their diversity, and through these effects may mediate plant responses to climate change and disturbance. Little is known, however, about the environmental determinants of plant pathogen communities. Therefore, we explored the impact of climate gradients and anthropogenic disturbance on root-associated pathogens in grasslands. We examined the community structure of two pathogenic groups—fungal pathogens and oomycetes—in undisturbed and anthropogenically disturbed grasslands across a natural precipitation and temperature gradient in the Midwestern USA. In undisturbed grasslands, precipitation and temperature gradients were important predictors of pathogen community richness and composition. Oomycete richness increased with precipitation, while fungal pathogen richness depended on an interaction of precipitation and temperature, with precipitation increasing richness most with higher temperatures. Disturbance altered plant pathogen composition and precipitation and temperature had a reduced effect on pathogen richness and composition in disturbed grasslands. Because pathogens can mediate plant community diversity and structure, the sensitivity of pathogens to disturbance and climate suggests that degradation of the pathogen community may mediate loss, or limit restoration of, native plant diversity in disturbed grasslands, and may modify plant community response to climate change

Rotation Measure Synthesis of Galactic Polarized Emission with the DRAO 26-m Telescope

Radio polarimetry at decimetre wavelengths is the principal source of information on the Galactic magnetic field. The diffuse polarized emission is strongly influenced by Faraday rotation in the magneto-ionic medium and rotation measure is the prime quantity of interest, implying that all Stokes parameters must be measured over wide frequency bands with many frequency channels. The DRAO 26-m Telescope has been equipped with a wideband feed, a polarization transducer to deliver both hands of circular polarization, and a receiver, all operating from 1277 to 1762 MHz. Half-power beamwidth is between 40 and 30 arcminutes. A digital FPGA spectrometer, based on commercially available components, produces all Stokes parameters in 2048 frequency channels over a 485-MHz bandwidth. Signals are digitized to 8 bits and a Fast Fourier Transform is applied to each data stream. Stokes parameters are then generated in each frequency channel. This instrument is in use at DRAO for a Northern sky polarization survey. Observations consist of scans up and down the Meridian at a drive rate of 0.9 degree per minute to give complete coverage of the sky between declinations -30 degree and 90 degree. This paper presents a complete description of the receiver and data acquisition system. Only a small fraction of the frequency band of operation is allocated for radio astronomy, and about 20 percent of the data are lost to interference. The first 8 percent of data from the survey are used for a proof-of-concept study, which has led to the first application of Rotation Measure Synthesis to the diffuse Galactic emission obtained with a single-antenna telescope. We find rotation measure values for the diffuse emission as high as approximately 100 rad per square metre, much higher than recorded in earlier work.Comment: Accepted for publication in The Astronomical Journa