A Novel Classification System to Address Financial Impact and Referral Decisions for Bile Duct Injury in Laparoscopic Cholecystectomy

Purpose. The study was undertaken to evaluate a novel classification system developed to estimate financial cost of bile duct injury (BDI) and to aid in decision making for referral. Study Design. A retrospective review of patients referred for BDI was performed. Grade I injuries involve the duct of Luschka or accessory right hepatic ducts, grade II includes all other biliary injuries, and grade III includes all vasculobiliary injuries. Groups were compared using standard statistical methods. Results. There were 14 grade I, 74 grade II, and 20 grade III injuries. There was a significant difference in the cost and mortality of grade I ($12,457, 0$46,481, 1.4%), and grade III ($69,368, 15%, P = 0.002 and P = 0.030, resp.) injuries. Grade II and III injuries were significantly more likely to require surgical repair (OR 27.7, P < 0.001). Conclusion. We have presented a simple classification system that is able to accurately predict cost and need for surgical repair

Surgical resection for hilar cholangiocarcinoma: experience improves resectability

AbstractObjectivesIn hilar cholangiocarcinoma, resection provides the only opportunity for longterm survival. A US experience of hilar cholangiocarcinoma was examined to determine the effect of clinical experience on negative margin (R0) resection rates.MethodsWe conducted a retrospective analysis of 110 consecutive hilar cholangiocarcinoma patients presenting over an 18-year period. Analyses were performed using chi-squared, Wilcoxon rank sum and Kaplan–Meier methods, and multivariable Cox and logistic regression modelling.ResultsOf the 110 patients in the cohort, 59.1% were male and 90.9% were White. The median patient age was 64 years. A total of 59 (53.6%) patients underwent resection; 37 of these demonstrated R0. The 30-day mortality rate was 5.1%; the complication rate was 39.0%. The rate of resectability increased over time (36.4% vs. 70.9%; P= 0.001), as did the percentage of R0 resections (10.9% vs. 56.5%; P < 0.001). Of the 59 patients who underwent resection, 23 (39.0%) experienced recurrence. Multivariable Cox regression analysis identified resection margins [hazard ratio (HR) = 4.124 for positive vs. negative; P= 0.002] and type of operation (HR = 5.075 for exploration vs. resection; P= 0.001) as significant to survival.ConclusionsAlthough R0 resection can be achieved in only a minority of patients, these patients have a reasonable chance of longterm survival. The last decade has seen a significant rise in rates of resectability of Klatskin's tumour at specialty centres

A Search for the Damped Ly-alpha Absorber at z=1.86 toward QSO 1244+3443 with NICMOS

We have carried out a high-resolution imaging search for the galaxy associated with the damped Lyman-alpha (DLA) absorber at z=1.859 toward the z_{em}=2.48 quasar QSO 1244+3443, using the HST and the NICMOS. Images were obtained in the broad filter F160W and the narrow filter F187N with camera 2 on NICMOS with the goal of detecting the rest-frame optical continuum and the H-alpha line emission from the DLA. After PSF subtraction, two weak features are seen at projected separations of 0.16-0.24" from the quasar. Parts of these features may be associated with the DLA absorber, although we cannot completely rule out that they could be artifacts of the point spread function (PSF). If associated with the DLA, the objects would be ~1-2 h_{70}^{-1} kpc in size with integrated flux densities of 2.5 and 3.3 mu Jy in the F160W filter, implying luminosities at lambda_{central}=5600 A in the DLA rest frame of 4.4-5.9 x 10^{9} h_{70}^{-2} L_{solar} at z=1.86, for q0=0.5. However, no significant H-alpha line emission is seen from these objects, suggesting low star formation rates (SFRs). Our 3 sigma upper limit on the SFR in the DLA is 1.3 h_{70}^{-2} M_{solar}/yr for q0 = 0.5 (2.4 h_{70}^{-2} M_{solar} yr^{-1} for q0 = 0.1). This together with our earlier result for LBQS 1210+1731 mark a significant improvement over previous constraints on the star formation rates of DLAs. A combination of low SFR and some dust extinction is likely to be responsible for the lack of H-alpha emission. Alternatively, the objects, may be associated with the quasar host galaxy. In any case, our observations suggest that the DLA is not a large bright proto-disk, but a compact object or a low-surface brightness galaxy. If the two features are PSF artifacts then the constraints on DLA properties are even more severe.Comment: 28 pages, 9 figures. Accepted for publication in The Astrophysical Journal. Figures are given at a slightly lower resolution here, to decrease file sizes. The higher resolution versions can be found in the Ap

A label-free, quantitative assay of amyloid fibril growth based on intrinsic fluorescence.

Kinetic assay of seeded growth: The graph shows the variation in intrinsic fluorescence intensity of amyloid fibrils. Fluorescence increases during the seeded aggregation of α-synuclein seeds with α-synuclein monomeric protein (blue curve) but not when α-synuclein seeds are incubated with β-synuclein monomeric protein (black curve), thus showing that no seeded growth occurred in this case

Gravitational instability of Einstein-Gauss-Bonnet black holes under tensor mode perturbations

We analyze the tensor mode perturbations of static, spherically symmetric solutions of the Einstein equations with a quadratic Gauss-Bonnet term in dimension $D > 4$. We show that the evolution equations for this type of perturbations can be cast in a Regge-Wheeler-Zerilli form, and obtain the exact potential for the corresponding Schr\"odinger-like stability equation. As an immediate application we prove that for $D \neq 6$ and $\alpha >0$, the sign choice for the Gauss-Bonnet coefficient suggested by string theory, all positive mass black holes of this type are stable. In the exceptional case $D =6$, we find a range of parameters where positive mass asymptotically flat black holes, with regular horizon, are unstable. This feature is found also in general for $\alpha < 0$.Comment: 7 pages, 1 figure, minor corrections, references adde

Molecular characterisation, expression and localisation of human neurokinin-3 receptor

AbstractThe complete amino acid sequence of the human neurokinin-3 receptor was deduced by DNA sequence analysis of human genomic fragments. Comparison of the predicted primary structure with those for the human neurokinin receptors 1 and 2 shows a highly conserved pattern of seven hydrophobic regions with maximum divergence occuring at the amino- and carboxy-termini. The position of intron-exon junctions are identical to those in other reported neurokinin genes. Using a chimeric genomic-cDNA gene, the human NK-3 receptor was expressed in Xenopus laevis oocytes where it mediates membrane conductance changes in response to its agonist, neurokinin B. More significantly, expression of the gene in mammalian cells resulted in detection of receptor binding as well as neurokinin-stimulated calcium mobilization and arachidonic acid release, all displaying the pharmacological characteristics expected of a neurokinin-3 receptor, By using the polymerase chain reaction we have shown that mRNA for the human neurokinin-3 receptor is expressed predominantly in the central nervous system

Quantum Particles Constrained on Cylindrical Surfaces with Non-constant Diameter

We present a theoretical formulation of the one-electron problem constrained on the surface of a cylindrical tubule with varying diameter. Because of the cylindrical symmetry, we may reduce the problem to a one-dimensional equation for each angular momentum quantum number $m$ along the cylindrical axis. The geometrical properties of the surface determine the electronic structures through the geometry dependent term in the equation. Magnetic fields parallel to the axis can readily be incorporated. Our formulation is applied to simple examples such as the catenoid and the sinusoidal tubules. The existence of bound states as well as the band structures, which are induced geometrically, for these surfaces are shown. To show that the electronic structures can be altered significantly by applying a magnetic field, Aharonov-Bohm effects in these examples are demonstrated.Comment: 7 pages, 7 figures, submitted to J. Phys. Soc. Jp