Imaging for Quality Control: Comparison of Systematic Video Recording to the Operative Note in Colorectal Cancer Surgery.

__Background:__ Oncological and functional results after colorectal cancer surgery vary considerably between hospitals and surgeons. At present, the only source of technical information about the surgical procedure is the operative note, which is subjective and omits critical information. This study aimed to evaluate the feasibility of operative video recording in demonstrating both objective information concerning the surgical procedure and surgical quality, as using a systematic approach might improve surgical performance. __Methods:__ From July 2015 through November 2015, patients aged ≥18 years undergoing elective colorectal cancer surgery were prospectively included in a single-institution trial. Video recording of key moments was performed peroperatively and analyzed for adequacy. The study cases were compared with a historic cohort. Video was compared with the operative note using the amount of adequate steps and a scoring system. __Results:__ This study compared 15 cases to 32 cases from the historic control group. Compared to the written operative note alone, significant differences in availability of information were seen in favor of video as well as using a combination of video plus the operative note. __Conclusions:__ Systematic video registration is feasible and seems to improve the availability of essential information after colorectal cancer surgery. In this respect, combining video with a traditional operative note would be the best option. A multicenter international study is being organized to further evaluate the effect of operative video capture on surgical outcomes

Increased forefoot loading is associated with an increased plantar flexion moment

The aim of this study was to identify the cascade of effects leading from alterations in force generation around the ankle joint to increased plantar pressures under the forefoot. Gait analysis including plantar pressure measurement was performed at an individually preferred and a standardized, imposed gait velocity in diabetic subjects with polyneuropathy (n=94), without polyneuropathy (n=39) and healthy elderly (n=19). The plantar flexion moment at 40% of the stance phase was negatively correlated with the displacement rate of center of pressure (r=-.749, p<.001 at the imposed, and r=-.693, p<.001 at the preferred gait velocity). Displacement rate of center of pressure was strongly correlated with forefoot loading (r=-.837, p<.001 at the imposed, and r=-.731, p<.001 at the preferred gait velocity). People with a relatively high plantar flexion moment at 40% of the stance phase, have a faster forward transfer of center of pressure and consequently higher loading of the forefoot. This indicates that interventions aimed at increasing the control of the roll-off of the foot may contribute to a better plantar pressure distribution

Strength Training Affects Lower Extremity Gait Kinematics, Not Kinetics, in People With Diabetic Polyneuropathy

Increased forefoot loading in diabetic polyneuropathy plays an important role in the development of plantar foot ulcers and can originate from alterations in muscle strength, joint moments and gait pattern. The current study evaluated whether strength training can improve lower extremity joint moments and spatiotemporal gait characteristics in patients with diabetic polyneuropathy. An intervention group receiving strength training during 24 weeks and a control group receiving no intervention. Measurements were performed in both groups at t= 0, t= 12, t= 24 and t= 52 weeks at an individually preferred and standardized imposed gait velocity. The strength training did not affect the maximal amplitude of hip, knee and ankle joint moments, but did result in an increase in stance phase duration, stride time and stride length of approximately 5 %, during the imposed gait velocity. In addition, both groups increased their preferred gait velocity over one year. Future longitudinal studies should further explore the possible effects of strength training on spatiotemporal gait characteristics. The current study provides valuable information on changes in gait velocities and the progressive lower extremity problems in patients with polyneuropathy

Quantum driven Bounce of the future Universe

It is demonstrated that due to back-reaction of quantum effects, expansion of the universe stops at its maximum and takes a turnaround. Later on, it contracts to a very small size in finite future time. This phenomenon is followed by a " bounce" with re-birth of an exponentially expanding non-singular universe

Comparison of different modalities for the diagnosis of parastomal hernia: a systematic review

Purpose: Parastomal hernia (PSH) is a common complication following stoma formation. The incidence of PSH varies widely due to several factors including differences in diagnostic modality, observer, definition, and classification used for diagnosing PSH. The aim of this systematic review was to evaluate the diagnostic accuracy of the modalities used to identify PSH. Methods: Embase, MEDLINE, Cochrane, Web of Science, and Google Scholar databases were searched. Studies reporting PSH incidence rates detected by two or more different diagnostic modalities or inter-observer variation on one diagnostic modality were included. Article selection and assessment of study quality were conducted independently by two researchers using Cochrane Collaboration’s tool for assessing risk of bias. PROSPERO registration: CRD42018112732. Results: Twenty-nine studies (n = 2514 patients) were included. Nineteen studies compared CT to clinical examination with relative difference in incidence rates ranging from 0.64 to 3.0 (n = 1369). Overall, 79% of studies found an increase in incidence rate when using CT. Disagreement between CT and clinical examination ranged between 0 and 37.3% with pooled inter-modality agreement Kappa value of 0.64 (95% CI 0.52–0.77). Four studies investigated the diagnostic accuracy of ultrasonography (n = 103). Compared with peroperative diagnosis, CT and ultrasonography both seemed accurate imaging modalities with a sensitivity of 83%. Conclusion: CT is an accurate diagnostic modality for PSH diagnosis and increases PSH detection rates, as compared with clinical examination. Studies that specially focus on the diagnostic accuracy are needed and should aim to take patient-reported outcomes into account. A detailed description of the diagnostic approach, modality, definition, and involved observers is prerequisite for future PSH research

Topography of associations between cardiovascular risk factors and myelin loss in the ageing human brain.

Our knowledge of the mechanisms underlying the vulnerability of the brain's white matter microstructure to cardiovascular risk factors (CVRFs) is still limited. We used a quantitative magnetic resonance imaging (MRI) protocol in a single centre setting to investigate the cross-sectional association between CVRFs and brain tissue properties of white matter tracts in a large community-dwelling cohort (n = 1104, age range 46-87 years). Arterial hypertension was associated with lower myelin and axonal density MRI indices, paralleled by higher extracellular water content. Obesity showed similar associations, though with myelin difference only in male participants. Associations between CVRFs and white matter microstructure were observed predominantly in limbic and prefrontal tracts. Additional genetic, lifestyle and psychiatric factors did not modulate these results, but moderate-to-vigorous physical activity was linked to higher myelin content independently of CVRFs. Our findings complement previously described CVRF-related changes in brain water diffusion properties pointing towards myelin loss and neuroinflammation rather than neurodegeneration

Curvature Inspired Cosmological Scenario

Using modified gravity with non-linear terms of curvature, $R^2$ and $R^{(r +2)}$ (with $r$ being the positive real number and $R$ being the scalar curvature), cosmological scenario,beginning at the Planck scale, is obtained. Here, a unified picture of cosmology is obtained from $f(R)-$ gravity. In this scenario, universe begins with power-law inflation, followed by deceleration and acceleration in the late universe as well as possible collapse of the universe in future. It is different from $f(R)-$ dark energy models with non-linear curvature terms assumed as dark energy. Here, dark energy terms are induced by linear as well as non-linear terms of curvature in Friedmann equation being derived from modified gravity.It is also interesting to see that, in this model, dark radiation and dark matter terms emerge spontaneously from the gravitational sector. It is found that dark energy, obtained here, behaves as quintessence in the early universe and phantom in the late universe. Moreover, analogous to brane-tension in brane-gravity inspired Friedmann equation, a tension term $\lambda$ arises here being called as cosmic tension. It is found that, in the late universe, Friedmann equation (obtained here) contains a term $- \rho^2/2\lambda$ ($\rho$ being the phantom energy density) analogous to a similar term in Friedmann equation with loop quantum effects, if $\lambda > 0$ and brane-gravity correction when $\lambda < 0.$Comment: 19 Pages. To appear in Int. J. Thro. Phy

Targeting of the MAPK and AKT pathways in conjunctival melanoma shows potential synergy

Purpose: Conjunctival melanoma (CM) is a rare but lethal form of cancer. Similar to cutaneous melanoma, CM frequently carries activating mutations in BRAF and NRAS. We studied whether CM as well as conjunctival benign and premalignant melanocytic lesions express targets in the mitogen-activated protein kinase (MAPK) and AKT pathways, and whether specific inhibitors can suppress CM growth in vitro. Methods: 131 conjunctival lesions obtained from 129 patients were collected. The presence of BRAF V600E mutation and expression of phosphorylated (p)-ERK and p-AKT were assessed by immunohistochemistry. We studied cell proliferation, phosphorylation, cell cycling and apoptosis in three CM cell lines using two BRAF inhibitors (Vemurafenib and Dabrafenib), a MEK inhibitor (MEK162) and an AKT inhibitor (MK2206). Results: The BRAF V600E mutation was present in 19% of nevi and 26% of melanomas, but not in primary acquired melanosis (PAM). Nuclear and cytoplasmic p-ERK and p-AKT were expressed in all conjunctival lesions. Both BRAF inhibitors suppressed growth of both BRAF mutant CM cell lines, but only one induced cell death. MEK162 and MK2206 inhibited proliferation of CM cells in a dose-dependent manner, and the combination of these two drugs led to synergistic growth inhibition and cell death in all CM cell lines. Conclusion: ERK and AKT are constitutively activated in conjunctival nevi, PAM and melanoma. While BRAF inhibitors prohibited cell growth, they were not always cytotoxic. Combining MEK and AKT inhibitors led to more growth inhibition and cell death in CM cells. The combination may benefit patients suffering from metastatic conjunctival melanoma

B→D(∗)B \to D^{(*)} Form Factors from QCD Light-Cone Sum Rules

We derive new QCD sum rules for $B\to D$ and $B\to D^*$ form factors. The underlying correlation functions are expanded near the light-cone in terms of $B$-meson distribution amplitudes defined in HQET, whereas the $c$-quark mass is kept finite. The leading-order contributions of two- and three-particle distribution amplitudes are taken into account. From the resulting light-cone sum rules we calculate all B\to \Dst form factors in the region of small momentum transfer (maximal recoil). In the infinite heavy-quark mass limit the sum rules reduce to a single expression for the Isgur-Wise function. We compare our predictions with the form factors extracted from experimental B\to \Dst l \nu_l decay rates fitted to dispersive parameterizations.Comment: 20 pages, 6 figures; one reference, one figure and several comments added; version to appear in European Physical Journal

SN1A data and the CMB of Modified Curvature at short and long distances

The SN1a data, although inconclusive, when combined with other observations makes a strong case that our universe is presently dominated by dark energy. We investigate the possibility that large distance modifications of the curvature of the universe would perhaps offer an alternative explanation of the observation. Our calculations indicate that a universe made up of no dark energy but instead, with a modified curvature at large scales, is not scale-invariant, therefore quite likely it is ruled out by the CMB observations. The sensitivity of the CMB spectrum is checked for the whole range of mode modifications of large or short distance physics. The spectrum is robust against modifications of short-distance physics and the UV cutoff when: the initial state is the adiabatic vacuum, and the inflationary background space is de Sitter.Comment: 13 pages, 2 eps figures, typos corrected, references added; to appear in Phys. Rev.