Minimally invasive resection of benign esophageal tumors

ObjectiveBenign tumors of the esophagus are uncommon. Traditionally, resection has required thoracotomy or laparotomy. In this study we present our experience with resection of these tumors using a minimally invasive approach.MethodsA retrospective review of patients who underwent resection of benign esophageal tumors between 1990 and 2005 was conducted. Operative approach, tumor size, and outcomes after surgery were recorded.ResultsTwenty patients were identified (leiomyoma: n = 15; stromal tumor: n = 3; granular cell tumor, n = 1; schwannoma: n = 1). Four patients underwent an open approach (right thoracotomy); the remainder were resected using minimally invasive techniques (thoracoscopy, n = 9; laparoscopy, n =7). There were no postoperative leaks or other major complications after surgery. Two patients required repair of a mucosal injury during resection. Mean tumor size in the open group was 8.1 cm (range 7–10 cm) compared with 3.5 cm (range 0.9–8 cm) in the minimally invasive group. Median length of stay was 5.5 days in the open group compared with 2.75 days in the minimally invasive group. Five patients subsequently required fundoplication for worsening (n = 3) or new-onset (n = 2) gastroesophageal reflux disease after tumor resection.ConclusionsMinimally invasive resection of benign esophageal tumors is technically safe and associated with a shorter length of stay compared with open approaches. Although no specific cutoff for size could be identified, most tumors greater than 7 cm were removed by thoracotomy. The subsequent development of reflux may be related to the esophageal myotomy required for resection

Automated flow rate calculation based on digital analysis of flow convergence proximal to regurgitant orifice

AbstractObjectives. The purpose of the study was to develop and validate an automated method for calculating regurgitant flow rate using color Doppler echocardiography.Background. The proximal flow convergence method is a promising approach to quantitate valvular regurgitation noninvasively because it allows one to calculate regurgitant flow rate and regurgitant orifice area; however, defining the location of the regurgitant orifice is often difficult and can lead to significant error in the calculated flow rates. To overcome this problem we developed an automated algorithm to locate the orifice and calculate flow rate based on the digital Doppler velocity map.Methods. This algorithm compares the observed velocities with the anticipated relative velocities, cos ϑ/μt2. The orifice is localized as the point with maximal correlation between predicted and observed velocity, whereas flow rate is specified as the slope of the regression line. We validated this algorithm in an in vitro model for flow through circular orifices with planar surroundings and a porcine bioprosthesis.Results. For flow through circular orifices, flow rates calculated on individual Doppler maps and on an average of eight velocity maps showed excellent agreement with true flow, with r = 0.977 and ΔQ = −3.7 ± 15.8 cm3/s and r = 0.991 and ΔQ = −4.3 ± 8.5 cm3/s, respectively. Calculated flow rates through the bioprosthesis correlated well but underestimated true flow, with r = 0.97, ΔQ = −10.9 ± 12.5 cm3/s, suggesting flow convergence over an >2π. This systematic underestimation was corrected by assuming an effective convergence angle of 212 δ.Conclusions. This algorithm accurately locates the regurgitant orifice and calculates regurgitant flow rate for circular orifices with planar surroundings. Automated analysis of the proximal flow field is also applicable to more physiologic surfaces surrounding the regurgitant orifice; however, the convergence angle should be adjusted. This automated algorithm should make quantification of regurgitant flow rate and regurgitant orifice area more reproducible and readily available in clinical cardiology practice

Cerium-Based Spontaneous Coating Process for Corrosion Protection of Aluminum Alloys

A cerium-based coating for corrosion resistance is applied by exposing a cleaned aluminum-based component to a corrosion-inhibiting cerium solution containing cerium ions in the presence of an oxidizing agent. The coating deposits spontaneously without an external source of electrons

How does the radio enhancement of broad absorption line quasars relate to colour and accretion rate?

The origin of radio emission in different populations of radio-quiet quasars is relatively unknown, but recent work has uncovered various drivers of increased radio-detection fraction. In this work, we pull together three known factors: optical colour (g - i), C IV distance (a proxy for L/LEdd), and whether or not the quasar contains broad absorption lines (BALQSOs) which signify an outflow. We use SDSS (Sloan Digital Sky Survey) DR14 spectra along with the LOFAR Two Metre Sky Survey Data Release 2 and find that each of these properties have an independent effect. BALQSOs are marginally more likely to be radio-detected than non-BALQSOs at similar colours and L/LEdd, moderate reddening significantly increases the radio-detection fraction and the radio detection increases with L/LEdd above a threshold for all populations. We test a widely used simple model for radio wind shock emission and calculate energetic efficiencies that would be required to reproduce the observed radio properties. We discuss interpretations of these results concerning radio-quiet quasars more generally. We suggest that radio emission in BALQSOs is connected to a different physical origin than the general quasar population since they show different radio properties independent of colour and C IV distance

Characterizing the Epidemiological Transition in Mexico: National and Subnational Burden of Diseases, Injuries, and Risk Factors

Gretchen Stevens and colleagues estimate deaths and loss of healthy life years (measured in disability-adjusted life years, DALYs) for Mexico as a whole and its 32 states

IFNAR1-Signalling Obstructs ICOS-mediated Humoral Immunity during Non-lethal Blood-Stage Plasmodium Infection

Funding: This work was funded by a Career Development Fellowship (1028634) and a project grant (GRNT1028641) awarded to AHa by the Australian National Health & Medical Research Council (NHMRC). IS was supported by The University of Queensland Centennial and IPRS Scholarships. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Peer reviewedPublisher PD

The Maunakea Spectroscopic Explorer Book 2018

(Abridged) This is the Maunakea Spectroscopic Explorer 2018 book. It is intended as a concise reference guide to all aspects of the scientific and technical design of MSE, for the international astronomy and engineering communities, and related agencies. The current version is a status report of MSE's science goals and their practical implementation, following the System Conceptual Design Review, held in January 2018. MSE is a planned 10-m class, wide-field, optical and near-infrared facility, designed to enable transformative science, while filling a critical missing gap in the emerging international network of large-scale astronomical facilities. MSE is completely dedicated to multi-object spectroscopy of samples of between thousands and millions of astrophysical objects. It will lead the world in this arena, due to its unique design capabilities: it will boast a large (11.25 m) aperture and wide (1.52 sq. degree) field of view; it will have the capabilities to observe at a wide range of spectral resolutions, from R2500 to R40,000, with massive multiplexing (4332 spectra per exposure, with all spectral resolutions available at all times), and an on-target observing efficiency of more than 80%. MSE will unveil the composition and dynamics of the faint Universe and is designed to excel at precision studies of faint astrophysical phenomena. It will also provide critical follow-up for multi-wavelength imaging surveys, such as those of the Large Synoptic Survey Telescope, Gaia, Euclid, the Wide Field Infrared Survey Telescope, the Square Kilometre Array, and the Next Generation Very Large Array.Comment: 5 chapters, 160 pages, 107 figure

Pan-Cancer Analysis of lncRNA Regulation Supports Their Targeting of Cancer Genes in Each Tumor Context

Long noncoding RNAs (lncRNAs) are commonly dys-regulated in tumors, but only a handful are known toplay pathophysiological roles in cancer. We inferredlncRNAs that dysregulate cancer pathways, onco-genes, and tumor suppressors (cancer genes) bymodeling their effects on the activity of transcriptionfactors, RNA-binding proteins, and microRNAs in5,185 TCGA tumors and 1,019 ENCODE assays.Our predictions included hundreds of candidateonco- and tumor-suppressor lncRNAs (cancerlncRNAs) whose somatic alterations account for thedysregulation of dozens of cancer genes and path-ways in each of 14 tumor contexts. To demonstrateproof of concept, we showed that perturbations tar-geting OIP5-AS1 (an inferred tumor suppressor) andTUG1 and WT1-AS (inferred onco-lncRNAs) dysre-gulated cancer genes and altered proliferation ofbreast and gynecologic cancer cells. Our analysis in-dicates that, although most lncRNAs are dysregu-lated in a tumor-specific manner, some, includingOIP5-AS1, TUG1, NEAT1, MEG3, and TSIX, synergis-tically dysregulate cancer pathways in multiple tumorcontexts

Pan-cancer Alterations of the MYC Oncogene and Its Proximal Network across the Cancer Genome Atlas

Although theMYConcogene has been implicated incancer, a systematic assessment of alterations ofMYC, related transcription factors, and co-regulatoryproteins, forming the proximal MYC network (PMN),across human cancers is lacking. Using computa-tional approaches, we define genomic and proteo-mic features associated with MYC and the PMNacross the 33 cancers of The Cancer Genome Atlas.Pan-cancer, 28% of all samples had at least one ofthe MYC paralogs amplified. In contrast, the MYCantagonists MGA and MNT were the most frequentlymutated or deleted members, proposing a roleas tumor suppressors.MYCalterations were mutu-ally exclusive withPIK3CA,PTEN,APC,orBRAFalterations, suggesting that MYC is a distinct onco-genic driver. Expression analysis revealed MYC-associated pathways in tumor subtypes, such asimmune response and growth factor signaling; chro-matin, translation, and DNA replication/repair wereconserved pan-cancer. This analysis reveals insightsinto MYC biology and is a reference for biomarkersand therapeutics for cancers with alterations ofMYC or the PMN