Management of complex hernias with loss of domain using daily and fractioned preoperative progressive pneumoperitoneum: a retrospective single-center cohort study.

PURPOSE: The incidence of complex hernias with loss of domain (CHLD) has been increasing and the treatment of these cases may require auxiliary techniques in addition to surgery. This study aims to refine the progressive preoperative pneumoperitonium (PPP) in patients with CHLD, to achieve an increased in wall dimensions. METHODS: Patients presented with a CHLD undergoing PPP protocol were analyzed between May 2017 and May 2019. Our PPP protocol was to use two daily insufflations of 1000 ml of ambient air during a period of 14 days. We compared the abdominal cavity volume (ACV), the hernial sac volume (HSV) and the volume ratio (VR), before and after our refined PPP. RESULTS: During our evaluation period, the protocol was performed on 16 patients. The mean age was 55.73 (± 12.87), and the mean BMI was 31.35 (± 7.33). The median of HSV was 2104.53 ml; Mean ACV was 6722.36 ml, and median of VR was 29.97% (27.46-34.38 IIQ). The averages were: daily volume of gas ± 1526.66 ml, total volume ± 17,350 ml, and the PPP period of ± 10.7 days. The increase in post-PPP ACV was 52.13% (p < 0.0001), and the VR decreased to 26.9% (p < 0.609). All patients' symptoms and complications were mild (according Clavien-Dindo grades I and II), and there were no loop injuries, no catheter complications, or any surgical re-interventions. CONCLUSION: The study suggests that the use of this method results in a significant increase in ACV, and reduction of the herniated content in a safe and efficient manner, with mild complications.

Wildfire responses to abrupt climate change in North America.

It is widely accepted, based on data from the last few decades and on model simulations, that anthropogenic climate change will cause increased fire activity. However, less attention has been paid to the relationship between abrupt climate changes and heightened fire activity in the paleorecord. We use 35 charcoal and pollen records to assess how fire regimes in North America changed during the last glacial-interglacial transition (15 to 10 ka), a time of large and rapid climate changes. We also test the hypothesis that a comet impact initiated continental-scale wildfires at 12.9 ka; the data do not support this idea, nor are continent-wide fires indicated at any time during deglaciation. There are, however, clear links between large climate changes and fire activity. Biomass burning gradually increased from the glacial period to the beginning of the Younger Dryas. Although there are changes in biomass burning during the Younger Dryas, there is no systematic trend. There is a further increase in biomass burning after the Younger Dryas. Intervals of rapid climate change at 13.9, 13.2, and 11.7 ka are marked by large increases in fire activity. The timing of changes in fire is not coincident with changes in human population density or the timing of the extinction of the megafauna. Although these factors could have contributed to fire-regime changes at individual sites or at specific times, the charcoal data indicate an important role for climate, and particularly rapid climate change, in determining broad-scale levels of fire activity.

The association between multifocal electroretinograms and OCT retinal thickness in retinitis pigmentosa patients with good visual acuity.

AIMS: To investigate relationships between retinal morphology and retinal function in patients with retinitis pigmentosa (RP) using optical coherence tomography (OCT) and multifocal electroretinography (mfERG). METHODS: In all, 14 patients with RP who had visual acuities of 0.2 logMAR or better and Humphrey central fields of 10 degrees or larger participated in the study along with 16 normal control subjects. The amplitudes and timings of the mfERG responses were compared with spatially corresponding measures of retinal layer thickness from OCT within the macula region (central 12 degrees ). RESULTS: Eyes with RP showed thinning of the photoreceptor retinal (PR) layer and thickening of mid-inner retinal (MIR) layers beyond the fovea. mfERG amplitude was reduced in all regions, whereas mfERG timing was only significantly delayed at a retinal eccentricity of 6-12 degrees and was otherwise preserved within the foveal and parafoveal retina (0-6 degrees). PR layer thickness was correlated with mfERG amplitude across the macula region. mfERG timing was correlated with the total change in retinal thickness (combined PR thinning and MIR thickening) at an eccentricity of 6-12 degrees. CONCLUSIONS: The relationship between mfERG timing and retinal thickness in RP is dependent on the retinal eccentricity. Preserved timing in the central retina (0-6 degrees ), despite significant disruption to retinal laminar structure, could be suggestive of inner retinal remodelling or functional redundancy. Cone system activity derived from mfERG amplitude appears to be related to the thickness of the photoreceptor layer in the macula region.

Investigation of the effect of simulated lens yellowing, transparency loss and refractive error on in vivo resonance Raman spectroscopy.

PURPOSE: To separately investigate the impact of simulated age-related lens yellowing, transparency loss and refractive error on measurements of macular pigment (MP) using resonance Raman spectroscopy. METHODS: Two healthy young subjects with clear media underwent Raman spectroscopy under the following conditions: age-related lens yellowing was simulated using seven broad-band yellow filters with transmittance at 488 nm ranging from 0.54 to 0.90; cataract was simulated using five white filters of increasing opacity (scatter filters), the transmittance of which ranged from 0.42 to 0.86, each of which reduced peak contrast sensitivity by approximately 0.1 log units over the previous filter. Refractive error up to +6.25 D was achieved using soft contact lenses. RESULTS: The Raman signal declined steadily to an average value of 43% of the starting value with the densest yellow filter in place. The white scatter filters produced a progressive linear reduction in signal resulting in almost complete signal loss with the densest filter. Refractive error resulted in an initial slight improvement in Raman count up to a value of +2.00 D followed by a decline thereafter. CONCLUSIONS: These results imply that lens yellowing and increasing scatter has an influence on the Raman signal and suggest that studies using this technology to estimate MP levels in older populations should carefully account for the status of the lens.

In vivo macular pigment measurements: a comparison of resonance Raman spectroscopy and heterochromatic flicker photometry.

AIM: To investigate whether two methods of measuring macular pigment-namely, heterochromatic flicker photometry (HFP) and resonance Raman spectroscopy (RRS)--yield comparable data. METHODS: Macular pigment was measured using HFP and RRS in the right eye of 107 participants aged 20-79 years. Correlations between methods were sought and regression models generated. RRS was recorded as Raman counts and HFP as macular pigment optical density (MPOD). The average of the top three of five Raman counts was compared with MPOD obtained at 0.5 degrees eccentricity, and an integrated measure (spatial profile; MPODsp) computed from four stimulus sizes on HFP. RESULTS: The coefficient of variation was 12.0% for MPODsp and 13.5% for Raman counts. MPODsp exhibited significant correlations with Raman counts (r = 0.260, p = 0.012), whereas MPOD at 0.5 degrees did not correlate significantly (r = 0.163, p = 0.118). MPODsp was not significantly correlated with age (p = 0.062), whereas MPOD at 0.5 degrees was positively correlated (p = 0.011). Raman counts showed a significant decrease with age (p = 0.002) and were significantly lower when pupil size was smaller (p = 0.015). CONCLUSIONS: Despite a statistically significant correlation, the correlations were weak, with those in excess of 90% of the variance between MPODsp and Raman counts remaining unexplained, meriting further research.

Importância anatomocirúrgica das características macroscópicas, localização e suprimento vascular das glândulas paratireóides cervicais / Anatomic and surgical importance of macroscopic characteristics, location and vascular supply of cervical parathyroid glands

OBJETIVOS: A importância anatômica e cirúrgica das glândulas paratireóides, notadamente, no curso das tireoidectomias continua viva e despertando interesse científico. Por outro lado, são raros os trabalhos científicos sobre a investigação da anatomia das paratireóides. Dessa forma, o objetivo deste trabalho é contribuir para estabelecer essa ponte anatomocirúrgica. MÉTODO: Estudo macro e microscópico das glândulas paratireóides dissecadas nas peças anatômicas de dezenove cadáveres, todos do sexo masculino e com idade entre 20 e 60 anos. Na abordagem do suprimento vascular foi utilizada a técnica de corrosão para identificar a vascularização e a glândula tireóide adotada como referência espacial na localização das paratireóides. RESULTADOS: Foram identificadas na macro e microscopia 76 glândulas paratireóides cervicais. Trinta e quatro (44,73 por cento) possuíam a coloração vermelho-amarelada, 26 (34,21 por cento) a cor preto-acinzentada e dezesseis (21,06 por cento) a cor castanho-amarelada. O tamanho encontrado ficou entre 3 e 15mm, prevalecendo o intervalo de 4 a 6,9mm em 43 (56,58 por cento) glândulas. Foram encontradas de duas a seis paratireóides por cadáver, prevalecendo o número de quatro (47,37 por cento) em nove necrópsias. Quarenta e duas (55,26 por cento) glândulas localizavam- se superior à tireóide e 34 (47,74 por cento) inferiormente. Os moldes da vascularização das paratireóides após a corrosão demonstraram que os capilares provenientes das artérias tireóideas superiores e inferiores se unem próximo à glândula. CONCLUSÕES: Com forte influência no curso das tireoidectomias, o estudo evidenciou que as glândulas paratireóides cervicais superiores e inferiores podem ser encontradas em diferentes posições frente à tireóide com maior ou menor intimidade em relação à cápsula tireóidea e que a irrigação vascular de uma paratireóide não é proveniente apenas de uma artéria.

OBJECTIVES: The anatomic and surgical importance of the parathyroid glands, notably in the course of thyroidectomy still continues alive and awaking scientific interests. On the other hand, there are scarce scientific studies about the investigation of parathyroid glands anatomy. The main objective of this study is to contribute to establish these anatomic and surgical connections. METHODS: The macro and microscopic studies of the parathyroid glands dissected in anatomic parts from nineteen corpses, all male between 20 and 60 years old. To approach the vascular supply, it was used an erosion technique to identify the blood vessels and the thyroid gland adopted as a space reference in the parathyroid glands location. RESULTS: There were identified in macro and microscopy 76 cervical parathyroid glands. Thirty-four (44.73 percent) had a yellow-red colouring, 26 (34.21 percent) a grey-black colouring and sixteen (21.06 percent) a yellow-tan colouring. The size was between 3 to 15 mm, prevailing the interval of 4 to 6.9 mm in 43 (56.58 percent) glands. There were found from two to six parathyroid glands per corpse, prevailing the number of four in nine (47.37 percent) necropsies. Forty-two (55.26 percent) parathyroid glands were from the upper and 34 (47.74 percent) from the lower thyroid gland. Blood vessels moulds of parathyroid glands after the erosion technique, demonstrated that capillaries prevailing from the upper and lower thyroid arteries join together next to the gland. CONCLUSION: With strong influence in the course of thyroidectomies, the study showed up that upper and lower cervical parathyroid glands can be found in different positions face to thyroid gland, with greater or smaller intimacy gland is not prevailing of a unique artery.

[Invariants of spatial summation for S (short wavelength) cone vision]. / Invarianty prostranstvennoi summatsii dlia S (korotkovolnovogo) kolbochkovogo zreniia.

Spatial summation in the human visual system was studied as a function of retinal eccentricity upon selective stimulation of the short-wavelength sensitive cones. The area of complete spatial summation (Ricco's area) was found to increase with retinal eccentricity while the threshold of stimuli equal in size with Ricco's area remained constant. Comparisons with known morphology of the small bistratified retinal ganglion cells, the only cells known to be excited by S-one ON stimulation, showed that Ricco's area included 2-4 such cells and is up to 1.5 times larger than the dendritic field of a single cell. These relationships were relatively constant within the eccentricity range tested (5-20 deg along the temporal horizontal meridian) and might be the source of threshold invariance of stimuli matching Ricco's area.

The contrast sensitivity function for detection and resolution of blue-on-yellow gratings in foveal and peripheral vision.

Previous studies using polychromatic gratings have shown that the peripheral grating contrast sensitivity function is significantly different when the task is resolution rather than detection. Specifically, in the middle frequency range, while resolution acuity drops suddenly to zero, detection performance continues up to much higher frequencies, accompanied by observations of aliasing. We wanted to determine if the same holds true for blue-cone isolating gratings in either foveal or peripheral vision. Contrast sensitivity function (CSFs) were measured at the fovea and 20 degrees eccentricity in the temporal retina under conditions of short-wavelength-sensitive (SWS)-cone pathway isolation using a two-alternative forced choice paradigm. The detection and resolution CSF were identical at the low frequency end but at higher frequencies resolution sensitivity falls abruptly while contrast detection remained possible till higher frequencies [cut-off frequencies: fovea detection 6.0 cycles (degree)(-1), resolution 4.6 cycles (degree)(-1); periphery detection 1.6 cycles (degree)(-1), resolution 1.05 cycles (degree)(-1)]. Aliasing was observable when spatial frequency exceeded the resolution limit. Medium/high contrast blue-cone-mediated resolution acuity is sampling limited in both the fovea and periphery. Previous studies of blue-cone contrast sensitivity which employed a detection task do not reflect the true resolution limit.

Binocular summation for grating detection and resolution in foveal and peripheral vision.

Peripheral monocular grating resolution has been shown to be limited by the sampling density of the underlying retinal ganglion cells. We wanted to determine if peripheral resolution is also sampling limited binocularly; and, if so, how great is any improvement in either detection or resolution when viewing binocularly? We measured detection and resolution acuity for sinusoidal gratings in foveal and peripheral vision both monocularly and binocularly. Detection and resolution acuity were very similar in foveal vision and displayed a binocular improvement of 5% over best monocular acuity. However, in peripheral vision, while detection acuity improved by 6% binocularly, resolution acuity improved by 16%, with a subsequently smaller aliasing zone. This improvement was greater than predicted by probability summation and implies that the two monocular ganglion cell sampling arrays combine at a higher level resulting in a higher binocular sampling density.

Controlled trial of acyclovir for chickenpox evaluating time of initiation and duration of therapy and viral resistance.

BACKGROUND: Chickenpox is prevalent in the US despite the availability of an effective vaccine. Acyclovir treatment is limited by concerns about efficacy if given after the first day of rash and by concerns about induction of viral resistance. OBJECTIVE: Evaluate initiation and duration of acyclovir treatment of chickenpox and its effect on viral resistance. STUDY DESIGN: Randomized, placebo-controlled, double blind trial in immunocompetent patients who were stratified by age at enrollment (children, 2 to 11 years; adolescents, > or = 12 to 18 years; adults, > or = 19 years) and duration of rash (< or = 24 h vs. >24 to 48 h). Lesions were staged, counted and cultured; temperatures and symptoms were recorded daily. INTERVENTION: Subjects presenting within 24 h of rash onset (Group A) were randomly assigned to 5 or 7 days of oral acyclovir treatment, 80 mg/kg/day up to a maximum of 3,200 mg/day in four divided doses. Subjects whose rash was >24 to 48 h old were randomized to receive 5 days of acyclovir treatment beginning on the first (Group B1) or second study day (Group B2). Matching placebos were used to ensure that subjects uniformly received 28 doses of study compound. RESULTS: Of the 177 subjects recruited Group A patients who were treated on the first day of rash had the greatest number of significantly shortened event times with 5 days of therapy being equivalent to 7 days. There also were some shorter times to events for Group B1 patients who began therapy on the second day of rash vs. Group B2 patients who started acyclovir on the third. These included: time to maximum lesion formation (adolescents, P = 0.007; children, P = 0.03); 50% healing in adolescents (P = 0.005); and residual facial lesions in adults (P = 0.047). The probability of viral shedding was significantly reduced for Group A subjects vs. Group B1 subjects (P = 0.006). Viruses shed during therapy remained susceptible to acyclovir and retained normal thymidine kinase function. CONCLUSIONS: Immunocompetent children, adolescents and adults with chickenpox displayed a gradation in their clinical responses to acyclovir that correlated with the time from onset of rash to initiation of therapy. Five days of therapy is sufficient because a 7-day course provided no additional benefit. The susceptibility to acyclovir of viruses shed during treatment did not change; however, the effect of therapy on resistance of latent virus was not assessed.

A simple method for electron energy constancy measurement.

A device is described for use in confirming the energy constancy of clinical electron beams. A wedge shaped absorber is placed over an ionization chamber leading to an energy dependent response. A measurement under the energy filter is divided by a measurement in air to correct for the inherent energy dependence of the chamber. A nearly linear response is demonstrated.

Geometry function of a linear brachytherapy source.

An equation is derived for the TG43 geometry function, G(r,theta), of a linear brachytherapy source in terms of its active length. This equation is validated by comparison to published values. It is then used to calculate values of the geometry function for the Model 200 (103)Pd seed, which is a segmented linear source.

Evidence for nonacetylcholinesterase targets of organophosphorus nerve agent: supersensitivity of acetylcholinesterase knockout mouse to VX lethality.

The possibility that organophosphate toxicity is due to inhibition of targets other than acetylcholinesterase (AChE, EC 3.1.1.7) was examined in AChE knockout mice. Mice (34-55 days old) were grouped for this study, after it was determined that AChE, butyrylcholinesterase (BChE), and carboxylesterase activities had reached stable values by this age. Mice with 0, 50, or 100% AChE activity were treated subcutaneously with the nerve agent VX. The LD50 for VX was 10 to 12 microg/kg in AChE-/-, 17 microg/kg in AChE+/-, and 24 microg/kg in AChE+/+ mice. The same cholinergic signs of toxicity were present in AChE-/- mice as in wild-type mice, even though AChE-/- mice have no AChE whose inhibition could lead to cholinergic signs. Wild-type mice, but not AChE-/- mice, were protected by pretreatment with atropine. Tissues were extracted from VX-treated and untreated animals and tested for AChE, BChE, and acylpeptide hydrolase activity. VX treatment inhibited 50% of the AChE activity in brain and muscle of AChE+/+ and +/- mice, 50% of the BChE activity in all three AChE genotypes, but did not significantly inhibit acylpeptide hydrolase activity. It was concluded that the toxicity of VX must be attributed to inhibition of nonacetylcholinesterase targets in the AChE-/- mouse. Organophosphorus ester toxicity in wild-type mice is probably due to inhibition or binding to several proteins, only one of which is AChE.

Effect of localized defocus on detection thresholds for different sized targets in the fovea and periphery.

PURPOSE: Previous studies of optical blur in perimetry have measured the effect of foveal refractive error on peripheral perimetric detection thresholds. Since peripheral refractive error can be significantly different from that of the fovea we wished to remove the ambiguity of previous results by correcting the actual peripheral refractive error first before adding blur. METHODS: We measured detection thresholds in the fovea and at 30 degrees in the horizontal temporal field in two trained observers. Peripheral refractive error was determined at each location and thresholds measured at the same locations for stimuli ranging in size from 0.2 to 6.4 degrees and refractive errors between +/-4.00 diopters. RESULTS: Foveal thresholds increased immediately with increasing refractive error, particularly for smaller stimulus sizes. At 30 degrees, thresholds for smaller stimuli were less affected by defocus initially and then increased more sharply. Larger stimuli were relatively unaffected by defocus such that when stimulus size reached 1.6 degrees there was little or no increase in threshold for refractive error between +/-4.00 diopters. CONCLUSIONS: Peripheral refractive error, largely forgotten by perimetrists, has a significant effect on performance, particularly for smaller stimuli. Differences in foveal vs peripheral viewing can be explained by differences in ganglion cell receptive field sizes.

Radioimmunoguided surgery using indium-111 capromab pendetide (PROSTASCINT) to diagnose supraclavicular metastasis from prostate cancer.

A 59-year-old man presented with a Gleason score of 4 + 4 = 8 prostate cancer and with multiple bilateral pelvic nodes involved at open pelvic lymph node dissection. On indium-111 capromab pendetide (ProstaScint) scan, there was increased tracer deposition in the prostate, the mesenteric nodes, the right pulmonary hilum, and the left supraclavicular fossa. The ProstaScint injection was repeated, and the gamma probe was used to localize tissue that accumulated radiotracer. Two nodes were excised, one that exhibited increased uptake and one that did not. The radioactive lymph node contained metastatic prostate cancer. No malignancy was found in the second node.

Care-seeking behavior for upper respiratory infections.

BACKGROUND: Many recent efforts to reduce unnecessary medical services have targeted care of upper respiratory infections (URIs). We tested whether patients who seek care very early in their illness differ from those who seek care later and whether they might require a different approach to care. METHODS: We surveyed by telephone 257 adult patients and 249 parents of child patients who called or visited one of 3 primary care clinics within 10 days (adults) or 14 days (parents) of the onset of uncomplicated URI symptoms. Those who contacted the clinic within the first 2 days of illness were compared with those who made contact later. RESULTS: Although 28% of adults and 41% of parents contacted their clinic within the first 2 days of symptom onset, we found very few differences in the characteristics of the caller or patient between those who called early and later. The illnesses of those who called early were not more severe, and they did not have different beliefs, histories, approaches to medical care, or needs. The only clinician-relevant difference was that adult patients calling in the first 2 days had a greater desire to rule out complications (84.7% vs 64.1% calling in 3-5 days and 70.6% calling after 5 days of illness, P < or = .05). CONCLUSIONS: Those who seek medical care very early for a URI do not appear to be different in clinically important ways. If we are going to reduce overuse of medical care and antibiotics for URIs, clinical trials of more effective and efficient strategies are needed to encourage home care and self-management.

The effects of chlorothalonil on oyster hemocyte activation: phagocytosis, reduced pyridine nucleotides, and reactive oxygen species production.

The production of reactive oxygen species (ROS) by a putative NADPH oxidase-like enzyme system is thought to contribute to antimicrobial activity in oyster hemocytes. NADPH oxidase in vertebrate phagocytes generates superoxide anion from molecular oxygen and NADPH, which is then converted to additional ROS, including H2O2 and HOCl. The fungicide chlorothalonil (TCIN) is a thiol-reactive compound that binds to protein sulfhydryl groups, which can result in enzyme inactivation. NADPH oxidase, containing several sulfhydryl groups, is a potential target of TCIN. Previous studies have demonstrated that in vitro exposure of fish (Morone saxatilus) macrophages to TCIN (10-500 microg/L) suppressed immunostimulated ROS and baseline NAD[P]H concentration but did not inhibit phagocytosis; the production of NADPH in stimulated cells was decreased only at the highest concentration. In this study, we evaluated the effects of TCIN (10-500 microg/L) on oyster hemocyte functions. As with striped bass macrophages, in vitro exposure to TCIN suppressed hemocyte ROS production in a dose-dependent manner, but did not affect phagocytosis. In contrast to the striped bass data, baseline NAD[P]H concentration was relatively unaffected and immunostimulated NAD[P]H production was marginally suppressed at the higher exposure concentrations. Despite these minor differences, these results suggest that TCIN may also be inhibiting an NAD[P]H oxidase-like enzyme in oyster hemocytes.