bluuebunny/crossref_metadata_2025 huggingface dataset:
Local Resistances of Gas–Liquid Two-Phase Flows in Vertical L-Shaped and Z-Shaped Pipes
Authors: Wang Bing , Chen Shan-qun , Liao Bin
Published: November 2022

In this paper, a systematic numerical study of the local resistance coefficients of vertical L-shaped and Z-shaped pipes for gas‒liquid two-phase flows under vertical conditions was carried out using a realizable k-ε turbulence model combined with a mixture model in Fluent software. Specifically, the influence of the Reynolds number Rel, the gas-phase volume rate α, the radius–diameter ratio R/D, the height–diameter ratio H/D, and the two-phase flow direction on the local resistance coefficient ξ were discussed in detail. ξ of the vertical Z-shaped pipe decreases with increasing Rel, while ξ of the vertical L-shaped pipe does not change significantly. In a specific range, ξ of vertical L-shaped and Z-shaped pipes increases with increasing α and decreases with increasing R/D. In Z-shaped pipes, under the upward flow condition, ξ increases with increasing H/D, and under the downward flow and horizontal flow conditions, ξ first decreases and then increases with increasing H/D. Overall, upward and downward flow conditions have a larger ξ than the horizontal flow condition. When H/D is larger than 14, ξ tends to be stable under all three flow conditions. Finally, the relationship equations between ξ and Rel, α, R/D, and H/D were fitted, which agreed with the numerical results.
Influence of Self‐Perceived Burden on Quality of Life in Patients with Urostomy Based on Structural Equation Model: The Mediating Effects of Resilience and Social Support
Authors: Chang Yan , Zhang Xiao Na , Yu Fang , Zhang Rui , Li Xin Dan , Zhao Jie , Lu Hong Yan
Published: November 2022

Objective. To investigate the current situation of self‐perceived burden in patients with urostomy, analyze the correlation between self‐perceived burden and quality of life, and explore the intermediary role of resilience and social support. Methods. The convenience sampling method was used to select 303 patients with urostomy of outpatient departments of the three tertiary hospitals in Yinchuan, Ningxia region, China, from April 1, 2020, to October 1, 2020, who then completed a survey questionnaire. The survey questionnaire contained a general data questionnaire and self‐perceived burden scale, city of hope‐quality of life‐ostomy questionnaire, Connor‐Davidson resilience scale, and social support rating scale. Results. Self‐perceived burden was present among 89.8% patients with urostomy; the quality of life of patients with urostomy is low. The results showed that the self‐perceived burden and quality of life, resilience, and social support are related in pairs; self‐perceived burden was significantly negatively correlated with quality of life，resilience, and social support; there was a significant positive correlation between quality of life, resilience, and social support; resilience and social support were parallel mediators. Conclusions. Patients with urostomy had a heavy self‐perceived burden and low quality of life. Reducing the self‐perceived burden of patients with urostomy by improving the level of resilience and social support, could raise the level of quality of life. This study could provide empirical basis for nurses to take continuous nursing intervention measures in order to reduce the self‐perceived burden of patients with urostomy and ultimately to improve the quality of life.
Soluções Baseadas na Natureza como instrumento de melhoria da arborização urbana, auxiliando na construção de cidades sensíveis à água e resilientes às mudanças climáticas
Authors: Marchioni Mariana , Raimondi Anita , Silva Juliana Caroline de Alencar da , Yazaki Luiz Fernando Orsini de Lima , Velasco Giuliana Del Nero , Brazolin Sérgio , Silva Filho Carlos Alberto da , Becciu Gianfranco
Published: November 2022

Diante do contexto de mudanças climáticas, torna-se cada vez mais imperativa a adoção de estratégias para a construção de paisagens mais resilientes, que consigam responder aos eventos climáticos extremos, como as chuvas intensas e os períodos de estiagem prolongados, que já podem ser observados e segundo às previsões serão ainda mais críticos nas próximas décadas. O conceito de cidades sensíveis à água estabelece os princípios para a construção de um ambiente urbano saudável, onde sejam agregados serviços ecossistêmicos, desempenhado pelos elementos naturais, ao território e a sua comunidade. A arborização urbana é essencial nesse processo, já que atua na manutenção de diversos processos de regulação, de provisão, culturais e de suporte. Apesar de sua importância a arborização urbana encontra nas grandes cidades um ambiente altamente adverso ao seu desenvolvimento, principalmente no que se refere à disponibilidade hídrica, de nutrientes e de espaço para o seu crescimento adequado, sendo a queda das árvores urbanas durante chuvas intensas  responsável por danos ao patrimônio e às pessoas. O pivotamento, ou seja, a queda com o soerguimento de todo o sistema radicular, é causado pelo desenvolvimento inadequado do sistema radicular, que em áreas urbanas se dá devido principalmente a compactação do solo dos passeios públicos ou calçadas; a má distribuição da umidade por todo o volume de solo abaixo do calçamento também contribui para limitar o desenvolvimento das raízes, somado a isso temos muitas vezes a escolha inadequada de espécies que não observa as características do local. As áreas dos canteiros, responsáveis pela captação das águas das chuvas, não são suficientes para coletar um volume de água que permita um ambiente adequado desenvolvimento do sistema radicular e da árvore como um todo. Pavimentos permeáveis, que permitem a infiltração da água no solo e armazenam parte das águas pluviais, podem potencializar um habitat favorável ao desenvolvimento vegetal. Neste estudo foram simulados os processos hidrológicos nos passeios públicos com diferentes configurações com o objetivo de verificar o efeito da implantação de pavimentação permeável na disponibilidade hídrica como instrumento da manutenção da arborização urbana. Os resultados obtidos demonstram a potencialidade do uso destes sistemas para aumentar a disponibilidade hídrica no solo para mantenimento da arborização urbana.
Lipoprotein(a) in Youth and Prediction of Major Cardiovascular Outcomes in Adulthood
Authors: Raitakari Olli , Kartiosuo Noora , Pahkala Katja , Hutri-Kähönen Nina , Bazzano Lydia A. , Chen Wei , Urbina Elaine M. , Jacobs David R. , Sinaiko Alan , Steinberger Julia , Burns Trudy , Daniels Stephen R. , Venn Alison , Woo Jessica G. , Dwyer Terry , Juonala Markus , Viikari Jorma
Published: November 2022

Background:

Elevated lipoprotein(a) [Lp(a)] is a common risk factor for cardiovascular disease outcomes with unknown mechanisms. We examined its potential role in identifying youths who are at increased risk of developing adult atherosclerotic cardiovascular disease (ASCVD).

Methods:

Lp(a) levels measured in youth 9 to 24 years of age were linked to adult ASCVD and carotid intima-media thickness in the YFS (Cardiovascular Risk in Young Finns Study), in which 95 of the original 3596 participants (2.7%) recruited as children have been diagnosed with ASCVD at a median of 47 years of age. Results observed in YFS were replicated with the use of data for White participants from the BHS (Bogalusa Heart Study). In BHS, 587 White individuals had data on youth Lp(a) (measured at 8–17 years of age) and information on adult events, including 15 cases and 572 noncases. Analyses were performed with the use of Cox proportional hazard regression.

Results:

In YFS, those who had been exposed to high Lp(a) level in youth [defined as Lp(a) ≥30 mg/dL] had ≈2 times greater risk of developing adult ASCVD compared with nonexposed individuals (hazard ratio, 2.0 [95% CI, 1.4–2.6]). Youth risk factors, including Lp(a), low-density lipoprotein cholesterol, body mass index, and smoking, were all independently associated with higher risk. In BHS, in an age- and sex-adjusted model, White individuals who had been exposed to high Lp(a) had 2.5 times greater risk (95% CI, 0.9–6.8) of developing adult ASCVD compared with nonexposed individuals. When also adjusted for low-density lipoprotein cholesterol and body mass index, the risk associated with high Lp(a) remained unchanged (hazard ratio, 2.4 [95% CI, 0.8–7.3]). In a multivariable model for pooled data, individuals exposed to high Lp(a) had 2.0 times greater risk (95% CI, 1.0–3.7) of developing adult ASCVD compared with nonexposed individuals. No association was detected between youth Lp(a) and adult carotid artery thickness in either cohort or pooled data.

Conclusions:

Elevated Lp(a) level identified in youth is a risk factor for adult atherosclerotic cardiovascular outcomes but not for increased carotid intima-media thickness.
Distinct Mechanisms of β-Arrestin–Biased Agonist and Blocker of AT1R in Preventing Aortic Aneurysm and Associated Mortality
Authors: Jara Zaira Palomino , Harford Terri J. , Singh Khuraijam Dhanachandra , Desnoyer Russell , Kumar Avinash , Srinivasan Dasarathy , Karnik Sadashiva S.
Published: November 2022

Background:

Aortic aneurysm (AA) is a “silent killer” human disease with no effective treatment. Although the therapeutic potential of various pharmacological agents have been evaluated, there are no reports of β-arrestin–biased AT1R (angiotensin-II type-1 receptor) agonist (TRV027) used to prevent the progression of AA.

Methods:

We tested the hypothesis that TRV027 infusion in AngII (angiotensin II)-induced mouse model of AA prevents AA. High–fat-diet–fed ApoE (apolipoprotein E gene)-null mice were infused with AngII to induce AA and co-infused with TRV027 and a clinically used AT1R blocker Olmesartan to prevent AA. Aortas explanted from different ligand infusion groups were compared with assess different grades of AA or lack of AA.

Results:

AngII produced AA in ≈67% male mice with significant mortality associated with AA rupture. We observed ≈13% mortality due to aortic arch dissection without aneurysm in male mice. AngII-induced AA and mortality was prevented by co-infusion of TRV027 or Olmesartan, but through different mechanisms. In TRV027 co-infused mice aortic wall thickness, elastin content, new DNA, and protein synthesis were higher than untreated and Olmesartan co-infused mice. Co-infusion with both TRV027 and Olmesartan prevented endoplasmic reticulum stress, fibrosis, and vasomotor hyper responsiveness.

Conclusions:

TRV027-engaged AT1R prevented AA and associated mortality by distinct molecular mechanisms compared with the AT1R blocker, Olmesartan. Developing novel β-arrestin–biased AT1R ligands may yield promising drugs to combat AA.
What Time is Not
Authors: Seissl Thomas
Published: November 2022

In one of the most famous but equally obscure passages in the Timaeus, Plato describes the generation of time and the heavens. The “moving image of eternity” (37d5) is commonly read as Plato’s most general characterisation of time. Rémi Brague famously challenged the traditional interpretation on linguistic grounds by claiming that Plato actually did not conceive of time as an image (εἰκών) but rather as a number (ἀριθμός). In this paper, I shall claim that this controversy is by no means a modern one. The traditional interpretation is mostly owed to Plato’s most prominent reader, Plotinus, who famously conceives of time in relation to eternity (Enn. III.7.13.24-25). Brague’s alternative reading, however, is anticipated by Simplicius’ attempt to refute the Plotinian interpretation, as I shall show. According to my reconstruction, Simplicius’ reading of the Timaeus not only shows why the traditional interpretation falls short, but it also offers a systematic argument that bolsters Brague’s alternative reading. Finally, I shall show that this is consistent with Plato’s text. It shall become clear that current interpretative problems are essentially prefigured in the late ancient debate.
Sayyid Ḥaydar Āmulī (d. ca. 787/1385) and Ismailism
Authors: Mansouri Mohammad Amin
Published: November 2022

Sayyid Ḥaydar Āmulī (d. ca. 787/1385) was a significant Twelver Shiʿi philosopher. This paper argues that his work reveals major similarities with Ismaili Shiʿism in two crucial aspects: soteriology and negative theology. The first section explores several parallels between Ḥaydar Āmulī’s soteriological concept of the seven major prophets and the seven cycles of prophecy in the Ismaili tradition. The following sections demonstrate that his theorization of God’s transcendence (tanzīh) reflects Ismaili negative theology as articulated by Abū Yaʿqūb al-Sijistānī (fl. 4th/10th c.) and Ḥamīd al-Dīn al-Kirmānī (d. after 411/1021), two doyens of Fāṭimid Ismaili literature. Āmulī’s idea of transcendence parallels that of the Ismaili thinkers as he similarly attempts to deny the applicability of all attributes to God, even if they presumably exalt Him. Similar to Ismaili writers, Āmulī also uses the technique of double negation to express his negative theology. The final section, based on Āmulī’s Naqd al-nuqūd (The Critique of the Critiques), sheds light on a similar form of negative theology in the Akbarian school and Twelver Shiʿi thought, which helps appreciate the larger intellectual milieu in which Āmulī produced his ideas. The paper provides new evidence for significant intellectual similarities between Ismaili Shiʿism, Twelver Shiʿism, and Sufism in the period succeeding the destruction of the fortress of Alamut.
A new semiterrestrial crab from limestone hills in Vietnam (Crustacea: Brachyura: Potamidae: Tiwaripotamon)
Authors: NG PETER K. L. , TRI NGO VAN
Published: November 2022

A new species of semiterrestrial crab of the potamid genus Tiwaripotamon Bott, 1970, is described from limestone hills in northern Vietnam. Tiwaripotamon bellum n. sp. is one of the largest known species in the genus, and its external morphology is most similar to T. vietnamicum (Đăng & Hồ, 2002), described from northern Vietnam. Tiwaripotamon bellum n. sp., however, can easily be separated by its much darker colour in life, possession of a distinct epibranchial tooth on the carapace, the proportionately shorter ambulatory meri, and the gently curved terminal segment of the male first gonopod, with a subtruncate tip and dorsal lobe on the proximal part of the structure.
Antineoplastic Therapy in Colorectal Cancer through Proteasome Inhibition
Authors: Hochwald Steven N. , Lind D. Scott , Malaty John , Copeland Edward M. , Moldawer Lyle L. , MacKay Sally L.D.
Published: November 2022

Upregulation of nuclear factor (NF)-κB is found in many forms of cancer. Activation of NF-κB in cancer cells by chemotherapy or radiation can blunt the ability of this therapy to induce cell death. Proteasome inhibitors stimulate apoptosis in part via prevention of NF-κB activation. We sought to determine whether constitutive NF-κB activity is present in human colon cancer. In addition we studied whether alterations of NF-κB activity with a proteasome inhibitor would prevent colon cancer cell growth and induce apoptosis. We demonstrated constitutive transcriptional activation of NF-κB in SW48 and SW116 colon cancer cells by luciferase and electromobility shift assays. This was confirmed by p65 immunostaining. This activity was further induced in the presence of chemotherapy. In colon cancer specimens constitutive activation of NF-κB was observed in the majority of tumors. Treatment with the proteasome inhibitor (MG-132) inhibited growth and also stimulated apoptosis of colon cancer cells. We conclude that inhibition of NF-κB activation may be a logical therapy for certain cancers. This can be done via specific approaches on molecules necessary for keeping NF-κB inactivated in the cytoplasm. Other potentially useful ways to promote apoptosis in cancer cells include the utilization of proteasome inhibitors. Such inhibitors are currently being evaluated in clinical trials.
Neuroblastoma, Apoptosis, and Growth Factors
Authors: Beierle Elizabeth A. , Dai Wei , Langham Max R. , Chen Mike K.
Published: November 2022

Neuroblastoma is the most common extracranial tumor of childhood. This tumor is associated with alterations in apoptosis and is affected by various growth factors and cytokines. In this short review we will discuss recent findings in our laboratory where we have been studying a cell culture model of neuroblastoma.
Omega-3 Fatty Acids: Implications for the Treatment of Tumor-Associated Inflammation
Authors: Jho David , Babcock Tricia A. , Helton W. Scott , Espat N. Joseph
Published: November 2022

Our in vivo and in vitro studies using ω-3 fatty acids (FA) have provided insight into the biological effects and mechanisms of their anti-inflammatory action(s). The implications for this research are profound because there are few nutritional therapies available that have the potential to be clinically effective in malignancies and other chronic inflammatory conditions as ω-3 FA. In this summary of experiments the biological effects of ω-3 FA are discussed and the potential mechanisms of action presented.
Laser Flap Delay: Comparison of Erbium: YAG and CO2Lasers
Authors: Reichner Daniel R. , Scholz Thomas , Vanderkam Victoria M. , Gutierrez Socorro , Steward Earl , Evans Gregory R.D.
Published: November 2022

The delay phenomenon has long been recognized as a powerful tool in reconstructive surgery. This phenomenon involves creating alterations in skin flap blood supply or microcirculation to increase the size of the surviving flap. In the past many reconstructive surgeons depended on surgical delay as an integral part of their surgical planning. Today surgical delay remains a reliable method for maximizing flap survival. Although surgical delay remains the gold standard many have searched for methods to create the same effect with less morbidity and reduced cost. The purpose of this study was to determine whether near-scarless delay can be performed with either the Erbium:YAG or CO2 laser using a standard McFarlane skin flap model. Four groups were identified. Surgical delay, Erbium laser delay, and CO2 laser delay groups were each compared with a nondelayed control. Each group consisted of ten Sprague-Dawley rats. On Day 0 all delay procedures were performed on the lateral periphery of the outlined dorsal skin flaps. Interruption of this lateral blood supply was accomplished by two parallel 10-cm incisions in the surgical delay group. Likewise blood supply and microcirculatory alterations were accomplished in the laser delay groups by two parallel 10-cm laser treatments. On Day 7 a 10 x 4-cm cranially based dorsal skin flap was elevated. On Day 14 flap survival was analyzed by calculating percentage flap survival. The Erbium:YAG laser delay of the McFarlane flaps resulted in an average of 32 per cent less flap loss compared with controls ( P = 0.0001). The CO2 laser resulted in an average of 36 per cent less flap loss compared with controls ( P = 0.0002), whereas the surgical delay group had a 23 per cent smaller flap loss ( P = 0.009). There was no significant difference between any of the delay groups. These results indicated that CO2 and Erbium:YAG lasers are as effective as surgery for delay of skin flaps in the rat model. They may provide an effective and inexpensive method for near-scarless skin flap delay in humans.
Management of Traumatic Abdominal Wall Hernia
Authors: Lane Christopher T. , Cohen Allen J. , Cinat Marianne E.
Published: November 2022

Traumatic abdominal wall hernia (TAWH) can occur after blunt trauma and can be classified into low- or high-energy injuries. Low energy injuries occur after impact on a small blunt object. High-energy injuries are sustained during motor vehicle accidents or automobile versus pedestrian accidents. We present six cases of high-energy TAWH cases that were treated at our trauma center. All patients presented with varying degrees of abdominal tenderness with either abdominal skin ecchymosis or abrasions, which made physical examination difficult. CT scan confirmed the hernia in each patient. All six patients had associated injuries that required open repair. The abdominal wall defects were repaired primarily. Three patients (50%) in our series developed a postoperative wound infection or abscess. Review of the literature on low-energy TAWH shows no associated abdominal injuries. In conclusion distinction between low- and high-energy injury is imperative in the management of TAWH. Hernias following low-energy injuries can be repaired after local exploration through an incision overlying the defect. TAWHs following high-energy trauma should undergo exploratory laparotomy through a midline incision. The defect should be repaired primarily and prosthetics avoided because of the high incidence of postoperative infection.
Preoperative Sestamibi Localization Combined with Intraoperative Parathyroid Hormone Assay Predicts Successful Focused Unilateral Neck Exploration during Surgery for Primary Hyperparathyroidism
Authors: Miller Pringl , Kindred Amanda , Kosoy Daniel , Davidson David , Lang Hewitt , Waxman Kenneth , Dunn James , Latimer Ronald G.
Published: November 2022

A retrospective review of 54 cases of primary hyperparathyroidism operated upon by five general surgeons at Santa Barbara Cottage Hospital between March 1998 and March 2001 was performed to determine whether positive preoperative sestamibi localization (PSL) of a solitary adenoma combined with intraoperative parathyroid hormone assay (IOPHA) could predict successful focused unilateral neck exploration. A solitary adenoma was found in each of 50 patients (93%). PSL for solitary adenomas had an accuracy of 87 per cent, positive predictive value (PPV) of 96 per cent, sensitivity of 90 per cent, and specificity of 50 per cent. Forty-five patients (83%) achieved a 50 per cent reduction in IOPHA at 10 minutes after excision of a solitary adenoma for an accuracy of 85 per cent, PPV of 97 per cent, sensitivity of 88 per cent, and specificity of 50 per cent. All patients remain eucalcemic. The combination of PSL and IOPHA resulted in a PPV of 97.5 per cent and a sensitivity of 100 per cent. From these data we conclude that a focused unilateral neck exploration could have been performed successfully in 78 per cent of the cases.
Evaluation of Student Experience and Performance in a Surgical Clerkship
Authors: Libbin Jennifer B. , Hauge Linnea S. , Myers Jonathan A. , Millikan Keith W.
Published: November 2022

Phase I of this study compared students’ experiences regarding patient demographics, surgical content, and clinical skill practice in three different hospital settings: university, community, and public. Phase II examines the aspects of clerkship performance that contribute to students’ final grades. An instrument to track the experiences of students on their surgical clerkship was developed and piloted. Data were analyzed to compare the frequency of common surgical tasks performed and exposure to various surgical topics and patient demographics as well as to identify factors that explain variance on student grades. Students performed an average of 33 clinical tasks per week and were exposed to a broad range of surgical topics. Analysis of variance results demonstrated no significant differences between public, private, or university settings with respect to students’ clinical practice opportunities or content exposure. Clinical evaluations and National Board of Medical Examiners scores account for 75.5 per cent of the variance in students’ final grades. There was no significant correlation between patient load and clinical task load with final clerkship grades. The common clinical and didactic components of a surgical clerkship can balance a student's experience with surgical topics and tasks performed. It is important to utilize this information in program review of multisite clerkships to ascertain and enhance the validity of student performance measures.
Delay in Diagnosis of Hollow Viscus Injuries: Effect on Outcome
Authors: Niederee Mark J. , Byrnes Matthew C. , Helmer Stephen D. , Smith R. Stephen
Published: November 2022

Delay in the recognition of hollow viscus injury may lead to increased morbidity and mortality. Unfortunately the early diagnosis of these injuries remains a diagnostic challenge increasing the likelihood of delay. Patients transferred to Level I trauma centers from outlying institutions may be at increased risk of morbidity from hollow viscus injury, as there is an inherent delay associated with transfer. Herein we reviewed our institution's 11-year experience with the diagnosis and treatment of hollow viscus injury caused by blunt mechanism. Forty-one patients met defined criteria of hollow viscus injury. Patients were stratified into two groups: interval to operating room ≤24 hours versus >24 hours. Length of hospital stay, number of ventilator days, and percentage of patients developing acute respiratory distress syndrome were significantly greater in the >24-hour group. Mortality was not significantly different between the groups (26.7% vs 36.4%). Patients transferred from other institutions were more likely to experience complications and operative delay. In conclusion delay in operative intervention (>24 hours) adversely affected outcomes. Early transfer of patients to Level I trauma centers may improve outcomes. A high index of suspicion and the use of multiple diagnostic modalities may lead to earlier operative treatment and improved outcome.
The Effect of Pneumoperitoneum on Kidney Function in Laparoscopic Donor Nephrectomy
Authors: Hawasli Abdelkader , Oh Henry , Schervish Edward , Frontera Rene , Gonsherova Irene , Khoury Habib
Published: November 2022

Between June 1999 and November 2001 a prospective study was conducted to evaluate the effects of pneumoperitoneum during laparoscopic donor nephrectomy on kidney function using two different pressure settings (15 and 10 mm Hg). The effects were evaluated in both the donor's remaining kidney and the procured kidney in the recipient. There was no statistical significant difference in donors and recipients in regard to age, gender, and body mass index. In the two donor groups there was no difference in operative time (2.77 ± 0.51 vs 2.70 ± 0.52 hours; P = 0.579), intraoperative fluid (16.53 ± 4.72 vs 19.54 ± 7.04, P = 0.056), and urine output (1.81 ± 0.53 vs 1.75 ± 0.96 mL/kg/hour, P = 0.782) respectively. Donors’ preoperative and first-day postoperative serum creatinine concentrations also did not differ for the groups (preoperative 0.87 ± 0.21 vs 0.88 ± 0.17 mg/dL; and postoperative 1.44 ± 0.32 vs 1.38 ± 0.29 mg dL, respectively; P = 0.696). Recipients’ preoperative and postoperative serum creatinine concentrations on days 1, 2, 3, 7, 14, and 30 differed over time ( P < 0.001) but not between groups ( P = 0.541). We conclude that procurement of kidneys under either 10 or 15 mm Hg abdominal pressure gives equally good intraoperative and postoperative results.
Prospective Assessment of the Predictive Value of α-Glutathione S-Transferase for Intestinal Ischemia
Authors: Gearhart Susan L. , Delaney Conor P. , Senagore Anthony J. , Banbury Michael K. , Remzi Feza H. , Kiran Ravi P. , Fazio Victor W.
Published: November 2022

Nonspecific investigations resulting in treatment delays contribute to the 30 per cent mortality associated with acute mesenteric ischemia (AMI). As preliminary studies indicate that α-glutathione S-transferase (α-GST) is elevated in AMI we compare the ability of a-GST against conventional biochemical tests to predict AMI. There were 58 patients prospectively evaluated for AMI. Samples for α-GST (Biotrin International, Dublin, Ireland), lactate, pH, amylase, base excess, and white blood cell count (WBC) were evaluated. Intestinal ischemia was confirmed by colonoscopy, angiography, or laparotomy. Ischemia was present in 35 (60%) patients: small bowel (n = 14), colonic (n = 17), and global (n = 4). Four patients without autopsy were excluded. α-GST was elevated in those with AMI [22.2 (7–126) ng/mL vs 2.2 (1–3) ( P = 0.001)]. α-GST was more accurate at predicting intestinal ischemia (74%) than conventional tests (47–69% accuracy). Accuracy was increased to 80 per cent by combination with lactate or WBC, which increased sensitivity to 97 to 100 per cent. α-GST monitoring is a useful tool for the diagnosis of intestinal ischemia. A normal α-GST and WBC may exclude the presence of AMI.
Giant Presacral Myelolipoma
Authors: Singla Aneesh K. , Kechejian Gregory , Lopez Marvin J.
Published: November 2022

Myelolipomas are benign tumors composed of hematopoietic tissue and mature fatty tissue and occur primarily in the adrenal glands. Extra-adrenal sites for these tumors are rare. To date 37 cases have been reported in the literature with more than half of these lesions being presacral in location. The purpose of this report is to raise awareness of this unusual tumor when formulating a differential diagnosis for retroperitoneal tumors. Presacral myelolipomas are easily confused with both primary and secondary malignant retroperitoneal tumors, which are far more common and aggressive neoplasms. Particular radiographic and histologic qualities distinguish this tumor from invasive malignancy. A case report is presented with a review of the literature on extra-adrenal myelolipomas.
Anisakiasis of the Colon Presenting as Bowel Obstruction
Authors: Schuster Rob , Petrini John L. , Choi Rosa
Published: November 2022

Anisakiasis is a disease caused by human infection by the Anisakis larvae, a marine nematode found in raw or undercooked fish. With the increased popularity of eating sushi and raw fish (sashimi) in the United States infection with anisakis is expected to rise. We present the first reported case in the United States of intestinal anisakiasis presenting as a bowel obstruction. A 25-year-old healthy woman with no prior history of surgery presented to the emergency room with bowel obstruction by history and CT. CT also showed a mass in the right lower quadrant. She had eaten seviche, a raw fish appetizer, 2 days earlier and sashimi 3 weeks before admission. She was taken to the operating room for an exploratory laparotomy and was found to have an obstruction, the 2-cm mass in the mesentery, and diffuse mesenteric adenopathy. She had an ileocolectomy. Pathology showed a degenerating fish worm, anisakiasis. She also had a serologic test for immunoglobulin E specific to anisakiasis and it was highly positive. Human infections, as mentioned before, are principally the result of ingestion of the Anisakis larvae. These larvae are usually found in herring, mackerel, salmon, cod, halibut, rockfish, sardine, and squid. Most human infections have been reported from Japan and the Netherlands and involve the stomach. Invasion of the gastric or intestinal wall one to 5 days after eating raw fish may be characterized by the abrupt onset of abdominal pain, nausea and/or vomiting, diarrhea, or an ileus. For transient anisakiasis, supportive measures and reassurance are all that is needed. If the larvae have invaded the intestine or the stomach wall diagnosis and cure occur with endoscopic or surgical removal if evidence of obstruction or perforation is found. The incidence of anisakiasis in the United States is unknown but will likely continue to increase with the popularity of eating sashimi. This case is meant to demonstrate another possible cause for bowel obstruction in the patient who has just eaten raw or undercooked fish.
Autoimmune Pancreatitis Presenting as a Mass in the Head of the Pancreas: A Diagnosis to Differentiate from Cancer
Authors: Tabata Minoru , Kitayama Joji , Kanemoto Hideyuki , Fukasawa Tomoki , Goto Hideki , Taniwaka Koichi
Published: November 2022

We report a case of autoimmune pancreatitis presenting as a mass in the head of the pancreas that was successfully diagnosed without pancreaticoduodenectomy. The patient was a 64-year-old man who had no complaint. A routine physical checkup unexpectedly revealed mild diabetes and a low-echoic mass in the pancreatic head. The diagnosis was made by noting irregular narrowing of the main pancreatic duct, hypergammaglobulinemia, and increased immunoglobulin G levels. An open wedge biopsy of the mass was performed; this showed a marked fibrosis with lymphocyte- or macrophage-predominant inflammatory infiltrates. Immunohistochemical study revealed that the remnant acinar cells expressed Fas (CD95) ligand and not Fas. We review some of the literature and discuss various features and diagnostic clues of autoimmune pancreatitis. Awareness of this pathologic condition may prevent confusion with pancreatic malignancy and unnecessary surgery.
Genetic Testing for Hereditary Nonpolyposis Colorectal Cancer
Authors: Hoedema Rebecca , Monroe Thomas , Bos Cindy , Palmer Sharon , Kim Donald , Marvin Monica , Luchtefeld Martin
Published: November 2022

Approximately 80 per cent of patients with colorectal cancer have sporadic disease whereas the remaining 20 per cent seem to have a genetic component. Hereditary nonpolyposis colorectal cancer (HNPCC) is the most common autosomal dominant hereditary syndrome predisposing to colorectal cancer. Various methods have been described to screen for HNPCC and to directly test for mismatch repair gene mutations. This study evaluates the initial results of 1) microsatellite instability (MSI) and immunohistochemistry (IHC) staining of tumors and 2) genetic sequencing for mismatch repair gene mutations in patients suspected to have HNPCC. Appropriate patients for HNPCC testing were identified through a high-risk colorectal cancer clinic. Of those patients screened only those who met Amsterdam criteria (AC) for HNPCC or were young age onset (YAO) (<40 years of age) were eligible for testing. The tumors underwent testing for MSI and had IHC performed in those patients with available tumor specimens. MSI was performed on the five markers approved by the NIH consensus conference. MSI-High (MSI-H) was defined as two or more markers being unstable. IHC was done with commercially available stains for MLH1 and MSH2. All patients had sequencing of the MLH1 and MSH2 genes performed to search for mutations by a commercial laboratory. Genetic counseling was provided and written informed consent was obtained. Fourteen patients were part of kindreds that met the AC. An additional 10 patients were <40 years of age at diagnosis of colorectal cancer but lacked any family history. Testing for MSI and IHC was performed on those available tissue blocks. Of the AC patients five had MSH2 mutations and two had MLH1 variants. Of the five with MSH2 mutations three of four had MSI-H tumors and all four had loss of expression of MSH2 on IHC. Of the MLH1 variants only one had MSI-H tumor and lacked expression of MLH-1 on IHC. Of those patients with no mutation identified three of six had MSI-H tumors. For those patients YAO no genetic mutations were identified. Two of the seven had MSI-H tumors. Genetic testing for HNPCC even in those patients fulfilling the rigid AC yielded mutations in only five of 14 patients with variants of unknown significance being found in an additional two patients. Only one MSH2 variant of unknown significance was identified in the 10 YAO patients, which would suggest that screening in this group of patients with MSI and/or IHC would be appropriate.
Effect of Increasing the Surface Sampled by Imprint Cytology on the Intraoperative Assessment of Axillary Sentinel Lymph Nodes in Breast Cancer Patients
Authors: Cserni G.
Published: November 2022

As axillary sentinel nodes predict the nodal status and may allow dissection of the axilla on a selective basis we assessed the effects of increasing the surface sampled during intraoperative imprint cytology. Sentinel nodes from 110 patients identified with Patent blue and/or the high radioactivity due to the uptake of 99m-Tc-labeled colloidal albumin were analyzed via hematoxylin and eosin-stained touch preparations. Imprint cytology was performed either on bisected nodes (Protocol One; n = 55) or on sentinel nodes sliced into multiple pieces at 2- to 3-mm intervals (Protocol Two; n = 55). The sentinel nodes were submitted in toto to permanent step sectioning and immunostaining for cytokeratins. There were equal numbers of patients with involved nodes in the two groups assessed. With Protocols One and Two the imprints had sensitivities of 52 and 61 per cent, negative predictive values of 74 and 78 per cent, and false negative rates of 47 and 39 per cent, respectively. No macrometastasis missed by Protocol Two was absent from the surface sampled. These data suggest that increasing the surface sampled improves the proportion of involved sentinel nodes detected intraoperatively by imprint cytology, but a number of metastatic nodes still remain undetected by this method. The sampling of multiple surfaces is encouraged for a more accurate intraoperative assessment.
Laparoscopic Adrenalectomy: A Worthwhile Procedure Performed in a General Surgery Department
Authors: Ramacciato Giovanni , Lombardi Marco , Amodio Pietro M. , Mercantini Paolo , Petrocca Sergio , Stipa Francesco , Digiacomo Giovanni , Bellagamba Riccardo , Puce Ernesto , Ziparo Vincenzo
Published: November 2022

A laparoscopic procedure is considered the treatment of choice for adrenalectomy. We report the experience of a nonreferring unit for adrenal pathology; we have evaluated its safety and feasibility in a series of 40 patients. From 1994 to 2001, forty consecutive patients underwent laparoscopic adrenalectomy, 37 with transperitoneal and 3 with retroperitoneal approach. The mean operative time was 129 ± 51.7 minutes (range 60–300): 107 ± 29 minutes (range 60–100) for the right-sided transperitoneal adrenalectomy and 144 ± 62 minutes (range 90–300) for the left-sided transperitoneal adrenalectomy. The mean intraoperative blood loss was 90 mL (range 40–200). The procedure laparoscopic was converted to open in one case for the presence of a voluminous angiolipoma arising from the retroperitoneal fat strictly adherent to the adrenal gland. The postoperative morbidity rate was 5.1 per cent. Pain medication was required for a mean period of 1.6 ± 0.6 days (range 1–3). The patients were able to resume solid food after an average time of 1.8 ± 0.7 days (range 1–4). Postoperative hospital stay was 3 ± 1.4 days (range 2–8). We believe that laparoscopic adrenalectomy is safe and effective in removing benign functioning or nonfunctioning adrenal masses and also in a general surgery department.
The Natural History of Stab Wounds of the Diaphragm: Implications for a New Management Scheme for Patients with Penetrating Thoracoabdominal Trauma
Authors: Shatney Clayton H. , Sensaki Koji , Morgan Lori
Published: November 2022

For most patients with abdominal stab wounds expectant management has become the norm. Thoracoabdominal stab wounds, however, raise concern about possible diaphragmatic injury, and diagnostic minilaparotomy, laparoscopy, or thoracoscopy have been advocated in such patients. The present study examined the natural course of an untreated diaphragmatic stab wound. With Institutional Review Board approval eight 25- to 30-kg anesthetized pigs underwent a small upper-midline laparotomy. A 1.5- to 2-cm incision was made in each diaphragm—in the muscular portion on one side and in the tendinous area on the other side. Thereafter a 12-F catheter was placed into each thoracic cavity and attached to suction to resolve pneumothoraces. The laparotomy incision was closed, and the thoracic catheters were removed. Six weeks later the animals were reanesthetized, and the diaphragmatic stab wounds were examined at laparotomy. Fifteen of the 16 (93.8 per cent) diaphragmatic wounds were completely healed. All eight stab wounds in the muscular portion of either diaphragm healed spontaneously. In one animal there was a persistent defect in the tendinous portion of the left diaphragm at the site of the stab wound. The tip of the left lateral segment of the liver and the superior pole of the spleen were found in the defect at laparotomy. We conclude that the vast majority of stab wounds to either the muscular or tendinous diaphragm heal spontaneously. Thus invasive procedures to assess the status of the diaphragm in all patients with thoracoabdominal stab wounds is unwarranted.
Acquired Thoracic Scoliosis following Minimally Invasive Repair of Pectus Excavatum
Authors: Niedbala Angela , Adams Michael , Boswell William C. , Considine John M.
Published: November 2022

The minimally invasive pectus excavatum repair as described by Nuss et al. is rapidly gaining acceptance as an effective method of repair of severe pectus excavatum deformities in the pediatric population. It potentially offers several advantages over previous techniques. The incidence of major complications of the procedure has been reduced by recent modifications including utilization of video-assisted thoracoscopy during placement of the Lorenz pectus bar as well as utilizing the pectus bar stabilizer that provides more rigid fixation of the strut. We report two cases of acquired thoracic scoliosis following minimally invasive repair of severe pectus excavatum deformity. This particular complication has not been reported in previous literature and warrants concern. In both cases the thoracic scoliosis slowly improved with physical therapy and range-of-motion exercises.
Pseudomembranous Gastritis: A Complication from Aspergillus Infection
Authors: Sanders Danny L. , Pfeiffer Ralph B. , Hashimoto Luis A. , Subramony Charulochana , Chen Favu
Published: November 2022

Pseudomembranes in the gastrointestinal tract are usually associated with the use of antibiotics, steroids, and severe immunosuppression. Reported cases of this condition have usually been confined to the large and small bowel. We discuss a 41-year-old woman who was transferred to The University of Mississippi Medical Center for severe upper gastrointestinal bleeding after admission to an outside facility following a motor vehicle collision. Upper endoscopy revealed an antral ulcer with fungal hyphae found in the biopsy specimen. Because of her exsanguinating hemorrhage from her gastric pathology a total gastrectomy was performed. Pathological inspection of the stomach revealed a green/brown pseudomembranous gastritis throughout the entire stomach. Aspergillus cultures confirmed the etiologic agent. The patient later fell into multiorgan system failure and died. Autopsy results showed no aspergillus in other organ systems. The current literature suggests that this is the first reported case of isolated pseudomembranous gastric aspergillosis.
Overview of Current Inferior Vena Cava Filters
Authors: Kercher Kent , Sing Ronald F.
Published: November 2022

Inferior vena cava (IVC) filter technology has expanded dramatically over the past decade. Improvements in catheter and filter technology have allowed for the safe and rapid insertion of IVC filters from multiple venous access sites, using increasingly lower-profile percutaneous delivery systems. While the currently available filters have slightly different designs and insertion techniques, all function in a similar fashion to prevent venous thromboembolic propagation through the inferior vena cava. This article describes the construction and deployment mechanisms of the various filters that are currently on the market.
Bedside Insertion of the Inferior Vena Cava Filter in the Intensive Care Unit
Authors: Sing Ronald F. , Heniford B. Todd
Published: November 2022

Historically, inferior vena cava (IVC) filters have been inserted in the Radiology Department or the Operating Room. When initially designed, vena cava filters required surgical cut down of the internal jugular vein to insert a large (24 French) introducer and it was therefore necessary to perform this procedure in the operating room. Percutaneous methods (e.g., the Seldinger technique) with smaller profile sheath-dilator devices (6 to 12 French) have made IVC filter insertion a much easier procedure. Furthermore, the remaining equipment is simple, portable, and readily available throughout most hospitals (e.g., C-arm, contrast, sterile drapes, gowns, gloves, catheters, etc.). These factors have made it easy to “bring the procedure to the patient.” This is particularly advantageous in critically ill ICU patients. Complication rates of “road trips” for critically ill patients from the ICU to other parts of the hospital (i.e., radiology department or operating room) can result in a mishap rate of 5–30. Secondary benefits of bedside insertion of vena cava filters include cost-effectiveness.
A Preliminary Investigation of Balloon Angioplasty versus Surgical Treatment of Thrombosed Dialysis Access Grafts
Authors: McCutcheon Brion , Weatherford David , Maxwell Gary , Hamann Mary Sue , Stiles Anquonette
Published: November 2022

It has been estimated that 180,000 patients in the United States have end-stage renal disease requiring hemodialysis, and this number is currently increasing at a rate of 10 per cent per year. With the growing number of patients requiring hemodialysis the insertion and maintenance of dialysis access has become a common task for vascular surgeons. In fact dialysis access is now the most common vascular operation and may account for as much as 40 to 50 per cent of the practice of a busy vascular surgeon. The two major techniques for repairing thrombosed dialysis access grafts are open surgical revision and balloon angioplasty. Surgical revisions of access sites include patch angioplasty and interposition jump grafts. Balloon angioplasty involves declotting the graft mechanically or chemically followed by dilation of the stenotic segment by an angioplasty balloon under fluoroscopy. Few studies have compared the two methods of repair, and the studies that have been done reveal conflicting results. A retrospective chart review of patients treated at the New Hanover Regional Medical Center for repair of thrombosed dialysis access grafts was conducted. The final sample available for analysis consisted of 16 patients with balloon angioplasty and 44 patients with surgical revision. These two groups were compared in terms of demographics, past medical history, surgery time, complications, length of stay, length of graft patency, and typical costs. Overall balloon angioplasty as compared with surgical revision was associated with longer patency (5.5 vs 3.2 months), shorter surgical time (43.9 vs 64.5 minutes), shorter length of hospital stay (less than one day vs one day or more), and fewer complications (12% vs 30% of the patients). We concluded from this analysis that endovascular treatment of thrombosed dialysis grafts is an acceptable alternative to surgical revision and should be the first option after primary failure of the grafts caused by stenotic lesions.
Natural Killer Cell Activation Primes Macrophages to Clear Bacterial Infection
Authors: Scott Melanie J. , Hoth J. Jason , Gardner Sarah A. , Peyton James C. , Cheadle William G.
Published: November 2022

Natural killer (NK) cells are major cytokine producers during bacterial sepsis, but their precise role is undefined. This study investigates the effect of NK cell depletion with and without prior activation on macrophage function and bacterial clearance during cecal ligation and puncture. Two different NK cell-depleting antibodies were used: anti-asialo-GM1 (GM1), a nonactivating antibody, and anti-NK1.1 (NK1.1), an NK cell-activating antibody. C57BL/6 mice were NK depleted with either GM1 or NK1.1 by intraperitoneal injection 7 and 3 days before experimentation. Control animals received isotype immunoglobulin G. Depletion was confirmed by flow cytometry. Bacterial levels in peritoneal washout, blood, and liver were determined 4 hours after cecal ligation and puncture. Macrophage activation was measured by phagocytosis ability and by production of nitric oxide and interleukin-6. Depletion with GM1 resulted in significantly higher bacterial levels at 4 hours, whereas depletion with NK1.1 had the opposite effect of significantly decreasing bacterial levels. Macrophage phagocytosis ability was significantly increased in mice depleted with NK1.1 compared with those mice depleted with GM1. We conclude that activation of NK cells improves bacterial clearance by priming macrophages to help clear a subsequent bacterial challenge. Macrophages are less able to clear bacteria when NK cells are depleted without activation. NK cells are therefore important in bacterial clearance through interactions with macrophages.