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Neurokinin receptor 1 antagonists are effective in reducing nausea and vomiting in chemotherapy-induced emesis. We investigated the safety and efficacy of tradipitant, a neurokinin receptor 1 antagonist, in patients with idiopathic and diabetic gastroparesis. A total of 201 adults with gastroparesis were randomly assigned to oral tradipitant 85 mg (n = 102) or placebo (n = 99) twice daily for 12 weeks. Symptoms were assessed by a daily symptom dairy, Gastroparesis Cardinal Symptom Index scores, and other patient-reported questionnaires. Blood levels were monitored for an exposure-response analysis. The primary outcome was change from baseline to week 12 in average nausea severity, measured by daily symptom diary. The intention-to-treat (ITT) population did not meet the prespecified primary endpoint at week 12 (difference in nausea severity change drug vs placebo; P =.741) or prespecified secondary endpoints. Post hoc analyses were performed to control for drug exposure, rescue medications, and baseline severity inflation. Subjects with high blood levels of tradipitant significantly improved average nausea severity beginning at early time points (weeks 2–4). In post hoc sensitivity analyses, tradipitant treatment demonstrated strengthened effects, with statistically significant improvements in nausea at week 12. Although tradipitant did not reach significance in the ITT population, a pharmacokinetic exposure-response analysis demonstrated significant effects with adequate tradipitant exposure. When accounting for confounding factors such as baseline severity inflation and rescue medication, a statistically significant effect was also observed. These findings suggest that tradipitant has potential as a treatment for the symptom of nausea in gastroparesis. (ClincialTrials.gov , Number: NCT04028492). [Display omitted] [ABSTRACT FROM AUTHOR]

Postoperative pulmonary complications are a common cause of postoperative morbidity in patients undergoing hepatectomy. This study aimed to identify risk factors, define severity, and evaluate the impact of postoperative pulmonary complications on postoperative morbidity after hepatectomy. We used a prospective database in identifying all hepatectomies from 2013 to 2018. The database was then augmented using extensive review of medical records. The Strasburg system was used in categorizing resections per complexity: major hepatic resection and minor hepatic resection, whereas the Clavien-Dindo system was used in defining postoperative pulmonary complications per severity. Potential confounders were controlled for on multiple regression models. A total of 702 cases were identified: major hepatic resection 413 (60%) and minor hepatic resection 289 (40%). Patients demonstrated comparable characteristics, but the postoperative pulmonary complications group was more likely to have chronic obstructive pulmonary disease (10% vs 5%; P =.02). Severe postoperative pulmonary complications among major hepatectomy was observed in 38 patients (13%). Predictors for severe postoperative pulmonary complications requiring intervention included postoperative liver failure (odds ratio = 2.8; P =.002) and biliary fistula (odds ratio = 3.5; P =.001). In addition, the occurrence of severe postoperative pulmonary complications markedly hindered recovery, increasing length of stay by 4.4-fold and readmission rates by 3-fold (P <.001). On multivariable analysis, postoperative pulmonary complications significantly increase postoperative length of stay (8 vs 5 days; P <.001) and readmission (odds ratio = 3.2; P =.001). Mortality was similar (1% vs 4%; P =.066). Postoperative pulmonary complications are a major cause of delayed recovery and worse outcomes after hepatectomy. Further, postoperative liver failure and biliary fistula can predict the occurrence of severe postoperative pulmonary complications among major hepatic resection and the associated need for readmission with these complications. [ABSTRACT FROM AUTHOR]

• Dieulafoy lesions are aberrant submucosal lesions that, in rare circumstances, can result in massive gastrointestinal bleeding. • These lesions are particularly rare in the jejunum, thus usual diagnostic and therapeutic modalities such as endoscopy may prove difficult. • Additional imaging such as angiography or radionuclide scanning can be beneficial in identifying the source of bleeding. • If advanced endoscopic instruments are unavailable at one's facility, the surgeon must consider operative intervention for life-saving measures. • The operative findings and management discussed can guide clinicians unexposed to this disease process when surgical intervention is imminent. Dieulafoy lesions are enlarged atypical submucosal vessels that erode the superimposing epithelium in the absence of a primary ulcer. They occur predominantly in the gastric mucosa; however, cases have been seen throughout the gastrointestinal (GI) tract, and rarely, the jejunum. These lesions can cause massive GI hemorrhage leading to shock. We present a healthy 19-year-old male who arrived at our institution's emergency department with multiple episodes of hematemesis and hematochezia that began earlier that morning. The patient was resuscitated and underwent a computerized tomographic (CT) angiography that did not identify any areas of active extravasation. The patient was then taken for an emergent upper and lower endoscopy that was inconclusive. He was subsequently sent for a tagged red blood cell scan, which demonstrated active bleeding in the proximal jejunum. Shortly thereafter, the patient began to decompensate requiring additional blood products and vasopressors. The decision was made for immediate operative intervention, which identified the bleeding Dieulafoy lesion (confirmed by histopathology) in the jejunum. Dieulafoy lesions are rare with an initial presentation of upper or lower GI bleeding, generally treated with endoscopic intervention. They are predominately found in the stomach or duodenum. When no clear source is identified by endoscopy, further diagnostic testing may be of value. Various imaging modalities exist; however, CT angiography or radionuclide scanning are particularly sensitive and can be beneficial in localizing the bleed when preparing for operative intervention. With advances in endoscopic techniques, surgical intervention is rarely performed for a Dieulafoy lesion. If endoscopy is unsuccessful, additional imaging can be obtained to localize the source of bleeding. However, in emergent cases, when additional imaging cannot be obtained due to lack of time or resources, adequate resection of the lesion should be performed for complete resolution of the disease process. Based on the case presentation and pathologic findings, this case provides further insight into Dieulafoy lesions and the rare need for surgical management. [ABSTRACT FROM AUTHOR]

Tumors of the ovary and appendix have been well documented in the setting of pseudomyxoma peritonei (PMP) with constant debate over tumor origin. Generally, these tumors are found to have a single primary origin, most commonly the appendix, with metastatic spread to the ovaries. Here we present a 61-year-old female who underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO) for a primary mucinous ovarian carcinoma. She presented to our institution one year later with abdominal pain and a palpable right lower quadrant mass, which on histopathologic exam was found to be a primary low grade mucinous appendiceal neoplasm (LAMN), alluding to the potential of two separate primary disease processes. With two primary, non-synchronous lesions, a thorough literature review suggests that during the patient's initial TAH-BSO, she could have additionally undergone an appendectomy. In doing so, this would provide accurate, complete staging and determine if the two neoplasms were truly primary in origin or metastatic. In addition, new genetic markers are being discovered, such as the Special AT-rich sequence-binding protein 2 (SATB2) marker, which has been found to be positive in those with a LAMN and negative in those with a primary mucinous ovarian carcinoma. By acquiring appropriate and complete staging we can better diagnose and treat these neoplasms. [ABSTRACT FROM AUTHOR]

Abstract: LumiCal will be the luminosity calorimeter for the proposed International Large Detector of the International Linear Collider (ILC). The ILC physics program requires the integrated luminosity to be measured with a relative precision on the order of 10e-3, or 10e-4 when running in GigaZ mode. Luminosity will be determined by counting Bhabha scattering events coincident in the two calorimeter modules placed symmetrically on opposite sides of the interaction point. To meet these goals, the energy resolution of the calorimeter must be better than 1.5% at high energies. LumiCal has been designed as a 30-layer sampling calorimeter with tungsten as the passive material and silicon as the active material. Monte Carlo simulation using the Geant4 software framework has been used to identify design elements which adversely impact energy resolution and correct for them without loss of statistics. BeamCal, covering polar angles smaller than LumiCal, will serve for beam tuning, luminosity optimisation and high energy electron detection. Secondly, prototypes of the sensors and electronics for both detectors have been evaluated during beam tests, the results of which are also presented here. [Copyright &y& Elsevier]

THE DECADES OF THE 1960s and 1970s were unlike any US society had previously experienced. The order of society was openly challenged, which resulted in diverse viewpoints about what was acceptable behavior and thinking. THE EFFECTS OF SCIENTIFIC DISCOVERIES were evident in health care, and demands for options in care influenced the delivery of health services. Many of these influences were felt by nurses in the OR, and OR nursing itself transformed in response to the changes in society. THE AORN JOURNAL is used in this article as a source of information to ascertain how changes in society were reflected in OR nursing during the period from 1963 to 1983. [ABSTRACT FROM AUTHOR]