Search

Key Clinical Message If patient anatomy or disease does not allow for a traditional or partial cholecystectomy, an omental pedicle plug may be a viable option to limit the risk of postoperative uncontrolled bile leak from the cystic duct and to control patient symptoms.

We describe a hybrid numerical method to solve a boundary value problem where an unknown parameter of the model is chosen to satisfy an additional boundary condition. After the solution of the differential equation is approximated using a one-step method, a secant method is used to update the value of the unknown parameter. The model is a generalization of a model first used to describe water flow through roots, which was later used to describe water flow through the tank bromeliad Guzmania lingulata. In both cases, identification of the unknown parameter represents the decomposition of overall plant conductance into components in the radial and axial directions. We describe convergence of the one-step and secant portions of the method in a base case corresponding to previous applications of the model and in an intermediate case corresponding to a first approximation of the geometry of the leaf. We demonstrate that in the more general case, which better represents the geometry of G. lingulata, the one-step method also converges as expected. Finally, we discuss the implications of including a better description of the geometry of the leaf in context of radial conductance and show that our modeling of the leaf geometry increases the component of the overall leaf conductance in the radial direction by as much as 25%.

ObjectiveResolvins have been shown to attenuate inflammation, whereas NETosis, the process of neutrophils releasing neutrophil extracellular traps (NETs), produces increased inflammation. It is hypothesized that treatment of animals with resolvin D1 (RvD1) would reduce abdominal aortic aneurysm (AAA) formation by inhibiting NETosis.MethodsWild-type 8- to 12-week-old C57BL/6 male mice (n = 47) and apolipoprotein E-deficient (ApoE-/-) mice (n = 20) were used in two models to demonstrate the effects of RvD1 on AAA growth. In the topical elastase AAA model, wild-type mice were divided into three groups: a deactivated elastase control group, in which sham surgery was performed using deactivated elastase and mice were intravenously injected with phosphate-buffered saline (PBS) once a day until harvest; an elastase group, in which active elastase was used to induce AAA and mice were injected with PBS daily until harvest; and an RvD1-treated group, in which AAA was induced and mice were injected with RvD1 daily until harvest. In the angiotensin II (Ang II)-induced AAA model, ApoE-/- mice were fed a high-fat diet and implanted with osmotic infusion pumps containing Ang II (1000 ng/kg/min). The Ang II model was divided into two groups: an Ang II control group, in which Ang II was delivered and mice were injected with PBS daily until harvest; and an RvD1-treated group, in which Ang II was delivered and mice were injected with RvD1 daily until harvest. On postoperative day 3, day 14, or day 28, aortic and blood samples were collected for Western blot, histology, cytokine array, enzyme-linked immunosorbent assay, and gelatin zymography after aortic diameter measurement.ResultsThe day 14 RvD1-treated group demonstrated 42% reduced AAA diameter compared with the elastase group (P < .001). On postoperative day 3, the RvD1-treated group showed decreased levels of NETosis markers citrullinated histone H3 (P = .04) and neutrophil elastase (P = .002) compared with the elastase group. Among important cytokines involved in AAA formation, interleukin (IL) 1β was downregulated (P = .02) whereas IL-10, a protective cytokine, was upregulated (P = .01) in the RvD1-treated group. Active matrix metalloproteinase 2 also decreased in the RvD1-treated group (P = .03). The RvD1-treated group in the Ang II AAA model, a second model, demonstrated reduced AAA diameter compared with the Ang II control group on day 28 (P < .046). The RvD1-treated group showed decreased levels of citrullinated histone H3 on day 3 (P = .002). Cytokines interferon γ, IL-1β, C-X-C motif chemokine ligand 10, monocyte chemotactic protein 1, and regulated on activation, normal T cell expressed and secreted (RANTES) were all decreased on day 28 (P < .05).ConclusionsRvD1-mediated inhibition of NETosis may represent a future medical treatment for the attenuation of AAA growth.

Natural orifice surgery has evolved from a preclinical setting into a common occurrence at the University of California San Diego (UCSD). With close to 40 transvaginal cases, we have become comfortable with this technique and are exploring other indications. One of the perceived advantages in natural orifice surgery is the potential reduction in the incidence of hernia formation. Patients with abdominal wall hernias may be at increased risk of forming additional hernias at incision sites. In addition, patients with recurrent incisional hernias may, likewise, be at increased risk. We believe that reducing or eliminating abdominal wall incisions may be of benefit in the repair of abdominal wall hernias. Here, we describe what we believe to be the first natural orifice transluminal endoscopic surgical (NOTES) approach to the repair of an abdominal wall hernia.The patient is a 38-year-old female with a painful recurrent umbilical hernia, previously repaired 8 years prior with a polypropylene-based mesh. The patient underwent a transvaginal recurrent umbilical hernia repair with one other 5-mm port in the abdomen for safety.The patient had no intraoperative or postoperative complications. At 5 months follow up, the patient had no complaints, no evidence of hernia recurrence, and was very pleased with her result.The repair of primary and incisional hernias of the ventral abdominal wall via a transvaginal approach is technically feasible, and the result of our initial case was exceptional. However, there are still significant obstacles which must be addressed before this approach can be widely utilized. These obstacles include safe entrance into the abdominal cavity via a transvaginal approach, the proper mesh to be placed during the repair, and the risk of infection.

Background: Liver transplantation (LT) is the only potentially curative option for children with unresectable hepatoblastoma (HBL). Although post‐transplant outcomes have improved in the contemporary era, the impact of donor graft type on survival remains unclear. Methods: Using the United Network for Organ Sharing database (02/2002–06/2021), demographics, clinical characteristics, and patient and graft survival were analyzed in children (<18 years) who underwent LT for HBL according to donor graft type. The Kaplan–Meier method, log‐rank tests, and Cox regression modeling were used to evaluate the effect of whole, partial, and split deceased donor liver transplantation (DDLT) and living donor liver transplantation (LDLT) on patient and graft survival. Results: A total of 590 pediatric HBL LT recipients (344 whole graft DDLT; 62 partial graft DDLT; 139 split graft DDLT; 45 LDLT) were included. During 2012–2021 the proportion of LDLTs for HBL decreased to about 5% compared with about 11% during 2002–2011. No significant differences were identified by donor graft type in either patient survival (log‐rank test, p =.45) or graft survival (log‐rank test, p =.69). The results remained similar during the 2002–2011 era, while during the 2012–2021 era, split graft DDLT was associated with decreased graft loss risk versus whole graft DDLT (hazard ratio: 0.48, 95% confidence interval: 0.23–0.99, p =.046) without any other significant between‐group differences. Conclusions: Utilizing non‐whole liver grafts can increase access to LT in children with unresectable HBL while ensuring favorable outcomes. LDLT is underutilized in children with HBL in the United States, and efforts to explore LDLT options should be undertaken. Non‐whole grafts can increase access to pediatric liver transplantation for hepatoblastoma with favorable outcomes. Living donor liver transplantation for hepatoblastoma is underutilized in the United States and the benefit of time optimization between chemotherapy and living donor liver transplantation warrants consideration of referral to transplant centers with living donor programs. [ABSTRACT FROM AUTHOR]

Objective: Accepted treatments for cigarette smoking rarely achieve abstinence rates of >35% at 1 year. Low rates may reflect failure to provide extended and multifocal treatment for this complex and chronic addiction. Using a chronic disease model of smoking, the authors undertook a study to determine the effects of long-term antidepressant and psychological treatment. Method: One hundred sixty smokers of greater than or equal to10 cigarettes/day were randomly assigned to one of four treatment conditions in a two-by-two (nortriptyline versus placebo by brief versus extended treatment) design. All subjects received 8 weeks of a transdermal nicotine patch, five group counseling sessions, and active or placebo treatment. Interventions for subjects in brief treatment ended at this point. Subjects in extended treatment continued taking drug or placebo to week 52 and received an additional 9 monthly counseling sessions, with checkup telephone calls midway through each session. Subjects were assessed at baseline and weeks 12, 24, 36, and 52. The principal outcome variables were repeated abstinence at each assessment after the first over a 1-year period and a point prevalence of 7 days of abstinence. Results: At week 52, point-prevalence abstinence rates with missing subjects imputed as smokers were 30% for placebo brief treatment, 42% for placebo extended treatment, 18% for active brief treatment, and 50% for active extended treatment. With missing subjects omitted, these rates were 32%, 57%, 21 %,and 56%, respectively. Conclusions: Comprehensive extended treatments that combine drug and psychological interventions can produce consistent abstinence rates that are substantially higher than those in the literature.

Deadwood in forests influences fire intensity, stores carbon and nutrients, and provides wildlife habitat. We used a 54-year-old density management experiment in Larix occidentalis Nutt. forests to evaluate density dependence of woody detritus accumulation. Based on self-thinning theory, we expected woody detritus produced by the current stand to increase with stand density. Density-dependent woody detritus accumulation was apparent for fine woody debris and snags and for all woody detritus pools combined. Clear size-density relationships were apparent for coarse woody debris (CWD) and snags; mean piece size decreased with increasing stand density. Legacy CWD that originated from the preharvest old-growth stands accounted for about 45% of total woody detritus biomass. Live trees were largest in the low-density thinning treatments. Greater woody detritus biomass in the high-density and unthinned treatments originates primarily from past self-thinning, with additional inputs from density-dependent top breakage due to snow and ice and branch self-pruning. Because our results were driven by self -thinning mortality, the general trend of increasing woody detritus accumulation with increasing stand density should hold for maturing even-aged stands in other cool temperate and boreal forests. Key words: self-thinning, coarse woody debris, fine woody debris, surface fuels, Larix occidentalis. Le bois mort present en foret influence l'intensite des feux, entrepose du carbone et des nutriments et fournit un habitat faunique. Nous avons utilise un dispositif d'amenagement de la densite etabli il y a 54 ans dans des forets de Larix occidentalis Nutt. pour evaluer la dependance a la densite de l'accumulation de debris ligneux. Suivant la theorie de l'autoeclaircie, nous avons anticipe que les debris ligneux produits par le peuplement actuel allaient augmenter avec la densite du peuplement. Une dependance a la densite de l'accumulation des debris ligneux etait apparente pour les petits debris ligneux, les chicots et l'ensemble des formes de debris ligneux. Des relations claires entre la taille des debris ligneux et la densite des peuplements etaient apparentes dans le cas des debris ligneux grossiers (DLG) et des chicots. Dans ces deux cas, la taille des debris diminuait avec la densite du peuplement. Les legs de DLG provenant des vieux peuplements anterieurs a la coupe correspondaient a environ 45 % de la biomasse totale de debris ligneux. Les plus gros arbres vivants etaient dans les traitements d'eclaircie a forte intensite. La plus grande biomasse de debris ligneux dans les traitements a intensites d'eclaircie faible et nulle provenait principalement de l'auto-eclaircie passee avec des apports additionnels provenant des bris du haut de la cime des arbres causes par la neige et la glace et l'auto-elagage des branches, tous deux dependants de la densite des peuplements. Parce que nos resultats sont fortement lies a la mortalite causee par l'auto-eclaircie, on devrait observer cette tendance generale selon laquelle l'accumulation de debris ligneux augmente avec la densite des peuplements dans le cas des peuplements equiennes presque a maturite, etablis dans d'autres forets temperees froides et boreales. [Traduit par la Redaction] Mots-cles: auto-eclaircie, debris ligneux grossiers, petits debris ligneux, biocarburant de surface, Larix occidentalis., Introduction Dead woody structures are essential attributes of forest ecosystems (Sollins 1982; Harmon and Hua 1991). Downed fine (FWD) and downed coarse (CWD) woody debris and standing dead trees (snags) [...]