Strict Selection Research Articles

НОВЫЙ СОРТ ОЗИМОЙ РЖИ БЕЗЕНЧУКСКАЯ 110 С РЕЦЕССИВНО-ПОЛИГЕННЫМ ТИПОМ КОРОТКОСТЕБЕЛЬНОСТИ ДЛЯ ЗОНЫ СРЕДНЕГО ПОВОЛЖЬЯ

The results of breeding for winter rye in recent years in experiments located on the chernozem of the ordinary steppe Volga region are presented. The characteristic of the new variety Bezenchukskaya 110 is given. In the nursery of competitive variety testing, the average yield (2015-2019) of grain of this variety was 4.36 t/ ha, which is 0.35 t/ha more than that of Bezenchuk 87. The high quality of grain makes it possible to use the Bezenchukskaya 110 variety both in the bakery and in the feed industry. Based on research, it has been established that the most rational way in the breeding process is the formation of a complex hybrid population based on its adaptive properties by means of strict selection of the starting material with directional polytopcross, using individual-family and family-group selections by the method of halves. According to the results of the correlation analysis, it was revealed that precipitation at the end of the spring and beginning of the summer vegetation period is one of the leading external factors of plant growth and development and largely determines the productivity of winter rye. The yield also depends on the amount of precipitation per year, on the temperature regime and the duration of the dry period in May and June. Grain quality is largely determined by the temperature regime and the intensity of precipitation during the grain filling period. Varieties with a polygenic recessive type of plant height control are most adapted to the arid conditions of the Middle Volga region.

Maximum luminosities of normal stripped-envelope supernovae are brighter than explosion models allow

Context. Stripped-envelope supernovae (SE SNe) of Type Ib and Type Ic are thought to be the result of explosions of massive stars that have lost their outer envelopes. The favored explosion mechanism is via core-collapse, with the shock later revived by neutrino heating. However, there is an upper limit to the amount of radioactive 56Ni that such models can accommodate. Recent studies in the literature point to a tension between the maximum luminosity from such simulations and the observations. Aims. We used a well-characterized sample of SE SNe from the Zwicky Transient Facility (ZTF) Bright Transient Survey (BTS) to scrutinize the observational caveats regarding estimates of the maximum luminosity (and thus the amount of ejected radioactive nickel) for the sample members. Methods. We employed the strict selection criteria for the BTS to collect a sample of spectroscopically classified normal Type Ibc SNe, for which we used the ZTF light curves to determine the maximum luminosity. We culled the sample further based on data quality, shape of the light curves, distances, and colors. Then we examined the uncertainties that may affect the measurements. The methodology of the sample construction based on this BTS sample can be used for other future investigations. Results. We analyzed the observational data, consisting of optical light curves and spectra, for the selected sub-samples. In total, we used 129 Type Ib or Type Ic BTS SNe with an initial rough luminosity distribution peaking at Mr = −17.61 ± 0.72, and where 36% are apparently brighter than the theoretically predicted maximum brightness of Mr = −17.8. When we further culled this sample to ensure that the SNe are normal Type Ibc with good LC data within the Hubble flow, the sample of 94 objects gives Mr = −17.64 ± 0.54. A main uncertainty in absolute magnitude determinations for SNe is the host galaxy extinction correction, but the reddened objects only get more luminous after corrections. If we simply exclude red objects, or those with unusual or uncertain colors, then we are left with 14 objects at Mr = −17.90 ± 0.73, whereof a handful are most certainly brighter than the suggested theoretical limit. The main result of this study is thus that normal SNe Ibc do indeed reach luminosities above 1042.6 erg s−1, which is apparently in conflict with existing explosion models.

Paraoxonase 1 -L55M polymorphism and coronary heart disease risk in the Chinese population: evidence from a meta-analysis

Many studies have examined the association between paraoxonase 1 (PON1) -L55M polymorphisms and risk of coronary heart disease (CHD), but the results remained inconsistent. We therefore aimed to address this association by performing an updated meta-analysis in the Chinese population. The PubMed, EMBASE, Web of Science, and Chinese National Knowledge Infrastructure were searched up to May 2020. The strength of statistical association was assessed with odds ratio (OR) and 95% confidence interval (CI). A total of eight studies with 1826 CHD cases and 1817 controls were finally included in the analysis. In the overall and subgroup analyses by control sources and geographic areas, the results showed no significant associations with CHD among all analysis models. Furthermore, we performed the analysis by including or excluding the HWE-violating studies. The results suggested that the MM genetype were significantly associated with CHD in studies not consistent with HWE under recessive and dominant models. This meta-analysis demonstrates that the PON1 -L55M polymorphism may not be associated with CHD risk in the Chinese population. Further studies with strict selection of patients and controls in different ethnic populations will be required to clarify this finding.

Ensuring safe blood supply

Abstract Background: The use of unscreened blood exposes the patient to many transfusion-transmitted infections (TTIs) including hepatitis B and C viruses, human immunodeficiency virus (HIV), malaria and syphilis, among others. Thus, blood transfusion demands for meticulous pre-transfusion testing and screening. Methods: In this retrospective study carried out from September 2019 to September 2021, 5 mandatory screening tests for TTIs, namely, anti-HIV 1 and 2, anti-hepatitis C virus antibodies, hepatitis surface antigen (HBsAg), serological testing for syphilis and malarial parasite antigen detection were performed. Results: From 2019 September to 2021 September, 2576 blood donations (n = 2474; 96% males) were studied. Of these, 529 (20.5%) were from voluntary donors (VD) and 2047 (79.5%) from replacement donors (RD). Thirty-four (1.3%) of the total 2576 blood donors tested positive for one of the TTIs, including 6 (17.6%) VD and 28 (82.4%) RD. Conclusions: Strict selection of blood donors is mandatory and the need to increase voluntary blood donations can ensure safe blood supply and reducing the occurrence of TTI.

Embryo development of hatching eggs of superior local broiler (ALPU) with Arab native chickens (Kamaras)

Efforts to improve the quality of local chickens, especially free-range chickens, are carried out by improving genetic traits, namely through a strict selection method to produce broilers with the name of Superior Local Broilers (ALPU) and laying purposes with Arab Kampung Chickens (Kamaras). This study was conducted to obtain information on the comparison of ALPU and Kamaras embryo development for genetic improvement as the basis for further research. This study used 105 ALPU hatching eggs and 105 Kamaras hatching eggs, the observations were carried out for 21 days. Eggs were collected for 7 days and then put into the incubator, then observed every day by breaking each 5 ALPU and Kamaras eggs to see 7 parameters of embryo development in the form of: body weight, body length, head circumference, neck length, beak length, wing length and leg length. The results showed that there was no significant developmental difference between ALPU and Kamaras embryos. However, the embryo weight and beak length of Kamaras tended to be larger than those of ALPU, while the head circumference and wing length of ALPU tended to be larger than that of Kamaras. In conclusion, the embryonic development between ALPU and Kamaras showed relatively similar embryo development during the hatching period.

KINETIC INDICATORS OF TRAINING METHODS AND SELECTION OF YOUNG ROWERS

Modern diagnostics in rowing enables more and more possibilities for recording, and comparing numerous stroke variables. At the same time, many coaches fall into the trap of strict respect for the prescribed norms, ratios, and temporarily results, which the athlete must achieve if he wants to stay in the world of competitive rowing. On the example of the comparison of rowing schools RC "Danubius" and RC "Partizan", descriptive indicators are on the side of RC "Danubius" at a time of 2000m, average force and average power. No significant differences were found in average force (sig = 0,167) between rowers of RC "Danubius" and RC "Partizan", while statistically significant differences were recorded in time at 2000m (sig = 0,036) and power (sig = 0,02) in favor of rowers of RC “Danubius”. On the other hand, a higher correlation of average force (-0,955) and power (-0,928) with time on 2000m was achieved by RC "Partizan" than RC "Danubius" (-0,931) and (-0,896). The correlation between the average force, and the average power within one team shows a higher correlation for RC “Partizan" (0,95) compared to RC "Danubius" (0,755). The obtained results are not enough for single rower or crew elimination from competition to recreational section in the process of too frequent and strict selection of rowers, considering different possible ways of building rowing techniques and numerous parasitic factors that may affect measured variables, specialy at the age under 14 and novice rowers in general.

International Aspects of the COVID-19 Infodemic

At present, the speed and scale of the dissemination of false health information has increased significantly, due to the Internet and social networks, which has become a serious problem and challenge for the worlds public health systems. The issue of spreading implausible news has become most acute against the background of the COVID-19 pandemic. Since February 2020, the World Health Organization has introduced the term infodemiс, which characterizes the rapid growth of unreliable and false reports of a pandemic by analogy with the spread of the virus. The purpose of this article is to study the issues of the emergence and ways of spreading misinformation about health, to consider approaches for taking effective response measures in the conditions of infodemiс. The article was prepared using a systematic review of research publications based on strict selection criteria in the bibliographic databases PubMed, ScienceDirect, as well as online resources that addressed the issues of dissemination and countering false information in the field of healthcare. Countering disinformation needs to be done through correcting information, purposeful refutations based on evidence, implementing initiatives to improve the media literacy of the population, as well as by improving the supervision of social networks. Coordinated interaction between governmental and international organizations, the scientific community, the media, and global Internet social media platforms is crucial in this process.

Risk factors and prognostic significance of lateral pelvic lymph node dissection after neoadjuvant chemoradiotherapy for rectal patients with clinically suspected lateral lymph node metastasis

AimIt is still controversial whether the addition of lateral pelvic lymph node (LPN) dissection (LPND) to total mesorectal excision (TME) can provide a survival benefit after neoadjuvant chemoradiotherapy (nCRT) in rectal cancer patients with pathological lateral lymph node metastasis (LPNM).MethodsPatients with clinically suspected LPNM who underwent nCRT followed by TME + LPND were systematically reviewed and divided into the positive LPN group (n = 15) and the negative LPN group (n = 58). Baseline characteristics, clinicopathological data and survival outcomes were collected and analysed.ResultsOf the 73 patients undergoing TME + LPND after nCRT, the pathological LPNM rate was 20.5% (15/73). Multivariate analysis showed that a post-nCRT LPN short diameter ≥ 7 mm (OR 49.65; 95% CI 3.98–619.1; P = 0.002) and lymphatic invasion (OR 9.23; 95% CI 1.28–66.35; P = 0.027) were independent risk factors for pathological LPNM. The overall recurrence rate of patients with LPNM was significantly higher than that of patients without LPNM (60.0% vs 27.6%, P = 0.018). Multivariate regression analysis identified that LPNM was an independent risk factor not only for overall survival (OS) (HR 3.82; 95% CI 1.19–12.25; P = 0.024) but also for disease-free survival (DFS) (HR 2.33; 95% CI 1.02–5.14; P = 0.044). Moreover, N1-N2 stage was another independent risk factor for OS (HR 7.41; 95% CI 1.63–33.75; P = 0.010).ConclusionsPost-nCRT LPN short diameter ≥ 7 mm and lymphatic invasion were risk factors for pathological LPNM after nCRT. Furthermore, patients with pathological LPNM still show an elevated overall recurrence rate and poor prognosis after TME + LPND. Strict patient selection and intensive perioperative chemotherapy are crucial factors to ensure the efficacy of LPND.

The majority of the patients with a monogenic predisposition for dementia did not fulfill current criteria for genetic testing.

Dementia in families can be caused by one genetic variant. Identifying these so-called monogenic causes of dementia is important, because it explains the origin of dementia in families and raises the possibility of predictive testing for relatives. Still, we do not know how frequent these monogenic causes are, due to strict selection criteria for DNA testing based on age at onset and a positive family history. We aimed to identify the mutation frequency of monogenetic dementia by screening a large, unselected cohort of patients from a memory clinic specialized in early onset dementia. Between 1-1-2010 and 1-7-2012, 1,138 patients visited the Alzheimer Center Amsterdam and all patients underwent the same diagnostic trajectory (van der Flier et al 2018). Of these, 1,093 (96%) consented to research and donated blood. An additional 73 patients (7%) were excluded because suboptimal DNA quality. Whole exome sequencing and C9orf72-repeat length analysis was performed in the remaining 1,020 patients (90% of all patients). All variants in 54 dementia related genes were analysed and classified. C9orf72 repeat length >30 repeat units was considered pathogenic. Variants classified as likely pathogenic and pathogenic were considered a monogenic cause of dementia. The average age at presentation was 62(±6SD) years and 419(41%) were female. We found a monogenic cause of dementia in 34 (3.4%) patients. The most frequently occurring (likely) pathogenic variants were found in the genes C9orf72, PSEN1, NOTCH3 and MAPT. These genes explained 65% of the (likely) pathogenic variants. The clinical characteristics of the patients screened positive; 50% were diagnosed with dementia and 50% had a first degree relative with dementia; and 40% had an age at presentation of <60 years and 44% was between 60 to 70 years, the remainder was older. Surprisingly, only 47% of the patients with a (likely) pathogenic variant fulfilled our current criteria (based on diagnosis, age and familial history) for offering diagnostic genetic testing (21% of patients). In our large unselected cohort of patients from a memory clinic specialized in early onset dementia, the majority of the patients with a monogenetic predisposition for dementia did not fulfill our current criteria for genetic testing.

Clinical and radiographic success of (partial) pulpotomy and pulpectomy in primary teeth: A systematic review.

The aim of this systematic review was to evaluate the clinical outcome of partial pulpotomy, pulpotomy and pulpectomy for treating primary teeth with normal or infected pulp or with irreversible pulpitis. Two reviewers on Pubmed and ISI Web of Science performed a comprehensive literature review of publications from 1966 until July 2019. Pico outline was used to facilitate literature research. Among abstracts, publications were selected according to the following criteria: prospective clinical study, correct indication for the performed treatment, clear definition of clinical and/or radiographic success criteria and at least 6-month follow-up period. The strict selection criteria under the keywords "pulpotomy", "partial pulpotomy" and "pulpectomy" resulted in a limited amount of randomised controlled trials (RCT) or controlled clinical trials (CT). Qualitative assessment of the selected clinical studies and level of evidence was included according to the criteria described by the Oxford Centre for Evidence-Based Medicine (CEBM). Prerequisites for a successful pulpotomy are symptom-free teeth, sterile removal of coronal pulp and haemostasis. Both MTA and formocresol perform well for partial pulpotomies after caries exposure. Formocresol had been the most popular amputation material for pulpotomies. Due to the potential side effects, other medicaments, such as ferric sulfate, mineral trioxide aggregate (MTA) or NaOCl are suggested. Grey and white MTA yeld the same results. Lasers are not recommended due to their large diversity. Regarding pulpectomy, the conditions, procedures, and evaluation for the treatment were not well defined in the studies. Nevertheless, there is evidence to use calcium hydroxide, zinc oxide eugenol paste or iodoform based pastes as root filling materials for non-vital molars. Pulpectomies showed better success rates than pulpotomies. Stainless steel crowns are recommended as definite restorations after both endodontic treatments. Longer follow-up periods, further clinical studies with comparable conditions and clear definition of evaluation criteria are needed to further confirm the results of endodontic treatment in primary teeth.

Digital Twin Integrated Reinforced Learning in Supply Chain and Logistics

Background: As the Internet of Things (IoT) has become more prevalent in recent years, digital twins have attracted a lot of attention. A digital twin is a virtual representation that replicates a physical object or process over a period of time. These tools directly assist in reducing the manufacturing and supply chain lead time to produce a lean, flexible, and smart production and supply chain setting. Recently, reinforced machine learning has been introduced in production and logistics systems to build prescriptive decision support platforms to create a combination of lean, smart, and agile production setup. Therefore, there is a need to cumulatively arrange and systematize the past research done in this area to get a better understanding of the current trend and future research directions from the perspective of Industry 4.0. Methods: Strict keyword selection, search strategy, and exclusion criteria were applied in the Scopus database (2010 to 2021) to systematize the literature. Results: The findings are snowballed as a systematic review and later the final data set has been conducted to understand the intensity and relevance of research work done in different subsections related to the context of the research agenda proposed. Conclusion: A framework for data-driven digital twin generation and reinforced learning has been proposed at the end of the paper along with a research paradigm.

Postrecurrence Survival After Liver Transplantation for Liver Metastases From Neuroendocrine Tumors.

Liver metastases from neuroendocrine tumors (NETs) are an accepted indication for liver transplantation (LT). Despite strict patient selection, post-LT recurrence is observed in 30%-50% of cases. Postrecurrence survival is poorly investigated as well as factors influencing postrecurrence outcomes. Consecutive patients treated at a single institution for post-LT recurrence of NET between January 1, 2004, and December 31, 2018, were included. Baseline patients' characteristics, data on the primary tumor, pretransplant therapies, posttransplant recurrence and treatments, and long-term outcomes were prospectively collected and retrospectively analyzed. Thirty-two patients presented with post-LT NET recurrence occurring 82.9 mo (interquartile range, 29.4-119.1 mo) from LT, and the most common sites were abdominal lymph nodes (59.4%), peritoneum (6.3%), and lungs (6.3%). Fourteen patients (43.8%) underwent surgery with radical intent. Five- and 10-y survival after recurrence were 76.3% and 45.5%, respectively. Only time from LT to recurrence had a significant impact on postrecurrence survival, being 5-y overall survival 89.5% versus 0% for patients recurring >24 mo after LT versus ≤24 mo, respectively (P = 0.001). Moreover, for patients with Ki-67 monoclonal antibody staining >2% at recurrence, 5 y overall survival was 87.5% versus 0% for those undergoing surgery versus locoregional or systemic treatments (P = 0.011). The presented results, although based on a retrospective and relatively small series, show that excellent long-term survival is observed after post-LT NET recurrence, particularly in those patients recurring long after LT (>24 mo). An aggressive surgical treatment might result in a new chance of cure for a selected subgroup of patients.

Can the Limits of Liver Transplantation Be Expanded in Perihilar Cholangiocarcinoma?

The most common location of cholangiocarcinomas is the perihilar region with a frequency of 50-70%. Current standard treatment for perihilar cholangiocarcinomas (pCCA) is surgical resection. In cases where resection treatment is possible, the 5-year survival rate is 8-40%. However, usinga very strict patient selection, neoadjuvant radiochemotherapy (NRCT), staging laparotomy, and liver transplantation (LT), called "the Mayo protocol," 5-year survivals of up to 70% in pCCAwere reported. This treatment protocol clearly requires an intensive workforce and a harmonious multidisciplinary approach. Reoperation and retransplantation rates are high, which is a reflection of the NRCT. Multicenter studies, systemic reviews, and meta-analysis results, comparing both resection and LT in pCCA treatment and evaluating only LT results, pointed to LT with strict patient selection and full compliance with the treatment. The results of centers experienced in LT are better in treatingpCCA. According to Mayo clinical data, histopathological diagnosis could not be obtained in half of the patients with pCCA before NRCT was given. This situation can be explained by the necrosis of the tumor due tothe effect of NRCT and the fact that the tumor cannot be detected in the explant liver. This situation raises the following questions: did all patients actually have pCCA? Were these good results due to some patients not having pCCA? The 5-year survival rate was worse in patients with a pathological diagnosis than those without a pathological diagnosis. However, interestingly, recurrence rates were statistically similar in both groups. There was no difference in survival between LT and resection in the R0N0 subgroup in de novo pCCA. There are still many issues that need to be addressed and corrected in pCCA, which is one of the most problematic indications forLT. Significant success has been achieved with NRCT, staging laparotomy, and LT in selected patients with pCCA developing on the basis of PSC or early-stage unresectable de novo pCCA. It can be expected that new NRCT modalities will provide better survival by expanding the indications for LT in pCCA.

Enhanced corrosion protection action of biofilms based on endogenous and exogenous bacterial cellulose

The use of biomineralized films to protect steel surfaces is limited by the strict selection of bacteria capable of mineralization. Inspired by the different effects of the Pseudoalteromonas lipolytica mutants on steel corrosion, we found that bacterial cellulose (BC) plays an important role in corrosion protection. The endogenous cellulose was beneficial to the formation of uniform biofilms, while exogenous BC provided a stable anticorrosion activity through biomineralization. Moreover, the addition of BC extracted from the P. lipolytica ∆17125 strain into a culture medium with corrosive P. lipolytica ∆bcs or Vibrio natriegens resulted in systems with significant corrosion-inhibition abilities.

Resuming elective orthopaedic services during the COVID-19 pandemic : our experience.

AimsThe aim of this study was to surveil whether the standard operating procedure created for the NHS Golden Jubilee sufficiently managed COVID-19 risk to allow safe resumption of elective orthopaedic surgery.MethodsThis was a prospective study of all elective orthopaedic patients within an elective unit running a green pathway at a COVID-19 light site. Rates of preoperative and 30-day postoperative COVID-19 symptoms or infection were examined for a period of 40 weeks. The unit resumed elective orthopaedic services on 29 June 2020 at a reduced capacity for a limited number of day-case procedures with strict patient selection criteria, increasing to full service on 29 August 2020 with no patient selection criteria.ResultsA total of 2,373 cases were planned in the 40-week study period. Surgery was cancelled in 59 cases, six (10.2%) of which were due to having a positive preoperative COVID-19 screening test result. Of the remaining 2,314, 996 (43%) were male and 1,318 (57%) were female. The median age was 67 years (interquartile range 59.2 to 74.6). The median American Society of Anesthesiologists grade was 2. Hip and knee arthroplasties accounted for the majority of the operations (76%). Six patients tested positive for COVID-19 preoperatively (0.25%) and 39 patients were tested for COVID-19 within 30 days after discharge, with only five patients testing positive (0.22%).ConclusionThrough strict application of a COVID-19 green pathway, elective orthopaedic surgery could be safely delivered to a large number of patients with no selection criteria.Cite this article: Bone Jt Open 2021;2(11):951–957.

Factors affecting sustainability of agricultural machinery assistance program

One of the Ministry of Agriculture’s efforts to support agricultural development is by providing equipment and machinery assistance. There are many multi-dimensional problems, both technical, socio-cultural, economic, and environmental. This study aimed to analyze the sustainability status of the agricultural equipment and machinery assistance program. This research was conducted in 2020 with the object of the two-wheeled tractor and four-wheeled tractor assistance program in 2018-2019. Research location covers six districts, the selection of site determined by the provinces considered the most successful and the least successful in realizing activities. The sustainability status of the activity program was analyzed using Multidimensional Scale Analysis. The collected data and information through structured questionnaires from 47 institutional respondents and literature studies, both printed and electronic. The results showed that agricultural equipment and machinery assistance program (TR2 and TR4) was less sustainable. The comparison of the MDS value and Monte Carlo’s analysis was 49.93, with an R2 value of 89%. The S-Stress statistical test is still relatively high, namely 0.30 (above 0.25), which means improvements and refinement needs from the implementation aspect. Improvements from various elements are divides into two groups. First, leverage factors that encourage the sustainability and success of the implementation of activities, and the second is the improvement of the performance of TR2 and TR4 beneficiary groups. Policy recommendations for implementing future program activities are a strict selection of potential beneficiaries and improvements in the management aspects of beneficiaries at the farmer level by providing guidance.

Liver resection is associated with good outcomes for hepatocellular carcinoma patients beyond the Barcelona Clinic Liver Cancer criteria: A multicenter study with the Hiroshima Surgical study group of Clinical Oncology

BackgroundLiver resection for hepatocellular carcinoma beyond the Barcelona Clinic Liver Cancer criteria remains controversial. Strict candidate selection is crucial to achieve optimal results in this population. This study explored postoperative outcomes and developed a preoperative predictive formula to identify patients most likely to benefit from liver resection. MethodsIn total, 382 patients who underwent liver resection for hepatocellular carcinoma beyond the Barcelona Clinic Liver Cancer resection criteria between 2000 and 2017 were identified from a multicenter database with the Hiroshima Surgical study group of Clinical Oncology. An overall survival prediction model was developed, and patients were classified by risk status. ResultsThe 5-year overall survival after curative resection was 50.0%. Overall survival multivariate analysis identified that a high a-fetoprotein level, macrovascular invasion, and high total tumor burden were independent prognostic risk factors; these factors were used to formulate risk scores. Patients were divided into low-, moderate-, and high-risk groups; the 5-year overall survival was 65.7%, 49.5%, and 17.0% (P < .001), and the 5-year recurrence-free survival was 31.3%, 26.2%, and 0%, respectively (P < .001). The model performance was good (C-index, 0.76). Both the early and extrahepatic recurrence increased with higher risk score. ConclusionThe prognosis of patients with hepatocellular carcinoma beyond the Barcelona Clinic Liver Cancer resection criteria depended on a high a-fetoprotein level, macrovascular invasion, and high total tumor burden, and risk scores based on these factors stratified the prognoses. Liver resection should be considered in patients with hepatocellular carcinoma beyond the Barcelona Clinic Liver Cancer criteria with a low or moderate-risk score.

EP.FRI.99 Penetrating Abdominal Trauma: Comperative Study Between Operative and Conservative Management

Abstract Aim to Assess the feasibility and safety of selective non-operative management in penetrating abdominal injuries and to identify a protocol for selection of patient candidates for non-operative management. Methods In this comparative study 40 abdominal stab victims (admitted to Emergency Department) were selected during a 6 months period where 20 patients were suitable for non-operative management according to strict selection criteria whereas the other 20 patients were operated according to clinical and/or radiological indications or on basis of department protocol, the results were compared in view of final outcome. Results In our study, 15 patients were assigned for operative management according to selected clinical and/or radiological indications only 3 of them (20%) had non-therapeutic laparotomies, On the other hand, five patients were explored on basis of department protocol in violation of our indications for exploration; four of them (80%) were non-therapeutic. So, the rate of non-therapeutic laparotomies was significantly higher when done mandatory without selected clinical and radiological indications. Conclusion Assessment of vital signs together with abdominal examination are the most important and dependable tools in decision making in penetrating abdominal trauma patients. Patients with shock on admission (but responding to resuscitation), proved low grade solid organ injury (by CT), and proved intraperitoneal collection (by US or CT) could be managed conservatively regarding that they remain vitally and clinically stable. If failure of conservation occurs, it is usually during the 1st 24 hours after admission.

Gait status 26–35 years after selective dorsal rhizotomy: A 9 year follow up study

BackgroundAlthough the short-term outcomes of selective dorsal rhizotomy (SDR) in children with cerebral palsy (CP) have been well documented, less is known about the long-term benefits of SDR, especially while aging. Research questionDoes the gait of adults with CP, who underwent SDR in childhood, change during a nine-year aging follow-up period? Do associations exists between the gait deviation index (GDI) and contextual factors at follow-up? MethodsThree-dimensional motion data was captured (Vicon system) of 26 adults (10 female) with CP and spastic diplegia at baseline (17-to-26 years post-SDR) and at nine-year follow-up (26-to-35 years post-SDR), as well as 41 matched typically developed (TD) adults used for reference data. Kinematic, non-dimensional temporal distance and GDI parameters were determined, and associations with contextual factors were studied. ResultsAt follow-up the adults with CP had a (median [interquartile ranges]) age of 35.8 [34.2–41.2] years and classified as Gross Motor Function Classification System (GMFCS) level I (n = 13), level II (n = 10) and level III (n = 3). Overall no clinically relevant change in gait quality (GDI) was detected over the nine-year follow-up period. However, small changes were found in hip and knee range of motion, peak knee flexion and walking speed. In line with the baseline study, a number of gait parameters were different to TD adults. The only association found was between GDI and GMFCS at follow-up (r = 0.64, p < 0.01). SignificanceThe overall walking pattern of the adults with CP who underwent SDR in childhood was characterised by mild crouch gait with minimal signs of spasticity, confirming former physical examination findings. Some small changes in certain gait parameters were determined, though clinically the gait quality remained stable during the nine-year aging period. This finding supports the stability of the gait pattern during mid-life in adults with CP, who met the strict SDR selection criteria.

Prediction of Complete Pathological Response to Neo-Adjuvant Chemoradiotherapy Using Magnetic Resonance Imaging-Based Radiomics Analysis in Locally Advanced Rectal Cancer.

In locally advanced rectal cancer (LARC) patients treated with neoadjuvant chemoradiotherapy (CRT), surgery could be omitted in patients with complete pathological response (pCR) without compromising progression-free and overall survivals. Our objective is to develop a radiomic model based on Magnetic Resonance Imaging (MRI) and contrast-enhanced computed tomography (CT) scans to predict the pathologic complete response (pCR) to neoadjuvant CRT in LARC.All patients treated for a LARC with neoadjuvant CRT and subsequent surgery in 2 centers in the West of France (Insitut of Cancerologie Brittany Occidental (ICBO) and Nantes) were considered. Both pre-CRT pelvic MRIs and contrast-enhanced CT-scans were mandatory for inclusion. The tumor was manually segmented on the T2-weighted and diffusion axial sequences and on the contrast-enhanced CT-scan. Eighty-eight radiomic parameters (15 shape and geometry features, 11 first-order and 62 second-order) were extracted from each sequence using the in-house MirasÓ software, with a total of 1056 features by patient. The overall cohort was randomly split into two independent cohorts (training: 70% and testing: 30%). A strict feature set selection workflow based on the Spearman's correlation coefficient and the Area Under the Curve (AUC) was developed to reduce the number of features. Based on these selected features, three pCR prediction models (clinical, radiomics and combined: clinical + radiomics) were developed on the training set only with a random forest approach and a Bootstrap internal validation with n = 1000 replications. An optimal cut-off maximizing the model's performance was defined on the training set. Each model was then evaluated on the testing set, based on the AUC and the C-statistic calculated with the pre-defined cut-off. Finally, a posteriori harmonization using the ComBat approach was applied to account for imaging modalities heterogeneity.Of the 124 included patients, 14 had a complete response (11,3%). In the training set, the clinical model based on 2 parameters (initial T-stage and degree of tumor differentiation) obtained an AUC of 0.67 and a C-statistic of 0.65. The radiomic model based on 1 parameter (entropy histogram derived from T2 sequence) obtained an AUC of 1 and a C-statistic of 1. The combined clinical and radiomic model was strictly identical to the radiomics model and thus had the same performance. On the testing set, models resulted in a C-statistic of 0.70/0.73/0.73 for the clinical, radiomics and combined models, respectively. Finally, after harmonization, the radiomic model achieved a C-statistic of 0.77 on the testing set while the combined resulted in a C-statistic of 0 .75.Radiomic model based on T2-weighted pre-therapeutic MRIs sequences could help to predict pCR after neoadjuvant CRT in LARC.