关键词： astrocytes   neuropsychiatric disorders   pruning   synapse remodelling  

摘要： Investigating interactions of glia cells and synapses during development and in adulthood is the focus of several research programmes which aim at understanding the neurobiology of brain physiological and pathological processes. Both glia-specific released and membrane-bound proteins play essential roles in the development, maintenance and functionality of synaptic connections. Alterations in synaptic contacts in specific brain areas are hallmarks of several brain diseases, such as major depressive disorder, autism spectrum disorder and schizophrenia. Thus, a deeper knowledge about putative astrocyte dysfunctions which might affect the synaptic compartment is warranted to improve treatment options. Here, we present the latest advances about the role of glia cells in orchestrating the arrangement of synapses and neuronal networks in physiological and pathological states. We specifically focus on the role of astrocytes in the phagocytosis of neuronal synapses as a novel mechanism which drives the refinement of neuronal circuits and might be affected in pathological conditions. Finally, we propose this astrocyte-dependent mechanism as a putative alternative target of pharmacological interventions for the treatment of brain disorders.

关键词： Finite element method   Initial boundary value problems   Convolutional variational principles   Elastodynamics   Structural dynamics  

摘要： A finite element procedure is proposed for wave propagation in elastic media. The method is based on an alternative formulation for the equations of motion that can systematically be constructed for linear evolutionary partial differential equations. A weak formulation-corresponding to convolutional variational principles-is then defined, which paves the way for introducing a particular type of time-wise shape functions. Next, some mathematical characteristics of the method are investigated, and upon those properties, a new solution procedure for elastodynamics problems is proposed. Subsequently, several numerical examples are considered, including a single degree of freedom mass-spring-damper system as the prototype of structural dynamics along with 1d and 2d elastodynamics problems for the case of the wave motion in elastic solids. The present method can be considered as an alternative approach for time integration and time-marching algorithms, e.g., Newmark's algorithm, to solve time-domain problems in elastic media.

关键词： Karst hydrology   Groundwater recharge   Partial cross-correlation function   Conceptual hydrological model   Water balance   Objective function  

摘要： Aquifers with time variant catchment boundaries, regional flows, and inflows from surface streams and accumulations are common in karst areas. Due to the lack of reliable methods for determination of water balance in the phreatic zone of such aquifers, groundwater recharge estimation is a challenge task. This paper introduces a new method for estimation of groundwater recharge in karst - the so-called partial correlation method (PCM). The basic hypothesis is that the groundwater recharge rates can be determined from the time series of precipitation, air temperature, relative humidity, and spring discharge, by using a partial cross-correlation function as objective function. Following this hypothesis, a simple conceptual model of water balance in the soil cover, epikarst and vadose zone is developed, and an objective function for estimation of the optimal value of parameter of this model is proposed. PCM is applied on the catchment of 2rnovnica Spring located in the Dinaric karst area of Croatia. The results of application are compared with the results of previous studies, as well as with the results obtained by five empirical models that have been used for estimation of groundwater recharge in the Mediterranean karst. The effective infiltration coefficients obtained by PCM for the Zrnovnica Spring are generally in accordance with the previously published ones.

关键词： COVID   MIS-c   neck pain   pediatric inflammatory multisystem syndrome temporally associated with COVID-19   retropharyngeal edema  

摘要： We defined the prevalence of neck pain, trismus, or dysphagia (28.4%) and retropharyngeal edema (2.9%) among 137 patients with multisystem inflammatory syndrome in children (MIS-c). Retropharyngeal edema or phlegmon has been documented radiologically in at least 9 children. Symptoms of neck inflammation are common in MIS-c.

关键词： Computed tomography   X-ray   Pelvic bones   Tin   Radiation dosage  

摘要： Objectives To compare ultra-low-dose CT (ULD-CT) of the osseous pelvis with tin filtration to standard clinical CT (CT), and to assess the quality of computed virtual pelvic radiographs (VRs). Methods CT protocols were optimized in a phantom and three pelvic cadavers. Thirty prospectively included patients received both standard CT (automated tube voltage selection and current modulation) and tin-filtered ULD-CT of the pelvis (Sn140kV/50mAs). VRs of ULD-CT data were computed using an adapted cone beam-based projection algorithm and were compared to digital radiographs (DRs) of the pelvis. CT and DR dose parameters and quantitative and qualitative measures (1 = worst, 4 = best) were compared. CT and ULD-CT were assessed for osseous pathologies. Results Dose reduction of ULD-CT was 84% compared to CT, with a median effective dose of 0.38 mSv (quartile 1-3: 0.37-0.4 mSv) versus 2.31 mSv (1.82-3.58 mSv;p < .001), respectively. Mean dose of DR was 0.37 mSv (+/- 0.14 mSv). The median signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of bone were significantly higher for CT (64.3 and 21.5, respectively) compared to ULD-CT (50.4 and 18.8;p <= .01), while ULD-CT was significantly more dose efficient (figure of merit (FOM) 927.6) than CT (FOM 167.6;p < .001). Both CT and ULD-CT were of good image quality with excellent depiction of anatomy, with a median score of 4 (4-4) for both methods (p = .1). Agreement was perfect between both methods regarding the prevalence of assessed osseous pathologies (p > .99). VRs were successfully calculated and were equivalent to DRs. Conclusion Tin-filtered ULD-CT of the pelvis at a dose equivalent to standard radiographs is adequate for assessing bone anatomy and osseous pathologies and had a markedly superior dose efficiency than standard CT.

关键词： Thyroid Gland   Palatine Tonsil   Skin   Parathyroid Glands   Endocrine Surgical Procedures   Otolaryngology   Wound Infection   Burns  

摘要： Background Thyroid and parathyroid surgery often involves the use of heated instruments for dissection. Whilst these are beneficial, accidental thermal damage to the exposed skin edges can occur, resulting in an unsatisfactory cosmetic outcome. Tonsil swabs can be used in head and neck surgery intra-operatively to control bleeding. This paper describes an alternative use for them in protecting wound edges during the procedure. Method Damp tonsil swabs are sutured onto the wound edges after the initial skin incision. They remain present for the duration of the surgery and are removed at the time of skin closure. Results The tonsil swabs provide protection and help avoid accidental injury to the skin. No complications with this technique have been experienced. Conclusion This paper describes a simple, effective and practical technique for protecting the skin during neck procedures using resources readily available in a standard ENT operating theatre.

摘要： Highlights•The OCM and other Alternative Payment Models are likely to increase in the future. •Several aspects of the OCM may not adequately incentivize higher value care. •Advocacy specific to the care of gynecologic cancer patients is needed for the next generation APMs.

关键词： robotics   minimally invasive surgical procedures   carcinoma   renal cell   von Hippel-Lindau disease  

摘要： Purpose: Historically, open techniques have been favored over minimally invasive approaches for complex surgeries. We aimed to identify differences in perioperative outcomes, surgical footprints, and complication rates in patients undergoing either open or robotic reoperative partial nephrectomy. Materials and Methods: A retrospective review of patients undergoing reoperative partial nephrectomy was performed. Patients were assigned to cohorts based on current and prior surgical approaches: open after open, open after minimally invasive surgery, robotic after open, and robotic after minimally invasive surgery cohorts. Perioperative outcomes were compared among cohorts. Factors contributing to complications were assessed. Results: A total of 192 patients underwent reoperative partial nephrectomy, including 103 in the open after open, 10 in the open after minimally invasive surgery, 47 in the robotic after open, and 32 in the robotic after minimally invasive surgery cohorts. The overall and major complication (grade >= 3) rates were 65% and 19%, respectively. The number of blood transfusions, overall complications, and major complications were significantly lower in robotic compared to open surgical cohorts. On multivariate analysis, the robotic approach was protective against major complications (OR 0.3, p=0.02) and estimated blood loss was predictive (OR 1.03, p=0.004). Prior surgical approach was not predictive for major complications. Conclusions: Reoperative partial nephrectomy is feasible using both open and robotic approaches. While the robotic approach was independently associated with fewer major complications, prior approach was not, implying that prior surgical approaches are less important to perioperative outcomes and in contributing to the overall surgical footprint.

关键词： Blind loop syndrome   Intestinal pseudo-obstruction   Parenteral nutrition   Short-bowel syndrome   stagnant loop syndrome  

摘要： INTRODUCTION: Several techniques have been described to taper the dilated small bowel to improve intestinal motility and decrease complications related to overdilated small bowel, including longitudinal intestinal lengthening and tapering, serial transverse enteroplasty, and spiral intestinal lengthening and tailoring. We propose an alternative technique designed to optimize bowel function and minimize the effects of recurrent small-bowel bacterial overgrowth in patients with short or ultra-short gut syndrome and dysfunctional anastomosis with maintenance of the actual absorptive surface. TECHNIQUE: The dilated side-to-side anastomosis is identified, and the mesentery leaves from both the proximal and distal small-bowel loops are separated by using blunt dissection. The previous anastomosis is divided longitudinally with a GI stapler. Once the small-bowel transection is completed, 2 separate blind loops of intestine are created, each one with half the circumference of the dilated side-to-side anastomosis. The antimesenteric stapled line is then reinforced with an outer layer of running suture. The blind loops of the tapered small bowel are then trimmed and anastomosed in an end-to-end isoperistaltic fashion in 2 layers. RESULTS: There were no postoperative complications. The length of the tapering ranged from 10 to 23 cm, corresponding to approximately 16% (range, 13%-20%) of the remaining small-bowel length. Three of 4 patients presented significant improvement of their symptoms and were able to have their parenteral support discontinued. CONCLUSIONS: Modified antimesenteric tapering enteroplasty is an alternative technique to improve intestinal motility and treat patients with short-bowel syndrome and dysfunctional side-to-side anastomosis without the need for further small-bowel resection. This bowel-sparing technique represents a valuable option in the armamentarium of the surgeon who manages patients with intestinal failure.