Cholangioscopy under direct visualization: skill progress during a dedicated Image-Guided Surgery Course.

AIMS: Training programs are essential to introduce new methods for bile duct clearance. Visual examination via cholangioscopy is ideal to diagnose and treat biliary tract diseases such as cancer and choledocholithiasis. However, surgeons rarely use cholangioscopes. Specific training is required to master laparoscopic and percutaneous cholangioscopy. This study aims to assess skill acquisition and retention during cholangioscopy training in the Image-Guided Therapies Masterclass. METHODS: This prospective study enrolled 17 physicians undergoing training in interventional treatments of biliary diseases. A novel disposable cholangioscope and access kit were used with a biliary tract model including two simulated common bile duct (CBD) stones. The curriculum required visualization of all critical structures before removal of one stone with a Dormia basket. After informed consent, demographic data and time to exercise completion were recorded on each of two subsequent training days. Task-specific questions were measured at the completion of training using a Likert scale (strongly disagree to strongly agree, 1-5 points). RESULTS: All participants successfully completed the task (6F/11 M, age 36 ± 5 years; 13 surgeons, 4 interventional radiologists; median experience with percutaneous procedures 2 years, range 0-20). Significant improvement in mean task completion time was observed (day 1: 172 ± 59 s, day 2: 89 ± 45 s; P < 0.0001). All task-specific questions were answered with a median rating of 5/5: "The platform facilitates cholangioscopy" and "This training method accelerates gain in proficiency and is useful for residents/fellows" (IQR 5-5), "This platform is useful to measure the proficiency level" and "There is an application for simulation in percutaneous surgery training" (IQR 4.5-5), "The platform is user-friendly" and "The model quality recreates realistic scenarios" (IQR 4-5). CONCLUSION: Cholangioscopic bile duct exploration and stone retrieval were achieved by all participants using a dedicated training program and physical simulator. Significant skill progress was observed during 2 days of dedicated training.

Percutaneous transhepatic cholangioscopy for benign and malignant biliary disease using a novel short single-operator cholangioscope.

BACKGROUND: The length of conventional single-use cholangioscopes poses a challenge for percutaneous or laparoscopic approaches for direct visualization of the biliary tract. The aim of this retrospective observational clinical study was to assess the use of a dedicated percutaneous short single-operator cholangioscope (PSSOC) for diagnosis and treatment of benign or malignant biliary diseases. METHODS: Retrospective analysis of a prospectively maintained database including all consecutive patients undergoing percutaneous transhepatic cholangioscopy with the PSSOC between 06/2021 and 01/2023. RESULTS: Forty patients were included (22F/18 M, age 58.7 ± 16.7 years). The diagnostic and therapeutic management plan was based on procedural findings. Indications were bile duct obstruction associated with complex anatomy (n = 13), choledocholithiasis (n = 11), suspected malignant stenosis of the biliary tract (n = 11), biliary stent placement (n = 2) and removal (n = 1), and failed endoscopic retrograde cholangiopancreatography (n = 2). The cholangioscopies were diagnostic (n = 5), therapeutic (n = 20) or both simultaneously (n = 15). The most frequent procedures were electrohydraulic lithotripsy (n = 25) and biopsy sampling (n = 12). Complications occurred in 7 cases (17.5%), including cholangitis (n = 4, B2), pleural perforation (n = 1, B2), portal bleeding (n = 1, B3), and Tako-Tsubo syndrome (n = 1, B3), classified according to the Society of Interventional Radiology classification. Intraprocedural visual diagnosis was confirmed by the histopathologic result in 11/12 patients in which biopsies were performed (91.7%). PSSOC was relevant to avoid surgery in 2 patients (5%) with indeterminate strictures, allowing to rule out malignancy and treat the lithiasis. CONCLUSIONS: Direct visualization of the biliary tract enabled targeted biopsies for histopathological diagnosis. The visual and histopathological diagnoses were concordant in all but one case. Percutaneous cholangioscopy with a dedicated PSSOC allows to optimize identification and treatment of complex biliary disease including biliary lithiasis while assessing bile duct patency. The clinical use of the novel PSSOC system was safe and effective and could prevent surgical exploration in select patients.

Galgo: a bi-objective evolutionary meta-heuristic identifies robust transcriptomic classifiers associated with patient outcome across multiple cancer types.

MOTIVATION: Statistical and machine-learning analyses of tumor transcriptomic profiles offer a powerful resource to gain deeper understanding of tumor subtypes and disease prognosis. Currently, prognostic gene-expression signatures do not exist for all cancer types, and most developed to date have been optimized for individual tumor types. In Galgo, we implement a bi-objective optimization approach that prioritizes gene signature cohesiveness and patient survival in parallel, which provides greater power to identify tumor transcriptomic phenotypes strongly associated with patient survival. RESULTS: To compare the predictive power of the signatures obtained by Galgo with previously studied subtyping methods, we used a meta-analytic approach testing a total of 35 large population-based transcriptomic biobanks of four different cancer types. Galgo-generated colorectal and lung adenocarcinoma signatures were stronger predictors of patient survival compared to published molecular classification schemes. One Galgo-generated breast cancer signature outperformed PAM50, AIMS, SCMGENE and IntClust subtyping predictors. In high-grade serous ovarian cancer, Galgo signatures obtained similar predictive power to a consensus classification method. In all cases, Galgo subtypes reflected enrichment of gene sets related to the hallmarks of the disease, which highlights the biological relevance of the partitions found. AVAILABILITY AND IMPLEMENTATION: The open-source R package is available on www.github.com/harpomaxx/galgo. SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

Application of a novel material in the inguinal region using a totally percutaneous approach in an animal model: a new potential technique?

PURPOSE: To evaluate the feasibility and safety of a new percutaneous image-guided surgery technique to simulate a hernia repair using hydrogel. MATERIALS AND METHODS: A comparative prospective study was conducted in animals, with survival. Five pigs without any hernias were used. A hydrogel was injected at a site corresponding to the preperitoneal inguinal region. This procedure was performed bilaterally. An image-guided needle (ultrasound and computed tomography) was used, through which the material was injected. After survival, the local and systemic inflammatory reaction generated by the new material, was studied. RESULTS: All animals survived the procedure. No hemorrhagic or infectious complications were reported. The solidification of the material occurred as expected. In eight out of ten cases, the material was found in the planned site. No systemic inflammatory reaction secondary to the administration of hydrogel was reported. The adhesion of the material to surrounding tissues was satisfactory. CONCLUSION: The introduction of a liquid material which solidifies after injection in a short time (hydrogel) using a needle is feasible. The combined CT-scan and US image guidance allows for the percutaneous placement of the needle in the required location. The introduced hydrogel remains in this space, corresponding to the inguinal region, without moving. The placed hydrogel compresses the posterior wall composed of the transversalis fascia, supporting the potential use of hydrogel for hernia defects.

Percutaneous Radiofrequency Assisted Liver Partition with Portal Vein Embolization for Staged Hepatectomy (PRALPPS)

BACKGROUND: When a major hepatic resection is necessary, sometimes the future liver remnant is not enough to maintain sufficient liver function and patients are more likely to develop liver failure after surgery. AIM: To test the hypothesis that performing a percutaneous radiofrecuency liver partition plus percutaneous portal vein embolization (PRALPPS) for stage hepatectomy in pigs is feasible. METHODS: Four pigs (Sus scrofa domesticus) both sexes with weights between 25 to 35 kg underwent percutaneous portal vein embolization with coils of the left portal vein. By contrasted CT, the difference between the liver parenchyma corresponding to the embolized zone and the normal one was identified. Immediately, using the fusion of images between ultrasound and CT as a guide, radiofrequency needles were placed percutaneouslyand then ablated until the liver partition was complete. Finally, hepatectomy was completed with a laparoscopic approach. RESULTS: All animals have survived the procedures, with no reported complications. The successful portal embolization process was confirmed both by portography and CT. In the macroscopic analysis of the pieces, the depth of the ablation was analyzed. The hepatic hilum was respected. On the other hand, the correct position of the embolization material on the left portal vein could be also observed. CONCLUSION: "Percutaneous radiofrequency assisted liver partition with portal vein embolization" (PRALLPS) is a feasible procedure (AU)

Applying a dryland degradation framework for rangelands: the case of Mongolia.

Livestock-caused rangeland degradation remains a major policy concern globally and the subject of widespread scientific study. This concern persists in part because it is difficult to isolate the effects of livestock from climate and other factors that influence ecosystem conditions. Further, degradation studies seldom use multiple plant and soil indicators linked to a clear definition of and ecologically grounded framework for degradation assessment that distinguishes different levels of degradation. Here, we integrate two globally applicable rangeland degradation frameworks and apply them to a broad-scale empirical data set for the country of Mongolia. We compare our assessment results with two other recent national rangeland degradation assessments in Mongolia to gauge consistency of findings across assessments and evaluate the utility of our framework. We measured livestock-use impacts across Mongolia's major ecological zones: mountain and forest steppe, eastern steppe, steppe, and desert steppe. At 143 sites in 36 counties, we measured livestock-use and degradation indicators at increasing distances from livestock corrals in winter-grazed pastures. At each site, we measured multiple indicators linked to our degradation framework, including plant cover, standing biomass, palatability, species richness, forage quality, vegetation gaps, and soil surface characteristics. Livestock use had no effect on soils, plant species richness, or standing crop biomass in any ecological zone, but subtly affected plant cover and palatable plant abundance. Livestock effects were strongest in the steppe zone, moderate in the desert steppe, and limited in the mountain/forest and eastern steppes. Our results aligned closely with those of two other recent country-wide assessments, suggesting that our framework may have widespread application. All three assessments found that very severe and irreversible degradation is rare in Mongolia (1-18% of land area), with most rangelands slightly (33-53%) or moderately (25-40%) degraded. We conclude that very severe livestock-induced rangeland degradation is overstated in Mongolia. However, targeted rangeland restoration coupled with monitoring, adaptive management and stronger rangeland governance are needed to prevent further degradation where heavy grazing could cause irreversible change. Given the broad applicability of our degradation framework for Mongolia, we suggest it be tested for application in other temperate grasslands throughout Central Asia and North America.

Latino/"Hispanic"--who needs a name? The case against a standardized terminology.

Public health specialists, policy makers, social scientists, and politicians, for different reasons, have welcomed the "Hispanic" label. The label presumably identifies an ethnic group that is also a minority group (i.e., a group historically subject to economic exploitation and racial discrimination). Consequently, its consistent use by federal and state agencies would produce large quantities of comparable data useful for research, and for policy making and implementation. Critics have argued that the label is racist, it mystifies the real reasons for the disproportionately high proportion of people of Mexican and Puerto Rican descent in disadvantaged social and economic conditions, and stands in the way of a fair implementation of affirmative action. Latino, a race-neutral term with historical roots, has been suggested as an alternative to be used in conjunction with national origin or regional forms of self-identification. In this article, I argue that any standardized terminology is unavoidably flawed and conducive to the development of racist or, at best, trivial stereotypical analysis of the data thus produced. The "Hispanic" label does not identify an ethnic group or a minority group, but a heterogeneous population whose characteristics and behavior cannot be understood without necessarily falling into stereotyping. The label should be abandoned; social scientists and policy makers should, instead, acknowledge the existence of six aggregates, qualitatively different in their socioeconomic stratification, needs, and form of integration in the U.S. economy: two minority groups (people of Mexican and Puerto Rican descent), and four immigrant populations (Cubans, Central American refugees, Central American immigrants, and South American immigrants).

The feminization of poverty: myth or reality?

The feminization of poverty is a widely discussed concept in the mass media, and in academic circles, which captures the following facts: there are more poor women than poor men, and women are more likely to fall into poverty because of gender-related factors. In this article, I examine the concept's empirical basis and theoretical significance. The data show that poverty among men increased faster than poverty among women during the 1980-81 recession. While the sex composition of the poverty population has remained relatively unchanged since 1966, its age composition has changed: poverty has increased substantially among working men and women aged 18 to 44. Also, the higher proportion of women in the poverty population cannot be considered simply an effect of male privilege; on the contrary, it may be partially accounted for by higher mortality rates among working-class men. Theoretically, I argue that the meaning of these trends cannot be established using only age and sex categories of analysis. The trends document the progressive immiseration of the working class. Younger workers of both sexes today are worse off than older workers. A discussion of poverty purely in terms of the age, sex, or racial/ethnic composition of the poverty population hides the roots of poverty in the mode of production and succeeds in obfuscating the issues, fueling conflict between men and women, young and old, and white and nonwhite. Only by taking into account the class relations that structure people's life chances is it possible to understand the significance of present trends.