Laparoscopic and robotic pyeloplasty as minimally invasive alternatives to the open approach for the treatment of uretero-pelvic junction obstruction in infants: a multi-institutional comparison of outcomes and learning curves.

BACKGROUND: Since the development of minimally invasive surgery (MIS), laparoscopic and robotic approaches have been widely adopted. However, little has been published detailing the learning curve of MIS, especially in infants. OBJECTIVE: To quantify the learning curve of laparoscopic (LP) and robot-assisted laparoscopic pyeloplasty (RAL-P) for treatment of uretero-pelvic junction obstruction (UPJO) in infants evidenced by number of cases, operative time, success and complications. PATIENTS AND METHODS: Between 2009 and 2017, we retrospectively reviewed pyeloplasty cases for treatment of UPJO in infants at three academic institutions. The primary outcome was success. Secondary outcomes were UPJO recurrence, complications, and operative time as a surrogate of skill acquisition. Continuous variables were analyzed by t test, Welch-test, and one-way ANOVA. Non-continuous variables were analyzed by Chi-squared test or Fisher's exact test. Learning curves (LC) were studied by r-to-z transformation and CUSUM. RESULTS: Thirty-nine OP, 26 LP, and 39 RAL-P had mean operative times (OT) of 106, 121, and 151 min, respectively. LCs showed plateau in OT after 18 and 13 cases for LP and RAL-P, respectively. RAL-P showed a second phase of further improvements after 37 cases. At 16 months follow-up, there were similar rates of success and complications between the three groups. CONCLUSIONS: Despite different duration of learning phases, proficiency was achieved in both LP and RAL-P as evidenced by stabilization of operative time and similar success rates and complications to OP. Before and after achievement of proficiency, LP and RAL-P can be safely learned and implemented for treatment of UPJO in infants.

Optical cages made of graphitic frameworks.

In pursuit of perfect infrared (IR) radiation absorbers, we examined quasi-crystal structures made of graphite wires. Simulations on an array of subwavelength graphitic cages and cage-within-cage frameworks indicate a flat absorption coefficient between 10-30 µm. The concept could be scaled up through the 50-120 µm [far-IR, terahertz (THz)] region by a proper structural design. For cage-within-cage, the IR radiation energy is funneled toward the inner cage, resulting in a rather hot structure. At longer wavelengths (microwave region), the electrical conductivity dominates the negative dielectric effect, and experiments with copper cages indicate scattering resonances. Graphitic structures allude to some absorption even at microwave frequencies. Applications are envisioned as anti-fogging surfaces, adaptable electromagnetic shields, energy harvesting, and efficient absorbers in the far-IR (THz frequencies).

Evaluation of SMAP downscaled brightness temperature using SMAPEx-4/5 airborne observations.

The Soil Moisture Active and Passive (SMAP) mission, launched by the National Aeronautics and Space Administration (NASA) on 31st January 2015, was designed to provide global soil moisture every 2 to 3 days at 9 km resolution by downscaling SMAP passive microwave observations obtained at 36 km resolution using active microwave observations at 3 km resolution, and then retrieving soil moisture from the resulting 9 km brightness temperature product. This study evaluated the SMAP Active/Passive (AP) downscaling algorithm together with other resolution enhancement techniques. Airborne passive microwave observations acquired at 1 km resolution over the Murrumbidgee River catchment in south-eastern Australia during the fourth and fifth Soil Moisture Active Passive Experiments (SMAPEx-4/5) were used as reference data. The SMAPEx-4/5 data were collected in May and September 2015, respectively, and aggregated to 9 km for direct comparison with a number of available resolution-enhanced brightness temperature estimates. The results show that the SMAP AP downscaled brightness temperature had a correlation coefficient (R) of 0.84 and Root-Mean-Squared Error (RMSE) of ~10 K, while SMAP Enhanced, Nearest Neighbour, Weighted Average, and the Smoothing Filter-based Modulation (SFIM) brightness temperature estimates had somewhat better performance (RMSEs of ~7 K and an R exceeding 0.9). Although the SFIM had the lowest unbiased RMSE of ~6 K, the effect of cloud cover on Ka-band observations limits data availability.

Estimating surface soil moisture from SMAP observations using a Neural Network technique.

A Neural Network (NN) algorithm was developed to estimate global surface soil moisture for April 2015 to March 2017 with a 2-3 day repeat frequency using passive microwave observations from the Soil Moisture Active Passive (SMAP) satellite, surface soil temperatures from the NASA Goddard Earth Observing System Model version 5 (GEOS-5) land modeling system, and Moderate Resolution Imaging Spectroradiometer-based vegetation water content. The NN was trained on GEOS-5 soil moisture target data, making the NN estimates consistent with the GEOS-5 climatology, such that they may ultimately be assimilated into this model without further bias correction. Evaluated against in situ soil moisture measurements, the average unbiased root mean square error (ubRMSE), correlation and anomaly correlation of the NN retrievals were 0.037 m3m-3, 0.70 and 0.66, respectively, against SMAP core validation site measurements and 0.026 m3m-3, 0.58 and 0.48, respectively, against International Soil Moisture Network (ISMN) measurements. At the core validation sites, the NN retrievals have a significantly higher skill than the GEOS-5 model estimates and a slightly lower correlation skill than the SMAP Level-2 Passive (L2P) product. The feasibility of the NN method was reflected by a lower ubRMSE compared to the L2P retrievals as well as a higher skill when ancillary parameters in physically-based retrievals were uncertain. Against ISMN measurements, the skill of the two retrieval products was more comparable. A triple collocation analysis against Advanced Microwave Scanning Radiometer 2 (AMSR2) and Advanced Scatterometer (ASCAT) soil moisture retrievals showed that the NN and L2P retrieval errors have a similar spatial distribution, but the NN retrieval errors are generally lower in densely vegetated regions and transition zones.

Joint Sentinel-1 and SMAP data assimilation to improve soil moisture estimates.

SMAP (Soil Moisture Active and Passive) radiometer observations at ~40 km resolution are routinely assimilated into the NASA Catchment Land Surface Model to generate the 9-km SMAP Level-4 Soil Moisture product. This study demonstrates that adding high-resolution radar observations from Sentinel-1 to the SMAP assimilation can increase the spatio-temporal accuracy of soil moisture estimates. Radar observations were assimilated either separately from or simultaneously with radiometer observations. Assimilation impact was assessed by comparing 3-hourly, 9-km surface and root-zone soil moisture simulations with in situ measurements from 9-km SMAP core validation sites and sparse networks, from May 2015 to December 2016. The Sentinel-1 assimilation consistently improved surface soil moisture, whereas root-zone impacts were mostly neutral. Relatively larger improvements were obtained from SMAP assimilation. The joint assimilation of SMAP and Sentinel-1 observations performed best, demonstrating the complementary value of radar and radiometer observations.

Evaluating soil moisture retrievals from ESA's SMOS and NASA's SMAP brightness temperature datasets.

Two satellites are currently monitoring surface soil moisture (SM) using L-band observations: SMOS (Soil Moisture and Ocean Salinity), a joint ESA (European Space Agency), CNES (Centre national d'études spatiales), and CDTI (the Spanish government agency with responsibility for space) satellite launched on November 2, 2009 and SMAP (Soil Moisture Active Passive), a National Aeronautics and Space Administration (NASA) satellite successfully launched in January 2015. In this study, we used a multilinear regression approach to retrieve SM from SMAP data to create a global dataset of SM, which is consistent with SM data retrieved from SMOS. This was achieved by calibrating coefficients of the regression model using the CATDS (Centre Aval de Traitement des Données) SMOS Level 3 SM and the horizontally and vertically polarized brightness temperatures (TB) at 40° incidence angle, over the 2013 - 2014 period. Next, this model was applied to SMAP L3 TB data from Apr 2015 to Jul 2016. The retrieved SM from SMAP (referred to here as SMAP_Reg) was compared to: (i) the operational SMAP L3 SM (SMAP_SCA), retrieved using the baseline Single Channel retrieval Algorithm (SCA); and (ii) the operational SMOSL3 SM, derived from the multiangular inversion of the L-MEB model (L-MEB algorithm) (SMOSL3). This inter-comparison was made against in situ soil moisture measurements from more than 400 sites spread over the globe, which are used here as a reference soil moisture dataset. The in situ observations were obtained from the International Soil Moisture Network (ISMN; https://ismn.geo.tuwien.ac.at/) in North of America (PBO_H2O, SCAN, SNOTEL, iRON, and USCRN), in Australia (Oznet), Africa (DAHRA), and in Europe (REMEDHUS, SMOSMANIA, FMI, and RSMN). The agreement was analyzed in terms of four classical statistical criteria: Root Mean Squared Error (RMSE), Bias, Unbiased RMSE (UnbRMSE), and correlation coefficient (R). Results of the comparison of these various products with in situ observations show that the performance of both SMAP products i.e. SMAP_SCA and SMAP_Reg is similar and marginally better to that of the SMOSL3 product particularly over the PBO_H2O, SCAN, and USCRN sites. However, SMOSL3 SM was closer to the in situ observations over the DAHRA and Oznet sites. We found that the correlation between all three datasets and in situ measurements is best (R > 0.80) over the Oznet sites and worst (R = 0.58) over the SNOTEL sites for SMAP_SCA and over the DAHRA and SMOSMANIA sites (R= 0.51 and R= 0.45 for SMAP_Reg and SMOSL3, respectively). The Bias values showed that all products are generally dry, except over RSMN, DAHRA, and Oznet (and FMI for SMAP_SCA). Finally, our analysis provided interesting insights that can be useful to improve the consistency between SMAP and SMOS datasets.

Self-produced locomotion restores visual capacity after striate lesions.

Rats permitted unrestrained movement in a patterned visual environment during the interval between two-stage vilateral lesions of the visual cortex reacquire a preoperatively learned pattern discrimination. Rats passively transported through the identical visual environment do not. This is the first demonstration that interoperative self-produced locomotion is essential for recovery of function in the visual system.

Coulomb pre-stress and fault bends are ignored yet vital factors for earthquake triggering and hazard.

Successive locations of individual large earthquakes (Mw > 5.5) over years to centuries can be difficult to explain with simple Coulomb stress transfer (CST) because it is common for seismicity to circumvent nearest-neighbour along-strike faults where coseismic CST is greatest. We demonstrate that Coulomb pre-stress (the cumulative CST from multiple earthquakes and interseismic loading on non-planar faults) may explain this, evidenced by study of a 667-year historical record of earthquakes in central Italy. Heterogeneity in Coulomb pre-stresses across the fault system is >±50 bars, whereas coseismic CST is <±2 bars, so the latter will rarely overwhelm the former, explaining why historical earthquakes rarely rupture nearest neighbor faults. However, earthquakes do tend to occur where the cumulative coseismic and interseismic CST is positive, although there are notable examples where earthquake propagate across negatively stressed portions of faults. Hence Coulomb pre-stress calculated for non-planar faults is an ignored yet vital factor for earthquake triggering.

Slip on a mapped normal fault for the 28th December 1908 Messina earthquake (Mw 7.1) in Italy.

The 28th December 1908 Messina earthquake (Mw 7.1), Italy, caused >80,000 deaths and transformed earthquake science by triggering the study of earthquake environmental effects worldwide, yet its source is still a matter of debate. To constrain the geometry and kinematics of the earthquake we use elastic half-space modelling on non-planar faults, constrained by the geology and geomorphology of the Messina Strait, to replicate levelling data from 1907-1909. The novelty of our approach is that we (a) recognise the similarity between the pattern of vertical motions and that of other normal faulting earthquakes, and (b) for the first time model the levelling data using the location and geometry of a well-known offshore capable fault. Our results indicate slip on the capable fault with a dip to the east of 70° and 5 m dip-slip at depth, with slip propagating to the surface on the sea bed. Our work emphasises that geological and geomorphological observations supporting maps of capable non-planar faults should not be ignored when attempting to identify the sources of major earthquakes.

Role of gastrin and gastrin receptors on the growth of a transplantable mouse colon carcinoma (MC-26) in BALB/c mice.

We recently reported trophic response of transplantable mouse colon cancer cells (MC-26) to pentagastrin, in vivo, and demonstrated gastrin receptors on MC-26 cells, in vitro. In the present study, growth of MC-26 cells in mice, in response to pentagastrin, was studied in relation to binding kinetics and capacity of gastrin receptor. Gastrin receptor levels on mouse fundic and colonic membranes and on MC-26 cellular membranes were determined before MC-26 cell inoculation and designated as Day 0 levels. Four groups of mice were next inoculated with MC-26 cells and given injections of either pentagastrin (treated) or normal saline (control) for 10 or 15 days. At the end of the treatment periods, body, tumor, fundic, and colon weights were noted and gastrin receptor measured. tumor and fundic weights increased significantly within 15 days of pentagastrin treatment, compared to control values. In control (non-pentagastrin treated) mice, the binding affinity of gastrin receptor on tumor membranes was significantly decreased and associated with the complete loss of high-affinity gastrin receptor (Kd = less than 0.5 nM) by Day 15 of tumor growth. On the other hand, both the binding affinity and gastrin receptor levels of tumor membranes were maintained at Day 0 values by pentagastrin treatment. Endogenous gastrin was therefore ineffective in maintaining high-affinity gastrin receptor on control tumors. A significant number of low-affinity gastrin-binding sites (Kd = less than 2 nM) appeared in control tumors by Day 15, which could reflect rapid dedifferentiation or conformational changes of gastrin receptor in the absence of high levels of normal regulatory hormones. These studies demonstrate that the trophic effects of gastrin on MC-26 cells are probably mediated by its regulation and maintenance of the binding affinity and capacity of gastrin receptor on the cancer cells, in vivo.

Reward dependence is positively related to urinary monoamines in normal men.

According to Cloninger, three major personality dimensions, novelty seeking, harm avoidance, and reward dependence, are dependent on central monoaminergic systems. This study examined the relationship between the urinary levels of different monoamines and the above personality dimensions. Fifty normal men answered the Tridimensional Personality Questionnaire (TPQ); their levels of dopamine, norepinephrine, epinephrine, normetanephrine, metanephrine, 3-methoxy-4-hydroxyphenylglycol, vanilmandelic acid, homovanilic acid, and serotonin metabolite 5-hydroxyindolacetic acid were measured in urine on two consecutive nights. Significant and positive correlations were found between reward dependence, 3-methoxy-4-hydroxyphenylglycol, and epinephrine (r = .50 and r = .51, respectively). Monoamine levels explained 44% of the variance of reward dependence. Cluster analysis identified three groups of subjects presenting specific patterns of monoamine excretion. The TPQ scores could discriminate among subjects belonging to these clusters. These results point out a narrow relationship between urinary monoamine excretion and the basic personality dimension of reward dependence.

The effect of aging on the growth of colon cancer.

Reports on the effect of patient age on the prognosis for colon cancer vary. We have tested the effect of aging using a model of murine colon adenocarcinoma in groups of mice of different ages. In experiment A, Balb/c mice of age groups 3-4 weeks, 10-12 weeks, 24-32 weeks and 40-48 weeks (13 mice/group) were injected with 5 X 10(4) MC-26 cells subcutaneously in the right flank. Tumors were measured twice weekly, and the rate of occurrence of tumor, mortality rate, and growth rate were calculated. In experiment B, the same plan as experiment A was used, except mice of age groups I (14 days), II (3-4 weeks), and III (20-22 months) were used with tumor doses of 1 X 10(4) cells and 5 X 10(5) cells (9-15 mice/group). In both experiments, the rate of growth of tumor, mortality rate, and sizes of tumors obtained were the same. In experiment A, the rate of occurrence of the tumors was the same in all groups, but in experiment B the occurrence of the tumor varied. A palpable tumor appeared earliest in the weanling mice (14 days), next in old mice (20-22 months), and last in the young adult group (3-4 weeks). Tumor doubling time was longest in the young adult mice (7 days), intermediate in the old mice (6.1 days), and shortest in the weanling mice (5.5 days). Established tumors grew at similar rates (as assessed by doubling time), independent of host age. Mortality rates were similar.(ABSTRACT TRUNCATED AT 250 WORDS)

Indications for the use of parenteral H2-receptor antagonists.

Development of acute mucosal ulceration is a complex series of catabolic interactions. Hospitalized patients with duodenal or gastric ulcer, pathologic gastric hypersecretory states (such as Zollinger-Ellison syndrome), gastric outlet obstruction, esophagitis, severe gastritis or duodenitis, sepsis, trauma (particularly head injury or burns), and some patients receiving high-dose corticosteroids are at risk of developing acute stress ulcers. Treatment should be initiated as soon as the patient is identified as being at risk, because measures designed to prevent bleeding or perforation are more effective than those designed to stop bleeding once it supervenes and the cascade of multiple organ failure commences. The presence of acid will trigger the onset of this condition; however, ulceration will not occur if the intraluminal pH can be maintained above 5 by periodic antacid treatment or by H2-receptor blockade. The dosing regimen of antacid or of H2-receptor antagonist should not be fixed, but should be sufficient to keep the gastric pH higher than 5. Antagonists administered via a nasogastric tube are the first line of defense, but 30 to 50 percent of the most ill patients will also be treated parenterally with H2-receptor antagonists. Parenteral H2-receptor blockade therapy is indicated in these patients when the risk of acute or continued ulceration of esophageal, gastric, or duodenal mucosa is high and the oral administration of medication is either not possible or the response to such therapy is unreliable. Parenteral H2-receptor antagonists are rarely administered alone.

Importance of the ileum in neurotensin released by fat.

Neurotensin is a potent stimulant of pancreatic exocrine secretion. Ileal mucosa is the storage site for about 90% of total neurotensin. Release occurs rapidly after a fatty meal and during perfusion of the duodenum and jejunum with fat but not during perfusion of the ileum with fat. To determine the origin of neurotensin released after fat stimulation, we studied the pattern of release of neurotensin before and after resection of the distal two thirds of the small bowel. Six dogs with gastric and duodenal fistulas were studied on different days. All dogs received infusions (in random order) of intraduodenal corn oil (Lipomul) (3 ml/kg/hr) and intravenous calcium chloride (0.36 mmol/kg intravenous bolus, followed by 0.36 mmol/kg/hr infusion) before and 6 weeks after resection of the distal two thirds of the small bowel with preservation of the ileocecal valve. Plasma levels of neurotensin were measured by specific radioimmunoassay. We found that release of neurotensin, in response to both intraduodenal Lipomul and intravenous calcium chloride stimulation, was abolished by resection of the distal small bowel. Before surgery, Lipomul-stimulated release of neurotensin rose to a peak concentration of 51 +/- 17 pg/ml at 30 minutes. After surgery there was no release (the levels were unchanged from basal). Before surgery, intravenous calcium chloride produced a peak release of neurotensin (52 +/- 15 pg/ml) 2 minutes after bolus injection. After surgery, neurotensin was not released by intravenous calcium. We conclude that the source of neurotensin released by perfusion of the proximal gut and by intravenous calcium infusion is the ileum. The release of neurotensin from the distal gut appears to be dependent on a signal from proximal to distal gut. The identity of the signal is unknown but is either a nerve reflex or a peptide agent.

Effect of aging on gallbladder contraction and release of cholecystokinin-33 in humans.

The objective of this study was to examine the effect of aging on gallbladder contraction and cholecystokinin (CCK) release, as well as on the correlation between the two in humans who are free of gallbladder disease. Twenty-nine human volunteers were divided into a young group of 14 individuals (ages 22 to 42 years, median age 32 years) and an older group of 15 individuals (ages 60 to 84 years, median age 66 years). In the study each person in both groups was given corn oil (Lipomul), 1.5 ml/kg, by mouth after an overnight fast. Blood was collected for measurement of CCK-33 by radioimmunoassay before and at intervals after ingestion of Lipomul. Simultaneous measurements of gallbladder volume were obtained by real-time varian ultrasonography. Both fasting and fat-stimulated concentrations of CCK in plasma were significantly higher in the older individuals than in the younger volunteers. The 60-minute integrated measurement of CCK release was significantly increased in the older people as compared with the young. Both fasting and maximally contracted gallbladder volumes were equal in the older and younger groups. The rate of emptying of the gallbladder was equal in both age groups, but the gallbladders of older people appeared to show an earlier initiation of contraction. The highly significant correlation of gallbladder contraction with levels of CCK was similar in both age groups, but the sensitivity of the gallbladder to CCK in the older people was significantly decreased. In conclusion, both fasting and fat-stimulated plasma levels of CCK increase with aging. The sensitivity of the gallbladder muscle to stimulation by CCK is diminished with age, but this appears, teleologically, to be matched by the increased release of CCK, so the kinetics of gallbladder emptying are little different in the aged.

Lower sex hormones in men during anticipatory stress.

Free cortisol, luteinizing hormone (LH), total testosterone and monoamines were measured in two successive nocturnal urine collections in 50 healthy men to assess the influence of anticipatory stress. The first collection (N-2) was two nights before and the second (N-1) was just on the night before a one-day experimental stressor consisting of participation in a one-day clinical research protocol. The mean cortisol level increased from 23.4 (N-2) to 66.6 micrograms (N-1), while mean LH level decreased from 2.68 (N-2) to 1.71 IU (N-1) and the mean testosterone level fell from 1.31 (N-2) to 0.70 microgram (N-1). There were no changes in monoamines. Inhibition of sex hormones is a relatively neglected area of stress research.

Uveal malignant melanoma in three generations of the same family.

Three patients in three successive generations from the same family had choroidal malignant melanoma. The third generation patient had multiple primary malignancies; his siblings also had multiple malignancies. Chromosome studies of the third generation patient revealed no abnormality. To the best of our knowledge, this is the second such pedigree reported.

Day-to-day intraindividual reliability and interindividual differences in monoamines excretion.

The urine of 44 normal men was collected during 2 nights to evaluate components of biological variation, i.e., intraindividual day-to-day variability and interindividual variability in monoamines excretion. Monoamines presented important interindividual variability [interindividual coefficients of variation (%): dopamine 18.3, norepinephrine 66.7, epinephrine 85.3, normetanephrine 22.4, metanephrine 76.8, 3-methoxy-4-hydroxyphenylglycol (MHPG) 77.0, vanilmandelic acid (VMA) 64.3, homovanilic acid (HVA) 71.3, 5-hydroxyindolacetic acid (5-HIAA) 20.4]. The reliability of these amounts was high, with intraclass correlation coefficients ranging from 0.43 (P < 0.001) for MHPG free form to 0.65 (P < 10(-6)) for dopamine and normetanephrine (intraindividual coefficients of variation (%): dopamine 8.5, norepinephrine 39.9, epinephrine 45.9, normetanephrine 10.3, metanephrine 46.3, MHPG 37.5, VMA 30.7, HVA 41.0, 5-HIAA 12.3).

Caloric restriction and spatial learning in old mice.

Spatial learning in old mice (19 or 24 months old), some of which had been calorically restricted beginning at 14 weeks of age, was compared to that of young mice, in two separate experiments using a Morris water maze. In the first experiment, only old mice reaching criterion performance on a cued learning task were tested in a subsequent spatial task. Thus, all old mice tested for spatial learning had achieved escape latencies equivalent to those of young controls. Despite equivalent swimming speeds, only about half the old mice in each diet group achieved criterion performance in the spatial task. In the second experiment, old and young mice all received the same number of training trials in a cued task and then in a spatial task. Immediately following spatial training, they were given a 60-s probe trial, with no platform in the pool. Both groups of old mice spent significantly less time in the quadrant where the platform had been and made significantly fewer direct crosses over the previous platform location than did the young control group. As in Experiment 1, calorie restriction failed to provide protection against aging-related deficits. However, in both experiments, some individual old mice evidenced performance in spatial learning indistinguishable from that of young controls. Separate comparisons of "age-impaired" and "age-unimpaired" old mice with young controls may facilitate the identification of neurobiological mechanisms underlying age-related cognitive decline.

Prosodic facilitation in the resolution of syntactic ambiguities in subjects with left and right hemisphere damage.

The purpose of this study was to determine if prosody facilitates the comprehension of sentences containing temporary syntactic ambiguities in control, and left (LHD) and right hemisphere damaged (RHD) subjects. To test for effects of prosodic facilitation, sentences were created where prosodic boundaries coincided with (cooperating), were absent (baseline), or conflicted (conflicting) with syntactic boundaries in three response times (RTs) experiments. Despite differences in overall RTs and response accuracy for each group, all three groups responded faster and more accurately to sentences in the cooperating than in the baseline and conflicting conditions across experiments, indicating that prosody facilitates syntactic parsing in brain-damaged subjects just as it does with normal control subjects. Results are discussed in relation to psycholinguistic theories of syntactic parsing and neurolinguistic theories of hemispheric specialization in processing the acoustic properties of prosodic structures.