Association of keel bone morphometry with keel bone damage and skeletal quality in the laying hen.

1. The aim of this work was to identify a heritable keel bone phenotype with a correlation to keel bone damage and/or skeletal bone strength that could be easily measured in the living hen to aid selection to prevent welfare issues.2. The scoring system used reflected the observed damage, keel bone dimensions and shape compared to traditional measurements of bone quality.3. Increased keel bone damage was associated with poor humerus and tibia breaking strengths (p < 0.01). Bone damage was associated with higher whole keel density (p < 0.01) due to the effect of callus formation.4. Keel bone depth and area was moderately heritable at indices of 0.32 and 0.40, respectively. Keel bone depth was genetically correlated with tibia (0.36) and humerus density (0.68) and keel bone area was correlated with humerus density (0.59). Deeper keel bones and those with larger areas had small, negative phenotypic correlations with keel bone damage (-0.07 and -0.11, respectively). The second principal component of keel bone shape represented the caudal section of the keel bone and cranial edge concavity. The third principal component represented the differences in the caudal tip of the keel bone, the concavity of the dorsal edge and convexity of the ventral edge. Heritability estimates were 0.44 and 0.39, respectively.5. The results suggested that genetics contribute to morphometric traits. Hens with poorer skeletal quality are likely to accumulate more damage. Some of the traits may be a predictor of damage, although mid keel depth or concavity may simply reflect the effect of damage or deviation.

Factors of importance for the development of evidence-based practice amongst radiographers in public healthcare.

INTRODUCTION: Research evidence suggests that radiographers often rely on previous training, traditional practices, work experience and protocols developed within the department rather than up-to-date research-based evidence in their daily practice. The aim of the study was to investigate factors that might impact the development of evidence-based practice amongst radiographers in clinical public settings in the Nordic countries. METHODS: An online survey was performed amongst 640 radiographers in four Nordic countries. Multivariate logistic regression was performed to investigate the odds ratio (OR) of facilitators for and barriers to radiographers' development of evidence-based practice. RESULTS: A reflective approach in everyday practice and being aware of the current research evidence were significant facilitators for radiographers' development of evidence-based practice (OR ≥ 3.10, p < 0.001). Discussing research with colleagues and managers was associated with engagement in the utilisation of evidence (OR 7.21, p < 0.001). Difficulties in evaluating research evidence represented the only significant barrier (OR 1.84, p 0.009). CONCLUSION: A critical approach amongst radiographers in their performance of healthcare in diagnostic imaging, and the development of their academic skills to improve awareness of the available research evidence are important factors for developing evidence-based practice in radiography. Leadership is crucial for the engagement of radiographers in the development of evidence-based practice. Management should facilitate the development of a learning culture within diagnostic imaging. IMPLICATIONS FOR PRACTICE: The results provide suggestions for the development of a learning culture, proactive and person-centred leadership, and strategic management for the provision of research infrastructure, all of which contribute to the further integration of evidence-based practice in radiography. Also, the study results suggest the importance of shared responsibility for creating a critical fellowship in diagnostic imaging.

Predictive Factors for Delayed Gastric Emptying After Pancreatoduodenectomy: A Swedish National Registry-Based Study.

BACKGROUND: Delayed gastric emptying (DGE) is a common complication after pancreatoduodenectomy (PD). DGE causes prolonged hospital stay and a decrease in quality of life. This study analyzes predictive factors for development of DGE after PD, also in the absence of surgical complications. METHOD: Data from the Swedish National Pancreatic Cancer Registry for patients undergoing standard and pylorus preserving open PD from January 2010 until June 30, 2018, were collected. Data were analyzed in two groups, no DGE and DGE. A subgroup of patients with DGE but without surgical complications was compared to patients without DGE or any other surgical complication. RESULTS: In total, 2503 patients were included, of which 470 (19%) had DGE. In the DGE group, 238 had other coexisting surgical complications and 232 had not. Postoperative pancreatic fistula (OR = 4.22, p < 0.001), surgical infection (OR = 1.44, p = 0.013), heart disease (OR = 1.32, p = 0.023) and medical complications (OR = 1.35, p = 0.025) increased the risk for DGE. A standard PD compared with pylorus preserving resection (OR = 1.69, p = 0.001) and a reconstruction with a pancreaticojejunostomy compared with a pancreaticogastrostomy (OR = 1.83, p < 0.001) increased the risk. For patients without surgical complications, a standard PD and reconstruction with pancreaticojejunostomy still increased the risk for DGE. CONCLUSION: DGE is more common after standard PD compared to pylorus preserving PD and after reconstruction with PJ compared to PG in this national cohort, both in the presence of other surgical complications as well as in the absence of other complications.

An analysis of the maxillary beak shape variation between 2 pure layer lines and its relationship to the underlying premaxillary bone, feather cover, and mortality.

Beak shape varies considerably within and between intact-beak laying hens, and aspects of beak shape appear to be heritable. As an alternative to beak treatment (an effective method of reducing damage from severe feather pecking (SFP)), this variation could be used to genetically select hens whose beak shapes are less apt to cause damage. To be able to select certain phenotypes, the beak shape variation that exists within laying hen flocks must first be characterized. The objectives of this study were to 1) describe the maxillary beak shape variation in 2 pure White Leghorn layer lines with intact beaks using geometric morphometrics to analyze images, and 2) examine the beak shape's relationship to the premaxillary bone, feather cover, and mortality. A lateral head image was taken of each hen (n = 710), and 20 landmarks were placed along each image's dorsal and ventral margins of the maxillary beak. Landmark coordinates were standardized by Procrustes superimposition, and the covariation was analyzed by principal components analysis and multivariate regression. Feather cover was scored at 3 ages and mortality was monitored throughout the production cycle. Three principal components (PCs) explained 83% of the maxillary beak shape variation and the first PC partially separated the 2 lines. Maxillary beak shapes ranged from long and narrow with pointed tips to short and wide with more curved tips. Moderate correlations were found between the maxillary beak and premaxillary bone shape (rs = 0.44) and size (rs = 0.52). Line A hens had better feather cover than Line B at all ages. Line A hens also had less total and cannibalism-related mortality than Line B (10.7 and 0.4% vs. 16.7 and 2.4%, respectively). Beak shape may be one factor contributing to the observed differences in feather cover and mortality. The results suggest that distinct maxillary beak phenotypes within each line could be selected to help reduce SFP damage and improve bird welfare.

Differences in phenotypes, symptoms, and survival in patients with cardiomyopathy-a prospective observational study from the Sahlgrenska CardioMyoPathy Centre.

Introduction: Cardiomyopathy is the fourth most common cause of heart failure. The spectrum of cardiomyopathies may be impacted by changes in environmental factors and the prognosis may be influenced by modern treatment. The aim of this study is to create a prospective clinical cohort, the Sahlgrenska CardioMyoPathy Centre (SCMPC) study, and compare patients with cardiomyopathies in terms of phenotype, symptoms, and survival. Methods: The SCMPC study was founded in 2018 by including patients with all types of suspected cardiomyopathies. This study included data on patient characteristics, background, family history, symptoms, diagnostic examinations, and treatment including heart transplantation and mechanical circulatory support (MCS). Patients were categorized by the type of cardiomyopathy on the basis of the diagnostic criteria laid down by the European Society of Cardiology (ESC) working group on myocardial and pericardial diseases. The primary outcomes were death, heart transplantation, or MCS, analyzed by Kaplan-Meier and Cox proportional regression, adjusted for age, gender, LVEF and QRS width on ECG in milliseconds. Results: In all, 461 patients and 73.1% men with a mean age of 53.6 ± 16 years were included in the study. The most common diagnosis was dilated cardiomyopathy (DCM), followed by cardiac sarcoidosis and myocarditis. Dyspnea was the most common initial symptom in patients with DCM and amyloidosis, while patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) presented with ventricular arrythmias. Patients with ARVC, left-ventricular non-compaction cardiomyopathy (LVNC), hypertrophic cardiomyopathy (HCM), and DCM had the longest time from the debut of symptoms until inclusion in the study. Overall, 86% of the patients survived without heart transplantation or MCS after 2.5 years. The primary outcome differed among the cardiomyopathies, where the worst prognosis was reported for ARVC, LVNC, and cardiac amyloidosis. In a Cox regression analysis, it was found that ARVC and LVNC were independently associated with an increased risk of death, heart transplantation, or MCS compared with DCM. Further, female gender, a lower LVEF, and a wider QRS width were associated with an increased risk of the primary outcome. Conclusions: The SCMPC database offers a unique opportunity to explore the spectrum of cardiomyopathies over time. There is a large difference in characteristics and symptoms at debut and a remarkable difference in outcome, where the worst prognosis was reported for ARVC, LVNC, and cardiac amyloidosis.

Facilitators for and barriers to radiography research in public healthcare in Nordic countries.

INTRODUCTION: It has been suggested that the future of diagnostic imaging relies on engagement in research and evidence-based practice. This implies a role transition from a clinical radiographer to a clinical radiographer-researcher. Clinical radiographers' stimuli for engaging in research in Nordic countries are unknown. This study aimed to address this gap. METHODS: Cross-sectional data collection via an online questionnaire on facilitators for and barriers to participation in radiography research was carried out among 507 clinical radiographers in public healthcare in the Nordic countries: Denmark, Finland, Norway and Sweden. RESULTS: Support from colleagues (odds ratio [OR] 2.62) and other professionals (OR 2.74), and self-esteem in research skills (OR ≥ 2.21), were facilitators for radiography research. Lack of knowledge and skills to conduct research (OR 2.48) was revealed to hinder radiographers' participation in research. The absence of a radiography research culture in the workplace explained non-participation in research (OR 1.75). CONCLUSION: This study revealed significant factors for clinical radiographers' participation in research. IMPLICATIONS FOR PRACTICE: A strategy for establishing a radiography research culture in healthcare is proposed that is novel for the context. Management support for knowledge development and activity leading to inter-professional research projects across knowledge fields, provision of a radiography research lead and acknowledgement of radiography research among colleagues signify the establishment of the culture. These prerequisites might provide a paradigm change towards not only the symbiosis of a clinical radiographer and an autonomous researcher but also a partner who adds radiography research to evidence-based practice in diagnostic imaging.

Thrombospondin-2 as a diagnostic biomarker for distal cholangiocarcinoma and pancreatic ductal adenocarcinoma.

PURPOSE: Distal cholangiocarcinoma and pancreatic ductal adenocarcinoma are malignancies with poor prognoses that can be difficult to distinguish preoperatively. Thrombospondin-2 has been proposed as a novel diagnostic biomarker for early pancreatic ductal adenocarcinoma. The aim of the present study was to evaluate thrombospondin-2 as a diagnostic and prognostic biomarker in combination with current biomarker CA 19-9 for distal cholangiocarcinoma and pancreatic ductal adenocarcinoma. METHODS: Thrombospondin-2 was measured in prospectively collected serum samples from patients who underwent surgery with a histopathological diagnosis of distal cholangiocarcinoma (N = 51), pancreatic ductal adenocarcinoma (N = 52) and benign pancreatic diseases (N = 27) as well as healthy blood donors (N = 52) using an enzyme-linked immunosorbent assay. RESULTS: Thrombospondin-2 levels (ng/ml) were similar in distal cholangiocarcinoma 55 (41-77) and pancreatic ductal adenocarcinoma 48 (35-80) (P = 0.221). Thrombospondin-2 + CA 19-9 had an area under the curve of 0.92 (95% CI 0.88-0.97) in differentiating distal cholangiocarcinoma and pancreatic ductal adenocarcinoma from healthy donors which was superior to CA 19-9 alone (P < 0.001). The diagnostic value of adding thrombospondin-2 to CA 19-9 was larger in early disease stages. Thrombospondin-2 did not provide additional value to CA 19-9 in differentiating the benign disease group; however, heterogeneity was notable in the benign cohort. Three of five patients with autoimmune pancreatitis patients had greatly elevated thrombospondin-2 levels. Thrombospondin-2 levels had no correlation with prognoses. CONCLUSIONS: Serum thrombospondin-2 in combination with CA 19-9 has potential as a biomarker for distal cholangiocarcinoma and pancreatic cancer.

Determining the variation in premaxillary and dentary bone morphology that may underlie beak shape between two pure layer lines.

Beak treatment is an effective method of reducing the damage inflicted by severe feather pecking (SFP) but there is significant pressure to eliminate these treatments and rely solely on alternative strategies. Substantial variation in beak shape exists within non-beak treated layer flocks and beak shape appears to be heritable. There is the potential to use this pre-existing variation and genetically select for hens whose beak shapes are less apt to cause damage during SFP. To do this, we must first understand the range of phenotypes that exist for both the external beak shape and the bones that provide its structure. The objective of this study was to determine the variation in premaxillary (within the top beak) and dentary (within the bottom beak) bone morphology that exists in 2 non-beak treated pure White Leghorn layer lines using geometric morphometrics to analyze radiographs. Lateral head radiographs were taken of 825 hens and the premaxillary and dentary bones were landmarked. Landmark coordinates were standardized by Procrustes superimposition and the covariation was analyzed by principal components analysis and multivariate regression using Geomorph (an R package). Three principal components (PCs) explained 85% of total premaxillary bone shape variation and showed that the shape ranged from long and narrow with pointed bone tips to short and wide with more curved tips. Two PCs explained 81% of total dentary bone shape variation. PC1 described the dentary bone length and width and PC2 explained the angle between the bone tip and its articular process. For both bones, shape was significantly associated with bone size and differed significantly between the two lines. Bone size accounted for 42% of the total shape variation for both bones. Together, the results showed a range of phenotypic variation in premaxillary and dentary bone shape, which in turn may influence beak shape. These bone phenotypes will guide further quantitative genetic and behavioral analyses that will help identify which beaks shapes cause the least damage when birds engage in SFP.

Antimicrobial and osteoconductive properties of two different types of titanium silver coating.

In prosthetic joint surgery, Ag coating of implant areas in direct contact with bone has been met with hesitation for fear of compromising osseointegration. The physicochemical, antibacterial and osteoconductive properties of three different Ti samples were studied: Ti6Al4V alloy that was grit-blasted (GB), Ti6Al4V alloy with an experimental Ti-Ag-nitride layer (SN) applied by physical vapour deposition (PVD) and commercially available PVD-coated Ti6Al4V alloy with a base Ag layer and a surface Ti-Ag-nitride layer (SSN, clinically known as PorAg®). Ag content on the surface of experimental SN and SSN discs was 27.7 %wt and 68.5 % wt, respectively. At 28 d, Ag release was 4 ppm from SN and 26.9 ppm from SSN substrates. Colonisation of discs by Staphylococcus aureus was the highest on GB [944 (± 91) × 10 4 CFU/mL], distinctly lower on experimental SN discs [414 (± 117) × 104 CFU/mL] and the lowest on SSN discs [307 (± 126) × 10 4 CFU/mL]. Primary human osteoblasts were abundant 28 d after seeding on GB discs but their adhesion and differentiation, measured by alkaline-phosphatase production, was suppressed by 73 % on SN and by 96 % on SSN discs, in comparison to GB discs. Thus, the PVD-applied Ag coatings differed considerably in their antibacterial effects and osteoconductivity. The experimental SN coating had similar antibacterial effects to the commercially available SSN coating while providing slightly improved osteoconductivity. Balancing the Ag content of Ti implants will be vital for future developments of implants designed for cementless fixation into bone.

Radiographers' involvement in research activities and opinions on radiography research: A Nordic survey.

INTRODUCTION: Radiographers' engagement in research is important for the development of evidence-based practice in radiography; however, radiographers' interest in research has rarely been reported. This study sought to ascertain radiographers' opinions about radiography research and investigate their involvement in research activities in four Nordic countries. METHODS: This study was conducted in Denmark, Finland, Norway and Sweden. A study-specific questionnaire was developed in English and adapted to each language of the study sample, and the content and face validity of the adaptations were evaluated. An online tool was used to collect the study data. The questionnaire link was distributed in September 2019 to radiographers working in clinical settings in four Nordic countries (n = 4572). RESULTS: The overall response rate was 14% (n = 662/4572). Research involvement was reported by 33% of the respondents; data collection was the main type of contribution. Radiographers who contributed to research were more likely to be male, have longer work experience, hold a master's or doctoral degree, work as managers and be employed in university hospitals. Nearly all agreed that radiography research is needed to promote the radiography profession and provide the evidence base for radiographic practice. However, only 14% were aware of the current research evidence regarding their professional field of specialisation, and 19% indicated that they developed current practices based on research evidence. CONCLUSION: The findings indicate that, although radiographers had positive attitudes towards radiography research, their involvement in research and utilisation of research evidence in practice is low. IMPLICATIONS FOR PRACTICE: Strategies should be developed to improve knowledge and skills related to evidence-based practice and stimulate radiographers' engagement in research.

Cost-effectiveness of gallbladder histopathology after cholecystectomy for benign disease.

BACKGROUND: The prevalence of incidental gallbladder cancer is low when performing cholecystectomy for benign disease. The performance of routine or selective histological examination of the gallbladder is still a subject for discussion. The aim of this study was to assess the cost-effectiveness of these different approaches. METHODS: Four management strategies were evaluated using decision-analytical modelling: no histology, current selective histology as practised in Sweden, macroscopic selective histology, and routine histology. Healthcare costs and life-years were estimated for a lifetime perspective and combined into incremental cost-effectiveness ratios (ICERs) to assess the additional cost of achieving an additional life-year for each management strategy. RESULTS: In the analysis of the four strategies, current selective histology was ruled out due to a higher ICER compared with macroscopic selective histology, which showed better health outcomes (extended dominance). Comparison of routine histology with macroscopic selective histology resulted in a gain of 12 life-years and an incremental healthcare cost of approximately €1 000 000 in a cohort of 10 000 patients, yielding an estimated ICER of €76 508. When comparing a macroscopic selective strategy with no histological assessment, 50 life-years would be saved and the ICER was estimated to be €20 708 in a cohort of 10 000 patients undergoing cholecystectomy. CONCLUSION: A macroscopic selective strategy appears to be the most cost-effective approach.

Predictive Factors for Postoperative Pancreatic Fistula-A Swedish Nationwide Register-Based Study.

BACKGROUND: A serious complication after pancreatoduodenectomy (PD) is postoperative pancreatic fistula (POPF). The aim of this study was to analyse the incidence and predictive factors for POPF by using a large nationwide cohort. METHODS: Data from the Swedish National Registry for Pancreatic and Periampullary Cancer for all patients undergoing a PD from 2010 until 30th June 2018 were collected. The material was analysed in two groups, no POPF and clinically relevant (grade B and C) POPF. RESULTS: A total of 2503 patients underwent PD, of which 245 (10%) developed POPF. Patients with POPF had significantly more overall complications (Clavien Dindo ≥3a, 75% vs. 21%, p < 0.001) and longer hospital stay (median 23 [16-35] vs. 11 [8-15], p < 0.001) than patients without POPF. The risk of POPF was higher with increased BMI (OR 1.08, p < 0.001). Preoperative presence of diabetes (OR 0.52, p = 0.012) and preoperative biliary drainage (OR 0.34, p < 0.001) reduced the risk of POPF. Reconstruction with pancreaticojejunostomy caused a more than two folded increase in POPF compared with pancreaticogastrostomy (OR 2.41, p < 0.001). Weight gain ≥2 kg on postoperative day 1 was also a risk factor (OR 1.76, p < 0.001). CONCLUSION: A high BMI, a pancreaticojejunostomy and postoperative weight gain were risk factors for developing POPF. Diabetes or preoperative biliary drainage was protective.

Radiographers' academic development in Sweden: Towards and after a doctoral degree.

INTRODUCTION: Radiography is a young discipline and having radiographers with a doctoral degree is central for its development. Academic development of this field in Sweden has been evolving. This study explored the diagnostic radiographers' prerequisites for doctoral studies, post-doctoral employment and research activities. METHODS: Data were collected through a questionnaire designed to give insight into doctoral radiographers' qualification paths, funding, doctoral status, employment and basic demography. Sixteen radiographers participated. A conventional content analysis was used. RESULTS: The median age at dissertation defence was 53 for doctorates and 60 for licentiates. This indicates that after receiving the doctorate, there is short time left in the profession, increasing the challenge to develop the field. Most doctorates were employed within educational establishments. Unfortunately, few had supervised doctoral students, but those employed within academia contributed significantly to academic research. CONCLUSION: Compared to other Nordic countries, Sweden is at the forefront with a positive development in obtained high academic degrees. Nevertheless, there is an urgent need for post-doctorate radiographers in order to maintain the workforce to meet current and future demands. Radiographers with doctorates need to be consulted when planning research projects to establish a clear radiographic perspective. Swedish radiographers with a doctorate or licentiate have limited research time, indicating that Sweden may not invest enough in radiographic research. IMPLICATIONS FOR PRACTICE: There is a need for more doctoral positions and doctorates radiographers to supervise doctoral students. Clinical departments should recognise the benefits of having radiographic clinical research.

A rapid and accurate method to quantify neurite outgrowth from cell and tissue cultures: Two image analytic approaches using adaptive thresholds or machine learning.

BACKGROUND: Assessments of axonal outgrowth and dendritic development are essential readouts in many in vitro models in the field of neuroscience. Available analysis software is based on the assessment of fixed immunolabelled tissue samples, making it impossible to follow the dynamic development of neurite outgrowth. Thus, automated algorithms that efficiently analyse brightfield images, such as those obtained during time-lapse microscopy, are needed. NEW METHOD: We developed and validated algorithms to quantitatively assess neurite outgrowth from living and unstained spinal cord slice cultures (SCSCs) and dorsal root ganglion cultures (DRGCs) based on an adaptive thresholding approach called NeuriteSegmantation. We used a machine learning approach to evaluate dendritic development from dissociate neuron cultures. RESULTS: NeuriteSegmentation successfully recognized axons in brightfield images of SCSCs and DRGCs. The temporal pattern of axonal growth was successfully assessed. In dissociate neuron cultures the total number of cells and their outgrowth of dendrites were successfully assessed using machine learning. COMPARISON WITH EXISTING METHODS: The methods were positively correlated and were more time-saving than manual counts, having performing times varying from 0.5-2 min. In addition, NeuriteSegmentation was compared to NeuriteJ®, that uses global thresholding, being more reliable in recognizing axons in areas of intense background. CONCLUSION: The developed image analysis methods were more time-saving and user-independent than established approaches. Moreover, by using adaptive thresholding, we could assess images with large variations in background intensity. These tools may prove valuable in the quantitative analysis of axonal and dendritic outgrowth from numerous in vitro models used in neuroscience.

Radiographic research in Sweden - A review of dissertations.

INTRODUCTION: Radiographers have performed research since 1988 in Sweden. The amount of doctoral and licentiate dissertations written by registered diagnostic radiographers has increased considerably since 2000. How this new field of research was established and developed has facilitated understand of the boundaries that strengthen the professional evidence base. The aim of this dissertation review was to explore the nature and the current state of radiographic research, written by registered diagnostic radiographers in Sweden. METHODS: Dissertations published between 1988 and 2017 were analysed both deductively and inductively with content analysis. RESULTS: Radiographic research focused on structural factors, clinical radiography, radiographic technology and pedagogical approaches. The findings indicated a large interest in advancing patient information, wellbeing and care during examinations. The participants were predominantly clinical patients, followed by radiographers, adults/children and the general public. The most common study designs were descriptive with a trend towards interventional studies. Interviews and questionnaires were the most common data collection methods followed by clinical examinations and documents. CONCLUSION: The analyses demonstrate that the current radiographer research has its roots in clinical practice, focusing on pragmatic aspects and applied knowledge. The findings suggest that radiographer's dissertations meet the challenges of new technologies and working practise. If the knowledge is connected to the radiographic framework, radiography can be viewed as an independent discipline with its own philosophical base. When radiographers are encouraged to conduct research, evidence based knowledge increase which strengthens the profession. Radiography, as a scientific discipline is evolving in Sweden.

Management of incidental gallbladder cancer in a national cohort.

BACKGROUND: Incidental gallbladder cancer is a rare event, and its prognosis is largely affected by the tumour stage and treatment. The aim of this study was to analyse the management, treatment and survival of patients with incidental gallbladder cancer in a national cohort over a decade. METHODS: Patients were identified through the Swedish Registry of Gallstone Surgery (GallRiks). Data were cross-linked to the national registry for liver surgery (SweLiv) and the Cancer Registry. Medical records were collected if registry data were missing. Survival was measured as disease-specific survival. The study was divided into two intervals (2007-2011 and 2012-2016) to evaluate changes over time. RESULTS: In total, 249 patients were identified with incidental gallbladder cancer, of whom 92 (36·9 per cent) underwent re-resection with curative intent. For patients with pT2 and pT3 disease, median disease-specific survival improved after re-resection (12·4 versus 44·1 months for pT2, and 9·7 versus 23·0 months for pT3). Residual disease was present in 53 per cent of patients with pT2 tumours who underwent re-resection; these patients had a median disease-specific survival of 32·2 months, whereas the median was not reached in patients without residual disease. Median survival increased by 11 months for all patients between the early and late periods (P = 0·030). CONCLUSION: Re-resection of pT2 and pT3 incidental gallbladder cancer was associated with improved survival, but survival was impaired when residual disease was present. A higher re-resection rate and more R0 resections in the later time period may have been associated with improved survival.

Virome definition in cerebrospinal fluid of patients with neurological complications after hematopoietic stem cell transplantation.

BACKGROUND: Neurological complications (NC) in allogeneic hematopoietic stem cell transplant (HSCT) recipients lead to long-term sequelae and result in significant morbidity and mortality. Since risk factors for NC include viral infection or reactivation, virome inspection after HSCT might be helpful to the clinical management of patients after HSCT. OBJECTIVES AND STUDY DESIGN: In this study we investigated whether any viruses are found in association with NC after HSCT. For this purpose, unbiased next generation sequencing (NGS) was used to characterize nucleic acid (NA) content in cerebrospinal fluid (CSF) taken at time of NC in 35 HSCT patients. Virome definition in CSF from non-transplanted subjects (controls) was also tested to define the commensal flora. RESULTS AND CONCLUSIONS: A higher number of reads/contigs mapped to viruses in patients compared to the controls (7,626 vs 235). Besides bacteriophages, Torque teno virus (TTV) was also identified in both controls and patients. Interestingly, a significantly higher number of TTV-like sequences was detected in the patient samples (7,236 vs 9), showing similarities to distinct genotypes; 3/2,575, 2/1,692 and 2/2,969 contigs/reads mapped to TTV11, TTV13 and Torque teno midi virus, respectively. In conclusion, unbiased NGS demonstrated to be a suitable approach to characterize the virome in samples containing limiting amounts of NA. The higher TTV levels and genetic diversity found in CSF of subjects with NC after HSCT might suggest a possible association between TTV reactivation and the disorder. However, further studies are needed to evaluate the possible role of TTV on NC in HSCT patients.