Modern trends in minimally invasive versus open hepatectomy for colorectal liver metastasis: an analysis of ACS-NSQIP.

BACKGROUND: Surgical resection of colorectal liver metastasis (CRLM) provides the best opportunity for prolonged survival. Eligibility for metastasectomy has expanded with technical advancements including parenchymal-sparing hepatectomy (PSH). Meanwhile, enthusiasm for minimally invasive surgery (MIS) has increased, though this approach may be preferentially utilized for technically straightforward cases. The purpose of this study is to characterize modern trends in open versus MIS approaches to partial hepatectomy and anatomic hepatectomy for CRLM within a nationwide cohort. METHODS: The American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) was used to investigate trends in MIS versus open hepatectomy for CRLM from 2015 to 2019. We examined baseline clinicopathologic and disease-related characteristics and compared trends in treatments over the study period. RESULTS: A total of 7457 patients undergoing hepatectomy for CRLM were identified (1367 MIS, 6090 open). Patients had similar clinicopathologic features between the two groups. Patients undergoing MIS resection less frequently received neoadjuvant therapy (51.1% vs 64.0%, p < 0.001) or concurrent intraoperative ablation (15.0% vs 21.3%, p < 0.001). Patients with tumors < 2 cm (34.9% vs 26.8%, p < 0.001) or only one to two tumors (82.8% vs 65.0%, p < 0.001) more commonly underwent MIS. MIS and open partial hepatectomies both significantly increased over the study period, but open partial hepatectomy increased at a greater rate than MIS (p < 0.001). Rates of anatomic resections have remained the same, with a greater proportion performed using an open approach (34.9% vs 16.4%, p < 0.001). Rates of operations consisting of > 1 concurrent partial hepatectomy are stable, but significantly more likely to be performed open (p < 0.001). CONCLUSIONS: Hepatectomy for CRLM has increased from a rise in partial hepatectomy, potentially translating to increased use of PSH. Current trends suggest MIS approaches appear to be increasing, but selectively implemented for patients with less technically demanding disease characteristics. Educational efforts should be directed towards increased dissemination of parenchymal-sparing MIS techniques for more complex resections.

Effects of intake-based weaning and forage type on feeding behavior and growth of dairy calves fed by automated feeders.

The objective of this study was to assess the effects of intake-based weaning methods and forage type on feeding behavior and growth of dairy calves. Holstein dairy calves (n = 108), housed in 12 groups of 9, were randomly assigned to 1 of 3 weaning treatments: milk reduction based on age (wean-by-age), individual dry matter intake (DMI; wean-by-intake), or a combination of individual DMI and age (wean-by-combination). Groups of calves were alternately assigned to 1 of 2 forage treatments: grass hay or a silage-based total mix ration (TMR; n = 6 groups per treatment). Until 30 d of age, all calves were offered 12 L/d of whole milk. Starting on d 31, milk was gradually reduced by 25% of the individual's average milk intake. For wean-by-age calves (n = 31), the milk allowance remained stable until d 62 when milk was again reduced gradually until weaning at d 70. For wean-by-intake calves (n = 35), milk allowance was reduced by a further 25% once calves consumed on average 200, 600, and (finally) 1,150 g of dry matter (DM) per day of calf starter and forage. For wean-by-combination calves (n = 35), milk intake remained stable until calves consumed on average 200 g of DM/d, at which point milk was reduced linearly until weaning at d 70. If calves failed to reach DMI targets by d 62 (n = 10), milk was then reduced gradually until weaning at d 70. Of the 35 wean-by-intake calves, 27 met all 3 DMI targets (successful-intake), and 33 of the 35 calves in the wean-by-combination treatment met the 200 g of DM/d target (successful-combination). Successful-intake and successful-combination calves had greater final body weight (BW) at 12 wk of age than wean-by-age calves (123.7 vs. 122.3 vs. 117.7 ± 3.1 kg, respectively). During weaning, successful-intake calves ate more starter and consumed less milk than successful-combination and wean-by-age calves (starter: 1.19 vs. 0.89 vs. 0.49 ± 0.07 kg of DM/d, respectively; milk: 2.7 vs. 4.2 vs. 5.9 ± 0.17 L/d, respectively). After weaning, successful-combination and successful-intake calves consumed similar amounts of starter; however, wean-by-age calves continued to consume less starter (2.85 vs. 2.78 vs. 2.44 ± 0.10 kg of DM/d, respectively). During weaning, hay and TMR calves ate similar amounts of forage, but hay calves consumed more starter (0.96 vs. 0.75 ± 0.07 kg of DM/d, respectively). After weaning, hay calves continued to consume more starter (2.88 vs. 2.50 ± 0.10 kg of DM/d, respectively), whereas TMR calves consumed more forage (0.33 vs. 0.15 ± 0.02 kg of DM/d, respectively). Hay calves had greater final BW at 84 d compared with TMR calves (124.0 vs. 119.0 ± 1.6 kg, respectively). These results show that the inclusion of a DMI target can improve starter intake and BW for calves that successfully wean, and that forage type can influence the transition onto solid feed. We also found that approximately 10% of calves failed to consume even 200 g of DM/d by 9 wk of age; more research is needed to better understand why some calves struggle to transition onto solid feed.

The ASACUSA antihydrogen and hydrogen program: results and prospects.

The goal of the ASACUSA-CUSP collaboration at the Antiproton Decelerator of CERN is to measure the ground-state hyperfine splitting of antihydrogen using an atomic spectroscopy beamline. A milestone was achieved in 2012 through the detection of 80 antihydrogen atoms 2.7 m away from their production region. This was the first observation of 'cold' antihydrogen in a magnetic field free region. In parallel to the progress on the antihydrogen production, the spectroscopy beamline was tested with a source of hydrogen. This led to a measurement at a relative precision of 2.7×10-9 which constitutes the most precise measurement of the hydrogen hyperfine splitting in a beam. Further measurements with an upgraded hydrogen apparatus are motivated by CPT and Lorentz violation tests in the framework of the Standard Model Extension. Unlike for hydrogen, the antihydrogen experiment is complicated by the difficulty of synthesizing enough cold antiatoms in the ground state. The first antihydrogen quantum states scan at the entrance of the spectroscopy apparatus was realized in 2016 and is presented here. The prospects for a ppm measurement are also discussed.This article is part of the Theo Murphy meeting issue 'Antiproton physics in the ELENA era'.

Increased attention enhances both behavioral and neuronal performance.

Single cells were recorded from cortical area V4 of two rhesus monkeys (Macaca mulatta) trained on a visual discrimination task with two levels of difficulty. Behavioral evidence indicated that the monkeys' discriminative abilities improved when the task was made more difficult. Correspondingly, neuronal responses to stimuli became larger and more selective in the difficult task. A control experiment demonstrated that changes in general arousal could not account for the effects of task difficulty on neuronal responses. It is concluded that increasing the amount of attention directed toward a stimulus can enhance the responsiveness and selectivity of the neurons that process it.

Characterization of phosphatidate phosphohydrolase activity associated with isolated lamellar bodies.

It has been demonstrated that lamellar bodies isolated from porcine lung have L-alpha-phosphatidate phosphohydrolase (EC 3.1.3.4) activity which cannot be accounted for by microsomal or mitochondrial contamination. Phosphatidate phosphohydrolase activity associated with the lamellar bodies is relatively insensitive to Mg2+ and more heat labile than the activity associated with whole lung microsomes. The enzyme was found to be the most active phosphohydrolase present in isolated lamellar bodies and is inhibited by 5 mM Be2+. Lamellar bodies isolated from human and rat lung tissue were also found to have this activity, and the functional role of the enzyme in lamellar bodies is proposed in relation to glycerophospholipid metabolism.

Attentional effort modulated by task difficulty.

It has been assumed that stimulus discrimination in a visual task is performed with fixed attentive effort. Here we show that attention to the same pair of stimuli can be modulated by varying the task difficulty when a task requires the discrimination of only a small number of different stimuli. We used a matching-to-sample paradigm, where a test stimulus is presented after a sample stimulus. When both stimuli Gabor gratings have identical orientations ("matching" trial) the required response is different from when they have different orientations ("non-matching" trial). The task difficulty was manipulated by changing the orientation difference between sample and test stimuli for non-matching trials. Difficult non-matching probe trials were embedded within an easy block of trials (easy environment), and vice versa for easy probe trials. Detectability (d') differences for the same pairs of stimuli (probe trials) in the two environments were calculated as a measure for change in attentional effort, regardless of changes in likelihood ratios (beta). Our results show an increase in d' during the difficult task, for both types of probe trials, in paradigms that contained a small number of stimulus combinations. Thus a modulation in attentional effort along a single discrimination dimension is revealed. However it is restricted by the number of stimulus combinations, due to the limited capacity of the attention available for each stimulus combination.

Spatio-temporal model for subjective colours based on colour coded ganglion cells.

We propose a mathematical model for the generation of the subjective colour phenomenon through Benham's disk stimuli. The model relates to the spatial and temporal properties of three colour coded retinal ganglion cells: L+/M-, M+/L- and S-/(L+M)+ [or (L+M)-/S+]. It is suggested that the phenomenon is based on both the opponent mechanisms in the cells' receptive fields, and the "rebound response"--a common cell response to turning off of an inhibitory stimulus (nonlinear cell dynamics). A physiological mechanism is suggested for this response. The integrated cell responses to Benham disk-stimuli create imbalances between the colour pathways that are interpreted as actual colours. The model also predicts the shift in the perceived colours when the disk rotation rate is varied.

A model for detection of spatial and temporal edges by a single X cell.

When an inhibitory visual stimulus is turned off, an increased rate of spike discharge is evoked which we term the "rebound response". This response exists as a part of different cell responses from the retina to the cortex. The rebound response, with its temporal dependence on stimulus parameters, has not been previously considered in models. Here we present such a model, and also show its dependence on stimulus duration and its turning off rate. The rebound response enables detection of temporal changes when a visual stimulus involves spatial changes. The temporal change detection is affected by the actual stimulus duration, which can also be seen as a cell memory operation.

Insulin glulisine: a faster onset of action compared with insulin lispro.

AIM: This randomized, single-centre, double-blind, crossover study compared the pharmacodynamic and pharmacokinetic properties of two different doses of insulin glulisine (glulisine) and insulin lispro (lispro) in lean to obese subjects. METHODS: Eighty subjects without diabetes, stratified into four body mass index (BMI) classes (<25, >or=25 to <30, >or=30 to <35 and >or=35 kg/m(2)), were randomized to receive single injections of glulisine and lispro (0.2 and 0.4 U/kg) on four study days under glucose clamp conditions. Glucose infusion rates (GIR) and insulin (INS) concentrations were assessed for 10 h postdose. RESULTS: Glulisine showed a greater early metabolic action than lispro [GIR-area under the curve (GIR-AUC) between 0 and 1 h (0.2 U/kg: 102.3 +/- 75.1 vs. 83.1 +/- 72.8 mg/kg, p < 0.05; 0.4 U/kg: 158.0 +/- 100.0 vs. 112.3 +/- 70.8 mg/kg, p < 0.001)], with an earlier time to 10% of total GIR-AUC (0.2 U/kg: 1.4 +/- 0.4 vs. 1.5 +/- 0.4 h; 0.4 U/kg: 1.4 +/- 0.3 vs. 1.5 +/- 0.3 h, p < 0.05). The total metabolic effect was not different between the two insulins. In accordance with these findings, the time to 10% of total INS-AUC was faster with glulisine compared with lispro at either dose (0.2 U/kg: 0.7 +/- 0.2 vs. 0.8 +/- 0.2 h; 0.4 U/kg: 0.8 +/- 0.2 vs. 0.9 +/- 0.2 h, p < 0.001). The faster rise in insulin concentrations and the earlier onset of activity of glulisine vs. lispro was consistently observed in each individual BMI class. CONCLUSIONS: Glulisine shows a faster onset of action than lispro, independent of BMI and dose.

An analysis of the health benefits associated with the use of MTBE reformulated gasoline and oxygenated fuels in reducing atmospheric concentrations of selected volatile organic compounds.

To assess the health benefits gained from the use of cleaner burning gasoline, an analysis was conducted of changes in the atmospheric concentration of eight VOCs: acetaldehyde, benzene, 1,3-butadiene, ethylbenzene, formaldehyde, POM, toluene, and xylenes resulting from the use of reformulated gasoline and oxyfuel containing the additive MTBE. Modeled ambient air concentrations of VOCs were used to assess three seasonally-based scenarios: baseline gasoline compared to (a) summer MTBE:RFG, (b) winter MTBE:RFG, and (c) MTBE oxyfuel. The model predicts that the addition of MTBE to RFG or oxyfuel will decrease acetaldehyde, benzene, 1,3-butadiene and POM, but increase formaldehyde tailpipe emissions. The increased formaldehyde emissions, however, will be offset by the reduction of formaldehyde formation in the atmosphere from other VOCs. Using a range of plausible risk estimates, the analysis predicts a positive health benefit, i.e., a decline in cancer incidence associated with use of MTBE:RFG and MTBE oxyfuel. Using EPA cancer risk estimates, reduction in 1,3-butadiene exposure accounts for the greatest health benefit while reduction of benzene exposure accounts for the greatest health benefits based on alternative risk estimates. An analysis of microenvironment monitoring data indicates that most exposures to VOCs are significantly below levels of concern based on established margin-of-safety standards. The analysis does suggest, however, that health effects associated with short-term exposures to acetaldehyde and benzene may warrant further investigation.

Zero-crossing detectors in primary visual cortex?

David Marr and others have hypothesized that the visual system processes complex scene information in stages, the first of which involves the detection of light intensity edges or "zero-crossings" (Marr, 1982). Ideal zero-crossing detector mechanisms have been described and modeled in terms of their possible physiological implementation (Marr and Hildreth, 1980; Poggio, 1983). We now present evidence of visual cortical receptive fields which resemble in spatial organizational terms the requirements of zero-crossing analysis. The linear and nonlinear summation within and between the receptive field subunits are described and compared with predicted processes. The relative subunit sizes and separations are analyzed in these terms. Our findings support the notion that receptive fields may correspond with zero-crossing filters rather than zero-crossing detector gates.

Response histogram shapes and tuning curves: the predicted responses of several cortical cell types to drifting gratings stimuli.

The responses to visual stimuli of simple cortical cells show linear spatial summation within and between their receptive field subunits. Complex cortical cells do not show this linearity. We analyzed the simulated responses to drifting sinusoidal grating stimuli of simple and of several types of complex cells. The complex cells, whose responses are seen to be half-wave rectified before pooling, have receptive fields consisting of two or more DOG (difference-of-Gaussians) shaped subunits. In both cases of stimulation by contrast-reversal gratings or drifting gratings, the cells' response as a function of spatial frequency is affected by the subunit distances 2 lambda and the stimulation frequency omega. Furthermore, an increased number of subunits (a larger receptive field) yields a narrower peak tuning curve with decreased modulation depth for many of the spatial frequencies. The average and the peak response tuning curves are compared for the different receptive field types.

Spatiotemporal adaptation model for retinal ganglion cells.

An adaptation model for the level of the ganglion cell in the retina is presented. The model assumes separate adaptation mechanisms for each of the receptive field (RF) regions, i.e., before edge detection. According to the model, the decay in the response time course of each RF region reflects its adaptation process. A mathematical description of adaptation that includes its temporal properties is developed through the change in the semisaturation constant theta in the Naka-Rushton equation. The model and its simulations show a good agreement with a wide variety of physiological studies.