Clinical outcome and quality of life after gracilis muscle transposition for fistula closure over a 10-year period.

PURPOSE: Gracilis muscle transposition (GMT) is an established surgical technique in the treatment of anorectal fistulas and fistulas to the vagina and the urinary system when previous closure options have failed. There is little evidence on the success rate of this procedure in the long term. METHODS: This is a follow-up study on all patients undergoing GMT over a 10-year period at a tertiary referral center for complex fistulas. Postoperative function and quality of life were evaluated by standardized questionnaires (Wexner score, Fecal Incontinence Quality of Life Score (FIQL), SF-12 and a brief questionnaire designed for this study). Sexual function was evaluated by the Female Sexual Function Index (FSFI) and the International Index of Erectile Function. RESULTS: Forty-seven gracilis muscle transpositions (GMT) in 46 patients were performed. Most treated patients had (neo-)-rectovaginal fistulas (n = 29). An overall fistula closure was achieved in 34 of 46 patients (74%): in 25 cases primarily by GMT (53%) and in nine patients with persistent or recurrent fistula by additional surgical procedures. A clinically apparent relapse occurred on average 276 days (median: 180 days) after GMT (mean follow-up 73.4 months). CONCLUSION: GMT in our hands has a primary closure rate of 53%, and after further procedures, this rises to 74%. Fecal continence is impaired in patients having undergone GMT. The overall quality of life in patients after GMT is only slightly impaired, and sexual function is severely impaired in female patients.

Resection enterostomy versus Hartmann's procedure for emergency colonic resections.

BACKGROUND: If a primary anastomosis is considered too risky after emergency colon resection either a resection enterostomy or an end stoma with closure of the distal bowel (Hartmann's procedure) is possible. This study analyzes the rate of restoration of intestinal continuity and other surgical outcomes after resection enterostomy placement versus Hartmann's procedure for emergency colon resections. METHODS: All patients who underwent emergency colorectal resections between August 2009 and June 2014 at the University Medical Center Mannheim were reviewed in regard to therapeutic approach, rate of restoration of bowel continuity, and surgical morbidity after the primary operation and after reversal surgery. RESULTS: Fifty-five patients in whom both studied interventions would have been technically feasible were further analyzed. The rate of revisional surgery was significantly higher in the resection enterostomy cohort after the primary operation. There were no significant differences regarding morbidity, mortality, and the rate of restoration of intestinal continuity. Overall, bowel continuity could be restored in 63% (29/46) of the surviving patients. The median time of surgery of the initial as well as of the reversal surgery was significantly longer in the Hartmann's group. Five of 13 patients underwent protective ileostomy placement in the Hartmann's group at the time of the reversal (vs. none in the resection enterostomy group). CONCLUSIONS: The bowel continuity can be restored in the majority of patients after emergency colonic resection. Conclusive evidence which surgical option should be preferred when a primary anastomosis is considered too risky-Hartmann's procedure or resection enterostomy-is still lacking.

Mid-infrared emissivity of partially dehydrated asteroid (162173) Ryugu shows strong signs of aqueous alteration.

The near-Earth asteroid (162173) Ryugu, the target of Hayabusa2 space mission, was observed via both orbiter and the lander instruments. The infrared radiometer on the MASCOT lander (MARA) is the only instrument providing spectrally resolved mid-infrared (MIR) data, which is crucial for establishing a link between the asteroid material and meteorites found on Earth. Earlier studies revealed that the single boulder investigated by the lander belongs to the most common type found on Ryugu. Here we show the spectral variation of Ryugu's emissivity using the complete set of in-situ MIR data and compare it to those of various carbonaceous chondritic meteorites, revealing similarities to the most aqueously altered ones, as well as to asteroid (101955) Bennu. The results show that Ryugu experienced strong aqueous alteration prior to any dehydration.

The InSight HP3 Penetrator (Mole) on Mars: Soil Properties Derived from the Penetration Attempts and Related Activities.

The NASA InSight Lander on Mars includes the Heat Flow and Physical Properties Package HP3 to measure the surface heat flow of the planet. The package uses temperature sensors that would have been brought to the target depth of 3-5 m by a small penetrator, nicknamed the mole. The mole requiring friction on its hull to balance remaining recoil from its hammer mechanism did not penetrate to the targeted depth. Instead, by precessing about a point midway along its hull, it carved a 7 cm deep and 5-6 cm wide pit and reached a depth of initially 31 cm. The root cause of the failure - as was determined through an extensive, almost two years long campaign - was a lack of friction in an unexpectedly thick cohesive duricrust. During the campaign - described in detail in this paper - the mole penetrated further aided by friction applied using the scoop at the end of the robotic Instrument Deployment Arm and by direct support by the latter. The mole tip finally reached a depth of about 37 cm, bringing the mole back-end 1-2 cm below the surface. It reversed its downward motion twice during attempts to provide friction through pressure on the regolith instead of directly with the scoop to the mole hull. The penetration record of the mole was used to infer mechanical soil parameters such as the penetration resistance of the duricrust of 0.3-0.7 MPa and a penetration resistance of a deeper layer ( > 30 cm depth) of 4.9 ± 0.4 MPa . Using the mole's thermal sensors, thermal conductivity and diffusivity were measured. Applying cone penetration theory, the resistance of the duricrust was used to estimate a cohesion of the latter of 2-15 kPa depending on the internal friction angle of the duricrust. Pushing the scoop with its blade into the surface and chopping off a piece of duricrust provided another estimate of the cohesion of 5.8 kPa. The hammerings of the mole were recorded by the seismometer SEIS and the signals were used to derive P-wave and S-wave velocities representative of the topmost tens of cm of the regolith. Together with the density provided by a thermal conductivity and diffusivity measurement using the mole's thermal sensors, the elastic moduli were calculated from the seismic velocities. Using empirical correlations from terrestrial soil studies between the shear modulus and cohesion, the previous cohesion estimates were found to be consistent with the elastic moduli. The combined data were used to derive a model of the regolith that has an about 20 cm thick duricrust underneath a 1 cm thick unconsolidated layer of sand mixed with dust and above another 10 cm of unconsolidated sand. Underneath the latter, a layer more resistant to penetration and possibly containing debris from a small impact crater is inferred. The thermal conductivity increases from 14 mW/m K to 34 mW/m K through the 1 cm sand/dust layer, keeps the latter value in the duricrust and the sand layer underneath and then increases to 64 mW/m K in the sand/gravel layer below. Supplementary Information: The online version contains supplementary material available at 10.1007/s11214-022-00941-z.

Geology of the InSight landing site on Mars.

The Interior Exploration using Seismic Investigations, Geodesy and Heat Transport (InSight) spacecraft landed successfully on Mars and imaged the surface to characterize the surficial geology. Here we report on the geology and subsurface structure of the landing site to aid in situ geophysical investigations. InSight landed in a degraded impact crater in Elysium Planitia on a smooth sandy, granule- and pebble-rich surface with few rocks. Superposed impact craters are common and eolian bedforms are sparse. During landing, pulsed retrorockets modified the surface to reveal a near surface stratigraphy of surficial dust, over thin unconsolidated sand, underlain by a variable thickness duricrust, with poorly sorted, unconsolidated sand with rocks beneath. Impact, eolian, and mass wasting processes have dominantly modified the surface. Surface observations are consistent with expectations made from remote sensing data prior to landing indicating a surface composed of an impact-fragmented regolith overlying basaltic lava flows.

Images from the surface of asteroid Ryugu show rocks similar to carbonaceous chondrite meteorites.

The near-Earth asteroid (162173) Ryugu is a 900-m-diameter dark object expected to contain primordial material from the solar nebula. The Mobile Asteroid Surface Scout (MASCOT) landed on Ryugu's surface on 3 October 2018. We present images from the MASCOT camera (MASCam) taken during the descent and while on the surface. The surface is covered by decimeter- to meter-sized rocks, with no deposits of fine-grained material. Rocks appear either bright, with smooth faces and sharp edges, or dark, with a cauliflower-like, crumbly surface. Close-up images of a rock of the latter type reveal a dark matrix with small, bright, spectrally different inclusions, implying that it did not experience extensive aqueous alteration. The inclusions appear similar to those in carbonaceous chondrite meteorites.

Comparison of reticular and rectal core body temperatures in lactating dairy cows.

The Phase IV Cattle Temperature Monitoring System (CTMS; Phase IV Engineering Inc., Boulder, CO) marketed by MaGiiX (MaGiiX Inc., Post Falls, ID) uses a passive bolus equipped with a temperature sensor, a panel reader placed at a parlor entrance or exit to query the bolus, and a software package to collect, analyze, and view data. The biologically inert bolus resides in the cow's reticulum and is queried each time the cow passes the reader. Reticular temperature (RETT) and rectal temperature (RECT) were recorded simultaneously in the milking parlor exit lane in 4 consecutive milkings in each of 4 seasons, totaling 16 measurements per cow. The RETT were obtained by using the phase IV CTMS, whereas the RECT were obtained manually with a GLA M750 thermometer (GLA Agricultural Electronics, San Luis Obispo, CA). Data were edited to remove RETT likely to have been affected by a recent drinking bout. For the 2,042 observations used in analyses, means (+/-SD) were 39.28 (+/-0.41), 38.83 (+/-0.36), and 0.45 (+/-0.33) for RETT, RECT, and the difference between RETT and RECT, respectively. The RETT and RECT were strongly correlated (r = 0.645). The relationship between RETT and RECT varied by season, milking, housing system, and parity. Because dairy producers and veterinarians are accustomed to viewing rectal temperatures, equations to adjust reticular temperatures to a rectal-based scale may increase the utility of the phase IV CTMS. The resulting conversion equations were RECT = 19.23 + 0.496(RETT) for the a.m. milking and RECT = 15.88 + 0.587(RETT) for the p.m. milking.

Impact of intake water temperatures on reticular temperatures of lactating dairy cows.

Automatic temperature recording may allow early detection of disease, estrus, heat stress, and the onset of calving. The phase IV Cattle Temperature Monitoring System (MaGiiX Inc., Post Falls, ID) utilizes a passive bolus equipped with a temperature sensor, a stationary panel reader to query the bolus, and software to collect, analyze, and display data. One potential limitation to collection of reticular temperatures is the effect of water temperature and consumption on recorded temperatures. Two replicated 3 x 3 Latin square experiments were conducted at the Purdue Dairy Research and Education Center to assess the impact of water intake on reticular temperatures using the Cattle Temperature Monitoring System. Nine high-producing, mid-lactation, second-parity cows with low somatic cell counts were selected. Before administering a water treatment, access to feed and water was restricted for at least 2 h. Baseline reticular temperatures were established from measurements before water intake. In experiment 1, treatments were 25.2 kg of hot water (34.3 degrees C +/- 1.0), warm water (18.2 degrees C +/- 0.4), or cold water (7.6 degrees C +/- 0.4). In experiment 2, treatments were 18.9 kg of body-temperature water (38.9 degrees C +/- 0.2), cold water (5.1 degrees C +/- 0.4), or control (no water). Following water intake, reticular temperatures were collected for 3 h. In experiment 1, an initial dramatic decrease in reticular temperature was observed followed by a gradual increase toward baseline. Least squares means for maximum drop in temperature were 8.5 +/- 0.5, 6.9 +/- 0.5, and 2.2 +/- 0.5 degrees C for cold, warm, and hot water treatments, respectively. Yet at 3 h, reticular temperatures did not return to the baseline. In experiment 2, control cows remained within the baseline confidence interval through the observation period, and cows receiving body temperature water experienced an initial decrease in temperature (0.4 +/- 0.2 degrees C) with a return to within the baseline confidence interval within 15 min. Cows receiving cold water did not return to within the baseline confidence interval after a large decrease of 9.2 +/- 0.2 degrees C during the 3-h observational period. Moreover, a regression analysis of continued ascent in temperatures predicted that temperatures would return to baseline within 3.5 h. These results demonstrate that, when cows consume large quantities of cold water, the effect of water intake is sizable and sustained. The value of reticular temperatures for daily monitoring in a production setting hinges largely on the implications of this impact.

COMETARY SCIENCE. Thermal and mechanical properties of the near-surface layers of comet 67P/Churyumov-Gerasimenko.

Thermal and mechanical material properties determine comet evolution and even solar system formation because comets are considered remnant volatile-rich planetesimals. Using data from the Multipurpose Sensors for Surface and Sub-Surface Science (MUPUS) instrument package gathered at the Philae landing site Abydos on comet 67P/Churyumov-Gerasimenko, we found the diurnal temperature to vary between 90 and 130 K. The surface emissivity was 0.97, and the local thermal inertia was 85 ± 35 J m(-2) K(-1)s(-1/2). The MUPUS thermal probe did not fully penetrate the near-surface layers, suggesting a local resistance of the ground to penetration of >4 megapascals, equivalent to >2 megapascal uniaxial compressive strength. A sintered near-surface microporous dust-ice layer with a porosity of 30 to 65% is consistent with the data.

Mixed anxiety-depression in a primary-care clinic.

To determine the prevalence and clinical significance of a mixed anxiety-depressive (MAD) syndrome in primary care, a two-stage sampling design was applied to 796 consecutive clinic attendees without known psychiatric illness. Among 78 systematically interviewed subjects, 10.3% (n = 8) had a depressive disorder alone, 12.8% (n = 10) had an anxiety disorder alone, 19.2% (n = 15) had a comorbid anxiety and depressive disorder and 12.8% (n = 10) had a combination of subsyndromal anxiety and depressive features that fulfilled either ICD-10 or our own operational criteria for MAD. Patients with MAD rated their disability as being comparable to that of patients with anxiety or depressive disorders. These findings lend support to the notion that there is a sizeable subgroup of patients in primary care who appear to be suffering from a psychiatric syndrome with an admixture of subsyndromal depressive and anxiety features. Questions about the temporal stability of MAD and preferred approaches to treatment have yet to be answered.