Characterizing Bodyweight-Supported Treadmill Walking on Land and Underwater Using Foot-Worn Inertial Measurement Units and Machine Learning for Gait Event Detection.

Gait rehabilitation commonly relies on bodyweight unloading mechanisms, such as overhead mechanical support and underwater buoyancy. Lightweight and wireless inertial measurement unit (IMU) sensors provide a cost-effective tool for quantifying body segment motions without the need for video recordings or ground reaction force measures. Identifying the instant when the foot contacts and leaves the ground from IMU data can be challenging, often requiring scrupulous parameter selection and researcher supervision. We aimed to assess the use of machine learning methods for gait event detection based on features from foot segment rotational velocity using foot-worn IMU sensors during bodyweight-supported treadmill walking on land and underwater. Twelve healthy subjects completed on-land treadmill walking with overhead mechanical bodyweight support, and three subjects completed underwater treadmill walking. We placed IMU sensors on the foot and recorded motion capture and ground reaction force data on land and recorded IMU sensor data from wireless foot pressure insoles underwater. To detect gait events based on IMU data features, we used random forest machine learning classification. We achieved high gait event detection accuracy (95-96%) during on-land bodyweight-supported treadmill walking across a range of gait speeds and bodyweight support levels. Due to biomechanical changes during underwater treadmill walking compared to on land, accurate underwater gait event detection required specific underwater training data. Using single-axis IMU data and machine learning classification, we were able to effectively identify gait events during bodyweight-supported treadmill walking on land and underwater. Robust and automated gait event detection methods can enable advances in gait rehabilitation.

Implementation of a Level 1 Neuro Trauma Activation at a Tertiary Pediatric Trauma Center.

INTRODUCTION: Timely management improves outcomes in patients with traumatic brain injury (TBI), especially those requiring operative intervention. We implemented a "Level 1 Neuro" (L1N) trauma activation for severe TBI, aiming to decrease times to intervention. METHODS: We evaluated whether an L1N activation was associated with shorter times to operating room (OR) incision and pediatric intensive care unit (PICU) admission using multivariable regression models. Trauma patients with severe TBI undergoing operative intervention or PICU admission from January 2008-October 2020 met inclusion. The L1N cohort included patients meeting our institution's L1N criteria. The L1 and L2 cohorts included head injury patients with hAIS ≥3 and an L1 or L2 activation, respectively. RESULTS: Median hAIS, GCS, Rotterdam CT score, and ISS were 4.5 (4-5), 8 (3-15), 2 (1-3), and 17 (11-26), respectively. We demonstrate clinically shorter times to OR incision among L1N traumas (93.3 min) compared to L1 (106.7 min; P = 0.73) and L2 cohorts (133.5 min; P = 0.03). We also demonstrate clinically shorter times to anesthesia among L1N traumas (51.9 min) compared to L1 (70.1 min; P = 0.13) and L2 cohorts (101.3 min; P < 0.01). Median GCS, ISS and hAIS in the PICU patients were 10 (IQR:3-15), 17 (11-26), and 4 (3-4), respectively. We demonstrate clinically shorter times to PICU among L1N traumas (82.1 min) and the L2 cohort (154.7 min; P < 0.01). CONCLUSIONS: An L1N activation is associated with shorter times to anesthesia and OR management. Enhancing communication with standardized neurotrauma activation has the potential to improve timeliness of care in severe pediatric TBI.

British Gynaecological Cancer Society recommendations for women with gynecological cancer who received non-standard care during the COVID-19 pandemic.

During the COVID-19 pandemic, pressures on clinical services required adaptation to how care was prioritised and delivered for women with gynecological cancer. This document discusses potential 'salvage' measures when treatment has deviated from the usual standard of care. The British Gynaecological Cancer Society convened a multidisciplinary working group to develop recommendations for the onward management and follow-up of women with gynecological cancer who have been impacted by a change in treatment during the pandemic. These recommendations are presented for each tumor type and for healthcare systems, and the impact on gynecological services are discussed. It will be important that patient concerns about the impact of COVID-19 on their cancer pathway are acknowledged and addressed for their ongoing care.

Quantification of Global Myoelectric Spatial Activations to Delineate Normal Hamstring Function at Progressive Running Speeds: A Technical Report.

ABSTRACT: Schlink, BR, Nordin, AD, Diekfuss, JA, and Myer, GD. Quantification of global myoelectric spatial activations to delineate normal hamstring function at progressive running speeds: A technical report. J Strength Cond Res 36(3): 867-870, 2022-Hamstring function is critical to maintain sport performance, and strain injuries to the biceps femoris muscle commonly force an athlete to withdraw from their sport while the muscle heals. Current mechanistic understanding of underlying injury and return-to-play (RTP) guidelines has limited prognostic value because of limitations in technology and nonfunctional assessment strategies to guide clinical care. Integrated structural and functional determinants and dynamic assessment methods are needed to guide advanced rehabilitation strategies for safe and rapid return to sport. A potential solution for assessment of hamstring function is high-density electromyography (EMG), which can noninvasively measure spatial muscle activity in dynamic environments. In this study, we demonstrated the utility of high-density EMG by measuring spatial myoelectric activity from the biceps femoris from a group of recreational athletes running at a range of speeds. The level of significance set for this study was p < 0.05. During the late swing phase of running, we observed increased EMG amplitudes in the central and distal portions of the muscle. There were no changes in this pattern of EMG activation across speed, suggesting that running speed does not affect the general neuromuscular recruitment in the biceps femoris. Applying these methods to athletes with hamstring strains may lead to a more complete understanding of muscle function during rehabilitation and adjunctively support current methods to enhance RTP decision-making.

Fatigue induces altered spatial myoelectric activation patterns in the medial gastrocnemius during locomotion.

This research investigates the effects of muscle fatigue on spatial myoelectric patterns in the lower limb during locomotion. Both spatial and frequency aspects of neuromuscular recruitment in the medial gastrocnemius change in response to fatigue, resulting in altered myoelectric patterns during walking and running. These data may help us better understand the adaptations that occur in lower limb muscles to avoid overuse injuries caused by fatigue.

Footwear and footstrike change loading patterns in running.

Loading rates have been linked to running injuries, revealing persistent impact features that change direction among three-dimensional axes in different footwear and footstrike patterns. Extracting peak loads from ground reaction forces, however, can neglect the time-varying loading patterns experienced by the runner in each footfall. Following footwear and footstrike manipulations during laboratory-based overground running, we examined three-dimensional loading rate-time features in each direction (X, Y, Z) using principal component analysis. Twenty participants (9 M, 11 F, age: 25.3 ± 3.6 y) were analysed during 14 running trials in each of two footwear (cushioned and minimalist) and three footstrike conditions (forefoot, midfoot, rearfoot). Two principal components (PC) captured the primary loading rate-time features (PC1: 42.5% and PC2: 22.8% explained variance) and revealed interaction among axes, footwear, and footstrike conditions (PC1: F (2.1, 40.1) = 5.6, p = 0.007, η 2 = 0.23; PC2: F (2.0, 38.4) = 62.3, p < 0.001, η 2 = 0.77). Rearfoot running in cushioned footwear attenuated impact loads in the vertical direction, and forefoot running in minimalist footwear attenuated impact loads in the anterior-posterior and medial-lateral directions relative to forefoot running in cushioned shoes. Loading patterns depend on footwear and footstrike interactions, which require shoes that match the runner's footstrike pattern.

Standardized ultrasound templates for diagnosing appendicitis reduce annual imaging costs.

BACKGROUND: Ultrasound is preferred over computed tomography (CT) for diagnosing appendicitis in children to avoid undue radiation exposure. We previously reported our experience in instituting a standardized appendicitis ultrasound template, which decreased CT rates by 67.3%. In this analysis, we demonstrate the ongoing cost savings associated with using this template. METHODS: Retrospective chart review for the time period preceding template implementation (June 2012-September 2012) was combined with prospective review through December 2015 for all patients in the emergency department receiving diagnostic imaging for appendicitis. The type of imaging was recorded, and imaging rates and ultrasound test statistics were calculated. Estimated annual imaging costs based on pretemplate ultrasound and CT utilization rates were compared with post-template annual costs to calculate annual and cumulative savings. RESULTS: In the pretemplate period, ultrasound and CT rates were 80.2% and 44.3%, respectively, resulting in a combined annual cost of $300,527.70. Similar calculations were performed for each succeeding year, accounting for changes in patient volume. Using pretemplate rates, our projected 2015 imaging cost was $371,402.86; however, our ultrasound rate had increased to 98.3%, whereas the CT rate declined to 9.6%, yielding an annual estimated cost of $224,853.00 and a savings of $146,549.86. Since implementation, annual savings have steadily increased for a cumulative cost savings of $336,683.83. CONCLUSIONS: Standardizing ultrasound reports for appendicitis not only reduces the use of CT scans and the associated radiation exposure but also decreases annual imaging costs despite increased numbers of imaging studies. Continued cost reduction may be possible by using diagnostic algorithms.

Understanding the quality of life (QOL) issues in survivors of cancer: towards the development of an EORTC QOL cancer survivorship questionnaire.

BACKROUND: The number of cancer survivors is growing steadily and increasingly, clinical trials are being designed to include long-term follow-up to assess not only survival, but also late effects and health-related quality of life (HRQOL). Therefore it is is essential to develop patient-reported outcome measures (PROMs) that capture the full range of issues relevant to disease-free cancer survivors. The objectives of this project are: 1) to develop a European Organisation for Research and Treatment of Cancer (EORTC) questionnaire that captures the full range of physical, mental and social HRQOL issues relevant to disease-free cancer survivors; and 2) to determine at which minimal time since completion of treatment the questionnaire should be used. METHODS: We reviewed 134 publications on cancer survivorship and interviewed 117 disease-free cancer survivors with 11 different types of cancer across 14 countries in Europe to generate an exhaustive, provisional list of HRQOL issues relevant to cancer survivors. The resulting issue list, the EORTC core questionnaire (QLQ-C30), and site-specific questionnaire modules were completed by a second group of 458 survivors. RESULTS: We identified 116 generic survivorship issues. These issues covered body image, cognitive functioning, health behaviors, negative and positive outlook, health distress, mental health, fatigue, sleep problems, physical functioning, pain, several physical symptoms, social functioning, and sexual problems. Patients rated most of the acute symptoms of cancer and its treatment (e.g. nausea) as no longer relevant approximately one year after completion of treatment. CONCLUSIONS: Compared to existing cancer survivorship questionnaires, our findings underscore the relevance of assessing issues related to chronic physical side effects of treatment such as neuropathy and joint pain. We will further develop a core survivorship questionnaire and three site-specific modules for disease-free adult cancer survivors who are at least one year post-treatment.

Effects of Cable Sway, Electrode Surface Area, and Electrode Mass on Electroencephalography Signal Quality during Motion.

More neuroscience researchers are using scalp electroencephalography (EEG) to measure electrocortical dynamics during human locomotion and other types of movement. Motion artifacts corrupt the EEG and mask underlying neural signals of interest. The cause of motion artifacts in EEG is often attributed to electrode motion relative to the skin, but few studies have examined EEG signals under head motion. In the current study, we tested how motion artifacts are affected by the overall mass and surface area of commercially available electrodes, as well as how cable sway contributes to motion artifacts. To provide a ground-truth signal, we used a gelatin head phantom with embedded antennas broadcasting electrical signals, and recorded EEG with a commercially available electrode system. A robotic platform moved the phantom head through sinusoidal displacements at different frequencies (0-2 Hz). Results showed that a larger electrode surface area can have a small but significant effect on improving EEG signal quality during motion and that cable sway is a major contributor to motion artifacts. These results have implications in the development of future hardware for mobile brain imaging with EEG.

Cervical cancer - does the morphological subtype affect survival rates?

A retrospective population-based observational study using cancer registration data of women diagnosed with invasive cervical cancer between 2006 and 2010, in England, was carried out to explore how different morphological subtypes affect survival rates. Age-standardised net survival rates by morphological subtype are presented alongside with excess mortality modelling accounting for the impact of demographic, diagnostic and tumour factors. The three main morphological subtypes (squamous cell carcinoma (SCC), adenocarcinoma and adenosquamous carcinoma) have similar one-year net survival rates of approximately 85%. After adjusting for other important determinants of survival, there were no differences at five-years amongst the three main morphological subtypes, with unadjusted survival rates of 55-65%. As expected, women presenting with neuroendocrine tumours had a much poorer outcome than other epithelial cervical malignancies, with 1-year survival of up to 55%, five-year survival of 34% and excess mortality rates compared to SCC varying between 1.9 and 5.9. Impact Statement What is already known on this subject: This is the first study on survival by cervical cancer morphological subtype using national cancer data. What the results of this study add: This study uses excess mortality modelling to investigate the effects of the morphological subtypes whilst adjusting the other factors that affect cervical cancer survival such as stage, age and grade. What the implications are of these findings for clinical practice and/or further research: It is known that cervical neuroendocrine tumours have a poor prognosis and this is confirmed by this study. Squamous cell carcinomas (SCC), adenocarcinomas (AC) and adenosquamous carcinomas (ASC) have the highest net survival and when accounting for other factors there are no differences amongst these morphological subtypes in terms of survival.

Variations in Treatment of Cervical Cancer According to Tumor Morphology-Population-Based Cohort Analysis of English National Cancer Registration Data.

OBJECTIVE: This study aimed to investigate differences in the treatment of cervical cancer by tumor morphology after accounting for demographic, diagnostic, and tumor factors. METHODS: Retrospective population-based observational study using linked cancer registration and treatment data from administrative data sources of women diagnosed with cervical cancer (International Classification of Diseases, Tenth Edition C53, malignant behavior) during 2009 and 2010 in England. Descriptive analyses and multinomial regression modeling have been used to consider differences in treatment by morphological subtype. For each morphological subtype, number and percentage of cases are presented by demographic, diagnostic, and tumor factors and treatment modality. Relative risk ratios are provided for each treatment modality by morphological subtype and other specified factors. RESULTS: Forty-three percent of women were treated surgically; 36% by clinical oncology and only 8% by combination of surgery and clinical oncology. Compared with squamous cell carcinomas, both adenocarcinomas and adenosquamous carcinomas were more likely to be treated by trachelectomy, hysterectomy, radiotherapy with hysterectomy, or chemoradiotherapy with hysterectomy than by chemoradiotherapy without hysterectomy. These differences were explained mainly by a different stage distribution, but some difference remained after adjustment for other factors including stage. As clinically recommended, neuroendocrine tumors were not treated surgically. Further treatment differences were found by age, route to diagnosis, stage, and grade. Deprivation was not generally associated with treatment differences, with 1 exception that those from more deprived areas were less likely to be treated by trachelectomy. CONCLUSIONS: Important treatment differences according to tumor morphology remain after adjusting for relevant patient demographic, diagnostic, and tumor factors. In particular, the difference between the treatment of squamous cell carcinoma and adenocarcinoma is notable.

Biomechanics and neural control of movement, 20 years later: what have we learned and what has changed?

We summarize content from the opening thematic session of the 20th anniversary meeting for Biomechanics and Neural Control of Movement (BANCOM). Scientific discoveries from the past 20 years of research are covered, highlighting the impacts of rapid technological, computational, and financial growth on motor control research. We discuss spinal-level communication mechanisms, relationships between muscle structure and function, and direct cortical movement representations that can be decoded in the control of neuroprostheses. In addition to summarizing the rich scientific ideas shared during the session, we reflect on research infrastructure and capacity that contributed to progress in the field, and outline unresolved issues and remaining open questions.

Classifying performer strategies in drop landing activities.

Our purpose was to use group and single-case methods to examine inter-individual variability in the context of factors related to landing injuries. We tested the load accommodation strategies model (An exploration of load accommodation strategies during walking with extremity-carried weights. Human Movement Science, 35, 17-29) using landing impulse, revealing pre-landing strategies following height and external load manipulations. Ten healthy volunteers (8 male, 2 female, 24.0 ± 1.4 years, 1.72 ± 0.06 m, 73.5 ± 8.7 kg) were analysed across 12 trials in each of three load conditions (100% body weight [BW], 110% BW, 120% BW) from two landing heights (30 cm, 60 cm). Landing impulse (BW ∙ s) was computed for each participant-condition-trial, using impulse ratios (unit-less; BW ∙ s/BW ∙ s) to evaluate load accommodation strategies between adjacent load conditions (110%/100%, 120%/110%) at each landing height. Load accommodation strategy classifications were based on 95% confidence intervals (CIs) containing mechanically predicted impulse ratios (1.10 and 1.09 for 110/100% BW and 120/110% BW, respectively; α = 0.05). Mean group impulse ratios matched and exceeded predicted impulse ratios. Single-case analyses revealed a range of individual landing strategies that might be overlooked during group analyses, possibly uncovering individuals at greater risk of injury during landing activities.

Load Accommodation Strategies and Movement Variability in Single-Leg Landing.

Our purpose was to examine changes in participant-specific single-leg landing strategies and intra-individual movement variability following alterations in mechanical task demands via external load and landing height. Nineteen healthy volunteers (15M, 4 F, age: 24.3 ± 4.9 y, mass: 78.5 ± 14.7 kg, height: 1.73 ± 0.08 m) were analyzed among 9 single-leg drop landing trials in each of 6 experimental conditions (3 load and 2 landing height) computed as percentages of participant bodyweight (BW, BW + 12.5%, BW + 25%) and height (H12.5% & H25%). Lower-extremity sagittal joint angles and moments (hip, knee, and ankle), vertical ground reaction forces (GRFz), and electrical muscle activities (gluteus maximus, biceps femoris, vastus medialis, medial gastrocnemius, and tibialis anterior muscles) were analyzed. Individual single-leg drop landing strategies were identified using landing impulse predictions and the Load Accommodation Strategies Model (James et al., 2014). Intra-individual movement variability was assessed from neuromechanical synergies extracted using single-case principal component analyses (PCA). Fewer contrasting single-leg landing strategies were identified among participants under greater mechanical task demands (p < .001) alongside lesser intra-individual movement variability (p < .001). These results reveal changes in movement control under greater mechanical task demands, which may have implications for understanding overuse injury mechanisms in landing.

Lower extremity variability changes with drop-landing height manipulations.

Landing is a common lower extremity injury mechanism in sport, with potential connections to movement control accessed through variability measures. We investigated intra-subject lower extremity variability changes following drop-landing height manipulations using standard deviation (SD) and coefficient of variation (CV) among lower extremity peak sagittal joint angles and moments. Fourteen healthy participants completed five drop-landing trials from five heights 20%, 60%, 100%, 140% and 180% maximum vertical jump height (MVJH). Peak joint angles and moments increased with greater landing height (p < 0.001), highlighting inter-joint differences (Flexion: Knee > Hip > Ankle, p < 0.001; Extensor Moment: Hip > Knee > Ankle, in excess of 60% MVJH, p < 0.05). Kinematic and kinetic SD increased with variable magnitudes, while CV decreased at greater landing heights (p ≤ 0.016). Decreased relative variability under greater task demands may underscore non-contact injury mechanisms from repetitive loading of identical structures.

Factors Affecting Short-term Mortality in Women With Ovarian, Tubal, or Primary Peritoneal Cancer: Population-Based Cohort Analysis of English National Cancer Registration Data.

OBJECTIVE: International studies show lower survival rates in the United Kingdom than other countries with comparable health care systems. We report on factors associated with excess mortality in the first year after diagnosis of primary invasive epithelial ovarian, tubal, and primary peritoneal cancer. METHODS: Routinely collected national data were used for patients diagnosed in England in 2008 to 2010. A multivariate Poisson model was used to model excess mortality in 3 periods covering the first year after diagnosis, adjusting for various factors including age at diagnosis, route to diagnosis, tumor stage, tumor morphology, and treatment received. RESULTS: Of 14,827 women diagnosed as having ovarian cancer, 5296 (36%) died in the first year, with 1673 deaths in the first month after diagnosis. Age older than 70 years, diagnosis after an emergency presentation or by an unknown route, and unspecified or unclassified epithelial morphologies were strongly and independently associated with excess mortality in the first year after diagnosis. Of the 2100 (14%) women who fulfilled all 3 criteria, 1553 (74%) did not receive any treatment and 1774 (85%) died in the first year after diagnosis. In contrast, only 193 (4%) of the 4414 women without any of these characteristics did not receive any treatment, and only 427 (9%) died in the first year after diagnosis. CONCLUSIONS: Although our results are based on data from England, they are likely to have implications for cancer care pathways worldwide because most of the identified factors are not specific to the UK health care system. Our results suggest the need to increase symptom awareness, promote timely general practitioner referral, and optimize diagnostic and early treatment pathways within secondary care to increase access to treatment for women with advanced-stage invasive epithelial ovarian, tubal, and primary peritoneal cancer. This process should be pursued alongside continued efforts to develop primary prevention and screening strategies.

Specialist surgery for ovarian cancer in England.

OBJECTIVE: The aim of this study is to evaluate the impact of the 1999 national recommendations for ovarian cancer surgery in England to be performed by specialist surgeons in specialist centres. METHODS: A retrospective analysis of English cancer registry records, Hospital Episode Statistics (HES) data for all English NHS providers and General Medical Council (GMC) sub-specialty accreditation, to consider changes to the annual proportion of ovarian cancer (ICD10 C56-C57) patients undergoing major gynaecological surgery in gynaecological cancer centres (GCCs) or by specialist gynaecological oncologists (GOs). RESULTS: From 2000 to 2009, 2428 consultants were responsible for surgery on 30,753 patients. There were significant increases in the proportions of patients undergoing surgery at GCCs (43% to 76%, P<0.001), by GMC accredited GOs (5% to 36%, P<0.001), and by high ovarian cancer caseload (≥18 cases) surgeons (22% to 56%, P<0.001). CONCLUSION: There have been increased centralisation and specialisation of surgery for ovarian cancer patients since the NHS Cancer Plan (2000) and there has also been improved survival. However, by 2009, many ovarian cancer patients were still not receiving specialist surgery; the majority of patients were not operated on by GMC accredited gynaecological oncologists and there was considerable regional variation. Systems of accreditation should be reviewed and trusts should ensure that HES data accurately records clinical activity.

Activity, safety, and feasibility of cidofovir and imiquimod for treatment of vulval intraepithelial neoplasia (RT³VIN): a multicentre, open-label, randomised, phase 2 trial.

BACKGROUND: Vulval intraepithelial neoplasia is a skin disorder affecting the vulva that, if left untreated, can become cancerous. Currently, the standard treatment for patients with vulval intraepithelial neoplasia is surgery, but this approach does not guarantee cure and can be disfiguring, causing physical and psychological problems, particularly in women of reproductive age. We aimed to assess the activity, safety, and feasibility of two topical treatments--cidofovir and imiquimod--as an alternative to surgery in female patients with vulval intraepithelial neoplasia. METHODS: We recruited female patients (age 16 years or older) from 32 centres to an open-label, randomised, phase 2 trial. Eligibility criteria were biopsy-proven vulval intraepithelial neoplasia grade 3 and at least one lesion that could be measured accurately. We randomly allocated patients to topical treatment with either 1% cidofovir (supplied as a gel in a 10 g tube, to last 6 weeks) or 5% imiquimod (one 250 mg sachet for every application), to be self-applied three times a week for a maximum of 24 weeks. Randomisation (1:1) was done by stratified minimisation via a central computerised system, with stratification by hospital, disease focality, and presentation stage. The primary endpoint was a histologically confirmed complete response at the post-treatment assessment visit 6 weeks after the end of treatment (a maximum of 30 weeks after treatment started). Analysis of the primary endpoint was by intention to treat. Secondary outcomes were toxic effects (to assess safety) and adherence to treatment (to assess feasibility). We present results after all patients had reached the primary endpoint assessment point at 6 weeks; 2-year follow-up of complete responders continues. This trial is registered with Current Controlled Trials, ISRCTN 34420460. FINDINGS: Between Oct 21, 2009, and Jan 11, 2013, 180 participants were enrolled to the study; 89 patients were randomly allocated cidofovir and 91 were assigned imiquimod. At the post-treatment assessment visit, a complete response had been achieved by 41 (46%; 90% CI 37·0-55·3) patients allocated cidofovir and by 42 (46%; 37·2-55·3) patients assigned imiquimod. After 6 weeks of treatment, 156 (87%) patients (78 in each group) had adhered to the treatment regimen. Five patients in the cidofovir group and seven in the imiquimod group either withdrew or were lost to follow-up before the first 6-week safety assessment. Adverse events of grade 3 or higher were reported in 31 (37%) of 84 patients allocated cidofovir and 39 (46%) of 84 patients assigned imiquimod; the most frequent grade 3 and 4 events were pain in the vulva, pruritus, fatigue, and headache. INTERPRETATION: Cidofovir and imiquimod were active, safe, and feasible for treatment of vulval intraepithelial neoplasia and warrant further investigation in a phase 3 setting. Both drugs are effective alternatives to surgery for female patients with vulval intraepithelial neoplasia after exclusion of occult invasive disease. FUNDING: Cancer Research UK.

Congenital hepatic cyst with antenatal diagnosis: a case report and literature review.

Congenital hepatic cysts are rare lesions of infancy. While operative management and outcomes have been extensively studied in adult patients with hepatic cysts, data in pediatric patients are limited. We discuss our experience in an infant and review relevant literature regarding operative technique and surgical outcomes.

General Surgery Resident Operative Experiences in Solid Organ Injury: An Examination of Case Logs.

BACKGROUND: Non-operative management (NOM) of traumatic solid organ injury (SOI) has become commonplace. This paradigm shift, along with reduced resident work hours, has significantly impacted surgical residents' operative trauma experiences. We examined ongoing changes in residents' operative SOI experience since duty hour restriction implementation, and assessed whether missed operative experiences were gained elsewhere in the resident experience. METHODS: We examined data from American College of Graduate Medical Education case log reports from 2003 to 2018. We collected mean case volumes in the categories of non-operative trauma, trauma laparotomy, and splenic, hepatic, and pancreatic trauma operations; case volumes for comparable non-traumatic solid organ operations were also collected. Solid organ injury operative volumes were compared against non-traumatic cases, and change over time was analyzed. RESULTS: Over the study period, both trauma laparotomies and non-operative traumas increased significantly (P < .001). In contrast, operative volumes for splenic, hepatic, and pancreatic trauma all significantly decreased (P < .001; P = .014; P < .001, respectively). Non-traumatic spleen cases also significantly decreased (P < .001), but liver cases and distal pancreatectomies increased (P < .001; P = .017). Pancreaticoduodenectomies increased, albeit not to a significant degree (P = .052). CONCLUSIONS: Continuing increases in NOM of SOI correlate with declining resident experience with operative solid organ trauma. These decreases can adversely affect residents' technical skills and decision-making, although trends in specific non-traumatic areas may help to mitigate such losses. Further work should determine the impact of these trends on resident competence and autonomy.