Ballardholmberg6854

A 7-day old term neonate with D-malposition of great arteries, large perimembranous ventricular septal defect (almost single ventricle), without pulmonary stenosis was admitted with cyanosis and congestive heart failure. ECG revealed supraventricular tachycardia with alternating QRS axis with every beat. We discuss our approach to this scenario, which leads us to a rather rare cause of changing QRS morphology.The spatial correlation between defects in crystalline materials and trace element segregation plays a fundamental role in determining the physical and mechanical properties of a material, which is particularly important in naturally deformed materials. Herein, we combine electron backscatter diffraction, electron channelling contrast imaging, scanning transmission electron microscopy and atom probe tomography on a naturally occurring metal sulphide in an attempt to document mechanisms of element segregation in a brittle-dominated deformation regime. Within APT reconstructions, features with a high point density comprising O-rich discs stacked over As-rich spherules are observed. The combined microscopy data allow us to interpret these as nanoscale fluid inclusions. Our observations are confirmed by simulated APT experiments of core-shell particles with a core exhibiting a very low evaporation field and the shell emulating a segregated layer at the inclusion interface. Our data has significant trans-disciplinary implications to the geosciences, the material sciences, and analytical microscopy.

Critical thyroid nodule features are contained in unstructured ultrasound (US) reports. The Thyroid Imaging, Reporting, and Data System (TI-RADS) uses five key features to risk stratify nodules and recommend appropriate intervention. This study aims to analyze the quality of US reporting and the potential benefit of Natural Language Processing (NLP) systems in efficiently capturing TI-RADS features from text reports.

This retrospective study used free-text thyroid US reports from an academic center (A) and community hospital (B). Physicians created "gold standard" annotations by manually extracting TI-RADS features and clinical recommendations from reports to determine how often they were included. Similar annotations were created using an automated NLP system and compared with the gold standard.

Two hundred eighty-two reports contained 409 nodules at least 1-cm in maximum diameter. The gold standard identified three nodules (0.7%) which contained enough information to calculate a complete TI-RADS score. Shape was described most often (92.7% of nodules), whereas margins were described least often (11%). A median number of two TI-RADS features are reported per nodule. The NLP system was significantly less accurate than the gold standard in capturing echogenicity (27.5%) and margins (58.9%). One hundred eight nodule reports (26.4%) included clinical management recommendations, which were included more often at site A than B (33.9 versus 17%, P<0.05).

These results suggest a gap between current US reporting styles and those needed to implement TI-RADS and achieve NLP accuracy. Synoptic reporting should prompt more complete thyroid US reporting, improved recommendations for intervention, and better NLP performance.

These results suggest a gap between current US reporting styles and those needed to implement TI-RADS and achieve NLP accuracy. Synoptic reporting should prompt more complete thyroid US reporting, improved recommendations for intervention, and better NLP performance.

Assessment of preoperative handgrip strength (HGS) is an objective and inexpensive bedside tool, which has been investigated to predict morbidity risk in elective surgery. However, its use is not validated in patients undergoing major elective hepatobiliary surgery (MEHS). Afatinib mw The aim of this study is to investigate the use of HGS to predict morbidity in patients undergoing MEHS.

This is a single-center prospective study involving 81 patients who underwent MEHS over 21mo from July 2014 to March 2016. MEHS was defined as any hepatobiliary surgery expected to last more than 2h and/or with an anticipated blood loss of ≥500mL. HGS was assessed in both dominant and nondominant hands with standardization and subsequently recorded and expressed as a percentage of a general, age- and gender-matched normative values.

The mean age was 65.2±9.5y with male predominance (n=52, 64.2%). Approximately, half of the patients underwent liver resection (n=43, 53.1%). There was no difference in the incidence of Clavien-Dindo≥grade IIIA in both dominant HGS (impaired HGS 8/33 [24.2%], normal HGS 6/48 [12.5%]; P=0.170) and nondominant HGS (impaired HGS 8/33 [21.1%], normal HGS 6/43 [14%]; P=0.399). Dominant and nondominant HGS showed poor discriminatory ability in the prediction of Clavien-Dindo≥grade IIIA complications (dominant HGS area under the curve [AUC]=0.572; nondominant HGS AUC 0.545). However, the use of dominant HGS showed moderate discriminatory ability to predict the length of hospital stay ≥21d (AUC=0.759).

The use of HGS may not predict Clavien-Dindo≥grade IIIA complications, but predicts a prolonged length of hospital stay ≥21d.

The use of HGS may not predict Clavien-Dindo ≥ grade IIIA complications, but predicts a prolonged length of hospital stay ≥21 d.

Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a promising technique for eliminating a neck incision. A new risk of TOETVA is the potential for injury to the mental nerves during placement of three oral endoscopic ports. A better understanding of the variations in mental nerve anatomy is needed to inform safer TOETVA technique.

We performed 120 dissections of mental nerve branches exiting the mental foramen in 60 human cadavers. Anatomic distances and relationships of the foramen to the midline were evaluated. Mental nerve branching patterns were studied and compared with previously reported classification systems to determine surgical safe zones free of nerve branches.

The mean midline-to-mental foramen distance was 29.2±3.3mm, with high variability across individuals (18.8-36.8mm). There were differences in this distance between the left and right foramina (29.8±3.2 versus 28.8±3.3mm, P=0.03). All mental nerve branches exiting the mental foramen distributed medially. The branching patterns were classified into eight distinct categories, three of which are previously undescribed.