Artificial Intelligence Assistance in Point-of-Care Ultrasound Skill Retention for Novice Users in Space Medicine Scenarios.

Introduction: As humanity progresses further into space, astronauts must be increasingly independent from mission control, especially in high-consequence medical scenarios. The high-utility and low-mass nature of point-of-care ultrasound (POCUS) makes this imaging modality ideal for spaceflight mission deployment. However, POCUS operator skill degrades over time, presenting an operational barrier to continuous, effective use.

Uncommon Anal Cancers.

Anal cancer is by itself a rare entity. Even rarer are the uncommon anal tumors described in this article. Diagnosis of these lesions can be challenging as some of these have no symptoms in their initial stages and only cause symptoms once they have progressed to advanced stages.

School food programmes in the Pacific Islands: exploring opportunities and challenges for creating healthier school food environments.

Objective: The school setting can provide an environment that supports healthy behaviours, including the provision of food. School food activities, that is, school feeding, are commonplace globally, but not well understood in the Pacific Islands region. The aim of this research is to explore learnings associated within existing school food programmes (SFP), and adoption resistors in those Pacific Island Countries and Territories (PICT) without SFP, with the intent of improving current and future SFP interventions.

Galunisertib plus neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer: a single-arm, phase 2 trial.

Background: TGF-β is an immunosuppressive cytokine that is upregulated in colorectal cancer. TGF-β blockade improved response to chemoradiotherapy in preclinical models of colorectal adenocarcinoma. We aimed to test the hypothesis that adding the TGF-β type I receptor kinase inhibitor galunisertib to neoadjuvant chemoradiotherapy would improve pathological complete response rates in patients with locally advanced rectal cancer.

Food literacy in Pacific Island countries: a scoping review protocol.

Objective: The aim of this scoping review is to identify how food literacy is characterized and measured in the context of the Pacific Islands, and describe food literacy initiatives that may inform future policy, practice, and research.

Introduction: "Food literacy" is an emerging term used to describe the knowledge, skills, and behaviors required from individuals, households, communities, or nations to make healthy food choices. Given the complexity of changing food systems and the significant health challenges facing Pacific Island communities, understanding the evidence on food literacy in these communities may contribute to ensuring adequate nutrition for this population.

Transanal total mesorectal excision outcomes for advanced rectal cancer in a complex surgical population.

Background: Total mesorectal excision (TME) is the gold standard for oncologic resection in low and mid rectal cancers. However, abdominal approaches to TME can be hampered by poor visibility, inadequate retraction, and distal margin delineation. Transanal TME (taTME) is a promising hybrid technique that was developed to mitigate the difficulties of operating in the low pelvis and to optimize the circumferential resection and distal margins.

TGFβ suppresses CD8 T cell expression of CXCR3 and tumor trafficking.

Transforming growth factor beta (TGFβ) is a multipotent immunosuppressive cytokine. TGFβ excludes immune cells from tumors, and TGFβ inhibition improves the efficacy of cytotoxic and immune therapies. Using preclinical colorectal cancer models in cell type-conditional TGFβ receptor I (ALK5) knockout mice, we interrogate this mechanism.

A δ2H Isoscape of blackberry as an example application for determining the geographic origins of plant materials in New Zealand.

In this investigation, two previously reported precipitation δ2H isoscapes for New Zealand were used to develop a δ2H isoscape for blackberry (Rubus sp.) leaf. These isoscapes were calibrated using the measured δ2H values of 120 authentic blackberry leaf samples collected from across the country.

P NMR-Based Phospholipid Fingerprinting of Powdered Infant Formula.

Infant formula (IF), regarded as the optimal substitute for human breast milk, is very important for infant growth and development. Phospholipids (PLs) are ubiquitous components of infant formula as they have good emulsifier properties in addition to their nutritional and biological functions. In this study, the PL contents in four different commercial IF brands (indicated as A, M, O, and W) were characterized and quantified using optimized P NMR spectroscopy.

Enhanced Recovery After Surgery in Community Hospitals.

Multidisciplinary collaboration and administrative support are essential to enhanced recovery program (ERP) success. The key tenets for ERP are opiate-sparing pain regimen, decreased fasting, and minimizing intravenous fluids. Getting buy-in from community surgeons may be difficult due to varied practice patterns and clinical fragmentation.

Benefit of Postresection Adjuvant Chemotherapy for Stage III Colon Cancer in Octogenarians: Analysis of the National Cancer Database.

Background: Clinical trials demonstrate that postresection chemotherapy conveys survival benefit to patients with stage III colon cancer. It is unclear whether this benefit can be extrapolated to the elderly, who are underenrolled in clinical trials.

Objective: The purpose of this study was to determine outcomes of selected octogenarians with stage III colon cancer with/without postresection adjuvant therapy.

The Dual Syk/JAK Inhibitor Cerdulatinib Antagonizes B-cell Receptor and Microenvironmental Signaling in Chronic Lymphocytic Leukemia.

B-cell receptor (BCR)-associated kinase inhibitors, such as ibrutinib, have revolutionized the treatment of chronic lymphocytic leukemia (CLL). However, these agents are not curative, and resistance is already emerging in a proportion of patients. IL4, expressed in CLL lymph nodes, can augment BCR signaling and reduce the effectiveness of BCR kinase inhibitors.

Outcomes with multimodal therapy for elderly patients with rectal cancer.

Background: Treatment guidelines for stage II and III rectal cancer include neoadjuvant chemoradiotherapy, surgery and postoperative adjuvant chemotherapy. Although data support this recommendation in younger patients, it is unclear whether this benefit can be extrapolated to elderly patients (aged 75 years or older).

Methods: This was a retrospective review of patients aged at least 75 years with stage II or III rectal cancer who underwent surgery with curative intent from 1996 to 2013 at the Mayo Clinic.

Is Chemotherapy or Radiation Therapy in Addition to Surgery Beneficial for Locally Advanced Rectal Cancer in the Elderly? A National Cancer Data Base (NCDB) Study.

Introduction: Current National Comprehensive Cancer Network guidelines for Stages II and III rectal cancer recommend neoadjuvant chemoradiation followed by curative intent surgery and adjuvant chemotherapy. It is unclear whether therapies in addition to surgery are truly beneficial in elderly patients. Our aim was to compare the survival of patients over 80 with Stages II and III rectal cancer undergoing curative intent surgery with or without additional therapy.

Compound-specific isotope analysis of diesel fuels in a forensic investigation.

Compound-specific isotope analysis (CSIA) offers great potential as a tool to provide chemical evidence in a forensic investigation. Many attempts to trace environmental oil spills were successful where isotopic values were particularly distinct. However, difficulties arise when a large data set is analyzed and the isotopic differences between samples are subtle.

Sample size requirements to estimate key design parameters from external pilot randomised controlled trials: a simulation study.

Background: External pilot or feasibility studies can be used to estimate key unknown parameters to inform the design of the definitive randomised controlled trial (RCT). However, there is little consensus on how large pilot studies need to be, and some suggest inflating estimates to adjust for the lack of precision when planning the definitive RCT.

Methods: We use a simulation approach to illustrate the sampling distribution of the standard deviation for continuous outcomes and the event rate for binary outcomes.

Using a modification of the Clavien-Dindo system accounting for readmissions and multiple interventions: defining quality for pancreaticoduodenectomy.

Background: The Clavien-Dindo system (CD) does not change the grade assigned a complication when multiple readmissions or interventions are required to manage a complication. We apply a modification of CD accounting for readmissions and interventions to pancreaticoduodenectomy (PD).

Methods: PDs done between 1999 and 2009 were reviewed.

Ethical decision-making in the dilemma of the intersex infant.

The Making Ethical Decisions about Surgical Intervention (MEDSI) tool is designed to guide health care professionals, patients, and families faced with ethically charged decisions regarding surgical interventions for pediatric patients. MEDSI is built on the principles of beneficence, nonmaleficence, and patient autonomy and created to promote truth-telling, compassion, respect for patient cultural and religious preferences, and appropriate follow up in the clinical setting. Following an overview of the 8 steps that compose MEDSI, the tool is applied to the management of intersex infants.

Correlation of geographical location with stable isotope values of hydrogen and carbon of fatty acids from New Zealand milk and bulk milk powder.

The aim of this study was to investigate the correlation of δ²H and δ¹³C of bulk milk powder and milk powder fatty acids to their production region. A total of 46 milk powder samples from across New Zealand were collected and analyzed. Principal component analysis (PCA) showed that the δ²H and δ¹³C of four fatty acids (C4:0, C14:0, C16:0, C18:1) and bulk milk powder were found to be correlated with regional production area.

Colonoscopy is high yield in spinal cord injury.

Objectives/background: Colorectal cancer (CRC) can be prevented by routine colonoscopy. CRC screening in special populations, e.g.

Severe everolimus-induced steatohepatis: a case report.

The mammalian target of rapamycin inhibitors are normally favored as immunosuppressant agents for solid organ transplantation such as kidney, liver or heart. Only in recent years have they been increasingly administered for the treatment of neuroendocrine tumors. Even though mammalian target of rapamycin inhibitors are known to exhibit specific side effects, everolimus-related severe hepatic steatosis has not as yet been described in the literature.