Morphology and molecular evidence of a new species of Characidium (Characiformes: Crenuchidae) from the edges of a protected area at Rio Itararé, upper Rio Paraná, southern Brazil.

A new species of Characidium is described from the headwaters of the Rio Itararé, upper Rio Paraná basin, at the boundaries of the Ponta Grossa Arch and the Devonian Escarpment Environmental Protection Area. The new species is supported by both morphological and molecular data, including species delimitation methods (Assemble Species by Automatic Partitioning, Barcode Index Number, Poisson Tree Process and its Bayesian implementation, and Generalized Mixed Yule Coalescent). The species is genetically close to other species that also exhibit the presence of scales on the isthmus, including Characidium litorale, Characidium satoi, Characidium xanthopterum, and Characidium aff.

Ornamental fish mortality reveals an old parasite introduction: A case study of Koi carp and fish louse.

Koi carp are globally known for their colors and cultural significance. The introduction of these fish to new environments poses a threat to local biodiversity, in addition to releasing parasites, such as argulid ectoparasites. This study presents a record of Argulus japonicus infecting carp in an artificial lake in Southern Brazil using morphological and molecular methods, with a 100% prevalence (n = 3) and a mean intensity of 21.

The first record of Centrocestus formosanus (Trematoda: Heterophyidae) in southern Brazil supported by molecular data.

Centrocestus formosanus is a digenean parasite first described from Asia, which parasitizes Melanoides tuberculata (Gastropoda: Thiaridae) at the first intermediate stage, and different fish species as second intermediate host. C. formosanus was previously recorded in Brazilian states, but never before in the southern region of this country.

Molecular evidence of new freshwater turtle blood flukes (Digenea: Spirorchiidae) in the intermediate snail host Biomphalaria occidentalis Paraense, 1981 in an urban aquatic ecosystem in Brazil.

In this study, two potentially new species of turtle blood flukes (TBFs) (Digenea: Spirorchiidae) have been recorded from South Brazil. The spirorchiid parasites infect the vascular system of turtles, thereby compromising their health. The life cycle of these parasites is not well studied.

The Persisting Importance of Rhetoric and Equity in Health Policy and Outcomes.

This editorial considers the persisting importance of rhetoric and equity in health policy analysis, implementation, and outcomes. It argues that employing social determinants of health, and intersectional and rhetorical frames, can improve life and health outcomes, as measured by morbidity and mortality. The pertinence of these frames with regard to the crises brought on by the COVID-19 pandemic is discussed, and the plan for a special issue on disparties and COVID-19 is announced.

Mothers' beliefs about indigenous and traditional food affordability, availability and taste are significant predictors of indigenous and traditional food consumption among mothers and young children in rural Kenya.

Objective: To examine mothers' and young children's consumption of indigenous and traditional foods (ITF), assess mothers' perception of factors that influence ITF consumption, and examine the relationship between perceived factors and ITF consumption.

Design: Longitudinal study design across two agricultural seasons. Seven-day FFQ utilized to assess dietary intake.

Surgical malpractice in California: res judicata.

Medical negligence claims are of increasing concern to surgeons. Although noneconomic damage awards in California are limited by the Medical Injury Compensation Reform Act (MICRA) law to $250,000, the total amount of such settlements can increase significantly based on claims for economic damages. We reviewed negligence litigation involving California surgeons to determine outcomes and monetary awards through retrospective review of surgical malpractice cases published in a legal journal.

Duodenal adenocarcinoma: why the extreme rarity of duodenal bulb primary tumors?

Adenocarcinoma of the small bowel accounts for only one per cent of all gastrointestinal malignancies. Duodenal adenocarcinoma accounts for half of all small bowel adenocarcinomas. The duodenum is divided into four segments: D1 (proximal horizontal 5 cm beginning with the 3-cm duodenal bulb), D2 (descending), D3 (distal horizontal), and D4 (ascending).

Senior residents as teaching assistants during laparoscopic cholecystectomy in the 80-hour workweek era: effect on biliary injury and overall complication rates.

Purpose: The resident as teaching assistant (TA) in the operating room is an important role in the maturation of surgical trainees. One concern in the current 80-hour workweek era is that current senior residents (SRs) are unprepared to serve as TAs, potentially leading to higher complication rates and a significant increase in the length of operations. The aim of this study was to analyze whether SRs serving as TAs during laparoscopic cholecystectomy (LC) resulted in an adverse effect on complication rates in the 80-hour workweek era.

Choledochoduodenostomy as the biliary-enteric bypass of choice for benign and malignant distal common bile duct strictures.

Choledochoduodenostomy (including hepaticoduodenostomy) for common bile duct (CBD) strictures has been underused because of concerns regarding postoperative duodenal fistula and cholangitis attending the so-called "sump syndrome." An institutional retrospective review of 55 consecutive choledochoduodenostomy procedures for CBD strictures from 1995 to 2011 was performed to examine its suitability as the biliary-enteric bypass procedure of choice. There were 30 male (55%) and 25 female (45%) patients with a mean age of 49 years (range, 13 to 73 years).

The unequal distribution of parathyroid neoplasms in male patients.

There is a known lesser incidence of primary hyperparathyroidism and parathyroid neoplasms in male patients. Any difference in the anatomic distribution between males and females has not been documented. Review of our institutional experience with 125 pathologically confirmed parathyroid adenomas (119) or carcinomas (six) from 2000 through 2012 was conducted.

Laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy achieve comparable weight loss at 1 year.

Laparoscopic sleeve gastrectomy has gained popularity as a weight loss surgical option for morbidly obese patients. Although initial studies have shown weight loss and comorbidity resolution comparable to those after laparoscopic Roux-en-Y gastric bypass (RYGB), many of these studies are limited by the small patient size. Thus, the purpose of this study was to compare the outcomes of laparoscopic sleeve gastrectomy and laparoscopic RYGB.

Effect of socioeconomic status on surgery for pancreatic adenocarcinoma.

Survival for pancreatic cancer remains poor. Surgical resection remains the only chance for cure. The intent of this study was to investigate the role of socioeconomic status (SES) on resection rates for pancreatic adenocarcinoma.

Early laparoscopic cholecystectomy for mild gallstone pancreatitis: time for a paradigm shift.

HYPOTHESIS Patients with mild gallstone pancreatitis may undergo an early laparoscopic cholecystectomy (LC) within 48 hours of hospital admission without awaiting the normalization of pancreatic and liver enzyme levels. This may decrease the hospital stay without increasing morbidity or mortality and may minimize the unnecessary use of endoscopic retrograde cholangiopancreatography. DESIGN A retrospective review.

Preoperative serum albumin but not prealbumin is an excellent predictor of postoperative complications and mortality in patients with gastrointestinal cancer.

Preoperative serum albumin level is well recognized as a general predictor of adverse surgical outcomes in patients with gastrointestinal (GI) malignancy. Whether serum albumin or prealbumin levels can better predict postoperative surgical complications and death remains unknown. A retrospective review of 641 consecutive patients operated nonemergently for GI malignancies between January 1, 1997, and July 31, 2008, disclosed that 104 patients (16.

Fluorescence in situ hybridization and K-ras analyses improve diagnostic yield of endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic masses.

Objectives: Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) is the main diagnostic modality for pancreatic mass lesions. However, cytology is often indeterminate, leading to repeat FNAs and delay in care. Here, we evaluate whether combining routine cytology with fluorescence in situ hybridization (FISH) and K-ras/p53 analyses improves diagnostic yield of pancreatic EUS-FNA.

Staining for p53 and Ki-67 increases the sensitivity of EUS-FNA to detect pancreatic malignancy.

Aim: To investigate whether tumor marker staining can improve the sensitivity of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) to diagnose pancreatic malignancy.

Methods: Patients who underwent EUS-FNA were retrospectively identified. Each EUS-FNA specimen was evaluated by routine cytology and stained for tumor markers p53, Ki-67, carcinoembryonic antigen (CEA) and CA19-9.

Use of clinical triage criteria decreases monitored care bed utilization in gallstone pancreatitis.

Admission indicators for monitored care in gallstone pancreatitis have been lacking. Recently, we established three criteria for admission to intensive care unit or step down versus ward beds: (1) concomitant cholangitis, (2) heart rate >110 beats/min, and (3) blood urea nitrogen >15 mg/dL. The purpose of this study was to determine whether these criteria would be effective in decreasing monitored care bed utilization without adversely affecting outcomes.

Solid pseudopapillary neoplasm of the pancreas: a rare and atypically aggressive disease among male patients.

Solid pseudopapillary neoplasm (SPN) of the pancreas is uncommon, has low metastatic potential, typically afflicts young females, and expresses progesterone receptors. In the rare male patient, its biologic behavior may be more aggressive and lethal. A retrospective case series analysis and literature review of SPN was performed to compare its clinical behaviors in males and females.

Acute care surgery performed by sleep deprived residents: are outcomes affected?

Background: The Institute of Medicine recently recommended further reductions in resident duty hours, including a 5-h rest time for on-call residents after 16 h of work. This recommendation was purportedly intended to better protect patients against fatigue-related errors made by physician trainees. Yet no data are available regarding outcomes of operations performed by surgical trainees working without rest beyond 16 h in the current 80-h workweek era.

Early cholecystectomy safely decreases hospital stay in patients with mild gallstone pancreatitis: a randomized prospective study.

Objective: We hypothesized that laparoscopic cholecystectomy performed within 48 hours of admission for mild gallstone pancreatitis, regardless of resolution of abdominal pain or abnormal laboratory values, would result in a shorter hospital stay.

Summary Of Background Data: Although there is consensus among surgeons that patients with gallstone pancreatitis should undergo cholecystectomy to prevent recurrence, the precise timing of laparoscopic cholecystectomy for mild disease remains controversial.

Methods: Consecutive patients with mild pancreatitis (Ranson score View Article and Find Full Text PDF

Narrowing the gap: early and intermediate outcomes after percutaneous coronary intervention and coronary artery bypass graft procedures in California, 1997 to 2006.

Objective: Percutaneous coronary intervention is increasingly used to treat multivessel coronary artery disease. Coronary artery bypass graft procedures have decreased, and as a result, percutaneous coronary intervention has increased. The overall impact of this treatment shift is uncertain.

What's the matter with Kansas? Legislative debates over stem cell research in Kansas and Massachusetts.

This paper examines the contextual factors shaping legislative debates affecting stem cell research in two states, Kansas and Massachusetts, which both permit therapeutic cloning for stem cell research but markedly vary in their legislative approach to the issue. In Kansas, restrictive legislation was proposed but effectively blocked by research proponents, while in Massachusetts permissive legislation was successfully implemented under the auspices of an act to promote stem cell research. The importance of university and industry involvement is highlighted in each case, as are the roles of enterprising and persistent policy entrepreneurs.