Exodus 21–22

Parallels between Exod 21:18–22:16 and the law collections from Mesopotamia have long prompted scholars to classify the biblical unit as belonging to the same genre. Compared to the Near Eastern law collections, however, Exod 21:18–22:16 is far more narrowly focused, disjointed, and ambiguous than its cuneiform counterparts. There may be a closer Mesopotamian analogue to Exod 21:18–22:16 than the law collections. Mesopotamian scribes occasionally copied a limited series of laws in the context of their education, such as the Laws about Rented Oxen or the Sumerian Laws Exercise Tablet. These provisions were limited in scope, related to the law collections but not excerpts, and marked by disjointedness and ambiguities. Given the parallels between Exod 21:18–22:16 and these legal-pedagogical exercises, it appears that the biblical unit is rooted in an analogous type of legal-pedagogical exercise.

Contemporary knee arthroplasty: one fits all or time for diversity?

Introduction Total knee arthroplasty (TKA) has historically been the preferred solution for any type of knee osteoarthritis, independently of the number of compartments involved. In these days of patient-specific medicine, mono-compartmental disease could also be approached with a more individualized treatment, such as partial knee arthroplasty (PKA). Off-the-shelf (OTS) implants are often the compromise of averages and means of a limited series of anatomical parameters retrieved from patients and the pressure of cost control by limited inventory. Personalized medicine requires respect and interest for the individual shape and alignment of each patient. Materials and methods A Pubmed and Google Scholar search were performed with the following terms: “patient-specific knee” and “arthroplasty” and “custom implant” and “total knee replacement” and “partial knee replacement” and “patellofemoral knee replacement” and “bicompartmental knee replacement”. The full text of 90 articles was used to write this narrative review. Results Unicondylar, patellofemoral and bicompartmental knee arthroplasty are successful treatment options, which can be considered over TKA for their bone and ligament sparing character and the superior functional outcome that can be obtained with resurfacing procedures. For TKA, where compromises dominate our choices, especially in patients with individual variations of their personal anatomy outside of the standard, a customized implant could be a preferable solution. Conclusion TKA might not be the only solution for every patient with knee osteoarthritis, if personalized medicine wants to be offered. Patient-specific mono-compartmental resurfacing solutions, such as partial knee arthroplasty, can be part of the treatment options proposed by the expert surgeon. Customized implants and personalized alignment options have the potential to further improve clinical outcome by identifying the individual morphotype and respecting the diversity of the surgical population.

El México que no fue: The Tentative Retelling of Luis Donaldo Colosio’s Assassination

On the occasion of the 25th anniversary of his death in 2019, Netflix released two limited series focused on Mexican presidential candidate Luis Donaldo Colosio and his assassination. 1994 (directed by Diego Enrique Osorno) and Crime Diaries: The Candidate (Historia de un crimen: Colosio, directed by Hiromi Kamata and Natalia Beristáin) are, respectively, a documentary series and a drama, both delving into the political conjuncture surrounding both Colosio’s candidacy and the investigations subsequent to his assassination. Since his dramatic death, the image of Colosio has maintained its associations with heroism and his unrealized presidency has come to embody the “México que no fue,” a radically innovated Mexican state that never was and, possibly, will never be. Both series rely on the exploitation of original footage and underlying political takes on the events. This analysis will critically compare the two series from three main thematic perspectives: the Mexican political context at the time of the assassination; Colosio’s characterization and private life; and the procedural aspects of the investigations.

Transvenous lead revision for cardiac perforation: a single centre experience

Funding Acknowledgements Type of funding sources: None. Background Cardiac perforation is an uncommon but life-threatening complication of cardiac implantable electronic device (CIED) implantation. Management strategy commonly relies on diagnostic Computed Tomography (CT) imaging and cardiac surgery. Emerging evidence has indicated a diversion from this approach. Transvenous culprit lead revision has been shown to be safe and efficacious in limited series. We sought to evaluate the outcomes of transvenous lead revision in patients with cardiac perforation. Method Data was collected retrospectively of patients admitted to a single tertiary centre with CIED-related cardiac perforation between December 2013 – October 2019. Transvenous lead revision was performed as standard with cardiac surgery on standby. Patient demographics, use of CT imaging, method of removal and 30-day outcomes were recorded. Results Of the 46 recorded CIED-related cardiac perforations, the majority occurred in female patients (63%) and hypertensives (61%), whilst a proportion had cancer (20%) and ischaemic heart disease (30%). The culprit in most cases was a standard pacing lead (92%) of an active fixation (98%) in the right ventricle (80%) positioned at the ventricular apex (65%). The median time to presentation from implant was 14 days [IQR 4-50 days] with chest pain (44%); abnormal pacing indices was highly prevalent (95%) whilst a pericardial effusion was noted in the majority of cases (57%). CT scanning was performed in 19 cases (41%) for various indications but deemed essential in only 4, all of which had non-diagnostic pacing indices and imaging. Chest X-ray (CXR) found clear perforation, lead displacement or pleural effusion in 74% of cases, whilst an echocardiogram found these in 64% of cases. The culprit lead was replaced in the majority of cases (87%) under local anaesthesia (76%) with surgical backup. The median hospital stay was 7 days [IQR 3-10 days] with zero procedural and 30-day mortality. Conclusion Transvenous lead revision for CIED-related cardiac perforation is safe and efficacious. CT modality for diagnostic purposes is useful in providing incremental value in a minority of cases; patients with non-diagnostic pacing parameters and non-CT imaging benefit most from this.

Dural Contact to the Malleus Head in Patients with Superior Semicircular Canal Dehiscence (SSCD): Case Series and Review of SSCD and Tegmen Defects

Objective: Report a series of cases in which patients have concomitant superior semicircular canal dehiscence (SSCD) and a dehiscent tegmen tympani with Dural contact to the malleus head (DCMH). Methods: An analysis of radiologic and audiologic data in 4 patients who presented with SSCD and DCMH at a tertiary care institution. A pertinent literature review was performed. Results: Four patients (5 ears) had SSCD and DCMH. In 3 patients with unilateral DCMH, the mean maximum air-bone gap was 15 dB in the ear with DCMH compared to 50 dB in the ear without DCMH. Of the 5 ears with DCMH, the mean air conduction threshold at 250 Hz was 17 dB compared to 42 dB in the 3 ears without DCMH. Conclusions: We report the findings of DCMH in a series of 4 patients with bilateral SSCD. This limited series suggests that ears with SSCD and DCMH have less of an air-bone gap than would be expected, as 1 would expect an additive effect of DCMH and SSCD on the air-bone gap.

Modification of the Marquardt method for training a neural network predictor in eddy viscosity models

The subject of this article is the numerical optimization techniques used in training neural networks that serve as predicate components in certain modern eddy viscosity models. Qualitative solution to the problem of training (minimization of the functional of neural network offsets) often requires significant computational costs, which necessitates to increase the speed of such training based on combination of numerical methods and parallelization of calculations. The Marquardt method draws particular interest, as it contains  the parameter that allows speeding up the solution by switching the method from the descent away from the solution to the Newton’s method of approximate solution. The article offers modification of the Marquardt method, which uses the limited series of random samples for improving the current point and calculate the parameter of the method. The author demonstrate descent characteristics of the method in numerical experiments, both on the test functions of Himmelblau and Rosenbrock, as well as the actual task of training the neural network predictor applies in modeling of the turbulent flows. The use of this method may significantly speed up the training of neural network predictor in corrective models of eddy viscosity. The method is less time-consuming in comparison with random search, namely in terms of a small amount of compute kernels; however, it provides solution that is close to the result of random search and is better than the original Marquardt method.

Abstract 14685: Long-term Outcomes of Aortic Body Tumors: A Nationwide Study

Introduction: Aortic body tumors are rare intrathoracic tumors. The majority of existing literature for aortic body tumors exists as case reports or a limited series. Our aim was to analyze a large national database, providing a contemporary view of this cancer. Methods: The national cancer database, which includes data from 1,500 cancer centers was queried to retrospectively review all aortic body tumors between 2004 and 2015. The cohort was divided into patients who underwent surgery versus those who were treated with chemotherapy or radiation. Cohorts were assigned a year range based on when they were diagnosed. Survival between these cohorts were compared using Kaplan-Meier survival estimates. Cox multivariable analysis was performed using baseline variables (age, year range, metastasis, surgery, radiation, and chemotherapy). Overall survival of the cohort was analyzed via Kaplan-Meier survival estimates. Results: A total of 87 patients who were diagnosed with an aortic body tumor were identified. The mean age was 51 ± 15.7 years and the majority of patients were female (51.7%). Most patients were treated at an academic/research center (62.7%) or a comprehensive community cancer program (25.4%). A significant portion of patients (19.5%) had metastatic disease on diagnosis. The treatment modalities utilized were surgery (54%), radiation (44.8%), and chemotherapy (20.7%). Long-term survival was 35.5% with a median survival of 8.25 years (Figure 1A) . Overall survival was significantly higher in the surgery cohort (p<0.001) (Figure 1B) . On Cox multivariable analysis (Figure 1C) , surgery (HR 0.32, p=0.01) was associated with increased survival. An independent predictor of mortality was having a metastasis on diagnosis (HR 8.49, p=0.001). Conclusion: The overall prognosis of aortic body tumors is poor, with metastasis on presentation significantly increasing mortality. Surgery provides a substantial benefit to these patients; however, this may be a result of selection bias. Aggressive surveillance in predisposed populations may be warranted given the grave prognosis once metastasis occurs.

Salvage DC ablation of ventricular tachycardia following failed RF attempts

Background Ablation of ventricular tachycardia (VT) is a frequent clinical necessity. Modification of ventricular substrate can usually be achieved by radiofrequency ablation (RF). We present 4 cases of failed RF for recurrent VT. Two patients had multiple RF failures, one patient had in-procedure failure, and one patient had multiple RF attempts and a failed alcohol ablation (pt4). Objective To evaluate success of DC ablation after failed RF Methods A 6 Fr 4mm tip steerable ablation catheter, was placed at the site felt to be critical for the circuit following mapping (earliest activation, mid-diastolic, fractionated, site of concealed entrainment, or ventricular breakout). Two connection cables were utilized, one to the recording/mapping system, and one connected to an external biphasic defibrillator (DC). The DF was connected with one pad anterior chest and the other connected by the cable to electrode pins 1 and 2 folded within the second pad. The electrodes were secured by placing a hemostat on the pad. DC energy (360j) was delivered synchronized by electrodes 1–2 Results During follow-up 3 months to 1 year, no recurrent VT was observed. 3 patients received a total of 4 DC pulses, while the pt4 received 16 (RV and LV septum), complicated by prolonged hypotension. No other complications were observed. Figure shows broad RV breakout from the septum in pt4. Conclusion In patients with RF refractory VT, DC ablation may be safely used and in this limited series, provides long-term success. Interestingly, biphasic energy did not induce transient hypotension in 3 of 4 pts. DC ablation should be considered following failed RF, especially when mid-myocardial origin suspected. Funding Acknowledgement Type of funding source: None

A non-conventional proximal inflow for the radial artery coronary graft

Despite good outcomes, the use of the radial artery as a coronary graft is not widespread. Concerns regarding its low versatility and the risk of hand ischaemia, as well as the lack of reliable information regarding the best storage solution of the graft, and regarding the treatment for preventing spasms have limited its use. In this manuscript, the (numerous) benefits and (few) drawbacks of the proximal inflow for the radial artery from the in situ right internal thoracic artery proximal stump are discussed. Outcomes are reported from a limited series of patients undergoing totally arterial myocardial revascularization using this composite graft and both internal thoracic arteries.

Infarct-Like Spindle Cell Carcinoma of the Lung: Clinicopathologic, Immunohistochemical, and Molecular Analysis of 4 Cases

Pulmonary spindle cell carcinoma is a rare and aggressive malignancy that often mimics benign conditions. We report 4 cases that simulate a pulmonary infarction, 2 of which were misdiagnosed. Patients were 3 men and 1 woman, smokers, presenting chest pain. All cases appeared as pleural-based, solitary, and rounded nodules. Patients underwent wedge resections followed by adjuvant chemotherapy (3/4) but died of disease. At histology, lesions consisted of widely necrotic nodules surrounded by organizing fibrosis and pleuritis. Examination and immunostains with pan-cytokeratins and epithelial membrane antigen (EMA) revealed atypical spindle cells encircling necrotic tissue and involving the vascular wall. Positive staining with PD-L1 was noted. Molecular analysis showed KRAS (2/4) and TP53 (1/4) mutations, whereas EGFR, ALK, and ROS1 alterations were not detected. Although in a limited series, these cases further evidence the treacherous appearance of spindle cell carcinomas and the need for careful attention when examining pulmonary infarcted tissue, thus requiring extensive sampling, meticulous examination of vascular structures, and immunostaining with cytokeratins.