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1.
Nat Commun ; 15(1): 550, 2024 Jan 16.
Article in English | MEDLINE | ID: mdl-38228584

ABSTRACT

Symmetry-protected topological crystalline insulators (TCIs) have primarily been characterized by their gapless boundary states. However, in time-reversal- ([Formula: see text]-) invariant (helical) 3D TCIs-termed higher-order TCIs (HOTIs)-the boundary signatures can manifest as a sample-dependent network of 1D hinge states. We here introduce nested spin-resolved Wilson loops and layer constructions as tools to characterize the intrinsic bulk topological properties of spinful 3D insulators. We discover that helical HOTIs realize one of three spin-resolved phases with distinct responses that are quantitatively robust to large deformations of the bulk spin-orbital texture: 3D quantum spin Hall insulators (QSHIs), "spin-Weyl" semimetals, and [Formula: see text]-doubled axion insulator (T-DAXI) states with nontrivial partial axion angles indicative of a 3D spin-magnetoelectric bulk response and half-quantized 2D TI surface states originating from a partial parity anomaly. Using ab-initio calculations, we demonstrate that ß-MoTe2 realizes a spin-Weyl state and that α-BiBr hosts both 3D QSHI and T-DAXI regimes.

2.
Phys Rev Lett ; 131(7): 076901, 2023 Aug 18.
Article in English | MEDLINE | ID: mdl-37656841

ABSTRACT

We report ultrafast x-ray scattering experiments of the quasi-1D charge density wave (CDW) material (TaSe_{4})_{2}I following ultrafast infrared photoexcitation. From the time-dependent diffraction signal at the CDW sidebands we identify a 0.11 THz amplitude mode derived primarily from a transverse acoustic mode of the high-symmetry structure. From our measurements we determine that this mode interacts with the valence charge indirectly through another collective mode, and that the CDW system in (TaSe_{4})_{2}I has a composite nature supporting multiple dynamically active structural degrees of freedom.

4.
Nat Mater ; 22(4): 429-433, 2023 Apr.
Article in English | MEDLINE | ID: mdl-36894771

ABSTRACT

The lowest-lying fundamental excitation of an incommensurate charge-density-wave material is believed to be a massless phason-a collective modulation of the phase of the charge-density-wave order parameter. However, long-range Coulomb interactions should push the phason energy up to the plasma energy of the charge-density-wave condensate, resulting in a massive phason and fully gapped spectrum1. Using time-domain terahertz emission spectroscopy, we investigate this issue in (TaSe4)2I, a quasi-one-dimensional charge-density-wave insulator. On transient photoexcitation at low temperatures, we find the material strikingly emits coherent, narrowband terahertz radiation. The frequency, polarization and temperature dependences of the emitted radiation imply the existence of a phason that acquires mass by coupling to long-range Coulomb interactions. Our observations underscore the role of long-range interactions in determining the nature of collective excitations in materials with modulated charge or spin order.

5.
PLoS One ; 18(2): e0279032, 2023.
Article in English | MEDLINE | ID: mdl-36812259

ABSTRACT

The coronavirus disease 2019 (COVID-19) stances an incredible impact on the quality of life and denigrates the physical and mental health of the patients. This cross-sectional study aimed to assess the health-related quality of life (HRQOL) of COVID-19 patients. We conducted this study at the National Institute of Preventive and Social Medicine (NIPSOM) of Bangladesh for the period of June to November 2020. All the COVID-19 patients diagnosed by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay in July 2020 formed the sampling frame. The study enrolled 1204 adult (aged >18 years) COVID-19 patients who completed a one-month duration of illness after being RT-PCR positive. The patients were interviewed with the CDC HRQOL-14 questionnaire to assess HRQOL. Data were collected by telephone interview on the 31st day of being diagnosed and by reviewing medical records using a semi-structured questionnaire and checklist. Around two-thirds (72.3%) of the COVID-19 patients were males and a half (50.2%) were urban residents. In 29.8% of patients, the general health condition was not good. The mean (±SD) duration of physical illness and mental illness was 9.83(±7.09) and 7.97(±8.12) days, respectively. Most of the patients (87.0%) required help with personal care, and 47.8% required assistance with routine needs. The mean duration of 'healthy days' and 'feeling very healthy' was significantly lower in patients with increasing age, symptoms, and comorbidity. The mean duration of 'usual activity limitation', 'health-related limited activity', 'feeling pain/worried', and 'not getting enough rest' were significantly higher among patients' having symptoms and comorbidity. 'Not so good' health condition was significantly higher in females (OR = 1.565, CI = 1.01-2.42) and those having a symptom (OR = 32.871, CI = 8.06-134.0) of COVID-19 and comorbidity (OR = 1.700, CI = 1.26-2.29). Mental distress was significantly higher among females (OR = 1.593, CI = 1.03-2.46) and those having a symptom (OR = 4.887, CI = 2.58-9.24). Special attention should be given to COVID-19 patients having symptoms and comorbidity to restore their general health, quality of life, and daily activities.


Subject(s)
COVID-19 , Mental Disorders , Male , Female , Humans , Adult , Quality of Life , Cross-Sectional Studies , Bangladesh
6.
Lancet Reg Health Southeast Asia ; 11: 100131, 2023 Apr.
Article in English | MEDLINE | ID: mdl-36575773

ABSTRACT

Background: COVID-19 pandemic imposed a devastating effect on the psychological health of health professionals as they worked nonstop to withstand the hardship of the pandemic. The present study intended to determine the post-traumatic stress disorders (PTSD) and coping strategies among health professionals during the COVID-19 pandemic in Bangladesh. Methods: This country-wide cross-sectional study was conducted from July to December 2021 among 1394 health professionals (596 physicians, 713 nurses, 85 medical technologists) who served COVID-19 patients at the secondary, tertiary, and specialized government healthcare facilities in Bangladesh and completed at least one month after exposure to COVID-19 patient-care. Data were collected through face-to-face interviews using a semi-structured questionnaire and analyzed by SPSS software. All the ethical issues were maintained strictly. Findings: Most of the participants, 877 (62.9%) [95% CI: 60.3-65.5], were female, and 327 (23.5%) [95% CI: 21.3-25.8] developed PTSD. Females (AOR:1.42 [95% CI: 1.083-1.868] p = 0.011), having an elderly family member (AOR:1.515 [95% CI: 1.173-1.956] p = 0.0014), working in specialized hospitals (AOR:2.685 [95% CI: 1.928-3.739] p < 0.001), and working ≥8 hours/day (AOR:1.897 [95% CI: 1.350-2.666] p = 0.0002) had higher odds of developing PTSD. Most of the participants adopted spiritual approaches 96 (29.4%) [24.5-34.6] and distraction by watching TV/YouTube 59 (18.0%) [14.0-22.6] as coping strategies. Interpretation: The study findings would be helpful for health policymakers and managers to develop comprehensive measures for restoring the mental well-being of health professionals by alleviating PTSD induced by a pandemic like COVID-19. Funding: The study got funding from the Directorate General of Medical Education under the Ministry of Health and Family Welfare, Bangladesh.

7.
J Cardiovasc Surg (Torino) ; 63(6): 664-673, 2022 Dec.
Article in English | MEDLINE | ID: mdl-36239927

ABSTRACT

INTRODUCTION: Malignancies involving the inferior vena cava (IVC) have historically been considered not amendable to surgery. More recently, involvement of the IVC by neoplastic processes in the kidney, liver or in the retroperitoneum can be managed successfully. EVIDENCE ACQUISITION: In this systematic review we summarize the current evidence regarding the surgical management of the IVC in cases of involvement in neoplastic processes. Current literature was searched, and studies selected on the base of the PRISMA guidelines. Evidence was synthesized in narrative form due to heterogeneity of studies. EVIDENCE SYNTHESIS: Renal cell carcinoma accounts for the greatest proportion of studied patients and can be managed with partial or complete vascular exclusion of the IVC, thrombectomy and direct closure or patch repair with good oncological prognosis. Hepatic malignancies or metastases may involve the IVC, and the joint expertise of hepatobiliary and vascular surgeons has developed various strategies, according to the location of tumor and the need to perform a complete vascular exclusion above the hepatic veins. In retroperitoneal lymph node dissection, the IVC can be excised en-block to guarantee better oncological margins. Also, in retroperitoneal sarcomas not arising from the IVC a vascular substitution may be required to improve the overall survival by clearing all the neoplastic cells in the retroperitoneum. Leiomyoma can have a challenging presentation with involvement of the IVC requiring either thrombectomy, partial or complete substitution, with good oncological outcomes. CONCLUSIONS: A multidisciplinary approach with specialist expertise is required when dealing with IVC involvement in surgical oncology. Multiple techniques and strategies are required to deliver the most efficient care and achieve the best possible overall survival. The main aim of these procedures must be the complete clearance of all neoplastic cells and achievement of a safe margin according to the perioperative treatment strategy.


Subject(s)
Carcinoma, Renal Cell , Kidney Neoplasms , Humans , Vena Cava, Inferior/diagnostic imaging , Vena Cava, Inferior/surgery , Vena Cava, Inferior/pathology , Carcinoma, Renal Cell/pathology , Carcinoma, Renal Cell/surgery , Thrombectomy/adverse effects , Retroperitoneal Space , Kidney Neoplasms/pathology , Kidney Neoplasms/surgery
8.
Cureus ; 14(8): e28619, 2022 Aug.
Article in English | MEDLINE | ID: mdl-36185898

ABSTRACT

Introduction The ability to predict risk of perforation in acute appendicitis (AA) could direct timely management and reduce morbidity. Platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) are surrogate severity markers in infections. This study investigates the use of PLR and NLR as a marker for distinguishing uncomplicated (UA) and complicated appendicitis (CA) in children. Materials and methods This retrospective single-center study collected data between January 1, 2014, and December 31, 2020. Children between five and 17 years of age with histologically confirmed appendicitis were included. Cut-off values for NLR and PLR were determined by employing the receiver operating characteristic (ROC) curve with sensitivity and specificity in addition to regression analysis. Results A total of 701 patients were included with a median age of 13 years. Out of which 52% of the cohort was female. The difference between the NLR and PLR ratios between UA and CA was significant (p=0.05, Kruskal-Wallis). For UA, the area under the ROC curve (AUC) and cut-off for NLR and PLR were 0.741, 3.80 with 95% CI of 0.701-0.781 and 0.660, 149.25 with 95% CI of 0.618-0.703, respectively. In CA, using NLR and PLR, AUC and cut-off were 0.776, 8.86 with 95%CI of 0.730-0.822 and 0.694, 193.67 with 95%CI of 0.634-0.755, respectively. All were significant with p<0.001. Conclusions NLR and PLR are reliable, synergistic markers predicting complicated appendicitis which can guide non-operative management in children.

9.
J Surg Case Rep ; 2022(7): rjac331, 2022 Jul.
Article in English | MEDLINE | ID: mdl-35903665

ABSTRACT

Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare malignancy with a low malignant potential and strong female preponderance. Diagnosis during pregnancy is extraordinary, and management must consider the risks to the mother and foetus of tumour growth and rupture. A large 35-cm SPN was identified on magnetic resonance imaging (MRI) in a 24-year-old woman at 6 weeks of gestation following presentation with an abdominal mass. Surgery was delayed to allow the foetus to reach as close to term as possible because surveillance MRIs showed incremental mass growth. Emergency c-section was undertaken at 35 weeks of gestation due to persistent tachycardia and suspected haemorrhage into the tumour. A Hb of 70 g/l post-delivery despite four units of RBCs and an albumin of 11 g/l necessitated urgent multivisceral surgery. Surgical resection is the mainstay of treatment for SPN. However, the strategy of choice during pregnancy remains undetermined, with more recent reports delaying surgery until post-partum.

10.
Cureus ; 14(1): e21446, 2022 Jan.
Article in English | MEDLINE | ID: mdl-35223231

ABSTRACT

Introduction Acute appendicitis (AA) is one of the most common acute general surgical presentations affecting 7% of the population at some point in their lifetime. The ability to assess the risk of complicated appendicitis (CA) from uncomplicated appendicitis (UA) in acute appendicitis (AA) could reduce the associated morbidity and mortality. The value of platelet lymphocyte ratio (PLR) as an inflammatory marker increases when its fluctuations are interpreted along with other complementary hematologic indices, such as neutrophil-to-lymphocyte ratio (NLR), which provides additional information about the disease activity. Hence, we postulated that NLR and/or PLR could serve as a potential surrogate marker in assessing the severity of AA. Aim This study aims to investigate the use of PLR and/or NLR as a surrogate biomarker in differentiating uncomplicated from complicated appendicitis. Material and methods This retrospective study was conducted at Russells Hall Hospital from January 1, 2017, to December 31, 2020. Data of all patients over age 16 years that had histologically confirmed appendicitis were retrieved. NLR and PLR were calculated from the admission hemogram, and the ratios were compared between uncomplicated (UA) or complicated appendicitis (CA). Cut-off values were calculated using the summarized ROC curve; in addition, the sensitivity and specificity with 95% confidence intervals were determined using SPSS 25.0 (IBM Corp., Armonk, NY). Results A total of 799 patients were analyzed, of which 469 (58.7%) were female. The median age was 31.2 years. The difference between NLR and PLR within the two appendicitis groups was significant (P=0.05; Kruskal-Wallis). Cohen's kappa (degree of inter-rater agreement) between NLR and PLR showed a moderate agreement of 0.589 (P<0.001). We equally demonstrated an exponential relationship between PLR and NLR (R2 =0.510, P<0.05). For UA, the area under the curve (AUC) and the cut-off for NLR and PLR were 0.715, 4.75 with a confidence interval (CI) of 0.678-0.653 and 0.632, 155 with a CI of 0.591-0.672, respectively. For CA, using NLR and PLR, the AUC and cut-off were 0.727, 6.96 with a CI of 0.687-0.768 and 0.653, 180.5 with a CI of 0.602-0.703, respectively; all were significant with a P of <0.001. Conclusion NLR and PLR are a reliable, less cumbersome surrogate biomarker for assessing the severity of acute appendicitis.

11.
BMJ Open ; 11(12): e053352, 2021 12 13.
Article in English | MEDLINE | ID: mdl-34903546

ABSTRACT

OBJECTIVE: Susceptibility of patients with cancer to COVID-19 pneumonitis has been variable. We aim to quantify the risk of hospitalisation in patients with active cancer and use a machine learning algorithm (MLA) and traditional statistics to predict clinical outcomes and mortality. DESIGN: Retrospective cohort study. SETTING: A single UK district general hospital. PARTICIPANTS: Data on total hospital admissions between March 2018 and June 2020, all active cancer diagnoses between March 2019 and June 2020 and clinical parameters of COVID-19-positive admissions between March 2020 and June 2020 were collected. 526 COVID-19 admissions without an active cancer diagnosis were compared with 87 COVID-19 admissions with an active cancer diagnosis. PRIMARY AND SECONDARY OUTCOME MEASURES: 30-day and 90-day post-COVID-19 survival. RESULTS: In total, 613 patients were enrolled with male to female ratio of 1:6 and median age of 77 years. The estimated infection rate of COVID-19 was 87 of 22 729 (0.4%) in the patients with cancer and 526 of 404 379 (0.1%) in the population without cancer (OR of being hospitalised with COVID-19 if having cancer is 2.942671 (95% CI: 2.344522 to 3.693425); p<0.001). Survival was reduced in patients with cancer with COVID-19 at 90 days. R-Studio software determined the association between cancer status, COVID-19 and 90-day survival against variables using MLA. Multivariate analysis showed increases in age (OR 1.039 (95% CI: 1.020 to 1.057), p<0.001), urea (OR 1.005 (95% CI: 1.002 to 1.007), p<0.001) and C reactive protein (CRP) (OR 1.065 (95% CI: 1.016 to 1.116), p<0.008) are associated with greater 30-day and 90-day mortality. The MLA model examined the contribution of predictive variables for 90-day survival (area under the curve: 0.749); with transplant patients, age, male gender and diabetes mellitus being predictors of greater mortality. CONCLUSIONS: Active cancer diagnosis has a threefold increase in risk of hospitalisation with COVID-19. Increased age, urea and CRP predict mortality in patients with cancer. MLA complements traditional statistical analysis in identifying prognostic variables for outcomes of COVID-19 infection in patients with cancer. This study provides proof of concept for MLA in risk prediction for COVID-19 in patients with cancer and should inform a redesign of cancer services to ensure safe delivery of cancer care.


Subject(s)
COVID-19 , Neoplasms , Aged , Female , Hospitalization , Humans , Male , Neoplasms/epidemiology , Retrospective Studies , SARS-CoV-2 , United Kingdom/epidemiology
12.
Cureus ; 13(2): e13592, 2021 Feb 27.
Article in English | MEDLINE | ID: mdl-33796428

ABSTRACT

Objectives The clinical diagnosis of complicated acute cholecystitis (CAC) remains difficult with several pathological or ultrasonography criteria used to differentiate it from uncomplicated acute cholecystitis (UAC). This study aims to evaluate the use of combined inflammatory markers C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR) as surrogate markers to differentiate between UAC and CAC. Methods We identified 600 consecutive patients admitted with biliary symptoms during an acute surgical take from our electronic prospectively maintained database over a period of 55 months. Only patients undergoing emergency cholecystectomy performed during the index admission were included. The primary outcome was the finding of CAC versus UAC. Results A total of 176 patients underwent emergency laparoscopic cholecystectomy (ELC) during the index admission, including 118 (67%) females with a median age of 51 years (range: 21-97 years). The proportion of UAC (130 [74%]) and CAC (46 [26%]) was determined along with demographic data. Multivariate regression analysis showed that patient's age (OR=1.047; p=0.003), higher CRP (OR=1.005; p=0.012) and NLR (OR=1.094; p=0.047) were significant independent factors associated with severity of cholecystitis. Receiver operating characteristic (ROC) analysis for CRP showed an AUC (area under the curve) of 0.773 (95% CI: 0.698- 0.849). Using a cut-off value of 55 mg/L for CRP, the sensitivity of CAC was 73.9% and specificity was 73.1% in predicting CAC. The median post-operative length of stay was four days. The conversion rate from laparoscopic cholecystectomy to open surgery was 2% (4/176), and 5% (9/176) patients suffered post-operative complications with no mortality at 30 days. Conclusion CRP, NLR and age were independent factors associated with the severity of acute cholecystitis. NLR and CRP can be used as surrogate markers to predict patients at risk of CAC during emergency admission, which can inform future guidelines. Moreover, ELC for CAC can be safely performed under the supervision of dedicated upper GI surgeons.

13.
Cureus ; 13(1): e12555, 2021 Jan 07.
Article in English | MEDLINE | ID: mdl-33575136

ABSTRACT

Background and objective Laparoscopic cholecystectomy is used for the treatment of symptomatic gallstones. Intraoperative cholangiogram (IOC) is used to diagnose common bile duct (CBD) stones. There is controversy surrounding routine vs selective use of IOC based on clinical, biochemical and ultrasound criteria. The aim of this study was to evaluate the outcomes from routine IOC and its utility in laparoscopic cholecystectomy. Materials and methods This was a UK-based single-centre retrospective study evaluating the outcomes from IOC for all laparoscopic cholecystectomies performed between May 2014 and February 2020. All adult patients undergoing elective, semi-elective or emergency operations were included. Demographics, biochemistry as well as radiological and endoscopic investigations were analysed. IOC was performed using a standardised technique and was interpreted by a single surgeon. Results A total of 744 out of 804 patients underwent IOC. The median age of the cohort was 51 years (SD: ±17.5); there were 468 females (62.9%) and 276 males (37.1%). Filling defects were identified in 43/744 (5.8%) patients, with 23/43 having stone extraction via endoscopic retrograde cholangiopancreatography (ERCP). Logistic regression analysis identified alkaline phosphatase (ALP) as a predictor of filling defects in IOC (OR: 1.003; 95% CI: 1.001-1.005, p=0.015). Conclusion Based on our findings, the routine use of IOC during laparoscopic cholecystectomy is safe and effective. Preoperative clinical, radiological and biochemical parameters apart from ALP have a limited role in predicting the diagnostic yield of IOC.

14.
Updates Surg ; 73(1): 357-358, 2021 Feb.
Article in English | MEDLINE | ID: mdl-33389653

ABSTRACT

Laparoscopic colectomy has become the standard practice for colorectal cancer surgery. A variety of techniques are described for anastomosis including extracorporeal and intracorporeal techniques. Intracorporeal anastomosis may be associated with better cosmesis and post-operative recovery. However, the review by Reddavid et al. (J Gastrointest Surg 24:2389-2392, 2020) describing an intracorporeal stapled technique for ileo-colonic anastomosis has several issues. First, the technique for forming intracorporeal anastomoses is not novel and has been previously reported. The conversion rate to open surgery does not relate to anastomosis technique but the difficulty of dissection and tumour stage. Furthermore, performing the technique requires an additional trocar adding to expense. Moreover, utilizing multiple sutures which close the enterostomy prior to stapling does not stand scrutiny when the defect has already been closed. The additional staple firing is a risky strategy particularly if the stapler splits. Thus, it is vital that new techniques promoted to trainees and residents have a sound technical and evidence base, avoid unnecessary expense or risk technical failure.


Subject(s)
Anastomosis, Surgical/methods , Colectomy/methods , Colon/surgery , Colorectal Neoplasms/surgery , Ileum/surgery , Laparoscopy/methods , Surgical Stapling/methods , Anastomotic Leak/etiology , Anastomotic Leak/prevention & control , Humans , Surgical Stapling/adverse effects , Wound Closure Techniques
15.
Langenbecks Arch Surg ; 406(5): 1341-1351, 2021 Aug.
Article in English | MEDLINE | ID: mdl-33416987

ABSTRACT

OBJECTIVE: The safety and role of emergency (EA) versus interval appendicectomy (IA) for appendicular abscess and phlegmon remains debatable with no optimal strategy identified. The aim of this systematic review and meta-analysis is to evaluate outcomes of managing appendicular abscesses and phlegmon with emergency or interval appendicectomy. METHODS: We conducted a systematic search of electronic databases using key terms including 'appendicular abscess', 'appendicular phlegmon' and 'interval appendicectomy'. Randomised controlled trials and observational studies comparing the two management approaches were included. Operative time, post-operation complication, unplanned bowel resection, rate of surgical site infection, post-operative length of stay and overall mortality rate were evaluated. RESULTS: We identified six studies (2 RCTs and 4 observational studies) with a total of 9264 patients of whom (n = 1352) underwent IA, and (n 7912) underwent EA. The EA group was associated with statistically significant unplanned bowel resection (OR 0.55, 95% CI [0.33-0.90], P = 0.02) and longer total operating time (MD - 14.11, 95% CI [- 18.26-- 9.96] P = 0.00001). However, the following parameters were compared for both EA and IA groups; there were no significant statistical differences: surgical site infection (OR 0.49, 95% CI [0.17-1.38], P = 0.18), post-operative intra-abdominal collection (RD - 0.01, 95% CI [- 0.04-0.01], P = 0.29), total length of hospital stay (MD 1.83, 95% CI [- 0.19-3.85], P = 0.08), post-operative length of hospital stay (MD - 0.27, 95% CI [- 3.66-3.13], P = 0.88) and mortality rate (MD - 0.27, 95% CI [- 3.66-3.13], P = 0.66). CONCLUSION: Emergency operation for appendicular abscess and phlegmon may lead to a higher rate of reported morbidity when compared with interval appendicectomy. Although emergency appendicectomy performed for appendicular abscess and phlegmon is a feasible and safe operative approach, it is associated with significantly increased operative time and unplanned bowel resection (ileocolic and right hemicolectomies) compared to interval appendicectomy.


Subject(s)
Appendicitis , Laparoscopy , Abscess/surgery , Appendectomy/adverse effects , Appendicitis/surgery , Cellulitis/surgery , Humans , Length of Stay
16.
BMJ Case Rep ; 13(12)2020 Dec 22.
Article in English | MEDLINE | ID: mdl-33370988

ABSTRACT

Cholecystocolonic fistula with associated idiopathic megabowel (megacolon and megarectum) is a rare presentation as acute large bowel obstruction. Frequently presenting with chronic constipation, acute bowel obstruction is rarely encountered in the presence of concomitant cholecystocolonic fistula. This presents diagnostic and management difficulties with no consensus on appropriate surgical approach. This case highlights the outcomes following emergency total colectomy and subtotal cholecystectomy as a single-stage procedure for a 68-year-old man presenting with cholecystocolonic fistula secondary to idiopathic megabowel as acute large bowel obstruction.


Subject(s)
Biliary Fistula/etiology , Gallbladder Diseases/etiology , Intestinal Fistula/etiology , Intestinal Obstruction/etiology , Megacolon/complications , Rectal Diseases/complications , Aged , Biliary Fistula/diagnosis , Biliary Fistula/surgery , Cholecystectomy , Colectomy , Colon/diagnostic imaging , Colon/surgery , Gallbladder/diagnostic imaging , Gallbladder/surgery , Gallbladder Diseases/diagnosis , Gallbladder Diseases/surgery , Humans , Intestinal Fistula/diagnosis , Intestinal Fistula/surgery , Intestinal Obstruction/diagnosis , Intestinal Obstruction/surgery , Male , Megacolon/diagnosis , Megacolon/surgery , Rectal Diseases/diagnosis , Rectal Diseases/surgery , Rectum/diagnostic imaging , Rectum/surgery , Tomography, X-Ray Computed , Treatment Outcome
17.
Ann Med Surg (Lond) ; 57: 212-217, 2020 Sep.
Article in English | MEDLINE | ID: mdl-32793341

ABSTRACT

Pilonidal sinus disease is chronic acquired condition leading to significant morbidity and associated healthcare costs. Several techniques have been described to manage this condition with no treatment gaining universal acceptance. With the shift towards minimally invasive surgery, Video Assisted-Ablation of Pilonidal Sinus (VAAPS) and Endoscopic Pilonidal Sinus Treatment (EPiST) have gained prominence. The aim of this review is to analyse current treatment modalities and the evidence for endoscopic pilonidal sinus surgery. Reported surgical techniques range from wide excision with or without primary closure to various flap closures. These aim to eliminate the underlying causes driven by natal cleft hair and reducing recurrence. However, long term (≥5 years) recurrence rates range between 10 and 30% with significant complication rates. Trials with endoscopic treatment which have shown comparable short-term results to established treatments with reduced morbidity. However, the potential higher cost, learning curve, patient selection criteria and need for long term outcomes from randomised trials limit widespread application of this promising method. Endoscopic treatment of pilonidal sinus disease therefore provides a minimally invasive alternative to traditional surgical methods with the potential to reduce morbidity. However long-term outcomes data from further prospective randomised trials is needed to establish its efficacy compared to traditional surgical methods.

18.
Int J Mol Sci ; 21(15)2020 Jul 27.
Article in English | MEDLINE | ID: mdl-32726923

ABSTRACT

Colorectal cancer (CRC) is a leading cause of death worldwide, despite progress made in detection and management through surgery, chemotherapy, radiotherapy, and immunotherapy. Novel therapeutic agents have improved survival in both the adjuvant and advanced disease settings, albeit with an increased risk of toxicity and cost. However, metastatic disease continues to have a poor long-term prognosis and significant challenges remain due to late stage diagnosis and treatment failure. Biomarkers are a key tool in early detection, prognostication, survival, and predicting treatment response. The past three decades have seen advances in genomics and molecular pathology of cancer biomarkers, allowing for greater individualization of therapy with a positive impact on survival outcomes. Clinically useful predictive biomarkers aid clinical decision making, such as the presence of KRAS gene mutations predicting benefit from epidermal growth factor receptor (EGFR) inhibiting antibodies. However, few biomarkers have been translated into clinical practice highlighting the need for further investigation. We review a range of protein, DNA and RNA-based biomarkers under investigation for diagnostic, predictive, and prognostic properties for CRC. In particular, long non-coding RNAs (lncRNA), have been investigated as biomarkers in a range of cancers including colorectal cancer. Specifically, we evaluate the potential role of lncRNA plasmacytoma variant translocation 1 (PVT1), an oncogene, as a diagnostic, prognostic, and therapeutic biomarker in colorectal cancer.


Subject(s)
Biomarkers, Tumor , Colorectal Neoplasms , Proto-Oncogene Proteins p21(ras) , RNA, Long Noncoding , RNA, Neoplasm , Biomarkers, Tumor/genetics , Biomarkers, Tumor/metabolism , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/genetics , Colorectal Neoplasms/metabolism , Colorectal Neoplasms/pathology , ErbB Receptors/genetics , ErbB Receptors/metabolism , Humans , Prognosis , Proto-Oncogene Proteins p21(ras)/genetics , Proto-Oncogene Proteins p21(ras)/metabolism , RNA, Long Noncoding/genetics , RNA, Long Noncoding/metabolism , RNA, Neoplasm/genetics , RNA, Neoplasm/metabolism
19.
Phys Rev Lett ; 124(3): 037203, 2020 Jan 24.
Article in English | MEDLINE | ID: mdl-32031844

ABSTRACT

NiNb_{2}O_{6} is an almost ideal realization of a 1D spin-1 ferromagnetic Heisenberg chain compound with weak unidirectional anisotropy. Using time-domain THz spectroscopy, we measure the low-energy electrodynamic response of NiNb_{2}O_{6} as a function of temperature and external magnetic field. At low temperatures, we find a magnonlike spin excitation, which corresponds to the lowest energy excitation at q∼0. At higher temperatures, we unexpectedly observe a temperature-dependent renormalization of the spin-excitation energy, which has a strong dependence on field direction. Using theoretical arguments, exact diagonalizations, and finite temperature dynamical Lanczos calculations, we construct a picture of magnon-magnon interactions that naturally explains the observed renormalization. We show how magnetic field strength and direction may be used to directly tune the sign of the magnon-magnon interaction. This unique scenario is a consequence of the spin-1 nature and has no analog in the more widely studied spin-1/2 systems.

20.
Phys Rev Lett ; 122(1): 017002, 2019 Jan 11.
Article in English | MEDLINE | ID: mdl-31012661

ABSTRACT

Epitaxial bilayer films of Bi(110) and Ni host a time-reversal symmetry breaking superconducting order with an unexpectedly high transition temperature T_{c}=4.1 K. Using time-domain THz spectroscopy, we measure the low energy electrodynamic response of a Bi/Ni bilayer thin film from 0.2 to 2 THz as a function of temperature and magnetic field. We analyze the data in the context of a Bardeen-Cooper-Schrieffer-like superconductor with a finite normal-state scattering rate. In a zero magnetic field, all states in the film become fully gapped, providing important constraints into possible pairing symmetries. Our data appear to rule out the odd-frequency pairing that is natural for many ferromagnetic-superconductor interfaces. By analyzing the magnetic field-dependent response in terms of a pair-breaking parameter, we determine that superconductivity develops over the entire bilayer sample which may point to the p-wave like nature of unconventional superconductivity.

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