Outcomes of complex colorectal polyps managed by multi-disciplinary team strategies-a multi-centre observational study.

PURPOSE: Team management strategies for complex colorectal polyps are recommended by professional guidelines. Multi-disciplinary meetings are used across the UK with limited information regarding their impact. The aim of this multi-centre observational study was to assess procedures and outcomes of patients managed using these approaches. METHOD: This was a retrospective, observational study of patients managed by six UK sites. Information was collected regarding procedures and outcomes including length of stay, adverse events, readmissions and cancers. RESULTS: Two thousand one hundred ninety-two complex polyps in 2109 patients were analysed with increasing referrals annually. Most presented symptomatically and the mean polyp size was 32.1 mm. Primary interventions included endoscopic therapy (75.6%), conservative management (8.3%), colonic resection (8.1%), trans-anal surgery (6.8%) or combined procedures (1.1%). The number of primary colonic resections decreased over the study period without a reciprocal increase in secondary procedures or recurrence. Secondary procedures were required in 7.8%. The median length of stay for endoscopic procedures was 0 days with 77.5% completed as day cases. Median length of stay was 5 days for colonic resections. Overall adverse event and 30-day readmission rates were 9.0% and 3.3% respectively. Malignancy was identified in 8.8%. Benign polyp recurrence occurred in 13.1% with a median follow up of 30.4 months. Screening detected lesions were more likely to undergo bowel resection. Colonic resection was associated with longer stays, higher adverse events and more cancers on final histology. CONCLUSION: Multi-disciplinary team management of complex polyps is safe and effective. Standardisation of organisation and quality monitoring is needed to continue positive effects on outcomes and services.

Dual Functional TiO2-Au Nanocomposite Material for Solid-State Dye-Sensitized Solar Cells.

Titanium dioxide-gold nanocomposite ((TiO2-Au)(nps)) materials dispersed in poly(diallyldimethylammonium chloride) (PDDA) polymer electrolyte are employed as solid-state electrolytes in a dye-sensitized solar cell (DSSC) containing nanocrystalline TiO2 nanoparticle (P25) or (P25-Au)(nps) thin film photoanode adsorbed with a near-IR dye sensitizer, nickel-phthalocyanine (NiPcTs). The photocurrent-photovoltage characteristics of the DSSCs are evaluated under standard AM 1.5 G simulated solar irradiation of 100 mW/cm2. The (TiO2-Au)(nps) nanocomposite material incorporated into the PDDA polymer electrolyte promotes interfacial charge transfer process, reduces crystallinity of the polymer electrolyte and enhances mobility of the /-/I3- redox couple, which are resulted in -6-fold increase in the overall solar to electrical energy conversion efficiency when compared to the unmodified polymer electrolyte based DSSC. When the P25 photoanode is replaced with the (P25-Au)(nps) photoanode, a further 8-fold increase in the overall energy conversion efficiency is achieved, owing to the increas in the charge transport through the photoanode. The photovoltaic performance of the present DSSC configuration is also compared with that of a cell sensitized by using standard N719 dye.

Peripartum cardiomyopathy.

Peripartum cardiomyopathy (PPCM) is a life-threatening condition of unknown cause that occurs in previously healthy women during the peripartum period. It is characterized by left ventricular (LV) dysfunction and symptoms of heart failure which occurs between the last trimester of pregnancy and the first five months of the postpartum period. Recent reports show that the mortality rate in the United States due to PPCM is much lower than previously reported and the LV systolic function recovery rates are now >50%. This review identifies the possible causes of PPCM and ways to recognize and manage these patients. Patients with PPCM often present with heart failure and therefore standard treatment for heart failure is recommended. Depending on the recovery of ventricular function subsequent pregnancies carry a higher risk of relapse of PPCM.

Poor correlation of estimated pulmonary artery systolic pressure between echocardiography and right heart catheterization in patients awaiting cardiac transplantation: results from the clinical arena.

BACKGROUND: Pulmonary arterial pressure measurement is an integral part of the pre-heart transplant evaluation. In the clinical arena, the correlation and agreement between pulmonary artery systolic pressure (PASP) measured by Doppler echocardiography versus catheterization in pre-heart transplant patients has not been studied. METHODS: Data on all patients evaluated for heart transplantation at our program between 2003 and 2005 (n = 176) were retrospectively reviewed. Patients with both transthoracic echocardiography (with interpretable images) and right heart catheterization performed were included (n = 108; mean time difference, 2.2 days; median, 2 days). The tricuspid valve regurgitant jet was identified by color flow Doppler and jet maximum velocity was measured by continuous wave Doppler. The PASP was estimated by using the modified Bernoulli equation and adding right atrial pressure. We correlated echocardiographically estimated PASP with that measured by right heart catheterization. RESULTS: Mean estimated PASP by echocardiography was 46.6 +/- 13.7 mmHg versus 44.8 +/- 17.9 mmHg by right heart catheterization (P = NS). However, the correlation between echocardiographic and measured PASP was poor (r = 0.49, P < .001). The correlation was poor in both ischemic and nonischemic cardiomyopathy. CONCLUSION: Among patients referred for heart transplant evaluation, there is poor agreement and correlation between echocardiographically estimated PASP and values obtained by right heart catheterization. Furthermore, echocardiographically obtained estimates of PASP should not be exclusively relied upon to exclude heart transplant recipient candidates.

Rationale for continuous chest compression cardiopulmonary resuscitation.

Every year more than a million cardiac arrests are documented in the industrialised nations of the world, with the majority occurring in settings outside hospital. A major factor in survival after out-of-hospital cardiac arrest (OHCA) is early institution of bystander resuscitation efforts. Sadly, the majority of OHCAs do not receive bystander resuscitation for a variety of reasons. One of them is the requirement for mouth-to-mouth (MTM) ventilation. The 2008 American Heart Association recommendation for "hands only" or continuous chest compression cardiopulmonary resuscitation (CPR) for untrained lay people was a welcome change. However, evidence indicates that MTM and other forms of positive pressure ventilation should be eliminated for all bystanders responding to primary cardiac arrest (unexpected witnessed collapse in an unresponsive person). The requirement for MTM ventilation may well be indicated for patients with respiratory arrest but is detrimental during early resuscitation efforts by anyone providing CPR to patients with primary cardiac arrest. This article provides rationale for continuous chest compression CPR by all bystanders.

Cardiovascular risk in South Asians.

Cardiovascular disease (CVD) has become a major clinical and public health problem. South Asian countries, namely India, Pakistan, Sri Lanka, Bangladesh and Nepal, not only represent a quarter of the world's population but also contribute to the highest proportion of CVD burden when compared with any other regions globally. This population carries the increased risk even if they migrate to other countries and have increased mortality due to CVD at a younger age in comparison to the local population. In this review, the risk factors and reasons for the higher rate of CVD in South Asians are discussed.

Micellar catalysis on the electron transfer reactions of iron(III)-polypyridyl complexes with organic sulfides-importance of hydrophobic interactions.

The oxidation of organic sulfides with iron(III)-polypyridyl complexes [Fe(NN)3]3+ proceeds through an electron transfer mechanism and an increase in the methanol content in the methanol-water mixture favors the reaction. The reaction is catalyzed by both the anionic surfactant, sodium dodecyl sulfate (SDS) and the cationic surfactant, cetyltrimethylammonium bromide (CTAB). The micellar catalysis in the presence of SDS is accounted for in terms of strong binding of the cationic oxidant with the anionic surfactant and the development of positive charge on sulfur center of substrate in the transition state. The micellar catalysis observed on the reaction involving a trication, [Fe(NN)3]3+, in the presence of CTAB indicates the importance of hydrophobic interaction between the micelle and hydrophobic ligand of [Fe(NN)3]3+. The micellar catalysis is explained in terms of a pseudophase ion exchange model.

Emission of thioflavin T and its off-on control in polymer membranes.

The absorption and emission spectral properties of thioflavin T (TFT+) in Nafion (Nf) and cellulose matrices have been studied. Formation of the emittive dimer is observed in both matrices. The monomer TFT+ emission is blueshifted in Nafion membrane (Nf), whereas it is red-shifted in cellulose membrane when compared with the emission in aqueous solution. The dimer emission of TFT+ in the Na+-Nf membrane undergoes off-on switching with acids and alkalis. The TFT+ molecule undergoes protonation in the H+-Nf and the protonated dye is fluorescent. The dimer emission of TFT+ is not observed in the dry H+-Nf membrane because of the protonation of the TFT+ molecule. The diffusion coefficient and the free energy of hydrophobic interaction for the TFT+ molecule in the Nf membrane are calculated. The TFT+ molecule experiences hydrophobic and electrostatic interactions in the Nf matrix, whereas it experiences a polar environment in the cellulose membrane. The 3D emission spectral studies support the formation of the emittive dimer in both Nf and cellulose matrices.