Search

The results of colectomy and ileorectal anastomosis (IRA) in patients diagnosed by physiologic testing as having slow transit constipation (STC) have been reported. The durability of functional results and long-term quality of life (QoL) in these patients, however, has not been established. Between 1987 and 2002, 3670 patients were evaluated for constipation at our institution; 110 (3%) fulfilled the criteria for STC and underwent an IRA. Patients were prospectively followed and functional outcomes assessed annually by standardized questionnaires. After a median follow-up of 11 years, 104 eligible patients were mailed validated questionnaires to assess functional outcomes and QoL (Knowles-Eccersley-Scott Symptom [KESS] score, the Irritable Bowel Syndrome Quality of Life [IBS-QOL], and the SF-12 health survey). Prospectively assessed functional data was available on 85 of 104 (82%) eligible patients. At last follow-up, improvement of constipation and satisfaction with bowel function was reported by 98% and 85% of patients, respectively. Performance measures including social activity, household work, sexual life, and family relationships were reported to have improved or were not affected as a result of surgery by 75%, 86%, 81%, and 86% of the patients respectively. Fifty-nine patients (57%) responded to the study questionnaires. All 59 patients reported their constipation to be better since IRA, 83% did not require any medication, and 85% reported being satisfied with bowel function. The KESS scores of patients undergoing IRA for STC (median 6, range 0−35) were lower than reported scores of STC patients not operated upon (median 21, range 11−35, P < 0.001) indicating symptomatic improvement after surgery. Mean IBS-QOL scores were similar to reported scores of patients undergoing IRA for other conditions [80 (23) versus 84 (16)], P = 0.7). Mean SF-12 physical and mental summary scores were similar to reported SF-12 scores of the normal population (49.5 versus 50 and P = 0.70, 48.7 versus 50, P = 0.42, respectively). Ileorectal anastomosis in appropriately selected patients with slow transit constipation results in durable symptomatic relief and a long-term quality of life indistinguishable from the general population. [Copyright &y& Elsevier]

Purpose: Definitive radiation therapy with concurrent chemotherapy is curative for nonmetastatic squamous cell carcinoma of the anus (SCCA). However, the true effect of chemoradiation on long-term functional outcomes is poorly understood owing to limited follow-up and patient-reported outcomes (PROs).Methods and Materials: We conducted a cross-sectional survey of 248 patients with SCCA treated with definitive intensity modulated radiation and concurrent chemotherapy from 2010 to 2018 who were alive and without recurrence. PRO measures were collected, including Functional Assessment of Cancer Therapy-General (FACT-G7), Fecal Incontinence Quality of Life (FIQoL), Low Anterior Resection Syndrome (LARS), and International Consultation on Incontinence Questionnaires (ICIQ). Models were used to determine the association between demographic, tumor, treatment, and dosimetric data with PROs.Results: One hundred twelve (45%) patients completed PROs. Median [interquartile range (IQR)] time from radiation completion to survey was 51 [37-85] months. The median scores [IQR] for FACT-G7, FIQoL, and LARS were 21 [15-24], 14 [11-16], and 32 [25-37], respectively. For men, median subscores [IQR] for ICIQ voiding and incontinence subscores were 5 [2-6] and 1 [1-3], respectively. For women, median subscores [IQR] for ICIQ voiding, incontinence, and filling were 1 [1-3], 5 [3-8], and 4 [2-5], respectively. Higher (better) FIQoL scores were associated with higher (better) FACT-G7 scores (β = 0.83; 95% confidence interval, 0.58-1.09; P < .001), and higher (worse) LARS scores were associated with lower (worse) FACT-G7 scores (β = -0.22; 95% confidence interval, -0.31 to -0.13; P < .001). A separate multivariable analysis revealed higher bowel bag D1% was associated with lower (worse) FIQoL (P = .001) and higher (worse) LARS (P = .003) scores. Higher bladder V40 Gy was associated with increased (worse) ICIQ voiding subscore (P = .001).Conclusions: Patients treated with modern chemoradiation for SCCA experience significant long-term bowel toxic effects with considerable effect on quality of life. Minimizing bowel hotspots and bladder V40 Gy may improve bowel and urinary function. Other interventions to reduce long-term toxic effects and improve quality of life are needed. [ABSTRACT FROM AUTHOR]

Abstract: In this paper, the effect of N distribution on the elastic and electronic properties of hexagonal ε-Fe6N x (x=1, 2, and 3) phases is studied by first-principles calculations. The calculated formation energies of ε-Fe6N x phases decrease with the increasing distance between the N atoms, which demonstrates that the interaction between the interstitial N atoms is of repulsive nature. The theoretical elastic constants, bulk modulus (B), shear modulus (G), ratios of B to G, Young's modulus (E), Poisson's ratios (v) of ε-Fe6N x phases are obtained, which are important parameters for the crystal materials and surface coatings. The more stable interstitial conifiguration enables the ε-Fe6N x phases to possess higher B, G and E. Densities of states are given for all the configurations of ε-Fe6N x phases to discuss the origins of the variations of energetic stability and elastic properties. [Copyright &y& Elsevier]

Abstract: The elastic and electronic properties of an ordered intermetallic phase Al18Ti2Mg3 with cubic structure are first investigated by an ab initio method based on density functional theory (DFT) implemented in the Cambridge Serial Total Energy Package (CASTEP) code. The elastic constants are calculated to characterize the elastic anisotropy, the direction-dependent Young’s modulus and the macroscopic elastic modulus. The calculated results show that compared with binary compound Al3Ti, Al18Ti2Mg3 exhibits lower stiffness, slighter elastic anisotropy and better ductility, and the bond of Al18Ti2Mg3 has both covalent and ionic properties. [Copyright &y& Elsevier]

Abstract: Neural stem cells in the subventricular zone (SVZ) generate progenitors which in turn give rise to neuroblasts. These neuroblasts then migrate along the rostral migratory stream (RMS) in chains and reach the olfactory bulb (OB), where they mature into local interneurons. Interneurons in the OB are heterogeneous, which are mainly located in granular cell layer (GCL), external plexiform layer (EPL) and glomerular layer (GL). In this study, we show that green fluorescent protein-expressing (GFP+) cells in the SVZ and RMS of the 5HT3aR-BACEGFP transgenic mouse exclusively express transcription factor Sp8 which is expressed in lateral ganglionic embryonic eminence (LGE) and postnatal SVZ. These GFP+ neuroblasts of the 5HT3aR-BACEGFP transgenic mouse migrate along the RMS to the OB where they differentiate into calretinin+ (CR+), parvabumin+ (PV+), vasoactive intestinal peptide+ (VIP+), somatostatin+ (Som+) and tyrosine hydroxylase+ (TH+), but not calbindin+ (CB+) interneurons. These GFP+ interneurons continuously express Sp8 in the OB. Furthermore, these results suggest that GFP-expressing cells are derived from LGE, and this transgenic mouse line will be a useful tool for studying the development and function of interneurons in both neocortex and OB. [Copyright &y& Elsevier]

Abstract: This paper proposes a robust residual carrier frequency offset (CFO) tracking scheme with an extended estimation range, as well as an improved estimation performance in a multiple-input multiple-output orthogonal frequency division multiplexing (MIMO-OFDM) system. An analytical expression for the mean square error (MSE) of the frequency synchronization scheme is reported, and simulation results are used to verify the theoretical analysis developed in this paper. [Copyright &y& Elsevier]

Abstract: We have synthesized the volatile, liquid, nickel precursor Ni(dmamb)2, nickel bis(1-dimethylamino-2-methyl-2-butanolate), Ni[OC(CH3)(C2H5)CH2N(CH3)2]2, and employed it in the MOCVD of nickel oxide (NiO). A stainless steel, cold-wall, low-pressure reactor was employed to grow the NiO films on Si and Pt/SiO2/Si substrates. In addition, the resistance switching property of the Pt/NiO/Pt capacitor structure was investigated. The substrate temperature was varied in the range 230–410 °C. The films deposited were characterized by scanning electron microscopy, X-ray photoelectron spectroscopy, X-ray diffraction, and I–V measurements. They were polycrystalline showing dominantly the NiO(111) peak in their X-ray diffraction patterns. The films were found to be almost stoichiometric with the Ni:O ratio of 1.1:0.9 and no appreciable amount of carbon incorporation was detected by XPS. The I–V measurements revealed an interesting switching property of the NiO films showing low and high resistance states thereby suggesting their application as ReRAM devices. [Copyright &y& Elsevier]

Abstract: This article describes a comprehensive literature review of liquid entrainment in horizontal pipes with vertical-up branches. Deficiencies in the available data and correlations were identified. The Air–water Test Loop for Advanced Thermal–hydraulic Studies (ATLATS) was constructed and entrainment onset and steady-state data were collected for a wide range of flow conditions. Using new insights gained from experimental testing, the authors developed a model for predicting the onset of entrainment and steady-state entrainment rate. Previously published correlations, along with the new model, are compared against all available data. The new model shows very good agreement with the onset data, but is not very good at predicting branch quality at high liquid flow rates. [Copyright &y& Elsevier]

• This study examined outcomes of panel testing of colorectal cancer genes in patients with colorectal cancer at 35 or younger. • The results confirmed a previous study showing a high incidence of hereditary colorectal cancer syndromes in young patients. • Disease-specific panel testing did not increase the yield of diagnostic workup over phenotype-driven testing. • Broader panels may increase the yield but also identify more uncertain variants in young patients with colorectal cancer. Adolescents and young adults with colorectal cancer (CRC) have attracted recent attention, with a hereditary syndrome identified in one-third of patients diagnosed ≤ 35. We aimed to study this population to determine if a CRC-specific gene panel increased the yield of testing. Patients with CRC ≤ 35 evaluated from 05/2014–11/2017 were identified from the genetic counseling database. Records were reviewed for personal/family history and genetic counseling outcomes. One hundred forty-three patients with CRC ≤ 35 were included. One hundred four (72.7%) underwent CRC panel testing. Thirty-nine (27.2%) had syndrome-directed testing, declined, or were lost to follow-up. Forty-two patients had a genetic syndrome (29.4%). Twenty-four of the 42 hereditary patients (57.1%) were identified via syndrome-directed testing. Mutations identified via panel testing were consistent with patient personal/family history. Thirty-three patients had at least one variant of uncertain significance. Hereditary syndromes were identified in 29.4% of patients. Panel testing in patients without a phenotype did not increase diagnostic yield, but identified variants in one-third. Disease-specific panel testing is of low yield in young patients without a suggestive personal/family history. Testing broader panels may increase the yield of mutation pick-up in this population, although at the expense of identifying variants. [ABSTRACT FROM AUTHOR]

Background Uncontrolled infections are known to be an absolute contraindication for liver transplantation; however, the posttransplant prognosis of recipients treated for pretransplant infection is unclear. The aim of this study was to analyze pretransplant infections among liver transplant recipients and to determine their impact on posttransplant clinical outcomes. Methods This study retrospectively analyzed 357 subjects who had undergone living-donor liver transplantation between January 2008 and May 2014. Results Among 357 recipients, 71 patients (19.8%) had 74 episodes of infectious complications before liver transplantation. These complications consisted of pneumonia (n = 13), spontaneous bacterial peritonitis (n = 12), catheter-related infection (n = 10), urinary tract infection (n = 12), biliary tract infection (n = 6), and skin and soft-tissue infection (n = 3). Twenty-six patients experienced 29 episodes of bacteremia, and the most common pathogens were coagulase-negative staphylococci (n = 8), followed by Klebsiella pneumoniae (n = 7), Staphylococcus aureus (n = 4), and Streptococcus species (n = 3). Twenty-one bacteremic episodes (70%) occurred within 1 month before transplantation (n = 4). Recipients with pretransplant infections had significantly more frequent posttransplant infections (71.8% [51 of 71] vs 47.2% [35 of 286]; P = .0001), posttransplant bacteremia (33.8% [24 of 71] vs 20.3% [58 of 286]; P = .015), and longer posttransplant intensive care unit stays (11.2 ± 10.7 days vs 7.3 ± 4.2 days; P = .0004) than those without pretransplant infections. However, episodes of rejection ( P = .36), length of hospitalization ( P = .10), 28-day mortality ( P = .31), and 1-year mortality ( P = .61) after transplantation were not significantly different between the 2 groups. Conclusions Pretransplant infection had an impact on posttransplant morbidity, although not on rejection and mortality. Alertness for posttransplant infection and proper management (including effective antimicrobial coverage) would improve patient morbidity. [ABSTRACT FROM AUTHOR]

Background Acinetobacter baumannii has become an increasingly important nosocomial pathogen. Carbapenem is the preferred drug of choice for treatment of multidrug-resistant gram-negative bacilli, but carbapenem-resistant A baumannii (CRAB) has now emerged. The aim of this study was to determine the incidence, outcomes, and risk factors for CRAB bacteremia in liver transplant recipients. Methods The medical records of 393 subjects who underwent living donor liver transplant at Seoul St. Mary's Hospital from January 2008 to April 2015 were reviewed. Results A total of 92 (23.4%) bacteremic patients, comprising 156 episodes, were identified. Fourteen patients, totaling 18 episodes, had CRAB bacteremia. The median time of emergence of CRAB bacteremia was 55.5 (range, 2–829) days after transplantation, and 72.2% of episodes (n = 13) occurred within 6 months of transplant. The presumed sources of infection were intra-abdominal (n = 11, 61.1%), biliary tract (n = 3, 16.7%), lung (n = 2, 11.1%), catheter (n = 1, 5.6%), and wound (n = 1, 5.6%). By multivariate analysis, length of post-transplant intensive care unit (ICU) stay (odds ratio [OR], 1.1, 95% confidence interval [CI], 1.11–1.15; P = .04) was associated with CRAB bacteremia. Overall mortality in 14 recipients with CRAB bacteremia was 50% (n = 7), but only 10% (30 of 301) in non-bacteremic patients and 20.5% (16 of 78) in other bacteremic patients excluding CRAB ( P < .001). Conclusion In our study, patients with CRAB bacteremia after liver transplant showed an unfavorable outcome and, recently, CRAB has become an increasingly major pathogen at our center. Reducing the length of ICU stay could be a solution for preventing CRAB bacteremia. [ABSTRACT FROM AUTHOR]

Blockage of cohesive fine particles in a packed structure of large particles may happen in many industrial processes, of particular interests to ironmaking COREX technology. In this work, blockage behaviour of cohesive fine particles in a simplified packing structure is studied by means of discrete element method. The typical phenomena about effects of sticking force on descending velocity and blockage frequency is described. Two kinds of blockage mechanisms of fine particles in a packed bed of large particles are explored: mechanical interactions between fine particles will create arches on the pore throat and stop the flow; fine particles with high interparticle stickiness will adhere to the surface near the pore throat of the orifice, thus the sectional area of the flow channel will decrease. With the increase of sticking force, the descending velocity will decrease, while the frequency of the blockage increases. In addition, the effects of size ratio of fine particle to packing particle, mass flow rate and magnitude of the upward force (e.g. from a gas stream) on blockage behaviour are also discussed. The results show that increasing the size ratio, mass flow rate and external force will increase the frequency of the blockage. The study provides a fundamental understanding on blockage behaviour of cohesive fine particles in a packed bed, and is useful for industry processes' understanding and optimization. [ABSTRACT FROM AUTHOR]

Glioblastoma is the most prevalent and lethal primary intrinsic tumor in the central nervous system. Glioblastoma stem cells (GSCs) reprogram the transcriptional and metabolic machinery to mediate therapeutic resistance to radiation. Understanding the regulatory mechanism of GSCs may inform novel approaches to improve the clinical outcome for glioblastoma patients. Nuclear pore complex (NPC) is an evolutionarily conserved structure that maintains the traffic between the nucleus and cytoplasm. In current study, we aim to interrogate the aberrant regulation of NPC in GSCs and develop novel targeted approach to sensitize GSC to radiation. Patient-derived GSCs were validated using functional assays. Transcriptional analysis of GSCs and matched differentiated glioblastoma cells (DGCs) were performed using RNA sequencing to identify aberrant regulatory pathways upregulated in GSCs. The clinical impact of target genes on patient survival was assessed using the glioblastoma dataset from The Cancer Genome Atlas (TCGA). Quantitative RT-PCR and Western blotting were performed to assess the relative expression between GSCs and DGCs. Radiation sensitivity was measured using Cs-137 irradiator. Validation of the stem-like function of target genes was performed using RNA interference followed by in vitro neurosphere formation assay and in vivo tumorigenesis with xenograft mouse model. 27 of the total 31 NPC genes were found to be upregulated in the primary glioblastoma patient specimens compared to non-tumor brain tissue in the TCGA dataset. Among them, a systematic approach combining transcriptional profiling and clinical validation linked nucleoporin 98 (NUP98) to a nexus between GSC phenotype and radiation resistance. GSCs preferentially express NUP98, which is essential for GSC maintenance and tumorigenesis in vitro and in vivo. RNA sequencing demonstrated that NUP98 regulates the expression of key DNA repair genes, including BRCA1, BRCA2, and RAD51. NUP98 forms a complex with the transcription factor P65, and directly stimulates the active transcription of genes involved in homologous recombination. Attenuation of NUP98 or P65 expression leads to the accumulation of unrepaired intrinsic DNA damage and sensitizes GSC to the treatment of ionizing radiation. Clinically, overexpression of NUP98 informs poor clinical outcome among patients with glioblastoma. Combining transcriptional discovery and clinical validation, we discovered that NUP98, an essential NPC component, maintains GSC proliferation and tumorigenesis through modulating the transcriptional control of homologous recombination pathway. Our results demonstrated a novel therapeutic approach of sensitizing GSC to radiation through targeting the nexus between aberrant transcriptional regulation and therapeutic resistance in stem-like glioma cells. [ABSTRACT FROM AUTHOR]

In this study, we prepared a kind of composite solid polymer electrolyte (CSPE) based on montmorillonite (MMT) nano-clay fillers, lithium-bis(trifluoromethanelsulfonyl) (LiTFSI), polyvinylidenedifluoride (PVDF) and polyvinyl alcohol (PVA) copolymer by the casting method. Effect of the montmorillonite on ionic conductivity and electrochemical properties of the polymer electrolyte was demonstrated. The result CSPE obtained a higher ionic conductivity up to 4.31 × 10 −4 S cm −1 at room temperature when 4.0 wt% MMT was contained, and the maximum lithium ions transference number of 0.40 was achieved. Electrochemical performance of the polymer solid electrolyte was evaluated in Li/polymer electrolyte/LiFePO 4 coin cell. Good performance with low capacity fading on charge–discharge cycling was achieved, indicating the potential application of the as-prepared CSPE in lithium ion batteries. [ABSTRACT FROM AUTHOR]

Highlights: [•] PN+LQ treatment results in thicker layer depth than single PN or LQ treatment. [•] The increase of layer depth is caused by the eutectoid point reduction due to introduction of N. [•] LQ treatment cause the brittle phase decomposed and the hardness redistributed of PN specimen. [•] PN+LQ specimen shows better wear resistance than the PN counterpart. [Copyright &y& Elsevier]

Abstract: Background: Routine microbiologic surveillance is a method of infection control, but its clinical significance in transplant recipients is not known. We analyzed microbiologic data to evaluate the influence of cultured microorganisms between the point of surveillance and infectious episodes in liver transplant recipients. Methods: We performed surveillance culture for sputum and peritoneal fluid in liver transplant recipients from January 2009 to December 2011, at the time of transplantation (T1), 5 days (T2), and 10 days (T3) postoperatively. Results: Of the 179 recipients, 32.9% had a positive sputum culture result and 37.4% had a positive peritoneal culture result during surveillance. In the culture surveillance of sputum, 37 organisms were isolated from 35 recipients at T1, and the most common organism was Staphylococcus aureus (n = 13). At T2, 45 organisms were isolated from 39 recipients, including Klebsiella pneumoniae (n = 10), S aureus (n = 8), and Acinetobacter baumannii (n = 6). At T3, 18 organisms were isolated from 15 patients, including Stenotrophomonas maltophilia (n = 5) and K pneumonia (n = 4). In the peritoneal fluid, 11 organisms were isolated from 10 recipients at T1, including Pseudomonas aeruginosa (n = 2) and Enterococcus species (n = 2). At T2, 39 organisms were isolated from 36 recipients, including coagulase-negative Staphylococcus species (CNS; n = 8) and Enterococcus species (n = 7). At T3, 54 organisms were isolated from 51 recipients, including CNS (n = 17) and Candida species (n = 8). Among the 59 patients with positive culture results for sputum surveillance, 16.9% developed pneumonia caused by the same organisms. Among the 67 patients with positive peritoneal fluid culture, 16.4% developed an intra-abdominal infection caused by the same organisms cultured. The recipients with positive surveillance culture had a higher risk of pneumonia (20.3% [12/59] vs 1.6% [2/120]; P < .001) and intra-abdominal infection (31.3% [21/67] vs 18.7% [21/112]; P = .05). Conclusions: Periodic microbiologic surveillance may be useful in the prediction of post-transplantation pneumonia and intra-abdominal infection and could offer a potential target for empirical antimicrobial therapy in cases of infection. [Copyright &y& Elsevier]

Purpose: The goal of this phase 1 trial was to determine the maximum tolerated dose (MTD) of concurrent capecitabine, bevacizumab, and erlotinib with preoperative radiation therapy for rectal cancer. Methods and Materials: Patients with clinical stage II to III rectal adenocarcinoma, within 12 cm from the anal verge, were treated in 4 escalating dose levels, using the continual reassessment method. Patients received preoperative radiation therapy with concurrent bevacizumab (5 mg/kg intravenously every 2 weeks), erlotinib, and capecitabine. Capecitabine dose was increased from 650 mg/m2 to 825 mg/m2 orally twice daily on the days of radiation therapy; erlotinib dose was increased from 50 mg orally daily in weeks 1 to 3, to 50 mg daily in weeks 1 to 6, to 100 mg daily in weeks 1 to 6. Patients underwent surgery at least 9 weeks after the last dose of bevacizumab. Results: A total of 19 patients were enrolled, and 18 patients were considered evaluable. No patient had grade 4 acute toxicity, and 1 patient had grade 3 acute toxicity (hypertension). The MTD was not reached. All 18 evaluable patients underwent surgery, with low anterior resection in 7 (39%), proctectomy with coloanal anastomosis in 4 patients (22%), posterior pelvic exenteration in 1 (6%), and abdominoperineal resection in 6 (33%). Of the 18 patients, 8 (44%) had pathologic complete response, and 1 had complete response of the primary tumor with positive nodes. Three patients (17%) had grade 3 postoperative complications (ileus, small bowel obstruction, and infection). With a median follow-up of 34 months, 1 patient developed distant metastasis, and no patient had local recurrence or died. The 3-year disease-free survival was 94%. Conclusions: The combination of preoperative radiation therapy with concurrent capecitabine, bevacizumab, and erlotinib was well tolerated. The pathologic complete response rate appears promising and may warrant further investigation. [ABSTRACT FROM AUTHOR]

Highlights: [•] BIG1 is colocalized with synaptic marker synaptophysin in soma and partly in neurites. [•] BIG1 content increased with embryonic rat brain growth. [•] BIG1 siRNA inhibited neurite development in primary cultured cortical neuron. [•] Depletion or inhibition of BIG1 decreased the phosphorylation of PI3K–AKT and ERK. [•] We report a novel function of BIG1 in regulating neurite outgrowth. [Copyright &y& Elsevier]