'PartBreCon' study. A UK multicentre retrospective cohort study to assess outcomes following PARTial BREast reCONstruction with chest wall perforator flaps

BACKGROUND

Partial breast reconstruction with a pedicled chest wall perforator flap (CWPF) enables breast conservation in a higher tumour: breast volume ratio scenario. Since there is limited evidence, this retrospective cohort study aimed to ascertain immediate (30-days) and medium-term (follow-up duration) surgical outcomes.

METHODS

STROBE-compliant protocol ascertained CWPF outcomes between March 2011-March 2021. UK centres known to perform CWPF were invited to participate if they performed at least 10 cases. Data were retrospectively collected, including patient demographics, tumour and treatment characteristics, and surgical and oncological outcomes. Statistical analysis (R™) included multivariable logistic regression and sensitivity analysis.

RESULTS

Across 15 centres, 507 patients with median age (54 years, IQR; 48-62), body mass index (25.4 kg/m2, IQR; 22.5-29), tumour size (26 mm, IQR; 18-35), and specimen weight (62 g, IQR; 40-92) had following flap types: LiCAP (54.1%, n = 273), MiCAP/AiCAP (19.6%, n = 99), LiCAP + LTAP (19.8%, n = 100) and TDAP (2.2%, n = 11). 30-days complication rates were in 12%: haematoma (4.3%, n = 22), wound infection (4.3%, n = 22), delayed wound healing (2.8%, n = 14) and flap loss (0.6%, n = 3; 1 full) leading to readmissions (2.6%, n = 13) and re-operations (2.6%, n = 13). Positive margins (n = 88, 17.7%) led to 15.9% (n = 79) re-excisions, including 7.5% (n = 37) at the planned 2nd of 2-stage surgery and 1.8% (n = 9) mastectomy. At median 23 months (IQR; 11-39) follow-up, there were 1.2% (n = 6) symmetrisations; recurrences: local (1%), regional/nodal (0.6%) and distant (3.2%).

CONCLUSIONS

This large multicentre cohort study demonstrates acceptable complication and margin re-excision rates. CWPF extends the range of breast conservation techniques. Further studies are required for long-term oncological outcomes.

Prediction of intermediate band in Ti/V doped γ-In2S3

Materials with an intermediate energy band (IB) introduced in the forbidden gap are viable alternatives to tandem configurations of solar cells for increasing the photon-conversion efficiency. One of the aspiring designs proposed for the intermediate band concept is hyperdoped (Ti, V):In₂S₃. Being very important in copper indium gallium sulfide (CIGS) solar cells, indium thiospinel (In₂S₃) is known for its three different temperature as well as pressure, polymorphs. The most stable β-In₂S₃ was experimentally shown to have an isolated intermediate band (IB) and exhibits sub-band gap absorption due to the completely filled IB after V-doping. Though experimental observation holds a positive signature, recent DFT studies did not show a metallic intermediate band for the V dopant in the 3+ charge state. In order to clarify this, we have taken incentive from experimental XRD analysis that V-doped β-In₂S₃ shows peaks from disordered In vacancies (either α or γ), in addition to the ordered In vacancies expected. Hence, we have carried out state-of-the-art DFT based computations on pure and Ti, V-doped In₂S₃ in the γ-phase which has not been studied yet. We considered the Ti and V dopants in various charge states. Our theoretical study including hybrid functional, does in fact find the IB in V-doped γ-In₂S₃. However, at equilibrium the IB lies in between the Fermi level (E_F) and conduction band minimum (CBM).

We find the band structure of In_1.5V_0.5S₃ with HSE functional, where the vanadium atom introduces an intermediate band inside the forbidden gap in the γ-phase of In₂S₃.

Metal transfer and related human health risk assessment through milk from cattle grazing at an industrial discharge area

The water bodies within industrial areas are often used for the disposal of effluents leading to metal contamination in water, soil, and vegetation. However, the impact of metal enrichment in the food grown in these areas has not been much explored. The present study investigates the food chain contamination of eight metals (Al, Cd, Cr, Cu, Fe, Mn, Pb, and Zn) in the milk from the cattle grazing on a shallow lake bed within the industrial town of Ranipet, India, and associated health risk from the consumption by adults and children. It also considers the possible sources of metals into the cattle from water, forage, and soil. The total number of cattle grazing in the study area was identified, along with their average daily intakes. The total milk yield from these cattle and the milk consumption rates were identified from surveys conducted among cattle owners and milk buyers. The primary sources of all the metals, except Al are forage; whereas for Al, it is the soil. The projected milk consumption pattern indicates that 531 children and 1279 adults drinking contaminated milk are at considerable risk. The hazard indices ranged from 0.86 to 2.74 for children, and 0.35 to 1.13 for adults. The Cancer Risk values for Cd and Cr were above 10^-4 for adults and children, signify serious health risk. The analyses of tail switch hair samples indicated that cattle are also environmentally exposed to metals indicating their subclinical effect. Hence, the study substantiates that soil can be a potential source of metals in the food chain, and apprises stringent quality control and monitoring food chain contamination from milk in industrial belts.

445 Review of Restarting Elective Surgical Service in District General Hospital Post COVID 19

Aim

National Health Service (NHS) has massively reduced non-urgent elective surgical service as COVID-19 hit the UK.This study aims to evaluate the measures taken by our trust to restart elective surgical work which was suspended due to the COVID-19 pandemic.

Method

This is a single centre, retrospective, observational study. We analysed records of the first 100 patients who underwent any type of elective General Surgical operative procedure since June 2020.

Results

Our cohort included 51 female, and 49 male patients. Youngest patient was 19 years old and the eldest was of 86 years with mean age of 55.5. In our group, 16 patients were ASA grade 1, 57 were ASA 2, 26 ASA 3 and 1 patient was ASA grade 4. The median ASA grade among our patient group was 2. In this study shortest hospital stay was of 1 day and longest of 53 days with average stay of 5.2 days and SD of 7.6. In our cohort, 18 patients developed Grade 2 Clavein-Dindo(CD) Complications,6 patients developed Grade 3 and none developed complications of CD Grade 4 or beyond. Repeat COVID-19 tests for all patients staying over 7 days were negative.

Conclusions

In conclusion, through appropriate isolation and with adhering to trust guidelines, restarting of elective surgery in non-covid free hospital compound via separate pathways are feasible and should be reflected upon before stopping all elective surgical services in the future considering the threat of further waves of covid-19 or the new variant of the virus looks very real.

Innovations for the future of breast surgery

BACKGROUND

Future innovations in science and technology with an impact on multimodal breast cancer management from a surgical perspective are discussed in this narrative review. The work was undertaken in response to the Commission on the Future of Surgery project initiated by the Royal College of Surgeons of England.

METHODS

Expert opinion was sought around themes of surgical de-escalation, reduction in treatment morbidities, and improving the accuracy of breast-conserving surgery in terms of margin status. There was emphasis on how the primacy of surgical excision in an era of oncoplastic and reconstructive surgery is increasingly being challenged, with more effective systemic therapies that target residual disease burden, and permit response-adapted approaches to both breast and axillary surgery.

RESULTS

Technologies for intraoperative margin assessment can potentially half re-excision rates after breast-conserving surgery, and sentinel lymph node biopsy will become a therapeutic procedure for many patients with node-positive disease treated either with surgery or chemotherapy as the primary modality. Genomic profiling of tumours can aid in the selection of patients for neoadjuvant and adjuvant therapies as well as prevention strategies. Molecular subtypes are predictive of response to induction therapies and reductive approaches to surgery in the breast or axilla.

CONCLUSION

Treatments are increasingly being tailored and based on improved understanding of tumour biology and relevant biomarkers to determine absolute benefit and permit delivery of cost-effective healthcare. Patient involvement is crucial for breast cancer studies to ensure relevance and outcome measures that are objective, meaningful, and patient-centred.

Oncoplastic breast surgery: A guide to good practice

Oncoplastic Breast Surgery has become standard of care in the management of Breast Cancer patients. These guidelines written by an Expert Advisory Group; convened by the Association of Breast Surgery (ABS) and the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS), are designed to provide all members of the breast cancer multidisciplinary team (MDT) with guidance on the best breast surgical oncoplastic and reconstructive practice at each stage of a patient's journey, based on current evidence. It is hoped they will also be of benefit to the wide range of professionals and service commissioners who are involved in this area of clinical practice.

Systematic review of partial breast reconstruction with pedicled perforator artery flaps: Clinical, oncological and cosmetic outcomes

The use of chest wall perforator flaps (CWPFs) following breast conservation surgery for breast cancer has become a useful tool in the armamentarium of the oncoplastic breast surgeon, however robust evidence for the technique is lacking. The aim of this study was to conduct a systematic review appraising the current evidence for the use of CWPFs, evaluating clinical, oncological and cosmetic outcomes. A PRISMA-compliant systematic review, with PROSPERO published protocol a priori and search of all relevant database and trial registries between 1990 to July 2020. Eleven studies amounting to 432 cases were reviewed and considered to be at high risk of bias due to small sample size, selective outcome reporting and selection bias. Heterogeneity due to lack of consensus of outcome measures prevented meaningful analysis. Fifty-two (12.3%) clinical complications were recorded: seroma (n = 9; 2.1%), fat necrosis (n = 9; 2.4%), haematoma (n = 8; 1.9%), infection (n = 9; 2.1%), and flap necrosis (n = 9; 2.1%). Thirty-four (10.8%) patients had an involved positive margin, 29 patients underwent re-excision (9.3%) and four underwent completion mastectomy (1.3%). One local recurrence and six distant recurrences were observed during a mean follow up of 21 months (1-49). A pooled patient cosmetic satisfaction descriptor of good or excellent was described in 93% of cases. CWPFs are a safe method of partial breast reconstruction following BCS. They are associated with a low complication rate, acceptable short-term oncological outcomes and satisfactory cosmetic outcome. There is a relative paucity in quality of data in this field and larger prospective studies are needed to investigate outcomes further.

The presentation, management and outcome of inflammatory breast cancer cases in the UK: Data from a multi-centre retrospective review

OBJECTIVES

Inflammatory Breast cancer (IBC) is a rare but aggressive form of breast cancer. Its incidence and behaviour in the UK is poorly characterised. We collected retrospective data from hospitals in the UK and Ireland to describe the presentation, pathology, treatment and clinical course of IBC in the UK.

MATERIALS AND METHODS

Patients with IBC diagnosed between 1997-2014 at fourteen UK and Irish hospitals were identified from local breast unit databases. Patient characteristics, tumour pathology and stage, and details of surgical, systemic and radiotherapy treatment and follow-up data were collected from electronic patient records and medical notes.

RESULT

This retrospective review identified 445 patients with IBC accounting for 0.4-1.8% of invasive breast cancer cases. Median follow-up was 4.2 years. 53.2% of tumours were grade 3, 56.2% were oestrogen receptor positive, 31.3% were HER2 positive and 25.1% were triple negative. 20.7% of patients had distant metastases at presentation. Despite trimodality treatment in 86.4%, 40.1% of stage III patients developed distant metastases. Five-year overall survival (OS) was 61.0% for stage III and 21.4% for stage IV patients.

CONCLUSIONS

This is the largest series of UK IBC patients reported to date. It indicates a lower incidence than in American series, but confirms that IBC has a high risk of recurrence with poor survival despite contemporary multi-modality therapy. A national strategy is required to facilitate translational research into this aggressive disease.

Time to redefine the intramammary lymph node as a separate entity?

The lymphatic drainage for the majority of primary breast tumors is to the axillary lymph nodes (ALNs). Some, however, drain to the so-called extra-axillary basins, namely the internal mammary, supra- and infraclavicular regions. Another potential drainage route includes the intramammary lymph nodes (IMLNs). Current guidance suggests IMLNs should be considered as part of the axillary group, potentially affecting axillary management. However, due to evolution in imaging and advancement in technology, IMLNs may now be distinguished more accurately pre-operatively. There are currently no published guidelines for the management of IMLNs in the United Kingdom. The authors suggest that it is time to reclassify IMLNs as a separate focus of cancer and treat it as a separate entity. Clin. Anat. 31:684-687, 2018. © 2018 Wiley Periodicals, Inc.

Subcutaneous implant breast reconstruction: Time to reconsider?

Improvements in breast surgery techniques such as skin and nipple preserving mastectomy and innovative prosthetics (implants, acellular dermal matrices and meshes) is renewing interest in subcutaneous (pre-pectoral) implant reconstruction. The aim of this paper is to review the current literature in an attempt to provide a rationale that may support a return to subcutaneous implant placement, so minimising the pain and functional problems resulting from submuscular breast reconstruction.

On the Performance of a Test for Coefficient of Variation

Approximate standard errors (s.e) of sample coefficient of variation (c.v.) are available in the literature (Kendall and Stuart, 1977; Serfting 1980). Using these s.e.'s a large sample test can be constructed to test for the specified value of population c.v. The test can also be justified on the principles of Wald test. These s.e.'s have been worked out assuming that the random variable has a distribution. Following Foutz and Srivastava (1977), we study the asymptotic performance of the test when the model is incorrect. Examples from realistic situations have been considered and approximate Babadur efficiencies have been worked out. Numerical results indicate that the test is fairly robust when the departure from the model is not too pronounced.

Report of leucine-rich repeats (LRRs) from Scylla serrata: Ontogeny, molecular cloning, characterization and expression analysis following ligand stimulation, and upon bacterial and viral infections

Leucine-rich repeat (LRR) proteins are present in all living organisms, and their participation in signal transduction and defense mechanisms has been elucidated in humans and mosquitoes. LRRs possibly involve in protein-protein interactions also and show differential expression pattern upon challenge with pathogens. In the present study, a new LRR gene was identified in mud crab, Scylla serrata. LRR gene mRNA levels in different developmental stages and various tissues of S. serrata were analysed. Further, the response of the gene against different ligands, Gram-negative bacterium, and white spot syndrome virus (WSSV) was investigated in vitro and in vivo. Full-length cDNA sequence of S. serrata LRR (SsLRR) was found to be 2290 nucleotide long with an open reading frame of 1893bp. SsLRR encodes for a protein containing 630 deduced amino acids with 17 conserved LRR domains and exhibits significant similarity with crustacean LRRs so that these could be clustered into a branch in the phylogenetic tree. SsLRR mRNA transcripts were detected in all the developmental stages (egg, Zoea1-5, megalopa and crab instar), haemocytes and various tissues such as, stomach, gill, muscle, hepatopancreas, hematopoietic organ, heart, epithelial layer and testis by reverse-transcriptase PCR. SsLRR transcripts in cultured haemocytes showed a 2-fold increase in expression at 1.5 and 12h upon Poly I:C induction. WSSV challenge resulted in significant early up-regulation at 3h in-vitro and late up-regulation at 72h in-vivo. Peptidoglycan (PGN)-induction resulted in marginal up-regulation of SsLRR at timepoints, 6, 12 and 24h (fold change below 1.5) and no significant change in the expression at early timepoints. LPS-stimulation, on the other hand, showed either down-regulation or normal level of expression at all timepoints. However, a delayed 5-fold up-regulation was observed in vivo against Vibrio parahaemolyticus infection at 72hpi. The constitutive expression of the LRR gene in all the early life-stages, and its response to various ligands and to viral challenge suggest the possible role of the LRR in immune defense in mud crab. The result provides additional information which would help in future studies in understanding the innate immune pathways in crustaceans.

Theoretical and experimental investigation on structural, electronic and magnetic properties of layered Mn5O8

Using density functional theory calculations and NPD measurements, we have identified that Mn₅O₈is a strongly correlated mixed valent antiferromagnetic metal.

Structural and electronic properties of transparent conducting delafossite: a comparison between the AgBO2 and CuBO2 families (B = Al, Ga, In and Sc, Y)

The Ag-based delafossite transparent conducting oxides are potential p-type materials for transparent electronics. However, they have attracted less attention due to their difficult synthetic chemistry and relatively low conductivity.

Observation of direct magneto-dielectric behaviour in Lu3Fe5O12−δ above room-temperature

Oxygen vacancy created an intrinsic magneto-dielectric effect in Lu₃Fe₅O₁₂.

White spot syndrome virus Manipulates Ubiquitin Gene Expression in Penaeus monodon

The present study reports the effect of WSSV on the expression profiles of shrimp ubiquitin gene both at protein and transcript levels at different time points after infection. A gradual decrease in ubiquitin protein levels was observed till 12 hpi (0.25 and 0.23 μg/mg of the total protein in gills and muscle, respectively) with a sudden increase at 18 hpi (1.86 and 1.8 μg/mg of total protein in gills and muscle, respectively). The RT-PCR results showed a gradual decrease in ubiquitin mRNA levels in gill tissue till 12 hpi while a more or less constant mRNA levels were observed in muscle tissue till 12 hpi. However, a fourfold and 16 fold induction in ubiquitin mRNA levels at 18 hpi in gill and muscle, respectively suggests its possible regulation by WSSV in the manifestation of the disease.

Effect of yoghurt containing Bifidobacterium lactis Bb12® on faecal excretion of secretory immunoglobulin A and human beta-defensin 2 in healthy adult volunteers

BACKGROUND

Probiotics are used to provide health benefits. The present study tested the effect of a probiotic yoghurt on faecal output of beta-defensin and immunoglobulin A in a group of young healthy women eating a defined diet.

FINDINGS

26 women aged 18-21 (median 19) years residing in a hostel were given 200 ml normal yoghurt every day for a week, followed by probiotic yoghurt containing Bifidobacterium lactis Bb12® (10⁹ in 200 ml) for three weeks, followed again by normal yoghurt for four weeks. Stool samples were collected at 0, 4 and 8 weeks and assayed for immunoglobulin A and human beta-defensin-2 by ELISA. All participants tolerated both normal and probiotic yoghurt well. Human beta-defensin-2 levels in faeces were not altered during the course of the study. On the other hand, compared to the basal sample, faecal IgA increased during probiotic feeding (P = 0.0184) and returned to normal after cessation of probiotic yoghurt intake.

CONCLUSIONS

Bifidobacterium lactis Bb12® increased secretory IgA output in faeces. This property may explain the ability of probiotics to prevent gastrointestinal and lower respiratory tract infections.

OT2-03-04: A Trial Model for the Future in the Search for Personalised Medicine – The UK POETIC and EPHOS-B Perioperative Trials Experience

Background

Perioperative therapy offers the opportunity to measure biological response to treatment in the primary tumor in early breast cancer (EBC), enhancing prospects for personalised medicine. Perioperative trials form an expanding component of the UK national breast cancer trials portfolio. Unlike traditional neoadjuvant studies, activity dovetails around timelines for standard treatment with no planned delay to primary surgery. Tissue samples collected prior to randomisation (baseline) & again at surgery address key biological endpoints & are essential for perioperative studies.

Methods: As the UK's largest perioperative trial, POETIC (ER+ve postmenopausal EBC, +/− aromatase inhibitor therapy, biomarker & disease outcome) aims to recruit 4000 patients from 100+ centres.

EPHOS-B (HER2+ve EBC, +/− lapatinib or trastuzumab) focuses on biomarker endpoints & aims to recruit 250 patients. Barriers to recruitment included 1) integration of research protocols into busy breast surgical clinics, extending a clinical trials culture across a multidisciplinary breast diagnostic team, & ensuring appropriate GCP training, 2) satisfying requirements for storing research tissue, 3) complying with government cancer wait times, 4) obtaining biomarker results within required timelines 5) ensuring completeness & quality of tissue samples. Additional challenges for EPHOS-B include managing requirements for scheduling of oncological therapy (e.g. trastuzumab) in pre-operative setting, delivery of such therapy outside the randomising hospital & rapid access to cardiac screening before randomisation.

Results: The following strategies were developed to overcome barriers 1) increasing collaborative working at sites & adopting a pragmatic approach to type of tissue required. Centres choose to provide both FFPE tissue & tissue in RNA-later, or FFPE tissue only; 2) working with national regulators to agree interpretation of current legislation in designation of when tissue is “in transit” (enabling it to reside outside a tissue bank) & “research” tissue (where transfer to a tissue bank is required); 3) agreement with government that procedures integral to perioperative trials comply with cancer wait times; 4) promoting reorganisation of site processes for obtaining essential biomarker results; 5) pilot lab work to inform site guidance on tissue collection procedures to ensure quality of samples received. A tracking database allows completeness of tissue samples to be monitored. Work to improve timelines for HER2 testing in EPHOS-B is ongoing, & challenges of delivering anti-HER2 therapy in this setting have been addressed.

Conclusions: Assessment of biological response to therapy in the primary tumor in EBC within national trials is feasible. Many barriers faced by POETIC have been overcome, & with recruitment now 100+ patients per month, newer centres benefit from earlier experience. Lessons learnt in POETIC apply to EPHOS-B, allowing investigators to focus on resolving more challenging issues specific to that trial. In many centres both trials have been important drivers in improving timeliness of molecular testing & therefore benefited the patient pathway in general as well as securing high quality trial data.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr OT2-03-04.

Hexamoll DINCH plasticised PVC containers for the storage of platelets

Introduction:

Containers for the storage of platelets are made using polyvinyl chloride plasticised with di, (2-ethyl hexyl) phthalate, n-butyryl, tri (n-hexyl) citrate and tri (2-ethyl hexyl) mellitate or using special poly olefins without plasticiser. Of these, the first two have disadvantages such as plasticiser leaching and impairment of platelet function. Polyolefin bags cannot be HF welded or steam sterilized. Mellitate plasticised bags can store platelets well for five days but they are not completely phthalate free.

Research and Development:

We have developed a new generation of containers made of PVC plasticised with the non DEHP, non aromatic plasticiser,1,2- Cyclohexanedicarboxylic acid, diisononyl ester (Hexamoll DINCH) which can store platelets without loss of function for at least six days.

Observation:

The present studies show that DINCH plasticised PVC bags (TPL-167) are well suited for the storage of platelet concentrates for more than five days.

Conclusion:

The present studies show that the PVC plasticised with the non phthalate, non aromatic, non toxic plasticiser DINCH is a viable alternative to other existing containers for the storage of platelets for more than five days.

Idiopathic granulomatous mastitis: rare but important

A 61-year-old woman attended the breast clinic with unresolving mastitis and an associated mass, following failed treatment with antibiotics. Triple assessment confirmed idiopathic granulomatous mastitis. Unresponsive to further conservative management and steroid therapy, she underwent surgical excision and made uneventful recovery. No evidence of recurrence was detected at 18 months follow-up.

Pre-operative diagnosis of obturator hernia: a report of two cases

Obturator hernias are rare, accounting for less than 1.5% of all hernias, and usually present with acute intestinal obstruction requiring emergency surgery. They are rarely diagnosed in the elective setting. We discuss two cases, a 52-year-old man and a 71-year-old woman, both presenting electively with a history suggestive of occult groin hernia; neither had a palpable lump. They both underwent out-patient herniography which demonstrated obturator hernia and both patients subsequently had elective laparoscopic repair, with good results. A high index of suspicion along with appropriate use of imaging modality allows for early identification of this rare condition. Early intervention can prevent the morbidity and mortality associated with complicated obturator hernia.

A rare case of giant cutaneous horn

Cutaneous horn, a clinical manifestation of hyper-proliferation of compact keratin, can represent a wide array of underlying benign and malignant pathologies. Here we report a unique case of a giant cutaneous horn (7x4x3 cm) that developed on a chronic ulcer in a non sun-exposed area. This case presented challenges in terms of diagnosis and treatment. We also review the literature about this rare condition.

Density functional theory studies of spin, charge, and orbital ordering in YBaT2O5 (T = Mn, Fe, Co)

Spin, charge, and orbital orderings are influenced by electron/hole doping, cation radii, oxygen stoichiometry, temperature, magnetic field, and so on. In order to understand the role of electron/hole doping, we have studied variations in spin, charge, and orbital ordering in terms of d-band filling for YBaT 2O 5 (T = Mn, Fe, Co). The calculations were performed using density functional theory as implemented in the full-potential linearized augmented-plane-wave method. We have carried out calculations for nonmagnetic, ferromagnetic, and antiferromagnetic configurations. A ferrimagnetic ground state was established for YBaMn 2O 5, whereas YBaFe 2O 5 and YBaCo 2O 5 have antiferromagnetic ground states; all of these results are in agreement with experimental findings. The effects of spin-orbit coupling, the Hubbard U parameter, and orbital polarization on the magnetic properties were also analyzed. The electronic band characteristics were analyzed using total as well as site- and orbital-projected densities of states. Inclusion of spin-orbit coupling and Coulomb correlation effects in the calculations was found to be important in order to reproduce the experimentally established semiconducting behaviors of YBaFe 2O 5 and YBaCo 2O 5. In order to quantify the charges at each atomic site, we made use of the Bader "atom-in-molecule" concept and Born effective-charge (BEC) analyses. The structural optimizations and BEC tensor calculations were performed using the VASP-PAW method. The different types of charge and orbital orderings in these compounds were visualized using the energy-projected density matrices of the d electrons. Substantial differences in ordering patterns with respect to d-band filling emerged. Ordering of the d z (2) orbital of Mn in YBaMn 2O 5 gave rise to G-type ferrimagnetic spin ordering along the c direction and checkerboard-type charge ordering, whereas ordering of the d x (2) - y (2) orbital of Fe in YBaFe 2O 5 caused Wollan-Koehler G-type antiferromagnetic spin ordering along the b direction and stripe-type charge ordering. Similarly, a complex pattern of orbital ordering in YBaCo 2O 5 activated spin and charge orderings similar to those in YBaFe 2O 5.

Are routine peritoneal fluid cultures during appendicectomy justified?

BACKGROUND

To determine the impact of obtaining routine peritoneal fluid cultures during appendicectomy, on the treatment and the clinical outcomes.

METHODS

The case notes of 137 consecutive patients having appendicectomy, selected from the microbiology database over a period of 1 year were reviewed. The microorganisms in peritoneal cultures, selection of antibiotics and clinical outcomes were recorded. Patients were subdivided into two groups; group I: uncomplicated appendicitis and group II: complicated appendicitis.

RESULTS

The study included 137 patients with a median age of 19 years. Cultures were obtained from 79.5% of patients (group I: 67/84, group II: 42/53). Cultures were positive in 28.3% (19/67) patients in group I and 69% (29/ 42) in group II. Wound infection (5.6%), prolonged ileus (7.5%) and intra-abdominal abscess (3.7%) were the recorded complications in group II. Antibiotics were modified in 3 out of 109 patients.

CONCLUSION

Intra-operative peritoneal cultures during appendicectomy do not significantly contribute towards patient management.

Should surgeons as well as radiologists report mammograms in symptomatic patients?

This study compared the accuracy of interpretation by surgeons and radiologists of 1053 women who had two view mammography and a histological or cytological diagnosis of benign or malignant breast disease. Patients with large or locally advanced breast cancers who had definite clinical findings where radiology was not required to make a diagnosis were excluded. The sensitivity for radiologists was non-significantly greater (81%) than surgeons (78%), but specificity and positive predictive value was identical in the two groups of readers. Combining the reports of the radiologists and surgeons increased sensitivity to 85.4% which is a significant increase in the sensitivity of the radiologist alone, P =0.02. This study indicates that symptomatic mammograms should be read by surgeons as well as radiologists.

Tailor-made electronic and magnetic properties in one-dimensional pure and Y-substituted Ca3Co2O6

Full-potential density-functional calculations show that the electronic structure of one-dimensional ferrimagnetic Ca3Co2O6 varies from metal to half metal to insulator as its magnetic ordering changes from the ferrimagnetic through the ferromagnetic to the paramagnetic state. The present Letter is the first to establish the occurrence of half metallicity in one-dimensional oxides. Moreover, the electronic and magnetic properties of this material can be tuned by substitution of Y for Ca, as shown by our detailed study on Ca(3-x)YxCo2O6 (x = 0, 0.3, 0.75, and 1). The Co ions are in two different valence states [Co4+ (low-spin) and Co2+ (high-spin)], and hence the occurrence of charge ordering in addition to spin ordering is established. For specific Y concentrations we predict a rarely seen combination of ferromagnetic and insulating behavior.

Violation of the minimum h-h separation "Rule" for metal hydrides

Using gradient-corrected, full-potential, density-functional calculations, including structural relaxations, it is found that the metal hydrides RTInH1.333 (R=La, Ce, Pr, or Nd; T= Ni, Pd, or Pt) possess unusually short H-H separations. The most extreme value (1.454 A) ever obtained for metal hydrides occurs for LaPtInH1.333. This finding violates the empirical rule for metal hydrides, which states that the minimum H-H separation is 2 A. The paired, localized, and bosonic nature of the electron distribution at the H site are polarized towards La and In which reduces the repulsive interaction between negatively charged H atoms. Also, R-R interactions contribute to shielding of the repulsive interactions between the H atoms.

Oxa bowls: synthesis and C-H...O mediated solid state structure of pentaoxa-[5]-peristylane

We have conceptualized [n]-oxa-[n]-peristylanes as a new family of "oxa bowls" having a crownlike shape and potential C(nv)() symmetry. Recognizing their equivalence to the corresponding [n]-formyl-[n]-cycloalkanes, we have conceived of a general synthetic strategy in which "intramolecular cascade acetalizations" constitute the pivotal step. As our first synthetic effort, we describe the synthesis of pentaoxa-[5]-peristylane 3b from the readily available Diels-Alder adduct 10 of 5,5-dimethoxy-tetrachlorocyclopentadiene and maleic anhydride. The norbornyl framework of 10 serves as the rigid structural matrix to build the stereochemical features and latent aldehyde functionalities as in 9 through a series of functional group adjustments. Ozonation of 9 furnished 3b in a one-step transformation in which five tetrahydrofuran rings were generated. While 3b exhibited C(5v) symmetry in solution, its symmetry in the solid state was observed to be C(s) by X-ray crystallography. In the solid state, 3b is endowed with a multicolumnar architecture, whose distinctive features include C-H...O interactions involving the less acidic cyclopentane hydrogens. Indeed, all the 10 CH moieties and 5 oxygen atoms (through both the lone pairs) of 3b (C(10)H(10)O(5)) are involved in short C-H...O contacts (strong and soft) and its crystal structure indicates marked proclivity toward maximal hydrogen bonding.

Oxa bowls: studies toward hexaoxa-[6]-peristylane. Synthesis of a seco-derivative of hexaoxa-[6]-peristylane

When the concept of equivalency of all-cis-[n]-formyl-[n]-cycloalkanes with [n]-oxa-[n]-peristylanes was followed, an approach to the "oxa bowl" hexaoxa-[6]-peristylane 4a was delineated. This required an access to all-cis-cyclohexane-hexacarbaldehyde 5, which could be subjected to a 6-fold intramolecular acetalization cascade. A readily available Diels-Alder adduct of cyclooctatetraene and maleic anhydride was chosen as the starting material and was elaborated to the endo, endo-tetraene 6 in which all the six aldehyde functionalities are present in a latent form with cis orientation in a locked cyclohexane ring. Although ozonolysis of 6 has so far led only to intractable products, the novelty and brevity of our approach have been demonstrated through the intramolecular acetalizations through ozonolysis in 7 and 15, leading to oxa bowls 9 (seco-hexaoxaperistylane) and 16, respectively. The formation of 9 and 16 requires the generation of five tetrahydrofuran and four oxacyclic rings, respectively, in a single-pot operation.