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Mental health and academic outcomes over the first year at university in international compared to domestic Canadian students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:2663-2672. [PMID: 34606410 DOI: 10.1080/07448481.2021.1982950] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 07/20/2021] [Accepted: 09/13/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To compare risk factors and associated mental health and academic outcomes between international and domestic students. PARTICIPANTS Canadian university undergraduate students. METHODS Electronic surveys were completed at university entry and the end of first year. Surveys assessed demographics, risk factors, symptoms of mental disorders, and access to support. Academic outcomes were obtained from university databases. RESULTS International students had comparable or lower rates of clinically significant anxiety, depression, and insomnia. Domestic female students reported the highest screening rates for common mental disorders. However, international students were more likely to report having attempted suicide. International students felt less connected to the university community and had lower academic performance. Psychosocial risk factor profiles and proportions accessing mental health services were similar. CONCLUSIONS The scope of mental health need appears more similar than different between international and domestic students; however, international students may benefit from targeted academic and social support initiatives.
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Ultra-Deep Sequencing Reveals the Mutational Landscape of Classical Hodgkin Lymphoma. CANCER RESEARCH COMMUNICATIONS 2023; 3:2312-2330. [PMID: 37910143 PMCID: PMC10648575 DOI: 10.1158/2767-9764.crc-23-0140] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/27/2023] [Accepted: 10/24/2023] [Indexed: 11/03/2023]
Abstract
The malignant Hodgkin and Reed Sternberg (HRS) cells of classical Hodgkin lymphoma (cHL) are scarce in affected lymph nodes, creating a challenge to detect driver somatic mutations. As an alternative to cell purification techniques, we hypothesized that ultra-deep exome sequencing would allow genomic study of HRS cells, thereby streamlining analysis and avoiding technical pitfalls. To test this, 31 cHL tumor/normal pairs were exome sequenced to approximately 1,000× median depth of coverage. An orthogonal error-corrected sequencing approach verified >95% of the discovered mutations. We identified mutations in genes novel to cHL including: CDH5 and PCDH7, novel stop gain mutations in IL4R, and a novel pattern of recurrent mutations in pathways regulating Hippo signaling. As a further application of our exome sequencing, we attempted to identify expressed somatic single-nucleotide variants (SNV) in single-nuclei RNA sequencing (snRNA-seq) data generated from a patient in our cohort. Our snRNA analysis identified a clear cluster of cells containing a somatic SNV identified in our deep exome data. This cluster has differentially expressed genes that are consistent with genes known to be dysregulated in HRS cells (e.g., PIM1 and PIM3). The cluster also contains cells with an expanded B-cell clonotype further supporting a malignant phenotype. This study provides proof-of-principle that ultra-deep exome sequencing can be utilized to identify recurrent mutations in HRS cells and demonstrates the feasibility of snRNA-seq in the context of cHL. These studies provide the foundation for the further analysis of genomic variants in large cohorts of patients with cHL. SIGNIFICANCE Our data demonstrate the utility of ultra-deep exome sequencing in uncovering somatic variants in Hodgkin lymphoma, creating new opportunities to define the genes that are recurrently mutated in this disease. We also show for the first time the successful application of snRNA-seq in Hodgkin lymphoma and describe the expression profile of a putative cluster of HRS cells in a single patient.
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Work-related musculoskeletal pain and discomfort in laparoscopic surgeons: an international multispecialty survey. Ann R Coll Surg Engl 2023; 105:734-738. [PMID: 37128858 PMCID: PMC10618035 DOI: 10.1308/rcsann.2023.0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
INTRODUCTION As laparoscopic surgery is used more widely across the globe and within multiple surgical specialties the potential impact on surgeons is yet to be fully quantified. Maintenance of uncomfortable body positions may lead to work-related musculoskeletal disorders (WMSD) in surgeons, with potential knock-on effects. METHODS An international open online survey of multispecialty laparoscopic surgeons was carried out, designed and reported in accordance with the CHERRIES checklist for internet e-survey research. There was no paid advertising and no incentives offered. RESULTS A total of 259 surgeons from 9 specialties and 32 countries answered the survey, with 90% reporting pain attributable to performing laparoscopic surgery. All training grades were represented. Longer average operative duration and a greater number of years in practice were both associated with a significantly higher prevalence of pain. Surgeons with a pre-existing injury were significantly more likely to report pain than those without. Twenty per cent of surgeons would consider early retirement owing to pain. CONCLUSIONS The impact on surgeons of performing laparoscopic surgery is significant, even given the limitations of an open survey. Innovations such as robotic surgery and improved ergonomic education may reduce the incidence of WMSD in surgeons, to mitigate both the personal effects on surgeons and the wider effect on the future surgical workforce.
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A systematic review of point-of-care abdominal ultrasound scans performed by general surgeons in paediatric patients. Surgeon 2023; 21:e238-e241. [PMID: 36670025 DOI: 10.1016/j.surge.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 07/14/2022] [Accepted: 01/03/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND/PURPOSE Bedside point-of-care ultrasound scans are a cheap, quick and safe diagnostic tool. There is increasing evidence for the use of point-of-care surgeon-performed ultrasound scans in adults, however there are fewer studies of its use in children. This systematic review aims to provide an up-to-date summary of the evidence behind surgeon-performed ultrasound scans in paediatric surgery. METHODS The PubMed database was used to conduct this systematic review between the dates 1 Jan 1980 to 1 June 2020 (last search: 1 June 2020). Seven primary research studies were included in this review. RESULTS There is good evidence for the use of ultrasound scans in appendicitis and hypertrophic pyloric stenosis. Training times are easily achievable and transferable within a surgical department. CONCLUSIONS Although the use of surgeon-performed bedside ultrasound scans has been described in appendicitis and hypertrophic pyloric stenosis, more research is required to embed this into clinical practice, particularly in low volume centres such as district general hospitals. A robust training programme is also recommended to incorporate ultrasound scans into clinical practice.
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Molecular polariton electroabsorption. Nat Commun 2022; 13:7937. [PMID: 36566224 DOI: 10.1038/s41467-022-35589-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 12/09/2022] [Indexed: 12/25/2022] Open
Abstract
We investigate electroabsorption (EA) in organic semiconductor microcavities to understand whether strong light-matter coupling non-trivially alters their nonlinear optical [[Formula: see text]] response. Focusing on strongly-absorbing squaraine (SQ) molecules dispersed in a wide-gap host matrix, we find that classical transfer matrix modeling accurately captures the EA response of low concentration SQ microcavities with a vacuum Rabi splitting of [Formula: see text] meV, but fails for high concentration cavities with [Formula: see text] meV. Rather than new physics in the ultrastrong coupling regime, however, we attribute the discrepancy at high SQ concentration to a nearly dark H-aggregate state below the SQ exciton transition, which goes undetected in the optical constant dispersion on which the transfer matrix model is based, but nonetheless interacts with and enhances the EA response of the lower polariton mode. These results indicate that strong coupling can be used to manipulate EA (and presumably other optical nonlinearities) from organic microcavities by controlling the energy of polariton modes relative to other states in the system, but it does not alter the intrinsic optical nonlinearity of the organic semiconductor inside the cavity.
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464 Local Extension of a Solitary Extra Medullary Nasal Plasmacytoma into the Orbit. Br J Surg 2022. [PMCID: PMC9452088 DOI: 10.1093/bjs/znac269.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Aim Method Results Conclusions
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Identifying the optimal developmental age of human pluripotent stem cell-derived midbrain dopaminergic progenitors for transplantation in a rodent model of Parkinson's disease. Exp Neurol 2022; 358:114219. [DOI: 10.1016/j.expneurol.2022.114219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/15/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022]
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Convergent Clonal Evolution of Signaling Gene Mutations Is a Hallmark of Myelodysplastic Syndrome Progression. Blood Cancer Discov 2022; 3:330-345. [PMID: 35709710 PMCID: PMC9338759 DOI: 10.1158/2643-3230.bcd-21-0155] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 02/21/2022] [Accepted: 05/06/2022] [Indexed: 12/17/2022] Open
Abstract
Progression from myelodysplastic syndromes (MDS) to secondary acute myeloid leukemia (AML) is associated with the acquisition and expansion of subclones. Our understanding of subclone evolution during progression, including the frequency and preferred order of gene mutation acquisition, remains incomplete. Sequencing of 43 paired MDS and secondary AML samples identified at least one signaling gene mutation in 44% of MDS and 60% of secondary AML samples, often below the level of standard sequencing detection. In addition, 19% of MDS and 47% of secondary AML patients harbored more than one signaling gene mutation, almost always in separate, coexisting subclones. Signaling gene mutations demonstrated diverse patterns of clonal evolution during disease progression, including acquisition, expansion, persistence, and loss of mutations, with multiple patterns often coexisting in the same patient. Multivariate analysis revealed that MDS patients who had a signaling gene mutation had a higher risk of AML progression, potentially providing a biomarker for progression. SIGNIFICANCE Subclone expansion is a hallmark of progression from MDS to secondary AML. Subclonal signaling gene mutations are common at MDS (often at low levels), show complex and convergent patterns of clonal evolution, and are associated with future progression to secondary AML. See related article by Guess et al., p. 316 (33). See related commentary by Romine and van Galen, p. 270. This article is highlighted in the In This Issue feature, p. 265.
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Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study. Lancet Digit Health 2022; 4:e520-e531. [PMID: 35750401 DOI: 10.1016/s2589-7500(22)00069-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/07/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. METHODS We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). FINDINGS In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]). INTERPRETATION In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. FUNDING British Journal of Surgery Society.
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301 Blood Grouping and Save in Day Case Laparoscopic Surgery – Potential for Resource Savings? Br J Surg 2022. [DOI: 10.1093/bjs/znac039.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Currently, patients listed for Laparoscopic cholecystectomy and Laparoscopic Appendicectomy undergo routine Blood Grouping and Saving (G&S) pre-operatively. Blood transfusion administration in this context is a rare occurrence. Processing of G&S samples takes approximately 45 minutes and costs £31 per sample. This excludes the phlebotomy and junior doctor resources for sample collection, which incurs additional costs.
We retrospectively assessed the blood transfusion requirements in those patients who underwent either a laparoscopic appendicectomy or cholecystectomy in the last 18 months at a busy District General Hospital (Milton Keynes Hospital) to determine if there were any potential costs and resource savings that could have been made.
Method
Retrospective case notes analysis of patients who had laparoscopic cholecystectomy and laparoscopic appendicectomy from January 2019 to June 2020 focusing on timing of G&S, preoperative and postoperative haemoglobin, the timing of blood transfusion and the number of units transfused.
Results
Of a total of 613 patients, 323 patients had laparoscopic cholecystectomy. 256 (78.8%) of these had 1 G&S sample and 96 (29.7%) had 2 samples.
290 patients had laparoscopic appendicectomy. 190 (65.5%) of these laparoscopic appendicectomy patients had 1 G&S sample and 89 (30.6%) had two G&S samples.
None of the 613 patients was transfused. The total cost of G&S was £22,196.
Conclusions
Our study illustrates that in this group there was no requirement for blood transfusion. Routine group and save samples result in a significant waste of resources and finances. Targeted groups and save samples should be reserved for high-risk groups only.
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Effectiveness of two tobacco cessation methods among TB patients. Int J Tuberc Lung Dis 2022; 26:12-17. [PMID: 34969423 DOI: 10.5588/ijtld.21.0211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Tobacco and TB are the world´s two greatest public health problems. Exposure to tobacco has been shown to be associated with higher risk of acquiring TB and adverse outcomes such as relapse and TB mortality.OBJECTIVE: To assess and compare self-reported tobacco quit status and biochemically verified cotinine levels among TB patients at different time intervals among two study groups.METHODS: A cluster, randomised controlled trial was conducted on TB patients attending DOTS centres in Delhi, India, who reported using tobacco in any form. Participants were assigned into one of two treatment groups. Centres were randomly assigned to two intervention groups: 1) integrated intervention using behavioural counselling with nicotine replacement therapy (NRT) gum, and 2) intervention using behavioural counselling alone (50 each in intervention and control group). The subjects were followed at Week 1, Month 1, Month 3 and Month 6 for tobacco cessation.RESULTS: At the end of 6 months, patients who received the integrated intervention had significantly higher rate of success in quitting tobacco than those who received the conventional TB treatment alone (78.7% vs. 57.8%; P < 0.03).CONCLUSION: DOTS with tobacco use dependence treatment was successful in our study in helping TB patients to quit tobacco dependence and should therefore be offered to every tobacco user.
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Risk of childhood TB from non-adherence to isoniazid chemoprophylaxis. Int J Tuberc Lung Dis 2021; 25:950-952. [PMID: 34686240 DOI: 10.5588/ijtld.21.0245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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U2af1 is a haplo-essential gene required for hematopoietic cancer cell survival in mice. J Clin Invest 2021; 131:141401. [PMID: 34546980 DOI: 10.1172/jci141401] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/16/2021] [Indexed: 11/17/2022] Open
Abstract
Somatic mutations in the spliceosome gene U2AF1 are common in patients with myelodysplastic syndromes. U2AF1 mutations that code for the most common amino acid substitutions are always heterozygous, and the retained WT allele is expressed, suggesting that mutant hematopoietic cells may require the residual WT allele to be viable. We show that hematopoiesis and RNA splicing in U2af1 heterozygous knockout mice were similar to those in control mice, but that deletion of the WT allele in U2AF1(S34F) heterozygous mutant-expressing hematopoietic cells (i.e., hemizygous mutant) was lethal. These results confirm that U2AF1 mutant hematopoietic cells are dependent on the expression of WT U2AF1 for survival in vivo and that U2AF1 is a haplo-essential cancer gene. Mutant U2AF1(S34F)-expressing cells were also more sensitive to reduced expression of WT U2AF1 than nonmutant cells. Furthermore, mice transplanted with leukemia cells expressing mutant U2AF1 had significantly reduced tumor burden and improved survival after the WT U2af1 allele was deleted compared with when it was not deleted. These results suggest that selectively targeting the WT U2AF1 allele in heterozygous mutant cells could induce cancer cell death and be a therapeutic strategy for patients harboring U2AF1 mutations.
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773 The Impact of Introducing an Enhanced Recovery Nurse Practitioner on Colorectal ERP Protocol Compliance and Surgical Outcome: A Single-Unit Experience. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
The enhanced recovery programme (ERP) is a validated perioperative care plan that has consistently shown to reduce morbidity and improve patient outcomes. Our trust introduced ERP for major elective colorectal procedures in 2007. However, it had been noted that compliance to protocol was variable. This audit was conducted to see if introduction of an enhanced recovery nurse (ERN) improved compliance.
Method
This was a single-centre, retrospective, closed-loop audit; each cycle consists of resectional cases over a 1-year period. Perioperative data were collected from preoperative assessment documents, anaesthetic charts, operation notes and post-operative patient records. Compliance to 20elements of the agreed ERP protocol and length of stay (LOS) were assessed. First-cycle results were presented locally, leading to protocol revision and introduction of a dedicated ERN. Two years following ERN introduction, data were re-audited and compliance assessed. Statistical analyses were performed using Chi-squared test or independent t-test as appropriate.
Results
Among 101 procedures analysed in the first-cycle, compliance to ERP elements ranged between 30-95%. Following intervention, among 113 cases, compliance improved to 46-99%. Statistically significant improvements were observed in post-operative ERP elements. Compliance to early cessation of intravenous fluids increased from 44% to 61% (p = 0.02), and early urinary catheter removal increased two-fold, from 30% to 62% (p < 0.01). Patients resumed light diet earlier and mobilised out of bed sooner. LOS improved from median of 7(1-48) to 6(2-50) days (p = 0.03).
Conclusions
This study demonstrates that the introduction of a dedicated ERN is associated with significantly improved protocol compliance and reduced LOS following major colorectal resection.
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Bam-readcount - rapid generation of basepair-resolution sequence metrics. ARXIV 2021:arXiv:2107.12817v1. [PMID: 34341766 PMCID: PMC8328062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Bam-readcount is a utility for generating low-level information about sequencing data at specific nucleotide positions. Originally designed to help filter genomic mutation calls, the metrics it outputs are useful as input for variant detection tools and for resolving ambiguity between variant callers1,2. In addition, it has found broad applicability in diverse fields including tumor evolution, single-cell genomics, climate change ecology, and tracking community spread of SARS-CoV-2.3-6.
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Robot assisted video endoscopic inguinal lymph node dissection in carcinoma penis with palpable inguinal lymphadenopathy: Our technique and long term functional and oncological outcomes. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01617-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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352 A Retrospective Audit to Determine the Appropriateness of Antibiotic Use in Surgical Patients in MKUH. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
This audit’s aim is to determine the appropriateness of antibiotics dispensed in Emergency Surgery Clinic (ESC) for a two-month period in 2020. Antibiotic stewardship promotes appropriate antibiotic use in clinical settings whilst limiting unnecessary use. Appropriate antibiotic use is important in reducing the risk of antibiotic resistance.
Method
We extracted the following details from 801 patients’ electronic notes who attended MKUH ESC: diagnosis, prescription of antibiotics, hospital admission, and re-attendance at the ESC. Prescriptions were analysed as to whether they were in accordance with our microbiology guidelines. Patients were analysed as a collective and within diagnosis sub-specialities (appendicitis, wound infection, gallstones/cholecystitis, testicular pathology, UTI, diverticulitis, renal stones and abscesses).
Results
218 (27%) patients were given antibiotics, 180 (22%) patients re-attended ESC and 111 (14%) were admitted. Only 77 patients (35%) receiving antibiotics were prescribed appropriately. Outcomes also varied by diagnosis. All patients presenting with UTI (n = 15) were treated correctly. In contrast, only 71% of patients with renal stones (n = 68) were incorrectly treated with antibiotics.
Conclusions
Two-thirds of patients receiving antibiotics were inappropriately prescribed. This together with the variation by diagnosis would suggest further measures be introduced to support antibiotic stewardship and mitigate the risk of antibiotic resistance.
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59 Should The ‘Normal’ And ‘Ideal’ Nipple Position in A Male Influence the Surgeon When Planning Severe Gynaecomastia Correction? Br J Surg 2021. [DOI: 10.1093/bjs/znab134.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
The ideal nipple position of the male chest following gynecomastia surgery is well documented however with increased development of the chest muscles, the NAC placement can change, leading to the medial displacement of the nipple giving a poor aesthetic outcome. Therefore, we feel these measurements need to be applied to the patients build and take into consideration the patient's future fitness goals.
Method
We have analysed photographs of 3 groups of men: super- athletes, athletes and severe gynaecomastia. We assessed the proportions of the chest in relation to the NAC and the degree of ptosis.
Results
There is wide variation in the position of the nipple to the chest wall between each group with minor variation within each group. Based on this research we believe that surgeons should be circumspect when considering breast reduction with a Wise pattern in patients with severe gynaecomastia.
In patient with increased development of the pectoralis major muscles, the NAC placement can change, leading to medial displacement of the nipple and ptosis and poor aesthetic result.
Conclusions
We suggest a two-stage procedure, carried out on two separate occasions wound be more ideal than a single stage as this allows better long-term better positioning of the nipple.
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Strengthened capacity of India´s bedaquiline Conditional Access Programme for introducing new drugs and regimens. Int J Tuberc Lung Dis 2021; 24:1067-1072. [PMID: 33126941 DOI: 10.5588/ijtld.20.0136] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Addressing TB in India is critical to meeting global targets. With the scale-up of diagnostic networks and the availability of new TB drugs, India had the opportunity to improve the detection and treatment outcomes in drug-resistant TB (DR-TB).OBJECTIVE: To document how the introduction of new drugs and regimens is helping India improve the care of DR-TB patients.DESIGN: In 2016, India´s National TB Programme (NTP) introduced bedaquiline (BDQ) under a Conditional Access Programme (BDQ-CAP) at six sites after providing extensive training and strengthening laboratory testing, pre-treatment evaluation, active drug safety monitoring and management (aDSM) and follow-up systems.RESULTS: An interim analysis reflected earlier and better culture conversion rates: 83% of the 620 patients converted within a median time of 60 days. However, 248 serious adverse events were reported, including 73 deaths (12%) and 100 cardiotoxicity events (16.3%). Encouraged by the evidence of safety and efficacy of BDQ, the NTP took steps to systematically expand its access to cover the entire population by 2018.CONCLUSION: The cautious yet focused approach used to introduce BDQ under BDQ-CAP paved the way for the rapid introduction of delamanid, as well as the shorter treatment regimen and the all-oral regimen for DR-TB.
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A case of Infective Native (Abdominal) Aortic Aneurysm Caused by Streptococcus Agalactiae: An Updated Literature Review Based on New Nomenclature. Ann Vasc Surg 2021; 75:531.e7-531.e13. [PMID: 33836232 DOI: 10.1016/j.avsg.2021.01.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 10/21/2022]
Abstract
The management of abdominal aortic aneurysms (AAA) has evolved significantly with the advent of endovascular strategies. Thus, there has been a decline in the number of open AAA repairs once an endovascular option is available. There have also been reports of successful endovascular management of infective native aortic aneurysms (INAA)1, previously called mycotic aneurysms2. The rarity of this condition makes its management a challenging one as there are no standard guidelines. The European Society of Vascular Surgery has suggested that the nomenclature be changed from mycotic aneurysms as this can be misleading to standardise reporting1. The authors' present a case of a 67-year old male who presented during the peak of the Corona Virus pandemic with constitutional gastrointestinal symptoms. He was subsequently diagnosed with an INAA and successfully managed with open Neo-Aorto Iliac System reconstruction with a homograft3. The report highlights various strategies used in the surgical approach and their benefits in the management of INAA. Furthermore, a literature review of Streptococcus (Streptococcus agalactiae) species as a rare cause of INAA and how these cases were managed are also highlighted.
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A systematic review of point-of-care abdominal ultrasound scans performed by general surgeons. Surgeon 2021; 19:e559-e563. [PMID: 33692002 DOI: 10.1016/j.surge.2021.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 01/25/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ultrasound is an established imaging modality in general surgery. With the increasing use of bedside point-of-care ultrasounds, general surgeons have been incorporating this skill into their clinical practice. This systematic review provides an up-to-date summary of the evidence for abdominal ultrasound scans performed by general surgeons to diagnose intra-abdominal pathology. METHODS Two independent reviewers searched the PubMed database between 1 January 1980 and 1 June 2020. Articles about surgeon-performed abdominal ultrasound in adult patients were included. Studies on trauma and vascular surgery were excluded. RESULTS 26 articles met the inclusion criteria, presented as a narrative analysis. There was good evidence for the use of surgeon-performed ultrasound, particularly in gallstone-related diseases and moderate evidence for the use of ultrasound in appendicitis. Further evidence is required for point-of-care ultrasounds for other pathologies such as diverticulitis and groin hernias. Ultrasound training for general surgeons is variable with notable heterogeneity across studies. CONCLUSION A standardised training programme for general surgeons will greatly improve confidence and skill. There is good evidence for the use of bedside ultrasound by general surgeons in the acute and elective setting with reduced time to definitive treatment and fewer unnecessary hospital admissions.
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Explicit environmental and vibronic effects in simulations of linear and nonlinear optical spectroscopy. J Chem Phys 2021; 154:084116. [PMID: 33639769 DOI: 10.1063/5.0038196] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Accurately simulating the linear and nonlinear electronic spectra of condensed phase systems and accounting for all physical phenomena contributing to spectral line shapes presents a significant challenge. Vibronic transitions can be captured through a harmonic model generated from the normal modes of a chromophore, but it is challenging to also include the effects of specific chromophore-environment interactions within such a model. We work to overcome this limitation by combining approaches to account for both explicit environment interactions and vibronic couplings for simulating both linear and nonlinear optical spectra. We present and show results for three approaches of varying computational cost for combining ensemble sampling of chromophore-environment configurations with Franck-Condon line shapes for simulating linear spectra. We present two analogous approaches for nonlinear spectra. Simulated absorption spectra and two-dimensional electronic spectra (2DES) are presented for the Nile red chromophore in different solvent environments. Employing an average Franck-Condon or 2DES line shape appears to be a promising method for simulating linear and nonlinear spectroscopy for a chromophore in the condensed phase.
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Utilizing Host-Plant Resistance to Circumvent Blast Disease in Rice. Fungal Biol 2021. [DOI: 10.1007/978-3-030-60585-8_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Epidemiological correlates and treatment outcomes of MULTIDRUG-RESISTANT Tuberculosis in Delhi, India: A record-based operational research study. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.1202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Major colorectal resection is feasible using a new robotic surgical platform: the first report of a case series. Tech Coloproctol 2020; 25:285-289. [PMID: 33156413 PMCID: PMC7645403 DOI: 10.1007/s10151-020-02366-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 10/22/2020] [Indexed: 12/13/2022]
Abstract
Background The number of abdominal procedures performed via a robotic-assisted approach is increasing as potential advantages of the modality are recognised. We report the first in human case series of major colorectal resection performed using a new system, Versius®, and assess the feasibility of its use. Methods The initial cases performed using Versius® at a single centre in the UK were included in the study. Anonymised data were prospectively collected including patient demographics, operative details and postoperative outcomes. Results Twenty-three operations were performed, including left (n = 14) and right (n = 9)-sided colonic resections. Rectal mobilisation was performed in 13. Fifty-seven percent of the patients were male, with a malignant indication for surgery in 70% of cases. Overall mean age was 59.1 ± 15.3 (range 23–89) years. Overall mean body mass index was 28.9 ± 5.2 with a mean of 31.3 ± 4.5 for left-sided resections. The median console operating time was 166 min (range 75–320 min). All malignant cases had negative resection margins and the mean lymph node yield was 18 (SD 9.4). Only one operation (4%) was converted from robotic to open approach. Postoperative length of stay was a median of 5 days (range 3–34 days) and there were no readmissions within 30 days. Conclusions These results compare favourably with the literature on existing robotic systems and also conventional laparoscopic surgery; hence, we believe that this series indicates the Versius® system is feasible for use in major colorectal resection. These early results from a robot-naïve centre show exciting promise for an expanding robotic market and highlight the need for further evaluation.
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P33 Menstrual regulation: Incidence, methods, and sources of this understudied reproductive practice in three countries. Contraception 2020. [DOI: 10.1016/j.contraception.2020.07.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Morbidity and Mortality after Treatment of Peritonitis with Prolonged Exchanges and Intraperitoneal Antibiotics. Perit Dial Int 2020. [DOI: 10.1177/089686088100200112] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Abstract
OBJECTIVES To evaluate the level of undergraduate and post-graduate ENT exposure amongst general practitioners and their perceived quality of this training. A secondary aim was to examine whether general practitioners believe ENT department based rotations should remain in the undergraduate curriculum. METHOD An online questionnaire-based survey was sent to general practices in England. RESULTS A total of 417 general practitioners completed the questionnaire. Sixty-seven per cent had completed an ENT rotation at medical school whereas 27 per cent had undertaken a postgraduate placement in ENT. Fifty-one per cent had received post-graduate teaching in ENT, mainly in the form of lectures. The majority of general practitioners were not satisfied with their training in ENT at undergraduate and post-graduate levels. Eighty-five per cent of general practitioners believed formal hospital-based ENT training should remain in the undergraduate curriculum. CONCLUSION General practitioners reported insufficient exposure to ENT during both post-graduate and undergraduate training. Proposals to outsource undergraduate ENT teaching to affiliated departments such as general practice are of concern.
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Patient experiences and health system responsiveness among internal migrants: A nationwide study in 13 Indian cities. J Healthc Qual Res 2019; 34:167-175. [PMID: 31713527 DOI: 10.1016/j.jhqr.2019.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 04/02/2019] [Accepted: 04/26/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To report various components of health system responsiveness among poor internal migrants who availed the government health facilities in 13 Indian cities. MATERIALS AND METHODS Cluster random sampling was used to select 50,806 migrant households, of which 14,263 households avail the government health facility in last six months. In addition, 5072 women, who sought antenatal care and 3946 women who had delivery in government health facility during last six months were also included. Data on different domains of health system responsiveness were collected using an interviewer-administered questionnaire, developed based on the World Health Survey of WHO. RESULTS Of the eight domains of responsiveness, namely, autonomy, communication, confidentiality, dignity, choice, quality of basic facilities, prompt attention and access to family and community, seven domains, except the 'choice', are assessed, and they are moderate. Only about 30% of participants said that doctor discussed on treatment options (autonomy). And 50-60% of participants said positively for questions of clarity of communication. About 59% of participants acknowledged the confidentiality. Not more than 40% of participants said they were treated with dignity, and privacy is respected (dignity). The responses to quality basic amenities, prompt attention and access to family and community domains are fairly satisfactory. CONCLUSIONS This study has implications as many urban poor, including migrants do not utilize the services of public healthcare facilities. Hence, a responsive health system is required. There should be a policy in place to train and orient healthcare workers on some of the domains of health system responsiveness.
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Treatment seeking pathways in pediatric tuberculosis patients attending DOTS centers in urban areas of Delhi. Indian J Tuberc 2018; 65:308-314. [PMID: 30522618 DOI: 10.1016/j.ijtb.2018.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 06/06/2018] [Accepted: 06/22/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND The treatment seeking pathways prior to initiation of Direct Observed Treatment Short-course Therapy (DOTS), provides the extent of patient and health system delays among pediatric tuberculosis (TB) patients. OBJECTIVES The study attempted to understand the treatment seeking pathways of pediatric TB patients under revised national tuberculosis control program (RNTCP). STUDY DESIGN AND SETTING It was a prospective observational study carried out from January 2015 to December 2015. A predesigned, pretested and semi-structured questionnaire was used to interview 141 caregivers of pediatric patients (0-14 years) at two chest clinics selected purposively. RESULTS Thirteen different treatment seeking pathways were identified and fever was the commonest symptom (41.8%) for seeking care from 1st health facility. Median time taken from onset of symptoms to first consultation varied from 1 to 144 weeks. More than half of the study subjects were first taken to a private practitioner (64.5%) followed by a pharmacist (19.1%) and trust in provider was the commonest reason for choosing the first care-provider in 52 (41.1%), followed by easy access or convenience in 49 (34.8%). CONCLUSION A significant delay was found in treatment initiation of patients with extra pulmonary tuberculosis (EPTB), those belonging to lower socio-economic class families, low literacy level of parents, who went to private facility first and availed more than three health facilities before diagnosis.
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Epigenetic Mechanisms and Events in Gastric Cancer-Emerging Novel Biomarkers. Pathol Oncol Res 2018; 24:757-770. [PMID: 29552712 DOI: 10.1007/s12253-018-0410-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 03/07/2018] [Indexed: 12/12/2022]
Abstract
Gastric cancer is one of the most common malignancy worldwide. The various genetic and epigenetic events have been found to be associated with its carcinogenesis. The epigenetic is a heritable and transient/reversible change in the gene expression that is not accompanied by modification in the DNA sequence. This event is characterized by the alteration in the promoter CpG island of the gene or histone modification. These events are associated with silencing of critical tumor suppressor gene and activation of oncogenes leading to carcinogenesis. The DNA methylation is a chemical change in the DNA sequence that most commonly occurs at cytosine moiety of CpG dinucleotide and histone, primarily on N- terminal tail that ultimately effect the interaction of DNA with chromatin modifying protein.Hypermethylation of tumor suppressor genes and global hypomethylation of oncogenes are widely studied epigenetic modifications. There are large number of publish reports regarding epigenetic events involving gastric cancer. These changes are potentially useful in identifying markers for early diagnosis and management of this lethal malignancy. Also, role of specific miRNAs and long non coding RNAs in regulation of gene expression is gaining interest and is a matter of further investigation. In this review, we aimed to summarize major epigenetic events (DNA methylation) in gastric cancer along with alteration in miRNAs and long non coding RNAs which plays an important role in pathology of this poorly understood malignancy.
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Thermal Hydraulic Safety Assessment of LLCB Test Blanket System in ITER Using Modified relap/scdapsim/mod4.0 Code. JOURNAL OF NUCLEAR ENGINEERING AND RADIATION SCIENCE 2018. [DOI: 10.1115/1.4038823] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This work attempts to investigate the thermal hydraulic safety of lithium lead ceramic breeder (LLCB) test blanket system (TBS) in International Thermonuclear Experimental Reactor (ITER) with the help of modified thermal hydraulic code relap/scdapsim/mod4.0. The design basis accidents, in-vessel and ex-vessel loss of coolant of first wall (FW) of test blanket module (TBM) are analyzed for this safety assessment. The sequence of accidents analyzed was started with postulated initiating events (PIEs). A detailed modeling of first wall helium cooling system (FWHCS) loop and lithium lead cooling system (LLCS) is presented. The analysis of steady-state normal operation along with 10 s power excursion before the accident is also discussed in order to better understanding of initial condition of accidents. The analysis discusses a number of safety concerns and issues that may result from the TBM component failure, such as vacuum vessel (VV) pressurization, TBM FW temperature profile, passive decay heat removal capability of TBM structure, pressurization of port cell and Tokomak cooling water system vault annex (TCWS-VA) and to check the capability of passive safety system (vacuum vessel pressure suppression system (VVPSS)). The analysis shows that in these accident scenarios, the critical parameters have reasonable safety margins.
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Factors associated with sputum culture conversion in multidrug-resistant pulmonary tuberculosis. Int J Tuberc Lung Dis 2018; 20:1671-1676. [PMID: 27931345 DOI: 10.5588/ijtld.16.0096] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Sputum culture conversion in pulmonary multidrug-resistant tuberculosis (MDR-TB) is important to make treatment-related decisions and prevent transmission of disease. OBJECTIVE To identify factors associated with sputum culture conversion, and to determine time to culture conversion and the impact of culture conversion on successful treatment outcomes in MDR-/rifampicin (RMP) resistant TB. METHOD Retrospective analysis of data from treatment cards and registers of MDR-/RMP-resistant patients initiated on treatment under India's Revised National TB Control Programme in Delhi, West Bengal and Kerala from January 2009 to December 2011. Proportions were calculated and logistic regression analysis was performed. RESULTS Of 836 patients, 787 were analysed, 651 (83%) of whom experienced culture conversion: respectively 57%, 73% and 79% culture converted by month 3, 4 and 6 of treatment. The median time to culture conversion was 91.3 days. Patients with body mass index (BMI) 16 kg/m2 (OR 0.403, P = 0.001) and 1618 kg/m2 (OR 0.519, P = 0.039) were less likely to have culture conversion. High rates of culture conversion were observed in patients with successful treatment outcomes compared to those without treatment success (462/469, 99% vs. 183/311, 59%; P 0.0001). CONCLUSION Low BMI is associated with poor sputum culture conversion in MDR-/RMP-resistant TB patients. Lack of culture conversion can impact successful treatment outcomes.
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P3.02-054 Prognostic Implications of ROS1 Positivity in Non-Small Cell Lung Cancer (NSCLC): A Systematic Review of Published Literature. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ex-Vessel Loss of Coolant Accident Analysis of ITER Divertor Cooling System Using Modified RELAP/SCADAPSIM/Mod 4.0. JOURNAL OF NUCLEAR ENGINEERING AND RADIATION SCIENCE 2017. [DOI: 10.1115/1.4037188] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The initial design of ITER incorporated the use of carbon fiber composites in high heat flux regions and tungsten was used for low heat flux regions. The current design includes tungsten for both these regions. The present work includes thermal hydraulic modeling and analysis of ex-vessel loss of coolant accident (LOCA) for the divertor (DIV) cooling system. The purpose of this study is to show that the new concept of full tungsten divertor is able to withstand in the accident scenarios. The code used in this study is RELAP/SCADAPSIM/MOD 4.0. A parametric study is also carried out with different in-vessel break sizes and ex-vessel break locations. The analysis discusses a number of safety concerns that may result from the accident scenarios. These concerns include vacuum vessel (VV) pressurization, divertor temperature profile, passive decay heat removal capability of structure, and pressurization of tokamak cooling water system. The results show that the pressures and temperatures are kept below design limits prescribed by ITER organization.
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Authors' response to letter 'Long-term noninvasive ventilation in muscular dystrophy: Need planning of future services'. Chron Respir Dis 2017; 14:196. [PMID: 28528564 DOI: 10.1177/1479972316679681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Thermal Hydraulic and Safety Assessment of First Wall Helium Cooling System of a Generalized Test Blanket System in ITER Using RELAP/SCDAPSIM/MOD4.0 Code. JOURNAL OF NUCLEAR ENGINEERING AND RADIATION SCIENCE 2016. [DOI: 10.1115/1.4034680] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The key objective of the test blanket module (TBM) program is to develop the design technology for DEMO and future power-producing fusion reactors. The proposed first wall of the test blanket system (TBS) is a generalized concept for testing in ITER, an experimental fusion reactor under construction in France presently. The first wall of TBM (TBM FW) directly faces the plasma and is cooled by the first wall helium cooling system (FWHCS), which is considered as a critical component from an ITER safety point of view. The scope of this work comprises thermal hydraulic analysis of the FWHCS of a generalized TBS and the assessment of postulated initiating events (PIEs) on the ITER safety with the help of thermal-hydraulic code RELAP/SCDAPSIM/MOD4.0. The three reference accidents: in-vacuum vessel (VV) loss of coolant accident (in-vessel LOCA), ex-vessel LOCA, and loss of flow accident (LOFA) in FWHCS are selected for the safety assessment. This safety assessment addresses safety concerns resulting from FWHCS component failure, such as VV pressurization, TBM FW temperature profile, pressurization of port cell (PC) and Tokomak cooling water system vault annex (TCWS-VA), and passive decay heat removal capability. The analysis shows that the critical parameters are under the design limit and have large safety margins, in the investigated accident scenarios. A comparative analysis is also carried out with the previous results to validate the results.
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Effect of expiratory positive airway pressure on tidal volume during non-invasive ventilation. Chron Respir Dis 2016; 14:105-109. [PMID: 27923982 DOI: 10.1177/1479972316674392] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
During non-invasive ventilation (NIV), tidal volume ( Vt) will depend upon the difference between inspiratory and expiratory positive airway pressure (IPAP and EPAP, respectively), provided the respiratory muscles are relaxed and the lungs and chest wall therefore move along their passive pressure-volume curves. To test this hypothesis, we studied the effect of increasing EPAP during pressure-controlled modes of NIV in 30 long-term ventilator users (10 each with scoliosis, obesity hypoventilation or neuromuscular disorders). While maintaining the same IPAP, addition of 5 cmH2O of EPAP reduced mean Vt by 167 ml; 10 cmH2O reduced Vt by 367 ml. This pattern was seen in all three patient groups. EPAP has several potential advantages, for example maintaining upper airway patency, preventing basal atelectasis and facilitating triggering. EPAP does, however, appear to reduce Vt. Decreasing EPAP is an alternative to increasing IPAP if measurements of gas exchange during NIV indicate that ventilation is inadequate.
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AP1000 station blackout study with and without depressurization using RELAP5/SCDAPSIM. NUCLEAR ENGINEERING AND DESIGN 2016. [DOI: 10.1016/j.nucengdes.2016.07.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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RELAP5/SCDAPSIM model development for AP1000 and verification for large break LOCA. NUCLEAR ENGINEERING AND DESIGN 2016. [DOI: 10.1016/j.nucengdes.2016.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Long-term non-invasive ventilation (NIV) was introduced in the 1980s, initially mainly for patients with poliomyelitis, muscular dystrophy (MD) or scoliosis. The obesity-hypoventilation syndrome has since become the commonest reason for referral to most centres providing home-NIV. Patients with MD are numerically a much smaller part of the workload, but as their disease progresses the need for ventilatory support changes and they require regular comprehensive assessment of their condition. We have examined the trend in MD use of home-NIV in our unit over the last 25 years. The number of new referrals appears to be stabilizing at around 20-25 over a 5-year period, equivalent to approximately 0.5 per 100,000 of population per year. The mean age at commencement of home-NIV is now 37.5 years, with 5-year survival rates of 70-75%. Ten-year survival rates are just over 40%. The distance of usual place of residence from our unit is fairly stable, currently at a mean of 27 km. Excellent survival rates mean that patients with MD, while numerically small, are likely to remain an important part of the workload of centres providing home-NIV. Our data should prove useful in the planning of future services for this group of patients.
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TH-CD-206-10: Clinical Application of the MIND Demons Algorithm for Symmetric Diffeomorphic Deformable MR-To-CT Image Registration in Spinal Interventions. Med Phys 2016. [DOI: 10.1118/1.4958191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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WE-AB-BRA-07: Operating Room Quality Assurance (ORQA) for Spine Surgery Using Known-Component 3D-2D Image Registration. Med Phys 2016. [DOI: 10.1118/1.4957736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Xpert ® MTB/RIF assay for the diagnosis of pulmonary tuberculosis in children. Int J Tuberc Lung Dis 2016; 20:839-43. [DOI: 10.5588/ijtld.15.0824] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Perioperative factors associated with acute kidney injury after partial nephrectomy. Br J Anaesth 2016; 116:70-6. [PMID: 26675951 DOI: 10.1093/bja/aev416] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Partial nephrectomy is performed with the aim to preserve renal function. But the occurrence of postoperative acute kidney injury (AKI) can interfere with this goal. Our primary aim was to evaluate associations between pre-specified modifiable factors and estimated glomerular filtration rate after partial nephrectomy. Our secondary aims were to evaluate associations between pre-specified modifiable factors and both serum creatinine concentration and type of nephrectomy. METHODS The records of 1955 patients who underwent partial nephrectomy were collected. Postoperative estimated glomerular filtration rate (eGFR) was used as the primary outcome measure. Twenty modifiable risk factors were studied. A repeated-measures linear model with autoregressive within-subject correlation structure was used. The interaction between all the factors and type of nephrectomy was also studied. RESULTS A total of 1187 (61%) patients had no kidney injury, 647 (33%) had stage I, 80 (4%) had stage II, and 41 (2%) had stage III injury. The mean eGFR increased an estimated 0.83 (99.76% CI 0.79-0.88) ml min(-1) 1.73 m(-2) for a unit increase in baseline eGFR. Mean eGFR was 2.65 (99.76% CI: 0.13, 5.18) ml min(-1) 1.73 m(-2) lower in patients with hypertension. Mean eGFR decreased 0.42 (99.76% CI: 0.22, 0.62) ml min(-1) 1.73 m(-2) for a 10-minute longer in duration of procedure and decreased 2.09 (99.76% CI: 1.39, 2.80) ml min(-1) 1.73 m(-2) for a 10-minute longer in ischemia time. It was 3.53 (99.76% CI: 0.83, 6.23) ml min(-1) 1.73 m(-2) lower for patients who received warm ischemia as compared to cold ischemia. CONCLUSION Potentially modifiable factors associated with AKI in the postoperative period were identified as baseline renal function, preoperative hypertension, longer duration of surgical time and ischaemia time, and warm ischaemia.
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Cyclin D1 and cyclin E2 are differentially expressed in gastric cancer. Med Oncol 2016; 33:40. [DOI: 10.1007/s12032-016-0754-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 03/15/2016] [Indexed: 01/01/2023]
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Lactating adenoma with infiltrating ductal carcinoma breast in a pregnant woman. Indian J Cancer 2016; 52:585-6. [PMID: 26960485 DOI: 10.4103/0019-509x.178391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Random blinded rechecking of AFB smears in a pilot project at an intermediate reference laboratory. Int J Tuberc Lung Dis 2016; 20:252-6. [PMID: 26792480 DOI: 10.5588/ijtld.15.0481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In most developing countries, sputum smear microscopy for acid-fast bacilli remains the front line and often the only diagnostic tool for the diagnosis of tuberculosis (TB), making quality assurance of smear microscopy an important activity. OBJECTIVE To evaluate the results of a pilot study, where the random blinded rechecking for the entire state of Delhi was conducted at a reference laboratory. METHODOLOGY Slides from 25 Revised National Tuberculosis Control Programme designated districts (200 peripheral microscopy centres) in Delhi were re-read after proper coding by all the Senior Tuberculosis Laboratory Supervisors (STLS) at an intermediate reference laboratory under proper supervision. RESULTS Of 12,162 re-read slides, 204 discrepant results were found. Of these, 150 (73.5%) errors were attributed to the peripheral microscopy centres and 54 (26.5%) to STLS. High false-positive errors were observed at a frequency of 12/150 (8%), and high false-negative errors at a frequency of 38/150 (25%). Minor errors, i.e., low false-negative, low false-positive and quantification errors, were observed at frequencies of respectively 68/150 (45.3%), 17/150 (11.3%) and 15/150 (10.0%). CONCLUSION Greater stringency in the supervision of random blinded rechecking at the district level is essential to make smear rechecking more efficient and effective.
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