Magnetic resonance imaging (MRI) in rectal cancer: a comprehensive review

Magnetic resonance imaging (MRI) has established itself as the primary method for local staging in patients with rectal cancer. This is due to several factors, most importantly because of the ability to assess the status of circumferential resection margin. There are several newer developments being introduced continuously, such as diffusion-weighted imaging and imaging with 3 T. Assessment of loco-regional lymph nodes has also been investigated extensively using different approaches, but more work needs to be done. Finally, evaluation of tumours during or after preoperative treatment is becoming an everyday reality. All these new aspects prompt a review of the most recent advances and opinions. In this review, a comprehensive overview of the current status of MRI in the loco-regional assessment and management of rectal cancer is presented. The findings on MRI and their accuracy are reviewed based on the most up-to-date evidence. Optimisation of MRI acquisition and relevant regional anatomy are also presented, based on published literature and our own experience

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Laser and GTAW torch processing of Fe-Cr-B coatings on steel : Part II - microstructure and hardness

A comparison has been made of the relationship between microstructure and microhardness developed by surface melting Nanosteel SHS 7170 Fe-Cr-B alloy powder onto a plain carbon steel surface. This powder was initially developed as a high velocity oxy fuel sprayed coating giving a strength ten times that of mild steel, and is particularly suitable for surface protection against wear and corrosion. In this study, the alloy powder was injected into the laser melted surface, while a preplaced powder was melted using the gas tungsten arc welding (GTAW) technique. The laser track consisted of fine dendrites and needle-like microstructures which produced a maximum hardness value of over 800 HV, while the GTAW track produced a mixture of equiaxed and columnar grain microstructures with a maximum hardness value of 670 HV. The lower hardness values are considered to be associated with dilution and grain size

Laser and GTAW torch processing of Fe-Cr-B coatings on steel : Part I - melt features

A comparison of a coating of Fe-Cr-B alloy powder processed on a plain carbon steel by surface melting using either laser or gas tungsten arc welding (GTAW) torch was made. The alloy powder was injected in laser melted surface, while the preplaced powder was melted using the GTAW technique. The topography of the GTAW tracks showed a relatively smooth surface, but the laser track surface was very rough. Because of high energy input, the GTAW method produced very wide and deep tracks with a high dilution compared to those of the laser tracks. Pores and fine cracks were seen in laser tracks; the cracks were elongated across the track width and some of them propagated down to the melt depth. The GTAW track produced at a low energy was free from any cracking, but a centerline crack was present when processed at a high energy input