Commensurate States and Pattern Switching via Liquid Crystal Skyrmions Trapped in a Square Lattice

Using continuum based simulations we show that a rich variety of skyrmion liquid crystal states can be realized in the presence of a periodic obstacle array. As a function of the number of skyrmions per obstacle we find hexagonal, square, dimer, trimer and quadrimer ordering, where the $n$-mer structures are a realization of a molecular crystal state of skyrmions. As a function of external field and obstacle radius we show that there are transitions between the different crystalline states as well as mixed and disordered structures. We discuss how these states are related to commensurate effects seen in other systems, such as vortices in type-II superconductors and colloids interacting with two dimensional substrates.Comment: 5 pages, 4 figure

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

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Perforated acute appendicitis resulting from appendiceal villous adenoma presenting with small bowel obstruction: a case report

<p>Abstract</p> <p>Background</p> <p>A villous adenoma is an extremely rare benign tumour in the appendix, in contrast to other benign appendiceal lesions. The clinical features are usually asymptomatic. Acute appendicitis is the most common complication with the lesion obstructing the orifice of the appendiceal lumen. Thus, a villous adenoma is usually found during surgical intervention for acute appendicitis. Mechanical obstruction induced by acute perforated appendicitis has been previously reported. Acute appendicitis caused by a villous adenoma presenting with acute intestinal obstruction has not been previously reported.</p> <p>Case presentation</p> <p>A 78-year-old woman presented to our Emergency Department with diffuse abdominal pain and tenderness. The abdominal plain film and computed tomography revealed an intestinal obstruction. After surgical intervention, the ruptured appendix was shown to be associated with intestinal obstruction. The post-operative pathologic diagnosis was an appendiceal villous adenoma.</p> <p>Conclusions</p> <p>This is the first report describing an appendiceal villous adenoma, which is an occasional cause of perforated acute appendicitis, presenting as a complete intestinal obstruction. We emphasize that in elderly patients without a surgical history, the occult cause of complete intestinal obstruction must be determined. If an appendiceal tumour is diagnosed, an intra-operative frozen section is suggested prior to selecting a suitable method of surgical intervention.</p

Thrombosis in vasculitis: from pathogenesis to treatment

In recent years, the relationship between inflammation and thrombosis has been deeply investigated and it is now clear that immune and coagulation systems are functionally interconnected. Inflammation-induced thrombosis is by now considered a feature not only of autoimmune rheumatic diseases, but also of systemic vasculitides such as Behçet’s syndrome, ANCA-associated vasculitis or giant cells arteritis, especially during active disease. These findings have important consequences in terms of management and treatment. Indeed, Behçet’syndrome requires immunosuppressive agents for vascular involvement rather than anticoagulation or antiplatelet therapy, and it is conceivable that also in ANCA-associated vasculitis or large vessel-vasculitis an aggressive anti-inflammatory treatment during active disease could reduce the risk of thrombotic events in early stages. In this review we discuss thrombosis in vasculitides, especially in Behçet’s syndrome, ANCA-associated vasculitis and large-vessel vasculitis, and provide pathogenetic and clinical clues for the different specialists involved in the care of these patients

Nonlinearity and Topology

The interplay of nonlinearity and topology results in many novel and emergent properties across a number of physical systems such as chiral magnets, nematic liquid crystals, Bose-Einstein condensates, photonics, high energy physics, etc. It also results in a wide variety of topological defects such as solitons, vortices, skyrmions, merons, hopfions, monopoles to name just a few. Interaction among and collision of these nontrivial defects itself is a topic of great interest. Curvature and underlying geometry also affect the shape, interaction and behavior of these defects. Such properties can be studied using techniques such as, e.g. the Bogomolnyi decomposition. Some applications of this interplay, e.g. in nonreciprocal photonics as well as topological materials such as Dirac and Weyl semimetals, are also elucidated

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background: Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods: The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results: A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion: Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

A retrospective study: Evaluation of patellar luxation cases in cats

Patellar luxation is an orthopedic disorder seen rarely in cats. In this study, patellar luxation was encountered in 8 of 7744 cats brought to the Department of Surgery of Faculty of Veterinary Medicine of Istanbul University between the years of 1995-2001. The rate of patellar luxation was 0.10 % of feline cases. The patellar luxation incidence in 5145 orthopedic lesions in cats was 0.15 %. Clinical symptoms such as difficulty in walking, running with a hop and abnormal stance in the hindlimb were seen in patients diagnosed using skyline radiography technique. The aim of the present study was the clinical diagnosis and early treatment of this low incidence disease of cats. Treatment procedures have been determined in these early-diagnosed cases according to the degree of the disease. Two of these cases were treated conservatively and 6 operatively. It was concluded that capsuloraphy combined with sulcoplasty increased the success rate

Gallbladder polypoid lesions >15 mm as indicators of T1b gallbladder cancer risk

PubMedID: 28958638Background and study aims Gallbladder polyps (GBPs) are found in 5–7% of the adult population. However, it is very important to differentiate between benign and malignant polyps to establish an appropriate treatment. The present study aimed to determine the relevance of the 10-mm size criterion and attempted to determine the cut-off diameter of T1b tumours, which requires additional surgical intervention. Patients and methods Cases with GBPs were collected between January 2005 and January 2015. A total of 109 patients were enroled retrospectively. Information on age, sex, ultrasound findings, and blood laboratory tests was reviewed. The 10-mm criterion and T1b tumours were examined. Results Sixty-nine females and 40 males were included in the study. Patient age was 45 ± 10.7 years (range 27–70 years). The 10-mm cut-off sensitivity and specificity for predicting malignant polyps was 93.6% and 85.2%, respectively. Fifteen patients had malignant pathologic results, and one patient had GBP 15 mm. Conclusion Gallbladder cancer may occur in polyps of <10 mm. Larger size and older age were predictors of neoplastic GBPs. We suggest 15 mm as the optimal cut-off point to predict T1b cancer. © 2017 Pan-Arab Association of Gastroenterolog