Adenocarcinoma of the appendix presenting as bilateral ureteric obstruction

<p>Abstract</p> <p>Background</p> <p>Adenocarcinoma of the vermiform appendix is a rare neoplasm of the gastrointestinal tract. Presentation mimics acute appendicitis, but right iliac fossa mass and intestinal obstruction have also been reported. These presentations reflect various stages of a locally expanding tumour causing luminal obstruction of appendix. The investigation and subsequent management with a review of the literature is presented.</p> <p>Case presentation</p> <p>We report a case of appendicular adenocarcinoma found unexpectedly in a 43 year old male who presented with urinary symptoms. Cystoscopy and uretero-renoscopy showed normal bladder but external compression of the ureters and therefore bilateral stents were inserted. CT scan showed a caecal mass. After colonoscopy, that showed external compression, and diagnostic laparoscopy the patient underwent right hemicolectomy. Histopathology revealed well differentiated adenocarcinoma with signet ring morphology with multiple lymph node involvement. The patient was referred for chemotherapy where he received infusional 5 fluorouracil but died 7 months after surgery.</p> <p>Conclusion</p> <p>Patients with atypical manifestations related to right lower abdominal quadrant should be thoroughly investigated with an open mind. Every attempt should be made to make a precise diagnosis through all the available means to direct the treatment along correct lines.</p

Amorphous Mo₅O₁₄-Type/Carbon Nanocomposite with Enhanced Electrochemical Capability for Lithium-Ion Batteries

An amorphous MomO3m−1/carbon nanocomposite (m ≈ 5) is fabricated from a citrate–gel precursor heated at moderate temperature (500 °C) in inert (argon) atmosphere. The as-prepared Mo5O14-type/C material is compared to α-MoO3 synthesized from the same precursor in air. The morphology and microstructure of the as-prepared samples are characterized by scanning electron microscopy (SEM), X-ray diffraction (XRD), and Raman scattering (RS) spectroscopy. Thermal gravimetry and elemental analysis indicate the presence of 25.8 ± 0.2% of carbon in the composite. The SEM images show that Mo5O14 is immersed inside a honeycomb-like carbon matrix providing high surface area. The RS spectrum of Mo5O14/C demonstrates an oxygen deficiency in the molybdenum oxide and the presence of a partially graphitized carbon. Outstanding improvement in electrochemical performance is obtained for the Mo5O14 encapsulated by carbon in comparison with the carbon-free MoO3. View Full-Tex

Do patients accurately represent their experiences after hip and knee replacements?

Background To investigate discrepancies, if any, between the complications that patients report on the patient-reported outcome measures (PROMs) questionnaire and what is formally recorded in their medical records. Methodology A retrospective analysis of PROMs-reported complications was performed at a single elective center for all patients who had an elective primary total knee or hip replacement between April 2016 and March 2017. Corresponding patient medical records were then analyzed to correlate the PROMs with any documentation of postoperative complications, which similar to the PROMs data were categorized into wound complications, urinary complications, readmission, and further operative procedures. Results A set of 54 complete patient records were compared to the corresponding PROMs data. The combined overall positive predictive value was 0.47 while the overall negative predictive value was 0.91. Concordance between patients and the medical records was 70.4% for wound complication, 66.7% for urinary complications, 83.3% for readmission, and 96.3% for reoperation. Conclusion PROMs data are becoming increasingly important in auditing and planning healthcare provision. This study highlights a significant level of discrepancy between the PROMs-reported complication rates and those documented in the medical records. There is a visible disparity between patient perception and the medical definition of postoperative complications. Further patient education and empowerment are required in preparation for arthroplasty

Structural and Electrochemical Properties of the High Ni Content Spinel LiNiMnO4

This work presents a contribution to the study of a new Ni-rich spinel cathode material, LiNiMnO4, for Li-ion batteries operating in the 5-V region. The LiNiMnO4 compound was synthesized by a sol-gel method assisted by ethylene diamine tetra-acetic acid (EDTA) as a chelator. Structural analyses carried out by Rietveld refinements and Raman spectroscopy, selected area electron diffraction (SAED) and X-ray photoelectron (XPS) spectroscopy reveal that the product is a composite (LNM@NMO), including non-stoichiometric LiNiMnO4-δ spinel and a secondary Ni6MnO8 cubic phase. Cyclic voltammetry and galvanostatic charge-discharge profiles show similar features to those of LiNi0.5Mn1.5O4 bare. A comparison of the electrochemical performances of 4-V spinel LiMn2O4 and 5-V spinel LiNi0.5Mn1.5O4 with those of LNM@NMO composite demonstrates the long-term cycling stability of this new Ni-rich spinel cathode. Due to the presence of the secondary phase, the LNM@NMO electrode exhibits an initial specific capacity as low as 57 mAh g−1 but shows an excellent electrochemical stability at 1C rate for 1000 cycles with a capacity decay of 2.7 × 10−3 mAh g−1 per cycle

Additional degrees of parallelism within the Adomian decomposition method

4th International Conference on Computational Engineering (ICCE 2017), 28-29 September 2017, DarmstadtThis is the author accepted manuscript. The final version is available from Springer via the DOI in this record.The trend of future massively parallel computer architectures challenges the exploration of additional degrees of parallelism also in the time dimension when solving continuum mechanical partial differential equations. The Adomian decomposition method (ADM) is investigated to this respects in the present work. This is accomplished by comparison with the Runge-Kutta (RK) time integration and put in the context of the viscous Burgers equation. Our studies show that both methods have similar restrictions regarding their maximal time step size. Increasing the order of the schemes leads to larger errors for the ADM compared to RK. However, we also discuss a parallelization within the ADM, reducing its runtime complexity from O(n^2) to O(n). This indicates the possibility to make it a viable competitor to RK, as fewer function evaluations have to be done in serial, if a high order method is desired. Additionally, creating ADM schemes of high-order is less complex as it is with RK.The work of Andreas Schmitt is supported by the ’Excellence Initiative’ of the German Federal and State Governments and the Graduate School of Computational Engineering at Technische Universit¨at Darmstadt

Unknotting night-time muscle cramp: a survey of patient experience, help-seeking behaviour and perceived treatment effectiveness

Background: Night-time calf cramping affects approximately 1 in 3 adults. The aim of this study was to explore the experience of night-time calf cramp; if and where people seek treatment advice; and perceived treatment effectiveness. Methods: 80 adults who experienced night-time calf cramp at least once per week were recruited from the Hunter region, NSW, Australia through newspaper, radio and television advertisements. All participants completed a pilot-tested survey about muscle cramp. Quantitative data were analysed with independent-sample t-tests, Chi square tests and Fisher’s tests. Qualitative data were transcribed and sorted into categories to identify themes. Results: Median recalled age of first night-time calf cramp was 50 years. Most participants recalled being awoken from sleep by cramping, and experiencing cramping of either calf muscle, calf-muscle soreness in the days following cramp and cramping during day-time. Despite current therapies, mean usual pain intensity was 66 mm on a 100 mm visual analogue scale. Participants described their cramps as being ‘unbearable’, ‘unmanageable’ and ‘cruel’. One participant stated that ‘sometimes I just wish I could cut my legs open’ and another reported ‘getting about 2h sleep a night due to cramps’. Most participants had sought advice about their night-time calf cramps from a health professional. Participants identified 49 different interventions used to prevent night-time calf cramp. Of all treatment ratings, 68% described the intervention used to prevent cramp as being ‘useless’ or of ‘a little help’. Of 14 participants who provided additional information regarding their use of quinine, eight had a current prescription of quinine for muscle cramp at the time of the survey. None had been asked by their prescribing doctor to stop using quinine. Conclusion: Night time calf cramps typically woke sufferers from sleep, affected either leg and caused ongoing pain. Most participants experienced little or no relief with current therapies used to prevent muscle cramp. Most people who were taking quinine for muscle cramp were unaware that the Australian Therapeutic Goods Administration withdrew support of quinine for muscle cramp in 2004 due to the risk of thrombocytopaenia. Case-control studies are required to identify therapeutic targets so that clinical trials can evaluate safe interventions to prevent recurrent cramp

Nanostructured Molybdenum-Oxide Anodes for Lithium-Ion Batteries: An Outstanding Increase in Capacity

This work aimed at synthesizing MoO3 and MoO2 by a facile and cost-effective method using extract of orange peel as a biological chelating and reducing agent for ammonium molybdate. Calcination of the precursor in air at 450 °C yielded the stochiometric MoO3 phase, while calcination in vacuum produced the reduced form MoO2 as evidenced by X-ray powder diffraction, Raman scattering spectroscopy, and X-ray photoelectron spectroscopy results. Scanning and transmission electron microscopy images showed different morphologies and sizes of MoOx particles. MoO3 formed platelet particles that were larger than those observed for MoO2. MoO3 showed stable thermal behavior until approximately 800 °C, whereas MoO2 showed weight gain at approximately 400 °C due to the fact of re-oxidation and oxygen uptake and, hence, conversion to stoichiometric MoO3. Electrochemically, traditional performance was observed for MoO3, which exhibited a high initial capacity with steady and continuous capacity fading upon cycling. On the contrary, MoO2 showed completely different electrochemical behavior with less initial capacity but an outstanding increase in capacity upon cycling, which reached 1600 mAh g−1 after 800 cycles. This outstanding electrochemical performance of MoO2 may be attributed to its higher surface area and better electrical conductivity as observed in surface area and impedance investigations

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

On the Variability of the Length Weight Relationship for Atlantic Bluefin Tuna, Thunnus thynnus (L.)

Following extensive review, a model of the Atlantic bluefin tuna (ABFT), Thunnus thynnus (L.), length–weight relationship for the eastern Atlantic and Mediterranean (RW = 0.0000188 SFL3.01247; Ec 1) is presented on the basis of samples of ABFT spawners, with an average value of index K = 2.03 ± 0.15SD, collected by the Atlantic traps of Portugal and Spain in the Strait of Gibraltar (1963; 1996–1998; 2000–2012), and a set of samples of juvenile fishes from ICCAT–GBYP (n = 707). The resulting model (Ec 1), together with the model used for the eastern stock assessment (RW = 0.000019607 SFL3.0092; Ec 2) and a recently adopted by ICCAT Standing Committee on Research and Statistics (SCRS) (RW = 0.0000315551 SFL2.898454; EAST) are analyzed in using a bi-variant sample [SFL (cm), RW (kg)] of 474 pairs of data with the aim of validating them and establishing which model(s) best fit the reality represented by the sample and, therefore, will have the greatest descriptive and predictive power. The result of the analysis indicates that the model EAST clearly underestimates the weight of spawning ABFT and that model Ec 2 overestimates it slightly, being model Ec 1 that best explains the data of the sample. The result of the classical statistical analysis is confirmed by means of the quantile regression technique, selecting the quantiles 5, 25, 50, 75, and 95%. Other fisheries and biological indicators also conclude that the model EAST gradually underestimates the weight of ABFT spawners (of 2–3 m) by 9–12.5 %, and does not meet the criterion that for RW = 725 kg (Wmax), SFL = 319.93 ± 11.3 cm (Lmax).Cort, JL.; Estruch Fuster, VD.; Neves Dos Santos, M.; Di Natale, A.; Abid, N.; De La Serna, JM. (2015). On the Variability of the Length Weight Relationship for Atlantic Bluefin Tuna, Thunnus thynnus (L.). Reviews in Fisheries Science & Aquaculture. 23(1):23-38. doi:10.1080/23308249.2015.1008625S2338231Aguado-Giménez, F., & García-García, B. (2005). Changes in some morphometric relationships in Atlantic bluefin tuna (Thunnus thynnus thynnus Linnaeus, 1758) as a result of fattening process. Aquaculture, 249(1-4), 303-309. doi:10.1016/j.aquaculture.2005.04.064Block, B. A., Teo, S. L. H., Walli, A., Boustany, A., Stokesbury, M. J. W., Farwell, C. J., … Williams, T. D. (2005). Electronic tagging and population structure of Atlantic bluefin tuna. Nature, 434(7037), 1121-1127. doi:10.1038/nature03463Chapman, E. W., Jørgensen, C., & Lutcavage, M. E. (2011). Atlantic bluefin tuna (Thunnus thynnus): a state-dependent energy allocation model for growth, maturation, and reproductive investment. Canadian Journal of Fisheries and Aquatic Sciences, 68(11), 1934-1951. doi:10.1139/f2011-109Cort, J. L., Arregui, I., Estruch, V. D., & Deguara, S. (2014). Validation of the Growth Equation Applicable to the Eastern Atlantic Bluefin Tuna,Thunnus thynnus(L.), UsingLmax, Tag-Recapture, and First Dorsal Spine Analysis. Reviews in Fisheries Science & Aquaculture, 22(3), 239-255. doi:10.1080/23308249.2014.931173Cort, J. L., Deguara, S., Galaz, T., Mèlich, B., Artetxe, I., Arregi, I., … Idrissi, M. (2013). Determination ofLmaxfor Atlantic Bluefin Tuna,Thunnus thynnus(L.), from Meta-Analysis of Published and Available Biometric Data. Reviews in Fisheries Science, 21(2), 181-212. doi:10.1080/10641262.2013.793284Fraser, K.Possessed. World Record Holder for Bluefin Tuna. Kingstown, Nova Scotia: T & S Office Essentials and printing, 243 pp. (2008).Fromentin, J.-M., & Powers, J. E. (2005). Atlantic bluefin tuna: population dynamics, ecology, fisheries and management. Fish and Fisheries, 6(4), 281-306. doi:10.1111/j.1467-2979.2005.00197.xHattour, A.Contribution a l’étude des Scombridés de Tunisie. Université de Tunis. Faculté des Sciences, 168 pp. (1979).Karakulak, S., Oray, I., Corriero, A., Deflorio, M., Santamaria, N., Desantis, S., & De Metrio, G. (2004). Evidence of a spawning area for the bluefin tuna (Thunnus thynnus L.) in the eastern Mediterranean. Journal of Applied Ichthyology, 20(4), 318-320. doi:10.1111/j.1439-0426.2004.00561.xKoenker, R., & Bassett, G. (1978). Regression Quantiles. Econometrica, 46(1), 33. doi:10.2307/1913643Koenker, R. (2005). Quantile Regression. doi:10.1017/cbo9780511754098Milatou, N., & Megalofonou, P. (2014). Age structure and growth of bluefin tuna (Thunnus thynnus, L.) in the capture-based aquaculture in the Mediterranean Sea. Aquaculture, 424-425, 35-44. doi:10.1016/j.aquaculture.2013.12.037Perçin, F., & Akyol, O. (2009). Lengthâ weight and lengthâ length relationships of the bluefin tuna,Thunnus thynnusL., in the Turkish part of the eastern Mediterranean Sea. Journal of Applied Ichthyology, 25(6), 782-784. doi:10.1111/j.1439-0426.2009.01288.xPercin, F., & Akyol, O. (2010). Some Morphometric Relationships in Fattened Bluefin Tuna, Thunnus thynnus L., from the Turkish Aegean Sea. Journal of Animal and Veterinary Advances, 9(11), 1684-1688. doi:10.3923/javaa.2010.1684.1688Rooker, J. R., Alvarado Bremer, J. R., Block, B. A., Dewar, H., de Metrio, G., Corriero, A., … Secor, D. H. (2007). Life History and Stock Structure of Atlantic Bluefin Tuna (Thunnus thynnus). Reviews in Fisheries Science, 15(4), 265-310. doi:10.1080/10641260701484135Sinovcic, G., Franicevic, M., Zorica, B., & Cikes-Kec, V. (2004). Length-weight and length-length relationships for 10 pelagic fish species from the Adriatic Sea (Croatia). Journal of Applied Ichthyology, 20(2), 156-158. doi:10.1046/j.1439-0426.2003.00519.xTičina, V., Grubišić, L., Šegvić Bubić, T., & Katavić, I. (2011). Biometric characteristics of small Atlantic bluefin tuna (Thunnus thynnus, Linnaeus, 1758) of Mediterranean Sea origin. Journal of Applied Ichthyology, 27(4), 971-976. doi:10.1111/j.1439-0426.2011.01752.

Supportive and symptomatic management of amyotrophic lateral sclerosis

The main aims in the care of individuals with amyotrophic lateral sclerosis (ALS) are to minimize morbidity and maximize quality of life. Although no cure exists for ALS, supportive and symptomatic care provided by a specialist multidisciplinary team can improve survival. The basis for supportive management is shifting from expert consensus guidelines towards an evidence-based approach, which encourages the use of effective treatments and could reduce the risk of harm caused by ineffective or unsafe interventions. For example, respiratory support using noninvasive ventilation has been demonstrated to improve survival and quality of life, whereas evidence supporting other respiratory interventions is insufficient. Increasing evidence implicates a causal role for metabolic dysfunction in ALS, suggesting that optimizing nutrition could improve quality of life and survival. The high incidence of cognitive dysfunction and its impact on prognosis is increasingly recognized, although evidence for effective treatments is lacking. A variety of strategies are used to manage the other physical and psychological symptoms, the majority of which have yet to be thoroughly evaluated. The need for specialist palliative care throughout the disease is increasingly recognized. This Review describes the current approaches to symptomatic and supportive care in ALS and outlines the current guidance and evidence for these strategies