“Free-Floating Anus”: A Flap-Free Approach for Definitive Excision of Circumferential Giant Condyloma Acuminata

Giant condyloma acuminata (GCA), or Buschke-Löwenstein tumor, is a rare exophytic cauliflower-like growth in the anogenital region. The spectrum of treatment options is wide, ranging from the application of topical ointments to the performance of an abdominoperineal resection. Currently, wide local excision is the most common approach and may entail the creation of a protective loop ileostomy or implementation of flaps or grafts that facilitate closure. We describe a unique surgical approach for the management of circumferential GCA void of the use a protective loop ileostomy, flaps, or grafts. Our report highlights that the implementation of a radical, circumferential, wide excision resulting in “free-floating anus” and healing via secondary intention can ultimately lead to excellent functional and cosmetic results and therefore may be considered a minimally invasive surgical option for patients afflicted with a large, circumferential GCA

Large-scale ocean connectivity and planktonic body size

Villarino, Ernesto ... et al.-- 13 pages, 5 figures, 5 tables, supplementary material https://dx.doi.org/10.1038/s41467-017-02535-8Global patterns of planktonic diversity are mainly determined by the dispersal of propagules with ocean currents. However, the role that abundance and body size play in determining spatial patterns of diversity remains unclear. Here we analyse spatial community structure - β-diversity - for several planktonic and nektonic organisms from prokaryotes to small mesopelagic fishes collected during the Malaspina 2010 Expedition. β-diversity was compared to surface ocean transit times derived from a global circulation model, revealing a significant negative relationship that is stronger than environmental differences. Estimated dispersal scales for different groups show a negative correlation with body size, where less abundant large-bodied communities have significantly shorter dispersal scales and larger species spatial turnover rates than more abundant small-bodied plankton. Our results confirm that the dispersal scale of planktonic and micro-nektonic organisms is determined by local abundance, which scales with body size, ultimately setting global spatial patterns of diversityThis research was funded by the project Malaspina 2010 Circumnavigation Expedition (Consolider-Ingenio 2010, CSD2008-00077) and cofounded by the Basque Government (Department Deputy of Agriculture, Fishing and Food Policy). [...] E.V. was supported by a PhD Scholarship granted by the Iñaki Goenaga−Technology Centres FoundationPeer Reviewe

Disparities in Outcomes following Resection of Locally Advanced Rectal Cancer

Surgical margins following rectal cancer resection impact oncologic outcomes. We examined the relationship between margin status and race, ethnicity, region of care, and facility type. Patients undergoing resection of a stage II-III locally advanced rectal cancer (LARC) between 2004 and 2018 were identified through the National Cancer Database. Inverse probability of treatment weighting (IPTW) was performed, with margin positivity rate as the outcome of interest, and race/ethnicity and region of care as the predictors of interest. In total, 58,389 patients were included. After IPTW adjustment, non-Hispanic Black (NHB) patients were 12% (p = 0.029) more likely to have margin positivity than non-Hispanic White (NHW) patients. Patients in the northeast were 9% less likely to have margin positivity compared to those in the south. In the west, NHB patients were more likely to have positive margins than NHW patients. Care in academic/research centers was associated with lower likelihood of positive margins compared to community centers. Within academic/research centers, NHB patients were more likely to have positive margins than non-Hispanic Other patients. Our results suggest that disparity in surgical management of LARC in NHB patients exists across regions of the country and facility types. Further research aimed at identifying drivers of this disparity is warranted

High-resolution observations of water masers in Bok globules

We present Very Large Array observations at 1.3 cm of several water maser detections obtained by previous single-dish studies of Bok globules in the Clemens & Barvainis (1988; CB) catalog. We report water maser emission in CB 3 (CB3-mm), CB 54 (IRAS 07020-1618), CB 101 (IRAS 17503-0833), and CB 232 (IRAS 21352+4307), and non-detection towards CB 65 (IRAS 16277-2332) and CB 205 (IRAS 19433+2743). These are the first reported interferometric observations of water masers in Bok globules of the CB catalog. We also present single-dish observations of millimeter and centimeter spectral lines towards CB 101 (IRAS 17503-0833) and CB 65 (IRAS 16277-2332). All the maser emission seems to be associated with star forming regions hosting bipolar molecular outflows, except IRAS 17503-0833 in CB 101, which we suggest to be a possible Mira evolved star, and IRAS 16277-2332 in CB 65, of unknown nature. We have used the precise position of the maser emission to derive information about the powering source of the masers. By analyzing the spatio-kinematical distribution of the water masers, we confirm the millimeter source CB 3-mm as the most likely powering source of the CB 3 masers. We propose the near-IR source CB 232 YC1-I as the best candidate for pumping the maser emission observed in CB 232, while in CB 54, we suggest that the pumping source of the masers could be located at the position of an elongated feature observed in near-infrared maps.Comment: 29 pages, 6 figures. Accepted by The Astronomical Journa

Transcriptome characterization by RNA sequencing identifies a major molecular and clinical subdivision in chronic lymphocytic leukemia

Chronic lymphocytic leukemia (CLL) has heterogeneous clinical and biological behavior. Whole-genome and -exome sequencing has contributed to the characterization of the mutational spectrum of the disease, but the underlying transcriptional profile is still poorly understood. We have performed deep RNA sequencing in different subpopulations of normal B-lymphocytes and CLL cells from a cohort of 98 patients, and characterized the CLL transcriptional landscape with unprecedented resolution. We detected thousands of transcriptional elements differentially expressed between the CLL and normal B cells, including protein-coding genes, noncoding RNAs, and pseudogenes. Transposable elements are globally derepressed in CLL cells. In addition, two thousand genes-most of which are not differentially expressed-exhibit CLL-specific splicing patterns. Genes involved in metabolic pathways showed higher expression in CLL, while genes related to spliceosome, proteasome, and ribosome were among the most down-regulated in CLL. Clustering of the CLL samples according to RNA-seq derived gene expression levels unveiled two robust molecular subgroups, C1 and C2. C1/C2 subgroups and the mutational status of the immunoglobulin heavy variable (IGHV) region were the only independent variables in predicting time to treatment in a multivariate analysis with main clinico-biological features. This subdivision was validated in an independent cohort of patients monitored through DNA microarrays. Further analysis shows that B-cell receptor (BCR) activation in the microenvironment of the lymph node may be at the origin of the C1/C2 differences

Quality of life and function after rectal cancer surgery with and without sphincter preservation

Despite improvements in surgical techniques, functional outcomes and quality of life after therapy for rectal cancer remain suboptimal. We sought to prospectively evaluate the effect of bowel, bladder, and sexual functional outcomes on health-related quality of life (QOL) in patients with restorative versus non-restorative resections after rectal cancer surgery. A cohort of 211 patients with clinical stage I-III rectal cancer who underwent open surgery between 2006 and 2009 at Memorial Sloan Kettering were included. Subjects were asked to complete surveys preoperatively and at 6, 12, and 24 months after surgery. Validated instruments were used to measure QOL, bowel, bladder, and sexual function. Univariable and multivariable regression analyses evaluated predictors of 24- month QOL. In addition, longitudinal trends over the study period were evaluated using repeated measures models. In total, 180 patients (85%) completed at least 1 survey, and response rates at each time point were high (>70%). QOL was most impaired at 6 and 12 months and returned to baseline levels at 24 months. Among patients who underwent sphincter-preserving surgery (SPS; n=153 [85%]), overall bowel function at 24 months was significantly impaired and never returned to baseline. There were no differences in QOL at 24 months between patients who underwent SPS and those who did not (p=.29). Bowel function was correlated with QOL at 24 months (Pearson correlation,.41; p<.001). QOL among patients who have undergone SPS for rectal cancer is good despite poor function. Patients with ostomies are able to adjust to the functional changes and, overall, have good global QOL. Patients with low anastomoses had lower global QOL at 24 months than patients with permanent stomas. Our findings can help patients set expectations about function and quality of life after surgery for rectal cancer with and without a permanent stoma

Risk factors associated with non-alcoholic fatty liver disease in subjects from primary care units. A case-control study

<p>Abstract</p> <p>Background</p> <p>Non alcoholic fatty liver disease (NAFL) consists in the accumulation of fat vacuoles in the cytoplasm of hepatocytes. Many etiologic factors are associated with NAFL, such as, the metabolic syndrome factors, medications, bariatric surgery, nutritional disorders. However, very little information is available on the clinical relevance of this disorder as a health problem in the general population.</p> <p>Methods and design</p> <p>The aim of the study is establish the risk factors most frequently associated with NAFL in a general adult population assigned to the primary care units and to investigate the relationship between each component of the metabolic syndrome and the risk of having a NAFL.</p> <p>A population based case-control, observational and multicenter study will be carried out in 18 primary care units from the "Area de Gestión del Barcelonés Nord y Maresme" (Barcelona) attending a population of 360,000 inhabitants and will include 326 cases and 370 controls. Cases are defined as all subjects fulfilling the inclusion criteria and with evidence of fatty liver in an abdominal ultrasonography performed for any reason. One control will be randomly selected for each case from the population, matched for age, gender and primary care center. Controls with fatty liver or other liver diseases will be excluded.</p> <p>All cases and controls will be asked about previous hepatic diseases, consumption of alcohol, smoking and drugs, and a physical examination, biochemical analyses including liver function tests, the different components of the metabolic syndrome and the HAIR score will also be performed. Paired controls will also undergo an abdominal ultrasonography.</p> <p>Discussion</p> <p>This study will attempt to determine the factors most frequently associated with the presence of NAFL investigate the relationship between the metabolic syndrome and the risk of fatty liver and study the influence of the different primary care professionals in avoiding the evolution of the disease.</p

Experimental study of differentially rotating supersonic plasma flows produced by aluminium wire array Z-pinches

A novel approach to cylindrical wire array z-pinches has been developed in order to create a rotating plasma flow analogous to astrophysical accretion discs. The method involves subjecting the wire array to a cusp magnetic field (B_r) to create converging off axis ablation streams to form a rotating flow. The rotation is sustained by the ram pressure of the ablation streams in a quasi-equilibrium state for approximately 150 ns. This corresponds to one full rotation of the plasma about the axis. The rotating plasma is supersonic with Mach number ~2 and a radially constant rotation velocity between 60 and 75 km/s; the angular velocity therefore has an r^-1 dependence and the flow is differential. A Thomson scattering diagnostic is used to measure the electron and ion temperatures as Te ~30 eV and Ti >55 eV and the ionisation of the plasma (Z) between 6 and 8. These parameters are used to calculate the Reynolds number (10^5 to 10^6) and magnetic Reynolds numbers (20 to 100) which are large enough for viscous and resistive effects to be negligible on the large scale of the flow. These are of sufficient magnitude for the experiment to be scalable to astrophysical accretion discs. Further more the Reynolds number for the experiment is large enough for shear instabilities to manifest in the plasma. Some evidence for this can be seen in XUV images and Thomson spectra which indicate the development of perturbations and vorticity within the flow. Predictions for the growth rate of the Kelvin Helmholtz instability, 12 to 40 ns, agree reasonably well with the observed perturbation growth of ~30 ns. It is also possible that shear instabilities are driving hydrodynamic turbulence. Turbulent heating of the plasma could explain the approximately 500 eV increase in the ion temperature observed from some Thomson spectra. Further work is required however to prove the existence of shear flows and turbulence within the experiments.Open Acces