C‐reactive protein level as a predictor of difficult emergency laparoscopic cholecystectomy

Background: Studies focused on C‐reactive protein (CRP) as a marker of difficult laparoscopic cholecystectomy are limited to small case series. The aim of this study was to evaluate the association between preoperative CRP concentration and difficulty of laparoscopic cholecystectomy in patients admitted with a biliary emergency presentation. Methods: Patients with an emergency admission for biliary disease treated between 2012 and 2017 with a documented preoperative CRP level were analysed. Elective patients and those with other concurrent causes of increased CRP concentration were excluded. The intraoperative difficulty grade was based on the Nassar scale. Statistical analysis was conducted to determine the association of preoperative CRP level with difficulty grading, adjusted for the interval to surgery. Results: A total of 804 emergency patients were included. The mean preoperative peak CRP level was 64·7 mg/l for operative difficulty grade I, 69·6 mg/l for grade II, 98·2 mg/l for grade III, 217·5 mg/l for grade IV and 193·1 mg/l for grade V, indicating a significant association between CRP concentration and Nassar grade (P < 0·001). Receiver operating characteristic (ROC) curve analysis showed an area under the curve of 0·78 (95 per cent c.i. 0·75 to 0·82), differentiating patients with grade I–III from those with grade IV–V operative difficulty. ROC curve analysis found a cut‐off CRP value of 90 mg/l, with 71·5 per cent sensitivity and 70·5 per cent specificity in predicting operative difficulty of grade IV or V. Logistic regression analysis found preoperative peak CRP level to be predictive of Nassar grade I–III versus grade IV–V operative difficulty, also when adjusted for timing of surgery (odds ratio 5·90, 95 per cent c.i. 2·80 to 12·50). Conclusion: Raised preoperative CRP levels are associated with greater operative difficulty based on Nassar scale grading

Articular contact in a three-dimensional model of the knee

This study is aimed at the analysis of articular contact in a three-dimensional mathematical model of the human knee-joint. In particular the effect of articular contact on the passive motion characteristics is assessed in relation to experimentally obtained joint kinematics. Two basically different mathematical contact descriptions were compared for this purpose. One description was for rigid contact and one for deformable contact. The description of deformable contact is based on a simplified theory for contact of a thin elastic layer on a rigid foundation. The articular cartilage was described either as a linear elastic material or as a non-linear elastic material. The contact descriptions were introduced in a mathematical model of the knee. The locations of the ligament insertions and the geometry of the articular surfaces were obtained from a joint specimen of which experimentally determined kinematic data were available, and were used as input for the model. The ligaments were described by non-linear elastic line elements. The mechanical properties of the ligaments and the articular cartilage were derived from literature data. Parametric model evaluations showed that, relative to rigid articular contact, the incorporation of deformable contact did not alter the motion characteristics in a qualitative sense, and that the quantitative changes were small. Variation of the elasticity of the elastic layer revealed that decreasing the surface stiffness caused the ligaments to relax and, as a consequence, increased the joint laxity, particularly for axial rotation. The difference between the linear and the non-linear deformable contact in the knee model was very small for moderate loading conditions. The motion characteristics simulated with the knee model compared very well with the experiments. It is concluded that for simulation of the passive motion characteristics of the knee, the simplified description for contact of a thin linear elastic layer on a rigid foundation is a valid approach when aiming at the study of the motion characteristics for moderate loading conditions. With deformable contact in the knee model, geometric conformity between the surfaces can be modelled as opposed to rigid contact which assumed only point contact

Recent developments of reconfigurable antennas for 4G and 5G wireless communications: A survey

YesReconfigurable antennas play important roles in smart and adaptive systems and are the subject of many research studies. They offer several advantages such as multifunctional capabilities, minimized volume requirements, low front-end processing efforts with no need for a filtering element, good isolation, and sufficient out-ofband rejection; these make them well suited for use in wireless applications such as fourth generation (4G) and fifth generation (5G) mobile terminals. With the use of active materials such as microelectromechanical systems (MEMS), varactor or p-i-n (PIN) diodes, an antenna’s characteristics can be changed through altering the current flow on the antenna structure. If an antenna is to be reconfigurable into many different states, it needs to have an adequate number of active elements. However, a large number of high-quality active elements increases cost, and necessitates complex biasing networks and control circuitry. We review some recently proposed reconfigurable antenna designs suitable for use in wireless communications such as cognitiveratio (CR), multiple-input multiple-output (MIMO), ultra-wideband (UWB), and 4G/5G mobile terminals. Several examples of antennas with different reconfigurability functions are analyzed and their performances are compared. Characteristics and fundamental properties of reconfigurable antennas with single and multiple reconfigurability modes are investigated.European Union’s Horizon 2020 research and innovation programme under grant agreement H2020-MSCA-ITN-2016 SECRET-722424

Final-State Phases in B→Dπ,D∗πB \to D \pi, D^* \pi, and DρD \rho Decays

The final-state phases in $\bar{B} \to D \pi, D^* \pi$, and $D \rho$ decays appear to follow a pattern similar to those in $D \to \bar{K} \pi$, $\bar{K}^* \pi$, and $\bar{K} \rho$ decays. Each set of processes is characterized by three charge states but only two independent amplitudes, so the amplitudes form triangles in the complex plane. For the first two sets the triangles appear to have non-zero area, while for the $D \rho$ or $\bar{K} \rho$ decays the areas of the triangles are consistent with zero. Following an earlier discussion of this behavior for $D$ decays, a similar analysis is performed for B decays, and the relative phases and magnitudes of contributing amplitudes are determined. The significance of recent results on \ob \to D^{(*)0} \bar{K}^{(*)0} is noted. Open theoretical and experimental questions are indicated.Comment: 16 pages, LaTeX, 3 figures, to be submitted to Phys. Rev. D. References added; comments on new experimental results and analysi

Potential for Precision Measurement of Solar Neutrino Luminosity by HERON

Results are presented for a simulation carried out to test the precision with which a detector design (HERON) based on a superfluid helium target material should be able to measure the solar pp and Be7 fluxes. It is found that precisions of +/- 1.68% and +/- 2.97% for pp and Be7 fluxes, respectively, should be achievable in a 5-year data sample. The physics motivation to aim for these precisions is outlined as are the detector design, the methods used in the simulation and sensitivity to solar orbit eccentricity.Comment: 15 pages, 11 figure

Nonresonant Contributions in B->rho pi Decay

We consider nonresonant contributions in the Dalitz plot analysis of B->rho pi->pi^+ pi^- pi^0 decay and their potential impact on the extraction of the CKM parameter alpha. In particular, we examine the role of the heavy mesons B^* and B_0, via the process B->pi (B^*, B_0)->pi^+ pi^- pi^0, and their interference with resonant contributions in the rho-mass region. We discuss the inherent uncertainties and suggest that the effects may be substantially smaller than previously indicated.Comment: 15 pages, 3 figures; minor changes, version to appear in Phys. Rev.

Evaluation of the GenoType MTBDRsl Version 2.0 Assay for second-line drug resistance detection of Mycobacterium tuberculosis isolates in South Africa

Early detection of resistance to second-line antituberculosis drugs is important for the management of multidrug-resistant tuberculosis (MDR-TB). The GenoType MTBDRsl version 2.0 (VER 2.0) line probe assay has been redesigned for molecular detection of resistance-conferring mutations of fluoroquinolones (FLQ) (gyrA and gyrB genes) and second-line injectable drugs (SLID) (rrs and eis genes). The study evaluated the diagnostic performance of the GenoType MTBDRsl VER 2.0 assay for the detection of second-line drug resistance compared with phenotypic drug susceptibility testing (DST), using the Bactec MGIT 960 system on Mycobacterium tuberculosis complex isolates from South Africa. A total of 268 repository isolates collected between 2012 and 2014, which were rifampin monoresistant or MDR based on DST, were selected. MTBDRsl VER 2.0 testing was performed on these isolates and the results analyzed. The MTBDRsl VER 2.0 sensitivity and specificity indices for culture isolates were the following: FLQ, 100% (95% confidence interval [CI] 95.8 to 100%) and 98.9% (95% CI, 96.1 to 99.9%); SLID, 89.2% (95% CI, 79.1 to 95.6%) and 98.5% (95% CI, 95.7 to 99.7%). The sensitivity and specificity observed for individual SLID were the following: amikacin, 93.8% (95% CI, 79.2 to 99.2%) and 98.5% (95% CI, 95.5 to 99.7%); kanamycin, 89.2% (95% CI, 79.1 to 95.6%) and 98.5% (95% CI, 95.5 to 99.7%); and capreomycin, 86.2% (95% CI, 68.3 to 96.1%) and 95.9% (95% CI, 92.2 to 98.2%). An interoperator reproducibility of 100% and an overall interlaboratory performance of 93% to 96% were found. The overall improvement in sensitivity and specificity with excellent reproducibility makes the GenoType MTBDRsl VER 2.0 a highly suitable tool for rapid screening of clinical isolates for second-line drug resistance for use in high-burden TB/HIV settings.CTB NICD/NHLShttp://jcm.asm.org2017-09-30Medical Microbiolog

Influence of Fertilizer Microdosing on Strigolactone Production and Striga hermonthica Parasitism in Pearl Millet

Parasitism by the root-parasitic plant, Striga (Striga hermonthica L.), is a main threat to pearl millet production in sub-Saharan Africa and nutrient deficiency aggravates this problem, often leading to complete failure of pearl millet crops. Like many other species, pearl millet secretes germination stimulants (strigolactones) into the soil in response to mineral nutrient deficiency, which triggers Striga seed germination resulting in infection. A greenhouse experiment was conducted to evaluate the influence of different doses of di-ammonium phosphate (DAP) fertilizer on strigolactone production and Striga infection in three different African pearl millet cultivars (KBH, Sadore Local and Striga resistance). All the pearl millet genotypes produced varying amounts of different strigolactones like orobanchol, epi-orobanchol, orobanchyl acetate and 5-deoxystrigol, the level of which decreases with increasing doses of DAP. The control treatment (no DAP) showed maximum Striga germination, emergence and dry biomass production in all cultivars of pearl millet. Supply of DAP fertilizer up to 4 g per hill suppressed Striga germination by 69, 64 and 59%; emergence by 87, 85 and 95% and dry biomass by 91, 98 and 83% in cvs KBH, Sadore Local and Striga Resistance, respectively. The present findings reveal that DAP fertilizer minimizes strigolactones production and, as a result, reduces Striga infection in pearl millet. Low doses of DAP fertilizer is a promising strategy to lower the destructive effect of Striga on pearl millet. The use of small doses of DAP fertilizer combined with resistant crop cultivars, intercropping with legumes and hand pulling of Striga at flowering in an integrated Striga control strategy should be developed to help African farmers control this noxious weed

S-Matrix Unitarity, Impact Parameter Profiles, Gluon Saturation and High-Energy Scattering

A model combining perturbative and non-perturbative QCD is developed to compute high-energy reactions of hadrons and photons and to investigate saturation effects that manifest the S-matrix unitarity. Following a functional integral approach, the S-matrix factorizes into light-cone wave functions and the universal amplitude for the scattering of two color-dipoles which are represented by Wegner-Wilson loops. In the framework of the non-perturbative stochastic vacuum model of QCD supplemented by perturbative gluon exchange, the loop-loop correlation is calculated and related to lattice QCD investigations. With a universal energy dependence motivated by the two-pomeron (soft + hard) picture that respects the unitarity condition in impact parameter space, a unified description of pp, pip, Kp, gamma* p, and gamma gamma reactions is achieved in good agreement with experimental data for cross sections, slope parameters, and structure functions. Impact parameter profiles for pp and longitudinal gamma* p reactions and the gluon distribution of the proton xG(x,Q^2,b) are calculated and found to saturate in accordance with S-matrix unitarity. The c.m. energies and Bjorken x at which saturation sets in are determined.Comment: 65 pages with 13 figures, Introduction, Sec. 3, and Conclusion extende

Spin-dependent cross sections from the three-body photodisintegration of He 3 at incident energies of 12.8 and 14.7 MeV

The first measurement of the three-body photodisintegration of polarized 3He using a circularly polarized photon beam has been performed at incident energies of 12.8 and 14.7 MeV. This measurement was carried out at the high-intensity γ-ray source located at Triangle Universities Nuclear Laboratory. A high-pressure 3He target, polarized via spin exchange optical pumping with alkali metals, was used in the experiment. The spin-dependent double- and single-differential cross sections from 3He(γ,n)pp for laboratory angles varying from 30° to 165° are presented and compared with state-of-the-art three-body calculations. The data reveal the importance of including the Coulomb interaction between protons in the three-body calculations