Extended abdominoperineal resection in women: the barbadian experience

BACKGROUND AND OBJECTIVES: We report our results of a selective approach to primary direct appositional vaginal repair versus transverse rectus abdominis flap repair (TRAM) in patients with extensive rectal/anal cancer or in cases with primary cancer of cervix, vagina or vulva involving the anal canal and anal sphincters. METHODS: Eighteen female patients (mean age: 62.9 years; range: 44–81 years) with a median follow-up of 14 months (range: 2–36 months) undergoing extended abdominoperineal reconstruction with total mesorectal excision between May 2002 and September 2005, were studied. RESULTS: Twelve patients underwent an extended abdominoperineal resection with hysterectomy and vaginectomy, with 6 patients undergoing primary TRAM flap reconstruction following pelvic exenteration. Exenterative procedures were performed in 2 cases of primary vaginal cancer, following Wertheim hysterectomy for carcinoma of the cervix with recurrence after radiation and in 2 further cases of anal cancer with extensive pelvic recurrence after primary chemoradiation. Fifteen cases are alive on follow-up with no evidence of disease; 2 patients who had recurrent carcinoma of the cervix and who underwent TRAM flap reconstruction, have recurrent disease after 5 and 6 months of follow-up, respectively. DISCUSSION: Our experience shows that careful primary closure of an extended abdominoperineal resection wound is effective and safe. Our one case of wound breakdown after primary repair underwent external beam and intracavitary irradiation primarily with wound breakdown of a primary repair followed by a delayed pedicled graciloplasty. TRAM flap reconstruction has been reserved in our unit for patients undergoing total pelvic extenteration. In general, we would recommend the use of TRAM flap reconstruction in younger sexually active patients where there has been external irradiation combined with brachytherapy

Towards a European ITS for freight transport and logistics: results of current EU funded research and prospects for the future

Objective The purpose of this paper is to review the developments of the last 15 years in the field of Freight Transport research and innovation, primarily (but not exclusively) in Europe focusing on the “Intelligent Transport Systems” aspects. Document type: Articl

A theoretical model for template-free synthesis of long DNA sequence

This theoretical scheme is intended to formulate a potential method for high fidelity synthesis of Nucleic Acid molecules towards a few thousand bases using an enzyme system. Terminal Deoxyribonucleotidyl Transferase, which adds a nucleotide to the 3′OH end of a Nucleic Acid molecule, may be used in combination with a controlled method for nucleotide addition and degradation, to synthesize a predefined Nucleic Acid sequence. A pH control system is suggested to regulate the sequential activity switching of different enzymes in the synthetic scheme. Current practice of synthetic biology is cumbersome, expensive and often error prone owing to the dependence on the ligation of short oligonucleotides to fabricate functional genetic parts. The projected scheme is likely to render synthetic genomics appreciably convenient and economic by providing longer DNA molecules to start with

The role of hypothalamic H1 receptor antagonism in antipsychotic-induced weight gain

Treatment with second generation antipsychotics (SGAs), notably olanzapine and clozapine, causes severe obesity side effects. Antagonism of histamine H1 receptors has been identified as a main cause of SGA-induced obesity, but the molecular mechanisms associated with this antagonism in different stages of SGA-induced weight gain remain unclear. This review aims to explore the potential role of hypothalamic histamine H1 receptors in different stages of SGA-induced weight gain/obesity and the molecular pathways related to SGA-induced antagonism of these receptors. Initial data have demonstrated the importance of hypothalamic H1 receptors in both short- and long-term SGA-induced obesity. Blocking hypothalamic H1 receptors by SGAs activates AMP-activated protein kinase (AMPK), a well-known feeding regulator. During short-term treatment, hypothalamic H1 receptor antagonism by SGAs may activate the AMPK—carnitine palmitoyltransferase 1 signaling to rapidly increase caloric intake and result in weight gain. During long-term SGA treatment, hypothalamic H1 receptor antagonism can reduce thermogenesis, possibly by inhibiting the sympathetic outflows to the brainstem rostral raphe pallidus and rostral ventrolateral medulla, therefore decreasing brown adipose tissue thermogenesis. Additionally, blocking of hypothalamic H1 receptors by SGAs may also contribute to fat accumulation by decreasing lipolysis but increasing lipogenesis in white adipose tissue. In summary, antagonism of hypothalamic H1 receptors by SGAs may time-dependently affect the hypothalamus-brainstem circuits to cause weight gain by stimulating appetite and fat accumulation but reducing energy expenditure. The H1 receptor and its downstream signaling molecules could be valuable targets for the design of new compounds for treating SGA-induced weight gain/obesity

The effects of lifestyle interventions on (long-term) weight management, cardiometabolic risk and depressive symptoms in people with psychotic disorders:A meta-analysis

AIMS: The aim of this study was to estimate the effects of lifestyle interventions on bodyweight and other cardiometabolic risk factors in people with psychotic disorders. Additionally, the long-term effects on body weight and the effects on depressive symptoms were examined. MATERIAL AND METHODS: We searched four databases for randomized controlled trials (RCTs) that compared lifestyle interventions to control conditions in patients with psychotic disorders. Lifestyle interventions were aimed at weight loss or weight gain prevention, and the study outcomes included bodyweight or metabolic parameters. RESULTS: The search resulted in 25 RCTs -only 4 were considered high quality- showing an overall effect of lifestyle interventions on bodyweight (effect size (ES)  =  -0.63, p<0.0001). Lifestyle interventions were effective in both weight loss (ES =  -0.52, p<0.0001) and weight-gain-prevention (ES =  -0.84, p = 0.0002). There were significant long-term effects, two to six months post-intervention, for both weight-gain-prevention interventions (ES =  -0.85, p = 0.0002) and weight loss studies (ES =  -0.46, p = 0.02). Up to ten studies reported on cardiometabolic risk factors and showed that lifestyle interventions led to significant improvements in waist circumference, triglycerides, fasting glucose and insulin. No significant effects were found for blood pressure and cholesterol levels. Four studies reported on depressive symptoms and showed a significant effect (ES =  -0.95, p = 0.05). CONCLUSION: Lifestyle interventions are effective in treating and preventing obesity, and in reducing cardiometabolic risk factors. However, the quality of the studies leaves much to be desired

The disappearance of steadily fixated visual test objects.

Baseball game statistics; game bookHead Coach: Bill KinnebergBaseballUCLA 16; Utah 3Utah Baseball UCLA at Utah Apr 13, 2018 at Salt Lake City, Utah (Smith's Ballpark) UCLA 16 (20-9,9-4 Pac-12) Player Ydens, Jeremy lf Silva, Jarron ph/lf Kendall, Kevin ss Strumpf, Chase 2b Stronach, Jack dh Pries, Jake ph Cuellar, Kyle ph/dh Toglia, Michael 1b Amaral, Daniel cf Kreidler, Ryan 3b Mitchell, Garrett rf Rosica, Daniel c Teijeiro, RJ ph Haselman, Ty c Bird, Jake p Scheidler, Nick p Garcia, Ryan p Mora, Kyle p Totals ab r 3 1 3 4 2 0 1 5 5 5 5 3 0 0 0 0 0 0 3 1 1 1 0 1 1 2 2 1 0 2 1 0 0 0 0 0 Utah 3 (9-23,4-6 Pac-12) h rbi po a lob 1 0 1 3 0 1 1 3 2 2 1 0 0 0 0 0 0 0 2 0 2 2 0 0 1 1 1 1 0 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 2 1 1 1 0 0 0 0 0 0 2 0 3 0 0 0 0 7 5 0 0 8 0 1 1 0 0 0 0 0 1 3 0 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 2 0 0 2 3 0 0 0 0 0 0 0 37 16 12 15 12 7 27 7 9 2 1 0 2 0 0 0 3 1 2 0 1 0 0 0 0 0 0 bb so Score by Innings 1 2 3 4 5 6 7 8 9 UCLA 0 0 1 2 5 0 5 0 3 Utah 1 0 0 0 0 1 0 0 1 Player ab r 5 3 3 1 3 3 4 4 4 2 2 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 3 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 1 2 2 0 1 0 0 0 0 0 0 0 0 34 3 7 2 3 8 Keirsey Jr., DaShawn cf Dunn, Oliver 2b Tom, Rykker 3b Colacchio, Demitri 3b Migueles, Erick rf Delorefice, Davis lf Anderson, Chandler dh Gulden, Wade 1b Richardson, Matt ss Rowan, Chris c Kramer, Shea ph/c Tedeschi, Josh p Robeniol, Kyle p Johnson, SpencerKev. p Johnson, Spencer p Moore, Austin p Totals H E 16 12 R 1 3 7 h rbi bb so po a lob 3 4 0 1 1 4 0 7 0 4 2 1 0 0 0 0 0 3 3 0 0 0 0 1 2 1 0 0 0 1 0 0 3 0 0 0 0 1 3 0 0 0 0 0 0 0 0 0 27 11 7 0 E - Kreidler. LOB - UCLA 9; UTAH 7. 2B - Ydens; Toglia; Amaral; Gulden, Wade. 3B - Kreidler; Delorefice. HR Ydens. HBP - Pries. SH - Kendall. SF - Cuellar. SB - Toglia; Amaral. CS - Delorefice. UCLA Bird, Jake Scheidler, Nick Garcia, Ryan Mora, Kyle ip h 7.1 0.1 0.1 1.0 5 0 0 2 r er bb so ab bf 2 0 0 1 2 0 0 1 3 0 0 0 7 27 30 0 1 1 1 1 1 0 5 5 np Utah 105 Tedeschi, Josh 3 Robeniol, Kyle 4 Johnson, SpencerKev. 23 Johnson, Spencer Moore, Austin ip h r 4.1 1.2 0.2 0.0 2.1 5 2 0 0 5 8 0 3 2 3 er bb so ab 8 0 3 2 3 4 0 3 3 2 Win - Bird (4-2). Loss - Tedeschi, J. (0-7). Save - None. WP - Bird 2; Johnson,S.K.. HBP - by Tedeschi, J. (Pries). Pitches/strikes: Bird 105/66; Scheidler 3/2; Garcia 4/3; Mora 23/12; Tedeschi, J. 84/49; Robeniol, K. 31/20; Johnson,S.K. 20/6; Johnson, S. 12/0; Moore, A. 56/37. Umpires - HP: Joe Burleson 1B: Joe Maiden 2B: Shawn Rakos 3B: Frank Pflugradt Start: 6:00 pm Time: 3:54 Attendance: 2082 Weather: Partly cloudy and cool Johnson, S. faced 3 batters in the 7th. bf np 2 17 23 3 7 7 0 2 5 0 0 3 2 11 14 84 31 20 12 56 Utah Baseball UCLA at Utah Apr 13, 2018 at Salt Lake City, Utah (Smith's Ballpark) Score by Innings UCLA Utah 1 2 3 4 5 6 7 8 9 0 1 0 0 1 0 2 0 5 0 0 1 5 0 0 0 3 1 UCLA starters: 18/lf Ydens; 4/ss Kendall; 33/2b Strumpf; 6/dh Stronach; 7/1b Toglia; 25/cf Amaral; 3/3b Kreidler; 5/rf Mitchell; 47/c Rosica; 14/p Bird; Utah starters: 21/cf Keirsey; 3/2b Dunn, Oliver; 9/3b Tom, Rykker; 15/rf Migueles, E.; 2/lf Delorefice; 16/dh Anderson, C.; 7/1b Gulden, Wade; 4/ss Richardson,M; 23/c Rowan, Chris; 22/p Tedeschi, J.; UCLA 1st - Ydens flied out to rf (1-2). Kendall grounded out to 2b (0-0). Strumpf walked (3-2). Stronach flied out to cf (2-2). 0 runs, 0 hits, 0 errors, 1 LOB. Utah 1st - Keirsey singled up the middle (1-0). Dunn, Oliver walked (3-0); Keirsey advanced to second. Tom, Rykker struck out swinging (0-2). Keirsey advanced to third on a wild pitch. Migueles, E. walked (3-2); Dunn, Oliver advanced to second. Migueles, E. advanced to second on a wild pitch; Dunn, Oliver advanced to third on a wild pitch; Keirsey scored on a wild pitch. Delorefice struck out swinging (2-2). Anderson, C. grounded out to 3b (1-2). 1 run, 1 hit, 0 errors, 2 LOB. UCLA 2nd - Toglia grounded out to 3b (0-0). Amaral struck out looking (2-2). Kreidler popped up to 2b (1-2). 0 runs, 0 hits, 0 errors, 0 LOB. Utah 2nd - Gulden, Wade doubled down the lf line (0-0). Richardson,M grounded out to 2b (2-1); Gulden, Wade advanced to third. Rowan, Chris lined out to ss (0-1). Keirsey struck out looking (2-2). 0 runs, 1 hit, 0 errors, 1 LOB. UCLA 3rd - Mitchell flied out to cf (1-1). Rosica flied out to lf (1-1). Ydens homered to left field, RBI (2-2). Kendall out at first 1b to p (0-0). 1 run, 1 hit, 0 errors, 0 LOB. Utah 3rd - Dunn, Oliver grounded out to 2b (0-0). Tom, Rykker popped up to 1b (0-0). Migueles, E. struck out swinging (3-2). 0 runs, 0 hits, 0 errors, 0 LOB. UCLA 4th - Strumpf struck out swinging (1-2). Stronach grounded out to 2b (2-2). Toglia singled up the middle (0-0). Toglia stole second. Amaral walked (3-2). Kreidler tripled to right center, 2 RBI (2-1); Amaral scored; Toglia scored. Mitchell flied out to cf (0-1). 2 runs, 2 hits, 0 errors, 1 LOB. Utah 4th - Delorefice walked (3-0). Anderson, C. flied out to lf (0-0). Delorefice out at second c to ss, caught stealing. Gulden, Wade struck out looking (2-2). 0 runs, 0 hits, 0 errors, 0 LOB. UCLA 5th - Rosica singled to right center (0-1). Ydens walked (3-1); Rosica advanced to second. Kendall grounded out to 3b, bunt, SAC (0-0); Ydens advanced to second; Rosica advanced to third. Strumpf walked (3-0). Pries pinch hit for Stronach. Pries hit by pitch, RBI (2-2); Strumpf advanced to second; Ydens advanced to third; Rosica scored. Toglia doubled to left center, 2 RBI (1-2); Pries advanced to third; Strumpf scored; Ydens scored. Robeniol, K. to p for Tedeschi, J.. Amaral doubled down the lf line, 2 RBI (1-0); Toglia scored; Pries scored. Kreidler struck out swinging (1-2); Amaral stole third. Mitchell grounded out to 2b (2-2). 5 runs, 3 hits, 0 errors, 1 LOB. R 16 3 H 12 7 E 1 0 Utah 5th - Richardson,M flied out to cf (0-1). Rowan, Chris grounded out to ss (1-1). Keirsey out at first 1b to p (3-2). 0 runs, 0 hits, 0 errors, 0 LOB. UCLA 6th - Rosica struck out looking (3-2). Ydens doubled to left field (0-2). Kendall struck out swinging, out at first c to 1b (2-2). Strumpf flied out to lf (2-1). 0 runs, 1 hit, 0 errors, 1 LOB. Utah 6th - Dunn, Oliver singled up the middle (1-0). Tom, Rykker flied out to cf (0-2). Migueles, E. struck out looking (1-2). Delorefice tripled to right field, RBI (0-0); Dunn, Oliver scored. Anderson, C. flied out to cf (0-0). 1 run, 2 hits, 0 errors, 1 LOB. UCLA 7th - Johnson,S.K. to p for Robeniol, K.. Cuellar pinch hit for Pries. Cuellar walked (3-1). Toglia walked (3-2); Cuellar advanced to second. Amaral reached on a fielder's choice (0-0); Toglia out at second 3b to 2b; Cuellar advanced to third. Amaral advanced to second on a wild pitch, advanced to third; Cuellar scored on a wild pitch. Kreidler walked (3-1). Mitchell grounded out to p, RBI (2-0); Kreidler advanced to second; Amaral scored. Johnson, S. to p for Johnson,S.K.. Rosica walked (3-0). Ydens walked (3-0); Rosica advanced to second; Kreidler advanced to third. Kendall walked, RBI (3-0); Ydens advanced to second; Rosica advanced to third; Kreidler scored. Moore, A. to p for Johnson, S.. Strumpf singled through the left side, 2 RBI (1-1); Kendall advanced to second; Ydens scored; Rosica scored. Cuellar flied out to lf (0-2). 5 runs, 1 hit, 0 errors, 2 LOB. Utah 7th - Gulden, Wade singled to left field (0-0). Richardson,M popped up to 1b (1-0). Kramer, Shea pinch hit for Rowan, Chris. Kramer, Shea flied out to lf (1-1). Keirsey flied out to cf (2-0). 0 runs, 1 hit, 0 errors, 1 LOB. UCLA 8th - Kramer, Shea to c. Colacchio, D to 3b for Tom, Rykker. Toglia popped up to 3b (3-2). Amaral struck out swinging (2-2). Kreidler singled up the middle (1-0). Mitchell struck out swinging (0-2). 0 runs, 1 hit, 0 errors, 1 LOB. Utah 8th - Dunn, Oliver reached on a throwing error by 3b, advanced to second (3-2). Colacchio, D struck out swinging (1-2). Scheidler to p for Bird. Migueles, E. popped up to ss (1-1). Garcia to p for Scheidler. Delorefice struck out swinging (1-2). 0 runs, 0 hits, 1 error, 1 LOB. UCLA 9th - Teijeiro pinch hit for Rosica. Teijeiro walked (3-2). Silva pinch hit for Ydens. Silva singled through the left side (3-2); Teijeiro advanced to second. Kendall walked (3-2); Silva advanced to second; Teijeiro advanced to third. Strumpf singled to left field, RBI (0-1); Kendall advanced to second; Silva advanced to third; Teijeiro scored. Cuellar to dh. Cuellar flied out to lf, SF, RBI (1-2); Silva scored. Toglia singled up the middle, RBI (0-0); Strumpf advanced to second; Kendall scored. Amaral reached on a fielder's choice (0-2); Toglia out at second ss to 2b; Strumpf advanced to third. Kreidler reached on a fielder's choice (0-2); Amaral out at second ss to 2b. 3 runs, 3 hits, 0 errors, 2 LOB. Utah 9th - Silva to lf. Haselman to c for Teijeiro. Mora to p for Garcia. Anderson, C. fouled out to c (0-2). Gulden, Wade singled up the middle (3-1). Gulden, Wade advanced to second on a fielder's Utah Baseball UCLA at Utah Apr 13, 2018 at Salt Lake City, Utah (Smith's Ballpark) choice. Richardson,M singled up the middle, RBI (3-2); Gulden, Wade scored. Kramer, Shea flied out to cf (1-0). Keirsey grounded out to 2b (3-2). 1 run, 2 hits, 0 errors, 1 LOB