Doppler-Guided Hemorrhoid Artery Ligation with Recto-Anal-Repair Modification: Functional Evaluation and Safety Assessment of a New Minimally Invasive Method of Treatment of Advanced Hemorrhoidal Disease

Purpose: We present 12-month followup results of functional evaluation and safety assessment of a modification of hemorrhoidal artery ligation (DGHAL) called Recto-Anal-Repair (RAR) in treatment of advanced hemorrhoidal disease (HD). Methods: Patients with grade III and IV HD underwent the RAR procedure (DGHAL combined with restoration of prolapsed hemorrhoids to their anatomical position with longitudinal sutures). Each patient had rectal examination, anorectal manometry, and QoL questionnaire performed before 3 months, and 12 months after RAR procedure. Results: 20 patients completed 12-month followup. There were no major complications. 3 months after RAR, 5 cases of residual mucosal prolapse were detected (25%), while only 3 patients (15%) reported persistence of symptoms. 12 months after RAR, another 3 HD recurrences were detected, to a total of 8 patients (40%) with HD recurrence. Anal pressures after RAR were significantly lower than before (P < 0.05), and the effect was persistent 12 months after RAR. One patient (5%) reported occasional soiling 3 months after RAR. Conclusions: RAR seems to be a safe method of treatment of advanced HD with no major complications. The procedure has a significant influence on anal pressures, with no evidence of risk of fecal incontinence after the operation

Spontaneous polar and chiral symmetry breaking in ordered fluids -- heliconical ferroelectric nematic phases

It is known that the chiral interaction described by Dzyaloshinskii-Moriya (DMI) term lead to the plethora of topological structures of magnetic spins, such as helical or skyrmion phases. Here we present the that analogues electrical DMI can lead to similar structural complexity of electric dipoles in soft matter. We report on a new polar liquid phase in which achiral molecules spontaneously form a heliconical structure. The helical pitch is comparable to the wavelength of visible light and unwinds critically at the transition to a uniformly polar, ferroelectric nematic phase. Although this new liquid crystalline phase resembles the twist-bend nematic phase, the mechanism of its formation is different and is attributed to electrical interactions that cause non-collinear arrangement of electric dipoles, similarly as observed for spins in magnetic systems

Sunitinib-induced hypothyroidism predicts progression-free survival in metastatic renal cell carcinoma patients

Sunitinib is a tyrosine kinase inhibitor (TKI) used in treatment of metastatic renal cell carcinoma (mRCC), gastrointestinal stromal tumors and pancreatic neuroendocrine tumors. One of the most common side effects related to sunitinib is hypothyroidism. Recent trials suggest correlation between the incidence of hypothyroidism and treatment outcome in patients treated with TKI. This study evaluates whether development of hypothyroidism is a predictive marker of progression-free survival (PFS) in patients with mRCC treated with sunitinib. Twenty-seven patients diagnosed with clear cell mRCC, after nephrectomy and in ‘good’ or ‘intermediate’ MSKCC risk prognostic group, were included in the study. All patients received sunitinib as a first-line treatment on a standard schedule (initial dose 50 mg/day, 4 weeks on, 2 weeks off). The thyroid-stimulating hormone serum levels were obtained at the baseline and every 12 weeks of treatment. In statistic analyses, we used Kaplan–Meier method for assessment of progression-free survival; for comparison of survival, we used log-rank test. In our study, the incidence of hypothyroidism was 44%. The patients who had developed hypothyroidism had better median PFS to patients with normal thyroid function 28,3 months [95% (CI) 20.4–36.2 months] versus 9.8 months (6.4–13.1 months). In survival analysis, we perceive that thyroid dysfunction is a predictive factor of a progression-free survival (PFS). In the unified group of patients, the development of hypothyroidism during treatment with sunitinib is a positive marker for PFS. During that treatment, thyroid function should be evaluated regularly

Low aberration and fast switching microlenses based on a novel liquid crystal mixture

In this work, we present a novel kind of LC mixture (5005) for photonic applications, with emphasis on a LC microlens array. This mixture is a nematic composition of three different families of rod like liquid crystals. The key is that frequency dependence of parallel component of electric permittivity is different for each component, resulting in a strongly dependent on frequency dielectric anisotropy. The unique properties of this LC mixture are demonstrated to work in a frequency modulated LC microlens array. A hole patterned structure is used. Thanks to the special characteristics of this mixture, the microlenses are reconfigurable by low voltage signals with variable frequency. This is a first demonstration of a LC lens with tunable focal length by frequency in an analog way. The result of this type of control are microlenses with low aberrations and fast switching (the frequency switching is around 10 times faster than amplitude modulation). The tunability with frequency and the fast switching, makes this liquid crystal of special interest not only for microlenses but for all kind of optical phase modulators.This work was supported by the Research and Development Program through the Comunidad de Madrid (SINFOTON S2013/MIT-2790), the Ministerio de Economía y Competitividad of Spain (TEC2013-47342-C2-2-R) and the funding from Agencia Estatal de Investigación (AEI) and Fondo Europeo de Desarrollo Regional (FEDER) for the Project TEC2016-77242-C3-1-R AEI/FEDER,UE. N Bennis and P Kula acknowledge the Polish Ministry of Science and Higher Education the Statutory Activity PBS-654 and PBS-651 of Military University of Technology respectively

Perspektywy skojarzonego leczenia raka wątrobowokomórkowego

Rak wątrobowokomórkowy (HCC) stanowi około 80% pierwotnych nowotworów wątroby oraz jest 5. przyczynązgonów z powodu nowotworów na świecie. Dotychczasowe postępy w diagnostyce oraz leczeniu HCC nie przełożyłysię na istotną poprawę rokowania. W zależności od zaawansowania choroby, a także obecności nadciśnieniawrotnego oraz chorób współistniejących, pacjenci mogą być poddawani takim zabiegom jak resekcja wątroby,transplantacja wątroby, leczenie z wykorzystaniem metod miejscowych: przeztętniczej chemoembolizacji (TACE),ablacji falami o częstotliwości radiowej (RFA) czy przezskórnego wstrzyknięcia etanolu (PEI). W przypadku chorobyzaawansowanej i dyskwalifikacji od leczenia miejscowego stosuje się sorafenib.Obecnie prowadzi się badania kliniczne nad kojarzeniem wyżej wymienionych metod leczenia. W przypadkuleczenia radykalnego obejmują one łączenie resekcji lub ablacji z zastosowaniem sorafenibu. U pacjentówz chorobą o pośrednim stopniu zaawansowania wykonuje się zabiegi TACE. Kojarzenie TACE z leczeniemsystemowym w różnych sekwencjach jest oceniane w badaniach klinicznych. Aktualnie trwają również badanianad łączeniem sorafenibu z cytostatykami, z terapiami celowanymi, a także z inhibitorami deacetylaz histonów(faza badań przedklinicznych)

Complications in the systemic treatment in elderly patients. Neutropenia as limiting factor

Wraz ze starzeniem się społeczeństwa, wzrostem średniej długości życia oraz zachorowalności na nowotwory złośliwe coraz częstszym problemem w praktyce onkologa klinicznego staje się leczenie systemowe osób powyżej 65. roku życia. Ze względu na różnice w stanie biologicznym, rezerwach narządowych, występowaniu chorób współistniejących oraz wynikającej z nich polipragmazji pacjenci w zaawansowanym wieku stanowią grupę niezwykle heterogenną. Kluczowym elementem kwalifikacji do leczenia systemowego pacjentów w podeszłym wieku jest wyselekcjonowanie chorych, u których można zastosować leczenie analogiczne do tego, jakie prowadzi się u osób młodszych, na przykład chemioterapię indukcyjną czy leczenie uzupełniające w przypadku pacjentów z długim przewidywanym okresem przeżycia. U pozostałych pacjentów należy rozważyć postępowanie mniej agresywne lub wyłącznie objawowe. Wraz z procesami starzenia dochodzi do zmian w farmakodynamice oraz farmakokinetyce leków, w związku z czym leczenie systemowe osób w podeszłym wieku wiąże się z występowaniem toksyczności o znacznym nasileniu. Szczególnie często obserwuje się istotną mielotoksyczność, a wiek powyżej 65 lat jest jednym z głównych czynników predysponujących do głębokiej neutropenii, co łączy się ze zwiększonym ryzykiem wystąpienia gorączki neutropenicznej. Wykazano również, że szereg chorób przewlekłych występujących w populacji osób starszych niezależnie zwiększa ryzyko wystąpienia gorączki neutropenicznej. Ponadto w przypadku leczenia o założeniu radykalnym mielosupresja oraz wynikające z niej powikłania mogą się wiązać z koniecznością redukcji dawek stosowanych cytostatyków i przerwami w leczeniu, a tym samym wpływać na skuteczność prowadzonej terapii. W związku z tym w tej grupie pacjentów właściwe oszacowanie ryzyka powikłań związanych z mielotoksycznością chemioterapii oraz zastosowanie czynników pobudzających wzrost kolonii granulocytów ma szczególnie istotne znaczenie kliniczne. The ageing of the population, increasing life expectancy and cancer morbidity make the systemic treatment of patients over the age of 65 common issue in medical oncology. Older patients constitute a very heterogeneous group due to the differences in their general condition, organ reserves, comorbidities and the polypharmacy as its consequence. In the treatment planning in geriatric oncology it is crucial to select those patients who are able to tolerate intensive treatment e.g. induction chemotherapy or adjuvant treatment (in those with expected longsurvival) and patients in whom less aggressive treatment or best supportive care is the most beneficial approach. The ageing process has been associated with changes in pharmacodynamics and pharmacokinetics of the cancer medications resulting in their higher toxicity in elderly. Myelotoxicity is very common and older age is one of the most important risk factors for severe neutropenia and febrile neutropenia. It has been exhibited that comorbid conditions in elderly independently increase the risk of febrile neutropenia. It should also be noticed that in caseof curative treatment myelosupression and its complications may result in chemotherapy dose reductions, treatment interruptions, decreasing overall treatment efficacy. For these reasons the assesment of risk of myelotoxicity and its complications as well as the appropiate use of granulocyte-colony stimulating factors in elderly patientsis very important in clinical practice

Scientific Opportunities for Heterogeneous Catalysis Research at the SuperXAS and SNBL Beam Lines

In this short review, we describe the complementary experimental capabilities for catalysis research at two beam lines available to the Swiss community, SuperXAS at SLS (Swiss Light Source, Villigen) and SNBL (Swiss Norwegian Beam lines) at ESRF (European Synchrotron Radiation Facility, Grenoble). Over the years, these two facilities have been developed to provide powerful techniques for structural studies under in situ and operando conditions. These techniques, X-ray diffraction (XRD), X-ray absorption spectroscopy (XAS), and X-ray emission spectroscopy (XES) in combination with Raman or infrared spectroscopy provide new avenues for structure–performance studies of catalysts. Several exemplary studies are used to demonstrate the capability of these facilities

Crowdsourcing human common sense for quantum control

Citizen science methodologies have over the past decade been applied with great success to help solve highly complex numerical challenges. Here, we take early steps in the quantum physics arena by introducing a citizen science game, Quantum Moves 2, and compare the performance of different optimization methods across three different quantum optimal control problems of varying difficulty. Inside the game, players can apply a gradient-based algorithm (running locally on their device) to optimize their solutions and we find that these results perform roughly on par with the best of the tested standard optimization methods performed on a computer cluster. In addition, cluster-optimized player seeds was the only method to exhibit roughly optimal performance across all three challenges. This highlights the potential for crowdsourcing the solution of future quantum research problems.Comment: 15 figure

Towards the development and verification of a 3D-based advanced optimized farm machinery trajectory algorithm

Efforts related to minimizing the environmental burden caused by agricultural activities and increasing economic efficiency are key contemporary drivers in the precision agriculture domain. Controlled Traffic Farming (CTF) techniques are being applied against soil compaction creation, using the on-line optimization of trajectory planning for soil-sensitive field operations. The research presented in this paper aims at a proof-of-concept solution with respect to optimizing farm machinery trajectories in order to minimize the environmental burden and increase economic efficiency. As such, it further advances existing CTF solutions by including (1) efficient plot divisions in 3D, (2) the optimization of entry and exit points of both plot and plot segments, (3) the employment of more machines in parallel and (4) obstacles in a farm machinery trajectory. The developed algorithm is expressed in terms of unified modeling language (UML) activity diagrams as well as pseudo-code. Results were visualized in 2D and 3D to demonstrate terrain impact. Verifications were conducted at a fully operational commercial farm (Rostenice, the Czech Republic) against second-by-second sensor measurements of real farm machinery trajectories