Postoperative complications after procedure for prolapsed hemorrhoids (PPH) and stapled transanal rectal resection (STARR) procedures

Procedure for prolapsing hemorrhoids (PPH) and stapled transanal rectal resection for obstructed defecation (STARR) carry low postoperative pain, but may be followed by unusual and severe postoperative complications. This review deals with the pathogenesis, prevention and treatment of adverse events that may occasionally be life threatening. PPH and STARR carry the expected morbidity following anorectal surgery, such as bleeding, strictures and fecal incontinence. Complications that are particular to these stapled procedures are rectovaginal fistula, chronic proctalgia, total rectal obliteration, rectal wall hematoma and perforation with pelvic sepsis often requiring a diverting stoma. A higher complication rate and worse results are expected after PPH for fourth-degree piles. Enterocele and anismus are contraindications to PPH and STARR and both operations should be used with caution in patients with weak sphincters. In conclusion, complications after PPH and STARR are not infrequent and may be difficult to manage. However, if performed in selected cases by skilled specialists aware of the risks and associated diseases, some complications may be prevented

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

Operating experience with a 30 MeV, 500 mu A H/sup -/ cyclotron

The prototype of a new design of H/sup -/ cyclotron for radioisotope production has been built in Louvain-la-Neuve (Belgium). After a brief description of the main design features, the paper describes the beam developments conducted since November 1986. After solving `vacuum runaway' and RF instabilities problems, extracted beam intensities up to 530 mu A have been achieved with the prototype. Low power consumption, high energy conversion efficiency, high reliability, automatic operation and low activation level have also been demonstrated on this prototype.Anglai

Advanced cancer pain: the search for genetic factors correlated with interindividual variability in opioid requirement

Item does not contain fulltextAIM: To assess association between genetic variants and opioid requirement in cancer patients. MATERIALS & METHODS: A prospective observational trial of 243 advanced cancer patients with inadequate analgesia treated by the palliative care team was analyzed for ABCB1, ARRB2, COMT, GCH1, IL1RN, KCNJ6, OPRM1, RHBDF2, SCN9A and Stat6 polymorphisms. RESULTS: For patients carrying OPRM1 118AG/GG and COMT 472GG (Val158Val) or these genotypes alone, a significant higher median percentage dose increase was observed (95.2% [32.8-345]) compared with OPRM1 118AA and COMT 472GA/AA (158Met allele carriers; 48.5% [0-98.8]; p = 0.0016). No associations were found with morphine equivalent dose after consultation palliative care team or ketamine use. CONCLUSION: Patients with the combined OPRM1 118AG/GG and COMT 472GG genotype required 50% higher dose increase for sufficient analgesia

The evidence for pharmacologic treatment of neuropathic cancer pain: beneficial and adverse effects

Item does not contain fulltextCONTEXT: The prevalence of neuropathic pain in patients with cancer pain has been estimated to be around 40%. Neuropathic pain may be caused by tumor invasion and is considered as mixed nociceptive-neuropathic pain, or caused by an anticancer treatment and considered as purely neuropathic pain. The use of adjuvant analgesics in patients with cancer is usually extrapolated from their efficacy in nononcological neuropathic pain syndromes. OBJECTIVES: In this systematic review, we sought to evaluate the evidence for the beneficial and adverse effects of pharmacologic treatment of neuropathic cancer pain. METHODS: A systematic review of the literature in PubMed and Embase was performed. Primary outcome measures were absolute risk benefit (ARB), defined as the number of patients with a defined degree of pain relief divided by the total number of patients in the treatment group, and absolute risk harm (ARH), defined as the fraction of patients who dropped out as a result of adverse effects. RESULTS: We identified 30 articles that fulfilled our inclusion criteria. Overall, ARB of antidepressants, anticonvulsants, other adjuvant analgesics, or opioids greatly outweighed ARH. There were no significant differences in ARB or ARH between the four groups of medication or between patients with mixed vs. purely neuropathic pain. Because of the low methodological quality of the studies, we could not draw conclusions about the true treatment effect size of the four groups of medications. CONCLUSION: Once a diagnosis of neuropathic pain has been established in patients with cancer, antidepressants, anticonvulsants, or other adjuvant analgesics should be considered in addition to or instead of opioids

Construction of the Louvain-la-Neuve 30 MeV 500 mu A H/sup -/ cyclotron

The prototype of a new design of a 30 MeV H/sup -/ cyclotron for isotope production in Louvain-la-Neuve (Belgium) is described. The original magnet design combines the advantages of compact and separated sector cyclotrons and requires less than 7 kW of electric power. The ions are produced in an external multicusp ion source biased at 30 kV, and injected axially. The two 30 degrees dees, supported on half-wavelength vertical resonators are connected at the center. The RF frequency is 65 MHz, and the power for 50 kV dee voltage is 5 kW for one cavity. The cyclotron operation will be fully automatic, using a high-level programmable controller. The magnetic field shimming is completed.Anglai

Initial operation of Cyclone II

Cyclone II is the prototype of a novel high-intensity, low-power-consumption cyclotron for radioisotope production. Its construction began in September 1985. A first H/sup -/ beam was accelerated to the maximum energy of 31.5 MeV in December 1986, and variable-energy extracted beams were obtained in February 1987. During the initial tests, with pulsed RF, the total power consumption was as low as 42 kW. Operation at full intensity (500 mu A) is scheduled for July 1987 after the installation of the prototype in its final shielding vault, currently under construction. A description is given to the magnet design, the RF system, beam injection and extraction, and the control system.Anglai

High intensity H/sup -/ cyclotrons for radioisotope production

A description is given of Cyclone 30, a 30-MeV, H/sup -/ cyclotron for radioscope production, designed for extremely high extracted beam intensity (500 mu A) and low power consumption (less than 100 kW with a 15-kW extracted beam). The Cyclone 30 prototype has now been operational for years at Louvain-La-Neuve and has achieved all design goals while demonstrating very high reliability. The major events in its development are reviewed. The data gathered so far give general basic trends for future designs; a 70-MeV, 2-mA machine design study is presented.Anglai

A new design of truly selfshielding baby-cyclotrons for positron emitter production

The successful design of the Cyclone 30, a 30-MeV H/sup -/ cyclotron, gave birth to an original design of truly selfshielding baby-cyclotrons dedicated to positron emitter production. This new negative ion cyclotron will deliver 10-MeV protons and 5-MeV deuterons. Up to eight targets are located inside the circular return yoke of the magnet, which serves as a primary neutron and gamma-ray shield. The cyclotron is embedded in an additional neutron shield made of borated-hydrogenated material. One of the main goals of the design is the ease of access to the targets and to the cyclotron inner parts without compromising the shielding efficiency. Any combination of two opposed targets can be irradiated simultaneously. The size and weight of the proposed system are considerably reduced compared to those of existing cyclotrons.Anglai

Personality traits are not associated with changes in employment status over 3 years in persons with multiple sclerosis

Previous research discovered a protective effect of higher conscientiousness against a 3-year deterioration in employment status in persons with multiple sclerosis (pwMS). To replicate these findings, we used data from a multicentre prospective cohort study where 145 employed pwMS completed questionnaires, neurological and neuropsychological examinations at baseline and after 3 years. A 3-year deterioration in employment status was reported in 31.0%. We observed no differences in personality, demographics or clinical characteristics between pwMS with deteriorated or stable employment status. These null findings may be partly explained by the classification of deteriorated employment status, which does not reflect Dutch labour conditions