A Rare Cause of Low Back Pain: Report of a Tailgut Cyst

Tailgut cysts, also known as retrorectal cystic hamartomas, are rare developmental abnormalities that typically occur in the retrorectal space. They are believed to arise from remnants of the embryonic hindgut (Hjermstad and Helwig, 1988). They can present as incidental findings during routine examination but over half of patients are thought to present with symptoms. MRI has become the modality of choice to image these frequently misdiagnosed cysts. Biopsy is not recommended. Complete intact surgical excision is advised to avoid the potential complications of these cysts which include infection, fistula formation, and the possibility of malignant transformation (Hjermstad and Helwig (1988), Mathis et al. (2010)). We describe the case of a 46-year-old female who presented with a 6-month history of low back pain. CT and MRI imaging demonstrated a complex retrorectal lesion with supralevator and infralevator components. This was removed using a combined transperineal and transabdominal approach. Histology confirmed a tailgut cyst

Peritoneal Dialysis Catheters

In peritoneal dialysis, a well-functioning catheter is of great importance because a dysfunctional catheter may be associated with exit-site infection, peritonitis, reduced efficiency of dialysis, and overall quality of treatment, representing one of the main barriers to optimal use of peritoneal dialysis. This chapter reviews the literature on indications and contraindications for peritoneal dialysis, peritoneal dialysis catheter design and materials, the techniques of insertion, complications, and method of removal of dialysis catheters

Dynamic Magnetic Resonance Imaging Demonstrates the Integrity of Perineal Reconstruction following Cylindrical Abdominoperineal Excision with Reconstruction of the Pelvic Floor Using Porcine Collagen

A 72-year-old female presented with a six-month history of increased frequency of defecation, rectal bleeding, and severe rectal pain. Digital rectal examination and endoscopy revealed a low rectal lesion lying anteriorly. This was confirmed histologically as adenocarcinoma. Radiological staging was consistent with a T3N2 rectal tumour. Following long-course chemoradiotherapy repeat staging did not identify any metastatic disease. She underwent a laparoscopic cylindrical abdominoperineal excision with en bloc resection of the coccyx and posterior wall of the vagina with a negative circumferential resection margin. The perineal defect was reconstructed with Permacol (biological implant, Covidien) mesh. She had no clinical evidence of a perineal hernia at serial followup. Dynamic MRI images of the pelvic floor obtained during valsalva at 10 months revealed an intact pelvic floor. A control case that had undergone a conventional abdominoperineal excision with primary perineal closure without clinical evidence of herniation was also imaged. This confirmed subclinical perineal herniation with significant downward migration of the bowel and bladder below the pubococcygeal line. We eagerly await further evidence supporting a role for dynamic MR imaging in assessing the integrity of a reconstructed pelvic floor following cylindrical abdominoperineal excision

Effect of Soil Chemistry on Microbial Biodiversity and Functionality in Grassland and Tilled Soils

Microorganisms are excellent indicators of soil health, because of their rapid response to environmental change. Traditional microbiology is ineffective for the study of soil, as \u3c 1% of microorganisms are currently culturable (Torsvik et al., 1996). Nucleic acid based methods, however, allow rapid detection of organisms, or particular genes, directly from soil samples. This work investigated, using polymerase chain reaction (PCR)-based approaches, the relationship between key chemical properties and bacterial biodiversity in grassland and tilled soils, with particular emphasis on the abundance and diversity of ammonium oxidisers

Results from an online survey of adults with cystic fibrosis: Accessing and using life expectancy information

Cystic fibrosis (CF) is the one of the most common inherited diseases. It affects around 10,000 people in the UK, and the median survival age is 47. Recent developments making use of longitudinal patient registry data are producing more detailed and relevant information about predicted life expectancy in CF based on current age and clinical measurements. The objective of this study was to conduct an online survey of adults with CF living in the UK using a web-based questionnaire to investigate: (i) if and how they access information on life expectancy; (ii) what they use it for; (iii) if they want more personalised information on life expectancy or the time until other milestones. The survey was advertised through the Cystic Fibrosis Trust using social media. There were 85 respondents, covering men (39%) and women (61%) aged 16–65. 75% had received information on life expectancy either from their CF care team (34%) or other sources (71%), the most common being the Cystic Fibrosis Trust website and research literature. Most people who received information found it to be beneficial and reported using it in a variety of ways, including to plan strategies for maintaining as best health as possible and to psychologically manage current health status. 82% of respondents were interested in more personalised information about their life expectancy, and participants also noted interest in other outcomes, including time to needing transplant or reaching a low level of lung function. Themes arising in text responses included the importance of good communication of information, the difficulty of relating general information to one’s own circumstances, and a desire for increased information on factors that impact on survival in CF. As an outcome from this work, research is underway to establish how information on life expectancy can be presented to people with CF in an accessible way

Contemporary temperature-driven divergence in a Nordic freshwater fish under conditions commonly thought to hinder adaptation

BACKGROUND: Evaluating the limits of adaptation to temperature is important given the IPCC-predicted rise in global temperatures. The rate and scope of evolutionary adaptation can be limited by low genetic diversity, gene flow, and costs associated with adaptive change. Freshwater organisms are physically confined to lakes and rivers, and must therefore deal directly with climate variation and change. In this study, we take advantage of a system characterised by low genetic variation, small population size, gene flow and between-trait trade-offs to study how such conditions affect the ability of a freshwater fish to adapt to climate change. We test for genetically-based differences in developmental traits indicating local adaptation, by conducting a common-garden experiment using embryos and larvae from replicate pairs of sympatric grayling demes that spawn and develop in natural cold and warm water, respectively. These demes have common ancestors from a colonization event 22 generations ago. Consequently, we explore if diversification may occur under severely constraining conditions. RESULTS: We found evidence for divergence in ontogenetic rates. The divergence pattern followed adaptation predictions as cold-deme individuals displayed higher growth rates and yolk conversion efficiency than warm-deme individuals at the same temperature. The cold-deme embryos had a higher rate of muscle mass development. Most of the growth- and development differences occurred prior to hatch. The divergence was probably not caused by genetic drift as there was a strong degree of parallelism in the divergence pattern and because phenotypic differentiation (Q(ST)) was larger than estimated genetic drift levels (microsatellite F(ST)) between demes from different temperature groups. We also document that these particular grayling populations cannot develop successfully at temperatures above 12°C, whereas other European populations can, and that increasing the muscle mass development rate comes at the cost of some skeletal trait development rates. CONCLUSIONS: This study shows that genetically based phenotypic divergence can prevail even under conditions of low genetic variation and ongoing gene flow. Furthermore, population-specific maximum development temperatures along with musculoskeletal developmental trade-offs may constrain adaptation

Small Bowel Gastrointestinal Bleeding Diagnosis and Management—A Narrative Review

Background: Small bowel bleeding accounts for 5–10% of all gastrointestinal bleeding. Despite advances in imaging, endoscopy and minimally invasive therapeutic techniques, its diagnosis and treatment remains a challenge and a standardized algorithm for approaching suspected small bowel bleeding remains elusive. Furthermore, the choice of investigation is subject to timing of presentation and accessibility to investigations. The aim of this study was to construct a narrative review of recent literature surrounding the diagnosis and management of small bowel bleeding.Methods: A literature review was conducted examining the database pubmed with the following key words and Boolean operators: occult GI bleed OR mesenteric bleed OR gastrointestinal hemorrhage OR GI hemorrhage AND management. Articles were selected and reviewed based on relevance to the research topic. Where necessary, the full text was sought to further assess relevance.Results: In overt GI bleeding, CT angiography and red cell scintigraphy are both feasible and reliable diagnostic imaging modalities if standard endoscopy is negative. Red cell scintigraphy may be advantageous through detection of lower bleeding rates but it is subject to availability. Overt bleeding and a positive CT angiogram or red cell scan improves the diagnostic yield of formal angiography ± embolization. Video capsule endoscopy or double balloon endoscopy can be considered in occult GI bleeding following normal upper and lower endoscopy.Conclusions: Small bowel bleeding remains a rare but significant diagnostic and therapeutic challenge. Technological advances in diagnostics have aided evaluation but have not broadened the range of therapeutic interventions

Corixidae (Hemiptera Heteroptera) in two artifical lakes on Irish cutaway raised bog

Oceanic raised bogs have long been exploited, both commercially and privately in Ireland. At present, 23,628 ha or 8% remains in an active state (Foss 1998), while at least 60,000 ha will be cutaway by the middle of the next century (Egan 1998). Industrial exploitation through milling involves the gradual removal of layers of peat until the less combustible fen peat is reached. On abandonment, the substrate is generally a mix of acid and alkaline peats and even occasionally lake marl and boulder clay. The surface level tends to be below the average water-table and in recent years areas of cutaway have been flooded to create lakes. Water is chiefly supplied by groundwater and precipitation, but some lakes may be fed by drains or small streams. these water-bodies have been allowed to colonise naturally. The development of macroinvertebrate communities was studied in two such lakes in central Ireland. As part of a wider investigation, Corixidae were sampled regularly over the course of a year and the animals examined. Interesting comparisons between sexes and between lakes were made

Orbital-selective band hybridisation at the charge density wave transition in monolayer TiTe2

Funding: We gratefully acknowledge support from the Leverhulme Trust and the Royal Society. W.R. is grateful to University College London for awarding a Graduate Research Scholarship and an Overseas Research Scholarship. O.J.C. and K.U. acknowledge PhD studentship support from the UK Engineering and Physical Sciences Research Council (EPSRC, Grant Nos. EP/K503162/1 and EP/L015110/1). I.M. and E.A.-M. acknowledge studentship support from the International Max-Planck Research School for Chemistry and Physics of Quantum Materials. S.R.K. acknowledges the EPSRC Centre for Doctoral Training in the Advanced Characterisation of Materials (CDT-ACM, EP/S023259/1) for funding a PhD studentship.Reducing the thickness of a material to its two dimensional (2D) limit can have dramatic consequences for its collective electronic states, including magnetism, superconductivity, and charge and spin ordering. An extreme case is TiTe2, where a charge density wave (CDW) emerges in the single-layer which is absent for the bulk compound, and whose origin is still poorly understood. Here, we investigate the electronic band structure evolution across this CDW transition using temperature-dependent angle-resolved photoemission spectroscopy. Our study reveals an orbital-selective band hybridisation between the backfolded conduction and valence bands occurring at the CDW phase transition, which in turn leads to a significant electronic energy gain, underpinning the CDW transition. For the bulk compound, we show how this energy gain is almost completely suppressed due to the three-dimensionality of the electronic band structure, including via a kz-dependent band inversion which switches the orbital character of the valence states. Our study thus sheds new light on how control of the electronic dimensionality can be used to trigger the emergence of new collective states in 2D materials.Publisher PDFPeer reviewe