Contemporary management of locally advanced and recurrent rectal cancer: views from the PelvEx collaborative

Pelvic exenteration is a complex operation performed for locally advanced and recurrent pelvic cancers. The goal of surgery is to achieve clear margins, therefore identifying adjacent or involved organs, bone, muscle, nerves and/or vascular structures that may need resection. While these extensive resections are potentially curative, they can be associated with substantial morbidity. Recently, there has been a move to centralize care to specialized units, as this facilitates better multidisciplinary care input. Advancements in pelvic oncology and surgical innovation have redefined the boundaries of pelvic exenterative surgery. Combined with improved neoadjuvant therapies, advances in diagnostics, and better reconstructive techniques have provided quicker recovery and better quality of life outcomes, with improved survival This article provides highlights of the current management of advanced pelvic cancers in terms of surgical strategy and potential future development

X-ray Polarisation in Magnetar Atmospheres - Effects of Mode Conversion

Magnetars, the most strongly magnetised neutron stars, are among the most promising targets for X-ray polarimetry. The Imaging X-ray Polarimetry Explorer (IXPE), the first satellite devoted to exploring the sky in polarised X-rays, has observed four magnetars to date. A proper interpretation of IXPE results requires the development of new atmospheric models that can take into proper account the effects of the magnetised vacuum on par with those of the plasma. Here we investigate the effects of mode conversion at the vacuum resonance on the polarisation properties of magnetar emission by computing plane-parallel atmospheric models under varying conditions of magnetic field strength/orientation, effective temperature and allowing for either complete or partial adiabatic mode conversion. Complete mode conversion results in a switch of the dominant polarisation mode, from the extraordinary (X) to the ordinary (O) one, below an energy that decreases with increasing magnetic field strength, occurring at ≈0.5 keV for a magnetic field strength of B = 1014 G. Partial adiabatic mode conversion results in a reduced polarisation degree when compared with a standard plasma atmosphere. No dominant mode switch occurs for B = 1014 G while there are two switches for lower fields of B = 3 × 1013 G. Finally, by incorporating our models in a ray-tracing code, we computed the expected polarisation signal at infinity for different emitting regions on the star surface and for different viewing geometries. The observability of QED signatures with IXPE and with future soft X-ray polarimeters as REDSoX is discussed

Optimal energy management of a grid-connected multiple energy carrier micro-grid

© 2019 Elsevier Ltd This paper presents a novel modeling approach to optimize the electrical and thermal energy management of a multiple energy carrier micro-grid with the aim of minimizing the operation cost such that system constraints are satisfied. The proposed micro-grid includes a micro-turbine, a fuel cell, a rubbish burning power plant, a wind turbine generator system, a boiler, an anaerobic reactor-reformer system, an inverter, a rectifier, and some energy storage units. The model uses day-ahead forecasting (24 h) to estimate the electrical and thermal loads on a micro-grid network. A day-ahead forecast is also used to estimate electricity generation from wind turbines. Due to the uncertainty associated with day-ahead forecasts, a Monte Carlo simulation is used to estimate thermal loads, electrical loads, and wind power generation. Also, a real-time pricing demand response program is used to shift non-vital loads. The operating cost of the micro-grid is minimized through the particle swarm optimization algorithm. The simulation results demonstrate the proposed modeling framework is superior over conventional centralized optimal scheduling models widely used in the literature in terms of reducing operating cost and computational complexity. In addition, the results obtained by applying the proposed modeling framework are analyzed and validated through scenario testing

Molecular Structure and Dimeric Organization of the Notch Extracellular Domain as Revealed by Electron Microscopy

Background: The Notch receptor links cell fate decisions of one cell to that of the immediate cellular neighbor. In humans, malfunction of Notch signaling results in diseases and congenital disorders. Structural information is essential for gaining insight into the mechanism of the receptor as well as for potentially interfering with its function for therapeutic purposes. Methodology/Principal Findings: We used the Affinity Grid approach to prepare specimens of the Notch extracellular domain (NECD) of the Drosophila Notch and human Notch1 receptors suitable for analysis by electron microscopy and three-dimensional (3D) image reconstruction. The resulting 3D density maps reveal that the NECD structure is conserved across species. We show that the NECD forms a dimer and adopts different yet defined conformations, and we identify the membrane-proximal region of the receptor and its ligand-binding site. Conclusions/Significance: Our results provide direct and unambiguous evidence that the NECD forms a dimer. Our studies further show that the NECD adopts at least three distinct conformations that are likely related to different functional states of the receptor. These findings open the way to now correlate mutations in the NECD with its oligomeric state and conformation

Multiscale correlative tomography: an investigation of creep cavitation in 316 stainless steel

Creep cavitation in an ex-service nuclear steam header Type 316 stainless steel sample is investigated through a multiscale tomography workflow spanning eight orders of magnitude, combining X-ray computed tomography (CT), plasma focused ion beam (FIB) scanning electron microscope (SEM) imaging and scanning transmission electron microscope (STEM) tomography. Guided by microscale X-ray CT, nanoscale X-ray CT is used to investigate the size and morphology of cavities at a triple point of grain boundaries. In order to understand the factors affecting the extent of cavitation, the orientation and crystallographic misorientation of each boundary is characterised using electron backscatter diffraction (EBSD). Additionally, in order to better understand boundary phase growth, the chemistry of a single boundary and its associated secondary phase precipitates is probed through STEM energy dispersive X-ray (EDX) tomography. The difference in cavitation of the three grain boundaries investigated suggests that the orientation of grain boundaries with respect to the direction of principal stress is important in the promotion of cavity formation

DEEP MOVEMENT: Deep learning of movie files for management of endovascular thrombectomy

Objectives: Treatment and outcomes of acute stroke have been revolutionised by mechanical thrombectomy. Deep learning has shown great promise in diagnostics but applications in video and interventional radiology lag behind. We aimed to develop a model that takes as input digital subtraction angiography (DSA) videos and classifies the video according to (1) the presence of large vessel occlusion (LVO), (2) the location of the occlusion, and (3) the efficacy of reperfusion. / Methods: All patients who underwent DSA for anterior circulation acute ischaemic stroke between 2012 and 2019 were included. Consecutive normal studies were included to balance classes. An external validation (EV) dataset was collected from another institution. The trained model was also used on DSA videos post mechanical thrombectomy to assess thrombectomy efficacy. / Results: In total, 1024 videos comprising 287 patients were included (44 for EV). Occlusion identification was achieved with 100% sensitivity and 91.67% specificity (EV 91.30% and 81.82%). Accuracy of location classification was 71% for ICA, 84% for M1, and 78% for M2 occlusions (EV 73, 25, and 50%). For post-thrombectomy DSA (n = 194), the model identified successful reperfusion with 100%, 88%, and 35% for ICA, M1, and M2 occlusion (EV 89, 88, and 60%). The model could also perform classification of post-intervention videos as mTICI < 3 with an AUC of 0.71. / Conclusions: Our model can successfully identify normal DSA studies from those with LVO and classify thrombectomy outcome and solve a clinical radiology problem with two temporal elements (dynamic video and pre and post intervention). / Key Points: • DEEP MOVEMENT represents a novel application of a model applied to acute stroke imaging to handle two types of temporal complexity, dynamic video and pre and post intervention. • The model takes as an input digital subtraction angiograms of the anterior cerebral circulation and classifies according to (1) the presence or absence of large vessel occlusion, (2) the location of the occlusion, and (3) the efficacy of thrombectomy. • Potential clinical utility lies in providing decision support via rapid interpretation (pre thrombectomy) and automated objective gradation of thrombectomy outcomes (post thrombectomy)

The interaction between a sexually transferred steroid hormone and a female protein regulates oogenesis in the malaria mosquito anopheles gambiae

Molecular interactions between male and female factors during mating profoundly affect the reproductive behavior and physiology of female insects. In natural populations of the malaria mosquito Anopheles gambiae, blood-fed females direct nutritional resources towards oogenesis only when inseminated. Here we show that the mating-dependent pathway of egg development in these mosquitoes is regulated by the interaction between the steroid hormone 20-hydroxy-ecdysone (20E) transferred by males during copulation and a female Mating-Induced Stimulator of Oogenesis (MISO) protein. RNAi silencing of MISO abolishes the increase in oogenesis caused by mating in blood-fed females, causes a delay in oocyte development, and impairs the function of male-transferred 20E. Co-immunoprecipitation experiments show that MISO and 20E interact in the female reproductive tract. Moreover MISO expression after mating is induced by 20E via the Ecdysone Receptor, demonstrating a close cooperation between the two factors. Male-transferred 20E therefore acts as a mating signal that females translate into an increased investment in egg development via a MISO-dependent pathway. The identification of this male–female reproductive interaction offers novel opportunities for the control of mosquito populations that transmit malaria

Swine flu: lessons we need to learn from our global experience

There are important lessons to be learnt from the recent ‘Swine Flu’ pandemic. Before we call it a pandemic, we need to have appropriate trigger points that involve not only the spread of the virus but also its level of virulence. This was not done for H1N1 (swine flu). We need to ensure that we improve the techniques used in trying to decrease the spread of infection—both in the community and within our hospitals. This means improved infection control and hygiene, and the use of masks, alcohol hand rubs and so on. We also need to have a different approach to vaccines. Effective vaccines were produced only after the epidemic had passed and therefore had relatively little impact in preventing many infections. Mass population strategies involving vaccines and antivirals also misused large amounts of scarce medical resources