Leakage after surgery for rectum cancer; inconsistency in reporting to the Danish Colorectal Cancer Group?

Purpose. Anastomotic leakage accounts for up to 1/3 of all fatalities after rectal cancer surgery. Evidence suggests that anastomotic leakage has a negative prognostic impact on local cancer recurrence and long-term cancer specific survival. The reported leakage rate in 2011 in Denmark varied from 7 to 45 percent. The objective was to clarify if the reporting of anastomotic leakage to the Danish Colorectal Cancer Group was rigorous and unequivocal. Methods. An Internet-based questionnaire was e-mailed to all Danish surgical departments, who reported to Danish Colorectal Cancer Group (DCCG) in 2011. There were 23 questions. Four core questions were whether pelvic collection, fecal appearance in a pelvic drain, rectovaginal fistula, and “watchfull” waiting patients were reported as anastomotic leakage. Results. Fourteen out of 17 departments, who in 2011 according to DDCG performed rectal cancer surgery, answered the questionnaire. This gave a response rate of 82%. In three of four core questions there was disagreement in what should be reported as anastomotic leakage. Conclusion. The reporting of anastomotic leakage to the Danish Colorectal Cancer Group was not rigorous and unequivocal. The reported anastomotic leakage rate in Danish Colorectal Cancer Group should be interpreted with caution

Endomicroscopic and transcriptomic analysis of impaired barrier function and malabsorption in environmental enteropathy

Introduction: Environmental enteropathy (EE) is associated with growth failure, micronutrient malabsorption and impaired responses to oral vaccines. We set out to define cellular mechanisms of impaired barrier function in EE and explore protective mechanisms. Methods: We studied 49 adults with environmental enteropathy in Lusaka, Zambia using confocal laser endomicroscopy (CLE); histology, immunohistochemistry and mRNA sequencing of small intestinal biopsies; and correlated these with plasma lipopolysaccharide (LPS) and a zinc uptake test. Results: CLE images (median 134 for each study) showed virtually ubiquitous small intestinal damage. Epithelial defects, imaged by histology and claudin 4 immunostaining, were predominantly seen at the tips of villi and corresponded with leakage imaged in vivo by CLE. In multivariate analysis, circulating log-transformed LPS was correlated with cell shedding events (β = 0.83; P = 0.035) and with serum glucagon-like peptide-2 (β = -0.13; P = 0.007). Zinc uptake from a test dose of 25mg was attenuated in 30/47 (64%) individuals and in multivariate analysis was reduced by HIV, but positively correlated with GLP-2 (β = 2.72; P = 0.03). There was a U-shaped relationship between circulating LPS and villus surface area. Transcriptomic analysis identified 23 differentially expressed genes in severe enteropathy, including protective peptides and proteins. Conclusions: Confocal endomicroscopy, claudin 4 immunostaining and histology identify epithelial defects which are probably sites of bacterial translocation, in the presence of which increased epithelial surface area increases the burden of translocation. GLP 2 and other protective peptides may play an important role in mucosal protection in EE

Structural and electronic inhomogeneity of superconducting Nb-doped Bi2Se3

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Development of a Dual-Stage Continuous Flow Reactor for Hydrothermal Synthesis of Hybrid Nanoparticles

This paper provides a comprehensive description of the design and commissioning of a dual-stage flow reactor for hydrothermal synthesis, notably heterogeneous nanomaterials such as core–shell particles or nanocomposites. The design is based on the hypothesis that the next frontier of studies within continuous, hydrothermal synthesis lies as much with scalability as it does with the materials properties and performance in applications. Therefore, this reactor belongs to the up-scaled end of a laboratory system with a synthesis capacity of up to 50 g/h. Commissioning was accomplished with TiO₂ nanoparticles as a model material. Results comply with earlier ones obtained from single-stage reactors. Dual-stage synthesis of a TiO₂@SnO₂ nanocomposite was performed by adding a SnCl₄ solution to newly formed 9 nm TiO₂ nanoparticles, yielding deposition of 2 nm rutile SnO₂. Synthesis of pure SnO₂ produced much larger nanocrystals, indicating that TiO₂ nanoparticles provide the nucleation sites for SnO₂ and impede the growth beyond 2 nm

Towards atomistic understanding of polymorphism in the solvothermal synthesis of ZrO2ZrO_2 nanoparticles

Varying atomic short-range order is correlated with the ratio of the monoclinic (m) to tetragonal (t) phase in ZrO$_2$ nanoparticle formation by solvothermal methods. Reactions from Zr oxynitrate in supercritical methanol and Zr acetate in water (hydrothermal route) were studied in situ by X-ray total scattering. Irrespective of the Zr source and solvent, the structure of the precursor in solution consists of edge-shared tetramer chains. Upon heating, the nearest-neighbor Zr-O and Zr-Zr distances shorten initially while the medium-range connectivity is broken. Depending on the reaction conditions, the disordered intermediate transforms either rapidly into m-ZrO$_2$, or more gradually into mixed m- and t-ZrO$_2$ with a concurrent increase of the shortest Zr-Zr distance. In the hydrothermal case, the structural similarity of the amorphous intermediate and m-ZrO$_2$ favors the formation of almost phase-pure m-ZrO$_2$ nanoparticles with a size of 5 nm, considerably smaller than the often-cited critical size below which the tetragonal is assumed to be favoured. Pair distribution function analysis thus unravels ZrO$_2$ phase formation on the atomic scale and in this way provides a major step towards understanding polymorphism of ZrO$_2$ beyond empirical approaches