Clinical management of 52 consecutive retro-rectal tumours treated at a tertiary referral centre

Abstract Aim The aim of this single institution study was to analyse the diagnostic methods, pre-operative work-up and outcomes of 52 retrorectal tumours. Method All patients treated for retro-rectal tumours from 2012 to 2017 were included. Results Out of 52 patients, 40 (77%) were women. The patients? median age at the time of surgery was 43 (19-76) years, and 30 (58%) of the patients were asymptomatic at the time of diagnosis. All tumours were visible on magnetic resonance imaging (MRI) prior to surgery. The sensitivity and specificity for predicting malignancy on pre-operative imaging for retro-rectal tumours were 25% and 98%, respectively. Forty-four procedures (85%) were performed using the perineal approach. The median hospital stay was three (1-18) days. There was no 30-day post-operative mortality. Eleven (21%) patients developed post-operative complications, mostly surgical site infections. Twenty-nine tumours (56%) were benign tailgut cysts. Four (8%) tumours were malignant and were considered to be removed with a tumour-free resection margin. Local recurrent disease was detected on MRI in 14 (27%) patients at a median of 1.05 (range: 0.78-1.77) years after primary surgery. Only the multi-lobular shape of the tumour was found to be an independent risk factor for recurrence (p=0.030). Conclusion A pre-operative MRI is mandatory in order to plan the surgical strategy for retro-rectal tumours. Symptomatic, solid, large tumours should be removed because of the risk of malignancy. Minor cystic lesions with thin walls as well as asymptomatic recurrences of benign tumours are suitable to be followed conservatively.Peer reviewe

Stellar wind interaction and pick-up ion escape of the Kepler-11 "super-Earths"

We study the interactions between stellar wind and the extended hydrogen-dominated upper atmospheres of planets and the resulting escape of planetary pick-up ions from the 5 "super-Earths" in the compact Kepler-11 system and compare the escape rates with the efficiency of the thermal escape of neutral hydrogen atoms. Assuming the stellar wind of Kepler-11 is similar to the solar wind, we use a polytropic 1D hydrodynamic wind model to estimate the wind properties at the planetary orbits. We apply a Direct Simulation Monte Carlo Model to model the hydrogen coronae and the stellar wind plasma interaction around Kepler-11b-f within a realistic expected heating efficiency range of 15-40%. The same model is used to estimate the ion pick-up escape from the XUV heated and hydrodynamically extended upper atmospheres of Kepler-11b-f. From the interaction model we study the influence of possible magnetic moments, calculate the charge exchange and photoionization production rates of planetary ions and estimate the loss rates of pick-up H+ ions for all five planets. We compare the results between the five "super-Earths" and in a more general sense also with the thermal escape rates of the neutral planetary hydrogen atoms. Our results show that for all Kepler-11b-f exoplanets, a huge neutral hydrogen corona is formed around the planet. The non-symmetric form of the corona changes from planet to planet and is defined mostly by radiation pressure and gravitational effects. Non-thermal escape rates of pick-up ionized hydrogen atoms for Kepler-11 "super-Earths" vary between approximately 6.4e30 1/s and 4.1e31 1/s depending on the planet's orbital location and assumed heating efficiency. These values correspond to non-thermal mass loss rates of approximately 1.07e7 g/s and 6.8e7 g/s respectively, which is a few percent of the thermal escape rates.Comment: 8 pages, 3 figures, accepted to A&

Transit Ly-α\alpha signatures of terrestrial planets in the habitable zones of M dwarfs

We modeled the transit signatures in the Lya line of a putative Earth-sized planet orbiting in the HZ of the M dwarf GJ436. We estimated the transit depth in the Lya line for an exo-Earth with three types of atmospheres: a hydrogen-dominated atmosphere, a nitrogen-dominated atmosphere, and a nitrogen-dominated atmosphere with an amount of hydrogen equal to that of the Earth. We calculated the in-transit absorption they would produce in the Lya line. We applied it to the out-of-transit Lya observations of GJ 436 obtained by the HST and compared the calculated in-transit absorption with observational uncertainties to determine if it would be detectable. To validate the model, we also used our method to simulate the deep absorption signature observed during the transit of GJ 436b and showed that our model is capable of reproducing the observations. We used a DSMC code to model the planetary exospheres. The code includes several species and traces neutral particles and ions. At the lower boundary of the DSMC model we assumed an atmosphere density, temperature, and velocity obtained with a hydrodynamic model for the lower atmosphere. We showed that for a small rocky Earth-like planet orbiting in the HZ of GJ436 only the hydrogen-dominated atmosphere is marginally detectable with the STIS/HST. Neither a pure nitrogen atmosphere nor a nitrogen-dominated atmosphere with an Earth-like hydrogen concentration in the upper atmosphere are detectable. We also showed that the Lya observations of GJ436b can be reproduced reasonably well assuming a hydrogen-dominated atmosphere, both in the blue and red wings of the Lya line, which indicates that warm Neptune-like planets are a suitable target for Lya observations. Terrestrial planets can be observed in the Lya line if they orbit very nearby stars, or if several observational visits are available.Comment: 17 pages, 12 figures, accepted for publication in Astronomy & Astrophysic

The Fermi Surface Effect on Magnetic Interlayer Coupling

The oscillating magnetic interlayer coupling of Fe over spacer layers consisting of Cu$_{x}$Pd$_{1-x}$ alloys is investigated by first principles density functional theory. The amplitude, period and phase of the coupling, as well as the disorder-induced decay, are analyzed in detail and the consistency to the Ruderman-Kittel-Kasuya-Yoshida (RKKY) theory is discussed. For the first time an effect of the Fermi surface nesting strength on the amplitude is established from first principles calculations. An unexpected variation of the phase and disorder-induced decay is obtained and the results are discussed in terms of asymptotics

Learning how to understand complexity and deal with sustainability challenges : A framework for a comprehensive approach and its application in university education

Sustainability challenges such as climate change, biodiversity loss, poverty and rapid urbanization are complex and strongly interrelated. In order to successfully deal with these challenges, we need comprehensive approaches that integrate knowledge from multiple disciplines and perspectives and emphasize interconnections. In short, they aid in observing matters in a wider perspective without losing an understanding of the details. In order to teach and learn a comprehensive approach, we need to better understand what comprehensive thinking actually is. In this paper, we present a conceptual framework for a comprehensive approach, termed the GHH framework. The framework comprises three dimensions: generalism, holism, and holarchism. It contributes to the academic community's understanding of comprehensive thinking and it can be used for integrating comprehensive thinking into education. Also, practical examples of the application of the framework in university teaching are presented. We argue that an ideal approach to sustainability challenges and complexity in general is a balanced, dialectical combination of comprehensive and differentiative approaches. The current dominance of specialization, or the differentiative approach, in university education calls for a stronger emphasis on comprehensive thinking skills. Comprehensiveness should not be considered as a flawed approach, but should instead be considered as important an aspect in education as specialized and differentiative skills. (C) 2017 Elsevier B.V. All rights reserved.Peer reviewe