Imaging for Quality Control: Comparison of Systematic Video Recording to the Operative Note in Colorectal Cancer Surgery.

__Background:__ Oncological and functional results after colorectal cancer surgery vary considerably between hospitals and surgeons. At present, the only source of technical information about the surgical procedure is the operative note, which is subjective and omits critical information. This study aimed to evaluate the feasibility of operative video recording in demonstrating both objective information concerning the surgical procedure and surgical quality, as using a systematic approach might improve surgical performance. __Methods:__ From July 2015 through November 2015, patients aged ≥18 years undergoing elective colorectal cancer surgery were prospectively included in a single-institution trial. Video recording of key moments was performed peroperatively and analyzed for adequacy. The study cases were compared with a historic cohort. Video was compared with the operative note using the amount of adequate steps and a scoring system. __Results:__ This study compared 15 cases to 32 cases from the historic control group. Compared to the written operative note alone, significant differences in availability of information were seen in favor of video as well as using a combination of video plus the operative note. __Conclusions:__ Systematic video registration is feasible and seems to improve the availability of essential information after colorectal cancer surgery. In this respect, combining video with a traditional operative note would be the best option. A multicenter international study is being organized to further evaluate the effect of operative video capture on surgical outcomes

External Operators and Anomalous Dimensions in Soft-Collinear Effective Theory

It has recently been argued that soft-collinear effective theory for processes involving both soft and collinear partons contains a new soft-collinear mode, which can communicate between the soft and collinear sectors of the theory. The formalism incorporating the corresponding fields into the effective Lagrangian is extended to include external current and four-quark operators relevant to weak interactions. An explicit calculation of the anomalous dimensions of these operators reveals that soft-collinear modes are needed for correctly describing the ultraviolet behavior of the effective theory.Comment: 15 pages, 2 figure

Increased forefoot loading is associated with an increased plantar flexion moment

The aim of this study was to identify the cascade of effects leading from alterations in force generation around the ankle joint to increased plantar pressures under the forefoot. Gait analysis including plantar pressure measurement was performed at an individually preferred and a standardized, imposed gait velocity in diabetic subjects with polyneuropathy (n=94), without polyneuropathy (n=39) and healthy elderly (n=19). The plantar flexion moment at 40% of the stance phase was negatively correlated with the displacement rate of center of pressure (r=-.749, p<.001 at the imposed, and r=-.693, p<.001 at the preferred gait velocity). Displacement rate of center of pressure was strongly correlated with forefoot loading (r=-.837, p<.001 at the imposed, and r=-.731, p<.001 at the preferred gait velocity). People with a relatively high plantar flexion moment at 40% of the stance phase, have a faster forward transfer of center of pressure and consequently higher loading of the forefoot. This indicates that interventions aimed at increasing the control of the roll-off of the foot may contribute to a better plantar pressure distribution

Strength Training Affects Lower Extremity Gait Kinematics, Not Kinetics, in People With Diabetic Polyneuropathy

Increased forefoot loading in diabetic polyneuropathy plays an important role in the development of plantar foot ulcers and can originate from alterations in muscle strength, joint moments and gait pattern. The current study evaluated whether strength training can improve lower extremity joint moments and spatiotemporal gait characteristics in patients with diabetic polyneuropathy. An intervention group receiving strength training during 24 weeks and a control group receiving no intervention. Measurements were performed in both groups at t= 0, t= 12, t= 24 and t= 52 weeks at an individually preferred and standardized imposed gait velocity. The strength training did not affect the maximal amplitude of hip, knee and ankle joint moments, but did result in an increase in stance phase duration, stride time and stride length of approximately 5 %, during the imposed gait velocity. In addition, both groups increased their preferred gait velocity over one year. Future longitudinal studies should further explore the possible effects of strength training on spatiotemporal gait characteristics. The current study provides valuable information on changes in gait velocities and the progressive lower extremity problems in patients with polyneuropathy

Quantum driven Bounce of the future Universe

It is demonstrated that due to back-reaction of quantum effects, expansion of the universe stops at its maximum and takes a turnaround. Later on, it contracts to a very small size in finite future time. This phenomenon is followed by a " bounce" with re-birth of an exponentially expanding non-singular universe

Severity of Diverticulitis Does Not Influence Abdominal Complaints during Long-Term Follow-Up

Background: Diverticulitis can lead to localized or generalized peritonitis and consequently induce abdominal adhesion formation. If adhesions would lead to abdominal complaints, it might be expected that these would be more prominent after operation for perforated diverticulitis with peritonitis than after elective sigmoid resection. Aims: The primary outcome of the study was the incidence of abdominal complaints in the long-term after acute and elective surgery for diverticulitis. Methods: During the period 2003 through 2009, 269 patients were opera

Matrix metalloproteinase-9 in relation to patients with complications after colorectal surgery: a systematic review

Purpose: Anastomotic leakage (AL) is the most severe complication following colorectal resection and is associated with increased mortality. The main group of enzymes responsible for collagen and protein degradation in the extracellular matrix is matrix metalloproteinases. The literature is conflicting regarding anastomotic leakage and the degradation of extracellular collagen by matrix metalloproteinase-9 (MMP-9). In this systematic review, the

Rank two quadratic pairs and surface group representations

Let $X$ be a compact Riemann surface. A quadratic pair on $X$ consists of a holomorphic vector bundle with a quadratic form which takes values in fixed line bundle. We show that the moduli spaces of quadratic pairs of rank 2 are connected under some constraints on their topological invariants. As an application of our results we determine the connected components of the $\mathrm{SO}_0(2,3)$-character variety of $X$.Comment: 37 pages, 1 figur

Cytokines as early markers of colorectal anastomotic leakage: A systematic review and meta-analysis

Purpose. Colorectal anastomotic leakage (CAL) is one of the most severe complications after colorectal surgery. This meta-analysis evaluates whether systemic or peritoneal inflammatory cytokines may contribute to early detection of CAL. Methods. Systematic literature search was performed in the acknowledged medical databases according to the PRISMA guidelines to identify studies evaluating systemic and peritoneal levels of TNF, IL-1β, IL-6, and IL-10 for early detection of CAL. Means and standard deviations of systemic and peritoneal cytokine levels were extracted, respectively, for patients with and without CAL. The meta-analysis of the mean differences was carried out for each postoperative day using Review Manager. Results. Seven articles were included. The meta-analysis was performed with 5 articles evaluating peritoneal cytokine levels. Peritoneal levels of IL-6 were significantly higher in patients with CAL compare

Curvature Inspired Cosmological Scenario

Using modified gravity with non-linear terms of curvature, $R^2$ and $R^{(r +2)}$ (with $r$ being the positive real number and $R$ being the scalar curvature), cosmological scenario,beginning at the Planck scale, is obtained. Here, a unified picture of cosmology is obtained from $f(R)-$ gravity. In this scenario, universe begins with power-law inflation, followed by deceleration and acceleration in the late universe as well as possible collapse of the universe in future. It is different from $f(R)-$ dark energy models with non-linear curvature terms assumed as dark energy. Here, dark energy terms are induced by linear as well as non-linear terms of curvature in Friedmann equation being derived from modified gravity.It is also interesting to see that, in this model, dark radiation and dark matter terms emerge spontaneously from the gravitational sector. It is found that dark energy, obtained here, behaves as quintessence in the early universe and phantom in the late universe. Moreover, analogous to brane-tension in brane-gravity inspired Friedmann equation, a tension term $\lambda$ arises here being called as cosmic tension. It is found that, in the late universe, Friedmann equation (obtained here) contains a term $- \rho^2/2\lambda$ ($\rho$ being the phantom energy density) analogous to a similar term in Friedmann equation with loop quantum effects, if $\lambda > 0$ and brane-gravity correction when $\lambda < 0.$Comment: 19 Pages. To appear in Int. J. Thro. Phy