Monitoring the premalignant potential of Barrett's oesophagus'.

The landscape for patients with Barrett's oesophagus (BE) has changed significantly in the last decade. Research and new guidelines have helped gastroenterologists to better identify those patients with BE who are particularly at risk of developing oesophageal adenocarcinoma. In parallel, developments in endoscopic image enhancement technology and optical biopsy techniques have improved our ability to detect high-risk lesions. Once these lesions have been identified, the improvements in minimally invasive endoscopic therapies has meant that these patients can potentially be cured of early cancer and high-risk dysplastic lesions without the need for surgery, which still has a significant morbidity and mortality. The importance of reaching an accurate diagnosis of BE remains of paramount importance. More work is needed, however. The vast majority of those undergoing surveillance for their BE do not progress towards cancer and thus undergo a regular invasive procedure, which may impact on their psychological and physical well-being while incurring significant cost to the health service. New work that explores cheaper endoscopic or non-invasive ways to identify the at-risk individual provides exciting avenues for research. In future, the diagnosis and monitoring of patients with BE could move away from hospitals and into primary care

Supporting laparoscopic general surgery training with digital technology: The United Kingdom and Ireland paradigm

Surgical training in the UK and Ireland has faced challenges following the implementation of the European Working Time Directive and postgraduate training reform. The health services are undergoing a digital transformation; digital technology is remodelling the delivery of surgical care and surgical training. This review aims to critically evaluate key issues in laparoscopic general surgical training and the digital technology such as virtual and augmented reality, telementoring and automated workflow analysis and surgical skills assessment. We include pre-clinical, proof of concept research and commercial systems that are being developed to provide solutions. Digital surgical technology is evolving through interdisciplinary collaboration to provide widespread access to high-quality laparoscopic general surgery training and assessment. In the future this could lead to integrated, context-aware systems that support surgical teams in providing safer surgical care

Ultrasubwavelength ferroelectric leaky wave antenna in a planar substrate-superstrate configuration

The possibility of achieving directive fan-beam radiation with planar Fabry-Pérot cavity antennas constituted by an upper ferroelectric thin film and a lower ground plane having ultrasubwavelength thickness is studied by means of a simple transverse-equivalent-network approach and a cylindrical leakywave analysis, deriving simple design formulas. The performance of the proposed antenna is investigated in terms of power density radiated at broadside and directivity in the principal planes, pointing out the main limitations and tradeoffs associated with the reduced thickness

Cost-effectiveness analysis of endoscopic eradication therapy for treatment of high-grade dysplasia in Barrett's esophagus

AIM: The aim was to evaluate the cost-effectiveness of endoscopic eradication therapy (EET) with combined endoscopic mucosal resection and radiofrequency ablation for the treatment of high-grade dysplasia (HGD) arising in patients with Barrett's esophagus compared with endoscopic surveillance alone in the UK. MATERIALS & METHODS: The cost-effectiveness model consisted of a decision tree and modified Markov model. A lifetime time horizon was adopted with the perspective of the UK healthcare system. RESULTS: The base case analysis estimates that EET for the treatment of HGD is cost-effective at a GB£20,000 cost-effectiveness threshold compared with providing surveillance alone for HGD patients (incremental cost-effectiveness ratio: GB£1272). CONCLUSION: EET is likely to be a cost-effective treatment strategy compared with surveillance alone in patients with HGD arising in Barrett's esophagus in the UK

Learning curves and the influence of procedural volume for the treatment of dysplastic Barrett's esophagus

BACKGROUND AND AIMS: Endoscopic resections (ER) and radiofrequency ablation (RFA) are the established treatments for Barrett's-associated dysplasia and early esophageal neoplasia. The UK RFA Registry collects patient outcomes from 24 centers in the United Kingdom and Ireland treating patients. Learning curves for treatment of Barrett's dysplasia and the impact of center caseload on patient outcomes is still unknown. METHODS: We examined outcomes of 678 patients treated with RFA in the UK Registry using risk-adjusted CUSUM plots to identify change points in complete resolution of intestinal metaplasia (CR-IM) and complete resolution of dysplasia (CR-D) outcomes. We compared outcomes between those treated at high- (>100 enrolled patients), medium- (51-100) and low- (<50) volume centers. RESULTS: There was no association between center volume and CR-IM and CR-D rates, but there were lower recurrence rates in high-volume versus low-volume centers (Log Rank p=0.001).There was a significant change-point for outcomes at 12 cases for CR-D (reduction from 24.5% to 10.4%; P<0.001) and at 18 cases for CR-IM (30.7% to 18.6%; P<0.001) from RA-CUSUM curve analysis. CONCLUSION: Our data suggest that 18 supervised cases of endoscopic ablation may be required before competency in endoscopic treatment of Barrett's dysplasia can be achieved. The difference in outcomes between a high-volume and low-volume center does not support further centralization of services to only high-volume centers

Mode Bifurcation and Fold Points of Complex Dispersion Curves for the Metamaterial Goubau Line

In this paper the complex dispersion curves of the four lowest-order transverse magnetic modes of a dielectric Goubau line ($\epsilon>0, \mu>0$) are compared with those of a dispersive metamaterial Goubau line. The vastly different dispersion curve structure for the metamaterial Goubau line is characterized by unusual features such as mode bifurcation, complex fold points, both proper and improper complex modes, and merging of complex and real modes

Porcine-derived collagen peptides promote re-epithelialisation through activation of integrin signalling

\ua9 2024 The Authors. Wound Repair and Regeneration published by Wiley Periodicals LLC on behalf of The Wound Healing Society.Chronic non-healing cutaneous wounds represent a major burden to patients and healthcare providers worldwide, emphasising the continued unmet need for credible and efficacious therapeutic approaches for wound healing. We have recently shown the potential for collagen peptides to promote proliferation and migration during cutaneous wound healing. In the present study, we demonstrate that the application of porcine-derived collagen peptides significantly increases keratinocyte and dermal fibroblast expression of integrin α2β1 and activation of an extracellular signal-related kinase (ERK)-focal adhesion kinase (FAK) signalling cascade during wound closure in vitro. SiRNA-mediated knockdown of integrin β1 impaired porcine-derived collagen peptide-induced wound closure and activation of ERK-FAK signalling in keratinocytes but did not impair ERK or FAK signalling in dermal fibroblasts, implying the activation of differing downstream signalling pathways. Studies in ex vivo human 3D skin equivalents subjected to punch biopsy-induced wounding confirmed the ability of porcine-derived collagen peptides to promote wound closure by enhancing re-epithelialisation. Collectively, these data highlight the translational and clinical potential for porcine-derived collagen peptides as a viable therapeutic approach to promote re-epithelialisation of superficial cutaneous wounds

Winter pruning: Effect on root density, root distribution and root/canopy ratio in vitis vinifera cv. Pinot Gris

As in any other plant, the grapevine roots play a vital role in terms of anchorage, uptake of water and nutrients, as well as storage and production of chemicals. Their behaviour and development depend on various factors, namely rootstock genetics, soil physical and chemical features, and field agronomic practices. Canopy management, involving techniques such as defoliation and pruning, could greatly influence root growth. To date, most of the studies on grapevine winter pruning have focused on the effects on yield and quality of the grapes achievable through different pruning systems and techniques, while knowledge regarding root distribution, development, and growth in relation to winter pruning is still not completely understood. In this context, the purpose of our study was to investigate the effect of winter pruning on the root system of field-grown Vitis vinifera cv. Pinot Gris grafted onto rootstock SO4. We compared two pruning treatments (pruned-P and no pruned-NP) and analysed the effect on root distribution and density, the root index, and the root sugar reserve. Root data were analysed in relation to canopy growth and yield, to elucidate the effect of winter pruning on the root/yield ratio. Our data indicated that: (1) winter pruning stimulated the root growth and distribution; (2) canopy development was not negatively affected by this technique; (3) no pruned treatment produced less growth of the roots but a larger canopy. Information regarding both root growth and root canopy ratio is important as it gives us an understanding of the relationship between the aerial and subterranean parts of the plant, how they compete, and finally, offers us the possibility to ponder on the cultural practices

Analysis of metal oxide varistor arresters for protection of multiconductor transmission lines using unconditionally-stable Crank-Nicolson FDTD

Surge arresters may represent an efficient choice for limiting lightning surge effects, significantly reducing the outage rate of power lines. The present work firstly presents an efficient numerical approach suitable for insulation coordination studies based on an implicit Crank-Nicolson finite difference time domain method; then, the IEEE recommended surge arrester model is reviewed and implemented by means of a local implicit scheme, based on a set of non-linear equations, that are recast in a suitable form for efficient solution. The model is proven to ensure robustness and second-order accuracy. The implementation of the arrester model in the implicit Crank-Nicolson scheme represents the added value brought by the present study. Indeed, its preserved stability for larger time steps allows reducing running time by more than 60% compared to the well-known finite difference time domain method based on the explicit leap-frog scheme. The reduced computation time allows faster repeated solutions, which need to be looked for on assessing the lightning performance (randomly changing, parameters such as peak current, rise time, tail time, location of the vertical leader channel, phase conductor voltages, footing resistance, insulator strength, etc. would need to be changed thousands of times)

Ultrasubwavelength Ferroelectric Leaky Wave Antenna in a Planar Substrate-Superstrate Configuration

The possibility of achieving directive fan-beam radiation with planar Fabry-Pérot cavity antennas constituted by an upper ferroelectric thin film and a lower ground plane having ultrasubwavelength thickness is studied by means of a simple transverseequivalent-network approach and a cylindrical leakywave analysis, deriving simple design formulas. The performance of the proposed antenna is investigated in terms of power density radiated at broadside and directivity in the principal planes, pointing out the main limitations and tradeoffs associated with the reduced thickness