Trainee participation during screening colonoscopy does not affect ADR at subsequent surveillance, but may result in early follow-up

Background and study aims: Training future endoscopists is essential to meet rising demands for screening and surveillance colonoscopies. Studies have shown conflicting results regarding the influence of trainees on adenoma detection rates (ADR). It is unclear whether trainee participation during screening adversely affects ADR at subsequent surveillance and whether it alters surveillance recommendations. Patients and methods: A retrospective analysis of average-risk screening colonoscopies and surveillance exams over a subsequent 10-year period was performed. The initial inclusion criteria were met by 5208 screening and 2285 surveillance exams. Patients with poor preparation were excluded. The final analysis included 7106 procedures, including 4922 screening colonoscopies and 2184 surveillance exams. Data were collected from pathology and endoscopy electronic databases. The primary outcome was the ADR with and without trainee participation. Surveillance recommendations were analyzed as a secondary outcome. Results: Trainees participated in 1131 (23 %) screening and in 232 (11 %) surveillance exams. ADR did not significantly differ ( P = 0.19) for screening exams with trainee participation (19.5 %) or those without (21.4 %). ADRs were higher at surveillance exams with (22.4 %) and without (27.5 %) trainee participation. ADR at surveillance was not adversely affected by trainee participation during the previous colonoscopy. Shorter surveillance intervals were given more frequently if trainees participated during the initial screening procedure ( P = 0.0001). Conclusions: ADR did not significantly differ in screening or surveillance colonoscopies with or without trainee participation. ADR at surveillance was not adversely affected by trainee participation during the previous screening exam. However, trainee participation may result in shorter surveillance recommendations

Is the reduced growth of the halophyte Suaeda maritima under hypoxia due to toxicity of iron or manganese?

For most plants, submergence in water is a rare occurrence, but for plants that grow on salt marshes flooding with seawater may be a twice-daily event. This is the case for plants of the halophyte Suaeda maritima, growing at low elevations on salt marshes. These plants are, however, smaller than those growing at higher elevations, where flooding is less frequent and the soil is better drained. We investigated whether the reduced growth brought about by flooding with saline water was a consequence of toxicity of manganese or iron. Seedlings of S. maritima were grown both in a sold medium (a mixture of salt-marsh mud and sand) that was either submerged twice a day or continuously flooded with half-strength seawater and in a hydroponic solution where the oxygen concentration was adjusted by bubbling with nitrogen or air. Hypoxia, reduced the growth of plants in both solid and liquid media and resuted in increases in manganese and iron in the shoots and roots. Experiments in culture solution showed that elevated levels of manganese were unlikely to be toxic, but that iron did reach toxic concentrations in flooded plants

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK

Abstract Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Conclusion Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions. </jats:sec

Distribution and Potential Uses of Halophytes within the Gulf Cooperation Council States

The continued growth in the human population of the world will generate an increased demand for food that will be hard to meet with existing agricultural systems, as an equivalent increase in agricultural land is not available. Predicted changes in the climate will likely exacerbate the situation by increasing sea levels and the salinisation of coastal areas. Although most of our crop plants are sensitive to salinity, salt-tolerant plants, halophytes, have evolved and offer a potential as crops that can yield in saline areas or areas irrigated with saline water. We searched the literature for halophytes, identified using the database eHALOPH, native to the countries of the Gulf Cooperation Council that could be developed as crops, with the aim of attracting the attention of plant breeders, agriculturists, farmers, and others in the region to the possible uses of halophytes. Halophytic species can be grown and irrigated with brackish water where good drainage is available and used for forage or fodder, to stabilise land, and to produce biomass for fuel. In the longer-term, the cultivation of horticultural crops and those grown for nutraceuticals or pharmaceuticals is feasible

Distribution and Potential Uses of Halophytes within the Gulf Cooperation Council States

The continued growth in the human population of the world will generate an increased demand for food that will be hard to meet with existing agricultural systems, as an equivalent increase in agricultural land is not available. Predicted changes in the climate will likely exacerbate the situation by increasing sea levels and the salinisation of coastal areas. Although most of our crop plants are sensitive to salinity, salt-tolerant plants, halophytes, have evolved and offer a potential as crops that can yield in saline areas or areas irrigated with saline water. We searched the literature for halophytes, identified using the database eHALOPH, native to the countries of the Gulf Cooperation Council that could be developed as crops, with the aim of attracting the attention of plant breeders, agriculturists, farmers, and others in the region to the possible uses of halophytes. Halophytic species can be grown and irrigated with brackish water where good drainage is available and used for forage or fodder, to stabilise land, and to produce biomass for fuel. In the longer-term, the cultivation of horticultural crops and those grown for nutraceuticals or pharmaceuticals is feasible

The role of lateral roots in bypass flow in rice (Oryza sativa L.)

Although an apoplastic pathway (the so-called bypass flow) is implicated in the uptake of Na+ by rice growing in saline conditions, the point of entry of this flow into roots remains to be elucidated. We investigated the role of lateral roots in bypass flow using the tracer trisodium-8-hydroxy-1,3,6-pyrenetrisulphonic acid (PTS) and the rice cv. IR36. PTS was identified in the vascular tissue of lateral roots using both epifluorescence microscopy and confocal laser scanning microscopy. Cryo-scanning electron microscopy and epifluorescence microscopy of sections stained with berberine-aniline blue revealed that the exodermis is absent in the lateral roots. We conclude that PTS can move freely through the cortical layers of lateral roots, enter the stele and be transported to the shoot via the transpiration stream

The effect of combined salinity and waterlogging on the halophyte Suaeda maritima: The role of antioxidants

Suaeda maritime is a halophytic plant and its habitat is salt marsh. In order to adapt to saline or waterlogged conditions, plants have evolved mechanisms that include antioxidant protection. However, the combined effect of salinity and waterlogging on antioxidants in S. maritime is unknown. The aim of this study was therefore to investigate the effect of saline-flooding on levels of glutathione and phenolic compounds (antioxidants) and the correlation between their concentration and activity in S. maritime shoots grown in their natural habitat and in a glasshouse. Shoots were collected from two different elevations (and so different degrees of flooding) of a salt marsh while other plants were grown in half strength seawater in the controlled conditions of a glasshouse for 8 weeks (drained and flooded). Shoot samples were used to measure dry weight, glutathione and its reduction state, malonyldialdehyde content (MDA), polyphenol content, superoxide anion and 2,2-diphenyl-1-picryl-hydrazyl-hydrate (DPPH) scavenging activity in the shoots of S. maritime. Growth of S. maritima was greater in plants growing on the high marsh than at a lower elevation and in drained medium as opposed to waterlogged conditions in the glasshouse. Waterlogging caused an increase in glutathione and its reduction state. The glutathione half-cell redox potential (E-GSSG/2GSH) was more negative in plant shoots grown under waterlogged conditions than in plants grown under normal conditions. Higher DPPH and superoxide anion scavenging activity was associated with high antioxidant concentrations (glutathione and polyphenols). Conclusions. Under saline-flooded conditions in the field and in the glasshouse, plants produced a higher concentration of antioxidants than under drained conditions. These result indicated that antioxidant molecules play an important role in S. maritima plants under combined salinity and waterlogging stress. (C) 2012 Elsevier B.V. All rights reserved

Designing Eight-port Antenna Array for Multi-Band MIMO Applications in 5G Smartphones

This article introduces a dual-functional low-profile compact multiple input multiple output (MIMO) antenna array for multi-band communication in 5G smartphones. The proposed eight elements of the antenna array form two different 4 ×4 MIMO systems. The first four elements are placed at the four mobile corners and operate in a single band of 3. 445– 3. 885 GHz for 5G n77 and n 78 applications. The other system, in which four antennas are positioned in the middle of the terminal board, supports two wide bands of 1 . 684– 2. 300 GHz and 4. 432 – 5. 638 for n 2, n 3, n 39, n 65, n 66, n 79 , and WLAN applications. The second iteration of a modified Peano-type fractal geometry served as the design foundation for the proposed antenna element. The system’s ground plane design is based on self-isolated and spatial diversity methods. The single-band MIMO system’s isolation is better than 23 dB. In the dual-band MIMO system that is based on self-isolation, isolation equals approximately 16 dB in the higher band and 10 dB in the lower band. To evaluate performance, radiation-related and total antenna efficiencies, scattering parameters and gains were investigated. Additionally, ECCs have been considered to evaluate MIMO performance. According to the results, such design constitutes a valuable option for MIMO applications in 5G smartphones