Laparoscopic repair of very large hiatus hernia with sutures versus absorbable mesh versus nonabsorbable mesh a randomized controlled trial

Author version made available in accordance with pubilsher policy. 12 month embargo applies from the date of publication (1 Feb 2015).Objective: Determine whether absorbable or non-absorbable mesh in repair of large hiatus hernias reduces the risk of recurrence, compared to suture repair. Summary Background Data: Repair of large hiatus hernia is associated with radiological recurrence rates of up to 30%, and to improve outcomes mesh repair has been recommended. Previous trials have shown less short term recurrence with mesh, but adverse outcomes limit mesh use. Methods: Multicentre prospective double blind randomized controlled trial of 3 methods of repair; sutures vs. absorbable mesh vs. non-absorbable mesh. Primary outcome - hernia recurrence assessed by barium meal X-ray and endoscopy at 6 months. Secondary outcomes - clinical symptom scores at 1, 3, 6 and 12 months. Results: 126 patients enrolled - 43 sutures, 41 absorbable mesh and 42 non-absorbable mesh. 96.0% were followed to 12 months, with objective follow-up data in 92.9%. A recurrent hernia (any size) was identified in 23.1% following suture repair, 30.8% - absorbable mesh, and 12.8% - non-absorbable mesh (p=0.161). Clinical outcomes were similar, except less heartburn at 3 & 6 months and less bloating at 12 months with non-absorbable mesh, and more heartburn at 3 months, odynophagia at 1 month, nausea at 3 & 12 months, wheezing at 6 months, and inability to belch at 12 months following absorbable mesh. The magnitude of the clinical differences were small. Conclusions: No significant differences were seen for recurrent hiatus hernia, and the clinical differences were unlikely to be clinically significant. Overall outcomes following sutured repair were similar to mesh repair

Pre-therapy mRNA expression of TNF is associated with regimen-related gastrointestinal toxicity in patients with esophageal cancer: a pilot study

Author version made available following 12 month embargo from date of publication (27 March 2015) in accordance with publisher copyright policy.Purpose Esophageal cancer has a high mortality rate, and its multimodality treatment is often associated with significant rates of severe toxicity. Effort is needed to uncover ways to maximize effectiveness of therapy through identification of predictive markers of response and toxicity. As such, the aim of this study was to identify genes predictive of chemoradiotherapy-induced gastrointestinal toxicity using an immune pathway-targeted approach. Methods Adults with esophageal cancer treated with chemotherapy consisting of 5-fluorouracil and cisplatin and 45–50 Gy radiation were recruited to the study. Pre-therapy-collected whole blood was analyzed for relative expression of immune genes using real-time polymerase chain reaction (RT-PCR). Gene expression was compared between patients who experienced severe regimen-related gastrointestinal toxicity vs. those experiencing mild to moderate toxicity. Results Blood from 31 patients were analyzed by RT-PCR. Out of 84 immune genes investigated, TNF was significantly elevated (2.05-fold, p = 0.025) in the toxic group (n = 12) compared to the non-toxic group (n = 19). Nausea and vomiting was the most commonly documented severe toxicity. No associations between toxicity and response, age, sex, histology, or treatment were evident. Conclusions This study supports evidence of TNF as a predictive biomarker in regimen-related gastrointestinal toxicity. Confirming these findings in a larger cohort is warranted

The 2020 photovoltaic technologies roadmap

Over the past decade, the global cumulative installed photovoltaic (PV) capacity has grown exponentially, reaching 591 GW in 2019. Rapid progress was driven in large part by improvements in solar cell and module efficiencies, reduction in manufacturing costs and the realization of levelized costs of electricity that are now generally less than other energy sources and approaching similar costs with storage included. Given this success, it is a particularly fitting time to assess the state of the photovoltaics field and the technology milestones that must be achieved to maximize future impact and forward momentum. This roadmap outlines the critical areas of development in all of the major PV conversion technologies, advances needed to enable terawatt-scale PV installation, and cross-cutting topics on reliability, characterization, and applications. Each perspective provides a status update, summarizes the limiting immediate and long-term technical challenges and highlights breakthroughs that are needed to address them. In total, this roadmap is intended to guide researchers, funding agencies and industry in identifying the areas of development that will have the most impact on PV technology in the upcoming years

Examining the relation between visual imagery and spatial ability tests

Research evidence indicates that self-report imagery ability is psychometrically distinct from objective, spatial test measures. One hypothesis put forward in the literature to explain this finding is that the nature of the stimulus is important. The aim of this paper was to examine the relationship between spatial abilities and measures of visual imagery obtained using different types of stimulus material. The main finding was that imagery tasks that required the mental synthesis and/or transformation of visual forms such as alphanumeric characters and simple geometric shapes correlated strongly with tests of spatial ability. In contrast, images of familiar items retrieved from long-term memory did not correlate with spatial test performance. It is argued that tasks that better control the stimuli imagined and the standards used to rate the quality of the image provide more objective measures of imagery ability. The implications of these findings are discussed

Regata del XX Settembre, ovvero il rinnovarsi delle tradizioni virili veneziane a fine XIX secolo

The Emergency Triage Education Kit ( ETEK ) was published in 2007. To date, the impact of ETEK has not been measured. The purpose of this study was to measure the effectiveness of ETEK on paediatric triage

Death due to Pulmonary Embolism and Pulmonary Hypertension in Klippel Trenaunay Syndrome.

Death due to Pulmonary Embolism and Pulmonary Hypertension in Klippel Trenaunay Syndrome. Klippel Trenaunay Syndrome (KTS) is a congenital disorder characterized by bony and soft tissue hypertrophy, capillary malformation, and varicosities (1). This syndrome has several complications, such as sepsis, hypercoagulability, rectal and bladder bleeding, venous thrombosis, and pulmonary embolism. Massive haemorrhage due to the rupture of malformed leg vessels has been reported as a cause of death. We present a case of KTS where an adult Caucasian male died suddenly at home. Clinically, the decedent had chronic pain and warmth in both legs, port wine stain, a longer and hypertrophied left leg, vascular malformation, big toes, and swollen soft tissues. Autopsy revealed did not reveal cardiomegaly or intrusive coronary artery disease. A ropy, granular, organized, and formed anti-mortem blood clot is observed in the pulmonary trunk, its branches, and in the lungs. He had an abnormal structure of the feet, as well as varicose veins and swelling of the legs. Grossly, the left calf circumference is greater than the right calf circumference, varicosity of the left lower extremity, bony and soft tissue hypertrophy, especially the lower left extremity, swollen and large toes, and cerebral swelling. Microscopic finding of the lungs includes thickened pulmonary interstitium with congestion and oedema; Pulmonary arterioles showed hypertrophied muscular layers with numerous thrombi of different ages, ranging from recent to remote with the complete organization of some vessels; trichrome stains confirmed the presence of recanalization and some plexiform lesions. There is a thick muscular wall, organized thrombotic material, intimal fibrosis, and artery recanalisation

Quantitative real-time PCR and fluorescence in situ hybridization approaches for enumerating Brevundimonas diminuta in drinking water

Brevundimonas diminuta is a small Gram-negative bacterium used for validation of membranes and filters used in the pharmaceutical and drinking water treatment industries. Current assays are time consuming, nonselective, and may be subject to interference by competing indigenous microorganisms. The focus of this study is to develop rapid and specific enumeration methodologies for B. diminuta. Quantitative real-time polymerase chain reaction (qPCR) and fluorescence in situ hybridization (FISH) assays were developed based on the gyrB (1,166 bp) and rpoD (829 bp) gene sequences of B. diminuta ATCC 19146. Species-specific primers and probes were designed, and a 100-200 bp segment of each gene was targeted in the qPCR studies. For both the qPCR and FISH assays, an internal 25 bp sequence was selected for use as a TaqMan probe (labeled with 6-FAM and a Black Hole Quencher). Probe specificity studies, conducted against Gram-negative and Gram-positive reference strains as well as environmental strains, revealed high specificity of the primer/probe pairs to B. diminuta. Sensitivities of the qPCR reactions using purified genomic DNA from B. diminuta were determined to be 0.89 pg for rpoD and 8.9 pg for gyrB. The feasibility of using whole-cell B. diminuta suspensions directly with the rpoD qPCR protocol was also evaluated. The greatest sensitivity observed for B. diminuta was 1 × 103 colony forming units (CFU) per mL when tryptic soy broth was used as the growth medium. When compared with direct microscopic enumeration using a 5†6-FAM FISH probe, traditional plating methods showed significant underestimation of B. diminuta concentration (P = 0.01) when this organism was cultivated in saline lactose broth. The results of this investigation demonstrate that qPCR and FISH are effective methods for rapid ( \u3c 4 h) enumeration of B. diminuta and may be viable alternatives to plating when validating drinking water filtration systems. © 2010 Society for Industrial Microbiology

Clinical care of children and adolescents with COVID-19: recommendations from the National COVID-19 Clinical Evidence Taskforce

INTRODUCTION: The epidemiology and clinical manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are different in children and adolescents compared with adults. Although coronavirus disease 2019 (COVID-19) appears to be less common in children, with milder disease overall, severe complications may occur, including paediatric inflammatory multisystem syndrome (PIMS-TS). Recognising the distinct needs of this population, the National COVID-19 Clinical Evidence Taskforce formed a Paediatric and Adolescent Care Panel to provide living guidelines for Australian clinicians to manage children and adolescents with COVID-19 and COVID-19 complications. Living guidelines mean that these evidence-based recommendations are updated in near real time to give reliable, contemporaneous advice to Australian clinicians providing paediatric care. MAIN RECOMMENDATIONS: To date, the Taskforce has made 20 specific recommendations for children and adolescents, including definitions of disease severity, recommendations for therapy, respiratory support, and venous thromboembolism prophylaxis for COVID-19 and for the management of PIMS-TS. CHANGES IN MANAGEMENT AS A RESULT OF THE GUIDELINES: The Taskforce currently recommends corticosteroids as first line treatment for acute COVID-19 in children and adolescents who require oxygen. Tocilizumab could be considered, and remdesivir should not be administered routinely in this population. Non-invasive ventilation or high flow nasal cannulae should be considered in children and adolescents with hypoxaemia or respiratory distress unresponsive to low flow oxygen if appropriate infection control measures can be used. Children and adolescents with PIMS-TS should be managed by a multidisciplinary team. Intravenous immunoglobulin and corticosteroids, with concomitant aspirin and thromboprophylaxis, should be considered for the treatment of PIMS-TS. The latest updates and full recommendations are available at www.covid19evidence.net.au