High resection rates of colorectal liver metastases after standardized follow-up and multimodal management:an outcome study within the COLOFOL trial

Background: Outcome after colorectal liver metastases (CRLM) resection has improved over time, despite increased resection rates. Hence, it's crucial to identify all patients possible to treat with curative intent. The objectives of this study were to map recurrence pattern, treatment strategy and survival depending on treatment and follow-up strategy. Methods: In the COLOFOL-trial, patients with radically resected stage II-III colorectal cancer were randomized to high-frequency (6, 12, 18, 24 and 36 months; HF) or low-frequency (12 and 36 months; LF) follow-up. In this study, all CRLM within 5 years were identified and medical files scrutinized. Overall survival (OS) was analysed in uni- and multivariable analyses. Primary endpoint was 5-year OS. Results: Of 2442 patients, 235 (9.6%) developed metachronous CRLM of which 123 (52.3%) underwent treatment with curative intent, resulting in 5-year OS of 58%. Five-year OS for patients with CRLM was 43% after HF versus 24% after LF. The survival benefit was confirmed for HF 8 years from resection of the primary tumour, HR 0.63 (CI 0.46–0.85). Conclusion: A high proportion of metachronous CRLM was possible to treat with curative intent, yielding high survival rates. More intense follow-up after colorectal cancer resection might be of value in high-risk patients

Single-molecule strong coupling at room temperature in plasmonic nanocavities

Emitters placed in an optical cavity experience an environment that changes their coupling to light. In the weak-coupling regime light extraction is enhanced, but more profound effects emerge in the single-molecule strong-coupling regime where mixed light-matter states form [1,2] . Individual two-level emitters in such cavities become non-linear for single photons, forming key building blocks for quantum information systems as well as ultra-low power switches and lasers [3–6] . Such cavity quantum electrodynamics has until now been the preserve of low temperatures and complex fabrication, severely compromising their use [5,7,8] . Here, by scaling the cavity volume below 40 nm^3 and using host-guest chemistry to align 1-10 protectively-isolated methylene-blue molecules, we reach the strong-coupling regime at room temperature and in ambient conditions. Dispersion curves from >50 plasmonic nanocavities display characteristic anticrossings, with Rabi frequencies of 300 meV for 10 molecules decreasing to 90 meV for single molecules, matching quantitative models. Statistical analysis of vibrational spectroscopy time-series and dark-field scattering spectra provide evidence of single-molecule strong coupling. This dressing of molecules with light can modify photochemistry, opening up the exploration of complex natural processes such as photosynthesis [9] and pathways towards manipulation of chemical bonds [10].We acknowledge financial support from EPSRC grants EP/G060649/1 and EP/I012060/1, and ERC grant LINASS 320503. RC acknowledges support from the Dr. Manmohan Singh scholarship from St. John’s College. FB acknowledges support from the Winton Programme for the Physics of Sustainability. SJB acknowledges support from the European Commission for a Marie Curie Fellowship (NANOSPHERE, 658360).This is the author accepted manuscript. The final version is available from Nature Publishing Group via http://dx.doi.org/10.1038/nature17974

Single-molecule strong coupling at room temperature in plasmonic nanocavities.

Photon emitters placed in an optical cavity experience an environment that changes how they are coupled to the surrounding light field. In the weak-coupling regime, the extraction of light from the emitter is enhanced. But more profound effects emerge when single-emitter strong coupling occurs: mixed states are produced that are part light, part matter1, 2, forming building blocks for quantum information systems and for ultralow-power switches and lasers. Such cavity quantum electrodynamics has until now been the preserve of low temperatures and complicated fabrication methods, compromising its use. Here, by scaling the cavity volume to less than 40 cubic nanometres and using host–guest chemistry to align one to ten protectively isolated methylene-blue molecules, we reach the strong-coupling regime at room temperature and in ambient conditions. Dispersion curves from more than 50 such plasmonic nanocavities display characteristic light–matter mixing, with Rabi frequencies of 300 millielectronvolts for ten methylene-blue molecules, decreasing to 90 millielectronvolts for single molecules—matching quantitative models. Statistical analysis of vibrational spectroscopy time series and dark-field scattering spectra provides evidence of single-molecule strong coupling. This dressing of molecules with light can modify photochemistry, opening up the exploration of complex natural processes such as photosynthesis and the possibility of manipulating chemical bonds.We acknowledge financial support from EPSRC grants EP/G060649/1 and EP/I012060/1, and ERC grant LINASS 320503. RC acknowledges support from the Dr. Manmohan Singh scholarship from St. John’s College. FB acknowledges support from the Winton Programme for the Physics of Sustainability. SJB acknowledges support from the European Commission for a Marie Curie Fellowship (NANOSPHERE, 658360).This is the author accepted manuscript. The final version is available from Nature Publishing Group via http://dx.doi.org/10.1038/nature17974

Injectable living marrow stromal cell-based autologous tissue engineered heart valves: first experiences with a one-step intervention in primates

Aims A living heart valve with regeneration capacity based on autologous cells and minimally invasive implantation technology would represent a substantial improvement upon contemporary heart valve prostheses. This study investigates the feasibility of injectable, marrow stromal cell-based, autologous, living tissue engineered heart valves (TEHV) generated and implanted in a one-step intervention in non-human primates. Methods and results Trileaflet heart valves were fabricated from non-woven biodegradable synthetic composite scaffolds and integrated into self-expanding nitinol stents. During the same intervention autologous bone marrow-derived mononuclear cells were harvested, seeded onto the scaffold matrix, and implanted transapically as pulmonary valve replacements into non-human primates (n = 6). The transapical implantations were successful in all animals and the overall procedure time from cell harvest to TEHV implantation was 118 ± 17 min. In vivo functionality assessed by echocardiography revealed preserved valvular structures and adequate functionality up to 4 weeks post implantation. Substantial cellular remodelling and in-growth into the scaffold materials resulted in layered, endothelialized tissues as visualized by histology and immunohistochemistry. Biomechanical analysis showed non-linear stress-strain curves of the leaflets, indicating replacement of the initial biodegradable matrix by living tissue. Conclusion Here, we provide a novel concept demonstrating that heart valve tissue engineering based on a minimally invasive technique for both cell harvest and valve delivery as a one-step intervention is feasible in non-human primates. This innovative approach may overcome the limitations of contemporary surgical and interventional bioprosthetic heart valve prosthese

Theory and practice: bulk synthesis of C3B and its H2- and Li-storage capacity.

Previous theoretical studies of C3B have suggested that boron-doped graphite is a promising H2- and Li-storage material, with large maximum capacities. These characteristics could lead to exciting applications as a lightweight H2-storage material for automotive engines and as an anode in a new generation of batteries. However, for these applications to be realized a synthetic route to bulk C3B must be developed. Here we show the thermolysis of a single-source precursor (1,3-(BBr2)2C6H4) to produce graphitic C3B, thus allowing the characteristics of this elusive material to be tested for the first time. C3B was found to be compositionally uniform but turbostratically disordered. Contrary to theoretical expectations, the H2- and Li-storage capacities are lower than anticipated, results that can partially be explained by the disordered nature of the material. This work suggests that to model the properties of graphitic materials more realistically, the possibility of disorder must be considered.We thank the ERC (Advance Investigator awards for D.S.W., C.P.G.), the EPSRC (T.C.K., P.D.M., H.G., J.C.), and the Spanish Ministerio de Economia y Competitividad (under grants ENE2011-24-412 and IPT-2011-1553-420000). We thank John Bulmer for Raman spectroscopy and Keith Parmenter for glass blowing. We thank the Schlumberger Gould Research Centre for XPS analysis.This is the author accepted manuscript. The final version is available from Wiley via http://dx.doi.org/10.1002/anie.20141220

Global unmet needs in cardiac surgery

More than 6 billion people live outside industrialized countries and have insufficient access to cardiac surgery. Given the recently confirmed high prevailing mortality for rheumatic heart disease in many of these countries together with increasing numbers of patients needing interventions for lifestyle diseases due to an accelerating epidemiological transition, a significant need for cardiac surgery could be assumed. Yet, need estimates were largely based on extrapolated screening studies while true service levels remained unknown. A multi-author effort representing 16 high-, middle-, and low-income countries was undertaken to narrow the need assessment for cardiac surgery including rheumatic and lifestyle cardiac diseases as well as congenital heart disease on the basis of existing data deduction. Actual levels of cardiac surgery were determined in each of these countries on the basis of questionnaires, national databases, or annual reports of national societies. Need estimates range from 200 operations per million in low-income countries that are nonendemic for rheumatic heart disease to >1,000 operations per million in high-income countries representing the end of the epidemiological transition. Actually provided levels of cardiac surgery range from 0.5 per million in the assessed low- and lower-middle income countries (average 107 ± 113 per million; representing a population of 1.6 billion) to 500 in the upper-middle-income countries (average 270 ± 163 per million representing a population of 1.9 billion). By combining need estimates with the assessment of de facto provided levels of cardiac surgery, it emerged that a significant degree of underdelivery of often lifesaving open heart surgery does not only prevail in low-income countries but is also disturbingly high in middle-income countries

Sutures bridging nerve defects

A new and simple method for the repair of nerve defects, in which sutures alone are used to guide regeneration between the nerve endings, was developed. Bilateral seven to 17 mm rat sciatic nerve defects were bridged by continuous longitudinal sutures with or without different modifications, by conventional autologous nerve grafts or direct repair under tension as controls. Evaluation was performed from two to 12 weeks postoperatively with routine histology, immunocytochemistry, morphometry, tetanic force measurement and wet weight of the target muscle. I found that both resorbable and non-resorbable sutures supported the formation of a new nerve structure. The sutures appeared to act as an intrinsic framework for fibrin matrix formation which subsequently supported migration of Schwann cells, formation of vessels and axonal regeneration. Although no differences with respect to the regenerative outcome was observed between the two suture types, resorbable sutures were easier to work with. The new nerve structure formed along the sutures was well defined and compartmented. The distribution of a subtype of macrophages (ED2) indicated an importance of these cells for perineurium formation. The number of suture laps bridging a simple nerve defect had some influence on the regeneration process. Bifurcated nerve defects could also be reconstructed successfully by suture guidance. When the muscle bed adjacent to the nerve defect was traumatized, regeneration took place in the suture model, but in some respects in a less favourable way. Axonal counts and recovery of muscle force or weight using the suture model did not differ significantly from those of nerve grafts across seven or 10 mm defects or those of direct repair of a seven mm defect. Regeneration was enhanced when a short nerve segment - a “stepping stone” of Schwann cells – was threaded onto the sutures and centered in the gap. The sutures could be pretreated with Triiodothyronine, T3, as a growth promoting factor to be released during at least three weeks in vitro. In vivo, this release gave rise to an increased myelin area in the regenerating nerve structure. In conclusion, longitudinal sutures can be used to bridge peripheral nerve defects. The model may be of clinical value as a cheap and easily available alternative to nerve grafts or other conduits when dealing with limited nerve defects

Bridging short nerve defects by direct repair under tension, nerve grafts or longitudinal sutures.

Purpose: To compare the longitudinal suture model for bridging nerve defects with direct approximation under tension or with autologuos nerve grafting. Methods: Seven mm nerve defects in the rat sciatic nerve were repaired by either of these three methods. Evaluation was performed at twelve weeks by morphometry of the tibial nerve distal to the repair site and by weight of the gastrocnemius muscle, an indicator of target reinnervation. Results: The number of nerve fibers and myelin areas in the tibial nerve were similar for all repair methods as were the weight of the gastrocnemius muscle. Conclusions: Longitudinal sutures can be used to bridge short nerve defects and could be an alternative to nerve grafting