The Evolution of Minimally Invasive Techniques in Restoration of Colonic Continuity

Restoration of bowel continuity after Hartmann’s procedure is considered technically challenging and is associated with high morbidity and mortality. This is the main reason why restoration of intestinal continuity is often not attempted. Over the past decade, considerable international experience has gained on this topic with new minimally invasive techniques being developed. This review details the evolution of minimally invasive techniques in restoration of colonic continuity after Hartmann’s procedure. A comprehensive search of PubMed and Embase was done. Different restoration modalities were included. Eight studies, from six different countries, in which multiport laparoscopic restoration of continuity was compared to conventional open restoration of bowel continuity, were included. In the total of 254 patients, continuity was restored laparoscopically compared with 255 patients in which continuity was performed in open fashion. Restoration of bowel continuity via trephine access was also reported; three studies including 37 patients were included in this review. Single-port restoration of bowel continuity after Hartmann’s procedure is a natural evolution of multiport laparoscopy and trephine access. Six studies reporting on single-port reversal of Hartmann’s procedure were included with a total of 75 patients. Single-port access in combination with a transanal approach has also been reported; however, data are extremely limited as there is only one study in the published literature. Success of restoration of bowel continuity with less morbidity and mortality has been demonstrated throughout the evolution of the different surgical techniques. In this review advantages of different approaches for restoration of bowel continuity after Hartmann’s procedure are discussed. Furthermore, surgical techniques are described, pictorial guides are added for some techniques, and flowcharts are given for easy use during clinical decision-making

Die Macht des Wissens

Pramod Ranjan wirft einen Blick aus Indien auf die Coronakrise und das wissenschaftliche Verständnis von der Welt, das oft erwähnt, aber meist ignoriert wird, sowie die Frage, wem das nutzt. Die übertriebene Angst vor Covid-19 hat die menschliche Zivilisation und Kultur in Gefahr gebracht. Die Richtung, in die sich die Menschheit bewegte, brachte ihre eigenen Probleme mit sich, aber diese neue Krise hat es zwingend erforderlich gemacht, zu untersuchen, welchen Weg wir in Zukunft einschlagen sollten. Auch müssen wir näher darauf eingehen, was genau Wissenschaft ist und wie sehr wir uns auf sie verlassen können. Sind Wissenschaft und das Verständnis über die Wissenschaft dasselbe? Oder besteht ein fundamentaler Unterschied zwischen beiden? Es ist notwendig, die Absichten der Wissenschaft zu hinterfragen und ihnen zu misstrauen

Conserved currents for Kerr and orthogonality of quasinormal modes

We introduce a bilinear form for Weyl scalar perturbations of Kerr. The form is symmetric and conserved, and we show that, when combined with a suitable renormalization prescription involving complex r integration contours, quasinormal modes are orthogonal in the bilinear form for different (l, m, n). These properties are apparently not evident consequences of standard properties for the radial and angular solutions to the decoupled Teukolsky relations and rely on the Petrov type D character of Kerr and its t-$\phi$ reflection isometry. We show that quasinormal mode excitation coefficients are given precisely by the projection with respect to our bilinear form. These properties can make our bilinear form useful to set up a framework for nonlinear quasinormal mode coupling in Kerr. We also provide a general discussion on conserved local currents and their associated local symmetry operators for metric and Weyl perturbations, identifying a collection containing an increasing number of derivatives.Comment: 14+11 pages, 2 figures. minor changes to match version accepted to PR

How does Switzerland's health sector contribute to the economy?

Health matters. The health sector is an important and innovative industry, as well as a source of stable employment for many people. Health systems support active and productive populations, reduce inequities and poverty and promote social cohesion. A strong health system makes good economic sense and underpins the overall sustainable development agenda Countries around the world are grappling with the health, economic and fiscal implications of the COVID-19 pandemic. As they begin to recover from the crisis, difficult decisions will need to be made about how to allocate scarce resources. These snapshots share valuable evidence for policy-makers on how investing in health sectors and health systems helps to achieve national economic objectives

Towards a framework for harm prevention in web search

We introduce a framework aimed at the information science (IS), information retrieval (IR) and data science communities as well as behavioral and cognitive scientists and policy makers inside government and at corporations operating Web search platforms. The goal of this framework is to instigate collaborative discussion and research across these communities to address potential dangers searchers and society face in modern Web search. We provide an overview of the harms, such as poor health outcomes, and their possible causes, including searcher and system biases being tuned for maximum profit. Modifications to policy, additional evaluation metrics, a mixture of cognitive decision making tools and improvements to the IR system are the suggested pathways. Examples are provided of how the framework can be put into practice

Inhibition of fatty acid oxidation promotes macrophage control of Mycobacterium tuberculosis

Macrophage activation involves metabolic reprogramming to support antimicrobial cellular functions. How these metabolic shifts influence the outcome of infection by intracellular pathogens remains incompletely understood

Super-enhancer-based identification of a BATF3/IL-2R-module reveals vulnerabilities in anaplastic large cell lymphoma

Anaplastic large cell lymphoma (ALCL), an aggressive CD30-positive T-cell lymphoma, comprises systemic anaplastic lymphoma kinase (ALK)-positive, and ALK-negative, primary cutaneous and breast implant-associated ALCL. Prognosis of some ALCL subgroups is still unsatisfactory, and already in second line effective treatment options are lacking. To identify genes defining ALCL cell state and dependencies, we here characterize super-enhancer regions by genome-wide H3K27ac ChIP-seq. In addition to known ALCL key regulators, the AP-1-member BATF3 and IL-2 receptor (IL2R)-components are among the top hits. Specific and high-level IL2R expression in ALCL correlates with BATF3 expression. Confirming a regulatory link, IL-2R-expression decreases following BATF3 knockout, and BATF3 is recruited to IL2R regulatory regions. Functionally, IL-2, IL-15 and Neo-2/15, a hyper-stable IL-2/IL-15 mimic, accelerate ALCL growth and activate STAT1, STAT5 and ERK1/2. In line, strong IL-2Rα-expression in ALCL patients is linked to more aggressive clinical presentation. Finally, an IL-2Rα-targeting antibody-drug conjugate efficiently kills ALCL cells in vitro and in vivo. Our results highlight the importance of the BATF3/IL-2R-module for ALCL biology and identify IL-2Rα-targeting as a promising treatment strategy for ALCL