Tracking Down Duodenopancreatic Malignancy

Background Malignant tumours of the duodenum are rare and often difficult to diagnose. Due to the small clinical experience with duodenal malignancies their prognosis is unknown and resection is the treatment of choice

Design and fabrication of ridge waveguide-based nanobeam cavities for on-chip single-photon sources

We report on the design of nanohole/nanobeam cavities in ridge waveguides for on-chip, quantum-dot-based single-photon generation. Our design overcomes limitations of a low-refractive-index-contrast material platform in terms of emitter-mode coupling efficiency and yields an outcoupling efficiency of 0.73 to the output ridge waveguide. Importantly, this high coupling efficiency is combined with broadband operation of 9 nm full-width half-maximum. We provide an explicit design procedure for identifying the optimum geometrical parameters according to the developed design. Besides, we fabricate and optically characterize a proof-of-concept waveguide structure. The results of the microphotoluminescence measurements provide evidence for cavity-enhanced spontaneous emission from the quantum dot, thus supporting the potential of our design for on-chip single-photon sources applications

Microscopy of bacterial translocation during small bowel obstruction and ischemia in vivo – a new animal model

BACKGROUND: Existing animal models provide only indirect information about the pathogenesis of infections caused by indigenous gastrointestinal microflora and the kinetics of bacterial translocation. The aim of this study was to develop a novel animal model to assess bacterial translocation and intestinal barrier function in vivo. METHODS: In anaesthetized male Wistar rats, 0.5 ml of a suspension of green fluorescent protein-transfected E. coli was administered by intraluminal injection in a model of small bowel obstruction. Animals were randomly subjected to non-ischemic or ischemic bowel obstruction. Ischemia was induced by selective clamping of the terminal mesenteric vessels feeding the obstructed bowel loop. Time intervals necessary for translocation of E. coli into the submucosal stroma and the muscularis propria was assessed using intravital microscopy. RESULTS: Bacterial translocation into the submucosa and muscularis propria took a mean of 36 ± 8 min and 80 ± 10 min, respectively, in small bowel obstruction. Intestinal ischemia significantly accelerated bacterial translocation into the submucosa (11 ± 5 min, p < 0.0001) and muscularis (66 ± 7 min; p = 0.004). Green fluorescent protein-transfected E. coli were visible in frozen sections of small bowel, mesentery, liver and spleen taken two hours after E. coli administration. CONCLUSIONS: Intravital microscopy of fluorescent bacteria is a novel approach to study bacterial translocation in vivo. We have applied this technique to define minimal bacterial transit time as a functional parameter of intestinal barrier function

A comprehensive analysis of coherent rainfall patterns in China and potential drivers. Part II: intraseasonal variability

The causes of subseasonal precipitation variability in China are investigated using observations and reanalysis data for extended winter (November–April) and summer (May–October) seasons from 1982 to 2007. For each season, the three dominant regions of coherent intraseasonal variability are identified with Empirical Orthogonal Teleconnection (EOT) analysis. While previous studies have focused on particular causes for precipitation variability or on specific regions, here a comprehensive analysis is carried out with an objective method. Furthermore, the associated rainfall anomaly timeseries are tied to specific locations in China, which facilitates their interpretation. To understand the underlying processes associated with spatially coherent patterns of rainfall variability, fields from observations and reanalysis are regressed onto EOT timeseries. The three dominant patterns in winter together explain 43% of the total space–time variance and have their origins in midlatitude disturbances that appear two pentads in advance. Winter precipitation variability along the Yangtze River is associated with wave trains originating over the Atlantic and northern Europe, while precipitation variability in southeast China is connected to the Mediterranean storm track. In summer, all patterns have a strong relationship with the Boreal Summer Intraseasonal Oscillation and are modulated by the seasonal cycle of the East Asian summer monsoon. The wet and dry phases of the regional patterns can substantially modulate the frequency of daily rainfall across China. The discovered links between weather patterns, precursors, and effects on local and remote precipitation may provide a valuable basis for hydrological risk assessments and the evaluation of numerical weather prediction models

TeDia - A Telemedicine-Based Treatment Model for Inpatient and Interprofessional Diabetes Care

Introduction: The proportion of hospitalized patients with diabetes as a secondary diagnosis increases continuously. Therefore, we have developed a team-based interprofessional and telemedicine-based diabetes management system named TeDia (Telemedical Diabetology) and implemented it in an inpatient setting. The aim of the retrospective real-world study was to show the clinical impact of TeDia following its implementation. Material and methods: TeDia is characterized by an interpersonal and telemedicine-based exchange of hospital routine data between specially trained nurses (diabetes managers) and external diabetologists. It was implemented in three acute hospitals of the Dusseldorf Catholic Hospital Group in Dusseldorf, Germany. Clinical awareness of diabetes, diabetesrelated complications and diagnosis-related group (DRG)-based revenues were analyzed using ICD routine coding. Furthermore, the frequency of HbAlc determinations as well as hospitalization days were investigated. Results: Before (2010), during (2012) and after the implementation of TeDia (2014), the number of patients with ICD coding for diabetes, decompensated diabetes, diabetic neuropathy, diabetic nephropathy as well as complicated diabetes increased by +18%, +93%, +101%, +113% and +89%, respectively. Using the same DRG grouper, revenues increased by +53% (from 27 (2013) to 42 (2014) DRG points). Frequency of HbAlc determinations rose by +85%, whereas the time for an average length of stay decreased by -12% (-0, 91 days) in comparison to patients without diabetes. Conclusion: TeDia improved clinical awareness for diabetes and its complications. This new treatment model increased revenues and reduced hospital days indicating enhanced treatment quality. Our findings emphasize the necessity of novel technologies in inpatient settings for the improvement of efficacy, safety and efficiency of diabetes care

Volumetric Modulated Arc Therapy Improves Outcomes in Definitive Radiochemotherapy for Anal Cancer Whilst Reducing Acute Toxicities and Increasing Treatment Compliance

Background: Intensity-modulated radiotherapy (IMRT) is the standard of care in chemoradiotherapy (CRT) for anal cancer. Until now, only a limited number of studies have analyzed the results with VMAT (volumetric modulated arc therapy). We conducted a retrospective study on patients treated at our institution. Patients and Methods: We included patients who received curative CRT for anal cancer. We compared VMAT-treated and 3DCRT (3D conformal radiotherapy)-treated patients. We analyzed toxicities (acute: CTCAE criteria; late: LENT/SOMA criteria), treatment compliance, overall survival, cancer-specific survival (CSS), distant control (DC), and locoregional control. Results: A total of 149 patients (3DCRT: n = 87, VMAT: n = 62) were included. The median follow-up was longer in 3DCRT-treated patients (3DCRT: 61.3 months; VMAT: 39.1 months; p &lt; 0.05). VMAT-treated patients had more G3 tumors (3DCRT: 12/87 (13.8%); VMAT: 18/62 (29.0%), p &lt; 0.001). VMAT reduced acute toxicities ≥grade 3 (3DCRT: n = 48/87 (55.2%); VMAT: n = 11/62 (17.7%), p &lt; 0.001). VMAT improved treatment compliance (less interruptions/delays) (3DCRT: 37/87, 42.5%; VMAT: 4/62, 6.5%; p &lt; 0.001), provided a shorter median overall treatment time (3DCRT: 41 days; VMAT: 38 days; p = 0.02), and gave a higher median absolute 5-fluorouracil dose (3DCRT: 13,700 mg; VMAT: 14,400 mg; p = 0.001). Finally, we found improved CSS (p = 0.02; 3DCRT: 81.9% at 3 years; VMAT: 94.1% at 3 years) and DC (p = 0.01; 3DCRT: 89.4% at 3 years; VMAT: 100.0% at 3 years) with VMAT. Summary: Our study is the first to demonstrate improved treatment compliance and outcomes with VMAT for anal cancer. Previous studies have indicated that organs at risk sparing might be more improved with the use of VMAT vs. with conventional IMRT. Future studies should address whether these advantages lead to a further reduction in CRT-associated morbidity