Treatment of rectal war wounds

Treatment strategies for penetrating rectal injuries (PRI) in civilian settings are still not uniformly agreed, in part since high-energy transfer PRI, such as is frequently seen in military settings, are not taken into account. Here, we describe three cases of PRI, treated in a deployed combat environment, and outline the management strategies successfully employed. We also discuss the literature regarding PRI management. Where there is a major soft tissue component, repetitive debridement and vacuum therapy is useful. A loop or end colostomy should be used, depending on the degree of damage to the anal sphincter complex

Understanding risk factors in cardiac rehabilitation patients with random forests and decision trees

Cardiac rehabilitation is a well-recognised non-pharmacological intervention recommended for the prevention of cardiovascular disease. Numerous studies have produced large amounts of data to examine the above aspects in patient groups. In this paper, datasets collected for over a 10 year period by one Australian hospital are analysed using decision trees to derive prediction rules for the outcome of phase II cardiac rehabilitation. Analysis includes prediction of the outcome of the cardiac rehabilitation program in terms of three groups of cardiovascular risk factors: physiological, psychosocial and performance risk factors. Random forests are used for feature selection to make the models compact and interpretable. Balanced sampling is used to deal with heavily imbalanced class distribution. Experimental results show that the outcome of phase II cardiac rehabilitation in terms of physiological, psychosocial and performance risk factor can be predicted based on initial readings of cholesterol level and hypertension, level achieved in six minute walk test, and Hospital Anxiety and Depression Score (HADS) anxiety score and HADS depression score respectively. This will allow for identifying high risk patient groups and developing personalised cardiac rehabilitation programs for those patients to increase their chances of success and minimize their risk of failure. © 2011, Australian Computer Society, Inc

Topical immunotherapy of severe alopecia areata with diphenylcyclopropenone (DPCP): experience in an Iranian population

BACKGROUND: Highly variable results of topical diphenylcyclopropenone (DPCP) in the treatment of alopecia areata have been reported so far. The purposes of the present study were to evaluate the efficacy and tolerability of DPCP treatment in severe alopecia areata. METHODS: Twenty-eight patients (16 female and 12 male, 10–35 years old, mean age 25 years) with extensive alopecia areata were enrolled in an open-label clinical trial. After sensitization with 2% DPCP, progressively higher concentrations beginning at 0.001% were applied weekly for 6 months to one side of the scalp, after which, if terminal hair growth was noted, the entire scalp was then treated under the same weekly protocol. The maximum concentration of DPCP in acetone was 2%. RESULTS: Twenty-seven of 28 patients completed therapy. The overall response rate was 81.5% (22/27), complete remission (90%-100% terminal hair re-growth) was obtained 22.2% (6/27) and partial remission (10%-90% terminal hair re-growth) in 59.3% (16/27). In all patients an eczematous reaction consisting of erythema, itching, and scaling at the site of application were observed. During therapy, other side effects including, occipital lymphadenopathy 40.7% (11/27), severe eczema/blister formation 40.7% (11/27), hyperpigmentation 18.5% (5/27) were observed, but no hypopigmentation, vitiligo, contact urticaria, and erythema multiforme-like reaction were seen in the patients. Nineteen of 27 (70.4%) patients had at least one side effect, other than eczematous reaction. Notably, partial recurrence was observed in 50.9% (13/22) of these patients after 6 to 12 months of follow-up. During the follow-up time the maintenance DPCP immunotherapy was continued. CONCLUSION: Topical DPCP treatment for alopecia areata is an effective therapy with a slightly high relapse rate during bilateral maintenance treatment. According to the author's knowledge this is the first experience with DPCP in Iran

Quantum Measurement and the Aharonov-Bohm Effect with Superposed Magnetic Fluxes

We consider the magnetic flux in a quantum mechanical superposition of two values and find that the Aharonov-Bohm effect interference pattern contains information about the nature of the superposition, allowing information about the state of the flux to be extracted without disturbance. The information is obtained without transfer of energy or momentum and by accumulated nonlocal interactions of the vector potential $\vec{A}$ with many charged particles forming the interference pattern, rather than with a single particle. We suggest an experimental test using already experimentally realized superposed currents in a superconducting ring and discuss broader implications.Comment: 6 pages, 4 figures; Changes from version 3: corrected typo (not present in versions 1 and 2) in Eq. 8; Changes from version 2: shortened abstract; added refs and material in Section IV. The final publication is available at: http://link.springer.com/article/10.1007/s11128-013-0652-

Phylogeography of the vector nematode Xiphinema index using mitochondrial and microsatellite markers highlights its Eastern origin closely linked to grapevine domestication.

The economic impact of the dagger nematode Xiphinema index is high in Western vineyards by transmitting the damaging Grapevine fanleaf virus. Our phylogeographical study based on mitochondrial sequences and microsatellite loci used more than 80 X. index representative samples collected from the Middle- and Near East, the Eastern-, Central- and Western Mediterranean, and the Western countries (Europe and the Americas). In this mainly (meiotic) parthenogenetic species, the mitochondrial marker CytB was first considered for comparison of X. index with the related amphimictic vector species X. diversicaudatum. Xiphinema index exhibits a significantly lower intraspecific molecular variability than X. diversicaudatum, in agreement with the respective reproduction modes of both nematodes. We then showed that CytB, concatenated with additional mitochondrial genes ATP6, ND4 and COI, display a robust phylogeographical pattern consisting in three clades grouping Eastern Mediterranean, Nearand Middle Eastern samples and a single clade grouping samples from Western Mediterranean, Europe and the Americas. The highest mitochondrial polymorphism is observed in one clade of Middle- and Near-East samples that overlaps the Transcaucasia and Southern Caspian Sea region from where grapevine has been presumably domesticated and that likely overlaps the nematode native area. East-to-west nematode dissemination appears to match that of its domesticated grapevine host during the Antiquity mainly by the Greeks and then the Romans. In Western Mediterranean, Europe and the Americas, two close and almost exclusive mitochondrial haplotypes were detected. The first haplotype, found in vineyards from the Southern Iberian Peninsula, Bordeaux and Provence, exhibits a high microsatellite polymorphism. By contrast, the second haplotype contains a single predominant microsatellite genotype surprisingly widespread in most Western countries. This is almost certainly due to its recent dispersal during the massive grapevine replants following the 19th century phylloxera crisis. Our data provide an improved knowledge of X. index diversity for future pest control strategies

Frozen section analysis of sentinel lymph nodes in patients with breast cancer does not impair the probability to detect lymph node metastases

Intra-operative frozen section analysis (FS analysis) of sentinel lymph nodes (SLNs) in patients with breast cancer can prevent a second operation for axillary lymph node dissection. In contrast, loss of tissue during FS analysis may impair the probability to detect lymph node metastases. To determine the effect of tissue loss on the probability of detection of metastases, dimensions and tissue loss resulting from intra-operative frozen section analysis were measured for 21 SLNs. In a mathematical model, the influence of tissue loss on the probability to detect metastases was calculated in relation to SLN size for various pathology protocols: an American, a widely used European, the extensive ‘Milan’ and the Dutch protocol. For median-sized SLN 11 × 8 × 5 mm (length × width × height), FS analysis led to a median loss of 680 μm (13.6%) of the height of the SLN. Irrespective of SLN size or used pathology protocol, the probability of detecting 2 mm metastases remained unchanged or even increased (0–12.8%). Moreover, the probability to detect 0.2 mm metastases increased for the majority of tested combinations of SLN size, tissue loss and used protocol. Only when combining maximum tissue loss and smallest SLN size in the Dutch protocol, or when applying the extensive Milan protocol on a median-sized SLN, the probability to detect 0.2 mm metastases decreased by 2.7% and 14.3%, respectively. Contrary to ‘common knowledge’, doing FS analysis of SLNs does not impair the probability to detect lymph node metastases

The role of cryptotephra in refining the chronology of Late Pleistocene human evolution and cultural change in North Africa

© 2014.Sites in North Africa hold key information for dating the presence of Homo sapiens and the distribution of Middle Stone Age (MSA), Middle Palaeolithic (MP) and Later Stone Age (LSA) cultural activity in the Late Pleistocene. Here we present new and review recently published tephrochronological evidence for five cave sites in North Africa with long MSA/MP and LSA cultural sequences. Four tephra horizons have been identified at the Haua Fteah (Cyrenaica, Libya). They include cryptotephra evidence for the Campanian Ignimbrite (CI) eruption dating to ~39 ka that allows correlation with other Palaeolithic sequences in the eastern Mediterranean and as far north as Russia. Cryptotephra have also been recorded from the Moroccan sites of Taforalt, Rhafas and Dar es-Soltane 1. At Taforalt the geochemical composition suggests a provenance in the Azores, while examples from Sodmein (Egypt) appear to derive from central Anatolia and another unknown source. In these latter examples chemical compositional data from relevant proximal volcanic centres is currently lacking so the identification of tephra in layers of known age and cultural association provides the first reliable age determinations for distal volcanic events and their geographical extent. The future potential for tephrochronological research in North Africa is also discussed

Double quantum dot with integrated charge sensor based on Ge/Si heterostructure nanowires

Coupled electron spins in semiconductor double quantum dots hold promise as the basis for solid-state qubits. To date, most experiments have used III-V materials, in which coherence is limited by hyperfine interactions. Ge/Si heterostructure nanowires seem ideally suited to overcome this limitation: the predominance of spin-zero nuclei suppresses the hyperfine interaction and chemical synthesis creates a clean and defect-free system with highly controllable properties. Here we present a top gate-defined double quantum dot based on Ge/Si heterostructure nanowires with fully tunable coupling between the dots and to the leads. We also demonstrate a novel approach to charge sensing in a one-dimensional nanostructure by capacitively coupling the double dot to a single dot on an adjacent nanowire. The double quantum dot and integrated charge sensor serve as an essential building block required to form a solid-state spin qubit free of nuclear spin.Comment: Related work at http://marcuslab.harvard.edu and http://cmliris.harvard.ed

Trends in treatment and overall survival among patients with proximal esophageal cancer

BACKGROUND: The management of proximal esophageal cancer differs from that of tumors located in the mid and lower part of the esophagus due to the close vicinity of vital structures. Non-surgical treatment options like radiotherapy and definitive chemoradiation (CRT) have been implemented. The trends in (non-)surgical treatment and its impact on overall survival (OS) in patients with proximal esophageal cancer are unclear, related to its rare disease status. To optimize treatment strategies and counseling of patients with proximal esophageal cancer, it is therefore essential to gain more insight through real-life studies. AIM: To establish trends in treatment and OS in patients with proximal esophageal cancer. METHODS: In this population-based study, patients with proximal esophageal cancer diagnosed between 1989 and 2014 were identified in the Netherlands Cancer Registry. The proximal esophagus consists of the cervical esophagus and the upper thoracic section, extending to 24 cm from the incisors. Trends in radiotherapy, chemotherapy, and surgery, and OS were assessed. Analyses were stratified by presence of distant metastasis. Multivariable Cox proportional hazards regression analyses was performed to assess the effect of period of diagnosis on OS, adjusted for patient, tumor, and treatment characteristics. RESULTS: In total, 2783 patients were included. Over the study period, the use of radiotherapy, resection, and CRT in non-metastatic disease changed from 53%, 23%, and 1% in 1989-1994 to 21%, 9%, and 49% in 2010-2014, respectively. In metastatic disease, the use of chemotherapy and radiotherapy increased over time. Median OS of the total population increased from 7.3 mo [95% confidence interval (CI): 6.4-8.1] in 1989-1994 to 9.5 mo (95%CI: 8.1-10.8) in 2010-2014 (logrank P < 0.001). In non-metastatic disease, 5-year OS rates improved from 5% (95%CI: 3%-7%) in 1989-1994 to 13% (95%CI: 9%-17%) in 2010-2014 (logrank P < 0.001). Multivariable regression analysis demonstrated a significant treatment effect over time on survival. In metastatic disease, median OS was 3.8 mo (95%CI: 2.5-5.1) in 1989-1994, and 5.1 mo (95%CI: 4.3-5.9) in 2010-2014 (logrank P = 0.26). CONCLUSION: OS significantly improved in non-metastatic proximal esophageal cancer, likely to be associated with an increased use of CRT. Patterns in metastatic disease did not change significantly over time