Arthritis in acute febrile neutrophilic dermatosis (Sweet's Syndrome)

Sir: Acute febrile neutrophilic dermatosis or Sweet's syndrome' is an uncommon condition characterised by fever, polymorphonuclear leucocytosis, painful erythematous cutaneous plaques, and a dense dermal infiltrate of neutrophils without vasculitis at the site of the skin lesions. Although many investigators suggest that acute febrile neutrophilic dermatosis is a hypersensitivity reaction,2 no defmitive cause is known. The role of the neutrophil as a cause or effect in this syndrome has not been clarified. Acute febrile neutrophilic dermatosis is histologically and clinically mimicked by several disorders, and the differential diagnosis with pyoderma gangrenosum3 and with some reactive erythemas such as erythema multiforme2 is usually difficult

Postoperative outcomes in oesophagectomy with trainee involvement

BACKGROUND: The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting. METHODS: Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups. RESULTS: Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005). CONCLUSION: Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery

Hybrid femtosecond/picosecond pure-rotational coherent anti-Stokes Raman scattering with chirped probe pulses

The influence of probe laser chirp on hybrid femtosecond/picosecond pure-rotational coherent anti-Stokes Raman scattering is studied theoretically and experimentally. Experiments of N2(hybrid fs/ps pure-rotational coherent anti-Stokes Raman scattering) are carried out using an in-house built second harmonic bandwidth compressor, results with different probe chirps of are reported. The experimental spectra are fitted with and without considering probe chirp. Including the chirp improves the fit to experimental spectra at all probe delays. The effect of probe pulse chirp is evaluated through a quantitative analysis of matching residuals