Collateral donor artery physiology and the influence of a chronic total occlusion on fractional flow reserve

Background— The presence of a concomitant chronic total coronary occlusion (CTO) and a large collateral contribution might alter the fractional flow reserve (FFR) of an interrogated vessel, rendering the FFR unreliable at predicting ischemia should the CTO vessel be revascularized and potentially affecting the decision on optimal revascularization strategy. We tested the hypothesis that donor vessel FFR would significantly change after percutaneous coronary intervention of a concomitant CTO. Methods and Results— In consecutive patients undergoing percutaneous coronary intervention of a CTO, coronary pressure and flow velocity were measured at baseline and hyperemia in proximal and distal segments of both nontarget vessels, before and after percutaneous coronary intervention. Hemodynamics including FFR, absolute coronary flow, and the coronary flow velocity–pressure gradient relation were calculated. After successful percutaneous coronary intervention in 34 of 46 patients, FFR in the predominant donor vessel increased from 0.782 to 0.810 (difference, 0.028 [0.012 to 0.044]; P=0.001). Mean decrease in baseline donor vessel absolute flow adjusted for rate pressure product: 177.5 to 139.9 mL/min (difference −37.6 [−62.6 to −12.6]; P=0.005), mean decrease in hyperemic flow: 306.5 to 272.9 mL/min (difference, −33.5 [−58.7 to −8.3]; P=0.011). Change in predominant donor vessel FFR correlated with angiographic (%) diameter stenosis severity (r=0.44; P=0.009) and was strongly related to stenosis severity measured by the coronary flow velocity–pressure gradient relation (r=0.69; P<0.001). Conclusions— Recanalization of a CTO results in a modest increase in the FFR of the predominant collateral donor vessel associated with a reduction in coronary flow. A larger increase in FFR is associated with greater coronary stenosis severity

A regional multidisciplinary team intervention programme to improve colorectal cancer outcomes: study protocol for the Yorkshire Cancer Research Bowel Cancer Improvement Programme (YCR BCIP)

Introduction: Although colorectal cancer outcomes in England are improving, they remain poorer than many comparable countries. Yorkshire Cancer Research has, therefore, established a Bowel Cancer Improvement Programme (YCR BCIP) to improve colorectal cancer outcomes within Yorkshire and Humber, a region representative of the nation. It aims to do this by quantifying variation in practice, engaging with the colorectal multidisciplinary teams (MDTs) to understand this and developing educational interventions to minimise it and improve outcomes. Methods and analysis: Initially, routine health datasets will be used to quantify variation in the demographics, management and outcomes of patients across the Yorkshire and Humber region and results presented to MDTs. The YCR BCIP is seeking to supplement these existing data with patient-reported health-related quality of life information (patient-reported outcome measures, PROMs) and tissue sample analysis. Specialty groups (surgery, radiology, pathology, clinical oncology, medical oncology, clinical nurse specialists and anaesthetics) have been established to provide oversight and direction for their clinical area within the programme, to review data and analysis and to develop appropriate educational initiatives. Ethics and dissemination: The YCR BCIP is aiming to address the variation in practice to significantly improve colorectal cancer outcomes across the Yorkshire and Humber region. PROMs and tissue sample collection and analysis will help to capture the information required to fully assess care in the region. Engagement of the region’s MDTs with their data will lead to a range of educational initiatives, studies and clinical audits that aim to optimise practice across the region

A Sixteen Channel Peak Sensing ADC for Singles Spectra in the FERA Format

To read out multi-element small X-ray detectors for X-ray fluorescence application with synchrotron radiation one needs the capability to record multiple singles spectra for each detector element at high rates. We have developed a sixteen channel 11 bit peak sensing ADC in a CAMAC module. We use the FERA readout bus to place the data into a commercially available histogramming module developed to generate multiple histograms from FERA ADCs. The sixteen channels digitize shaped pulses from the detectors without external gating. The digitizing time is 8 {mu}sec, the peak acquisition time is {>=} 2 {mu}sec. The module contains a LiFO to permit block transfers in order to minimize dead times associated with the readout. There is a common CAMAC controlled analog threshold for noise suppression and a 16 bit mask to enable or disable individual ADCs. Differential non-linearity is less than +8% / -4%. A {gamma}-ray spectrum collected using this ADC is presented

Germanium Blocked Impurity Band (BIB) detectors

Information is given in viewgraph form. The advantages of the Si blocked impurity band (BIB) detector invented by M. D. Petroff and M. G. Stabelbroek are noted: smaller detection volume leading to a reduction of cosmic ray interference, extended wavelength response because of dopant wavefunction overlap, and photoconductive gain of unity. It is argued that the stated advantages of Si BIB detectors should be realizable for Ge BIB detectors. Information is given on detector development, subtrate choice and preparation, wafer polising, epitaxy, characterization of epi layers, and preliminary Ge BIB detector test results

Standardised reports with a template format are superior to free text reports: the case for rectal cancer reporting in clinical practice

Purpose: Rectal cancer staging with magnetic resonance imaging (MRI) allows accurate assessment and preoperative staging of rectal cancers. Therefore, complete MRI reports are vital to treatment planning. Significant variability may exist in their content and completeness. Template-style reporting can improve reporting standards, but its use is not widespread. Given the implications for treatment, we have evaluated current clinical practice amongst specialist gastrointestinal (GI) radiologists to measure the quality of rectal cancer staging MRI reports. Materials and methods: Sixteen United Kingdom (UK) colorectal cancer multi-disciplinary teams (CRC-MDTs) serving a population over 5 million were invited to submit up to 10 consecutive rectal cancer primary staging MRI reports from January 2016 for each radiologist participating in the CRC-MDT. Reports were compared to a reference standard based on recognised staging and prognostic factors influencing case management Results: Four hundred ten primary staging reports were submitted from 41 of 42 (97.6%) eligible radiologists. Three hundred sixty reports met the inclusion criteria, of these, 81 (22.5%) used a template. Template report usage significantly increased recording of key data points versus non-template reports for extra-mural venous invasion (EMVI) status (98.8% v 51.6%, p < 0.01) and circumferential resection margin (CRM) status (96.3% v 65.9%, p < 0.01). Local tumour stage (97.5% v 93.5%, NS) and nodal status (98.8% v 96.1%, NS) were reported and with similar frequency. Conclusion: Rectal cancer primary staging reports do not meet published standards. Template-style reports have significant increases in the inclusion of key tumour descriptors. This study provides further support for their use to improve reporting standards and outcomes in rectal cancer

Old Plants, New Tricks:Phenological Research Using Herbarium Specimens

The timing of phenological events, such as leaf-out and flowering, strongly influence plant success and their study is vital to understanding how plants will respond to climate change. Phenological research, however, is often limited by the temporal, geographic, or phylogenetic scope of available data. Hundreds of millions of plant specimens in herbaria worldwide offer a potential solution to this problem, especially as digitization efforts drastically improve access to collections. Herbarium specimens represent snapshots of phenological events and have been reliably used to characterize phenological responses to climate. We review the current state of herbarium-based phenological research, identify potential biases and limitations in the collection, digitization, and interpretation of specimen data, and discuss future opportunities for phenological investigations using herbarium specimens

Addressing the variation in adjuvant chemotherapy treatment for colorectal cancer: can a regional intervention promote national change?

Analysis of routine population‐based data has previously shown that patterns of surgical treatment for colorectal cancer can vary widely, but there is limited evidence available to determine if such variation is also seen in the use of chemotherapy. This study quantified variation in adjuvant chemotherapy across both England using cancer registry data and in more detail across the representative Yorkshire and Humber regions. Individuals with Stages II and III colorectal cancer who underwent major resection from 2014 to 2015 were identified. Rates of chemotherapy were calculated from the Systemic Anticancer Treatment database using multilevel logistic regression. Additionally, questionnaires addressing different clinical scenarios were sent to regional oncologists to investigate the treatment preferences of clinicians. The national adjusted chemotherapy treatment rate ranged from 2% to 46% (Stage II cancers), 19% to 81% (Stage III cancers), 24% to 75% (patients aged <70 years) and 5% to 46% (patients aged ≥70 years). Regionally, the rates of treatment and the proportions of treated patients receiving combination chemotherapy varied by stage (Stage II 4%‐26% and 0%‐55%, Stage III 48%‐71% and 40%‐84%) and by age (<70 years 35%‐68% and 49%‐91%; ≥70 years 15%‐39% and 6%‐75%). Questionnaire responses showed significant variations in opinions for high‐risk Stage II patients with both deficient and proficient mismatch repair tumours and Stage IIIB patients aged ≥70 years. Following a review of the evidence, open discussion in our region has enabled a consensus agreement on an algorithm for colorectal cancer that is intended to reduce variation in practice

Tubulin-binding dibenz[c,e]oxepines: Part 2 Structural variation and biological evaluation as tumour vasculature disrupting agents

5,7-Dihydro-3,9,10,11-tetramethoxybenz[c,e]oxepin-4-ol 1, prepared from a dibenzyl ether precursor via Pd-catalysed intramolecular direct arylation, possesses broad-spectrum in vitro cytotoxicity towards various tumour cell lines, and induces vascular shutdown, necrosis and growth delay in tumour xenografts in mice at sub-toxic doses. The biological properties of 1 and related compounds can be attributed to their ability to inhibit microtubule assembly at the micromolar level, by binding reversibly to the same site of the tubulin αβ-heterodimer as colchicine 2 and the allocolchinol, N-acetylcolchinol 4

Past and future evolution in the Thames Estuary

In order to manage estuaries effectively it is important to be able to predict how they are likely to change in the future, both to natural and anthropogenic forcing. This paper looks at historical morphological development of the Thames Estuary, taking into account the effect of human intervention and uses the ASMITA morphological model to predict the long term evolution of estuary into the future, assuming either historic rates of sea-level rise, or accelerated sea-level rise. The historical sediment budget for the Thames Estuary was examined and source and sink terms, including fluvial sediment supply and historical dredging rates were included in the ASMITA model. ASMITA predictions showed good overall agreement with the historical data highlighting the benefits of detailed historical review and the inclusion of anthropogenic effects in the model. Future ASMITA predictions for the period 2000 to 2100 suggest that, under both historical and accelerated sea level rise scenarios, the estuary will experience accretion but, for the accelerated sea level rise scenario, accretion will be at a slower rate than sea level rise. With accelerated sea-level rise, intertidal profiles were predicted to be up to 0.5m lower with respect to High Water