Optimizing endoscopic resection for challenging large non-pedunculated colorectal polyps

Endoscopic mucosal resection (EMR) has revolutionized the management of large (≥ 20mm) non-pedunculated colorectal polyps. However, there are still challenges in performing EMR. Our aim was to assess EMR outcomes for challenging LNPCPs using the Australian Colonic Endoscopic Resection (ACE) study, a prospective multicenter observational cohort. No difference in technical success or recurrence were identified between LNPCPs at the anorectal junction (ARJ-LNPCPs) and large non-pedunculated rectal polyps. No recurrence was identified at first surveillance colonoscopy (SC1; 0.0% vs. 25.0%; p=0.002) amongst 30 ARJ-LNPCPs treated by EMR with margin thermal ablation (EMR-T) vs. those that did not. Comparing a universal EMR algorithm (UEA) and a selective resection algorithm (SRA), significant differences in cancer after EMR (SRA 1 (1.0%) vs. UEA 35 (12.1%); p = 0.001), and curative oncologic resection (SRA 7 (33.3%) vs. UEA 2 (5.7%); p = 0.010) were identified. Significant differences in resection duration (35 minutes vs. 25 minutes; p<0.001) technical success (93.0% vs. 96.6%; p=0.026) and use of adjuvant modalities (46.2% vs. 7.6%; p<0.001), were identified between previously attempted LNPCPs (PA-LNPCPs) and naïve LNPCPs. Recurrence was not identified in 65 PA-LNPCPs which underwent EMR-T at SC1 vs. 9 (18.0%; p<0.001) which did not. Significant deep mural injury (S-DMI) occurred in 101 cases (2.7%) which underwent EMR. Successful defect closure was achieved in 98 (97.0%). No difference in technical success (94 (93.1%) vs. 3316 (91.7%) p = 0.62) or SC1 recurrence (12 (20.0%) vs. 363 (13.6%); p = 0.15) were identified between LNPCPs with and without S-DMI. Significant differences in sensitivity (90.9% vs. 52.7%), specificity (96.3% vs. 93.7%) and SMIC miss rate (0.6% vs. 5.9%) between flat and nodular LNPCPs were identified (all p < 0.027). Multiple logistic regression identified nodular morphology (OR 7.2; 95%CI 2.8-18.9) as a predictor of missed cancer

Channel Length Scaling of MoS2 MOSFETs

In this article, we investigate electrical transport properties in ultrathin body (UTB) MoS2 two-dimensional (2D) crystals with channel lengths ranging from 2 {\mu}m down to 50 nm. We compare the short channel behavior of sets of MOSFETs with various channel thickness, and reveal the superior immunity to short channel effects of MoS2 transistors. We observe no obvious short channel effects on the device with 100 nm channel length (Lch) fabricated on a 5 nm thick MoS2 2D crystal even when using 300 nm thick SiO2 as gate dielectric, and has a current on/off ratio up to ~109. We also observe the on-current saturation at short channel devices with continuous scaling due to the carrier velocity saturation. Also, we reveal the performance limit of short channel MoS2 transistors is dominated by the large contact resistance from the Schottky barrier between Ni and MoS2 interface, where a fully transparent contact is needed to achieve a high-performance short channel device.Comment: 22 pages, 6 figures; ACS Nano, ASAP, 201

Treatment Outcomes of Multidrug-Resistant Tuberculosis: A Systematic Review and Meta-Analysis

BACKGROUND:Treatment outcomes for multidrug-resistant Mycobacterium Tuberculosis (MDRTB) are generally poor compared to drug sensitive disease. We sought to estimate treatment outcomes and identify risk factors associated with poor outcomes in patients with MDRTB. METHODOLOGY/PRINCIPAL FINDINGS:We performed a systematic search (to December 2008) to identify trials describing outcomes of patients treated for MDRTB. We pooled appropriate data to estimate WHO-defined outcomes at the end of treatment and follow-up. Where appropriate, pooled covariates were analyzed to identify factors associated with worse outcomes. Among articles identified, 36 met our inclusion criteria, representing 31 treatment programmes from 21 countries. In a pooled analysis, 62% [95% CI 57-67] of patients had successful outcomes, while 13% [9]-[17] defaulted, 11% [9]-[13] died, and 2% [1]-[4] were transferred out. Factors associated with worse outcome included male gender 0.61 (OR for successful outcome) [0.46-0.82], alcohol abuse 0.49 [0.39-0.63], low BMI 0.41[0.23-0.72], smear positivity at diagnosis 0.53 [0.31-0.91], fluoroquinolone resistance 0.45 [0.22-0.91] and the presence of an XDR resistance pattern 0.57 [0.41-0.80]. Factors associated with successful outcome were surgical intervention 1.91 [1.44-2.53], no previous treatment 1.42 [1.05-1.94], and fluoroquinolone use 2.20 [1.19-4.09]. CONCLUSIONS/SIGNIFICANCE:We have identified several factors associated with poor outcomes where interventions may be targeted. In addition, we have identified high rates of default, which likely contributes to the development and spread of MDRTB

The role of vedolizumab in patients with moderate-to-severe Crohn’s disease and ulcerative colitis

Vedolizumab, an α4β7-integrin antagonist, is the first gut-selective monoclonal antibody that has been approved for the treatment of moderate-to-severe ulcerative colitis and Crohn’s disease in many countries in the world. However, questions still remain regarding its appropriate use and placement in current treatment algorithms. Therefore, we sought out to evaluate the existing literature on the use of vedolizumab in inflammatory bowel disease. From inception to 21 June 2015 we searched MEDLINE for phase III randomized control trials assessing the utility of vedolizumab in inflammatory bowel disease, of which three were identified. The GEMINI trials demonstrate that vedolizumab is an effective and safe treatment for patients suffering from moderate-to-severe ulcerative colitis (GEMINI I) and Crohn’s disease (GEMINI II and III). However, further studies are needed comparing its efficacy directly with anti-tumor necrosis factor therapies to allow for further delineation of current treatment algorithms as well as ensuring its long-term safety profile