Colorectal Liver Metastases

The adenocarcinoma of the colon and rectum (CRC) affects more than 1.3 million patients each year, being the third most common malignancy in the world. Approximately, 30–50% of these patients will present with liver metastasis at the time of diagnosis or will develop metastasis later. The incidence of metastatic CRC (mCRC) is approximately 4.3% at 1 year, 8.7% at 2 years, 12% at 3 years, and 16.5% at 5 years after resection. Recently, the clinical outcome for patients with mCRC has improved, with a median overall survival (OS) for patients with mCRC is approximately 30 months, more than twice of that observed 20 years ago. The treatment approach for patients with colorectal liver metastases should be focused toward complete resection whenever possible, with both oncological and technical criteria being considered. Considering the fact that nearly 80% of patients with mCRC are not candidates for resection at diagnosis, initial treatment options include chemotherapy and locoregional therapies. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has emerged as modification on classic two-staged hepatectomy (TSH) with portal vein embolization. In experienced hepatobiliary centers and in well-selected patients, ALPPS can be performed with low morbidity and minimal mortality, resulting in good intermediate-term survival and excellent quality of life. Multidisciplinary tumor boards should critically scrutinize the best treatment options

Log-normal model for microbial survival in heat sterilization

Log-normal model for microbial survival in heat sterilizatio

A stochastic sterilization model

Stochastic sterilization mode

Pediatric Liver Transplantation

Liver transplantation (LT) has become standard management of pediatric liver diseases that lead to acute liver failure or can progress to end-stage liver disease (ESLD). Indications for LT in pediatric patients can be classified into cholestatic disorders, metabolic liver diseases causing liver cirrhosis, metabolic liver diseases without liver cirrhosis, acute liver failure, acute and chronic hepatitis, and liver tumors. The most common indication of PLT is biliary atresia. Generally, the patient is a child with biliary atresia with several prior surgical procedures, extremely malnourished, with stigmata of fat-soluble vitamin deficiency, bleeding diathesis, uncontrolled portal hypertension and massive ascites. Before the technique of liver splitting, pediatric patients were dependent on donors with similar age or size. Partial liver grafts can be obtained either by splitting a cadaveric donor organ or by living-donor liver donation. Living donor liver recipients have a shorter waiting time. The majority of centers employ a regime of\u27 triple therapy with prednisolone, mycophenolate and tacrolimus. LT in the pediatric setting is technically challenging due to the reduced size of the vasculature and biliary tree. Strategies for identification and mitigation of risk factors, prevention of technical complications, and protocols for early detection of vascular complications may reduce mortality, morbidity

From subduction to collision. a combined metamorphic, structural and geochronological study of polymetamorphic metasediments at the NE edge of the Lepontine dome (Swiss Central Alps)

This study analyses the tectono-metamorphic evolution of metasedimentary units belonging to the Valaisan and adjacent European domains at the north-eastern border of the Lepontine dome (Central Alps). The investigated area is characterized by a remarkable metamorphic gradient ranging from subduction-related HP/LT metamorphism in the NE to collision-related Barrovian overprint in the SW. Detailed structural fieldwork and petrological investigations including Raman spectroscopy of carbonaceous matter were carried out in order to reconstruct the tectono-metamorphic evolution on a larger scale. Furthermore, new 40Ar/39Ar dating of white mica and biotite reveal the timing of both subductionrelated high-pressure metamorphism and collision-related Barrovian overprint. The combination of all these investigations allows for deciphering a complete P-T-d-t path (pressure, temperature, deformation and time) of an area that occupies a key position in the Alpine orogenic belt for understanding the transition from subduction to collision. This study documents for the first time that relics of Fe-Mg carpholite indicating blueschist facies conditions occur also within metasedimentary units that are part of the north-eastern Lepontine dome where, so far, exclusively Barrovian assemblages were found. They occur in metasediments from both the Valaisan domain (Grava and Tomül nappes) and parts of the adjacent European domain (Peiden slices and Piz Terri-Lunschania unit). These high-pressure units were subsequently overprinted by a thermal event, as is documented by the growth of new minerals typical for Barrovian metamorphism. The investigated metasediments provide clear evidence for a bimodal P-T path in the north-eastern Lepontine dome characterized by the following polyphase metamorphic evolution: (1) Subductionrelated syn-D1 (Safien phase) HP/LT metamorphism under blueschist facies conditions (350-400 °C and 1.2-1.4 GPa) was established at 42-40 Ma, as revealed by 40Ar/39Ar dating of white mica associated with Fe-Mg carpholite; the early high-pressure event was followed by “cold” isothermal (or cooling) decompression during D2 nappe-stacking (Ferrera phase) for which an age of 36-33 Ma is inferred based on 40 Ar/39Ar dating of white mica replacing Fe-Mg carpholite. (2) Early collision-related greenschist facies overprint (350-425 °C) post-dating substantial decompression and associated D2 deformation was established at 32-29 Ma and affected both HP and LP metasediments. This metamorphic event clearly predates D3 deformation (Domleschg phase, ~25 Ma) as is evidenced by folded isotemperature contours. (3) Collision-related Barrovian overprint (500-590 °C and 0.5-0.8 GPa) represents a second and considerably younger (post 20 Ma) “isobaric” heating pulse only preserved in the SW part of the investigated area. Hence amphibolite facies metamorphism representing the mature stage of a colliding orogen is clearly separated by D2 and D3 deformations, as well as by an intervening greenschist facies event, from the D1 high-pressure stage. Amphibolite facies overprint occurred before and/or during the initial stages of D4 (Chièra phase), representing a second nappe-refolding event. This investigation revealed a significant time gap in the order of some 20 Ma between subductionrelated HP/LT metamorphism and collision-related MP/MT Barrovian overprint. This supports the notion of a polymetamorphic evolution associated with a bimodal P-T path. The results of this study argue that heat release from radioactive decay of vast amounts of accreted continental-derived basement nappes may play an important role in contributing much to heat production needed for amphibolite facies Barrow-type overprint. Based on field evidence, we conclude that heat transfer in the north-eastern Lepontine was essentially conductive during the latest stages of the thermal evolution

Simulating Dielectric Barrier Plasma Actuators with Varying Geometries

The idea of Ionic Wind Propulsion has long been a topic of research for whether or not it can be used as a practical power source for flight. MIT researchers proved in 2018 that a plane with zero moving parts powered by Ionic Wind Propulsion was possible, and sustained flight could work with an internal power supply. However, due to the thin wire electrodes required to generate the ion cloud that made such propulsion possible, large amounts of drag rendered the plane extremely inefficient and impractical. Dielectric Barrier Discharge Devices (DBDs) are being investigated as to whether they can serve as a more aerodynamically efficient replacement to the wire electrodes, as they can be shaped around the wing, and multiple geometries are being tested in order to find the most efficient one for plasma generation. As physically building and testing the DBDs takes time, COMSOL Multiphysics software was used to simulate the electric field of the DBDs to see if it could serve as a quicker method to test the DBD geometries. The results from COMSOL supported the initial findings from physically testing the DBDs. In addition, multiple geometries of DBDs were tested in order to see which one could generate the strongest electric field, and thus prove more efficient for plasma actuation. These results also showed the relationship between DBD geometry and strength of electric field, providing useful data for how best to design DBDs going forward

Simulating Dielectric Barrier Plasma Actuators with Varying Geometries

The idea of Ionic Wind Propulsion has long been a topic of research for whether or not it can be used as a practical power source for flight. MIT researchers proved in 2018 that a plane with zero moving parts powered by Ionic Wind Propulsion was possible, and sustained flight could work with an internal power supply. However, due to the thin wire electrodes required to generate the ion cloud that made such propulsion possible, large amounts of drag rendered the plane extremely inefficient and impractical. Dielectric Barrier Discharge Devices (DBDs) are being investigated as to whether they can serve as a more aerodynamically efficient replacement to the wire electrodes, as they can be shaped around the wing, and multiple geometries are being tested in order to find the most efficient one for plasma generation. As physically building and testing the DBDs takes time, COMSOL Multiphysics software was used to simulate the electric field of the DBDs to see if it could serve as a quicker method to test the DBD geometries. The results from COMSOL supported the initial findings from physically testing the DBDs. In addition, multiple geometries of DBDs were tested in order to see which one could generate the strongest electric field, and thus prove more efficient for plasma actuation. These results also showed the relationship between DBD geometry and strength of electric field, providing useful data for how best to design DBDs going forward

Optimal Treatment of Osteoporosis

Osteoporosis affects tens of millions of people in America and is the most common disease of the bones. New treatments are constantly sought, as existing ones have documented side effects. This review seeks to pinpoint the most effective and safe treatment for osteoporosis by looking at head-to-head trials and research regarding combination therapies. This review also looks at the effectiveness of non-pharmacologic treatments and whether any options are beneficial. The importance of an open patient/provider relationship proves itself, as many medications and treatment plans depend on personal factors that need to be measured and weighed by a medical professional together with the patient