Successful conservative management of a colorenal fistula complicating percutaneous cryoablation of renal tumors: a case report.

RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are.INTRODUCTION: Colorenal fistula is a rare phenomenon and may complicate percutaneous cryoablation of renal cell carcinoma. Treatment remains controversial. CASE PRESENTATION: A 62-year-old Caucasian man presented with pneumaturia and left flank pain six weeks following ultrasound-guided percutaneous cryoablation of two recurrent lesions in the left kidney 14 years after partial left nephrectomy for a left renal cell carcinoma. A computed tomography scan eight weeks after cryoablation revealed a cryoablated mass with adjacent stranding and adherent descending colon as well as bubbles of gas in the area of stranding, the left collecting system, and the bladder. These features were consistent with a colorenal fistula at the site of previous ablation. Successful resolution of the fistula, both clinical and radiological, was achieved following a complete conservative non-interventional out-patient approach. No ureteric stent or surgical intervention was employed. CONCLUSIONS: In the absence of severe symptoms or sepsis, complete conservative management of a colorenal fistula complicating percutaneous cryoablation of renal tumors should be considered prior to interventional stenting or resectional surgery

Spatial and temporal variations in interspecific interaction : impact of a recreational landscape

Anthropogenic activities, such as outdoor recreation, have the potential to change complex interactions between wildlife and livestock, with further consequences for the management of both animals, the environment, and disease transmission. We present the interaction amongst wildlife, livestock, and outdoor recreationists as a three-way interaction. Little is known about how recreational activities alter the interaction between herbivores in areas extensively used for recreational purposes. We investigate how hiking activity affects spatio-temporal co-occurrence between domestic sheep (Ovis aries) and red deer (Cervus elaphus). We used camera traps to capture the spatio-temporal distribution of red deer and sheep and used the distance from the hiking path as a proxy of hiking activity. We used generalized linear models to investigate the spatial distribution of sheep and deer. We analysed the activity patterns of sheep and deer and then calculated their coefficients of temporal overlap for each camera trap location. We compared these coefficients in relation to the distance from the hiking path. Finally, we used a generalized linear mixed-model to investigate which factors influence the spatio-temporal succession between deer and sheep. We do not find that sheep and red deer spatially avoid each other. The coefficient of temporal overlap varied with distance from the hiking trail, with stronger temporal co-occurrence at greater distances from the hiking trail. Red deer were more likely to be detected further from the path during the day, which increased the temporal overlap with sheep in these areas. This suggests that hiking pressure influences spatio-temporal interactions between sheep and deer, leading to greater temporal overlap in areas further from the hiking path due to red deer spatial avoidance of hikers. This impact of recreationists on the wildlife and livestock interaction can have consequences for the animals’ welfare, the vegetation they graze, their management, and disease transmission.Publisher PDFPeer reviewe

Laparoscopic adhesiolysis: not for all patients, not for all surgeons, not in all centres.

ASBO is a common cause of emergency surgery and the use of laparoscopy for the treatment of these patients is still under debate and conflicting results have been published, in particular regarding the high risk of iatrogenic bowel injury. In fact, although over the last few years there has been an increasing enthusiasm in the surgical community about the advantages and potential better outcomes of laparoscopic management of adhesive small bowel obstruction (ASBO), recently published studies have introduced a significant word of caution. From 2011 in our centre, we have started to systematically approach ASBO in carefully selected patients with a step-by-step standardized laparoscopic procedure, developed and performed by a single operator experienced in emergency laparoscopy, collecting data in a prospective database. Inclusion criteria were: stable patients (without diffuse peritonitis and/or septic shock with suspicion of bowel perforation), CT scan findings consistent with a clear transition point and therefore suspected to have a single obstructing adhesive band. Patients with diffuse SB distension in the absence of a well-defined transition point and suspected to have diffuse matted adhesions (based on their surgical history and radiological findings) should be initially managed conservatively, including gastrografin challenge. Up to date, 83 patients were enrolled in the study. The rate of iatrogenic full-thickness bowel injury was 4/83 (4.8%); two of these cases were managed with simple repair and the other two required bowel resection and anastomosis. Conversion to open was performed in 3/4 of these cases, whereas in one a repair of the full-thickness injury was completed laparoscopically. All the iatrogenic injuries were detected intraoperatively and none of the reoperations that occurred in this series were due to missed bowel injuries. At 30 days follow-up, none reported incisional hernias or SSI or death. With the described accurate selection of patients, the use of such standardized step-by-step technique and in the presence of dedicated operating surgeons with advanced emergency surgery laparoscopic expertise, such procedure can be safe and feasible with multiple advantages in terms of morbidity and LOS. A careful preoperative selection of those patients who might be best candidates for laparoscopic adhesiolysis is needed. The level of laparoscopic expertise can also be highly variable, and not having advanced surgical expertise in the specific subspecialty of emergency laparoscopy, ultimately resulting in performing standardized procedures with proper careful and safe step-by-step technique, is highly recommended

Probing Spectral Line Gradients Beyond One Effective Radius in NGC 3610

The outer region (0.75--1.25 r_e in the B-band) of the merger-remnant elliptical NGC 3610 is studied using extremely high signal to noise Keck spectra, with a supplementary spectrum of the galaxy center. Stellar population parameters -- age, [Z/H], [$\alpha$/Fe] -- are measured in several apertures along the slit. Using the multi-index simultaneous fitting method of Proctor et al. (2004), no significant stellar population gradients are detected in the outer parts of the galaxy. The overall gradients relative to the galaxy center are consistent with those found in many other early-type galaxies, though the metallicity gradient is much steeper than would be expected if NGC 3610 formed in a major merger event. Standard analysis methods using the H$\beta$ index are found to produce spurious radially variable gradients.Comment: 15 pages, 9 figures, accepted by A

Does the Choice of Extraction Site During Minimally Invasive Colorectal Surgery Change the Incidence of Incisional Hernia? Protocol for a Systematic Review and Network Meta-Analysis.

BACKGROUND: Various sites are used for specimen extraction in oncological minimally invasive colorectal surgery. The objective is to determine if the choice of extraction site modulates the incidence of incisional hernia (IH). METHODS/DESIGN: A systematic review will be performed in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. MEDLINE, Embase and CENTRAL will be searched to look for original studies reporting the incidence of IH after minimally invasive colorectal surgery. Studies will be excluded from the analysis if: 1) they do not report original data, 2) the outcome of interest (incidence of incisional hernia) is not clearly reported and does not allow to extrapolate and/or calculate the required data for network meta-analysis, 3) they include pediatric patients, 4) they include a patients' population with a conversion rate to laparotomy >10%, 5) they do not compare at least two different extraction sites for the operative specimen, 6) they report patients who underwent pure (and not hybrid) natural orifice transluminal endoscopic surgery (NOTES). Network meta-analysis will be performed to determine the incidence of IH per extraction site. DISCUSSION: By determining which specimen extraction site leads to reduced rate of IH, this systematic review and network meta-analysis will help colorectal surgeons to choose their extraction site and reduce the morbidity and costs associated with IH. REGISTRATION: The systematic review and meta-analysis protocol is registered in the International Prospective Register of Ongoing Systematic Reviews (PROSPERO) with number CRD42021272226. HIGHLIGHTS: Various sites are used for specimen extraction in oncological minimally invasive colorectal surgery, and the choice of the site may probably modulate the incidence of incisional hernia.The present protocol aims to design a systematic review which will identify original studies comparing two extraction sites during minimally invasive colorectal surgery in terms of incidence of incisional hernia.Network meta-analysis will be performed to determine the incidence of IH per extraction site

Risk assessment of feed ingredients of porcine origin as vehicles for transmission of Porcine Epidemic Diarrhea Virus (PEDV)

The objective of this project was to assess the likelihood that feed ingredients of porcine origin may function as vehicles of Porcine Epidemic Diarrhea virus (PEDV) transmission via feed. The scope of the assessment included rendered ingredients, ingredients derived through spray drying porcine blood, and ingredients derived by hydrolyzing porcine tissues. For any feed ingredient, the risk of the release of infective PEDV is a function of: (1) the concentration of PEDV in the raw materials; (2) the virus survival after ingredient processing (3) the survival of virus during post-processing storage and distribution; and 4) the likelihood of post-processing contamination incorporating PEDV into the finished ingredient. No data on PEDV contamination of raw materials were available for the rendering and hydrolyzed protein sources. Estimates of PEDV contamination of liquid plasma were available from industry, based on PCR testing of ingredients over time, and were used in quantitative modeling. The assessments made in this project were constrained by a paucity of specific data on several aspects that are germane to the risk of PEDV transmission in feed ingredients of porcine origin. Available data on thermal inactivation of PEDV indicate that risk of virus surviving the processes of rendering and hydrolysis (peptone production) are negligible. The time and temperature profiles used in spray-drying are much less severe, and therefore, the possibility of virus survival is inherently greater if non-thermal mechanisms are ignored. Overall, currently available data indicate that probability of PEDV surviving the spray-drying process and current commercial storage periods is extremely small. In the course of the project, several data gaps were identified that contributed to the uncertainty. Risk assessment is an iterative process and the findings of this report may be revised in the future if new knowledge becomes available.National Pork Board, Des Moines, I

Duality and Symmetry in Chiral Potts Model

We discover an Ising-type duality in the general $N$-state chiral Potts model, which is the Kramers-Wannier duality of planar Ising model when N=2. This duality relates the spectrum and eigenvectors of one chiral Potts model at a low temperature (of small $k'$) to those of another chiral Potts model at a high temperature (of $k'^{-1}$). The $\tau^{(2)}$-model and chiral Potts model on the dual lattice are established alongside the dual chiral Potts models. With the aid of this duality relation, we exact a precise relationship between the Onsager-algebra symmetry of a homogeneous superintegrable chiral Potts model and the $sl_2$-loop-algebra symmetry of its associated spin-$\frac{N-1}{2}$ XXZ chain through the identification of their eigenstates.Comment: Latex 34 pages, 2 figures; Typos and misprints in Journal version are corrected with minor changes in expression of some formula

Compact Optical Technique for Streak Camera Calibration

The National Ignition Facility is under construction at the Lawrence Livermore National Laboratory for the U.S. Department of Energy Stockpile Stewardship Program. Optical streak cameras are an integral part of the experimental diagnostics instrumentation. To accurately reduce data from the streak cameras a temporal calibration is required. This article describes a technique for generating trains of precisely timed short-duration optical pulses that are suitable for temporal calibrations

Continuity, Deconfinement, and (Super) Yang-Mills Theory

We study the phase diagram of SU(2) Yang-Mills theory with one adjoint Weyl fermion on R^3xS^1 as a function of the fermion mass m and the compactification scale L. This theory reduces to thermal pure gauge theory as m->infinity and to circle-compactified (non-thermal) supersymmetric gluodynamics in the limit m->0. In the m-L plane, there is a line of center symmetry changing phase transitions. In the limit m->infinity, this transition takes place at L_c=1/T_c, where T_c is the critical temperature of the deconfinement transition in pure Yang-Mills theory. We show that near m=0, the critical compactification scale L_c can be computed using semi-classical methods and that the transition is of second order. This suggests that the deconfining phase transition in pure Yang-Mills theory is continuously connected to a transition that can be studied at weak coupling. The center symmetry changing phase transition arises from the competition of perturbative contributions and monopole-instantons that destabilize the center, and topological molecules (neutral bions) that stabilize the center. The contribution of molecules can be computed using supersymmetry in the limit m=0, and via the Bogomolnyi--Zinn-Justin (BZJ) prescription in the non-supersymmetric gauge theory. Finally, we also give a detailed discussion of an issue that has not received proper attention in the context of N=1 theories---the non-cancellation of nonzero-mode determinants around supersymmetric BPS and KK monopole-instanton backgrounds on R^3xS^1. We explain why the non-cancellation is required for consistency with holomorphy and supersymmetry and perform an explicit calculation of the one-loop determinant ratio.Comment: A discussion of the non-cancellation of the nonzero mode determinants around supersymmetric monopole-instantons in N=1 SYM on R^3xS^1 is added, including an explicit calculation. The non-cancellation is, in fact, required by supersymmetry and holomorphy in order for the affine-Toda superpotential to be reproduced. References have also been adde