Is the spiral morphology of the Elias 2-27 circumstellar disc due to gravitational instability?

A recent ALMA observation of the Elias 2-27 system revealed a two-armed structure extending out to ~300 au in radius. The protostellar disc surrounding the central star is unusually massive, raising the possibility that the system is gravitationally unstable. Recent work has shown that the observed morphology of the system can be explained by disc self-gravity, so we examine the physical properties of the disc necessary to detect self-gravitating spiral waves. Using three-dimensional Smoothed Particle Hydrodynamics, coupled with radiative transfer and synthetic ALMA imaging, we find that observable spiral structure can only be explained by self-gravity if the disc has a low opacity (and therefore efficient cooling), and is minimally supported by external irradiation. This corresponds to a very narrow region of parameter space, suggesting that, although it is possible for the spiral structure to be due to disc self-gravity, other explanations, such as an external perturbation, may be preferred.Comment: 12 pages, 5 figure

Post-Operative Functional Outcomes in Early Age Onset Rectal Cancer

Background: Impairment of bowel, urogenital and fertility-related function in patients treated for rectal cancer is common. While the rate of rectal cancer in the young (<50 years) is rising, there is little data on functional outcomes in this group. Methods: The REACCT international collaborative database was reviewed and data on eligible patients analysed. Inclusion criteria comprised patients with a histologically confirmed rectal cancer, <50 years of age at time of diagnosis and with documented follow-up including functional outcomes. Results: A total of 1428 (n=1428) patients met the eligibility criteria and were included in the final analysis. Metastatic disease was present at diagnosis in 13%. Of these, 40% received neoadjuvant therapy and 50% adjuvant chemotherapy. The incidence of post-operative major morbidity was 10%. A defunctioning stoma was placed for 621 patients (43%); 534 of these proceeded to elective restoration of bowel continuity. The median follow-up time was 42 months. Of this cohort, a total of 415 (29%) reported persistent impairment of functional outcomes, the most frequent of which was bowel dysfunction (16%), followed by bladder dysfunction (7%), sexual dysfunction (4.5%) and infertility (1%). Conclusion: A substantial proportion of patients with early-onset rectal cancer who undergo surgery report persistent impairment of functional status. Patients should be involved in the discussion regarding their treatment options and potential impact on quality of life. Functional outcomes should be routinely recorded as part of follow up alongside oncological parameters

Is the spiral morphology of the Elias 2-27 circumstellar disc due to gravitational instability?

A recent Atacama Large Millimeter/submillimeter Array (ALMA) observation of the Elias 2-27 system revealed a two-armed structure extending out to ∼300 au in radius. The protostellar disc surrounding the central star is unusually massive, raising the possibility that the system is gravitationally unstable. Recent work has shown that the observed morphology of the system can be explained by disc self-gravity, so we examine the physical properties of the disc necessary to detect self-gravitating spiral waves. Using three-dimensional smoothed particle hydrodynamics, coupled with radiative transfer and synthetic ALMA imaging, we find that observable spiral structure can only be explained by self-gravity if the disc has a low opacity (and therefore efficient cooling), and is minimally supported by external irradiation. This corresponds to a very narrow region of parameter space, suggesting that, although it is possible for the spiral structure to be due to disc self-gravity, other explanations, such as an external perturbation, may be preferred

Characteristics of Early-Onset vs Late-Onset Colorectal Cancer: A Review.

ImportanceThe incidence of early-onset colorectal cancer (younger than 50 years) is rising globally, the reasons for which are unclear. It appears to represent a unique disease process with different clinical, pathological, and molecular characteristics compared with late-onset colorectal cancer. Data on oncological outcomes are limited, and sensitivity to conventional neoadjuvant and adjuvant therapy regimens appear to be unknown. The purpose of this review is to summarize the available literature on early-onset colorectal cancer.ObservationsWithin the next decade, it is estimated that 1 in 10 colon cancers and 1 in 4 rectal cancers will be diagnosed in adults younger than 50 years. Potential risk factors include a Westernized diet, obesity, antibiotic usage, and alterations in the gut microbiome. Although genetic predisposition plays a role, most cases are sporadic. The full spectrum of germline and somatic sequence variations implicated remains unknown. Younger patients typically present with descending colonic or rectal cancer, advanced disease stage, and unfavorable histopathological features. Despite being more likely to receive neoadjuvant and adjuvant therapy, patients with early-onset disease demonstrate comparable oncological outcomes with their older counterparts.Conclusions and relevanceThe clinicopathological features, underlying molecular profiles, and drivers of early-onset colorectal cancer differ from those of late-onset disease. Standardized, age-specific preventive, screening, diagnostic, and therapeutic strategies are required to optimize outcomes

Characteristics of Early-Onset vs Late-Onset Colorectal Cancer: A Review.

ImportanceThe incidence of early-onset colorectal cancer (younger than 50 years) is rising globally, the reasons for which are unclear. It appears to represent a unique disease process with different clinical, pathological, and molecular characteristics compared with late-onset colorectal cancer. Data on oncological outcomes are limited, and sensitivity to conventional neoadjuvant and adjuvant therapy regimens appear to be unknown. The purpose of this review is to summarize the available literature on early-onset colorectal cancer.ObservationsWithin the next decade, it is estimated that 1 in 10 colon cancers and 1 in 4 rectal cancers will be diagnosed in adults younger than 50 years. Potential risk factors include a Westernized diet, obesity, antibiotic usage, and alterations in the gut microbiome. Although genetic predisposition plays a role, most cases are sporadic. The full spectrum of germline and somatic sequence variations implicated remains unknown. Younger patients typically present with descending colonic or rectal cancer, advanced disease stage, and unfavorable histopathological features. Despite being more likely to receive neoadjuvant and adjuvant therapy, patients with early-onset disease demonstrate comparable oncological outcomes with their older counterparts.Conclusions and relevanceThe clinicopathological features, underlying molecular profiles, and drivers of early-onset colorectal cancer differ from those of late-onset disease. Standardized, age-specific preventive, screening, diagnostic, and therapeutic strategies are required to optimize outcomes