In the cuprates, high-temperature superconductivity, spin-density-wave order, and charge-density-wave (CDW) order are intertwined, and symmetry determination is challenging due to domain formation. ...We investigated the CDW in the prototypical cuprate La_{1.88}Sr_{0.12}CuO_{4} via x-ray diffraction employing uniaxial pressure as a domain-selective stimulus to establish the unidirectional nature of the CDW unambiguously. A fivefold enhancement of the CDW amplitude is found when homogeneous superconductivity is partially suppressed by magnetic field. This field-induced state provides an ideal search environment for a putative pair-density-wave state.
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CMK, CTK, FMFMET, IJS, NUK, PNG, UL, UM
To identify the lengthiest step of total laparoscopic hysterectomy (TLH) in a teaching hospital and to determine which clinical factors affect the duration of this step.
The University of Louisville ...Hospital.
Single institution retrospective case series.
This is a retrospective chart and video review that included 135 benign, elective TLHs performed at The University of Louisville. TLH was divided into 5 steps: (1) insertion of laparoscopic ports and adhesiolysis to restore normal anatomy; (2) identification of the ureter and resection of adnexal structures to transection of the round ligament; (3) transection of the round ligament to transection of the uterine artery; (4) lateralization of the uterine vessel pedicle to completion of colpotomy; and (5) completion of vaginal cuff closure. The random intercept and slope model was used to identify the lengthiest step of TLH, and the backward elimination procedure was used to evaluate which clinical factors affected this step. Mean ± SD total length of TLH was 81 ± 30 min. The lengthiest step was colpotomy, with a mean duration of 24 ± 13 min. Uterine weight significantly increased the length of time required for colpotomy (p = .001). The primary energy source (ultrasonic scalpel vs monopolar hook) used to perform colpotomy did not influence the length of time (p = .539 vs p = .583). Uterine weight (p < .001) and adhesiolysis (p = .003) significantly increased the total time of TLH.
At a teaching institution where surgeries are performed by residents and fellows, colpotomy is the lengthiest step of TLH and is influenced by uterine weight. This finding may reflect the training levels of the surgeons performing these cases and the learning curve associated with a challenging surgical skill. Further research should focus on simulation models and/or tools for colpotomy that may result in greater efficiency in the operating room.
Spontaneous symmetry breaking constitutes a paradigmatic classification scheme of matter. However, broken symmetry also entails domain degeneracy that often impedes identification of novel low ...symmetry states. In quantum matter, this is additionally complicated by competing intertwined symmetry breaking orders. A prime example is that of unconventional superconductivity and density-wave orders in doped cuprates in which their respective symmetry relation remains a key question. Using uniaxial pressure as a domain-selective stimulus in combination with x-ray diffraction, we unambiguously reveal that the fundamental symmetry of the charge order in the prototypical cuprate La\(_{1.88}\)Sr\(_{0.12}\)CuO\(_4\) is characterized by uniaxial stripes. We further demonstrate the direct competition of this stripe order with unconventional superconductivity via magnetic field tuning. The stripy nature of the charge-density-wave state established by our study is a prerequisite for the existence of a superconducting pair-density-wave -- a theoretical proposal that clarifies the interrelation of intertwined quantum phases in unconventional superconductors -- and paves the way for its high-temperature realization.
Minimally invasive surgery is now standard of care for many procedures in pediatric gynecology. Laparoscopy has been well documented to produce faster recovery,decreased postoperative pain, and ...because of smaller incisions, a better cosmetic result. These are important when considering an active pediatric patient. Although a laparoscopic approach to endometriosis, adnexal masses, and ovarian torsion are well supported in the literature in the pediatric patient, more data are needed with regard to SILS in younger patients. Laparoscopy seems to be a better approach to oopheropexy in children undergoing radiation, and in resection of certain mullerian anomalies; however, the numbers are low.Similarly in pregnant patients, laparoscopy provides for shorter recovery times,decrease analgesic use and shorter hospital stays. Concerns about poor fetal outcomes in surgery during pregnancy for non gynecologic problems have been brought to light; however, the evidence indicates that these outcomes can be attributed to the nature of the underlying disease and not the surgical approach. With regard to pneumoperitoneum the effect of CO2 insufflation on fetal physiology and long-term outcomes remains unclear, and will continue to be an issue of controversy until larger studies are published.With both the pediatric and pregnant populations, laparoscopic complications can be diminished when performed by skilled surgeons with strict adherence to good technical principles. The advantages of laparoscopy are great, and this approach should be considered in pediatric and pregnant patients.
