Background: Repeat preoperative endoscopy is common for patients with colorectal neoplasms. This can result in treatment delays and risks of colonoscopy-related complications. Repeat preoperative ...endoscopy has been attributed to poor communication between endoscopists and surgeons. In January 2019, mandatory electronic synoptic reporting for endoscopy was implemented to include elements consistent with quality indicators proposed in national guidelines. The aim of the present study is to assess whether the repeat preoperative endoscopy rate for colorectal lesions changed following synoptic report implementation. Methods: A retrospective review was performed of all patients who underwent elective surgical resection for colorectal neoplasms from January 2007 to June 2020 at a tertiary hospital in Canada. Patients who had an index endoscopy documented via synoptic report were compared with those reported via narrative report. Primary outcomes were rates of repeat preoperative endoscopy and inclusion of colonoscopy quality indicators (e.g., photo-documentation, tattoo placement and bowel preparation score). A total of 1429 patients who underwent elective colorectal resection for colorectal cancers or polyps between January 2007 and June 2020 were included. Of these, 115 had index endoscopies recorded via synoptic report and 1314 by narrative report. The repeat preoperative endoscopy rate after endoscopies documented by narrative report was 29.1% (95% confidence interval CI 26.6%-31.6%) and 25.2% (95% CI 17.6%-34.2%) for synoptic report. Patients whose index endoscopies where performed by a practitioner other than their operating surgeon had a re-endoscopy rate of 36.0% (95% CI 32.8%-39.3%) after narrative report and 38.8% (95% CI 27.1%-51.5%) for synoptic report. Rates of tattoo placement, photo-documentation and reporting of bowel preparation quality were all significantly increased with synoptic reports (p ≤ 0.003). Conclusion: Endoscopy synoptic reports based on current guidelines were not associated with a decrease in rates of repeat preoperative endoscopy at a high-volume colorectal cancer centre. Future study should examine synoptic report contents for this purpose and make necessary modifications.
Imaging analysis techniques were used to examine changes in the intrinsic optical properties in hippocampal brain slices that occurred during synaptic activity evoked by Schaffer collateral ...stimulation in CA1. Repetitive synaptic activity was associated with an increase in light transmission in the synaptic region in stratum radiatum. The effect was seen at wavelengths of light between 450 and 800 nm but was of greater amplitude at longer wavelengths. Blocking synaptic transmission with either Ca(2+)-free EGTA perfusate or kynurenic acid (an excitatory amino acid antagonist) blocked the optical signal, indicating that it resulted from postsynaptic activation of the cells and was not due to presynaptic fiber volleys or transmitter release alone. Because the optical changes were blocked by reducing extracellular Cl- (by replacement with gluconate) or by furosemide (an anion transport inhibitor), increased Cl- transport (conceivably Na-K-2Cl cotransport) may generate these signals possibly by causing cellular swelling and thereby less light scattering. These optical changes were not blocked, however, by bicarbonate-free solution, indicating that bicarbonate transport may not be involved. Changes in the intrinsic optical signal could be related to glial swelling due to K+ released during neuronal activity because high-K(+)-induced swelling of cultured astrocytes is blocked by furosemide and low-Cl- solution. Intrinsic optical signals of neuronal tissue should be considered when voltage- or ion-sensitive dyes are used.
High-precision HERA data corresponding to a luminosity of around 1 fb−1 have been used in the framework of eeqq contact interactions (CI) to set limits on possible high-energy contributions beyond ...the Standard Model to electron-quark scattering. Measurements of the inclusive deep inelastic cross sections in neutral and charged current ep scattering were considered. The analysis of the ep data has been based on simultaneous fits of parton distribution functions including contributions of CI couplings to ep scattering. Several general CI models and scenarios with heavy leptoquarks were considered. Improvements in the description of the inclusive HERA data were obtained for a few models. Since a statistically significant deviation from the Standard Model cannot be established, limits in the TeV range were set on all models considered.
A
bstract
Two-particle azimuthal correlations have been measured in neutral current deep inelastic
ep
scattering with virtuality
Q
2
>
5 GeV
2
at a centre-of-mass energy
s
= 318 GeV recorded with the ...ZEUS detector at HERA. The correlations of charged particles have been measured in the range of laboratory pseudorapidity
−
1
.
5
< η <
2
.
0 and transverse momentum 0
.
1
< p
T
<
5
.
0 GeV and event multiplicities
N
ch
up to six times larger than the average 〈
N
ch
〉 ≈ 5. The two-particle correlations have been measured in terms of the angular observables
c
n
{2}
= 〈〈
cosn
Δ
φ
〉〉, where
n
is between 1 and 4 and ∆
φ
is the relative azimuthal angle between the two particles. Comparisons with available models of deep inelastic scattering, which are tuned to reproduce inclusive particle production, suggest that the measured two-particle correlations are dominated by contributions from multijet production. The correlations observed here do not indicate the kind of collective behaviour recently observed at the highest RHIC and LHC energies in high-multiplicity hadronic collisions.
► We study the Black Lake shear zone (BLSZ) in the southern Grenville Province. ► The shear zone accommodated significant shortening and possible transpression. ► The shear zone was broadly active ...during the Shawinigan orogeny (ca. 1190–1140
Ma). ► The BLSZ is the boundary between the Frontenac and Adirondack lowlands terranes.
The Black Lake shear zone has been proposed as a potentially important tectonic boundary between the Frontenac and Adirondack Lowlands terranes based on geologic and isotopic evidence. We present new structural, geochronologic and anisotropy of magnetic susceptibility (AMS) results from the Black Lake area that constrain the location, kinematics and timing of deformation in the region. Both structural and AMS results document a northeast trending zone of high strain between Black Lake and the Saint Lawrence River. Within this zone, strain is heterogeneous and includes a strongly developed sub-vertical northeast trending foliation. Less commonly, two orthogonal lineation sets are present; one that is sub-horizontal and another that is down dip. The foliation and granitic dikes are locally folded forming tight to isoclinal northeast trending folds. Kinematic indicators show thrust deformation in areas of down-dip lineation but are mixed in areas of sub-horizontal lineation with a slight majority suggesting left-lateral shear. These results suggest major northwest directed shortening accommodated by flattening and ductile thrust faults, possibly with a component of sub-horizontal shear. The two lineations may have formed during discrete episodes or synchronously during transpression. U–Pb SHRIMP geochronology on igneous titanite from deformed dikes, in combination with previous geochronology, show that significant deformation occurred from ca. 1170–1100
Ma. This deformation likely occurred during the late stages of the Shawinigan orogeny and may record accretion of the Adirondacks to the margin of Laurentia during terrane assembly.
Abstract
Background
Empty pelvis syndrome (EPS) is a significant source of morbidity following pelvic exenteration (PE), but is undefined. EPS outcome reporting and descriptors of radicality of PE ...are inconsistent; therefore, the best approaches for prevention are unknown. To facilitate future research into EPS, the aim of this study is to define a measurable core outcome set, core descriptor set and written definition for EPS. Consensus on strategies to mitigate EPS was also explored.
Method
Three-stage consensus methodology was used: longlisting with systematic review, healthcare professional event, patient engagement, and Delphi-piloting; shortlisting with two rounds of modified Delphi; and a confirmatory stage using a modified nominal group technique. This included a selection of measurement instruments, and iterative generation of a written EPS definition.
Results
One hundred and three and 119 participants took part in the modified Delphi and consensus meetings, respectively. This encompassed international patient and healthcare professional representation with multidisciplinary input. Seventy statements were longlisted, seven core outcomes (bowel obstruction, enteroperineal fistula, chronic perineal sinus, infected pelvic collection, bowel obstruction, morbidity from reconstruction, re-intervention, and quality of life), and four core descriptors (magnitude of surgery, radiotherapy-induced damage, methods of reconstruction, and changes in volume of pelvic dead space) reached consensus—where applicable, measurement of these outcomes and descriptors was defined. A written definition for EPS was agreed.
Conclusions
EPS is an area of unmet research and clinical need. This study provides an agreed definition and core data set for EPS to facilitate further research.
One of the potential variables affecting the overall survival and quality of life of patients with intracranial gliomas is the extent of tumor resection that results in the smallest volume of ...residual disease. A technique involving enhanced optical imaging of human gliomas has the potential to localize tumors, identify tumor remaining at the resection margins, and determine the grade of the tumor. In a preliminary study involving nine patients undergoing surgery for the removal of intrinsic brain tumors, enhanced optical imaging was performed using indocyanine green as an intravenous contrast-enhancement agent. Optical images were obtained before and after injection of the indocyanine green. The studies in the nine patients showed differences in the dynamic optical signals among normal brain, low-grade astrocytomas, and malignant astrocytomas. Optical imaging of the resection margins in malignant tumors showed differences between adjacent normal tissue and remaining tumor tissue. Enhanced optical imaging of human gliomas using a contrast-enhancing dye, indocyanine green, provides a potential means to differentiate between normal brain and tumor tissue at the cortical surface and the depths of the resection margins. Having the ability to obtain real-time information and feedback in the operating room may allow neurosurgeons to maximize the extent of tumor resection while sparing normal brain and increasing the diagnostic accuracy of intraoperative biopsies. Enhanced optical imaging potentially could facilitate the accuracy and safety of surgery when tumors are removed at sites even outside the central nervous system.
A
bstract
The exclusive photoproduction reactions
γp
→
J/ψ
(1
S
)
p
and
γp
→
ψ
(2
S
)
p
have been measured at an
ep
centre-of-mass energy of 318 GeV with the ZEUS detector at HERA using an integrated ...luminosity of 373 pb
−
1
. The measurement was made in the kinematic range 30
< W <
180 GeV,
Q
2
<
1 GeV
2
and |
t
|
<
1 GeV
2
, where
W
is the photon-proton centre-of-mass energy,
Q
2
is the photon virtuality and
t
is the squared four-momentum transfer at the proton vertex. The decay channels used were
J/ψ
(1
S
)
→ μ
+
μ
−
,
ψ
(2
S
)
→ μ
+
μ
−
and
ψ
(2
S
)
→ J/ψ
(1
S
)
π
+
π
−
with subsequent decay
J/ψ
(1
S
)
→ μ
+
μ
−
. The ratio of the production cross sections,
R
=
σ
ψ
(2
S
)
/σ
J/ψ
(1
S
)
, has been measured as a function of
W
and |
t
| and compared to previous data in photoproduction and deep inelastic scattering and with predictions of QCD-inspired models of exclusive vector-meson production, which are in reasonable agreement with the data.
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