Objective The challenge of surgery for anal fistula is to eradicate the fistula track while maintaining anal continence. Seton placement is recommended to reduce postoperative faecal incontinence ...but interestingly a great range of functional impairment after surgery has been published. The aim of this study was to analyse the influence of intra‐operative internal anal sphincter division during tight or cutting seton technique for cryptogenic anal fistula, on the results of recurrence and postoperative faecal incontinence.
Method A systematic literature review was performed to identify published series from 1966 to May 2007 of patients with anal fistula treated by a tight or cutting seton technique. The published series has been divided in to those where preservation of internal anal sphincter was performed (PIAS group) or where intra‐operative surgical division was undertaken in the time of seton placement (SIAS group) .The main endpoints of the review were to study anal fistula recurrence rate and postoperative faecal incontinence.
Results Eighteen studies including 19 series and 448 patients were analysed in detail. Recurrence rate was 5.0% and 3.0% in PIAS and SIAS group respectively. Overall faecal incontinence rate was 5.6% in PIAS group and 25.2% in SIAS group.
Conclusion Although based on low‐evidence studies, intra‐operative preservation of internal anal sphincter at the time of seton insertion for anal fistula seems to reduce the postoperative faecal incontinence without a substantial increase in recurrence rates.
In this work the deposition of a thin YSZ electrolyte layer (< 10 μm) on a porous anode substrate is performed by sputtering Zr–Y metallic targets in argon–oxygen reactive gas mixtures under unstable ...deposition conditions. A plasma emission monitoring system is used to ensure a high deposition rate of the ceramic film. The deposition parameters are optimised in order to obtain a good compromise between quality, density and deposition rate for coatings realised under unstable conditions.
After a short description of the experimental setup, the characterisation of the YSZ coatings is performed using scanning electron microscopy, X‐ray diffraction and permeability measurements. Then a complete cell incorporating a thin YSZ electrolyte layer (6.2 ± 0.3 μm thick) obtained by magnetron sputtering is manufactured and tested. This single planar solid oxide fuel cell exhibits a power density of 560 mW cm–2 under a voltage of 0.7 V at 800 °C and a maximal power density of 660 mW cm–2 is reached.
This article introduces the energetic macroscopic representation (EMR) as approach for the dynamic modeling of a diesel fuel processing unit. The EMR is the first step toward model-based control ...structure development. The autothermal fuel processing system containing: heat exchanger, reformer, desulfurization, water gas shift, preferential oxidation and condensation is divided into a multitude simple subblocks. Each subblock describes an elementary step of the fuel conversion, several of these blocks may occur in a single module. Calculations are carried out using two basic principles: mass and energy balances. For model-based control development, it is imperative that the model represents dynamic behavior, therefore temperature and pressure dynamics are taken into account in the model. It is shown that the model is capable to predict the stationary behavior of the entire fuel processing unit correctly by comparison with given data. Predictions regarding reformer heat up, temperature and pressure dynamics are also provided.
Background and purpose
Following the commercial availability of nusinersen, there have been a number of new referrals of adults with spinal muscular atrophy (SMA) not regularly followed in ...tertiary‐care centers or enrolled in any disease registry.
Methods
We compared demographics and disease characteristics, including assessment of motor and respiratory function, in regularly followed patients and newcomers subdivided according to the SMA type.
Results
The cohort included 166 adult patients (mean age: 37.09 years): one type I, 65 type II, 99 type III, and one type IV. Of these 166, there were 67 newcomers. There was no significant difference between newcomers and regularly followed patients in relation to age and disease duration. The Hammersmith Functional Motor Scale Expanded and Revised Upper Limb Module scores were higher in the regularly followed patients compared to newcomers in the whole cohort and in both SMA II and II. A difference was also found on ventilatory status (p = 0.013) and Cobb’s angle >50° (p = 0.039) between the two subgroups. No difference was found in scoliosis surgery prevalence (p > 0.05).
Conclusions
Our results showed differences between the two subgroups, even if less marked in the type III patients. In the type II patients, there was a higher proportion of newcomers who were in the severe end of the spectrum. Of the newcomers, only approximately a third initiated treatment, as opposed to the 51% in the regularly followed patients. The identification of patients who were not part of the registries will help to redefine the overall prevalence of SMA and the occurrence of different phenotypes.
Percentages of regularly followed patients and newcomers.
Abstract Introduction EURECCA (EUropean REgistration of Cancer CAre) is a network aiming to improve cancer care by auditing outcome. EURECCA initiated an international survey to share and compare ...patient outcome for oesophagogastric cancer. The present study assessed how a uniform dataset could be introduced for oesophagogastric cancer in Europe. Methods Participating countries presented data using common data items describing patients', disease, strategies, and outcome characteristics. Patients treated with curative surgery for squamous cell carcinoma (SCC) or adenocarcinoma (ACA) were included. Results United Kingdom, the Netherlands, France, Spain and Ireland participated. There were differences in data source ranging from national registries to large collaborative groups. 4668 oesophagogastric cancer cases over a 12 months period were included. The predominant histological type was ACA. Disease stage tended to be earlier in France and Ireland. In oesophageal and junctional cancers neoadjuvant chemoradiotherapy was preferred in the Netherlands and Ireland contrasting with chemotherapy in the UK and France. All countries used perioperative chemotherapy in gastric cancer but 1/3 of patients received this treatment. The mean R0 resection rate was 86% for oesophageal and junctional resections and 88% for gastric resections. Postoperative mortality varied from 1% to 7%. Conclusion This European survey shown that implementing a uniform treatment and outcome data format of oesophagogastric cancer is feasible. It identified differences in disease presentation, treatment approaches and outcome, which need to be investigated, especially by increasing the number of participating countries. Future comparisons will facilitate developments in treatment for the benefit of patient outcomes.
Abstract Background We assessed the impact of complications on recurrence and survival after curative gastric cancer resection. Methods Patients undergoing R0 resections between 1990 and 2009 were ...identified in a prospectively maintained database and were categorized by presence of any complication Clavien-Dindo (CD) ≥ II, sepsis or intra-abdominal sepsis. Cox regression analyses to relate complications and clinico-pathological variables to time to recurrence (TTR) and overall survival (OS) were performed. Results A total of 271 patients were included with a median follow-up of 149.9 months (range 140.1–159.9). Complications CD ≥ II occurred in 162 (59.8%) patients, sepsis in 66 (22.5%), and intra-abdominal sepsis in 37 (13.6%). Recurrence developed in 88 (32.4%) patients. Independent predictors of short TTR were pTNM stage (IIIB-IIIC vs. IA-IIA) (hazard ratio HR = 37.55, 95% confidence interval CI 17.57–80.24; p < 0.001), D1 lymphadenectomy (HR = 3.14, 95% CI 1.94–5.07; p < 0.001), and male gender (HR = 1.65, 95% CI 1.06–2.57; p = 0.026). pTNM stage (IIIB–IIIC vs. IA–IIA, HR = 10.28, 95% CI 6.51–16.23; p < 0.001), male gender (HR = 1.64, 95% CI 1.17–2.31; p = 0.005), age (HR = 1.03, 95% CI 1.02–1.05; p < 0.001), and adjuvant therapy (HR = 0.55, 95% CI 0.37–0.83; p = 0.004) were identified as independent predictors of OS.. Conclusions Evidence provided by this study does not support a negative impact of postoperative complications CD ≥ II, sepsis, and intra-abdominal sepsis on the oncologic outcome after curative gastric cancer resection.
Evidence is presented for a new pathway participating in anterior neural development. It was found that IGF binding protein 5 (IGFBP-5), as well as three IGFs expressed in early embryos, promoted ...anterior development by increasing the head region at the expense of the trunk in mRNA-injected
Xenopus embryos. A secreted dominant-negative type I IGF receptor (DN-IGFR) had the opposite effect. IGF mRNAs led to the induction of ectopic eyes and ectopic head-like structures containing brain tissue. In ectodermal explants, IGF signals induced anterior neural markers in the absence of mesoderm formation and DN-IGFR inhibited neural induction by the BMP antagonist Chordin. Thus, active IGF signals appear to be both required and sufficient for anterior neural induction in
Xenopus.
gamma-Secretase is an intramembranous multi-protein complex that cleaves many type-I proteins with critical roles in neuronal function. In Alzheimer's disease (AD) interest in gamma-secretase comes, ...in part, from the fact that this complex is responsible for the last cleavage step of the amyloid precursor protein (APP) that generates the amyloid-beta peptide (Abeta). Abeta represents the primary component of the amyloid plaque, one of the main pathological hallmarks of AD. Over the last years, considerable efforts have been made to develop drugs to reduce Abeta production with the aim to slow AD progression. Many inhibitors of this protease have been identified, although the clinical use has been limited by concerns about the possible toxicity of these compounds. gamma-secretase inhibitors have been shown to reduce Abeta in vitro and in vivo, but interference with Notch proteolysis causes immunological and gastrointestinal toxicity in animal models. The observation that some nonsteroidal anti-inflammatory drug (NSAID) derivatives are able to specifically lower Abeta42 and the development of inhibitors with Notch-sparing selectivity has revived the interest in gamma-secretase as an attractive target for drug intervention in AD. Despite the fact that all clinical trials with NSAIDs or gamma-secretase modulators in AD have failed to show clinical benefit thus far, the main concern is that the Abeta-lowering potency of the tested compounds may be too low. Active efforts are being made to develop compounds able to penetrate into the brain to lower Abeta at physiological doses without interfering with the cleavage and function of other critical gamma-secretase substrates. These novel inhibitors and modulators may soon offer hope in the Alzheimer's fight.
The behaviour of the sea breeze developing along the Gulf of Jakarta during days with different synoptic condition is examined using observational data and simulations from the Weather Research and ...Forecasting (WRF). An objective and systematic selection method is used to detect sea breeze days from observational data. The simulation used three nested grids at 27, 9 and 3 km resolution covering Gulf of Jakarta and its joining region for sea breeze event at November 22th, 2016 which formed under offshore large-scale ambient wind, January 20th, 2017 which formed under westerly large-scale ambient wind, and August 10th, 2017 which formed under easterly large-scale ambient wind. Results show that the development of sea breeze circulation under offshore ambient wind produced lower 10-m wind speed simulation, while sea breeze conditions under westerly large-scale ambient wind are associated with highest surface wind speeds reaching 9.5 ms-1 in Gulf of Jakarta. Sea breeze simulation also indicates the formation of calm zone which is 22 - 56 km away from the Jakarta Gulf coastline. Model also shows the formation of thermal internal boundary layer that are about 300-700 m near the coast gradually merged with the mixing layer inland. Performance of WRF on the simulated circulation is studied by conducting value of correlation, RMSE, and MBE. Overall, model simulation agrees fairly well with the observations taken at a near-surface meteorological station.
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