Dynamics of Nucleation in Solids: A Self-Consistent Phase Field Approach.

We derive a phase field method for computing rigorously the nucleation rate and the incubation time from the sole knowledge of the free energy of the system in the metastable regime. Our theoretical results are assessed against experimental data relative to demixing of an iron-chromium alloy. Our work clarifies the notions of nucleation rate and incubation time extensively used in classical nucleation theory (CNT) processes in solids. Our work thus emerges as an alternative to CNT but of more general applicability, and enables us to model the nucleation process across the whole range of condition encountered in first order phase transitions, an aspect in which CNT fails.

Predicting Nonequilibrium Patterns beyond Thermodynamic Concepts: Application to Radiation-Induced Microstructures.

In this work, we derive an analytical model to predict the appearance of all possible radiation-induced steady states and their associated microstructures in immiscible A_{c[over ¯]}B_{1-c[over ¯]} alloys, an example of a nonequilibrium dynamical system. This model is assessed against numerical simulations and experimental results which show that different microstructures characterized by the patterning of A-rich precipitates can emerge under irradiation. We demonstrate that the steady-state microstructure is governed by irradiation conditions and also by the average initial concentration of the alloy c[over ¯]. Such a dependence offers new leverage for tailoring materials with specific microstructures overcoming limitations imposed by the equilibrium thermodynamic phase diagram.

Symmetry Breaking Resulting from Long-Range Interactions in Out of Equilibrium Systems: Elastic Properties of Irradiated AgCu.

This work presents a consistent formulation of the phase-field approach to model the behavior of nonmiscible alloys under irradiation which includes elastic strain fields, an example of a long-range interaction. Simulations show that the spatial isotropy that is characteristic of radiation-induced patterns breaks down as a result of the elastic strain energy. The consequence of this is the emergence of superlattice structures under irradiation liable to modify macroscopic material properties. This approach is assessed against the experimental study of a AgCu alloy under irradiation: we compare our simulation results to measured solubility limits and Young moduli.

What Is the Actual Local Crystalline Structure of Uranium Dioxide, UO2? A New Perspective for the Most Used Nuclear Fuel.

Up to now, uranium dioxide, the most used nuclear fuel, was said to have a Fm3̅m crystalline structure from 30 to 3000 K, and its behavior was modeled under this assumption. However, recently X-ray diffraction experiments provided atomic pair-distribution functions of UO2, in which UO distance was shorter than the expected value for the Fm3̅m space group. Here we show neutron diffraction results that confirm this shorter UO bond, and we also modeled the corresponding pair-distribution function showing that UO2 has a local Pa3̅ symmetry. The existence of a local lower symmetry in UO2 could explain some unexpected properties of UO2 that would justify UO2 modeling to be reassessed. It also deserves more study from an academic point of view because of its good thermoelectric properties that may originate from its particular crystalline structure.

Optical properties of Ar ions irradiated nanocrystalline ZrC and ZrN thin films.

Thin nanocrystalline ZrC and ZrN films (<400 nm), grown on (100) Si substrates at a substrate temperature of 500 °C by the pulsed laser deposition (PLD) technique, were irradiated by 800 keV Ar ion irradiation with fluences from 1 × 1014 at/cm2 up to 2 × 1015 at/cm2. Optical reflectance data, acquired from as-deposited and irradiated films, in the range of 500 - 50000 cm-1 (0.06 - 6 eV), was used to assess the effect of irradiation on the optical and electronic properties. Both in ZrC and ZrN films we observed that irradiation affects the optical properties of the films mostly at low frequencies, which is dominated by the free carriers response. In both materials, we found a significant reduction in the free carriers scattering rate, i.e. possible increase in mobility, at higher irradiation flux. This is consistent with our previous findings that irradiation affects the crystallite size and the micro-strain, but it does not induce major structural changes.

Structural Changes in the Local Environment of Uranium Atoms in the Three Phases of U4O9.

The crystal structure of U4O9 remains an enigma because of its differences with U(4+) and U(5+) coordination polyhedral mixtures, as shown in the XANES experimental results. To better understand this crystal structure, its diffraction pattern was measured at seven different temperatures using neutron diffraction before being independently refined by Rietveld's method and pair distribution function analysis. The O cuboctahedron-a structural element consisting of 13 oxygen atoms-is a specific feature of the U4O9 crystal structure. The volume of the cuboctahedron decreases when the temperature increases, whereas the overall volume of the crystal cell increases. This feature can be correlated with the two U4O9 phase transitions that induce sharp changes in the cuboctahedron geometry, suggesting that this structural element has internal dynamics. In particular, these structural modifications in the γ phase suggest that the high-temperature phase can be described as a mixture of U(4+) and U(5+) coordination polyhedra, the latter having U-O distances shorter than 2.2 Å, that are absent in the former. These changes in uranium polyhedra as a function of temperature are tentatively interpreted using steric arguments. They also raise the question of charge localization on the different U ion sites in the low-temperature phases of U4O9.

A systematic review and meta-analysis of germline BRCA mutations in pancreatic cancer patients identifies global and racial disparities in access to genetic testing.

BACKGROUND: Germline BRCA1 and BRCA2 mutations (gBRCAm) can inform pancreatic cancer (PC) risk and treatment but most of the available information is derived from white patients. The ethnic and geographic variability of gBRCAm prevalence and of germline BRCA (gBRCA) testing uptake in PC globally is largely unknown. MATERIALS AND METHODS: We carried out a systematic review and prevalence meta-analysis of gBRCA testing and gBRCAm prevalence in PC patients stratified by ethnicity. The main outcome was the distribution of gBRCA testing uptake across diverse populations worldwide. Secondary outcomes included: geographic distribution of gBRCA testing uptake, temporal analysis of gBRCA testing uptake in ethnic groups, and pooled proportion of gBRCAm stratified by ethnicity. The study is listed under PROSPERO registration number #CRD42022311769. RESULTS: A total of 51 studies with 16 621 patients were included. Twelve of the studies (23.5%) enrolled white patients only, 10 Asians only (19.6%), and 29 (56.9%) included mixed populations. The pooled prevalence of white, Asian, African American, and Hispanic patients tested per study was 88.7%, 34.8%, 3.6%, and 5.2%, respectively. The majority of included studies were from high-income countries (HICs) (64; 91.2%). Temporal analysis showed a significant increase only in white and Asians patients tested from 2000 to present (P < 0.001). The pooled prevalence of gBRCAm was: 3.3% in white, 1.7% in Asian, and negligible (<0.3%) in African American and Hispanic patients. CONCLUSIONS: Data on gBRCA testing and gBRCAm in PC derive mostly from white patients and from HICs. This limits the interpretation of gBRCAm for treating PC across diverse populations and implies substantial global and racial disparities in access to BRCA testing in PC.

Refinement of the α-U4O9 crystalline structure: new insight into the U4O9 → U3O8 transformation.

The oxidation reaction of UO(2) into U(3)O(8) is studied as a function of the crystalline distortion of interstitial oxygen clusters, named cuboctahedra, which appear in U(4)O(9) and U(3)O(7) intermediate phases. For that purpose, the refinement of α-U(4)O(9) was performed because this phase undergoes a trigonal distortion from cubic ß-U(4)O(9) when the temperature is decreased. In α-U(4)O(9), the cuboctahedra can be described as crumpled sheets taken from a fragment of U(3)O(8). The manner by which the accumulation of crumpled sheets can lead to the formation of U(3)O(8) is discussed.

Risk of malignancy in resected cystic tumors of the pancreas < or =3 cm in size: is it safe to observe asymptomatic patients? A multi-institutional report.

Recent international consensus guidelines propose that cystic pancreatic tumors less than 3 cm in size in asymptomatic patients with no radiographic features concerning for malignancy are safe to observe; however, there is little published data to support this recommendation. The purpose of this study was to determine the prevalence of malignancy in this group of patients using pancreatic resection databases from five high-volume pancreatic centers to assess the appropriateness of these guidelines. All pancreatic resections performed for cystic neoplasms < or =3 cm in size were evaluated over the time period of 1998-2006. One hundred sixty-six cases were identified, and the clinical, radiographic, and pathological data were reviewed. The correlation with age, gender, and symptoms (abdominal pain, nausea and vomiting, jaundice, presence of pancreatitis, unexplained weight loss, and anorexia), radiographic features suggestive of malignancy by either computed tomography, magnetic resonance imaging, or endoscopic ultrasound (presence of solid component, lymphadenopathy, or dilated main pancreatic duct or common bile duct), and the presence of malignancy was assessed using univariate and multivariate analysis. Among the 166 pancreatic resections for cystic pancreatic tumors < or =3 cm, 135 cases were benign [38 serous cystadenomas, 35 mucinous cystic neoplasms, 60 intraductal papillary mucinous neoplasms (IPMN), 1 cystic papillary tumor, and 1 cystic islet cell tumor], whereas 31 cases were malignant (14 mucinous cystic adenocarcinomas and 13 invasive carcinomas and 4 in situ carcinomas arising in the setting of IPMN). A greater incidence of cystic neoplasms was seen in female patients (99/166, 60%). Gender was a predictor of malignant pathology, with male patients having a higher incidence of malignancy (19/67, 28%) compared to female patients (12/99, 12%; p < 0.02). Older age was associated with malignancy (mean age 67 years in patients with malignant disease vs 62 years in patients with benign lesions (p < 0.05). A majority of the patients with malignancy were symptomatic (28/31, 90%). Symptoms that correlated with malignancy included jaundice (p < 0.001), weight loss (p < 0.003), and anorexia (p < 0.05). Radiographic features that correlated with malignancy were presence of a solid component (p < 0.0001), main pancreatic duct dilation (p = 0.002), common bile duct dilation (p < 0.001), and lymphadenopathy (p < 0.002). Twenty-seven of 31(87%) patients with malignant lesions had at least one radiographic feature concerning for malignancy. Forty-five patients (27%) were identified as having asymptomatic cystic neoplasms. All but three (6.6%) of the patients in this group had benign disease. Of the patients that had no symptoms and no radiographic features, 1 out of 30 (3.3%) had malignancy (carcinoma in situ arising in a side branch IPMN). Malignancy in cystic neoplasms < or =3 cm in size was associated with older age, male gender, presence of symptoms (jaundice, weight loss, and anorexia), and presence of concerning radiographic features (solid component, main pancreatic duct dilation, common bile duct dilation, and lymphadenopathy). Among asymptomatic patients that displayed no discernable radiographic features suggestive of malignancy who underwent resection, the incidence of occult malignancy was 3.3%. This study suggests that a group of patients with small cystic pancreatic neoplasms who have low risk of malignancy can be identified, and selective resection of these lesions may be appropriate.

A model of defect cluster creation in fragmented cascades in metals based on morphological analysis.

The impacts of ions and neutrons in metals cause cascades of atomic collisions that expand and shrink, leaving microstructure defect debris, i.e. interstitial or vacancy clusters or loops of different sizes. In De Backer et al (2016 Europhys. Lett. 115 26001), we described a method to detect the first morphological transition, i.e. the cascade fragmentation in subcascades, and a model of primary damage combining the binary collision approximation and molecular dynamics (MD). In this paper including W, Fe, Be, Zr and 20 other metals, we demonstrate that the fragmentation energy increases with the atomic number and decreases with the atomic density following a unique power law. Above the fragmentation energy, the cascade morphology can be characterized by the cross pair correlation functions of the multitype point pattern formed by the subcascades. We derive the numbers of pairs of subcascades and observed that they follow broken power laws. The energy where the power law breaks indicates the second morphological transition when cascades are formed by branches decorated by chaplets of small subcascades. The subcascade interaction is introduced in our model of primary damage by adding pairwise terms. Using statistics obtained on hundreds of MD cascades in Fe, we demonstrate that the interaction of subcascades increases the proportion of large clusters in the damage created by high energy cascades. Finally, we predict the primary damage of 500 keV Fe ion in Fe and obtain cluster size distributions when large statistics of MD cascades are not feasible.

Patterning in systems driven by nonlocal external forces.

This work focuses on systems displaying domain patterns resulting from competing external and internal dynamics. To this end, we introduce a Lyapunov functional capable of describing the steady states of systems subject to external forces, by adding nonlocal terms to the Landau Ginzburg free energy of the system. Thereby, we extend the existing methodology treating long-range order interactions, to the case of external nonlocal forces. By studying the quadratic term of this Lyapunov functional, we compute the phase diagram in the temperature versus external field and we determine all possible modulated phases (domain patterns) as a function of the external forces and the temperature. Finally, we investigate patterning in chemical reactive mixtures and binary mixtures under irradiation, and we show that the last case opens the path toward micro-structural engineering of materials.

Giant peptic ulcer: a surgical or medical disease?

BACKGROUND: Medical management of giant peptic ulcers has traditionally been associated with significant morbidity and mortality rates, dictating the need for surgical intervention. METHODS: To determine if recent advances in therapy has reduced the number of patients who require surgical procedures, we reviewed the medical records of all patients with peptic ulcers of 2 cm or more at our institution from January 1991 to August 1996. RESULTS: We identified 75 patients with giant ulcers who were followed for a mean duration of 36 months. Sixty-three patients (84%) were managed without operation with a good outcome, documented by healing on repeat esophagogastroduodenoscopy and/or resolution of symptoms. Medical management included treatment of Helicobacter pylori infection, stopping nonsteroidal anti-inflammatory drugs, and potent acid suppression. Endoscopic intervention to control bleeding was successful in 7 patients (9%), and 2 patients (3%) were treated successfully with angiographic embolization. Only 12 patients (16%) required surgical intervention: 6 as the result of bleeding, 2 as the result of perforation, 1 as the result of obstruction, and 3 with intractable disease. CONCLUSIONS: In this series of patients with giant peptic ulcers, most patients (84%) were managed without surgical treatment. Our data suggest that improvements in medical therapy have obviated the need for eventual surgical intervention in most patients with giant ulcers.

Adenoviral-mediated gene transfer of a constitutively active retinoblastoma gene inhibits human pancreatic tumor cell proliferation.

BACKGROUND: The development of pancreatic cancer involves an accumulation of genetic changes, including oncogene activation and mutations in tumor suppressor genes important in cell cycle regulation. As a step to developing gene therapies to restore cell cycle control, we hypothesized that adenoviral-mediated gene transfer of a constitutively active, nonphosphorylatable form of the retinoblastoma gene (AdRb) would inhibit human pancreatic tumor cell proliferation. METHODS: Transfection efficiency was assessed by beta-gal staining with an adenovirus expressing the beta-galactosidase gene (AdLacZ). The effect of AdRb on DNA synthesis in pancreatic cancer cell lines was determined by tritiated thymidine incorporation. Western blotting with an antihemagglutinin antibody directed to the hemagglutinin-tagged AdRb construct was performed to confirm transfection of pancreatic cancer cells. Apoptosis was evaluated with a TUNEL assay. RESULTS: Efficient transfection of human pancreatic cancer cell lines was achieved with AdLacZ. AdRb inhibited tritiated thymidine uptake in the cancer cell lines BxPC-3, MIA PaCa-2, and PANC-1. Western blotting confirmed transfection of cancer cells with AdRb. AdRb did not inhibit growth by apoptosis. CONCLUSIONS: Adenoviral-mediated gene delivery of constitutively active Rb produces significant growth inhibition in human pancreatic cancer cell lines and is not a result of apoptosis. Further studies examining the role of Rb in pancreatic cancer are warranted.

Undescended superior parathyroid gland: a potential cause of failed cervical exploration for hyperparathyroidism.

BACKGROUND: The undescended inferior parathyroid gland is a well-established although infrequent embryologic abnormality resulting in an ectopically located gland usually associated with thymic tissue and is found most commonly within the carotid sheath at the level of the carotid bifurcation. Embryologically undescended superior glands (either normal or enlarged), clearly above the level of the upper pole of the thyroid gland and found within or in approximation to the lateral pharyngeal wall, have not been previously described. METHODS: The locations of all parathyroid glands at the time of cervical exploration were carefully examined as to embryologic origin in a combined experience of more than 3000 patients with primary or secondary hyperparathyroidism. RESULTS: Five patients had enlarged abnormal glands located within or in close approximation to the pharyngeal wall. All were above the upper pole of the thyroid gland. Two were identified at reoperation on the basis of localization studies. One gland was found after resection of a massive concomitant cervical goiter. The other two were found after an extensive search for a superior gland. CONCLUSIONS: Undescended superior glands are extremely rare (0.08%). They are located within or in approximation to the pharynx above the level of the thyroid gland with an unusual blood supply, which supports an embryologic rather than acquired cause for their ectopic location.

Riedel's thyroiditis: treatment with tamoxifen.

BACKGROUND: Riedel's thyroiditis is an often disabling disease with clinical and histologic similarity to several other fibrous inflammatory disorders. Surgical treatment alone is often unsatisfactory in permanently alleviating airway compression, dysphagia, neck immobility, pain, or chronic fatigue syndrome. Investigation of drugs shown to be of benefit in the treatment of related fibrous disorders in which hormonal factors or inflammatory deregulation appear to be important is indicated. Tamoxifen has not been previously used in the treatment of Riedel's thyroiditis. METHODS: Four patients with clinical and histologic diagnoses of Riedel's thyroiditis were evaluated before and after treatment with tamoxifen. Each had progressive symptomatic disease of 3 to 16 years' duration despite one or more surgical procedures and steroid therapy. Subjective improvement was noted in all cases, and objective changes were confirmed by periodic physical and computed tomographic examinations. RESULTS: Patients have been monitored for 1 to 4 years with subjective improvement in 100% and objective disease regression ranging from 50% to 100% in all patients. One patient had complete regression within 6 months, and another had more than 50% regression within 3 months. All have returned to predisease activity levels. There were no significant side effects of the therapy. CONCLUSIONS: Tamoxifen has proved to be the most effective drug therapy available for managing Riedel's thyroiditis. Our studies suggest that this is unrelated to antiestrogen activity. Tamoxifen's effectiveness may be caused by a mechanism by which it stimulates the release of transforming growth factor-beta, which may inhibit the fibroblastic proliferation characteristic of Riedel's thyroiditis.

Bombesin-mediated calcium fluxes in myenteric plexus neurons.

Dual excitation microfluorimetry (Fura-2) was used to measure changes in intracellular calcium ([Ca2+]i) in individual cultured guinea pig myenteric neurons. Bombesin (5-500 nM) induced concentration-dependent increases in [Ca2+]i responses, with a maximal effect at 500 nM (56% of neurons responding, mean peak Ca2+ response 244 +/- 25 nM vs. basal 65 +/- 7 nM). Removal of Ca2+ from the median did not affect the initial [Ca2+]i peak but eliminated the subsequent plateau phase. The [Ca2+]i responses to bombesin was abolished by preincubation with thapsigargin (1 microM), a Ca(2+)-ATPase inhibitor (91 +/- 7% inhibition). [Ca2+]i responses to bombesin were inhibited by U73122 (1 microM), an inhibitor of phospholipase C (84 +/- 6% inhibition).

Ca2+ signaling through secretagogue and growth factor receptors on pancreatic AR42J cells.

Intracellular signaling by an increase in [Ca2+]i was observed in pancreatic AR42J cells in response to agonists whose receptors are G-protein coupled including cholecystokinin (CCK), bombesin, carbachol, substance P, pituitary adenylate cyclase activating peptide (PACAP), bradykinin, ATP, calcitonin gene related peptide (CGRP), and in response to growth factors EGF and FGF whose receptors are tyrosine kinases. The response to growth factors was smaller both in magnitude and in the percentage of cells responding but was independent of extracellular Ca2+. CCK and carbachol induced sizeable increases in inositol phosphates while growth factors did not. The responses to both carbachol and EGF, however, were blocked by the phospholipase C inhibitor U73122. The tyrosine kinase inhibitor, genestein, blocked the response to EGF but not that to CCK. These data are consistent with two types of signaling mechanisms in AR42J cells. Secretagogues act on receptors which couple through G proteins to induce a large amount of inositol phosphate production and subsequent intracellular Ca2+ mobilization. Growth factors act on receptors which signal through tyrosine kinase activity and in this cell type produced limited amounts of inositol phosphate and a smaller increase in intracellular Ca2+.

Acetylcholine-induced calcium signaling associated with muscarinic receptor activation in cultured myenteric neurons.

BACKGROUND: Within the enteric nervous system, acetylcholine (ACh) is an important neurotransmitter. Experimental evidence has suggested that in myenteric neurons, calcium plays a key role in the coupling of cholinergic receptors to secretory responses. STUDY DESIGN: We investigated the effects of ACh on intracellular calcium concentration ([Ca2+]i) in individual myenteric neurons using fura-2 microspectrofluorometry. RESULTS: Resting [Ca2+]i in myenteric neurons was 62.5 +/- 3 nM. Acetylcholine produced dose-dependent increases in [Ca2+]i in myenteric neurons. As the concentration of ACh was increased from 0.1 to 100 microM, both the peak [Ca2+]i response as well as the percentage of responding neurons progressively increased, with a maximal effect at 100 microM (347 +/- 31 nM, 95 percent of neurons). The effect of ACh was not sensitive to pertussis toxin (100 ng/mL). Calcium ion (Ca2+) responses to ACh were abolished by removal of extracellular Ca2+ as well as exposure to nifedipine (10 microM). Characterization of the specific muscarinic subtype(s) involved in ACh-mediated Ca2+ transients was performed using the specific antagonists pirenzepine (M1), gallamine (M2), and 4-DAMP (M3). Pirenzepine (1 microM) blocked increases in [Ca2+]i induced by ACh; gallamine (1 microM) and 4-DAMP (1 microM) had no significant effect. Intracellular Ca2+ responses to ACh were not affected by incubation with the phorbol ester tetradecanoylphorbol-13-acetate (1 microM). CONCLUSIONS: These findings suggest that ACh induces increases in [Ca2+]i in myenteric neurons by promoting influx of extracellular Ca2+ through L-type voltage-dependent Ca2+ channels by activation of the M1 muscarinic receptor subtype. The Ca2+ response does not appear to involve a pertussis toxin-sensitive G protein.

Doctor-patient communication in surgery: attitudes and expectations of general surgery patients about the involvement and education of surgical residents.

BACKGROUND: Education is a major function of academic medical centers. At these teaching institutions residents provide a substantial amount of care on medical and surgical services. The attitudes of patients about the training of surgical residents and the impact of residents on patients' perceptions of care in a surgical setting are unknown. STUDY DESIGN: Patients admitted to the gastrointestinal surgery service completed a 30-item survey designed for this study. Patients included in the study underwent operations and had a postoperative inpatient hospital stay. We analyzed patients' answers to determine frequency and correlations among answers. RESULTS: Two hundred patients participated in the study during a 7-month period between July 1999 and January 2000. A majority of patients were comfortable having residents involved in their care (86%) and felt it was important to help educate future surgeons (91%). Most did not feel inconvenienced by being at a teaching hospital (71%) and felt they received extra attention there (74%). Patients were more willing to participate in resident education if they expected to have several physicians involved in their care, felt that they received extra attention, or if the teaching atmosphere did not inconvenience them. Despite the stated willingness of patients to help with surgical resident education, 32% answered that they would not want residents doing any of their operation. CONCLUSIONS: Surgical resident education is well received and considered important by patients. Patient orientation to the resident education process is vital to patients' perceptions of care and may render patients more willing to participate in educational activities.

Stimulation of myenteric plexus neurite outgrowth by insulin and insulin-like growth factors I and II.

A defined culture medium containing insulin, insulin-like growth factor I (IGF-I) or insulin-like growth factor II (IGF-II) supported morphological development of myenteric plexus neurons derived from neonatal guinea pigs. Insulin increased neurite outgrowth 3-fold at concentrations as low as 0.2 nM. Similar significant and dose-dependent increases in neurite outgrowth were noted with IGF-I and IGF-II. Stimulation of neurite outgrowth was abolished by exposure to cytosine arabinofuranoside, an agent toxic to non-neuronal cells, implying that trophic effects of insulin or insulin-like growth factors require the presence of non-neuronal elements in culture.