Impact of anthropogenic accumulation on phytoplankton community and harmful algal bloom in temporarily open/closed estuary.

Spatio-temporal variation in phytoplankton community dynamics in a temporarily open/closed Swarnamukhi river estuary (SRE), located on the South East coast of India was investigated and correlated to that of the adjacent coastal waters. Understanding the seasonal variability of the phytoplankton community and influencing factors are essential to predicting their impact on fisheries as the river and coastal region serve as the main source of income for the local fishing communities. Downstream before the river meets the sea, an arm of the Buckingham Canal (BC), carrying anthropogenic inputs empties into the Swarnamukhi River (SR1). The impact of anthropogenic effects on the phytoplankton community at BC was compared to other estuarine stations SR2 (upstream), SR1 (downstream), SRM (river mouth) and coastal station (CS). In BC station, harmful algal blooms (HABs) of Chaetoceros decipiens (2940 × 103 cells L-1) and Oscillatoria sp. (1619 × 103 cells L-1) were found during the southwest monsoon and winter monsoon, respectively. These HABs can be linked to the anthropogenic input of increased nutrients and trace metals. The HABs of Oscillatoria sp. were shown to be induced by elevated concentrations of nitrate (10.18 µM) and Ni (3.0 ppm) compared to ambient, while the HABs of C. decipiens were caused by elevated concentrations of silicate (50.35 µM), nitrite (2.1 µM), and phosphate (4.37 µM). Elevated nutrients and metal concentration from the aquaculture farms, and other anthropogenic inputs could be one of the prime reasons for the recorded bloom events at BC station. During this period, observed bloom species density was found low at other estuarine stations and absent at CS. The formation of bloom events during the closure of the river mouth could be a major threat to the coastal ecosystem when it opens. During the Osillatoria sp. bloom, both the Cu and Ni levels were higher at BC. The elevated concentration of nutrients and metals could potentially affect the coastal ecosystem and in turn fisheries sector in the tropical coastal ecosystem.

Bioprospecting of unexplored halophilic actinobacteria against human infectious pathogens.

Human pathogenic diseases received much attention recently due to their uncontrolled spread of antimicrobial resistance (AMR) which causes several threads every year. Effective alternate antimicrobials are urgently required to combat those disease causing infectious microbes. Halophilic actinobacteria revealed huge potentials and unexplored cultivable/non-cultivable actinobacterial species producing enormous antimicrobials have been proved in several genomics approaches. Potential gene clusters, PKS and NRPKS from Nocardia, Salinospora, Rhodococcus, and Streptomyces have wide range coding genes of secondary metabolites. Biosynthetic pathways identification via various approaches like genome mining, In silico, OSMAC (one strain many compound) analysis provides better identification of knowing the active metabolites using several databases like AMP, APD and CRAMPR, etc. Genome constellations of actinobacteria particularly the prediction of BGCs (Biosynthetic Gene Clusters) to mine the bioactive molecules such as pigments, biosurfactants and few enzymes have been reported for antimicrobial activity. Saltpan, saltlake, lagoon and haloalkali environment exploring potential actinobacterial strains Micromonospora, Kocuria, Pseudonocardia, and Nocardiopsis revealed several acids and ester derivatives with antimicrobial potential. Marine sediments and marine macro organisms have been found as significant population holders of potential actinobacterial strains. Deadly infectious diseases (IDs) including tuberculosis, ventilator-associated pneumonia and Candidiasis, have been targeted by halo-actinobacterial metabolites with promising results. Methicillin resistant Staphylococus aureus and virus like Encephalitic alphaviruses were potentially targeted by halophilic actinobacterial metabolites by the compound Homoseongomycin from sponge associated antinobacterium. In this review, we discuss the potential antimicrobial properties of various biomolecules extracted from the unexplored halophilic actinobacterial strains specifically against human infectious pathogens along with prospective genomic constellations.

Gracilaria salicornia as potential substratum for green synthesis of Cerium Oxide Nanoparticles coupled hydrogel: An effective antimicrobial thin film.

Sodium alginate based (SA) hydrogel supplemented Cerium Oxide nanoparticles (CeO2NPs) was produced to fabricate an antimicrobial thin film using an aqueous extract of G. salicornia (Gs). The Gs-CeO2NPs were characterized via SEM, FT-IR, EDX, XRD and DLS, the particle size was 200 nm, agreed with XRD. Gs-SA powder was extracted and incorporated with CeO2NPs. The Gs-SA and its composite thin film (Gs-CeO2NPs-SATF) were characterized including viscosity, FT-IR, TGA, and SEM. The adhesion of Gs-SA coating around Gs-CeO2NPs confirmed via FTIR. The antimicrobial properties of Gs-CeO2NPs and CeO2NPs-SATF were proved in MICs for E. coli and Candida albicans at 62.5 and 250.0 µg/mL. The biofilm inhibition efficiency of CeO2NPs-SATF was 74.67 ± 0.98% and 65.45 ± 0.40% for E. coli and Candida albicans. The CeO2NPs-SATF was polydisperse in nature and film structure gets fluctuated with NPs concentration. Increased NPs into SATF enhances pore size of gel and corroborated with viscous behaviour. The cytotoxicity of Gs-CeO2NP-SA in Artemia salina at higher concentration 100 µg/mL provides less lethal effect into the adult. The antioxidant activity of Gs-CeO2NP-SA in DPPH assay was noticed at 0.6 mg ml-1 with radical scavenging activity at 65.85 ± 0.81%. Thus the Gs-CeO2NP-SATF would be suitable in antimicrobial applications.

Inguinal lymph node metastases from rectal adenocarcinoma: a systematic review.

PURPOSE: Inguinal lymph nodes are a rare but recognised site of metastasis in rectal adenocarcinoma. No guideline or consensus exists for the management of such cases. This review aims to provide a contemporary and comprehensive analysis of the published literature to aid clinical decision-making. METHODS: Systematic searches were performed using the PubMed, Embase, MEDLINE and Scopus and Cochrane CENTRAL Library databases from inception till December 2022. All studies reporting on the presentation, prognosis or management of patients with inguinal lymph node metastases (ILNM) were included. Pooled proportion meta-analyses were completed when possible and descriptive synthesis was utilised for the remaining outcomes. The Joanna Briggs Institute tool for case series was used to assess the risk of bias. RESULTS: Nineteen studies were eligible for inclusion, encompassing 18 case series and one population-based study using national registry data. A total of 487 patients were included in the primary studies. The prevalence of ILNM in rectal cancer is 0.36%. ILNM are associated with very low rectal tumours with a mean distance from the anal verge of 1.1 cm (95% CI 0.92-1.27). Invasion of the dentate line was found in 76% of cases (95% CI 59-93). In patients with isolated inguinal lymph node metastases, modern chemoradiotherapy regimens in combination with surgical excision of inguinal nodes are associated with 5-year overall survival rates of 53-78%. CONCLUSION: In specific subsets of patients with ILNM, curative-intent treatment regimens are feasible, with oncological outcomes akin to those demonstrated in locally advanced rectal cancers.

Hydrothermal synthesis of spindle structure copper ferrite-graphene oxide nanocomposites for enhanced photocatalytic dye degradation and in-vitro antibacterial activity.

In this study, a one-step hydrothermal approach was used to make pure magnetic copper ferrite (CuFe2O4) and copper ferrite-graphene oxide (CuFe2O4-rGO) nanocomposites (NCs) and spinel structure CuFe2O4 with a single phase of tetragonal CuFe2O4-rGO-NCs was confirmed by the XRD. Then, characterization of CuFe2O4-rGO-NCs was done using ng Raman spectroscopy, FT-IR, TGA-DTA, EDS, SEM, and TEM. The synthesized NCs was exposed to UV light to evaluate its photocatalytic activity for the degradation of methylene blue (MB) and rhodamine B (RhB) with CuFe2O4 and CuFe2O4-rGO-NCs, respectively. The catalyst CuFe2O4-rGO-NCs provided higher degradation of MB (94%) than for RhB (86%) under UV light irradiation compared to CuFe2O4. Further, the antibacterial activities of CuFe2O4-NPs and CuFe2O4-rGO-NCs were tested against Gram-negative and -positive bacterial pathogens such as Vibrio cholera (V. cholera); Escherichia coli (E. coli); Pseudomonas aeruginosa (P. aeruginosa); Bacillus subtilis (B. subtilis); Staphylococcus aureus (S. aureus); and Staphylococcus epidermidis (S. epidermidis) by well diffusion method. At 100 µg/mL concentrations of CuFe2O4-rGO-NCs, maximal growth inhibition was shown against E. coli (18 mm) and minimum growth inhibition against S. epidermidis (12 mm). This study suggests that CuFe2O4-rGO-NCs as a high-efficacy antibacterial material and plays an important role in exhibiting higher sensitivity depending on concentrations. The results encourage that the synthesized CuFe2O4-rGO-NCs can be used as a promising material for the antibacterial activity and also for dye degradation in the water/wastewater treatment plants.

Genomic and metabolic properties of Staphylococcus gallinarum FCW1 MCC4687 isolated from naturally fermented coconut water towards GRAS assessment.

Staphylococcus gallinarum FCW1 was isolated from naturally fermented coconut-water and identified by biochemical and molecular methods. Probiotic characterization and safety assessment were conducted through a series of in vitro tests. A high survival rate was observed when the strain was tested for resistance to bile, lysozyme, simulated gastric and intestinal fluid, phenol, and different temperature and salt concentrations. The strain showed antagonism against some pathogens, was susceptible to all antibiotics tested except penicillin, and showed no hemolytic and DNase activity. Hydrophobicity, autoaggregation, biofilm formation, and antioxidation tests indicated that the strain possessed a high adhesive and antioxidant ability. Enzymatic activity was used to evaluate the metabolic capacities of the strain. In-vivo experiment on zebrafish was performed to check its safety status. The whole-genome sequencing indicated that the genome contained 2,880,305 bp with a GC content of 33.23%. The genome annotation confirmed the presence of probiotic-associated genes and genes for oxalate degradation, sulfate reduction, acetate metabolism, and ammonium transport in the FCW1 strain, adding to the theory that this strain may be helpful in treating kidney stones. This study revealed that the strain FCW1 might be an excellent potential probiotic in developing fermented coconut beverages and treating and preventing kidney stone disease.

Synthesis of Bimetallic BiPO4/ZnO Nanocomposite: Enhanced Photocatalytic Dye Degradation and Antibacterial Applications.

Multidrug-resistant strains (MDRs) are becoming a major concern in a variety of settings, including water treatment and the medical industry. Well-dispersed catalysts such as BiPO4, ZnO nanoparticles (NPs), and different ratios of BiPO4/ZnO nanocomposites (NCs) were synthesized through hydrothermal treatments. The morphological behavior of the prepared catalysts was characterized using XRD, Raman spectra, PL, UV-Vis diffuse reflectance spectroscopy (UV-DRS), SEM, EDX, and Fe-SEM. MDRs were isolated and identified by the 16s rDNA technique as belonging to B. flexus, B. filamentosus, P. stutzeri, and A. baumannii. The antibacterial activity against MDRs and the photocatalytic methylene blue (MB) dye degradation activity of the synthesized NPs and NCs were studied. The results demonstrate that the prepared BiPO4/ZnO-NCs (B1Z4-75:300; NCs-4) caused a maximum growth inhibition of 20 mm against A. baumannii and a minimum growth inhibition of 12 mm against B. filamentosus at 80 µg mL-1 concentrations of the NPs and NCs. Thus, NCs-4 might be a suitable alternative to further explore and develop as an antibacterial agent. The obtained results statistically justified the data (p ≤ 0.05) via one-way analysis of variance (ANOVA). According to the results of the antibacterial and photocatalytic study, we selected the best bimetallic NCs-4 for the photoexcited antibacterial effect of MDRs, including Gram ve+ and Gram ve- strains, via UV light irradiation. The flower-like NCs-4 composites showed more effectiveness than those of BiPO4, ZnO, and other ratios of NCs. The results encourage the development of flower-like NCs-4 to enhance the photocatalytic antibacterial technique for water purification.

Evaluating different web applications to assess the toxicity of plasticizers.

Plasticizers increase the flexibility of plastics. As environmental leachates they lead to increased water and soil pollution, as well as to serious harm to human health. This study was set out to explore various web applications to predict the toxicological properties of plasticizers. Web-based tools (e.g., BOILED-Egg, LAZAR, PROTOX-II, CarcinoPred-EL) and VEGA were accessed via an 5th-10th generation computer in order to obtain toxicological predictions. Based on the LAZAR mutagenicity assessment was only bisphenol F predicted as mutagenic. The BBP and DBP in RF; DEHP in RF and XGBoost; DNOP in RF and XGBoost models were predicted as carcinogenic in the CarcinoPred-EL web application. From the bee predictive model (KNN/IRFMN) BPF, di-n-propyl phthalate, diallyl phthalate, dibutyl phthalate, and diisohexyl phthalate were predicted as strong bee toxicants. Acute toxicity for fish using the model Sarpy/IRFMN predicted 19 plasticizers as strong toxicants with LC50 values of less than 1 mg/L. This study also considered plasticizer effects on gastrointestinal absorption and other toxicological endpoints.

Bioactive Efficacy of Novel Carboxylic Acid from Halophilic Pseudomonas aeruginosa against Methicillin-Resistant Staphylococcus aureus.

Methicillin-resistant Staphylococcus aureus (MRSA) infections are increasingly causing morbidity and mortality; thus, drugs with multifunctional efficacy against MRSA are needed. We extracted a novel compound from the halophilic Pseudomonas aeruginosa using an ethyl acetate (HPAEtOAcE). followed by purification and structure elucidation through HPLC, LCMS, and 1H and 13C NMR, revealing the novel 5-(1H-indol-3-yl)-4-pentyl-1,3-oxazole-2-carboxylic acid (Compound 1). Molecular docking of the compound against the MRSA PS (pantothenate synthetase) protein was confirmed using the CDOCKER algorithm in BDS software with specific binding to the amino acids Arg (B:188) and Lys (B:150) through covalent hydrogen bonding. Molecular dynamic simulation of RMSD revealed that the compound-protein complex was stabilized. The proficient bioactivities against MRSA were attained by the HPAEtOAcE, including MIC and MBCs, which were 0.64 and 1.24 µg/mL, respectively; 100% biomass inhibition and 99.84% biofilm inhibition were observed with decayed effects by CLSM and SEM at 48 h. The hla, IrgA, and SpA MRSA genes were downregulated in RT-PCR. Non-hemolytic and antioxidant potential in the DPPH assay were observed at 10 mg/mL and IC50 29.75 ± 0.38 by the HPAEtOAcE. In vitro growth inhibition assays on MRSA were strongly supported by in silico molecular docking; Lipinski's rule on drug-likeness and ADMET toxicity prediction indicated the nontoxic nature of compound.

Primary Tumor Resection is Associated with Improved Disease-Specific Mortality in Patients with Stage IV Small Intestinal Neuroendocrine Tumors (NETs): A Comparison of Upfront Surgical Resection Versus a Watch and Wait Strategy in Two Specialist NET Centers.

INTRODUCTION: Small intestinal neuroendocrine tumors (SI-NETs) often present with metastatic disease. An ongoing debate exists on whether to perform primary tumor resection (PTR) in patients with stage IV SI-NETs, without symptoms of the primary tumor and inoperable metastatic disease. OBJECTIVE: The aim of this study was to compare a treatment strategy of upfront surgical resection versus a surveillance strategy of watch and wait. METHODS: This was a retrospective cohort study of patients with stage IV SI-NETs at diagnosis, between 2000 and 2018, from two tertiary referral centers (Netherlands Cancer Institute [NKI] and Aintree University Hospital [AUH]) who had adopted contrasting treatment approaches: upfront surgical resection and watch and wait, respectively. Patients without symptoms related to the primary tumor were included. Multivariable intention-to-treat (ITT), per-protocol (PP), and instrumental variable (IV) analyses using 'institute' as an IV were performed to assess the influence of PTR on disease-specific mortality (DSM). RESULTS: A total of 557 patients were identified, with 145 patients remaining after exclusion of stage I-III disease or symptoms of the primary tumor (93 from the NKI and 52 from AUH). The cohorts differed in performance status (PS; p = 0.006) and tumor grade (p < 0.001). PTR was independently associated with reduced DSM irrespective of statistical methods employed: ITT hazard ratio [HR] 0.60, p = 0.005; PP HR 0.58, p < 0.001; and IV HR 0.07, p = 0.019. Other factors associated with DSM were age, PS, high chromogranin A, and somatostatin analog treatment. CONCLUSION: Taking advantage of contrasting institutional treatment strategies, this study identified PTR as an independent predictor of DSM. Future prospective studies should aim to validate these results.

Recent Antimicrobial Responses of Halophilic Microbes in Clinical Pathogens.

Microbial pathogens that cause severe infections and are resistant to drugs are simultaneously becoming more active. This urgently calls for novel effective antibiotics. Organisms from extreme environments are known to synthesize novel bioprospecting molecules for biomedical applications due to their peculiar characteristics of growth and physiological conditions. Antimicrobial developments from hypersaline environments, such as lagoons, estuaries, and salterns, accommodate several halophilic microbes. Salinity is a distinctive environmental factor that continuously promotes the metabolic adaptation and flexibility of halophilic microbes for their survival at minimum nutritional requirements. A genetic adaptation to extreme solar radiation, ionic strength, and desiccation makes them promising candidates for drug discovery. More microbiota identified via sequencing and 'omics' approaches signify the hypersaline environments where compounds are produced. Microbial genera such as Bacillus, Actinobacteria, Halorubrum and Aspergillus are producing a substantial number of antimicrobial compounds. Several strategies were applied for producing novel antimicrobials from halophiles including a consortia approach. Promising results indicate that halophilic microbes can be utilised as prolific sources of bioactive metabolites with pharmaceutical potentialto expand natural product research towards diverse phylogenetic microbial groups which inhabit salterns. The present study reviews interesting antimicrobial compounds retrieved from microbial sources of various saltern environments, with a discussion of their potency in providing novel drugs against clinically drug-resistant microbes.

Shallow Hydrothermal Vent Bacteria and Their Secondary Metabolites with a Particular Focus on Bacillus.

Extreme environments are hostile for most organisms, but such habitats represent suitable settings to be inhabited by specialized microorganisms. A marine shallow-water hydrothermal vent field is located offshore in northeast Taiwan, near the shallow shore of the southeast of Kueishantao Island (121°55' E, 24°50' N). Research on extremophilic microorganisms makes use of the biotechnological potential associated with such microorganisms and their cellular products. With the notion that extremophiles are capable of surviving in extreme environments, it is assumed that their metabolites are adapted to function optimally under such conditions. As extremophiles, they need specific culture conditions, and only a fraction of species from the original samples are recovered in culture. We used different non-selective and selective media to isolate bacterial species associated with the hydrothermal vent crab Xenograpsus testudinatus and the sediments of its habitat. The highest number of colonies was obtained from Zobell marine agar plates with an overall number of 29 genetically distinct isolates. 16sRNA gene sequencing using the Sanger sequencing method revealed that most of the bacterial species belonged to the phylum Firmicutes and the class Bacilli. The present study indicates that hydrothermal vent bacteria and their secondary metabolites may play an important role for the reconstruction of the evolutionary history of the phylum Procaryota.

Rising incidence of colorectal cancer in individuals younger than 50 years and increasing mortality from rectosigmoid cancer in England.

AIM: The aim was to describe changes in incidence and mortality from colorectal cancer (CRC) in England by analysing data available from the National Cancer Registration and Analysis Service (NCRAS, 2001-2017). METHODS: Data analysis was undertaken to interpret trends and patterns in age-standardized incidence and death rates from CRC, including sub-analyses by six age groups (0-24, 25-49, 50-59, 60-69, 70-79, 80+) and three sites of cancer-colonic, rectosigmoid and rectal. RESULTS: Overall CRC incidence remained relatively stable-70.1 cases per 100 000 individuals (95% CI 69.3-71.0) in 2001 and 68.8 cases (95% CI 68.0-69.5) in 2017. Sub-analysis demonstrates a quarter fewer incidence of rectosigmoid cancer (-27%). This is counterbalanced by a 3% rise in colon cancers. The age-standardized incidence rate of CRC increased by 59% in the 25-49 age group. In the over 50s, CRC incidence remained stable, with reductions seen in rectosigmoid cancer (50-59 years, -19%; 60-69, -26%; 70-79, -39%; 80+, -27%). Overall, mortality improved (-18.7%), primarily as a result of the reduction in deaths from colon (-31.6%) and rectal cancers (-25.1%). Deaths from the small incident number of rectosigmoid cancers, however, demonstrated a significant increase overall (+166.7%). Grouped age-standardized death rate analyses showed increasing death rates in the under 50s (+28.3%) compared to declining rates in the over 50s (-15.8%). CONCLUSIONS: There is a clear trend in increased incidence and mortality in individuals under 50 years old. There is also a trend to increased mortality from rectosigmoid cancer. These findings should have implications for national screening programme extension to under 50s and a call to arms for appropriate identification, staging and treatment of rectosigmoid cancers.

The Value of Character-Based Judgement in the Professional Domain.

Dimensions of character are often overlooked in professional practice at the expense of the development of technical competence and operational efficiency. Drawing on philosophical accounts of virtue ethics and positive psychology, the present work attempts to elevate the role of 'good' character in the professional domain. A 'good' professional is ideally one that exemplifies dimensions of character informed by sound judgement. A total of 2340 professionals, from five discrete professions, were profiled based on their valuation of qualities pertaining to character and judgement. Profile differences were subsequently examined in the self-reported experience of professional purpose towards a wider societal 'good'. Analysis of covariance, controlling for stage of career, revealed that professionals valuing character reported higher professional purpose than those overweighting the importance of judgement or valuing neither character nor judgement, F(3, 2054) = 7.92, p < .001. No differences were found between the two groups valuing character, irrespective of whether judgement was valued simultaneously. This profiling analysis of entry-level and in-service professionals, based on their holistic character composition, paves the way for fresh philosophical discussion regarding what constitutes a 'good' professional and the interplay between character and judgement. The empirical findings may be of substantive value in helping to recognise how the dimensions of character and judgement may impact upon practitioners' professional purpose.

Developing a Parental-Friendly Scoring System for Children with Congenital Hand Differences.

Background: Congenital hand differences (CHD) exhibit enormous diversity and heterogeneity. Surgeons and parents often have different concepts of severity, making things difficult during parental consultation. This study aims to align surgeon/parental views on the severity of the child's CHD using a novel severity classification. Methods: Parents of affected children were asked to score the severity of their child's abnormality pre- and post-consultation using a subjective scale (1-4) without any explanation. Furthermore, parents were asked to rate their concerns about the future function and appearance of their child's hand condition using a similar scale of 1-4. They were then asked to rate the severity of the CHD post-consultation and three months post-operatively following explanation of the 4-point scale, as follows: 1 = treatment possible to normal; 2 = treatment possible to near normal; 3 = treatment possible but always some hand differences; 4 = treatment not possible. The surgeon also independently scored all children using his perception of the scale. Results: Forty-three children with a range of CHD were recruited into the sample. Linear weighted kappa analyses comparing inter-rater agreement showed no agreement between surgeon and parents during the initial scoring without any explanations. However, with explanations added, agreement rose significantly (kappa = 0.437 post-consultation and kappa = 0.706 three months post-op). No correlation was found between severity with both appearance and function (r = 0.277 and r = -0.184, respectively). Conclusions: This study demonstrated that the use of a simple scoring system was able to improve parental understanding of the severity and prognosis of CHD. The system demonstrated a good correlation between surgeon and parents. Such a scoring system can be easily utilised in the outpatient department to manage expectations and reduce anxiety.

Consultant versus trainee led surgery and impact on outcome following an emergency colonic resection.

PURPOSE: Emergency colonic surgery carries a high mortality rate. In the UK, strategies to improve outcomes in emergency general surgery recommend a consultant surgeon to be physically present during all operations involving a patient with a predicted mortality > 5%. To test the assertion of the consultant surgeon's presence in theatre as a determinate of improved outcome, we assessed patients following an emergency colonic resection and the effect of operator seniority. METHODS: A retrospective analysis was undertaken for all patients undergoing an emergency colonic resection during a 4-year period between 2013 and 2017. Patient's pre-operative risk was assessed using P-POSSUM score and ASA grade. Outcomes assessed were post-operative morbidity (recorded using Clavien-Dindo classification), 30 day/inpatient mortality and length of stay (LOS). Outcomes were then compared between consultant and trainee led cases using univariate logistic regression techniques with results presented in terms of odds ratios (95% confidence intervals). A p value of 0.05 is used to determine statistical significance. RESULTS: A total of 130 patients were identified over the 4-year study period. 65% had their operation performed by a consultant and 35% by a trainee. Pre-operative P-POSSUM scores were the same between the groups (9.4% [5.0-25.2] vs 9.4% [4.9-28.6] p 0.75). There was no significant difference in post-operative complication rates between consultant and trainee led cases for minor (OR 1.58 [0.76-3.20] p 0.27) or major complications (OR 1.08 [0.50-2.31] p 0.84). Overall post-operative mortality was 14% with a trend for higher mortality rates in consultant led cases (15% vs 9%) albeit not statistically significant (p 0.57). Despite similar complication rates, trainee led operations were associated with slightly longer LOS at 19 (IQR 12-38) vs 15 (IQR 9-23) days (p 0.56). CONCLUSION: Emergency colonic surgery remains associated with a high level of morbidity and mortality. However, consultant presence at the operating table does not appear to be the sole determinant of outcome following an emergency colonic resection.

Laparoscopic Surgery Is Safe and Beneficial in True Functional High-Risk Patients with Colorectal Cancer: Utilization of Cardiopulmonary Exercise Test.

Background: Patients with colorectal cancer deemed to be high-risk may be denied an elective laparoscopic resection due to subjective reasons. A comparison of the 30-day outcomes in true functional high-risk patients who underwent either open or laparoscopic colorectal resection was undertaken. Materials and Methods: A retrospective cohort of all functional high-risk patients as assessed by cardiopulmonary exercise test between July 2015 and April 2018 were identified. Anaerobic threshold of <11 mL/kg/minute was used as a physiologic indicator to determine a high-risk patient. Adherence to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) was ensured. P values were computed via two-sided Fisher's exact test, and the exact Mann-Whitney U-test. Forest plots for relative risks with 95% confidence intervals were displayed on a log scale. Results: One hundred forty-six patients were identified as high-risk. Outcomes demonstrated a trend to laparoscopic benefit in all Clavien-Dindo grades of postoperative complications, but especially in severe complications of grades 3-4 (3.5% versus 10.2%). Readmissions demonstrated a trend to laparoscopic surgery benefit (7% versus 11.8%), as did mortality (1.7% versus 3.4%). The rate of surgery-site complications was higher after open surgery (42.1% versus 22.4%, P = .0201). Wound infections were observed more frequently after open surgery (12.5% versus 1.72%, P = .0280). The estimated risk of all-grade complications was significantly higher after open anterior rectal resection (63.0% versus 29.6%, P = .0281) and there was significantly shorter stay after laparoscopic right colectomy (5 v. 7 days, P = .0490). Conclusions: Laparoscopic approach for colorectal resections in high-risk patients is safe and beneficial compared to open surgery, especially in patients undergoing laparoscopic resection of the rectum and right colon.

Spectrally efficient optical orthogonal frequency division multiplexing.

This paper charts the development of spectrally efficient forms of optical orthogonal frequency division multiplexing (OFDM) that are suited for intensity-modulated direct detection systems, such as wireless optical communications. The journey begins with systems using a DC-bias to ensure that no parts of the signal that modulates the optical source are negative in value, as negative optical intensity is unphysical. As the DC-part of the optical signal carries no information, it is wasteful in energy; thus asymmetrically clipped optical OFDM was developed, removing any negative-going peaks below the mean. Unfortunately, the clipping causes second-order distortion and intermodulation, so some subcarriers appear to be unusable, halving spectral efficiency; this is similar for unipolar and flipped optical OFDM. Thus, a considerable effort has been made to regain spectral efficiency, using layered techniques where the clipping distortion is mostly cancelled at the receiver, from a knowledge of one unpolluted layer, enabling one or more extra 'layers/paths/depths' to be received on the previously unusable subcarriers. Importantly, for a given optical power and high-order modulation, layered methods offer the best spectral efficiencies and need the lowest signal-to-noise ratios, especially if diversity combining is used. Thus, they could be important for high-bandwidth optical fibre systems. Efficient methods of generating all layers simultaneously, using fast Fourier transforms with their partial calculations extracted, are discussed, as are experimental demonstrations in both wireless and short-haul communications links. A musical analogy is also provided, which may point to how orchestral and rock music is deciphered in the brain. This article is part of the theme issue 'Optical wireless communication'.