When to Consider Lynch Syndrome in Non-Colon and Non-Endometrial Malignancies.

Lynch syndrome (LS) is a common genetic syndrome characterized by pathogenic mutations of DNA mismatch repair genes resulting in a hereditary predisposition to cancer. While typically associated with colonic and endometrial cancer, LS additionally influences the development of many other malignancies. The Amsterdam II and Revised Bethesda Guidelines are the established clinical criteria for diagnosing LS. These guidelines are based on the most general characteristics of LS and do not address specific characteristics of the less commonly LS-associated malignancies. For individuals that present initially with a non-colon and non-endometrial malignancy, recommendations and guidelines on when to consider screening for LS are limited. Therefore, it is essential that clinicians are familiar with distinct LS-associated patient- and tumor-specific characteristics, especially of the less common LS-associated cancers, so that LS's diagnosis is not missed. In this review article, we focus on extra-colonic and extra-endometrial LS-associated cancers, paying particular attention to any established or currently investigated cancer features that help raise suspicion for LS and potentially lead to its earlier diagnosis. This review will also discuss current guidelines specific to each LS-associated malignancy.

Optimal Pain Control after Outpatient Surgery for Cutaneous Malignancies.

Postoperative pain managed with opioids has contributed to the opioid crisis through overprescribing practices. We assessed opioid-prescribing habits and their use by patients undergoing surgery for cutaneous malignancies. An Institutional Review Board-approved retrospective analysis was conducted for patients who underwent skin cancer resection between January 2018 and June 2018. Data were collected from the electronic medical record, and opioid-related data were collected from patient interviews and state registries. There were 120 study participants (42 females and 78 males) with a median age of 67 years (range, 21-94 years). All received preincision local anesthetic: 64 had liposomal bupivacaine (LB) (53%) and 56 had non-LB bupivacaine (47%). Most participants (n = 88) used 0 opioids (73%), including 43 LB-anesthetic (67%) and 45 non-LB-anesthetic (80%). No significance was seen between those with a diagnosis of chronic pain, narcotic tolerance, an area of resection, and nodal sampling groups in opioid use. Four patients (3%) requested a refill. Of 105 prescriptions written for opioids, 99 had leftover opioids for an overprescribing rate of 94 per cent. This study suggests pain after skin cancer surgery is manageable with very limited opioid requirements. Our results support prescribing no more than five opioid tablets for postoperative pain control in patients undergoing resection for skin malignancies.

Human Acellular Dermal Matrix Is a Viable Alternative to Autologous Skin Graft in Patients with Cutaneous Malignancy.

Skin substitutes have shown success in complex wound reconstruction. We evaluate the use of a human acellular dermal matrix (ADM) as a viable alternative to autologous skin grafting for defects secondary to skin cancer excision. An institutional review board-approved, retrospective review of ADM-reconstructed defects secondary to skin cancer excision between 2012 and 2018 was conducted. ADM was indicated in patients with preclusive factors for general anesthesia, protracted procedure time, reluctance for additional donor site wound, and personal choice. We reviewed defect characteristics, healing time, postoperative outcomes, and patient demographics. The 228 participants (151 males, 77 females) had a median age of 72 years (range, 29-95 years), with melanoma diagnosed in 113 (49.6%), squamous cell carcinoma in 61 (26.8%), and basal cell carcinoma in 28 (12.2%) patients. The median interval to complete epidermal coverage was 42 days, with graft failure evident in six patients (2.6%). ADM is a viable, low-morbid alternative for reconstruction of defects secondary to skin cancer excision, with no donor site morbidity. With exception to complete healing time, outcomes are similar to those of autologous grafting.

Nutrient recovery from wastewater through pilot scale electrodialysis.

Nutrient recovery performance utilising an electrodialysis (ED) process was quantified in a 30-cell pair pilot reactor with a 7.2 m2 effective membrane area, utilising domestic anaerobic digester supernatant, which had been passed through a centrifuge as a feed source (centrate). A concentrated product (NH4-N 7100 ±â€¯300 mg/L and K 2490 ±â€¯40 mg/L) could be achieved by concentrating nutrient ions from the centrate wastewater dilute feed stream to the product stream using the ED process. The average total current efficiency for all major cations over the experimental period was 76 ±â€¯2% (NH4-N transport 40%, K transport 14%). The electrode power consumption was 4.9 ±â€¯1.5 kWh/kgN, averaged across the three replicate trials. This value is lower than competing technologies for NH4-N removal and production, and far lower than previous ED lab trials, demonstrating the importance of pilot testing. No significant variation in starting flux densities and cell resistance voltage for subsequent replicate treatments indicated effective cleaning procedures and operational sustainability at treatment durations of several days. This study demonstrates that ED is an economically promising technology for the recovery of nutrients from wastewater.

Predicting scale formation during electrodialytic nutrient recovery.

Electro-concentration of nutrients from waste streams is a promising technology to enable resource recovery, but has several operational concerns. One key concern is the formation of inorganic scale on the concentrate side of cation exchange membranes when recovering nutrients from wastewaters containing calcium, magnesium, phosphorous and carbonate, commonly present in anaerobic digester rejection water. Electrodialytic nutrient recovery was trialed on anaerobic digester rejection water in a laboratory scale electro-concentration unit without treatment (A), following struvite recovery (B), and following struvite recovery as well as concentrate controlled at pH 5 for scaling control (C). Treatment A resulted in large amount of scale, while treatment B significantly reduced the amount of scale formation with reduction in magnesium phosphates, and treatment C reduced the amount of scale further by limiting the formation of calcium carbonates. Treatment C resulted in an 87 ± 7% by weight reduction in scale compared to treatment A. A mechanistic model for the inorganic processes was validated using a previously published general precipitation model based on saturation index. The model attributed the reduction in struvite scale to the removal of phosphate during the struvite pre-treatment, and the reduction in calcium carbonate scale to pH control resulting in the stripping of carbonate as carbon dioxide gas. This indicates that multiple strategies may be required to control precipitation, and that mechanistic models can assist in developing a combined approach.

Microalgae digestate effluent as a growth medium for Tetraselmis sp. in the production of biofuels.

This study investigated an alternative nutrient source arising from anaerobically digested Tetraselmis sp. effluent (MDE) as a nutrient feed stock to form a closed loop nutrient system. To determine MDE suitability the following factors were observed: growth, lipid content, and the bacterial diversity. MDE was diluted according to the concentration of NH4(+) content (20, 40, 60, 80 mg/L) and compared against F/2 medium a standard medium for Tetraselmis sp. The growth rate on the MDE medium was not as rapid as the F/2 medium and the less diluted MDE correlated (R(2)) with lower total lipid contents (R(2), 0.927), additionally acyl carrier proteins (ACP) gene expression rates displayed lower gene expression within MDE treatments. Lastly, higher concentrations of MDE were correlated with a higher bacterial diversity throughout the investigation. The suitability of MDE as a nutrient supplement for the production of Tetraselmis sp. biomass and lipid is feasible.

Utilising bacterial communities associated with digested piggery effluent as a primary food source for the batch culture of Moina australiensis.

In this study, a cladoceran planktonic invertebrate, Moina australiensis was uniquely cultured in two stage digested piggery wastewater and fed associated piggery wastewater bacteria. The viability of M. australiensis cultured in digested piggery wastewater under closed dark conditions to limit phytoplankton activity was tested by determining suitable effluent total ammonia nitrogen (TAN) concentrations. The highest total M. australiensis biomass production 0.94+/-0.47g and the rate of population increase (r) 0.15+/-0.08 was recorded in the 30mgl(-1) TAN concentration treatment. The lowest 'r' values and decreased biomass production was observed with increasing TAN concentration levels. This study, also focused on profiling and quantification of the associated bacterial populations in the wastewater culture media and within the digestive tract of M. australiensis by denaturing gradient gel electrophoresis (DGGE) and real-time polymerase chain reaction (RT-PCR) which revealed the feeding specificity of M. australiensis towards "gamma-Proteobacteria."

Firing back: how great leaders rebound after career disasters.

Among the tests of a leader, few are more challenging-and more painful-than recovering from a career catastrophe. Most fallen leaders, in fact, don't recover. Still, two decades of consulting experience, scholarly research, and their own personal experiences have convinced the authors that leaders can triumph over tragedy--if they do so deliberately. Great business leaders have much in common with the great heroes of universal myth, and they can learn to overcome profound setbacks by thinking in heroic terms. First, they must decide whether or not to fight back. Either way, they must recruit others into their battle. They must then take steps to recover their heroic status, in the process proving, both to others and to themselves, that they have the mettle necessary to recover their heroic mission. Bernie Marcus exemplifies this process. Devastated after Sandy Sigoloff ired him from Handy Dan, Marcus decided to forgo the distraction of litigation and instead make the marketplace his batttleground. Drawing from his network of carefully nurtured relationships with both close and more distant acquaintances, Marcus was able to get funding for a new venture. He proved that he had the mettle, and recovered his heroic status, by building Home Depot, whose entrepreneurial spirit embodied his heroic mission. As Bank One's Jamie Dimon, J.Crew's Mickey Drexler, and even Jimmy Carter, Martha Stewart, and Michael Milken have shown, stunning comebacks are possible in all industries and walks of life. Whatever the cause of your predicament, it makes sense to get your story out. The alternative is likely to be long-lasting unemployment. If the facts of your dismissal cannot be made public because they are damning, then show authentic remorse. The public is often enormously forgiving when it sees genuine contrition and atonement.