Structured training pathway for robotic colorectal surgery: Short-term outcomes from five UK centres.

AIM: The aim of this study was to assess the short-term outcomes of robotic colorectal surgery implemented through a structured, standardized training pathway in five colorectal centres in the United Kingdom. METHOD: A multicentre retrospective observational study was conducted, involving 523 consecutive patients who underwent robotic colorectal resection between 2015 and 2019. All participating centres followed the European Academy of Robotic Colorectal Surgery training pathway. Patient data, including demographics, operative details, postoperative outcomes and pathology results, were collected and analysed. RESULTS: The study included 447 rectal resections and 76 colonic operations. The median age of the patients was 64.7 years, with the majority of patients (70%) being men. The mean body mass index was 27.4 kg/m2, and 89.7% of the patients underwent surgery for malignancy. The overall conversion rate to open surgery was 4.2%. The median length of stay was 6 days and there was no 30-day mortality. The readmission and reoperation rates were 8.8% and 7.3%, respectively. The anastomotic leak rate was 4.1% for rectal resections and 3.9% for colonic resections. Pathological examination showed a positive circumferential resection margin rate of 2.6%. CONCLUSION: Through the implementation of a structured, standardized training pathway, the participating colorectal centres in the UK achieved safe and effective robotic colorectal surgery pathways with favourable short-term oncological and clinical outcomes. Further studies examining long-term and functional outcomes are needed to assess the broader impact of robotic surgery in colorectal procedures.

Evaluation of serum adipokines (omentin-1 and visfatin) in coronary artery disease at a North Indian hospital.

Objective. Adipose tissue is considered to be an endocrine organ that secretes bioactive substances known as adipokines that contribute to the pathophysiology of metabolic and coronary diseases related to obesity. In this study, various novel biomarkers, such as inflammatory markers that are pro-inflammatory (visfatin) and anti-inflammatory (omentin-1), as prognostic indicators for people with coronary artery disease (CAD) were investigated. Methods. In this study, 30 diabetic patients with CAD, 30 diabetic patients without CAD, and 30 healthy control counterparts were included. Serum omentin and visfatin concentrations were evaluated by solid-phase enzyme linked immunosorbent assay (ELISA) kit. Patients with established diagnosis of CAD based on angiography, ECG, and elevated cardiac marker level were included into the study. Patients with cardioembolic stroke, cerebral venous sinus thrombosis, CNS vasculitis, and hemorrhage due to trauma, tumor, vascular malformation, and coagulopathy were excluded. Results. The serum omentin-1 levels were significantly higher in the healthy controls in comparison with the diabetic group (p<0.0001) and serum visfatin levels were significantly higher in the diabetic group in comparison with the healthy controls (p<0.0001). The serum omentin levels were significantly higher in the diabetic group in comparison with the cardio-diabetic group (p<0.0001) and serum visfatin levels were significantly higher in the cardio-diabetic group in comparison with the diabetic group (p<0.0001). The serum omentin-1 showed negative correlation with the serum visfatin in the cardio-diabetic group. Conclusion. The adipokines, such as omentin and visfatin, may be good therapeutic candidates in preventing or ameliorating CAD.

Management practices in myofascial pain syndrome among physical therapists in Karachi, Pakistan: A cross sectional survey.

OBJECTIVE: To investigate the treatment practice in myofascial pain syndrome among physical therapists in an urban setting. METHODS: The cross-sectional study was conducted from June to December, 2016, at the Institute of Physical Medicine and Rehabilitation, Dow University of Health Science, Karachi Pakistan, and comprised qualified physical therapists of either gender working at various health centres in the city. Data was collected using a self-administered questionnaire, and was analysed using SPSS 16. RESULTS: Of the 93 respondents, 37(39.8%) were males and 56(60.2%) were females; 39(41.9%) had Masters level professional education; and 29(31.2%) had 5-8 years of experience. Myofascial Pain Syndrome was diagnosed through physical examination by 78(83.9%) subjects, on the basis of history by 70(75.3%) and palpable band by 75(80%). Preferred treatment strategy was ischaemic compression for 63(67.7%) and postural re-education for 64(68.8%), while dry needling was used by 29(31.2%) subjects. Also, 75(80%) therapists preferred manual therapy superior combined with other treatments. CONCLUSIONS: Physical examination was found to be the most common diagnostic method used for myofascial pain syndrome by the therapists.

Hematological complications under hyper conditions of glucose and distilled water.

This work presents a pilot method of hematological diagnosis about changes in: shape, size and rouleaux formation, cell count of leucocytes and platelet cells in the presence of different glucose [C6H12O6] and water [H2O] concentrations. The 2D microscopic images after addition of ten different glucose concentrations to normal blood (0 mM- 450 mM) revealed the lyses (disintegration) of white blood cells (WBCs). This work provides a baseline to diagnose blood disorders and complications at labs and clinical environment.

Implementation of robotic rectal surgery training programme: importance of standardisation and structured training.

PURPOSE: A structured training programme is essential for the safe adoption of robotic rectal cancer surgery. The aim of this study is to describe the training pathway and short-term surgical outcomes of three surgeons in two centres (UK and Portugal) undertaking single-docking robotic rectal surgery with the da Vinci Xi and integrated table motion (ITM). METHODS: Prospectively, collected data for consecutive patients who underwent robotic rectal cancer resections with the da Vinci Xi and ITM between November 2015 and September 2017 was analysed. The short-term surgical outcomes of the first ten cases of each surgeon (supervised) were compared with the subsequent cases (independent). In addition, the Global Assessment Score (GAS) forms from the supervised cases were analysed and the GAS cumulative sum (CUSUM) charts constructed to investigate the training pathway of the participating surgeons. RESULTS: Data from 82 patients was analysed. There were no conversions to open, no anastomotic leaks and no 30-day mortality. Mean operation time was 288 min (SD 63), median estimated blood loss 20 (IQR 20-20) ml and median length of stay 5 (IQR 4-8) days. Thirty-day readmission and reoperation rates were 4% (n = 3) and 6% (n = 5) respectively. When comparing the supervised cases with the subsequent solo cases, there were no statistically significant changes in any of the short-term outcomes with the exception of mean operative time, which was significantly shorter in the independent cases (311 vs 275 min, p = 0.038). GAS form analysis and GAS CUSUM charting revealed that ten proctoring cases were enough for trainee surgeons to independently perform robotic rectal resections with the da Vinci Xi. CONCLUSIONS: Our results show that by applying a structured training pathway and standardising the surgical technique, the single-docking procedure with the da Vinci Xi is a valid, reproducible technique that offers good short-term outcomes in our study population.

Processing and storage of apricots: effect on physicochemical and antioxidant properties.

The present study was carried out to evaluate the effect of processing methods and storage periods on the three apricot varieties viz. CITH-1, CITH-2 and New Castle. Apricots were processed by freezing and canning of pulp and drying of whole apricots. After processing these were analysed for various physicochemical and antioxidant properties for a storage period of 12 months at 4 month interval. The results for physicochemical properties like moisture content, TSS, total sugars and reducing sugars showed significant variation with respect to varieties and processing methods during storage. Apricots processed by canning showed highest retention of antioxidants in terms of TPC, FRAP, DPPH and metal chelating activity throughout storage period than that of frozen and dried one. CITH-2 processed by canning, freezing and drying method showed highest antioxidant properties than CITH-1 and New Castle. It can be concluded from the study that canning and freezing can preserve the apricot pulp for 12 months and significantly retain bioactive compounds.

Incorporation of carrot pomace powder in wheat flour: effect on flour, dough and cookie characteristics.

Carrot pomace powder (CPP) of 72 and 120 mesh sizes was incorporated in wheat flour at 10, 15 and 20 % level and its impact on flour, dough and cookie characteristics was evaluated. Protein content of the flour blends (8.84-7.88 %) decreased and fibre content (4.63-6.68 %) increased upon blending of CPP in wheat flour. Wheat flour containing 120 mesh CPP showed better functional properties [water absorption (1.16-1.47 %), oil absorption (1.11-1.39 %), solubility index (41-50 %) and swelling power (1.34-1.39)] than those containing 72 mesh. Water solvent retention capacity and sucrose solvent retention capacity increased while lactic acid solvent retention capacity and sodium carbonate solvent retention capacity decreased with blending of CPP. Water absorption, dough development time and degree of softening increased whereas, dough stability and mixing tolerance decreased with increasing CPP. The highest decrease in pasting was observed flour containing 72 mesh CPP. Rheology of dough containing 120 mesh CPP closely resembled the control. Color of flour and cookies increased with blending of CPP irrespective of mesh size. Antioxidant activity of cookies was higher than the flour blends. The cookies containing CPP of 72 mesh showed the lowest hardness. However, cookies containing CPP of 120 mesh showed the best sensory properties. Incorporation of 120 mesh CPP produced low gluten cookies with manageable flour and dough characteristics and better antioxidant and sensory properties.

Monitoring of glucose, salt and pure water in human whole blood: An in vitro study.

Designing and implementation of non-invasive methods for glucose monitoring in blood is main focus of biomedical scientists to provide a relief from skin puncturing of diabete patient. The objective of this research work is to investigate the shape deformations and the aggregation of red blood cells (RBCs) in the human blood after addition of three different analytes i) (0mM-400mM: Range) of glucose (C(6)H(12)O(6)), ii) (0mM-400mM: range) of pure salt (NaCl) and iii) (0mM- 350mM: range) of pure water (H(2)O). We have observed that the changes in the shape of individual cells from biconcave discs to spherical shapes and eventually the lysis of the cells at optimum concentration of glucose, salts and pure water. This demonstration also provides a base line to facilitate diabetes during partial diagnosis and monitoring of the glucose levels qualitatively both in research laboratories and clinical environment.

VAAFT: Video Assisted Anal Fistula Treatment; Bringing revolution in Fistula treatment.

OBJECTIVE: To share our findings that the new treatment modality Video Assisted Anal Fistula Treatment (VAAFT) is a better alternate to the conventional treatments of Fistula in Ano in our setup with minor changes in the initial method described by Meinero. METHODS: Karl Storz Video equipment including Meinero Fistuloscope was used. Key steps are visualization of the fistula tract, correct localization of the internal fistula opening under direct vision and endoscopic treatment of the fistula. This is followed by an operative phase of fulguration of the fistula tract using glycine solution mixed with manitol, curetting the tract with curette and fistula brush. Internal opening is closed with a Vicryl 1 suture. RESULT: Total of 40 patients were operated using VAAFT from October 2013 to March 2014. Three were re-operated. The other 37 cases were followed up at 6 weeks, 3 months and 6 months. Primary healing took place in 20 (50%) cases at 6 weeks. In the remaining 17 (42.5%) cases, minor discharge occurred with itching which resolved till the next visit at 8 weeks and 12 weeks. CONCLUSION: As the main aim in treating fistula is proper identification of the internal opening, excision of the tract and sparing the sphincter function, VAAFT achieves all aims with additional benefits of patients' satisfaction and negligible scaring.

Comparison of primary wound closure with delayed primary closure in perforated appendicitis.

BACKGROUND: Delayed primary closure in cases of acute appendicitis is debated among the surgeons as to whether it decreases the rate of wound infection in comparison to primary closure. The aim of this study was to find out the optimal method of wound closure in cases of perforated appendicitis. METHODS: This randomized control trial was conducted at the surgical units of Ayub Teaching Hospital Abbottabad from May to November 2012. A total of 158 patients having perforated appendicitis were included in the study. They were randomly divided two groups. The wounds were primarily closed in one group and left open with daily saline soaked dressing, to be closed on postoperative day 4 in case of the other group. The main outcome measure was wound infection. A wound was considered infected if it was discharging pus, was red and swollen on postoperative day 8th. The method of wound closure was considered efficacious if there was no wound infection till 8th postoperative day. RESULTS: A total of 158 patients, 56 (35.4%) male and 102 (64.6%) female were included in the study. Primary closure group had a total number of 79 patients with 26 (32.9%) male and 53 (67.1%) female. Delayed primary group had also a total number of 79 patients with 30 (38%) male and 49 (62%) female. The mean age of patients in the primary closure group was 26.67 ± 7.32 years while in the delayed primary group was 28.15 ± 6.88 years. In the entire series, 36 (22.8%) patients developed wound infection. There was a significant association between wound infection and type of skin closure (Delayed Primary Closure 6.3% vs. Primary Closure 39.2%, p < 0.000). CONCLUSION: Delayed Primary closure is the optimal management strategy in case of perforated appendicitis as it decreases the incidence of wound infection.

Endoscopic findings in patients presenting with oesophageal dysphagia.

BACKGROUND: Dysphagia is the difficulty in swallowing and is often described by the patients as a 'perception' that there is an impediment to the normal passage of the swallowed material. It is frequently observed that there is an association of dysphagia with serious underlying disorders and warrants early evaluation. The current study aimed to determine the frequency of common endoscopic findings in patients presenting with oesophageal dysphagia. METHODS: This cross-sectional descriptive study was carried out in the department of Gastroenterology, Ayub Medical College, Abbottabad, from October 2012 to April 2013. Consecutive patients with dysphagia were included in the study and were subjected to endoscopy. RESULTS: A total of 139 patients presenting with dysphagia were studied, 81 (58.3%) were males and 58 (41.7%) were females. The mean age was 52.41 ± 16.42. Malignant oesophageal stricture was the most common finding noted in 38 (27.3%) patients with 28 (73.7%) males and 23 (60.5%) patients among them were above the age of 50 years. It was followed by normal upper Gastrointestinal (GI) endoscopy in 29 (20.9%) patients and reflux esophagitis in 25 (18.0%) patients. Schatzki's ring was present in 14 (10.1%) patients; benign oesophageal strictures in 12 (8.6%) patients while achalasia was noted in 7 (5.0%) patients. 14(10.1%) patients had findings other than the ones mentioned above. CONCLUSION: Malignancies are a more common cause of dysphagia in our population and early diagnosis can result in proper treatment of many of these cases.

Structural, morphological, mechanical, and electronic properties of nickel substituted manganese oxide (NixMn1-xO, x= 0.0, 0.2, 0.4) for electronic applications.

The structural, morphological, mechanical, and electronic properties of nickel-substituted manganese oxide (NixMn1-xO, where x = 0.0, 0.2, and 0.4) were studied using experimental techniques. The compounds were synthesized using a hydrothermal method. The face-centered cubic structures of the examined compounds were confirmed by XRD. Scanning electron microscopy (SEM) images revealed that the particles were well-shaped, while elemental mapping with energy dispersive spectroscopy (EDS) confirmed that the examined compounds had the appropriate proportions of Ni, Mn, and O. The FT-IR spectroscopy results indicated the respective functional groups. Raman spectroscopy results disclosed the vibration modes of the respective materials. The Tauc plot reveals the semiconducting nature of the compounds. The UV-Vis bandgap study revealed the semiconductor natures of compounds. This demonstrates that these nanoparticles can be used in atom lasers, photovoltaics, and other electronic applications.

Galeo-Pericranial Flap-A Rich Pedicle Flap for Temporisation of Large Maxillofacial Defect: A Case Report.

Reconstruction of large facial defects is quite a challenging and difficult task. Various surgical options are available, each with its challenges and complications. Galeo-pericranial flap has provided a suitable technique for reconstruction of radical parotidectomy defects with satisfactory outcomes. A 50-year-old farmer with a histologically diagnosed mucoepidermoid carcinoma of the right parotid gland of 15 years duration had radical parotidectomy and reconstruction of the defect with galeo-pericranial flap. The patient was followed up for 2 years, and the flap was completely taken with no donor site morbidity.

Pattern and Management of Missile Injury to the Oral and Maxillofacial Region: A 12-Year Experience During Boko Haram Insurgency in Maiduguri, North-Eastern Nigeria.

Introduction: Missile injury is a global public health problem, which occurs in both military and civilian settings. Boko Haram insurgency in North-Eastern Nigeria is one of the major violence the country experienced that resulted in many civilian casualties. This study was aimed at exploring the various patterns of the missile injuries to the maxillofacial region during Boko Haram insurgency. Methods: In this retrospective cross-sectional study, relevant information was retrieved from patient records including sociodemographic, causes of missile injuries, site of injuries, pattern of presentation, treatment, and the complications, and analysed using SPSS version 23. Result: A total of 526 patients with various maxillofacial injuries were seen during this 12-year study period, with age ranging from 4 to 65 years, the peak incidence in the age group 31-40 years, 89.5% were males, 92.9% of the injuries were allegedly inflicted by insurgents and comprised of 61.0% gunshot injuries, 24.5% bomb blast, and machete cuts 7.4%. Most of the injuries occurred in the lower third of the face, 39.8%, and mandible was the commonest fractured facial bone. Conclusion: Facial injuries commonly are associated with devastating consequences to survivors and, hence, may require long time monitoring and psychosocial rehabilitations.

Management of rare ectopic teeth eruption: case series.

Objectives: An ectopic tooth is a rare eruption of a tooth out of the normal dental apparatus and occurs commonly with the third molar. Thus, in this study, we reported a case series of ectopic teeth in rare jaw locations and highlight the associated pathology and our experience in the surgical management. Patients and. Methods: All cases of ectopic tooth managed at the Department of Oral and Maxillofacial Surgery, University of Maiduguri Teaching Hospital from January 2011 to December 2020 were reviewed. The information retrieved includes biodata, location of the ectopic tooth, signs, symptoms, type of tooth and associated pathology, surgical approach and complications. Results: Ten cases of ectopic teeth were identified over the study period. This comprised 80.0% males with a mean age was 23.3 years. The antrum and lower border of the mandible accounted for 50.0% and 40.0% of the ectopic locations, respectively. Dentigerous cyst was the most associated pathology (70%) and usually presented with pain and swelling. Surgical intervention predominantly via the intraoral route was performed if indicated. Conclusion: Ectopic teeth are rare and not always associated with pathology. A high index of suspicion and radiological investigation are necessary for diagnosis. A more extensive multi-center study is however recommended to determine the prevalence of ectopic teeth other than the third molar.

Textbook Oncological Outcomes for Robotic Colorectal Cancer Resections: An Observational Study of Five Robotic Colorectal Units.

BACKGROUND: The quality of care of patients receiving colorectal resections has conventionally relied on individual metrics. When discussing with patients what these outcomes mean, they often find them confusing or overwhelming. Textbook oncological outcome (TOO) is a composite measure that summarises all the 'desirable' or 'ideal' postoperative clinical and oncological outcomes from both a patient's and doctor's point of view. This study aims to evaluate the incidence of TOO in patients receiving robotic colorectal cancer surgery in five robotic colorectal units and understand the risk factors associated with failure to achieve a TOO in these patients. METHODS: We present a retrospective, multicentric study with data from a prospectively collected database. All consecutive patients receiving robotic colorectal cancer resections from five centres between 2013 and 2022 were included. Patient characteristics and short-term clinical and oncological data were collected. A TOO was achieved when all components were realized-no conversion to open, no complication with a Clavien-Dindo (CD) ≥ 3, length of hospital stay ≤ 14, no 30-day readmission, no 30-day mortality, and R0 resection. The main outcome measure was a composite measure of "ideal" practice called textbook oncological outcomes. RESULTS: A total of 501 patients submitted to robotic colorectal cancer resection were included. Of the 501 patients included, 388 (77.4%) achieved a TOO. Four patients were converted to open (0.8%); 55 (11%) had LOS > 14 days; 46 (9.2%) had a CD ≥ 3 complication; 30-day readmission rate was 6% (30); 30-day mortality was 0.2% (1); and 480 (95.8%) had an R0 resection. Abdominoperineal resection was a risk factor for not achieving a TOO. CONCLUSIONS: Robotic colorectal cancer surgery in robotic centres achieves a high TOO rate. Abdominoperineal resection is a risk factor for failure to achieve a TOO. This measure may be used in future audits and to inform patients clearly on success of treatment.

Synthesis, Characterization, Biological Activity and Molecular Docking Studies of Novel Organotin(IV) Carboxylates.

Four new carboxylates complexes with general formula R2SnL2 and R3SnL, where R = n-butyl (1, 3), methyl (2, 4) and L = 4-Chlorophenoxyacetate, were synthesized in significant yields. FT-IR analysis revealed a chelating (1 and 2) and a bridging bidentate (3 and 4) coordination modes for the carboxylate ligand in solid state which was further confirmed by the single crystal X-ray analysis of complex 4. The NMR data (1H, 13C and 119Sn) revealed a higher coordination number around the tin center in R2SnL2 (1 and 2) compared to R3SnL (3 and 4). A close matching was observed between the experimental and calculated structures (obtained at B3LYP/6-31G* + LANL2DZ basis set). Quantum chemical analysis indicates that the carboxylate moiety has the major contribution in the formation of filled and unfilled orbitals as well as in ligand to ligand intramolecular charge transfer during the electronic transitions. The cytotoxicity data of the screened compounds evaluated against lung cancer cell line (A549) and normal lung fibroblast cell line (MRC-5) revealed that 1, 3 and 4 have shown dose dependent cytotoxic effects while HL and 2 have shown steady and low cytotoxic activities. The antibacterial activity of complexes 1-4 is higher than that of HL. Molecular docking study showed an intercalation binding mode for complex 3 with DNA (docking score = -3.6005) involving four polar interactions. Complex 3 docking with tubulin (PDB ID 1SA0) with colchicine as a target protein resulted in three polar interactions (docking score -5.2957). Further, the docking analysis of the HL and 1-4 has shown an adequate interactions with the coronavirus SARS-CoV-2 spike protein, nucleocapsid protein and human angiotensin converting enzyme (ACE2).

Sciatic hernia clinically mimicking obturator hernia, missed by ultrasonography: case report.

Sciatic hernia is a rare pelvic floor hernia that occurs through the greater or lesser sciatic foramen. Sciatic hernias often present as pelvic pain, particularly in women, and diagnosis can be difficult. Sciatic hernia is one of the rarest forms of internal hernia, which can present as signs and symptoms of small bowel obstruction, swelling in the respective gluteal region or pelvic pain. Transabdominal and transgluteal operative approaches, including laparoscopic repair, have been reported. We present a case of left-sided sciatic hernia with incarcerated small bowel as its contents. The hernia was missed by ultrasonography and plain abdominal radiography, but the clinical features were suggestive of an obturator hernia.

Source profiling of air pollution and its association with acute respiratory infections in the Himalayan-bound region of India.

The studies related to air pollutants and their association with human health over the mountainous region are of utmost importance and are sparse especially over the Himalayan region of India. The linkages between various atmospheric variables and clinically validated data have been done using various datasets procured from satellite, model reanalysis, and surface observations during 2013-2017. Aerosol optical depth, air temperature, and wind speed are significantly related (p < 0.001) to the incidence of acute respiratory infections with its peak during winter. Model-derived particulate matter (PM2.5) shows high contributions of black carbon, organic carbon, and sulfate during winter. The wind roses show the passage of winds from the south-west and southern side of the region. Back trajectory density plot along with bivariate polar plot analyses have shown that most of the winds coming from the western side are taking a southward direction before reaching the study area and may be bringing pollutants from the Indo-Gangetic Plain and other surrounding regions. Our study shows that the accumulation of pollutants in the Himalayan valley is owing to the meteorological stability with significant local emissions from burning of biomass and biofuels along with long-range and mid-range transport during the winter season that significantly correlated with the incidence of acute respiratory infections in the region.

Lu modified ZnO/CNTs composite: A promising photocatalyst for hydrogen evolution under visible light illumination.

We report high photocatalytic hydrogen evolution from water-glycerol mixture under visible light illumination using sol-gel method synthesized zinc oxide (ZnO), Lutetium (Lu) modified ZnO and Lu modified ZnO/CNTs composite. X-ray diffraction (XRD), transmission electron microscopy (TEM), energy dispersive X-ray (EDX), Brunauer-Emmett-Teller (BET), UV-Visible diffuse reflectance spectroscopy (UV-Vis DRS), photoluminescence (PL), X-ray photoelectron spectroscopy (XPS), photocurrent transient response and electrochemical impedance spectroscopy (EIS) Nyquist studies were used to determine the reason for improved photocatalytic hydrogen evolution. The highest hydrogen evolution rate of 380 µmolh-1 was obtained for Lu modified ZnO/CNTs composite, 3.11 times the amount generated over Lu modified ZnO and 10.5 times than using pure ZnO sample. This efficient enhancement in the photocatalytic hydrogen evolution was apparently attributed to the red shift in the optical absorption, increased charge separation, high surface area, cleavage of glycerol by Lu and synergistic effect between Lu and CNTs. Moreover, the effect of Lu and CNTs loading on the photocatalytic hydrogen evolution activity of Lu modified ZnO/CNTs was also studied under analogous experimental conditions. A mechanism of photocatalytic hydrogen evolution by Lu modified ZnO/CNTs composite was also proposed. Additionally, synthesized samples showed prolonged photostability with steady hydrogen evolution in successive cycle runs. This report might attract much attention to design highly efficient and inexpensive photocatalyst for hydrogen evolution under visible light illumination.