ABSTRACT
Quantum computers built with superconducting artificial atoms already stretch the limits of their classical counterparts. While the lowest energy states of these artificial atoms serve as the qubit basis, the higher levels are responsible for both a host of attractive gate schemes as well as generating undesired interactions. In particular, when coupling these atoms to generate entanglement, the higher levels cause shifts in the computational levels that lead to unwanted ZZ quantum crosstalk. Here, we present a novel technique to manipulate the energy levels and mitigate this crosstalk with simultaneous off-resonant drives on coupled qubits. This breaks a fundamental deadlock between qubit-qubit coupling and crosstalk. In a fixed-frequency transmon architecture with strong coupling and crosstalk cancellation, additional cross-resonance drives enable a 90 ns CNOT with a gate error of (0.19±0.02)%, while a second set of off-resonant drives enables a novel CZ gate. Furthermore, we show a definitive improvement in circuit performance with crosstalk cancellation over seven qubits, demonstrating the scalability of the technique. This Letter paves the way for superconducting hardware with faster gates and greatly improved multiqubit circuit fidelities.
ABSTRACT
High-deflection strain gauges show potential as economical and user-friendly sensors for capturing large deformations. The interpretation of these sensors is much more complex than that of conventional strain gauges due to the viscoelastic nature of strain gauges. This research endeavor developed and tested a model for interpreting sensor outputs that includes the time-dependent nature of strain gauges. A model that captures the effect of quasi-static strains was determined by using a conventional approach of fitting an equation to observed data. The dynamic relationship between the strain and the resistance was incorporated by superimposing dynamic components onto the quasi-static model to account for spikes in resistances that accompany each change in sensor strain and subsequent exponential decays. It was shown that the model can be calibrated for a given sensor by taking two data points at known strains. The resulting sensor-specific model was able to interpret strain-gauge electrical signals during a cyclical load to predict strain with an average mean absolute error (MAE) of 1.4% strain, and to determine the strain rate with an average MAE of 0.036 mm/s. The resulting model and tuning procedure may be used in a wide range of applications, such as biomechanical monitoring and analysis.
Subject(s)
ViscosityABSTRACT
Improving two-qubit gate performance and suppressing cross talk are major, but often competing, challenges to achieving scalable quantum computation. In particular, increasing the coupling to realize faster gates has been intrinsically linked to enhanced cross talk due to unwanted two-qubit terms in the Hamiltonian. Here, we demonstrate a novel coupling architecture for transmon qubits that circumvents the standard relationship between desired and undesired interaction rates. Using two fixed frequency coupling elements to tune the dressed level spacings, we demonstrate an intrinsic suppression of the static ZZ while maintaining large effective coupling rates. Our architecture reveals no observable degradation of qubit coherence (T_{1},T_{2}>100 µs) and, over a factor of 6 improvement in the ratio of desired to undesired coupling. Using the cross-resonance interaction, we demonstrate a 180 ns single-pulse controlled not (cnot) gate, and measure a cnot fidelity of 99.77(2)% from interleaved randomized benchmarking.
ABSTRACT
Understanding the heritability of neural systems linked to psychopathology is not sufficient to implicate them as intergenerational neural mediators. By closely examining how individual differences in neural phenotypes and psychopathology cosegregate as they fall through the family tree, we can identify the brain systems that underlie the parent-to-child transmission of psychopathology. Although research has identified genes and neural circuits that contribute to the risk of developing anxiety and depression, the specific neural systems that mediate the inborn risk for these debilitating disorders remain unknown. In a sample of 592 young rhesus monkeys that are part of an extended multigenerational pedigree, we demonstrate that metabolism within a tripartite prefrontal-limbic-midbrain circuit mediates some of the inborn risk for developing anxiety and depression. Importantly, although brain volume is highly heritable early in life, it is brain metabolism-not brain structure-that is the critical intermediary between genetics and the childhood risk to develop stress-related psychopathology.
Subject(s)
Anxiety/physiopathology , Family Characteristics , Inheritance Patterns , Neurons/physiology , Temperament , Animals , Brain/metabolism , Brain/physiopathology , Macaca mulattaABSTRACT
Infection with parasitic helminths can ameliorate the severity of concomitant inflammatory disease. To use the tapeworm, Hymenolepis diminuta, and to extend this concept by assessing whether triggering a memory response against the worm inhibits dinitrobenzene sulphonic acid (DNBS)-induced colitis in Balb/c mice. Initial studies revealed that oral infection with 1, 3 or 5 H. diminuta cysticercoids 8 days before intrarectal administration of DNBS (3 mg) resulted in less severe inflammation and that infected mice displayed an increased propensity for T helper-2 immunity. A 1 mg dose of a PBS-soluble extract of the worm (HdAg) delivered intraperitoneally concomitant with DNBS was anticolitic as determined by macroscopic and histological disease scores 72 hour post-DNBS. Mice infected 28 days previously had a memory response as determined by HdAg-evoked increases in interleukin (IL)-4 and IL-10 from in vitro stimulated splenocytes and serum anti-H. diminuta IgG. Moreover, mice infected with 5 H. diminuta 28 days previously were protected from DNBS-induced colitis by secondary infection or 100 µg HdAg (ip.) at the time of DNBS treatment. An additional approach to managing inflammatory disease could be infection with H. diminuta followed by eliciting antiworm recall responses.
Subject(s)
Antibodies, Helminth/blood , Antigens, Helminth/therapeutic use , Colitis/immunology , Colitis/prevention & control , Hymenolepis diminuta/immunology , Immunologic Memory/immunology , Animals , Antigens, Helminth/immunology , Benzenesulfonates , Colitis/chemically induced , Colitis/parasitology , Hymenolepiasis/immunology , Hymenolepiasis/parasitology , Interleukin-10/blood , Interleukin-10/immunology , Interleukin-4/blood , Interleukin-4/immunology , Male , Mice , Mice, Inbred BALB CABSTRACT
BACKGROUND: Although high-dose interferon (hd-ifn) is the sole approved adjuvant systemic treatment for melanoma in many jurisdictions, it is toxic. We sought to assess the population-level effects of hd-ifn toxicity, particularly neuropsychiatric toxicity, hypothesizing that such toxicity would have the greatest effect on mental health services use in advanced resected melanoma. METHODS: This retrospective population-based registry study considered all melanoma patients receiving adjuvant hd-ifn in Ontario during 2008-2012. Toxicity was investigated through health services use compatible with hd-ifn toxicity (for example, mental health physician billings). Using stage data reported from cancer centres about a subset of patients (stages iib-iiic), a propensity-matched analysis compared such service use in patients who did and did not receive hd-ifn. Associations between early hd-ifn discontinuation and health services use were examined. RESULTS: Of 718 melanoma patients who received hd-ifn, 12% were 65 years of age and older, and 83% had few or no comorbidities. One third of the patients experienced 1 or more toxicity-associated health care utilization events within 1 year of starting hd-ifn. Of 420 utilization events, 364 (87%) were mental health-related, with 54% being family practitioner visits, and 39% being psychiatrist visits. In the propensity-matched analysis, patients receiving hd-ifn were more likely than untreated matched controls to use a mental health service (p = 0.01), with 42% of the control group and 51% of the hd-ifn group using a mental health service in the period spanning the 12 months before to the 24 months after diagnosis. In the multivariable analysis, early drug discontinuation was more likely in the presence of pre-existing mental health issues (odds ratio: 2.0; 95% confidence limits: 1.1, 3.4). CONCLUSIONS: Stage iib-iiic melanoma patients carry a substantial burden of mental health services use whether or not receiving hd-ifn, highlighting an important survivorship issue for these patients. High-dose interferon is associated with more use of mental health services, and pre-treatment use of mental health services is associated with treatment discontinuation. That association should be kept in mind when hd-ifn is being considered.
ABSTRACT
BACKGROUND: Diffusion tensor imaging studies show reductions in fractional anisotropy (FA) in individuals with bipolar disorder and their unaffected siblings. However, the use of various analysis methods is an important source of between-study heterogeneity. Using tract-based spatial statistics, we previously demonstrated widespread FA reductions in patients and unaffected relatives. To better interpret the neuroanatomical pattern of this previous finding and to assess the influence of methodological heterogeneity, we here applied tractography to the same sample. METHODS: Diffusion-weighted images were acquired for 96 patients, 69 unaffected siblings and 56 controls. We applied TRACULA, an extension of a global probabilistic tractography algorithm, to automatically segment 18 major fiber tracts. Average FA within each tract and at each cross-section along each tract was compared between groups. RESULTS: Patients had reduced FA compared to healthy controls and their unaffected siblings in general, and in particular in the parietal part of the superior longitudinal fasciculus. In unaffected siblings, FA was nominally reduced compared to controls in the corpus callosum. Point-wise analyses indicated that similar effects were present along extended sections, but with variable effect sizes. Current symptom severity negatively correlated with FA in several fronto-limbic association tracts. CONCLUSIONS: The differential sensitivity of analysis techniques likely explains between-study heterogeneity in anatomical localization of FA reductions. The present tractography analysis confirms the presence of overall FA reductions in patients with bipolar disorder, which are most pronounced in the superior longitudinal fasciculus. Unaffected siblings may display similar, albeit more subtle and anatomically restricted FA reductions. Hum Brain Mapp 37:3474-3485, 2016. © 2016 Wiley Periodicals, Inc.
Subject(s)
Bipolar Disorder/diagnostic imaging , Brain/diagnostic imaging , Siblings , Adult , Algorithms , Bipolar Disorder/drug therapy , Comorbidity , Diffusion Magnetic Resonance Imaging , Diffusion Tensor Imaging , Female , Genetic Predisposition to Disease , Humans , Image Interpretation, Computer-Assisted , Male , Neural Pathways/diagnostic imaging , Organ Size , Pattern Recognition, Automated , Psychiatric Status Rating Scales , Severity of Illness Index , Young AdultABSTRACT
Previous work has shown that the hippocampus is smaller in the brains of individuals suffering from major depressive disorder (MDD) than those of healthy controls. Moreover, right hippocampal volume specifically has been found to predict the probability of subsequent depressive episodes. This study explored the utility of right hippocampal volume as an endophenotype of recurrent MDD (rMDD). We observed a significant genetic correlation between the two traits in a large sample of Mexican American individuals from extended pedigrees (ρg = -0.34, p = 0.013). A bivariate linkage scan revealed a significant pleiotropic quantitative trait locus on chromosome 18p11.31-32 (LOD = 3.61). Bivariate association analysis conducted under the linkage peak revealed a variant (rs574972) within an intron of the gene SMCHD1 meeting the corrected significance level (χ(2) = 19.0, p = 7.4 × 10(-5)). Univariate association analyses of each phenotype separately revealed that the same variant was significant for right hippocampal volume alone, and also revealed a suggestively significant variant (rs12455524) within the gene DLGAP1 for rMDD alone. The results implicate right-hemisphere hippocampal volume as a possible endophenotype of rMDD, and in so doing highlight a potential gene of interest for rMDD risk.
Subject(s)
Chromosomal Proteins, Non-Histone/genetics , Depressive Disorder, Major/genetics , Depressive Disorder, Major/pathology , Hippocampus/pathology , Mutation/genetics , Nerve Tissue Proteins/genetics , Adolescent , Adult , Aged , Aged, 80 and over , Endophenotypes , Family Health , Female , Functional Laterality/genetics , Genetic Linkage , Genetic Predisposition to Disease , Humans , Image Processing, Computer-Assisted , Magnetic Resonance Imaging , Male , Mental Status Schedule , Mexican Americans , Middle Aged , Recurrence , SAP90-PSD95 Associated Proteins , Young AdultABSTRACT
Identification of genes associated with brain aging should markedly improve our understanding of the biological processes that govern normal age-related decline. However, challenges to identifying genes that facilitate successful brain aging are considerable, including a lack of established phenotypes and difficulties in modeling the effects of aging per se, rather than genes that influence the underlying trait. In a large cohort of randomly selected pedigrees (n = 1,129 subjects), we documented profound aging effects from young adulthood to old age (18-83 y) on neurocognitive ability and diffusion-based white-matter measures. Despite significant phenotypic correlation between white-matter integrity and tests of processing speed, working memory, declarative memory, and intelligence, no evidence for pleiotropy between these classes of phenotypes was observed. Applying an advanced quantitative gene-by-environment interaction analysis where age is treated as an environmental factor, we demonstrate a heritable basis for neurocognitive deterioration as a function of age. Furthermore, by decomposing gene-by-aging (G × A) interactions, we infer that different genes influence some neurocognitive traits as a function of age, whereas other neurocognitive traits are influenced by the same genes, but to differential levels, from young adulthood to old age. In contrast, increasing white-matter incoherence with age appears to be nongenetic. These results clearly demonstrate that traits sensitive to the genetic influences on brain aging can be identified, a critical first step in delineating the biological mechanisms of successful aging.
Subject(s)
Aging/physiology , Brain/physiology , Cognition/physiology , Memory Disorders/physiopathology , Mexican Americans/genetics , Nerve Fibers, Myelinated/physiology , Adult , Age Factors , Aged , Aged, 80 and over , Aging/genetics , Analysis of Variance , Anisotropy , Brain/pathology , Diffusion Tensor Imaging , Humans , Memory Disorders/genetics , Middle Aged , Nerve Fibers, Myelinated/pathology , Neuroimaging , PedigreeABSTRACT
The insula and medial prefrontal cortex (mPFC) share functional, histological, transcriptional, and developmental characteristics, and they serve higher cognitive functions of theoretical relevance to schizophrenia and related disorders. Meta-analyses and multivariate analysis of structural magnetic resonance imaging (MRI) scans indicate that gray matter density and volume reductions in schizophrenia are the most consistent and pronounced in a network primarily composed of the insula and mPFC. We used source-based morphometry, a multivariate technique optimized for structural MRI, in a large sample of randomly ascertained pedigrees (N = 887) to derive an insula-mPFC component and to investigate its genetic determinants. Firstly, we replicated the insula-mPFC gray matter component as an independent source of gray matter variation in the general population, and verified its relevance to schizophrenia in an independent case-control sample. Secondly, we showed that the neuroanatomical variation defined by this component is largely determined by additive genetic variation (h(2) = 0.59), and genome-wide linkage analysis resulted in a significant linkage peak at 12q24 (LOD = 3.76). This region has been of significant interest to psychiatric genetics as it contains the Darier's disease locus and other proposed susceptibility genes (e.g., DAO, NOS1), and it has been linked to affective disorders and schizophrenia in multiple populations. Thus, in conjunction with previous clinical studies, our data imply that one or more psychiatric risk variants at 12q24 are co-inherited with reductions in mPFC and insula gray matter concentration. © 2015 Wiley Periodicals, Inc.
Subject(s)
Chromosomes, Human, Pair 12 , Mexican Americans , Schizophrenia/genetics , Schizophrenia/pathology , Adolescent , Adult , Aged , Aged, 80 and over , Cerebral Cortex/pathology , Cognition , Female , Genetic Linkage , Genome-Wide Association Study , Gray Matter/pathology , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Multivariate Analysis , Prefrontal Cortex/pathology , Schizophrenia/ethnology , Young AdultABSTRACT
Genetic and environmental influences on brain morphology were assessed in an extended-pedigree design by extracting depth-position profiles (DPP) of the central sulcus (CS). T1-weighted magnetic resonance images were used to measure CS length and depth in 467 human subjects from 35 extended families. Three primary forms of DPPs were observed. The most prevalent form, present in 70% of subjects, was bimodal, with peaks near hand and mouth regions. Trimodal and unimodal configurations accounted for 15 and 8%, respectively. Genetic control accounted for 56 and 66% of between-subject variance in average CS depth and length, respectively, and was not significantly influenced by environmental factors. Genetic control over CS depth ranged from 1 to 50% across the DPP. Areas of peak heritability occurred at locations corresponding to hand and mouth areas. Left and right analogous CS depth measurements were strongly pleiotropic. Shared genetic influence lessened as the distance between depth measurements was increased. We argue that DPPs are powerful phenotypes that should inform genetic influence of more complex brain regions and contribute to gene discovery efforts.
Subject(s)
Cerebral Cortex/anatomy & histology , Genetic Pleiotropy , Quantitative Trait, Heritable , Adult , Aged , Aged, 80 and over , Cerebral Cortex/physiology , Female , Fingers/innervation , Fingers/physiology , Functional Laterality , Gene-Environment Interaction , Humans , Male , Mexican Americans/genetics , Middle Aged , Mouth/innervation , Mouth/physiology , Movement , PedigreeABSTRACT
Identifying genes that contribute to white matter microstructure should provide insights into the neurobiological processes that regulate white matter development, plasticity and pathology. We detected five significant SNPs using genome-wide association analysis on a global measure of fractional anisotropy in 776 individuals from large extended pedigrees. Genetic correlations and genome-wide association results indicated that the genetic signal was largely homogeneous across white matter regions. Using RNA transcripts derived from lymphocytes in the same individuals, we identified two genes (GNA13 and CCDC91) that are likely to be cis-regulated by top SNPs, and whose expression levels were also genetically correlated with fractional anisotropy. A transcript of HTR7 was phenotypically associated with FA, and was associated with an intronic genome-wide significant SNP. These results encourage further research in the mechanisms by which GNA13, HTR7 and CCDC91 influence brain structure, and emphasize a role for g-protein signaling in the development and maintenance of white matter microstructure in health and disease.
Subject(s)
Gene Expression/physiology , Genetic Variation/physiology , White Matter/anatomy & histology , White Matter/ultrastructure , Anisotropy , Cohort Studies , Diffusion Tensor Imaging , Genome-Wide Association Study , Genotype , Humans , Mexican Americans , Polymorphism, Single NucleotideABSTRACT
Phase-slips control dissipation in many bosonic systems, determining the critical velocity of superfluid helium and the generation of resistance in thin superconducting wires. Technological interest has been largely motivated by applications involving nanoscale superconducting circuit elements, such as standards based on quantum phase-slip junctions. Although phase slips caused by thermal fluctuations at high temperatures are well understood, controversy remains over the role of phase slips in small-scale superconductors--in solids, problems such as uncontrolled noise sources and disorder complicate their study and application. Here we show that phase slips can lead to dissipation in a clean and well-characterized Bose-Hubbard system, by experimentally studying the transport of ultracold atoms trapped in an optical lattice. In contrast to previous work, we explore a low-velocity regime described by the three-dimensional Bose-Hubbard model that is unaffected by instabilities, and we measure the effect of temperature on the dissipation strength. The damping rate of atomic motion (the analogue of electrical resistance in a solid) in the confining parabolic potential is well fitted by a model that includes finite damping at zero temperature. The low-temperature behaviour is consistent with the theory of quantum tunnelling of phase slips, whereas at higher temperatures a crossover consistent with a transition to thermal activation of phase slips is evident. Motion-induced features reminiscent of vortices and vortex rings associated with phase slips are also observed in time-of-flight imaging. These results clarify the role of phase slips in superfluid systems. They may also be of relevance in understanding the source of metallic phases observed in thin films, or serve as a test bed for theories of bosonic dissipation based upon variants of the Bose-Hubbard model.
ABSTRACT
BACKGROUND/AIMS: Obesity is a major contributor to the global burden of chronic disease and disability, though current knowledge of causal biologic underpinnings is lacking. Through the regulation of energy homeostasis and interactions with adiposity and gut signals, the brain is thought to play a significant role in the development of this disorder. While neuroanatomical variation has been associated with obesity, it is unclear if this relationship is influenced by common genetic mechanisms. In this study, we sought genetic components that influence both brain anatomy and body mass index (BMI) to provide further insight into the role of the brain in energy homeostasis and obesity. METHODS: MRI images of brain anatomy were acquired in 839 Mexican American individuals from large extended pedigrees. Bivariate linkage and quantitative analyses were performed in SOLAR. RESULTS: Genetic factors associated with an increased BMI were also associated with a reduced cortical surface area and subcortical volume. We identified two genome-wide quantitative trait loci that influenced BMI and the ventral diencephalon volume, and BMI and the supramarginal gyrus surface area, respectively. CONCLUSIONS: This study represents the first genetic analysis seeking evidence of pleiotropic effects acting on both brain anatomy and BMI. Our results suggest that a region on chromosome 17 contributes to the development of obesity, potentially through leptin-induced signaling in the hypothalamus, and that a region on chromosome 3 appears to jointly influence the food-related reward circuitry and the supramarginal gyrus.
Subject(s)
Brain/pathology , Genetic Pleiotropy , Obesity/genetics , Obesity/pathology , Adult , Body Mass Index , Cerebral Cortex/pathology , Endophenotypes , Female , Genetic Linkage , Humans , Inheritance Patterns/genetics , MaleABSTRACT
Endophenotypes are measurable biomarkers that are correlated with an illness, at least in part, because of shared underlying genetic influences. Endophenotypes may improve our power to detect genes influencing risk of illness by being genetically simpler, closer to the level of gene action, and with larger genetic effect sizes or by providing added statistical power through their ability to quantitatively rank people within diagnostic categories. Furthermore, they also provide insight into the mechanisms underlying illness and will be valuable in developing biologically-based nosologies, through efforts such as RDoC, that seek to explain both the heterogeneity within current diagnostic categories and the overlapping clinical features between them. While neuroimaging, electrophysiological, and cognitive measures are currently most used in psychiatric genetic studies, researchers currently are attempting to identify candidate endophenotypes that are less genetically complex and potentially closer to the level of gene action, such as transcriptomic and proteomic phenotypes. Sifting through tens of thousands of such measures requires automated, high-throughput ways of assessing, and ranking potential endophenotypes, such as the Endophenotype Ranking Value. However, despite the potential utility of endophenotypes for gene characterization and discovery, there is considerable resistance to endophenotypic approaches in psychiatry. In this review, we address and clarify some of the common issues associated with the usage of endophenotypes in the psychiatric genetics community.
Subject(s)
Brain/metabolism , Endophenotypes , Proteomics , Psychiatry , Animals , Biomarkers , Brain/anatomy & histology , Endophenotypes/metabolism , Genetic Predisposition to Disease , Humans , Proteomics/methodsABSTRACT
It is well established that risk for developing psychosis is largely mediated by the influence of genes, but identifying precisely which genes underlie that risk has been problematic. Focusing on endophenotypes, rather than illness risk, is one solution to this problem. Impaired cognition is a well-established endophenotype of psychosis. Here we aimed to characterize the genetic architecture of cognition using phenotypically detailed models as opposed to relying on general IQ or individual neuropsychological measures. In so doing we hoped to identify genes that mediate cognitive ability, which might also contribute to psychosis risk. Hierarchical factor models of genetically clustered cognitive traits were subjected to linkage analysis followed by QTL region-specific association analyses in a sample of 1,269 Mexican American individuals from extended pedigrees. We identified four genome wide significant QTLs, two for working and two for spatial memory, and a number of plausible and interesting candidate genes. The creation of detailed models of cognition seemingly enhanced the power to detect genetic effects on cognition and provided a number of possible candidate genes for psychosis.
Subject(s)
Basic Helix-Loop-Helix Transcription Factors/genetics , Cell Cycle Proteins/genetics , Memory, Short-Term , Psychotic Disorders/genetics , Quantitative Trait Loci/genetics , Schizophrenia/genetics , Adolescent , Adult , Aged , Aged, 80 and over , Cognition , Female , Genome-Wide Association Study , Genotype , Humans , Male , Mexican Americans/genetics , Middle Aged , Neuropsychological Tests , Risk , Young AdultABSTRACT
Linkage studies of alcoholism have implicated several chromosome regions, leading to the successful identification of susceptibility genes, including ADH4 and GABRA2 on chromosome 4. Quantitative endophenotypes that are potentially closer to gene action than clinical endpoints offer a means of obtaining more refined linkage signals of genes that predispose alcohol use disorders (AUD). In this study we examine a self-reported measure of the maximum number of drinks consumed in a 24-hr period (abbreviated Max Drinks), a significantly heritable phenotype (h(2) = 0.32 ± 0.05; P = 4.61 × 10(-14)) with a strong genetic correlation with AUD (ρg = 0.99 ± 0.13) for the San Antonio Family Study (n = 1,203). Genome-wide SNPs were analyzed using variance components linkage methods in the program SOLAR, revealing a novel, genome-wide significant QTL (LOD = 4.17; P = 5.85 × 10(-6)) for Max Drinks at chromosome 6p22.3, a region with a number of compelling candidate genes implicated in neuronal function and psychiatric illness. Joint analysis of Max Drinks and AUD status shows that the QTL has a significant non-zero effect on diagnosis (P = 4.04 × 10(-3)), accounting for 8.6% of the total variation. Significant SNP associations for Max Drinks were also identified at the linkage region, including one, rs7761213 (P = 2.14 × 10(-4)), obtained for an independent sample of Chinese families. Thus, our study identifies a potential risk locus for AUD at 6p22.3, with significant pleiotropic effects on the heaviness of alcohol consumption that may not be population specific.
Subject(s)
Alcohol Drinking/genetics , Alcoholism/genetics , Chromosomes, Human, Pair 6/genetics , Genetic Predisposition to Disease , Quantitative Trait Loci/genetics , Adolescent , Adult , Aged , Aged, 80 and over , Endophenotypes , Female , Genetic Association Studies , Genetic Linkage , Humans , Male , Middle Aged , Polymorphism, Single Nucleotide/genetics , Young AdultABSTRACT
Introduction: Worldwide colonic cancer is the third most common cancer with up to 30% of cases presenting with large bowel obstruction. Self-expanding metal stents (SEMS) have been used as a bridge to surgery (BTS) in the treatment of this malignant obstruction. We review the outcomes of SEMS as a BTS across two high volume colorectal units. Methodology: A retrospective analysis of patients undergoing colonic stenting as a bridge to surgery was performed; outcomes were compared to previously published figures on emergency colonic resections. Inclusion criteria were adults (>18 years of age) undergoing colonic stenting for colonic obstruction with a view to elective resection. Patients undergoing stenting for palliation of symptoms were excluded. Results: 39 patients were identified across both trusts over a ten-year period. 90 day mortality following BTS was found to be 3.6% and there was an 82.1% (32/39) technical success rate. 46.4% proceeded to an elective resection which was started laparoscopically. Permanent stoma rate was observed at 14.3% for elective surgery. Conclusion: Stenting for relief of acute malignant obstruction as a bridge to surgery is a viable option in select patients. Further research is required to determine oncological safety and rate of local recurrences.
Subject(s)
Colonic Neoplasms , Colorectal Neoplasms , Intestinal Obstruction , Adult , Humans , Retrospective Studies , Stents , Intestinal Obstruction/etiology , Intestinal Obstruction/surgery , Treatment Outcome , Colonic Neoplasms/complications , Colonic Neoplasms/surgeryABSTRACT
Corticosterone (CORT) levels in seabirds fluctuate across breeding stages and in different foraging conditions. Here we use a ten-year data set to examine whether CORT levels in Atlantic puffins differ in years with high or low availability of capelin, the preferred forage species. Female puffins had higher CORT levels than males, possibly related to cumulative costs of egg production and higher parental investment. Puffins had higher CORT levels and body mass during pre-breeding than during chick rearing. Yearly mean chick growth rates were higher in years when adults had higher body mass and in years where adults brought chicks a lower percentage of non-fish (invertebrates/larval fish) food. Unlike most results from seabird species with shorter chick-rearing periods, higher CORT levels in puffins were not associated with lower capelin abundance. Puffins may suppress CORT levels to conserve energy in case foraging conditions improve later in the prolonged chick-rearing period. Alternatively, CORT levels may be lowest both when food is very abundant (years not in our sample) or very scarce (e.g., 2009 in this study), and increase when extra foraging effort will increase foraging efficiency (most years in this study). If these data primarily represent years with medium to poor foraging, it is possible that CORT responses to variation in foraging conditions are similar for puffins and other seabirds.
Subject(s)
Breeding , Charadriiformes/metabolism , Corticosterone/blood , Animals , Charadriiformes/blood , Charadriiformes/physiology , Female , Male , Seasons , Sex FactorsABSTRACT
Straight to test (STT) is a recognised pathway for improving the waiting time for red flag referrals. Electronic patient care records (ECR) provide clinicians with a greater volume of clinical information allowing virtual triage and STT. We aimed to assess if using ECR and STT can reduce delays in diagnosis and treatment. A review of 300 colorectal referrals between 2018-2019 was performed. Patients awaiting an appointment were reviewed electronically, by a single colorectal surgeon and re-triaged STT if appropriate. The delay in time from referral to initial review was removed, creating a second group for statistical comparison to demonstrate time saved if the strategy was adopted at the point of original triage. 91.3% (n= 274) were red flag referrals. 94% (n=282) were sent STT. Patients processed via traditional referral and clinic had a median time to scope of 36 days compared with 22.5 days, p < 0.001 if triaged STT via virtual clinic. Median time to management was 59 days for traditional and 35 days for STT, p < 0.001.