Archaeal and Extremophilic Bacteria from Different Archaeological Excavation Sites.

Beside natural factors, human activities are important for the development of microbiomes. Thus, local soil bacterial communities are affected by recent activities such as agriculture, mining and industry. In addition, ancient human impacts dating back centuries or millennia have changed soils and can emboss the recent bacterial communities up to now, representing a certain long-term "memory of soil". Soil samples from five different archaeological excavation places were investigated for the presence of Archaea with a Next Generation Sequencing (NGS) analysis of the DNA coding for 16S r-RNA sequences. It was found that the abundance of Archaea differs strongly between less than one and more than 40 percent of bacteria. A Principal Component Analysis (PCA) of all samples shows that the archaeological excavation places can be distinguished from each other by the archaeal component of soil bacterial communities, which presents a typical pattern for each place. Most samples are marked by the dominance of Crenarchaeota, which are presented mainly by ammonia-related types. High contents of Nanoarchaeaota have been observed in one ash deposit of a historical saline and all samples of a historical tannery area. These samples are also marked by a significant presence of Dadabacteria. The specific abundancies of special Archaea-among them ammonia-oxidizing and sulphur-related types-are due obviously to former human activities and support the concept of the "ecological memory of soil".

Delayed Surgery for Perforated Appendicitis is Feasible in Children Without Compromising the Outcome in Selected Cases.

BACKGROUND AND AIM: The relationship between time to surgery and risk of postoperative complications and re-intervention has not been conclusively investigated in pediatric perforated appendicitis (PA). The aim of this study was to determine whether time to appendectomy (TTA) is a risk factor for postoperative complications and re-intervention in a cohort of children undergoing appendectomy for PA. METHODS: A total of 254 children (age: 8.7 ± 3.7 years) undergoing appendectomy for PA were retrospectively evaluated and stratified into Group I-III according to the Clavien-Dindo classification for postoperative complications (Group I n = 218, 86%; Group II n = 7, 3%; Group III n = 29, 11%). RESULTS: The TTA was comparable between all groups (group I: 8.8 ± 9.2 h; group II: 7.8 ± 5.3 h; group III: 9.5 ± 9.6 h; overall: 8.8 ± 9.1 h; p = 0.885). A C-reactive protein (CRP) value at admission of ≥128.6 mg/l indicated a higher risk for developing Grade II complications with no need for re-intervention (OR: 3.963; 95% CI: 1.810-8.678; p = 0.001) and Grade III complications with the need for re-intervention (OR: 3.346; 95% CI: 1.456-7.690; p = 0.004). This risk was independent of the TTA (OR: 1.007; 95% CI: 0.980-1.035; p = 0.613). CONCLUSIONS: Appendectomy can be delayed by an average time delay of about 9 h in children with PA without increasing the risk of postoperative complications and re-intervention, also in patients at high risk defined by the initial CRP level ≥ 128.6 mg/l. This data may support the correct risk-adjusted scheduling of surgical interventions in times of limited capacity.

Subsuns and rainbows during solar eclipses.

A photographic observation sequence was obtained of a subsun before, during, and after the total phase of the 2016 solar eclipse. The time-resolved images were obtained from a high-altitude jet aircraft. The image sequence was searched for the possible presence of a solar corona-generated subsun during totality. Although the subsun-creating conditions apparently persisted during totality, the drop in signal intensity compared to the local background prevented its detection. Separately, we document a visual observation from the 1977 total solar eclipse of a rainbow that faded, in the last a few seconds before totality, from being normally multicolored to monochromatic red from water drops then predominantly illuminated by light from the solar chromosphere. A similar transition in the final seconds before, and after, totality is expected to occur for parhelia. The posited short-living monochromatic red parhelion resulting from the momentary illumination of ice crystals by the solar chromosphere is still waiting to be observed.

Guidelines of the Brazilian Society of Oncologic Surgery for pelvic exenteration in the treatment of cervical cancer.

BACKGROUND AND OBJECTIVES: The primary treatment for locally advanced cases of cervical cancer is chemoradiation followed by high-dose brachytherapy. When this treatment fails, pelvic exenteration (PE) is an option in some cases. This study aimed to develop recommendations for the best management of patients with cervical cancer undergoing salvage PE. METHODS: A questionnaire was administered to all members of the Brazilian Society of Surgical Oncology. Of them, 68 surgeons participated in the study and were divided into 10 working groups. A literature review of studies retrieved from the National Library of Medicine database was carried out on topics chosen by the participants. These topics were indications for curative and palliative PE, preoperative and intraoperative evaluation of tumor resectability, access routes and surgical techniques, PE classification, urinary, vaginal, intestinal, and pelvic floor reconstructions, and postoperative follow-up. To define the level of evidence and strength of each recommendation, an adapted version of the Infectious Diseases Society of America Health Service rating system was used. RESULTS: Most conducts and management strategies reviewed were strongly recommended by the participants. CONCLUSIONS: Guidelines outlining strategies for PE in the treatment of persistent or relapsed cervical cancer were developed and are based on the best evidence available in the literature.

Oncologist recommendation matters!-Predictors of psycho-oncological service uptake in oncology outpatients.

OBJECTIVE: Highly distressed cancer patients often do not use psycho-oncological services (POS). Research on predictors of POS uptake has mainly focused on patient-related variables and less on communication variables, so we examined the link between patient-oncologist communication (ie, talking about psychosocial distress, providing detailed information, and recommending POS) and POS uptake. METHODS: We conducted a prospective, observational study in an Oncology Outpatient Clinic in Switzerland. Predictors (ie, patient-related variables and patient's reports of the patient-oncologist communication) were assessed via semistructured interviews, and information on outpatient POS uptake was assessed after 4 months. For statistical analysis, a multivariate logistic regression was performed. RESULTS: Of 333 participants (mean age 61 years; 55% male; 54% distress thermometer ≥5), 77 (23%) had used POS during a 4-month period. Patients who reported an oncologist-recommended POS (odds ratio [OR] = 6.27, 95% confidence interval [CI] = 3.14-12.85) and those who were not sure if they had received a recommendation (OR = 4.64, 95% CI = 1.83-11.97) were more likely to attend POS than those who reported receiving no recommendation. Talking about psychosocial distress (OR = 0.74, 95% CI = 0.38-1.46) and providing detailed information about POS did not predict POS uptake (OR = 1.06, 95% CI = 0.46-2.38). CONCLUSIONS: Oncologists' expert recommendations to attend POS were strongly associated with patients' uptake of POS. The central role played by oncologists should be accounted for in stepped psycho-oncological care when POS referral pathways are defined.

Rainbows by elliptically deformed drops. I. Möbius shift for high-order rainbows.

Using ray theory, the Möbius shift of the (p-1)-order rainbow angle for a particle having an elliptical cross section is obtained to first order in the ellipticity as a function of the tilt of the ellipse with respect to the propagation direction of the incoming rays. The result is then adapted to the geometry of scattering of light rays from the sun by a falling water drop as a function of sun height angle. The variation in the angular spacing between the supernumeraries is determined as a function of location along the rainbow arc, the conditions under which the rainbow angle is insensitive to drop flattening were determined, and the dependence of the Möbius shift on the drop refractive index is shown for rainbows up to fourth order (p=5).

Rainbows by elliptically deformed drops. II. The appearance of supernumeraries of high-order rainbows in rain showers.

The appearance of supernumeraries of high-order rainbows in heavy rain showers is explored for rainbows up to order five (p=6). This is done by using a combination of the ray-theory-based first-order Möbius approximation for high-order rainbows with the Airy approximation of the rainbow radiance distribution. We conclude that supernumerary formation of rainbows of order three, four, and five is possible in natural rain showers. Supernumeraries of the third-order and fourth-order rainbows are preferentially formed near the bottom of these rainbows. A strategy for observing supernumeraries of high-order rainbows is proposed.

Textile foreign body in a Green Iguana (Iguana iguana): Diagnostic imaging for localisation.

INTRODUCTION: This case report includes different diagnostic imaging methods for localization of textile foreign bodies in reptiles and shows the limitations and advantages of these methods. A six-year-old, male, green iguana was presented to our clinic after ingesting a sock 5 days earlier. Ultrasound, contrast x-ray, computed tomography and endoscopy were used to locate the foreign body before surgery. Attempts to remove the sock endoscopically failed. The sock was surgically removed via celiotomy and enterotomy.

Predicting Postoperative Complications After Pediatric Perforated Appendicitis.

PURPOSE: Assessment of risk factors for postoperative complications following surgical treatment of pediatric perforated appendicitis (PA) is necessary to identify those patients in need of closer monitoring. In this study, we have investigated the impact of different risk factors on the occurrence of complications after an appendectomy in children with PA. MATERIAL AND METHODS: The study was a retrospective, single-centre analysis of all pediatric PA conducted over a 10-year period. Preoperative clinical and laboratory results, intraoperative findings, and postoperative complications were analyzed. Risk factors were defined and a risk score was determined for postoperative complications and reinterventions. RESULTS: Surgical treatment for appendicitis was performed in 840 pediatric patients during the observation period. 163 of the included patients were diagnosed with PA (mean age 8.9 ± 3.6 years). 19 (11.7%) patients developed postoperative complications, 17 (10.4%) of which required complication-related intervention. We identified five predictors of postoperative complications: the C-related protein value at admission, purulent peritonitis, open appendectomy (primary, secondary, or converted), placement of an abdominal drain, and administration of antibiotics not compliant to results from the subsequent antibiogram. The determined risk score was significantly higher in the complication group (p < .0001) and reintervention group (p < .001). CONCLUSIONS: Postoperative complications following pediatric PA can be predicted using specific preoperative, intraoperative, and postoperative risk factors. In the high-risk group, an active prevention, detection, and intervention of any occurring complication is necessary and we present a new specific pediatric risk score to define patients at risk for complications.

Long-term outcome in displaced lateral humeral condyle fractures following internal screw fixation in children.

BACKGROUND: The aim of this study was to investigate the long-term clinical outcome following open reduction and internal screw fixation of displaced lateral condyle fractures (LCFs) of the distal humerus and compare the outcome of primary and secondary LCFs. METHODS: The clinical outcome in 31 children (mean age 5.8±2.4 years) operated for primary or secondary LCFs was retrospectively analyzed by standardized clinical examination and compared using the Mayo score, Morger score, and Patients Satisfaction score. RESULTS: The scores did not differ significantly between the primary and secondary displacement groups (Mayo score: 99.3±3.3 vs. 100±0, p=0.852; Morger score: 3.8±0.5 vs. 3.9±0.3, p=0.852; Patients Satisfaction score: 3.7±0.6 vs. 3.9±0.3, p=0.546). Deficits in range of motion and joint axis deviation were minor (< 10°) and no elbow instabilities were observed. CONCLUSIONS: Surgical treatment of a secondary displaced LCF with open reduction and internal screw fixation leads to a favorable long-term outcome. The long-term outcome is similar between primary and secondary displaced LCFs.

Contrast echocardiography for analysis of heart anatomy in tortoises.

OBJECTIVE: The cardiac anatomy in tortoises depicted on B-mode and color-Doppler should be better differentiated by additional contrast-echocardiography. MATERIAL AND METHODS: An intravenous contrast agent (INN-sulphur hexafluoride [SonoVue®]) was injected in four tortoises (three Testudo hermanni, one Agrionemys horsfieldii), via the coccygeal vein, with parallel B-mode echocardiographic examination. The results of the contrast-enhanced echocardiography were compared with the contrast-free B-mode recordings and color-Doppler ultrasound. RESULTS: The use of SonoVue® enabled clearer distinction of the cardiac structures, differentiation of the arising major arteries, identification of wash-out-shunts, and visualization of blood flow patterns throughout the tortoise heart. CONCLUSION AND CLINICAL RELEVANCE: This study enables the accurate depiction and differentiation of cardiac anatomy in tortoises through the use of a combination of B-mode, color-Doppler and contrast-echocardiography. Basic knowledge of blood flow in the reptile heart is essential to understand echocardiographic anatomy. Blood-flow-patterns and anatomy of the tortoise heart as found in this study will help to establish a basis for further echocardiographic examinations of these animals.

Naked eye visibility of Sirius in broad daylight.

Sirius was spotted with the naked eye at broad daylight by looking along the finder of a 1 m telescope on La Palma Observatory at a 2370 m height. Sun elevation was 73°; Sirius was nearly straight under the Sun at 37° elevation. The sky radiance, although not recorded directly, could be determined from the simultaneously obtained high-precision wavelength-dependent sky polarization data near Sirius. This was done by fitting the polarization data with the doubling-adding KNMI (DAK) radiative transfer model, which provided the values of the surface albedo and of the aerosol optical thickness required for determining the absolute sky radiance. Our analysis implies that Sirius, when positioned overhead, can be a daytime naked eye object from sea level even if its culmination occurs at solar noon. It also suggests that the second-brightest star (Canopus), if positioned overhead, could be perceptible even at solar noon.

A note on the radiance distributions of halos due to scattering by randomly orientated crystals.

The radiance distribution of light scattered by randomly oriented ice crystals differs fundamentally from the radiance distribution of light scattered by spherical raindrops or by preferentially oriented ice crystals. A formalism for light scattering by randomly oriented crystals is given and applied to four examples, among them the circular 22° halo and the antisolar halospot, the latter being the glory analogue for ice crystals. A long-standing misconception about the nature of the radiance distribution of circular halos is quantified and discussed.

The prodigious halo of the other Huygens.

At the height of the ceremony in the Principality of Orange of the restoration of the sovereignty of the House of Nassau in 1665, a ceremony led by Christiaan's father, Constantijn Huygens, a "solar crown" appeared in the sky, apparently a divine sign of approval. A nearly forgotten contemporary color engraving of this miraculous event has survived. Constantijn seized the opportunity by using to his advantage the general euphoria among the citizens caused by the appearance. We argue that Constantijn knew exactly what was going on in the sky because of his son's work on halo theory. Given its brightness and its time of appearance, it seems plausible that the most prominent halo in the Orange halo display was a circumscribed halo rather than the more familiar but bleaker circular 22° halo. The same probably holds for most of the other high-sun halos that caused general consternation, dating from the Octavian halo of 44 BC, to the Chernobyl halo of 1986, and indeed up to bright high-sun halos of the present.

Polarization and visibility of higher-order rainbows.

The degree of polarization of rainbows of order k with k≥3 is bounded in the interval [75%, 78%], where 75% is the limit for k→∞. A polarization filter can improve the signal-to-background ratio of the third and fourth rainbows by a factor of 2, which may lift their visibilities in natural circumstances above the threshold of human visual perception. Under optimal circumstances, the latter may be true for the recently photographed green fingerprint of the fifth rainbow, even without the aid of a polarization filter. The prospects for observing the sixth rainbow are unclear. There exists a possibility that the signal of the natural seventh rainbow (appearing at 64° from the Sun) may be separated from its background if photographed under perfect conditions through a polarization filter.

Probable photographic detection of the natural seventh-order rainbow.

We present a stacked and contrast-enhanced image comprised of 12 digital photographs that shows a series of color hues in the correct order and location to be part of the seventh-order rainbow. The observation was made on September 22, 2013, near Magdalena in New Mexico (USA). The seventh-order rainbow is located at 64° from the Sun in a region of the sky with little interference from the zero-order glow. The color hues in the image range from red to blue-violet, spanning about 12° in total extent; their locations generally agree with a numerical Debye-series simulation of the seventh-order rainbow. Despite the low color contrast of the seventh-order rainbow, the current observation indicates that it is feasible with current digital-imaging technology to detect this higher-order rainbow in near-ideal atmospheric conditions.

Sleeve Gastrectomy With or Without a Multimodal Perioperative Care. A Randomized Pilot Study.

BACKGROUND: Multimodal protocols may enhance postoperative recovery. The aim of this study was to evaluate the influence of a multimodal protocol in the clinical results, insulin resistance, and inflammatory response to trauma in morbidly obese patients undergoing sleeve gastrectomy. METHODS: The population of the study consisted of morbidly obese patients, who were operated using sleeve gastrectomy, from Cuiaba, MT, Brazil, between April and October 2012. Twenty patients were divided into two groups whom received either traditional preoperative care or treatment following the Acerto (accelerating the total recovery of patients in the postoperative period) protocol. The study examined inflammatory response and insulin resistance by measuring levels of glucose, insulin, Homa-IR, reactive C protein, albumin, prealbumin, alpha 1 acid glycoprotein, interleukin 6, and glycosylated hemoglobin. In addition, the study investigated hydration levels, nausea and vomiting, hypertension, and length of hospital stay. RESULTS: Patients who followed the Acerto protocol showed no postoperative hypertensive crises (p = 0.03), and 30 % less vomiting (p = 0.35), and showed significant reductions in length of hospital stay, on average of 3 days versus 2 days (p = 0.02). There were not significant statistical differences between the two groups with respect to inflammatory response and insulin resistance (p > 0.05). CONCLUSION: This pilot study suggests that the prescription of the Acerto multimodal protocol for morbidly obese patients undergoing sleeve gastrectomy was safe, reduced the rate hypertensive complications, and the length of both ICU and hospital postoperative stay. However, there was no improvement in postoperative insulin resistance or inflammatory acute phase response.

Long-term effects of fundoplication in children with chronic airway diseases.

BACKGROUND: Association between chronic airway diseases (CAD) and gastroesophageal reflux disease (GERD) is well described, but causality has not yet been conclusively established. This study evaluates the therapeutic significance of laparoscopic Thal fundoplication in children with CAD and diagnosed GERD. METHODS: We performed a retrospective analysis of 182 neurologically nonimpaired children, all with medically refractory CAD and GERD undergoing laparoscopic Thal fundoplication. The clinical response, ability to wean oral and inhaled medication and satisfaction with postoperative results were evaluated. RESULTS: Main symptoms disappeared completely in 68.7% of patients and were markedly improved in a further 22% of patients following surgery. Complete discontinuation of medication was achieved in 70.1-96.4% of cases and reduced in a further 1.8-23.5%. One intraoperative complication occurred (gastric perforation), however no conversion to laparotomy was necessary. Postoperative Dumping Syndrome occurred in 1% of cases and was managed dietetically. Prolonged postoperative dysphagia occurred in 4.3% of patients, but disappeared within 8 weeks in all but one case. CONCLUSIONS: Our study suggests that Thal fundoplication in neurologically nonimpaired children with CAD and documented GERD is effective and safe. Children unresponsive to preoperative medical management showed significant improvement in airway symptoms together with a marked reduction in the need for medication. We conclude that laparoscopic Thal fundoplication represents a significant treatment worthy of consideration in this group of patients.

Intracorporal suturing--driving license necessary?

BACKGROUND: Intracorporeal suturing and knot tying (ICKT) in minimal invasive surgery (MIS) represents a key skill for advanced procedures. Different methods exist for measuring knot quality and performance, but the heterogeneity of these methods makes direct comparisons difficult. The aim of this study is to compare the quality of a laparoscopic knot to one that is performed open. METHODS: To compare open and laparoscopic knot-tying methods we used a surgeon's square knot. For laparoscopic knot tying we used a Pelvitrainer. The 32 participants were divided among 4 groups of different skill levels. Group 1 consisted of 6 senior physicians. Group 2 was made up of 10 first to fourth year interns. Groups 3 and 4 contained 16 medical students who had never performed either laparoscopic procedures or open sutures before. Group 3 participants received a 1-hour hands-on training in suturing, whereas group 4 participants received no prior training. Total time, knot quality, suture placement accuracy, and performance defined the parameters for assessment in this study. RESULTS: All participants, irrespective of education level were inferior in ICKT compared to open suturing. Only Group 1 showed no significant difference in knot quality and accuracy between the open and laparoscopic suture performance. CONCLUSION: It is well documented that psychomotor skills need to be developed before more advanced skills can be put into practice. Training centres for minimally invasive surgery should be an integral part of surgical education. The variables in our study are meaningful and easy to implement. They can be used to measure personal progress and as objective parameters in the development of laparoscopic trainee education.