Incidence and treatment of positive pelvic sidewall lymph nodes in patients with rectal cancer.

AIM: The involvement of pelvic sidewall (PSW) lymph nodes in rectal cancer is a marker of locally advanced disease and poor prognosis. Eastern countries generally advocate lateral lymph node dissection (LLND) over the Western approach of neoadjuvant chemoradiotherapy and more limited surgery. The aim of this study was to evaluate how these advanced cancers were treated in three UK Health Boards. METHODOLOGY: This was a retrospective review of three colorectal multidisciplinary team meetings from 2008 to 2016. All patients with rectal cancer and suspicious PSW lymph nodes on pretreatment MRI were included. RESULTS: There were 153 (6.2%) patients who met the inclusion criteria from a total of 2461 diagnosed rectal cancers. There was significant variability between the three centres with surgical intervention ranging from 59.2% to 84.4%, P = 0.015. There were 81 patients who had neoadjuvant chemoradiotherapy prior to surgery; of these 67 (82.7%) still had positive PSW nodes on the restaging MRI, but only 13 (19.4%) had LLND. There was no difference in local recurrence (15.3% vs 11.8%, P = 0.66), 5-year overall survival (69.2% vs 80.1%, P = 0.16) or 5-year disease-free survival (69.2% vs 79.4%, P = 0.72) between patients having LLND and those receiving standard neoadjuvant treatment followed by total mesorectal excision surgery. CONCLUSIONS: This study has demonstrated that rectal cancer patients with PSW positive nodal disease have advanced disease, mostly of the lower rectum, and receive a highly heterogeneous spectrum of therapies, even within a relatively small geographical area. Greater accuracy in our preoperative staging is needed to select those patients who will benefit from LLND surgery.

High temperature singlet-based magnetism from Hund's rule correlations.

Uranium compounds can manifest a wide range of fascinating many-body phenomena, and are often thought to be poised at a crossover between localized and itinerant regimes for 5f electrons. The antiferromagnetic dipnictide USb2 has been of recent interest due to the discovery of rich proximate phase diagrams and unusual quantum coherence phenomena. Here, linear-dichroic X-ray absorption and elastic neutron scattering are used to characterize electronic symmetries on uranium in USb2 and isostructural UBi2. Of these two materials, only USb2 is found to enable strong Hund's rule alignment of local magnetic degrees of freedom, and to undergo distinctive changes in local atomic multiplet symmetry across the magnetic phase transition. Theoretical analysis reveals that these and other anomalous properties of the material may be understood by attributing it as the first known high temperature realization of a singlet ground state magnet, in which magnetism occurs through a process that resembles exciton condensation.

Phonon dispersion of Mo-stabilized γ-U measured using inelastic x-ray scattering.

We have measured the room-temperature phonon spectrum of Mo-stabilized γ-U. The dispersion curves show unusual softening near the H point, q = [1/2, 1/2, 1/2], which may derive from the metastability of the γ-U phase or from strong electron-phonon coupling. Near the zone center, the dispersion curves agree well with theory, though significant differences are observed away from the zone center. The experimental phonon density of states is shifted to higher energy compared to theory and high-temperature neutron scattering. The elastic constants of γ-UMo are similar to those of body-centered cubic elemental metals.

The people living with HIV stigma survey UK 2015: HIV-related sexual rejection and other experiences of stigma and discrimination among gay and heterosexual men.

We aim to understand the difference in stigma and discrimination, in particular sexual rejection, experienced between gay and heterosexual men living with HIV in the UK. The People Living with HIV StigmaSurvey UK 2015 recruited a convenience sample of persons with HIV through over 120 cross sector community organisations and 46 HIV clinics to complete an online survey. 1162 men completed the survey, 969 (83%) gay men and 193 (17%) heterosexual men, 92% were on antiretroviral therapy. Compared to heterosexual men, gay men were significantly more likely to report worrying about workplace treatment in relation to their HIV (21% vs. 11%), worrying about HIV-related sexual rejection (42% vs 21%), avoiding sex because of their HIV status (37% vs. 23%), and experiencing HIV-related sexual rejection (27% vs. 9%) in the past 12 months. In a multivariate logistic regression controlling for other sociodemographic factors, being gay was a predictor of reporting HIV-related sexual rejection in the past 12 months (aOR 2.17, CI 1.16, 4.02). Both gay and heterosexual men living with HIV experienced stigma and discrimination in the past 12 months, and this was higher for gay men in terms of HIV-related sexual rejection. Due to the high proportion of men reporting sexual rejection, greater awareness and education of the low risk of transmission of HIV among people on effective treatment is needed to reduce stigma and sexual prejudice towards people living with HIV.

Experiences of stigma and discrimination in social and healthcare settings among trans people living with HIV in the UK.

The People Living with HIV StigmaSurvey UK 2015 was a community led national survey investigating experiences of people living with HIV in the UK in the past 12 months. Participants aged 18 and over were recruited through over 120 cross-sector community organisations and 46 HIV clinics to complete an anonymous online survey. Trans is an umbrella term which refers to individuals whose current gender identity is different to the gender they were assigned at birth. Trans participants self-identified via gender identity and gender at birth questions. Descriptive analyses of reported experiences in social and health care settings were conducted and multivariate logistic regression analyses were used to identify sociodemographic predictors of reporting being treated differently to non-HIV patients, and being delayed or refused healthcare treatment in the past 12 months. 31 out of 1576 participants (2%) identified as trans (19 trans women, 5 trans men, 2 gender queer/non-binary, 5 other). High levels of social stigma were reported for all participants, with trans participants significantly more likely to report worrying about verbal harassment (39% vs. 23%), and exclusion from family gatherings (23% vs. 9%) in the last 12 months, compared to cisgender participants. Furthermore, 10% of trans participants reported physical assault in the last 12 months, compared to 4% of cisgender participants. Identifying as trans was a predictor of reporting being treated differently to non-HIV patients (48% vs. 30%; aOR 2.61, CI 1.06, 6.42) and being delayed or refused healthcare (41% vs. 16%; aOR 4.58, CI 1.83, 11.44). Trans people living with HIV in the UK experience high levels of stigma and discrimination, including within healthcare settings, which is likely to impact upon health outcomes. Trans-specific education and awareness within healthcare settings could help to improve service provision for this demographic.

Pressure dependence of Ce valence in CeRhIn5.

We have studied the Ce valence as a function of pressure in CeRhIn5 at 300 K and at 22 K using x-ray absorption spectroscopy in partial fluorescent yield mode. At room temperature, we found no detectable change in Ce valence greater than 0.01 up to a pressure of 5.5 GPa. At 22 K, the valence remains robust against pressure below 6 GPa, in contrast to the predicted valence crossover at P = 2.35 GPa. This work yields an upper limit for the change in Ce-valence and suggests that the critical valence fluctuation scenario, in its current form, is unlikely.

A combined theoretical and experimental investigation of uranium dioxide under high static pressure.

We have investigated the behavior of uranium dioxide (UO2) under high static pressure using a combination of experimental and theoretical techniques. We have made Raman spectroscopic measurements up to 87 GPa, electrical transport measurements up to 50 GPa from 10 K to room temperature, and optical transmission measurements up to 28 GPa. We have also carried out theoretical calculations within the GGA + U framework. We find that Raman frequencies match to a large extent, theoretical predictions for the cotunnite (Pnma) structure above 30 GPa, but at higher pressures some behavior is not captured theoretically. The Raman measurements also imply that the low-pressure fluorite phase coexists with the cotunnite phase up to high pressures, consistent with earlier reports. Electrical transport measurements show that the resistivity decreases by more than six orders of magnitude with increasing pressure up to 50 GPa but that the material never adopts archetypal metallic behavior. Optical transmission spectra show that while UO2 becomes increasingly opaque with increasing pressure, a likely direct optical band gap of more than 1 eV exists up to at least 28 GPa. Together with the electrical transport measurements, we conclude that the high pressure electrical conductivity of UO2 is mediated by variable-range hopping.

Persistent non-metallic behavior in Sr2IrO4 and Sr3Ir2O7 at high pressures.

Iridium-based 5d transition-metal oxides are attractive candidates for the study of correlated electronic states due to the interplay of enhanced crystal-field, Coulomb and spin-orbit interaction energies. At ambient pressure, these conditions promote a novel Jeff = 1/2 Mott-insulating state, characterized by a gap of the order of ~0.1 eV. We present high-pressure electrical resistivity measurements of single crystals of Sr2IrO4 and Sr3Ir2O7. While no indications of a pressure-induced metallic state up to 55 GPa were found in Sr2IrO4, a strong decrease of the gap energy and of the resistance of Sr3Ir2O7 between ambient pressure and 104 GPa confirm that this compound is in the proximity of a metal-insulator transition.

Quantum cascade laser absorption sensor for carbon monoxide in high-pressure gases using wavelength modulation spectroscopy.

A tunable quantum cascade laser sensor, based on wavelength modulation absorption spectroscopy near 4.8 µm, was developed to measure CO concentration in harsh, high-pressure combustion gases. The sensor employs a normalized second harmonic detection technique (WMS-2f/1f) at a modulation frequency of 50 kHz. Wavelength selection at 2059.91 cm⁻¹ targets the P(20) transition within the fundamental vibrational band of CO, chosen for absorption strength and relative isolation from infrared water and carbon dioxide absorption. The CO spectral model is defined by the Voigt line-shape function, and key line-strength and line-broadening spectroscopic parameters were taken from the literature or measured. Sensitivity analysis identified the CO-N2 collisional broadening coefficient as most critical for uncertainty mitigation in hydrocarbon/air combustion exhaust measurements, and this parameter was experimentally derived over a range of combustion temperatures (1100-2600 K) produced in a shock tube. Accuracy of the wavelength-modulation-spectroscopy-based sensor, using the refined spectral model, was validated at pressures greater than 40 atm in nonreactive shock-heated gas mixtures. The laser was then free-space coupled to an indium-fluoride single-mode fiber for remote light delivery. The fiber-coupled sensor was demonstrated on an ethylene/air pulse detonation combustor, providing time-resolved (~20 kHz), in situ measurements of CO concentration in a harsh flow field.

Pressure-induced unconventional superconducting phase in the topological insulator Bi2Se3.

Simultaneous low-temperature electrical resistivity and Hall effect measurements were performed on single-crystalline Bi2Se3 under applied pressures up to 50 GPa. As a function of pressure, superconductivity is observed to onset above 11 GPa with a transition temperature Tc and upper critical field Hc2 that both increase with pressure up to 30 GPa, where they reach maximum values of 7 K and 4 T, respectively. Upon further pressure increase, Tc remains anomalously constant up to the highest achieved pressure. Conversely, the carrier concentration increases continuously with pressure, including a tenfold increase over the pressure range where Tc remains constant. Together with a quasilinear temperature dependence of Hc2 that exceeds the orbital and Pauli limits, the anomalously stagnant pressure dependence of Tc points to an unconventional pressure-induced pairing state in Bi2Se3 that is unique among the superconducting topological insulators.

High pressure transport properties of the topological insulator Bi2Se3.

We report x-ray diffraction, electrical resistivity, and magnetoresistance measurements on Bi2Se3 under high pressure and low temperature conditions. Pressure induces profound changes in both the room temperature value of the electrical resistivity as well as the temperature dependence of the resistivity. Initially, pressure drives Bi2Se3 toward increasingly insulating behavior and then, at higher pressures, the sample appears to enter a fully metallic state coincident with a change in the crystal structure. Within the low pressure phase, Bi2Se3 exhibits an unusual field dependence of the transverse magnetoresistance Δρ(xx) that is positive at low fields and becomes negative at higher fields. Our results demonstrate that pressures below 8 GPa provide a non-chemical means to controllably reduce the bulk conductivity of Bi2Se3.

Extension of Bacillus endospore gas dynamic heating studies to multiple species and test conditions.

AIMS: Shock wave-induced damage to a variety of Bacillus endospore species is studied for a wide range of postshock temperatures and test times in oxidative and non-oxidative gas environments. METHODS AND RESULTS: Bacillus atrophaeus and Bacillus subtilis endospores are nebulized into an aqueous aerosol, loaded into the Stanford aerosol shock tube (SAST) and subjected to shock waves of controlled strength. Endospores experience uniform test temperatures between 500 and 1000 K and pressures ranging from 2 to 7 atm, for either a short test time (∼2·5 ms) or a relatively long test time (∼45 ms). During this process, the bioaerosol is observed using in situ laser absorption and scattering diagnostics. Additionally, shock-treated samples are extracted for ex situ analysis including viability plating and flow cytometry. For short test times, results are consistent with previous studies; all endospore species begin to lose the ability to form colonies when shock-heated to temperatures above 500 K, while significant breakdown in morphology is observed for postshock temperatures above 700 K. Oxidative bath gases did not affect viability losses or morphological breakdown rates. Experiments with extended postshock test time showed increased viability loss with minimal morphological damage for shocks between 600 and 700 K. CONCLUSIONS: Genetic differences between B. subtilis and B. atrophaeus endospores do not confer noticeable gains in resistance to shock heating. Oxidative environments do not exacerbate shock-induced damage to endospores. Extended test time experiments reinforce our hypothesis that a temperature/time-dependent inactivation mechanism that does not involve morphological breakdown exists at low-to-moderate postshock temperatures. SIGNIFICANCE AND IMPACT OF THE STUDY: The methodology and experiments described in this paper extend the study of the interactions of endospores with shock/blast waves to new species and environmental conditions.

Fractures of the femoral neck.

The ideal treatment of the intracapsular fracture of the femoral neck still is subject of discussion. The demographic development of the population in Europe with fractures of the neck of femur being typical in the older patient, requires conclusive and stringent concepts of treatment. Adequate and patient oriented therapy should be promoted, regional differences and provisional deficiencies need to be adjusted in order to minimize the rate of complications. The guideline "Schenkelhalsfraktur" of the German board of trauma surgeons, the 'Deutsche Gesellschaft für Unfallchirurgie', and the article at hand are meant to serve as a manual for the trauma surgeon. Based on evaluated data it simplifies rational decision-making for treatment of fractures of the proximal femur. Moreover, secondary prophylaxis as well as the subsequent outpatient treatment and the social reintegration of the patients recovering from fractures of the femoral neck remains vital- ly important. After all, even with ideal treatment of the fracture more than half of the patients are impaired for a long time and one out of four permanently depends on nursing assistance.

Bacillus endospore resistance to gas dynamic heating.

AIM: To develop a novel laboratory procedure for the study of shock wave-induced damage to Bacillus endospores. METHODS AND RESULTS: Bacillus atrophaeus endospores are nebulized into an aerosol, loaded into the stanford aerosol shock tube and subjected to shock waves of controlled strength. Endospores experience uniform test temperatures between 500 and 1000K and pressures ranging from 2 to 7atm, for a relatively short time (2-3ms). During this process, the bioaerosol is observed using in situ laser absorption and scattering diagnostics. Additionally, shock-treated samples are extracted for ex situ analysis including viability plating, flow cytometry and SEM imaging. Measurements indicate that endospores lose the ability to form colonies when heated to test temperatures above 500K while significant breakdown in morphology is observed at test temperatures above 750K. CONCLUSION: These results demonstrate the disruption of essential biochemical pathways or biomolecules prior to the onset of significant endospore morphological deterioration. SIGNIFICANCE AND IMPACT OF THE STUDY: This novel laboratory approach to study the interaction of endospores with shock waves provides an experimental means to investigate the mechanisms of endospore resistance to rapid heating. In addition, this methodology allows for the direct simulation of a blast wave-bioaerosol interaction in an atmospheric environment.

Measurements of CO(2) concentration and temperature at high pressures using 1f-normalized wavelength modulation spectroscopy with second harmonic detection near 2.7 microm.

Tunable diode lasers (TDL) near 2.7 mum are used to measure high-resolution direct absorption and wavelength modulation with second harmonic (WMS-2f) spectra at high pressures for two CO(2) transitions near 3633.08 and 3645.20 cm(-1), belonging to the nu(1)+ nu(3) vibrational band. Important factors influencing the design of a high-pressure TDL sensor and the variation of WMS-2f line shape with changes in pressure and laser parameters are discussed. Measurements of line strength and line broadening parameters are carried out for the 3645.20 cm(-1) transition in an atmospheric-pressure, high-temperature cell. A room-temperature high-pressure cell is then used to measure the pressure shift for both CO(2) transitions. Deviation of the direct absorption and wavelength modulation spectroscopy (WMS) spectra from the Lorentzian profile is studied in a high-density (9.2 amagats) CO(2)-Ar mixture. The WMS spectra are shown to be negligibly affected by non-Lorentzian effects up to 10 atm and room temperature, in contrast with direct absorption. Measurements of CO(2) concentration and temperature are carried out in nonreactive shock-tube experiments (P approximately 8-12 atm, T~800-1200 K) to validate the accuracy and precision of wavelength-modulation-spectroscopy-based sensing. CO(2) time histories are then measured in heptane ignition experiments and compared with reaction kinetics mechanisms to demonstrate the use of this sensor in high-pressure combustion systems.

Wide angle crystal spectrometer for angularly and spectrally resolved X-ray scattering experiments.

A novel wide angle spectrometer has been implemented with a highly oriented pyrolytic graphite crystal coupled to an image plate. This spectrometer has allowed us to look at the energy resolved spectrum of scattered x rays from a dense plasma over a wide range of angles (approximately 30 degrees ) in a single shot. Using this spectrometer we were able to observe the temporal evolution of the angular scatter cross section from a laser shocked foil. A spectrometer of this type may also be useful in investigations of x-ray line transfer from laser-plasmas experiments.

Competing ordered phases in URu2Si2: hydrostatic pressure and rhenium substitution.

A persistent kink in the pressure dependence of the "hidden order" (HO) transition temperature of URu(2-x)RexSi2 is observed at a critical pressure P(c)=15 kbar for 0

Field-dependent ordered phases and Kondo phenomena in the filled skutterudite compound PrOs4As12.

Electrical resistivity, specific heat, and magnetization measurements to temperatures as low as 80 mK and magnetic fields up to 16 T were made on the filled skutterudite compound PrOs4As12. The measurements reveal the presence of two ordered phases at temperatures below approximately 2.3 K and in fields below approximately 3 T. Neutron-scattering experiments in zero field establish an antiferromagnetic ground state < 2.28 K. In the antiferromagnetically ordered state, the electronic-specific heat coefficient gamma approximately 1 J/mol x K2 below 1.6 K and 0 < or = H < or = 1.25 T. The temperature and magnetic-field dependence of the electrical resistivity and specific heat in the paramagnetic state are consistent with single-ion Kondo behavior with a low Kondo temperature on the order of 1 K. The electronic-specific heat in the paramagnetic state can be described by the resonance-level model with a large zero-temperature electronic-specific heat coefficient that decreases with increasing magnetic field from approximately 1 J/mol x K2 at 3 T to approximately 0.2 J/mol x K2 at 16 T.

Pineapple juice as a negative oral contrast agent in magnetic resonance cholangiopancreatography: a preliminary evaluation.

The quality of magnetic resonance cholangiopancreatography (MRCP) images is frequently degraded by high signal from the gastrointestinal tract. The aim of this study is to evaluate pineapple juice (PJ) as an oral negative contrast agent in MRCP. Preliminary in vitro evaluation demonstrated that PJ shortened T(2) relaxation time and hence decreased T(2) signal intensity on a standard MRCP sequence to a similar degree to a commercially available negative contrast agent (ferumoxsil). Electrothermal atomic absorption spectrometry assay demonstrated a high manganese concentration in PJ of 2.76 mg dl(-1), which is likely to be responsible for its T(2) imaging properties. MRCP was subsequently performed in 10 healthy volunteers, before and at 15 min and 30 min following ingestion of 400 ml of PJ. Images were assessed blindly by two Consultant Radiologists using a standard grading technique based on contrast effect (degree of suppression of bowel signal), and image effect (diagnostic quality). There were statistically significant improvements in contrast and image effect between pre and post PJ images. There was particularly significant improvement in visualization of the pancreatic duct, but no significant difference between 15 min and 30 min post PJ images. Visualization of the ampulla, common bile duct, common hepatic and central intrahepatic ducts were also significantly improved at 15 min following PJ. Our results demonstrate that PJ, may be used as an alternative to commercially available negative oral contrast agent in MRCP.