Impact of visceral obesity and sarcobesity on surgical outcomes and recovery after laparoscopic resection for colorectal cancer

BACKGROUND & AIMS

Studies analyzing the impact of visceral fat excess on surgical outcomes after resection for colorectal cancer (CRC) have yielded conflicting results. Visceral obesity (VO) and sarcobesity (SO) have been recently addressed as risk factors for poor short-term results while no data are available for recovery goals after surgery. No data are available on the protective effect of ERAS in VO and SO patients. The aim of this study was to assess clinical implications of computed tomography (CT) assessed VO and SO on surgical and recovery outcomes after minimally invasive resection for CRC before and after ERAS protocol implementation.

METHODS

Visceral adipose tissue (VAT) and skeletal muscle area (SMA) were retrospectively assessed using pre-operative CT studies of 261 patients who underwent laparoscopic resection for CRC between January 2012 and April 2019; ERAS protocol was adopted in 160 patients operated on after March 2014. Patients' surgical and recovery outcomes were compared according to BMI categories, VO and SO which was defined using the VAT/SMA ratio (Sarcobesity Index). Predictive factors for poor surgical and recovery outcomes were evaluated by univariate and multivariate analyses.

RESULTS

Of the 261 patients, 12.6% were BMI obese while 68.6% presented visceral obesity. BMI was not associated to any of the outcomes considered. No differences in intra-operative results were found except for a lower number of retrieved lymph nodes both in VO and SO patients. While VO showed no impact on post-operative course, SO resulted an independent risk factor for cardiac complications and prolonged post-operative ileus (PPOI) at logistic regression analysis. Furthermore, sarcobese patients showed delayed recovery after surgery. Patients enrolled in the ERAS protocol showed improved recovery outcomes for both VO and SO groups, although ERAS did not result to be a protective factor for cardiac complications and PPOI.

CONCLUSIONS

A high Sarcobesity Index is a risk factor for developing cardiac complications and PPOI after laparoscopic resection for CRC. A reduced number of lymph nodes retrieved is associated to VO and SO. These conditions should then be considered in clinical practice for the risk of down staging the N stage. Effect of VO and SO on recovery items after surgery should be further investigated. ERAS protocol application should be implemented to improve recovery outcomes in VO and SO patients undergoing laparoscopic colorectal resection.

Programming multi-level quantum gates in disordered computing reservoirs via machine learning

Novel machine learning computational tools open new perspectives for quantum information systems. Here we adopt the open-source programming library TensorFlow to design multi-level quantum gates, including a computing reservoir represented by a random unitary matrix. In optics, the reservoir is a disordered medium or a multi-modal fiber. We show that trainable operators at the input and the readout enable one to realize multi-level gates. We study various qudit gates, including the scaling properties of the algorithms with the size of the reservoir. Despite an initial low slop learning stage, TensorFlow turns out to be an extremely versatile resource for designing gates with complex media, including different models that use spatial light modulators with quantized modulation levels.

Topological photonic crystal fibers and ring resonators

With an exact recursive approach, we study photonic crystal fibers and resonators with topological features induced by Aubry-Andre-Harper cladding modulation. We find nontrivial gaps and edge states at the interface between regions with different topological invariants. These structures show topological protection against symmetry-preserving local perturbations that do not close the gap and sustain strong field localization and energy concentration at a given radial distance. As topological light guiding and trapping devices, they may bring about many opportunities for both fundamentals and applications unachievable with conventional devices.

Nonlinear Optics: feature issue introduction

This joint issue of Optics Express and Optical Materials Express features 18 state-of-the art articles that witness actual developments in nonlinear optics, including those by authors who participated in the international conference Nonlinear Optics held in Waikoloa, Hawaii from July 15 to 19, 2019. As an introduction, the editors provide a summary of these articles that cover all aspects of nonlinear optics, from basic nonlinear effects and novel frequency windows to innovative nonlinear materials and devices, thereby paving the way for new nonlinear optical concepts and forthcoming applications.

Topological control of extreme waves

From optics to hydrodynamics, shock and rogue waves are widespread. Although they appear as distinct phenomena, transitions between extreme waves are allowed. However, these have never been experimentally observed because control strategies are still missing. We introduce the new concept of topological control based on the one-to-one correspondence between the number of wave packet oscillating phases and the genus of toroidal surfaces associated with the nonlinear Schrödinger equation solutions through Riemann theta functions. We demonstrate the concept experimentally by reporting observations of supervised transitions between waves with different genera. Considering the box problem in a focusing photorefractive medium, we tailor the time-dependent nonlinearity and dispersion to explore each region in the state diagram of the nonlinear wave propagation. Our result is the first realization of topological control of nonlinear waves. This new technique casts light on shock and rogue waves generation and can be extended to other nonlinear phenomena.

A five year retrospective study on Syphilis in the Sexual Transmitted Disease Centre (STDC) of the teaching Hospital Umberto I in Rome

OBJECTIVES

A retrospective study describing syphilis epidemiological and clinical features in patients referring to an infectious diseases centre in Rome, Italy.

METHODS

Between January 2011 and December 2015 demographic, behavioral and clinical data were collected from all adult patients attending the Sexually Transmitted Diseases Centre of the Teaching Hospital Umberto I in Rome.

RESULTS

Overall 723 patients, 495 males and 228 females, with syphilis infection diagnosis were included. Average age 39.6 ± 13.6 years (median 38) was higher in men than women (41.1 ± 13.6 vs. 36.3 ± 13.1; p<0.001). Patients were from Italy (486 or 67.2%), EU (90 or 12.4%), rest of Europe (38 or 5.3 %), Americas (46 or 6.4%), Africa (36 or 5.0%) and Asia (27 or 3.7%). One-hundred-twenty-three (17.0%) presented primary syphilis, 43 (5.9%) secondary syphilis, 8 (1.1%) tertiary syphilis, 246 (34.0%) serological syphilis, 80 (11.1%) preceding syphilis, 56 (7.7%) gravidic syphilis and 167 (23.1%) came to the Sexually Transmitted Diseases Centre to control a preceding syphilis treatment. Fifty-six (24.6%) women were diagnosed with syphilis during their pregnancies. Among Chinese female patients, those pregnant represented 87.5%. There were 100 subjects (13.8%) simultaneously HIV+ and 623 (86.2%) HIV- patients. HIV co-infection affected more frequently men (RR 5.30; CI 2.62 - 10.72; p<0.001). In males HIV co-infection affected more frequently homosexuals (RR 11.72; CI 6.72 - 20.45; p<0.001). Overall HIV co-infection affected more frequently foreign patients, specially from the Americas (26.1%), Africa (25.7%) and Asia (22.2%).

CONCLUSION

A serious problem of "gravidic syphilis" suggests the need for Public Health preventive action. Also an early diagnosis of both syphilis and HIV infection should be reinforced.

Nonlinear optical memory effect

Light propagating through random media produces characteristic speckle patterns, directly related to the large multitude of scattering events. These complex dynamics remarkably display robustness to perturbation of the incoming light parameters, maintaining correlation in the scattered wavefront. This behavior is known as the optical memory effect. Here we unveil the properties of the nonlinear optical memory effect, which occurs when an optothermal nonlinearity perturbs the random material. The effect is characterized through a series of pump and probe experiments in silica aerogel, in the visible range. This additional degree of freedom further generalizes the memory effect, opening the road to applications based on the nonlinear response of random media.

Large-Scale Photonic Ising Machine by Spatial Light Modulation

Quantum and classical physics can be used for mathematical computations that are hard to tackle by conventional electronics. Very recently, optical Ising machines have been demonstrated for computing the minima of spin Hamiltonians, paving the way to new ultrafast hardware for machine learning. However, the proposed systems are either tricky to scale or involve a limited number of spins. We design and experimentally demonstrate a large-scale optical Ising machine based on a simple setup with a spatial light modulator. By encoding the spin variables in a binary phase modulation of the field, we show that light propagation can be tailored to minimize an Ising Hamiltonian with spin couplings set by input amplitude modulation and a feedback scheme. We realize configurations with thousands of spins that settle in the ground state in a low-temperature ferromagneticlike phase with all-to-all and tunable pairwise interactions. Our results open the route to classical and quantum photonic Ising machines that exploit light spatial degrees of freedom for parallel processing of a vast number of spins with programmable couplings.

Flexible Organometal-Halide Perovskite Lasers for Speckle Reduction in Imaging Projection

Disorder is emerging as a strategy for fabricating random laser sources with very promising materials, such as perovskites, for which standard laser cavities are not effective or too expensive. We need, however, different fabrication protocols and technologies for reducing the laser threshold and controlling its emission. Here, we demonstrate an effectively solvent-engineered method for high-quality perovskite thin films on a flexible polyimide substrate. The fractal perovskite thin films exhibit excellent optical properties at room temperature and easily achieve lasing action without any laser cavity above room temperature with a low pumping threshold. The lasing action is also observed in curved perovskite thin films on flexible substrates. The lasing threshold can be further reduced by increasing the local curvature, which modifies the scattering strengths of the bent thin film. We also show that the curved perovskite lasers are extremely robust with respect to repeated deformations. Because of the low spatial coherence, these curved random laser devices are efficient and durable speckle-free light sources for applications in spectroscopy, bioimaging, and illumination.

Out-of-equilibrium electron dynamics of silver driven by ultrafast electromagnetic fields - a novel hydrodynamical approach

We investigate the ultrafast nonlinear response of silver upon excitation by infrared electromagnetic radiation pulses with a duration of a few femtoseconds. By adopting the Landau weak coupling approach to account for electron-electron and electron-phonon collisions, we solve the Boltzmann equation through the method of moments obtaining a novel set of hydrodynamical equations describing the ultrafast nonlinear dynamics of electrons in silver. While the novel hydrodynamical model that was obtained reduces to the Drude model for small intensities of the driving field, it predicts that absorption saturates for large but experimentally attainable peak intensities of the order of GW cm-2. Our results are important for absorption mitigation in plasmonic devices, with potential impact for low-loss plasmonic waveguides and interconnects.

Prognostic value of thrombocytosis in patients undergoing surgery for colorectal cancer with synchronous liver metastases

PURPOSE

The purpose of this study was to evaluate the prognostic role of thrombocytosis in patients with synchronous colorectal liver metastases (CRLM).

METHODS

Retrospective analysis of patients who underwent surgery for colorectal cancer with synchronous CRLM at the Division of General and Hepatobiliary Surgery, University of Verona Hospital Trust between 2005 and 2016.

RESULTS

One hundred and ninety-six patients met the inclusion criteria. High platelet count (H-PC) was found in 32%, and it was associated with a higher rate of palliative surgery (p < 0.001), extra-hepatic metastases (p < 0.001), bilobar liver disease (p = 0.007), presence of more than three metastases (p = 0.005), biggest metastasis larger than 5 cm (p < 0.001), and CEA level higher than 200 ng/mL (p = 0.035). H-PC was significantly associated with poorer 5-year overall survival (14.3% vs. 34.3%; p = 0.001). At the multivariate analysis on R0-1 cases, platelet count resulted the only independent predictor of survival (HR 2.07, p = 0.036).

CONCLUSION

H-PC correlates with the main negative clinical-pathological factors in patients with synchronous CRLM, as well as with overall survival. Moreover, it was the only independent prognostic factor in those who underwent curative surgery.

Control of soliton self-frequency shift dynamics via Airy soliton interaction

We investigate Airy-soliton interaction in a nonlinear fiber with Raman effect. We find that Airy solitons may fuse upon interaction at a position that can be controlled by a proper engineering of the Airy tail direction. This control allows us to generate Airy solitons with varying deceleration. At variance with the case of two solitons interaction, Raman-induced soliton self-frequency shift (SSFS) is strongly enhanced when the leading soliton is replaced with the accelerating Airy pulse and slightly suppressed for the decelerating one. These notable features are ascribed to the unique properties of asymmetrical Airy pulses with a switchable direction of the oscillatory tails. We show the way these processes are uncovered unambiguously by cross-correlation frequency resolved optical gating. We also investigate the impact of chirp imposed on the input pulse on the SSFS dynamics. Our results not only provide a new way to manipulate the SSFS, but may help to improve the control of soliton fusion events during supercontinuum generation, optical rogue waves and giant dispersive waves formation.

Graphene oxide coatings prevent Candida albicans biofilm formation with a controlled release of curcumin-loaded nanocomposites

AIM

Fabrication of graphene oxide (GO)-based medical devices coatings that limit adhesion of Candida albicans, a main issue of healthcare-associated infections.

METHODS

The GO composites noncovalently functionalized with curcumin (CU), a hydrophobic molecule with active antimicrobial action, polyethylene glycol (PEG) that hinders the absorption of biomolecules or a combination of CU and PEG (GO-CU-PEG) were drop-casted on surfaces and antifungal efficacy was assessed.

RESULTS

We demonstrate that GO-CU-PEG coatings can reduce fungal adhesion, proliferation and biofilm formation. Furthermore, in an aqueous environment, surfaces release curcumin-PEG nanocomposites that have a minimum inhibitory concentration of 9.25 μg/ml against C. albicans.

CONCLUSION

Prevention of early cell adhesion and creation of a proximal environment unfavorable for growth make these GO-supported biomaterials attractive for innovative medical device manufacturing.

Does the purinergic system affect extracellular matrix functions in the central nervous system?

Exracellular matrix (ECM) consists of a plethora of proteins and polysaccharides, which aggregate into an organized network connected to the surface of the producing cells. It is structurally and functionally present in all components of tissues and organs and represents the substrate on which cells adhere, migrate, proliferate and differentiate, influencing their survival, shape and function. In response to acute (trauma) or chronic (degenerative) insults, brain ECM modifies its composition and function, actively contributing to "scar forming" gliosis or tissue degeneration/remodelling. Moreover, morphological changes in dendritic spines associated with extracellular matrix remodeling play key roles in rewiring synaptic circuitry pertinent to memory formation. In the present report, we collected the main acquisitions on the functional interplay between ECM alterations and the adenine-/guaninebased purine system with particular regard on how purine compounds and their respective receptors may affect and be affected by changes of the cerebral ECM.

Graphene Oxide Induced Osteogenesis Quantification by In-Situ 2D-Fluorescence Spectroscopy

Graphene and graphene oxide can promote the adhesion, growth and differentiation of mesenchymal stem cells. Further, graphene surface coatings accelerate the differentiation of human mesenchymal stem cells acting as osteogenic inducers. Quantification of the osteogenic induction is conventionally performed with Alizarin Red S (ARS), an anthraquinone derivative used to identify calcium deposits in tissue sections and cell cultures. The ARS staining is quite versatile because the dye forms an Alizarin Red S⁻calcium complex that can be extracted from the stained monolayer of cells and readily assayed by absorbance measurements. Direct visualization of stained deposits is also feasible; however, an in-situ visualization and quantification of deposits is possible only on transparent supports and not on thick opaque materials like ceramics and graphene composites that are well-known inducers of osteogenesis. In this manuscript, the shape of the 2D-fluorescence spectra of the ARS-calcium complex is used to develop a method to detect and monitor the in-situ differentiation process occurring during the osteogenic induction mediated by opaque graphene oxide surfaces.

Curcumin-loaded graphene oxide flakes as an effective antibacterial system against methicillin-resistant Staphylococcus aureus

Methicillin-resistant Staphylococcus aureus (MRSA) is responsible for serious hospital infections worldwide and represents a global public health problem. Curcumin, the major constituent of turmeric, is effective against MRSA but only at cytotoxic concentrations or in combination with antibiotics. The major issue in curcumin-based therapies is the poor solubility of this hydrophobic compound and the cytotoxicity at high doses. In this paper, we describe the efficacy of a composite nanoparticle made of curcumin (CU) and graphene oxide (GO), hereafter GOCU, in MRSA infection treatment. GO is a nanomaterial with a large surface area and high drug-loading capacity. GO has also antibacterial properties due mainly to a mechanical cutting of the bacterial membranes. For this physical mechanism of action, microorganisms are unlikely to develop resistance against this nanomaterial. In this work, we report the capacity of GO to support and stabilize curcumin molecules in a water environment and we demonstrate the efficacy of GOCU against MRSA at a concentration below 2 µg ml-1. Further, GOCU displays low toxicity on fibroblasts cells and avoids haemolysis of red blood cells. Our results indicate that GOCU is a promising nanomaterial against antibiotic-resistant MRSA.

Synchrotron resonant radiation from nonlinear self-accelerating pulses

Solitons and nonlinear waves emit resonant radiation in the presence of perturbations. This effect is relevant for nonlinear fiber optics, supercontinuum generation, rogue waves, and complex nonlinear dynamics. However, resonant radiation is narrowband, and the challenge is finding novel ways to generate and tailor broadband spectra. We theoretically predict that nonlinear self-accelerated pulses emit a novel form of synchrotron radiation that is extremely broadband and controllable. We develop an analytic theory and confirm the results by numerical analysis. This new form of supercontinuum generation can be highly engineered by shaping the trajectory of the nonlinear self-accelerated pulses. Our results may find applications in novel highly efficient classical and quantum sources for spectroscopy, biophysics, security, and metrology.

New concepts in neuroinflammation: mast cells pro-inflammatory and anti-inflammatory cytokine mediators

The activation of brain nociceptors and neurons may lead to neurogenic inflammation, an event that involves immune cells including mast cells (MCs). Microglia are similar to macrophages and secrete pro-inflammatory IL-1 family members and TNF. TNF is rapidly released (first 10 minutes from MC granules) and is subsequently secreted along with other pro-inflammatory cytokines with a new synthesis after several hours. MC-derived TNF is a very powerful pro-inflammatory cytokine which mediates sensitization of the meningeal nociceptors. Here, we report the involvement of MCs in neuroinflammation, the role of inflammatory cytokine IL-1 family members, and of TNF, as well as the potential inhibition of IL-37.

Promotion of hand hygiene: the experience of the orthopaedic hospital Gaetano Pini-CTO, Milan, Italy

BACKGROUND

Hand hygiene is the primary preventive measure against health care-associated infections in terms of cost-effectiveness. In 2005, the WHO proposed the "Global Patient Safety Challenge" campaign, with the aim of reducing the overall incidence of such infections, through multimodal programs and strategies, interactive training tools and standardised methods for monitoring compliance.

STUDY DESIGN

On the basis of project "Rimani", sponsored by the Health and Social Care Authority of Emilia-Romagna, the Istituto Ortopedico Gaetano Pini has implemented a project which seeks to increase healthcare staff's compliance with hand hygiene.

METHODS

A multidisciplinary working group was created to prepare the project documents. Starting from 5th April 2015, twenty operational units were asked to produce information and training material. On 5th May, during a conference, a committee selected the three best works. The material was distributed on a monthly basis to the various departments. In addition to the training, the specifically trained operators of the Medical Monitoring Department carried out direct hand washing tests, filling out appropriate checklists. Non-compliance relating to the technique recorded in 2014 and 2015 was compared and a statistical analysis was conducted using Student's t-test for paired data.

RESULTS

Three tests were carried out in 2014. Ninety-nine cases were monitored and 5 non-compliance cases were reported, concerning the execution of the procedural steps, the running time and closing the tap with one's hands at the end of the wash. In 2015 two tests, involving 30 operational units, were carried out. 60 observations were performed, and no non-conformities emerged concerning the technique. Statistical analysis showed a significant reduction of non-compliances between the 2014 and 2015 P = 0.000).

CONCLUSION

The results obtained agree with the main findings in literature. The comparison between the 2014 and 2015 tests shows a trend of improvement in the wash technique. This confirms the effectiveness of a multidisciplinary approach and recognises the active and participatory involvement suggested by the WHO.

Aumento da sustentabilidade da produção de raças suínas locais através do uso de rótulos de qualidade – estudo de caso e desenvolvimento de uma marca comercial no projecto TREASURE

O interesse pelos recursos genéticos tradicionais, neste caso de raças suínas locais, tem crescido nas últimas décadas. No entanto, a maior parte das raças locais necessita, ainda, de ser subsidiada para garantir a sua conservação. Contudo, a melhor estratégia a seguir parece-nos ser garantir que essas raças atinjam autossustentabilidade o que será possível com uma estratégia de marketing eficiente para os seus produtos. A maioria das raças estudadas no projeto TREASURE são inexploradas, portanto a ambição é criar uma marca comercial coletiva (trademark) que servisse de “chapéu” que agregasse todas as raças e criasse valor acrescentado para os seus produtos. Os principais aspetos socioeconómicos relacionados com a implementação da marca comercial coletiva incluem os direitos, responsabilidades, e valor acrescentado expectável para os seus utilizadores finais. Baseados nos resultados obtidos num inquérito interno realizado no TREASUE, identificaram-se as principais características dessa marca comercial colaborativa: 1) deve atrair utilizadores finais como os criadores, associações de criadores e processadores de carne; 2) deve ser desenvolvida e promovida por um comité operacional constituído por utilizadores finais sob a coordenação e supervisão do consórcio do TREASURE; 3) deve realçar que os recursos genéticos locais suínos são o ponto-chave comum, considerando também os sistemas de produção e a nutrição; 4) deve ser explorada a possível colaboração ou conflito com os produtos presentemente protegidos pela EU (PDO, PGI, TSG) de forma a promover melhor os produtos locais. Apresenta-se uma análise dos direitos de propriedade intelectual (IPR) no contexto das fileiras de suínos existentes na União Europeia e as perspetivas para a marca comercial TREASURE analisada.

Phase-matching-free parametric oscillators based on two-dimensional semiconductors

Optical parametric oscillators are widely used as pulsed and continuous-wave tunable sources for innumerable applications, such as quantum technologies, imaging, and biophysics. A key drawback is material dispersion, which imposes a phase-matching condition that generally entails a complex design and setup, thus hindering tunability and miniaturization. Here we show that the burden of phase-matching is surprisingly absent in parametric micro-resonators utilizing mono-layer transition-metal dichalcogenides as quadratic nonlinear materials. By the exact solution of nonlinear Maxwell equations and first-principle calculations of the semiconductor nonlinear response, we devise a novel kind of phase-matching-free miniaturized parametric oscillator operating at conventional pump intensities. We find that different two-dimensional semiconductors yield degenerate and non-degenerate emission at various spectral regions due to doubly resonant mode excitation, which can be tuned by varying the incidence angle of the external pump laser. In addition, we show that high-frequency electrical modulation can be achieved by doping via electrical gating, which can be used to efficiently shift the threshold for parametric oscillation. Our results pave the way for the realization of novel ultra-fast tunable micron-sized sources of entangled photons-a key device underpinning any quantum protocol. Highly miniaturized optical parametric oscillators may also be employed in lab-on-chip technologies for biophysics, detection of environmental pollution and security.