977 Breaking Out of Tradition: Designing Escape Rooms as Novel Simulation

Aim

The emerging field of gamification, the addition of game play elements to non-game settings, is widely used in business and is increasingly being used in education. Successful methods have included live leader boards and a web-based game solving a protein folding conundrum.

Method

We designed an escape room (ER), incorporating gaming elements, focussing on communication in a surgical environment. A cross over study was delivered to 4th year medical students, comparing traditional simulation. The ER included logic puzzles, hidden clues, padlocked boxes, and surgical skills appropriate to their level. Self-reported engagement and teamwork were recorded, as was observed teamwork and communication skills.

Results

Self-reported engagement was very high for the students compared to more traditional simulation, including better understanding of effective communication strategies. The ER group were less likely to self-identify learning points but structured debrief mitigated this difference.

Conclusions

Gamification techniques can be integrated with good engagement and educational outcomes and should be considered as an adjunct to existing simulation strategy.

971 Gamification of Education; Can Playable Education Result in Better Learning Outcomes?

Aim

Combining traditional simulation (TS) and the emerging field of gamification, to create medical Escape Rooms (ERS) has been used in Nursing to good results but is yet to be widely adopted in medical education. We conducted a pilot study to create ERS for undergraduates to assess their educational value.

Method

Existing Simulation themes of sepsis, post-operative bleeding, trauma, burns and communication in the theatre environment were developed into Escape Rooms by a multidisciplinary team. A cross over study for 4th year students was carried out. Questionnaires were used to evaluate the experience, learning assessed by pre and post quiz and observational tools for teamwork, communication and leadership were utilised.

Results

Qualitative data demonstrated overall good feedback on enjoyment an engagement. Quantitative data collected as pre- and post-exposure learning demonstrated equivocal benefit. Self-assessed teamwork showed equal in all domains and improved in contribution of knowledge and maintaining team focus on the ER group.

Conclusions

Participants find ER enjoyable have similar educational benefits of traditional simulation with the benefits on enhancing non-technical skills amongst a novice group. Escape rooms may be useful as an adjunct to TS particularly at developing non-technical skills.

961 ‘WE CARE!’: CARE WORKERS’ SELF-PERCEIVED MEANING OF RESIDENTIAL AGED CARE WORK

Introduction

Aged care workers in residential care homes of the elderly (RCHEs) are socially devalued as less skilled, low-paid, and doing ‘dirty work’. Care workers’ insider experiences with the meaning of residential aged care work are largely absent from the community and the literature.

Method

A qualitative study was conducted to examine the self-perceived meaning of work (MOW) among care workers in RCHEs in Hong Kong, an East Asian metropolis with a rapidly aging population, and unique socio-cultural meanings of elderly care. Adopting the Grounded Theory Method, in-depth interviews with 27 care workers in 6 RCHEs were conducted.

Results

Findings suggest that regardless of the job requirements of carrying out ‘dirty tasks’ and shared experiences of public devaluations, RCHE care workers find positive meanings in their work including: contributing to the greater good of helping the elderly; establishing meaningful relationships; forming a professional identity of geriatric care; achieving personal growth; ensuring job security and benefits in the aged care job market. Care workers find their work meaningful primarily because it is essential to maintain the elderly’s health and quality of life, which echoes with the Chinese cultural values of ‘accumulating fortune’ and ‘respecting the elderly’. Engaging in residential care work allows care workers to build long-term relationships with the elderly, through which they found joys and knowledge of life such as letting go. Care workers propose that geriatric care is highly skillful and professional, requiring communication, coordination, and chronic illness care skills. Care workers identify several inhibitors of attaining MOW, including heavy workloads, manpower shortage, and dehumanizing bureaucratic practices.

Conclusion

Care workers offer counter-narratives of public devaluation and reframe the meaning of care work in RCHEs. These findings have broader implications on policy, professional, and education interventions in promoting the public recognition of aged care work.

The work described in this paper was fully supported by a grant from the Research Grants Council of the Hong Kong Special Administrative Region, China (UGC/FDS16/M12/20).

962 FROM DIRTY WORK TO MEANINGFUL WORK: A PHOTOVOICE STUDY OF RESIDENTIAL AGED CARE IN HONG KONG

Introduction

Caregiving work in ‘residential care homes for the elderly’ (RCHEs) has long been devalued as ‘dirty work’, which contributes to RCHE’s acute shortages of health care staff in Hong Kong. This study aims to unearth the voice of the RCHEs workers by delineating their insider perspectives of RCHE work.

Method

Adopting the Photovoice method, a participatory methodology, 30 RCHEs care workers (i.e. Registered Nurses, Enrolled Nurses, Health Workers, and Personal Care Workers) were invited to take photos that showcase their perspectives of doing aged care work. Two in-depth interviews were conducted with each research participant before and after the photo-taking procedure. Thematic analysis is then conducted to analyse the visual and verbal data.

Results

Findings show that RCHEs care workers perceive and revitalize the nature and meaning of their work in four ways: conducting ‘dirty tasks’ to help the elderly; valuing and engaging in long-term relationships; learning in work; and cultural meaning of working with the elderly. Contrary to public devaluation, RCHE care workers normalize the delivery of ‘dirty tasks’ (i.e. handling human excreta and wounds) as being helpful to both the elderly and the family members. Besides the routine caring tasks on paper, care workers highlight that they spend a lot of unrecognized labor to build rapport and provide emotional support to the elderly and their family members in their work. They also report that learning and self-development are an important part of residential care work, both in terms of professional knowledge and personal growth. Taking care of the elderly also conveys positive cultural meanings in Chinese society.

Conclusion

Policy, professional and educational initiatives of geriatric care primarily emphasize the delivery of clinical tasks (caring for), while undermining the emotional and relational aspects of aged care work.

The work described in this paper was fully supported by a grant from the Research Grants Council of the Hong Kong Special Administrative Region, China. (UGC/FDS16/M12/20).

A functional genomics screen identifying blood cell development genes in Drosophila by undergraduates participating in a course-based research experience

Undergraduate students participating in the UCLA Undergraduate Research Consortium for Functional Genomics (URCFG) have conducted a two-phased screen using RNA interference (RNAi) in combination with fluorescent reporter proteins to identify genes important for hematopoiesis in Drosophila. This screen disrupted the function of approximately 3500 genes and identified 137 candidate genes for which loss of function leads to observable changes in the hematopoietic development. Targeting RNAi to maturing, progenitor, and regulatory cell types identified key subsets that either limit or promote blood cell maturation. Bioinformatic analysis reveals gene enrichment in several previously uncharacterized areas, including RNA processing and export and vesicular trafficking. Lastly, the participation of students in this course-based undergraduate research experience (CURE) correlated with increased learning gains across several areas, as well as increased STEM retention, indicating that authentic, student-driven research in the form of a CURE represents an impactful and enriching pedagogical approach.

Core outcome set for surgical trials in gastric cancer (GASTROS study): international patient and healthcare professional consensus

BACKGROUND

Surgery is the primary treatment that can offer potential cure for gastric cancer, but is associated with significant risks. Identifying optimal surgical approaches should be based on comparing outcomes from well designed trials. Currently, trials report different outcomes, making synthesis of evidence difficult. To address this, the aim of this study was to develop a core outcome set (COS)-a standardized group of outcomes important to key international stakeholders-that should be reported by future trials in this field.

METHODS

Stage 1 of the study involved identifying potentially important outcomes from previous trials and a series of patient interviews. Stage 2 involved patients and healthcare professionals prioritizing outcomes using a multilanguage international Delphi survey that informed an international consensus meeting at which the COS was finalized.

RESULTS

Some 498 outcomes were identified from previously reported trials and patient interviews, and rationalized into 56 items presented in the Delphi survey. A total of 952 patients, surgeons, and nurses enrolled in round 1 of the survey, and 662 (70 per cent) completed round 2. Following the consensus meeting, eight outcomes were included in the COS: disease-free survival, disease-specific survival, surgery-related death, recurrence, completeness of tumour removal, overall quality of life, nutritional effects, and 'serious' adverse events.

CONCLUSION

A COS for surgical trials in gastric cancer has been developed with international patients and healthcare professionals. This is a minimum set of outcomes that is recommended to be used in all future trials in this field to improve trial design and synthesis of evidence.

Nasal septal angiofibroma: less vascular behaviour than observed in radiological imaging, a rare case in a 51-year-old woman

Angiofibroma of the head and neck is classically found in the nasopharynx of an adolescent male. We present a rare case where an angiofibroma was diagnosed in the anterior nasal septum of a 51-year-old woman, the eighth nasal septal angiofibroma reported in a female. This case highlights how an angiofibroma in an older woman has a less vascular behaviour than one in an adolescent male, even though radiological enhancement may suggest that the lesion is highly vascularised. Nasal septal angiofibromas can be managed by biopsy and removed by simple endoscopic resection with minimal haemorrhage. Although very rare, extranasopharyngeal angiofibroma/nasal septal angiofibroma should be included in the differential diagnosis when patients of all ages present with nasal obstruction secondary to a nasal mass, with or without epistaxis.

The value of neck drain in esophageal surgery: a randomized trial

The use of surgical drains in certain clean elective operations remains controversial. To evaluate the role of closed-suction drain for an esophageal anastomosis in the neck, we conducted a randomized, controlled study in 40 patients with esophageal carcinoma who underwent esophagectomy with an esophageal anastomosis in the neck, half of whom had a neck drain inserted at the end of operation. The median (range) duration of drainage was 46 hours (36 to 88 hours). The median (range) amount of drainage was 63 ml (15 to 210 ml). There was no incidence of haematoma or seroma formation in both the drained and non-drained groups. Anastomotic leakage did not occur in any patient. The benefits of closed suction neck drain could not be demonstrated. Routine use of neck drain for esophageal anastomosis in the neck is not necessary.

Appropriate timing for surgery after neoadjuvant chemoradiation for esophageal cancer

Optimal interval between neoadjuvant chemoradiotherapy (CRT) and surgery is not elucidated for esophageal squamous carcinoma. The aim of this study is to evaluate the impact of this time interval on patient outcome. Patients treated with neoadjuvant CRT followed by surgery between 2002 and 2009 were analyzed. Patients were divided into two groups based on the median interval to surgery (64 days): A </= 64 days (n = 54) and B > 64 days (n = 53). A second analysis was performed by re-classifying patients into three interval groups: A* ≤ 40 days (n = 16); B* 41-80 days (n = 60); C* > 80 days (n = 31). Operative outcome, pathological data, and long-term survival were analyzed. One hundred and seven (n = 107) patients were analyzed. Five patients (9.4%) in group B had an anastomotic leak compared with no leakage from group A (P < 0.021). The complete pathological response was comparable in groups A and B (35% vs. 24.5%, p = 0.23). R0 was significantly lower in group A* (A*: 56.3%, B*: 90%, C*: 74.2%, P = 0.006). In patients with R0 resection, 5-year survival was significantly better in group A than B (71.7% vs. 51%, P = 0.032) and in group A* (A* 100% vs. B* 60.2% & C* 48.3%; A* vs. B*, P = 0.036; A* vs. C*, P = 0.019). Complete pathological response was an independent predictor of survival. Early surgery with R0 resection following neoadjuvant CRT may lead to a better outcome. Further prospective studies are still necessary to provide better insight into the issue. At present, timing of surgery should be individualized and performed at the earliest opportunity.

Predictive factors for publication of abstracts at the Royal Australasian College of Surgeons Annual Scientific Congress

BACKGROUND

A key metric of the research quality of medical conferences is the publication rate of abstracts. The study objective was to determine the publication rate of abstracts presented at the Royal Australasian College of Surgeons Annual Scientific Congress (RACS ASC) and to examine for any predictive factors associated with publication.

METHODS

Abstracts presented at the RACS ASC from 2011 to 2013 were analysed. Abstract characteristics such as presentation format, study type, study design, study site, cohort size and author origin were recorded. Abstracts published were identified by a PubMed search using a strict algorithm. Univariate and multivariable logistic regressions were used to analyse for predictive factors of publication.

RESULTS

Overall, 1438 abstracts were presented and 423 abstracts (29%) were published. The median time to publication was 15.2 months (interquartile range: 8-26) with 110 in Australasian journals (26%). The median number of citations for published abstracts was 6 (interquartile range: 2-16). After multivariable analysis, publication was significantly associated with prospective study design (odds ratio (OR) = 1.34, P = 0.02), multicentre study site (OR = 1.43, P = 0.02), cohort size ≥100 (OR = 2.00, P < 0.001) and New Zealand author origin (OR = 1.50, P = 0.01).

CONCLUSION

Our study demonstrates that less than one-third of abstracts presented at the RACS ASC are subsequently published in a peer-reviewed journal. Factors significantly associated with journal publication include prospective studies, multicentre study, a larger cohort size and New Zealand author origin. Advances in surgery may progress from the preliminary findings of conference abstracts. However only after the rigorous peer review offered by journal publication should changes in decision-making of patient care occur.

MicroRNA-377 suppresses initiation and progression of esophageal cancer by inhibiting CD133 and VEGF

Esophageal cancer is one of the most lethal cancers worldwide with poor survival and limited therapeutic options. The discovery of microRNAs created a new milestone in cancer research. miR-377 is located in chromosome region 14q32, which is frequently deleted in esophageal squamous cell carcinoma (ESCC), but the biological functions, clinical significance and therapeutic implication of miR-377 in ESCC are largely unknown. In this study, we found that miR-377 expression was significantly downregulated in tumor tissue and serum of patients with ESCC. Both tumor tissue and serum miR-377 expression levels were positively correlated with patient survival. Higher serum miR-377 expression was inversely associated with pathologic tumor stage, distant metastasis, residual tumor status and chemoradiotherapy resistance. The roles of miR-377 in suppressing tumor initiation and progression, and the underlying molecular mechanisms were investigated. Results of in vitro and in vivo experiments showed that miR-377 overexpression inhibited the initiation, growth and angiogenesis of ESCC tumors as well as metastatic colonization of ESCC cells, whereas silencing of miR-377 had opposite effects. Mechanistically, miR-377 regulated CD133 and VEGF by directly binding to their 3' untranslated region. Moreover, systemic delivery of formulated miR-377 mimic not only suppressed tumor growth in nude mice but also blocked tumor angiogenesis and metastasis of ESCC cells to the lungs without overt toxicity to mice. Collectively, our study established that miR-377 plays a functional and significant role in suppressing tumor initiation and progression, and may represent a promising non-invasive diagnostic and prognostic biomarker and therapeutic strategy for patients with ESCC.

Outcomes after oesophageal perforation: a retrospective cohort study of patients with different aetiologies

INTRODUCTION

The mortality rate after oesophageal perforation is high despite advances in operative and non-operative techniques. In this study, we sought to identify risk factors for hospital mortality after oesophageal perforation treatment.

METHODS

We retrospectively examined patients treated for oesophageal perforation in a university teaching hospital in Hong Kong between January 1997 and December 2013. Their demographic and clinical characteristics, aetiology, management strategies, and outcomes were recorded and analysed.

RESULTS

We identified a cohort of 43 patients treated for perforation of the oesophagus (28 men; median age, 66 years; age range, 30-98 years). Perforation was spontaneous in 22 (51.2%) patients (15 with Boerhaave's syndrome and seven with malignant perforation), iatrogenic in 15 (34.9%), and provoked by foreign body ingestion in six (14.0%). Of the patients, 14 (32.6%) had pre-existing oesophageal disease. Perforation occurred in the intrathoracic oesophagus in 30 (69.8%) patients. Emergent surgery was undertaken in 23 patients: 16 underwent primary repair, six surgical drainage or exclusion, and one oesophagectomy. Twenty patients were managed non-operatively, 13 of whom underwent stenting. Two stented patients subsequently required oesophagectomy. Four patients had clinical signs of leak after primary repair: two were treated conservatively and two required oesophagectomy. Overall, six (14.0%) patients required oesophagectomy, one of whom died. Nine other patients also died in hospital; the hospital mortality rate was 23.3%. Pre-existing pulmonary and hepatic disease, and perforation associated with malignancy were significantly associated with hospital mortality (P=0.03, <0.01, and <0.01, respectively).

CONCLUSIONS

Most oesophageal perforations were spontaneous. Mortality was substantial despite modern therapies. Presence of pre-existing pulmonary disease, hepatic disease, and perforation associated with malignancy were significantly associated with hospital mortality. Salvage oesophagectomy was successful in selected patients.

Worldwide Esophageal Cancer Collaboration: clinical staging data

To address uncertainty of whether clinical stage groupings (cTNM) for esophageal cancer share prognostic implications with pathologic groupings after esophagectomy alone (pTNM), we report data-simple descriptions of patient characteristics, cancer categories, and non-risk-adjusted survival-for clinically staged patients from the Worldwide Esophageal Cancer Collaboration (WECC). Thirty-three institutions from six continents submitted data using variables with standard definitions: demographics, comorbidities, clinical cancer categories, and all-cause mortality from first management decision. Of 22,123 clinically staged patients, 8,156 had squamous cell carcinoma, 13,814 adenocarcinoma, 116 adenosquamous carcinoma, and 37 undifferentiated carcinoma. Patients were older (62 years) men (80%) with normal body mass index (18.5-25 mg/kg² , 47%), little weight loss (2.4 ± 7.8 kg), 0-1 ECOG performance status (67%), and history of smoking (67%). Cancers were cT1 (12%), cT2 (22%), cT3 (56%), cN0 (44%), cM0 (95%), and cG2-G3 (89%); most involved the distal esophagus (73%). Non-risk-adjusted survival for squamous cell carcinoma was not distinctive for early cT or cN; for adenocarcinoma, it was distinctive for early versus advanced cT and for cN0 versus cN+. Patients with early cancers had worse survival and those with advanced cancers better survival than expected from equivalent pathologic categories based on prior WECC pathologic data. Thus, clinical and pathologic categories do not share prognostic implications. This makes clinically based treatment decisions difficult and pre-treatment prognostication inaccurate. These data will be the basis for the 8th edition cancer staging manuals following risk adjustment for patient characteristics, cancer categories, and treatment characteristics and should direct 9th edition data collection.

Worldwide Esophageal Cancer Collaboration: pathologic staging data

We report data-simple descriptions of patient characteristics, cancer categories, and non-risk-adjusted survival-for patients with pathologically staged cancer of the esophagus and esophagogastric junction after resection or ablation with no preoperative therapy from the Worldwide Esophageal Cancer Collaboration (WECC). Thirty-three institutions from six continents submitted de-identified data using standard definitions: demographics, comorbidities, clinical cancer categories, and all-cause mortality from first management decision. Of 13,300 patients, 5,631 had squamous cell carcinoma, 7,558 adenocarcinoma, 85 adenosquamous carcinoma, and 26 undifferentiated carcinoma. Patients were older (62 years) men (80%) with normal body mass index (51%), little weight loss (1.8 kg), 0-2 ECOG performance status (83%), and a history of smoking (70%). Cancers were pT1 (24%), pT2 (15%), pT3 (50%), pN0 (52%), pM0 (93%), and pG2-G3 (78%); most involved distal esophagus (71%). Non-risk-adjusted survival for both squamous cell carcinoma and adenocarcinoma was monotonic and distinctive across pTNM. Survival was more distinctive for adenocarcinoma than squamous cell carcinoma when pT was ordered by pN. Survival for pTis-1 adenocarcinoma was better than for squamous cell carcinoma, although monotonic and distinctive for both. WECC pathologic staging data is improved over that of the 7th edition, with more patients studied and patient and cancer variables collected. These data will be the basis for the 8th edition cancer staging manuals following risk adjustment for patient, cancer, and treatment characteristics, and should direct 9th edition data collection. However, the role of pure pathologic staging as the principal point of reference for esophageal cancer staging is waning.

Worldwide Esophageal Cancer Collaboration: neoadjuvant pathologic staging data

To address uncertainty of whether pathologic stage groupings after neoadjuvant therapy (ypTNM) for esophageal cancer share prognostic implications with pathologic groupings after esophagectomy alone (pTNM), we report data-simple descriptions of patient characteristics, cancer categories, and non-risk-adjusted survival-for pathologically staged cancers after neoadjuvant therapy from the Worldwide Esophageal Cancer Collaboration (WECC). Thirty-three institutions from six continents submitted data using variables with standard definitions: demographics, comorbidities, clinical cancer categories, and all-cause mortality from first management decision. Of 7,773 pathologically staged neoadjuvant patients, 2,045 had squamous cell carcinoma, 5,686 adenocarcinoma, 31 adenosquamous carcinoma, and 11 undifferentiated carcinoma. Patients were older (61 years) men (83%) with normal (40%) or overweight (35%) body mass index, 0-1 Eastern Cooperative Oncology Group performance status (96%), and a history of smoking (69%). Cancers were ypT0 (20%), ypT1 (13%), ypT2 (18%), ypT3 (44%), ypN0 (55%), ypM0 (94%), and G2-G3 (72%); most involved the distal esophagus (80%). Non-risk-adjusted survival for yp categories was unequally depressed, more for earlier categories than later, compared with equivalent categories from prior WECC data for esophagectomy-alone patients. Thus, survival of patients with ypT0-2N0M0 cancers was intermediate and similar regardless of ypT; survival for ypN+ cancers was poor. Because prognoses for ypTNM and pTNM categories are dissimilar, prognostication should be based on separate ypTNM categories and groupings. These data will be the basis for the 8th edition cancer staging manuals following risk adjustment for patient, cancer, and treatment characteristics and should direct 9th edition data collection.

Spontaneous circumferential intramural esophageal dissection complicated with esophageal perforation and esophageal-pleural fistula: a case report and literature review

Spontaneous intramural esophageal dissection (IED) is a rare disease entity. There are few reports of spontaneous IED requiring surgical treatment. Hereby, we report a 37-year-old gentleman who was diagnosed to have spontaneous extensive circumferential IED complicated with esophageal perforation, empyema, and esophageal-pleural fistula. Esophageal stenting and drainage of empyema were unsuccessful. Computed tomography and gastrografin contrast swallow demonstrated a leak to the pleural cavity, suggestive of esophageal-pleural fistula. Subsequently, a two-stage operation was performed: cervical esophagogastrostomy to bypass the perforated esophagus, followed by esophagectomy and decortication of the right lung. The patient recovered and was discharged home after a 3-week hospitalization. The management principles and recent published literature related to IED were reviewed.

Single-material semiconductor hyperbolic metamaterials

Layered semiconductor hyperbolic metamaterials for the mid-infrared are grown by molecular beam epitaxy using a single material system, doped and undoped InAs. The onset wavelength for metamaterial behavior can be tuned from 5.8μm to beyond 10μm, while the fill factor ranges from 0.25 to 0.75, resulting in designer optical behavior. The reflection and transmission behavior were studied by Fourier transform spectroscopy and modeled using effective medium theory. We also conducted a geometric optics experiment to demonstrate negative refraction of our materials.

Durability of giant hiatus hernia repair in 455 patients over 20 years

INTRODUCTION

The surgical management of symptomatic giant hiatus hernia (GHH) aims to improve quality of life (QoL) and reduce the risk of life threatening complications. Previous reports are predominantly those with small sample sizes and short follow-up periods. The present study sought to assess a large cohort of patients for recurrence and QoL over a longer time period.

METHODS

This was a follow-up study of a prospectively collected database of 455 consecutive patients. Primary repair of GHH was evaluated by endoscopy/barium meal for recurrence and a standardised symptom questionnaire for QoL. Recurrence was assessed for size, elapsed time, oesophagitis and symptoms.

RESULTS

Objective and subjective review was achieved in 91.9% and 68.6% of patients. The median age was 69 years (range: 15-93 years) and 64% were female. Laparoscopic repair was completed in 95% (mesh in 6% and Collis gastroplasty in 7%). The 30-day mortality rate was 0.9%. The proportion of patients alive at five and ten years were 90% and 75% respectively. Postoperative QoL scores improved from a mean of 95 to 111 (p<0.01) and were stable over time (112 at 10 years). The overall recurrence rate was 35.6% (149/418) at 42 months; this was 11.5% (48/418) for hernias >2cm and 24.2% (101/418) for <2cm. The rate of new recurrence at 0-1 years was 13.7% (>2cm = 3.4%, <2cm = 10.3%), at 1-5 years it was 30.8% (>2cm = 9.5%, <2cm = 21.3%), at 5-10 years it was 40.1% (>2cm = 13.8%, <2cm = 26.3%) and at over 10 years it was 50.0% (>2cm = 25.0%, <2cm = 25.0%). Recurrence was associated with oesophagitis but not decreased QoL. Revision surgery was required in 4.8% of cases (14.8% with recurrence). There were no interval major GHH complications.

CONCLUSIONS

Surgery has provided sustained QoL improvements irrespective of recurrence. Recurrence occurred progressively over ten years and may predispose to oesophagitis.

Mid-infrared emission from In(Ga)Sb layers on InAs(Sb)

We demonstrate infrared light emission from thin epitaxially-grown In(Ga)Sb layers in InAs(Sb) matrices across a wide range (3-8 µm) of the mid-infrared spectral range. Our structures are characterized by x-ray diffraction, photoelectron spectroscopy, atomic force microscopy and transmission electron microscopy. Emission is characterized by temperature- and power-dependent infrared step-scan photoluminescence spectroscopy. The epitaxial In(Ga)Sb layers are observed to form either quantum wells, quantum dots, or disordered quantum wells, depending on the insertion layer and substrate material composition. The observed optical properties of the monolayer-scale insertions are correlated to their structural properties, as determined by transmission electron and atomic force microscopy.

All-semiconductor negative-index plasmonic absorbers

We demonstrate epitaxially grown all-semiconductor thin-film midinfrared plasmonic absorbers and show that absorption in these structures is linked to the excitation of highly confined negative-index surface plasmon polaritons. Strong (>98%) absorption is experimentally observed, and the spectral position and intensity of the absorption resonances are studied by reflection and transmission spectroscopy. Numerical models as well as an analytical description of the excited guided modes in our structures are presented, showing agreement with experiment. The structures investigated demonstrate a wavelength-flexible, all-semiconductor, plasmonic architecture with potential for both sensing applications and enhanced interaction of midinfrared radiation with integrated semiconductor optoelectronic elements.

Application of the International Diabetes Federation and American Diabetes Association criteria in the assessment of metabolic control after bariatric surgery

The International Diabetes Federation (IDF) and the American Diabetes Association (ADA) have introduced specific criteria to define the 'optimization' of the metabolic state and glycaemic 'remission' of type 2 diabetes mellitus (T2DM) after bariatric surgery, respectively. Our objective was to assess the percentage of patients achieving these criteria. Data were collected for body mass index, glycaemic markers, lipids, blood pressure, hypoglycaemia and medication usage from 396 morbidly obese T2DM patients who underwent bariatric surgery in two centres and followed up for 2 years. At year 1, 14% of patients achieved the IDF criteria and 38% the ADA criteria, whereas at 2 years 8 and 9% satisfied these criteria, respectively. A relatively low proportion of patients achieved optimization of the metabolic state and T2DM remission. These patients may potentially benefit from the combination of bariatric surgery and adjuvant medical therapy to achieve optimal metabolic outcomes.

Strong absorption and selective emission from engineered metals with dielectric coatings

We demonstrate strong-to-perfect absorption across a wide range of mid-infrared wavelengths (5-12µm) using a two-layer system consisting of heavily-doped silicon and a thin high-index germanium dielectric layer. We demonstrate spectral control of the absorption resonance by varying the thickness of the dielectric layer. The absorption resonance is shown to be largely polarization-independent and angle-invariant. Upon heating, we observe selective thermal emission from our materials. Experimental data is compared to an analytical model of our structures with strong agreement.

17-AAG mediated targeting of Hsp90 limits tert activity in peritoneal sarcoma related malignant ascites by downregulating cyclin D1 during cell cycle entry

AIM

Peritoneal or retro-peritoneal sarcomatosis related malignant ascites formation is a rare but serious consequence of the locoregional metastatic event. The present work aimed to study the effect of the Hsp90 inhibitor (17-AAG), an ansamycin analog, on cell cycle and DNA replication specific chaperone-clients interaction in the event of peritoneal sarcoma related malignant ascites formation in mouse model at the late stage of malignant growth.

METHODS

We administered 17-AAG, an Hsp90 inhibitor, divided doses (330 μg/kg b.w./day for first five days then next ten days with166 μg/kg b.w./day) through intra-peritoneal route of inbred Swiss albino mice bearing full grown peritoneal malignant ascites of sarcoma-180. Our study was evaluated by peripheral blood hemogram analysis, malignant ascitic cytology, cell viability test, survival time and mitotic indexing. Furthermore, flowcytometric HSP90, TERT, CyclinD1, PCNA and GM-CSF expression analysis has been considered for special objective of the study.

RESULTS

Our experimental efforts reduced the aggressive proliferation of malignant ascites by drastic downregulation of TERT and cyclin D1 on the verge of cell cycle entry along with DNA replication processivity factor PCNA by directly modulating their folding machinery - heat shock protein 90. Consequently, we observed that malignant ascitic cells became error prone during the event of karyokinesis and produced micronucleus containing malignant cells with low viability. Peripheral neutrophilia due to over-expression of GM-CSF by the peritoneal malignant ascites were also controlled by the treatment with 17-AAG and overall, the treatment modality improved the median survival time.

CONCLUSION

Finally we can conclude that 17AAG administration might serve as a prospective pharmacological agent for the management of peritoneal sarcoma related malignant ascites and throws light towards prolonged survival of the patients concerned.

Mid-infrared designer metals

We demonstrate the potential of highly-doped semiconductor epilayers as building blocks for mid-infrared plasmonic structures. InAs epilayers are grown by molecular beam epitaxy and characterized by Hall measurements and optical techniques. We show that the plasma frequency of our material can be controlled across a broad range of mid-infrared frequencies. Subwavelength disks are fabricated out of our material, and localized plasmonic resonances are observed from these structures. Experimental results are compared to both numerical simulations and a simple quasistatic dipole model of our disks with good agreement.

Post-oesophagectomy anastomotic-bronchial fistula

Anastomotic leakage after oesophagectomy is a dreaded complication. It has a wide range of presentations ranging from the patient being totally asymptomatic to septic with multi-organ failure. From the literature, in general, cervical anastomoses have a higher leakage rate than those that are intra-thoracic, but leaks from the latter confer greater morbidity. Cervical anastomotic leaks that are truly confined to the neck can be managed conservatively, but can extend into the mediastinum and result in more serious complications. Herein, we report on a patient with an oesophago-gastric anastomosis constructed in the neck but with extension into the mediastinum. Subsequently, the patient developed a fistulous erosion into the tracheobronchial tree, which was successfully managed endoscopically.

Telomerase reverse transcriptase (TERT) expression and role of vincristine sulfate in mouse model of malignancy related peritoneal ascites: an experimental metastatic condition

AIM

To evaluate the efficacy of intraperitoneal vincristine administration into ascitic sarcoma-180 bearing mice as a model of human malignant ascites regarding various peritoneal/retroperitoneal sarcomatosis, and to evaluate the flowcytometric telomerase reverse transcriptase expression for the diagnostic and prognostic purposes.

METHODS

Present study included disease induction by intraperitoneal homologous ascitic sarcoma-180 transplantation followed by in vivo intraperitoneal drug administration to study mitotic index, flowcytometric cell cycle and telomerase reverse transcriptase expression pattern, erythrosin-B dye exclusion study for malignant cell viability assessment. Besides, in vitro malignant ascite culture in presence and absence of vincristine sulfate and survival study were also taken into consideration.

RESULTS

Intraperitoneal vincristine administration (concentration 0.5 mg/kg body weight) significantly diminished the mitotic index in diseased subjects in comparison to untreated control subjects. Treated group of animals showed increased life span and median survival time. Cell viability assessment during the course of drug administration also revealed gradual depression on cell viability over time. Flowcytometric cell cycle analysis showed a good prognostic feature of chemotherapeutic administration schedule by representing high G2/M phase blocked cells along with reduced telomerase reverse transcriptase positive cells in treated animals.

CONCLUSION

We conclude that long term administration of vincristine sulfate in small doses could be a good pharmacological intervention in case of malignant peritoneal ascites due to sarcomatosis as it indirectly reduced the level of telomerase reverse transcriptase expression in malignant cells by directly regulating cell cycle and simultaneously increased the life expectancy of the diseased subjects.