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Summary Background Radical surgery via total mesorectal excision might not be the optimal first-line treatment for early-stage rectal cancer. An organ-preserving strategy with selective total mesorectal excision could reduce the adverse effects of treatment without substantially compromising oncological outcomes. We investigated the feasibility of recruiting patients to a randomised trial comparing an organ-preserving strategy with total mesorectal excision. Methods TREC was a randomised, open-label feasibility study done at 21 tertiary referral centres in the UK. Eligible participants were aged 18 years or older with rectal adenocarcinoma, staged T2 or lower, with a maximum diameter of 30 mm or less; patients with lymph node involvement or metastases were excluded. Patients were randomly allocated (1:1) by use of a computer-based randomisation service to undergo organ preservation with short-course radiotherapy followed by transanal endoscopic microsurgery after 8–10 weeks, or total mesorectal excision. Where the transanal endoscopic microsurgery specimen showed histopathological features associated with an increased risk of local recurrence, patients were considered for planned early conversion to total mesorectal excision. A non-randomised prospective registry captured patients for whom randomisation was considered inappropriate, because of a strong clinical indication for one treatment group. The primary endpoint was cumulative randomisation at 12, 18, and 24 months. Secondary outcomes evaluated safety, efficacy, and health-related quality of life assessed with the European Organisation for Research and Treatment of Cancer (EORTC) QLQ C30 and CR29 in the intention-to-treat population. This trial is registered with the ISRCTN Registry, ISRCTN14422743. Findings Between Feb 22, 2012, and Dec 19, 2014, 55 patients were randomly assigned at 15 sites; 27 to organ preservation and 28 to radical surgery. Cumulatively, 18 patients had been randomly assigned at 12 months, 31 at 18 months, and 39 at 24 months. No patients died within 30 days of initial treatment, but one patient randomly assigned to organ preservation died within 6 months following conversion to total mesorectal excision with anastomotic leakage. Eight (30%) of 27 patients randomly assigned to organ preservation were converted to total mesorectal excision. Serious adverse events were reported in four (15%) of 27 patients randomly assigned to organ preservation versus 11 (39%) of 28 randomly assigned to total mesorectal excision (p=0·04, χ2 test). Serious adverse events associated with organ preservation were most commonly due to rectal bleeding or pain following transanal endoscopic microsurgery (reported in three cases). Radical total mesorectal excision was associated with medical and surgical complications including anastomotic leakage (two patients), kidney injury (two patients), cardiac arrest (one patient), and pneumonia (two patients). Histopathological features that would be considered to be associated with increased risk of tumour recurrence if observed after transanal endoscopic microsurgery alone were present in 16 (59%) of 27 patients randomly assigned to organ preservation, versus 24 (86%) of 28 randomly assigned to total mesorectal excision (p=0·03, χ2 test). Eight (30%) of 27 patients assigned to organ preservation achieved a complete response to radiotherapy. Patients who were randomly assigned to organ preservation showed improvements in patient-reported bowel toxicities and quality of life and function scores in multiple items compared to those who were randomly assigned to total mesorectal excision, which were sustained over 36 months’ follow-up. The non-randomised registry comprised 61 patients who underwent organ preservation and seven who underwent radical surgery. Non-randomised patients who underwent organ preservation were older than randomised patients and more likely to have life-limiting comorbidities. Serious adverse events occurred in ten (16%) of 61 non-randomised patients who underwent organ preservation versus one (14%) of seven who underwent total mesorectal excision. 24 (39%) of 61 non-randomised patients who underwent organ preservation had high-risk histopathological features, while 25 (41%) of 61 achieved a complete response. Overall, organ preservation was achieved in 19 (70%) of 27 randomised patients and 56 (92%) of 61 non-randomised patients. Interpretation Short-course radiotherapy followed by transanal endoscopic microsurgery achieves high levels of organ preservation, with relatively low morbidity and indications of improved quality of life. These data support the use of organ preservation for patients considered unsuitable for primary total mesorectal excision due to the short-term risks associated with this surgery, and support further evaluation of short-course radiotherapy to achieve organ preservation in patients considered fit for total mesorectal excision. Larger randomised studies, such as the ongoing STAR-TREC study, are needed to more precisely determine oncological outcomes following different organ preservation treatment schedules. Funding Cancer Research UK.

Submitted by Wiqlifi Bruno de Freitas Melo (wbruno@ufersa.edu.br) on 2018-12-04T21:14:42Z No. of bitstreams: 1 ArthurASO_DISSERT.pdf: 1294160 bytes, checksum: d619a981dc40e2eeb43c658c084c12ac (MD5) Approved for entry into archive by Vanessa Christiane (referencia@ufersa.edu.br) on 2019-02-15T11:46:35Z (GMT) No. of bitstreams: 1 ArthurASO_DISSERT.pdf: 1294160 bytes, checksum: d619a981dc40e2eeb43c658c084c12ac (MD5) Approved for entry into archive by Vanessa Christiane (referencia@ufersa.edu.br) on 2019-02-15T11:46:53Z (GMT) No. of bitstreams: 1 ArthurASO_DISSERT.pdf: 1294160 bytes, checksum: d619a981dc40e2eeb43c658c084c12ac (MD5) Made available in DSpace on 2019-02-15T11:47:11Z (GMT). No. of bitstreams: 1 ArthurASO_DISSERT.pdf: 1294160 bytes, checksum: d619a981dc40e2eeb43c658c084c12ac (MD5) Previous issue date: 2018-08-17 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES fósforo remanescente mede a quantidade de P que permanece na solução de equilíbrio em resposta a uma concentração de P adicionada ao solo. No Brasil, a determinação do P remanescente é feita utilizando uma solução de CaCl2 a 0,01 mol L-1 contendo 60 mg L-1 de P numa relação solo/solução de 1:10. Entretanto, essa concentração pode ser elevada e inadequada para os solos da região Nordeste do Brasil, uma vez que os mesmos possuem baixa capacidade de sorção de fósforo, quando comparados aos solos das demais regiões do Brasil. Neste trabalho, objetivou-se avaliar o efeito de diferentes concentrações iniciais de P da solução de equilíbrio utilizada para a análise do P-rem em 52 solos da região Nordeste do Brasil. Foram testadas concentrações iniciais de 20, 30, 40, 50 e 60 mg L-1 de P da solução de equilíbrio, para a determinação do P-rem em 52 amostras de solos representativos da região Nordeste do Brasil. A determinação do P remanescente seguiu a metodologia proposta por Alvarez et al. (2000). Os solos com maiores teores de argila apresentaram baixos valores de P remanescente, isso provavelmente por esses solos apresentarem maior CMAP em relação aos demais. Nos solos estudados, o aumento da concentração inicial de P na solução de equilíbrio aumentou a média dos valores de P-rem encontrados e, consequentemente, diminuiu o coeficiente de variação (CV) desses valores. Os valores de CV para os solos estudados diminuíram em quase 1% para cada aumento de 1 mg L-1 de P na solução de equilíbrio. Nos solos estudados, o aumento da concentração inicial de P na solução de equilíbrio aumentou a média dos valores de P-rem encontrados e, consequentemente, diminuiu o coeficiente de variação desses valores. Portanto recomenda-se a concentração inicial de P na solução de equilíbrio de 60 mg L-1 de P, para a determinação do P remanescente em solos da região Nordeste do Brasil The remaining phosphorus measures the amount of P remaining in the equilibrium solution in response to a P concentration added to the soil. In Brazil, determination of the remaining P is done using a solution of 0.01 mol L-1 CaCl2 containing 60 mg L-1 of P in a soil / solution ratio of 1:10. However, this concentration may be high and unsuitable for the soils of the Northeast region of Brazil, since they have low phosphorus sorption capacity when compared to the soils of the other regions of Brazil. The objective of this work was to evaluate the effect of different initial concentrations of P of the equilibrium solution used for P-rem analysis in 52 soils of the Northeast region of Brazil. Initial concentrations of 20, 30, 40, 50 and 60 mg L-1 of P of the equilibrium solution were tested for the determination of Prem in 52 representative soil samples from the Northeast region of Brazil. The determination of the remaining P followed the methodology proposed by Alvarez et al. (2000). Soils with higher clay contents showed low values of P remaining, probably because these soils presented higher CMAP in relation to the others. In the studied soils, the increase in the initial concentration of P in the equilibrium solution increased the mean P-values found and consequently decreased the coefficient of variation (CV) of these values. The CV values for the studied soils decreased by almost 1% for each increase of 1 mg L-1 of P in the equilibrium solution. In the studied soils, the increase of the initial concentration of P in the equilibrium solution increased the mean of the P-values found and, consequently, the coefficient of variation of these values decreased. Therefore, the initial concentration of P in the equilibrium solution of 60 mg L-1 of P is recommended for the determination of the remaining P in soils of the Northeast region of Brazil

Sir, A 54-year-old man was referred by his GP for intermittent, painless self-limiting episode of rectal bleeding of 6-months duration. Patient denied drug abuse and there was no history of homosexuality. During his first clinic presentation, the physical examination was unremarkable except on his rigid sigmoidoscopy, we could find a small suspicious neoplastic looking like lesion 8 cm from anal margin, and thus biopsy was taken and sent for histopathology. He also had large hemorrhoids, which were banded during the same appointment. Stool examinations revealed no conventional pathogens. A full blood count and biochemistry determinations were normal. His initial biopsy report showed active chronic inflammation but indeterminate in type. It was, therefore, concluded that this was likely to be dysplasia-associated lesion or mass associated with inflammatory bowl disease. He underwent follow-up flexi-sigmoidoscopic biopsy, which was reported as being of inflammatory bowel disease, more likely to be of Crohn's disease. The rest of the colon was reported as normal in a follow up barium enema. He remained asymptomatic after his initial banding. He was again followed up for routine check flexi-sigmiodoscopy [Figure 1, Figure 2], and histology from this biopsy was suggestive of intestinal spirochetosis, but with no evidence of any acute or chronic inflammation. Figure 1 Endoscopic image showing lesion found in the rectum at 10 o'clock position Figure 2 Endoscopic image after dye spray of the area which didnot take up dye Clinically, patient remained asymptomatic with no symptoms suggestive of any fresh episode of rectal bleeding or proctitis. Intestinal spirochete infection is common in commercial poultry flocks as shown by studies in Australia.[1] The prevalence of spirochetosis in human varies from 2.5 to 16% in western countries.[2] The prevalence in homosexual and immune-compromised patients, based on stool culture and biopsy[3] finding was as high as 50%. In human, the pathological and clinical significance of these organisms is far less clear and controversial although there have been reported cases associated with rectal bleeding and diarrhea.[4] The histological appearance of this organism is that of a false brush border on the colonic mucosa, which represents a layer of spirochetes, especially Brachyspira aalborgi and Brachyspira pilosicoli (Serpulina pilosicoli). It can be identified readily on H and E-stained sections although silver stains also can be used to highlight the organisms and can detect cases not evident on routine H and E stains.[3] It is also important to note that these organisms are difficult to grow on ordinary culture medium, thus making characterization difficult in clinical practice. The most appropriate means of identification is by using polymerse chain reaction-based technique, is the best way of diagnosing the disease,[5] which is sophisticated, not easily available and costly, especially in developing countries. This may be the cause of it being under-reported and overlooked by less experienced surgical pathologists.[5] In this case, it might be argued that it is one of the incidental findings in an asymptomatic patient and thus required no active treatment. But in symptomatic and high-risk group an active treatment with metronidazole is needed. It is also important to consider patient symptoms and risk category before starting the treatment. Patient symptoms and risk category are paramount in identifying cases. Spirochetosis, therefore, should be looked into all rectal biopsy specimens, especially in high-risk and symptomatic patients. In an asymptomatic patient, it should be treated as a self-limiting disease.

Cut flowers have a very limited life after they have been cut off from the mother plant, as survival on their own reserves is generally low due to the special morphological and physiological characteristics of their tissues. The use of refrigeration for storage of flower cuttings is very important because it reduces water loss, senescence, infections caused by bacteria and fungi, thus extending the shelf-life of flowers during the storage period. Therefore, the aim of the present work is to show differences between requirements of various species of flowers during refrigerated storage. Keywords: Cooling, post-harvest, conservation, flowers, cold injury

The purpose of this work is to explore the roles of education and language in the creation of Japanese cultural identity. Education means first "schooling," but it also expands to include all cultural learning. In the attempt to unravel the inter-relationships of abstract concepts such as education, culture, identity, language and Japan, our understandings are necessarily influenced by our own education. Attempts by the educated elite of one culture to understand other cultures constitutes an intellectual conflict of interest that questions academic conventions, such as objectivity. In this work, I interweave expository and narrative chapters in an attempt to create a new "methodology" or "approach" to the study of culture, which I call cultural hermeneutics. The autobiographical chapters present an ongoing self-reflection upon my developing understanding of Japan. I have studied and taught in Japan for many years, and my increasing familiarity with things Japanese has gradually moved me beyond the boundaries of previous identities, and into spaces that once separated me from Japanese culture, involving me in the formation of new hybrid cultural identities. After an introductory chapter, the dissertation is split into three parts. The first part deals with the challenges of cultural hermeneutics as a methodology. The second part examines how the languages of Japan and foreign language education in Japan influence the formation of Japanese cultural identities. The third part explores how ideological debates, such as those about education, nationalism and internationalization, play a role in forming cultural identities. I conclude that identities are constantly contested by voices from both within and without the "imagined communities" of cultures. This contest is in progress even before we come to study "Culture." Because change is inherent to living cultures, and because lived experience is so abundant and complex, the knowledge we inherit about cultures is always incomplete, and full of prejudice and misunderstandings. We can never arrive at final understandings of cultures, not even our own. Nevertheless, it is important to continue conversations about cultures because they can lead us to form deepened understandings, and because these conversations ultimately contribute to greater self-understanding.

The Pembina field is an excellent example of a stratigraphic trap. The oil occurs at the updip (eastern) termination of sands of the Upper Cretaceous Cardium formation. The area of the field appears to be in excess of 800 square miles. Production is from at least four separate sands and a conglomerate of the Cardium formation. In some areas all of these reservoirs are present one above the other and are separated by shale breaks. As the areal distributions of the various reservoirs do not coincide, the "lean" and "rich" areas in the field can be determined by maps outlining the distribution of the various sand bodies. There are now more than 1,600 producing wells in the field. The daily (prorationed) production is about 106,000 barrels. The total recoverable primary reserve has been estimated to be in excess of one billion barrels. Pembina, situated on a hinge-line, is in an area of multiple stratigraphic traps. Other than from the Cardium, oil and gas have been obtained from the Basal Belly River sands, the Viking sand, a Jurassic sand, and the Mississippian carbonates. All these occurrences are within the limits of the Pembina field and all are stratigraphic traps. The reservoirs in these formations have not been evaluated to any extent at present. These reserves will probably not equal those of the Cardium but they will be of very considerable size.

The effect of temperature and maturity on the quality of Tendercrop green snap beans was studied by growing plants in controlled environment cabinets. Plants were grown in the greenhouse until 7 days after anthesis at which time they were removed and transferred to temperatures of 20°C, 25°C, 30°C and 35°C. The beans were harvested at 14, 19, 21, 29 and 34 days after anthesis and analyzed for various quality factors. Growing the fruit at a temperature of 35°C resulted in a significant stunting of the size and average weight of the pod. The optimum temperature for maximum yield was found to be 25°C. Temperature resulted in a significant increase in lightness and yellowness and increased significantly with maturity below 35°C over the period studied. Toughness did not change with maturity or temperature between 20°C and 30°C until 24 days after anthesis. After this point, toughness increased with increasing temperature. Beans grown at 35°C were significantly tougher than 20 - 30°C beans and increased in toughness over their 14 - 24 day maturity period. Increased temperature and maturity caused an increase in total solids, water insoluble solids, starch, fibre and in pectin above 30°C. Total sugars decreased with maturity and increased temperature. Total ash did not change significantly with temperature or maturity. Pod width and seed length were shown to be accurate indices of maturity. Total solids appeared to be a good index of edible maturity. The need for revision of standards to account for various rates of maturity onset was stressed.