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Introduction\ud \ud Patients with cancer who develop small bowel obstruction are at high risk of malnutrition and morbidity following compromise of gastrointestinal tract continuity. This study aimed to characterise current management and outcomes following malignant small bowel obstruction.\ud \ud \ud \ud Methods\ud \ud A prospective, multicentre cohort study of patients with small bowel obstruction who presented to UK hospitals between 16th January and 13th March 2017. Patients who presented with small bowel obstruction due to primary tumours of the intestine (excluding left-sided colonic tumours) or disseminated intra-abdominal malignancy were included. Outcomes included 30-day mortality and in-hospital complications. Cox-proportional hazards models were used to generate adjusted effects estimates, which are presented as hazard ratios (HR) alongside the corresponding 95% confidence interval (95% CI). The threshold for statistical significance was set at the level of P ≤ 0.05 a-priori.\ud \ud \ud \ud Results\ud \ud 205 patients with malignant small bowel obstruction presented to emergency surgery services during the study period. Of these patients, 50 had obstruction due to right sided colon cancer, 143 due to disseminated intraabdominal malignancy, 10 had primary tumours of the small bowel and 2 patients had gastrointestinal stromal tumours. In total 100 out of 205 patients underwent a surgical intervention for obstruction. 30-day in-hospital mortality rate was 11.3% for those with primary tumours and 19.6% for those with disseminated malignancy. Severe risk of malnutrition was an independent predictor for poor mortality in this cohort (adjusted HR 16.18, 95% CI 1.86 to 140.84, p = 0.012). Patients with right-sided colon cancer had high rates of morbidity.\ud \ud \ud \ud Conclusions\ud \ud Mortality rates were high in patients with disseminated malignancy and in those with right sided colon cancer. Further research should identify optimal management strategy to reduce morbidity for these patient groups.

In the present study, U-type barium hexagonal ferrite (Ba4Co2Fe36O60) powder was synthesized by solid state reaction route. The synthesized ferrite powder was further transformed into a series of toroidal shaped ferrite-epoxy composites with different volume concentrations (42.6, 47.2, 50.6 and 54.3 volume percentages) of ferrite powder in epoxy matrix. The prepared U-type barium hexagonal ferrite powder and fabricated ferrite-epoxy composites were characterized for surface morphology, phase formation and magnetic properties by FESEM, XRD and VSM techniques respectively. Complex permittivity (er = e′ − je″) and complex permeability (µr = µ′ − jµ″) of the fabricated composites were computed using an Agilent E8364B vector network analyzer in the frequency range of 2–18 GHz. The computed permittivity and permeability data of U-type ferrite composites were employed in the calculation of return loss (RL) of fabricated composites with varying thickness. The minimum RL was observed as −42.1 dB for the absorber with thickness of 3 mm and the bandwidth achieved was 8.5 GHz for RL ≤ −10 dB. Based on the above results these composites have potential use as excellent microwave absorbers in 2–18 GHz frequency range.

Background: High blood pressure is common in acute stroke and is a predictor of poor outcome; however, large trials of lowering blood pressure have given variable results, and the management of high blood pressure in ultra-acute stroke remains unclear. We investigated whether transdermal glyceryl trinitrate (GTN; also known as nitroglycerin), a nitric oxide donor, might improve outcome when administered very early after stroke onset.Methods: We did a multicentre, paramedic-delivered, ambulance-based, prospective, randomised, sham-controlled, blinded-endpoint, phase 3 trial in adults with presumed stroke within 4 h of onset, face-arm-speech-time score of 2 or 3, and systolic blood pressure 120 mm Hg or higher. Participants were randomly assigned (1:1) to receive transdermal GTN (5 mg once daily for 4 days; the GTN group) or a similar sham dressing (the sham group) in UK-based ambulances by paramedics, with treatment continued in hospital. Paramedics were unmasked to treatment, whereas participants were masked. The primary outcome was the 7-level modified Rankin Scale (mRS; a measure of functional outcome) at 90 days, assessed by central telephone follow-up with masking to treatment. Analysis was hierarchical, first in participants with a confirmed stroke or transient ischaemic attack (cohort 1), and then in all participants who were randomly assigned (intention to treat, cohort 2) according to the statistical analysis plan. This trial is registered with ISRCTN, number ISRCTN26986053.Findings: Between Oct 22, 2015, and May 23, 2018, 516 paramedics from eight UK ambulance services recruited 1149 participants (n=568 in the GTN group, n=581 in the sham group). The median time to randomisation was 71 min (IQR 45–116). 597 (52%) patients had ischaemic stroke, 145 (13%) had intracerebral haemorrhage, 109 (9%) had transient ischaemic attack, and 297 (26%) had a non-stroke mimic at the final diagnosis of the index event. In the GTN group, participants' systolic blood pressure was lowered by 5·8 mm Hg compared with the sham group (pvs 3 [2–5]; n=558, in the sham group; 1·04 [0·84–1·29]; p=0·69). We found no difference in secondary outcomes, death (treatment-related deaths: 36 in the GTN group vs 23 in the sham group [p=0·091]), or serious adverse events (188 in the GTN group vs 170 in the sham group [p=0·16]) between treatment groups.Interpretation: Prehospital treatment with transdermal GTN does not seem to improve functional outcome in patients with presumed stroke. It is feasible for UK paramedics to obtain consent and treat patients with stroke in the ultra-acute prehospital setting.Funding: British Heart Foundation.

This paper reports the study of surface-related mechanisms to explain the high reverse leakage current observed in the in-house fabricated Si3N4 passivated AlGaN/GaN High Electron Mobility Transistors. We propose that the Si3N4/AlGaN interface in the un-gated regions provides an additional leakage path between the gate and source/drain and may constitute a large component of reverse current. This surface related leakage component of current exhibits both temperature and electric field dependence and its Arrhenius behavior has been experimentally verified using Conductance Deep Level Transient Spectroscopy and temperature dependent reverse leakage current measurements. A thin interfacial amorphous semiconductor layer formed due to inter diffusion at Si3N4/AlGaN interface has been presumed as the source for this surface related leakage. We, therefore, conclude that optimum Si3N4 deposition conditions and careful surface preparation prior to passivation can limit the extent of surface leakage and can thus vastly improve the device performance. (C) 2016 Elsevier B.V. All rights reserved.

The present study was aimed to assess the cell-mediated immune response under PHA stimulus in leprosy patients and healthy contacts. Twenty-one cases suffering from leprosy were included in the study. They were diagnosed clinically by skin biopsy,. smear examination and lepromin reaction. Five cases had lepromatous, 7 borderlines and 9 tuberculoid leprosy. Eleven were healthy contacts. Lepromin reaction was negative in 5 patients in lepromatous group while it was positive in the other patients and healthy contacts. Blastogenic transformation was depressed only in patients with lepromatous leprosy. In tuberculoid and borderline cases, lymphocytes exhibited similar reactivity with PHA as was shown by the controls. Healthy contacts of lepromatous leprosy patients were leprom'm positive and did not show any C M I depression. it is suggested that depression of PHA response may develop after the on set of leprosy infection.

Critical limb ischemia is a complex disease process. The disease state inherently crosses several medical and surgical disciplines. As such, through a deliberate multidisciplinary approach, the wound healing and patient care will be optimized.

The treatment for peripheral artery disease include medical, endovascular, and surgical. When deciding treatment options, the risk of the intervention should be weighed against the benefit the patient will gain. Grading the lesions and symptoms of peripheral artery disease is very important in deciding the treatment strategy and assessing clinical outcome. In this chapter, we will discuss different classification systems for acute and chronic limb ischemia.

The occurrence of antiferromagnetism (AFM) in κ-(ET)2X can be understood within an effective 1/2-filled band with dimers of ET molecules containing one hole each. We argue that while this effective model can describe the presence of AFM, a complete description for these materials requires the correct carrier density of one-half per molecule. For dimerized and strongly frustrated 1/4-filled lattices we show that a singlet-paired statecoexisting with charge ordering occurs that we have termed the paired electron crystal (PEC). Here we investigate the 1/4-filled model on a dimerized lattice, showing regions where AFM, PEC, and the Wigner-crystal occur. We point out the need to go beyond quantum spin liquid concepts for highly frustrated materials such as κ-(ET)2Cu2(CN)3 and β′-EtMe3Sb[Pd(dmit)2]2 which we believe are PECs at low temperatures.

Purpose To determine the prevalence of secondary causes of bone loss among patients with breast cancer with osteopenia and osteoporosis. Patients and Methods All women referred to a bone health clinic over a 6-year period for bone evaluation were included in this retrospective study and stratified based on presence or absence of a breast cancer history. The prevalence of secondary causes of bone loss in the two groups was compared. Results Of the 238 women identified, 64 women had breast cancer. The non–breast cancer group (n = 174) was significantly older (P = .015), had a lower mean weight (P = .019), lower 25 hydroxy-vitamin D level (P = .019), and greater degree of bone loss in both the spine and hip (P < .001 and 0.004, respectively). The presence of at least one secondary cause of bone loss, excluding cancer-related therapies, was seen in 78% of the breast cancer patient group and in 77% of the non–breast cancer group (P = not significant). Newly diagnosed metabolic bone disorders were seen in 58% of the breast cancer population. The most common was vitamin D deficiency, seen in 38% of patients in the breast cancer group and 51% of patients in the non–breast cancer group. Idiopathic hypercalciuria was diagnosed in 15.6%, primary hyperparathyroidism in 1.6%, and normocalcemic hyperparathyroidism in 3.1% of the breast cancer population. Conclusion A high prevalence of secondary causes of bone loss among patients with breast cancer supports a comprehensive evaluation in these patients, particularly those considering therapy with an aromatase inhibitor.

A CONVERSE OF TAYLORS THEOREM ON LOCALLY CONVEX LINEAR SPACES

EXISTENCE OF nth BOUNDED PSEUDO PEANO AND nth PEANO DIFFERENTIALS FOR MAPPINGS ON NORMED LINEAR SPACES

PSEUDO-NORM TOPOLOGY ON THE SPACE OF CONTINUOUS MULTILINEAR OPERATORS ON LINEAR TOPOLOGICAL SPACES

BOUNDED AND FRÉCHET DIFFERENTIALS FOR MAPPINGS ON LINEAR TOPOLOGICAL SPACES USING PSEUDONORM TOPOLOGY

Type VII collagen is the main component of anchoring fibrils, structures that are integral to basement membrane homeostasis in skin. Mutations in the gene encoding type VII collagen COL7A1 cause recessive dystrophic epidermolysis bullosa (RDEB) an inherited skin blistering condition complicated by frequent aggressive cutaneous squamous cell carcinoma (cSCC). OATP1B3, which is encoded by the gene SLCO1B3, is a member of the OATP (organic anion transporting polypeptide) superfamily responsible for transporting a wide range of endogenous and xenobiotic compounds. OATP1B3 expression is limited to the liver in healthy tissues, but is frequently detected in multiple cancer types and is reported to be associated with differing clinical outcome. The mechanism and functional significance of tumour-specific expression of OATP1B3 has yet to be determined. Here, we identify SLCO1B3 expression in tumour keratinocytes isolated from RDEB and UV-induced cSCC and demonstrate that SLCO1B3 expression and promoter activity are modulated by type VII collagen. We show that reduction of SLCO1B3 expression upon expression of full-length type VII collagen in RDEB cSCC coincides with acquisition of front-to-rear polarity and increased organisation of 3D spheroid cultures. In addition, we show that type VII collagen positively regulates the abundance of markers implicated in cellular polarity, namely ELMO2, PAR3, E-cadherin, B-catenin, ITGA6 and Ln332.

One hundred female patients, in the age range of 14-60 years suffering from diffuse hair loss were studied for pattern of aiopecia and probable causes. Pattern of hair loss was of telogen effluvium in 92% patients, androgenetic alopecia in 7% and anagen defluvium in 1%. The probable causes of diffuse alopecia were found to be psychological stress in 30%, fever in 33%, abortion and delivery in 21%, trauma and surgical operation in 13%, and hypothyroidism in 10%. In 57% patients more than two fac-tors, while in 6% no probable cause could be found on the basis of history. Routine laboratory investiga-tions revealed Hb level less than 12gm% in 96% patients, hypochromic picture on PBF examination in 57% patients, GIT parasites in 13% patients on stool examination, T 3 value less than 70 p gm/dl in 7% and TSH more than 7IU in 8 % cases. Mircoscopic examination of hairs in all the cases showed (telogen) club root except in one case which showed broken and tapered root end (anagen).

Background The majority of breast conserving surgery (BCS) is performed in younger women. There is little published information about the views of women aged over 70 regarding BCS. The aim of this study was to investigate the attitudes of this age group towards BCS, and factors which may influence their treatment decision-making. Methods A questionnaire was sent to all patients who were aged 70 or over at the time they had breast cancer surgery in NHS Lanarkshire between 1999 and 2013. This detailed surgical options and recommendations, timing of decision making, treatment expectations, psychological and cosmetic concerns and other factors which may have influenced any decision made e.g. travel for radiotherapy and potential side effects. Results Responses were received from 339 patients, 192 of whom had a mastectomy with the remaining undergoing BCS. In the mastectomy group 18 % (35) would have preferred to have BCS had it been an option, with 40 % (76) of group being happy to take neoadjuvant endocrine therapy to try and facilitate this. However, only 14 % (26) of patients would have considered neoadjuvant chemotherapy with the same aim. Almost half (82) of the mastectomy patients said that the risk of local recurrence following BCS was a factor which influenced their decision. Conclusion BCS is something that patients aged over 70 are interested in considering in the same way as younger patients. More than a third of patients requiring mastectomy would be willing to take neoadjuvant endocrine therapy to attempt to downstage their tumour to facilitate BCS.

In model based control of multivariate processes, it has been common practice to identify a multi-input single-output (MISO) model for each output separately and then combine the individual models into a final MIMO model. If models for all outputs are independently parameterized then this approach is optimal. However, if there are common or correlated parameters among models for different output variables and/or correlated noise, then performing identification on all outputs simultaneously can lead to better and more robust models. In this paper, theoretical justifications for using multi-output identification for a multivariate process are presented and the potential benefits from using them are investigated via simulations on two process examples: a quality control example and an extractive distillation column. The identification of both the parsimonious transfer function models using multivariate prediction error methods, and of non-parsimonious finite impulse response (FIR) models using multivariate statistical regression methods such as partial least squares (PLS2), canonical correlation regression (CCR) and reduced rank regression (RRR) are considered. The multi-output identification results are compared to traditional single-output identification from several points of view: best predictions, closeness of the model to the true process, the precision of the identified models in frequency domain, stability robustness of the resulting model based control system, and multivariate control performance. The multi-output identification methods are shown to be superior to the single-output methods on the basis of almost all the criteria. Improvements in the prediction of individual outputs and in the closeness of the model to the true process are only marginal. The major benefits are in the stability and performance robustness of controllers based on the identified models. In this sense the multi-output identification methods are more ‘control relevant’.

A new and fast recursive, exponentially weighted PLS algorithm which provides greatly improved parameter estimates in most process situations is presented. The potential of this algorithm is illustrated with two process examples: (i) adaptive control of a two by two simulated multivariable continuous stirred tank reactor; and (ii) updating of a prediction model for an industrial flotation circuit. The performance of the recursive PLS algorithm is shown to be much better than that of the recursive least squares algorithm. The main advantage of the recursive PLS algorithm is that it does not suffer from the problems associated with correlated variables and short data windows. During adaptive control, it provided satisfactory control when the recursive least squares algorithm experienced difficulties (i.e., ‘blew’ up) due to the ill-conditioned covariance matrix, (XTX)t. For the industrial soft sensor application, the new algorithm provided much improved estimates of all ten response variables.

In this paper a proof is given that only one of either the X- or the Y-matrix in PLS algorithms needs to be deflated during the sequential process of computing latent vectors. With the aid of this proof the original kernel algorithm developed by Lindgren et al. (J. Chemometrics, 7, 45 (1993)) is modified to provide two faster and more economical algorithms. The performances of these new algorithms are compared with that of De Jong and Ter Braak's (J. Chemometrics, 8, 169 (1994)) modified kernel algorithm in terms of speed and the new algorithms are shown to be much faster. A very fast kernel algorithm for updating PLS models in a recursive manner and for exponentially discounting past data is also presented. © 1997 John Wiley & Sons, Ltd.

In model predictive control one often needs a finite impulse response (FIR) or step response model of the process. Several algorithms have been proposed for the direct identification of these nonparsimonious models (least-squares and biased algorithms such as regularized least squares and partial least squares). These algorithms are compared from several points of view: the closeness of the fit to the true model, the level of robust stability provided by the identified model, and the actual control performance obtained using the identified models. Although there are conveniences in directly identifying such nonparsimonious models (i.e., they can fit any complex dynamic system; there is no need for model structure selection), there are many disadvantages. In comparison with identifying parsimonious transfer function models by prediction error methods and then obtaining the impulse response from them, even the best direct FIR identification methods will generally provide much worse results or require much ...

We present many-body calculations of superconducting pair-pair correlations in the ground state of the half-filled band Hubbard model on large anisotropic triangular lattices. Our calculations cover nearly the complete range of anisotropies between the square and isotropic triangular lattice limits. We find that the superconducting pair-pair correlations decrease monotonically with increasing onsite Hubbard interaction U for inter-pair distances greater than nearest neighbor. For the large lattices of interest here the distance dependence of the correlations approaches that for noninteracting electrons. Both these results are consistent with the absence of superconductivity in this model in the thermodynamic limit. We conclude that the effective 1/2-filled band Hubbard model, suggested by many authors to be appropriate for the kappa-(BEDT-TTF)-based organic charge-transfer solids, does not explain the superconducting transition in these materials.

Mechanochemically synthesized amorphous 50SISOMO [50AgI-25Ag_2O-25MoO_3] fast ionic conductor shows high ionic conductivity of ~ 6x10^-3 {\Omega}^-1 cm-1 at room temperature. The highest ionic conductivity is achieved for 36 h milled sample, which is more than three orders of magnitude higher than that of crystalline AgI at room temperature. The samples are thermally stable at least up to ~70 {\deg}C. Thermoelectric power studies on 50 SISOMO amorphous fast ionic conductors (a-SIC) have been carried out in the temperature range 300-330K. Thermoelectric power (S) is found to vary linearly with the inverse of the absolute temperature, and can be expressed by the equation -S = [(0.19 \times 10^3/T) + 0.25] mV/K. The heat of transport (q*) of Ag+ ion i.e. 0.19 eV is nearly equal to the activation energy (E) i.e. 0.20 eV of Ag+ ion migration calculated from the conductivity plots indicating that the material has an average structure. This is also in consonance with earlier theories on heats of transport of ions in ionic solids., Comment: Presented in the "National Symposium on Advances in Material Science" held at Gorakhpur, India during 17-19 March 2005

An approach to the design of process experiments is presented for the situation where there is a large number of potentially adjustable processvariables, and where these variables are coupled due to process operating constraints. Some variations of the partial least squares (PLS) algorithmcalled ‘selective PLS’ are introduced. These algorithms allow one to combine information in past process data with current knowledge of theprocess, and thereby to separate the variables into a small number of orthogonal groups that form the basis for experimental designs and processoptimization. The concepts are illustrated using data from an industrial mineral flotation circuit used to concentrate valuable minerals from anore.

We present a study of the effects of simultaneous charge- and spin-frustration on the two-dimensional strongly correlated quarter-filled band on an anisotropic triangular lattice. The broken-symmetry states that dominate in the weakly frustrated region near the rectangular lattice limit are the well known antiferromagnetic state with in-phase lattice dimerization along one direction, and the Wigner crystal state with the checkerboard charge order. For moderate to strong frustration, however, the dominant phase is a novel spin-singlet paired-electron crystal (PEC), consisting of pairs of charge-rich sites separated by pairs of charge-poor sites. The PEC, with coexisting charge-order and spin-gap in two dimension, is the quarter-filled band equivalent of the valence bond solid (VBS) that can appear in the frustrated half-filled band within antiferromagnetic spin Hamiltonians. We discuss the phase diagram as a function of on-site and intersite Coulomb interactions as well as electron-phonon coupling strength. We speculate that the spin-bonded pairs of the PEC can become mobile for even stronger frustration, giving rise to a paired-electron liquid. We discuss the implications of the PEC concept for understanding several classes of quarter-filled band materials that display unconventional superconductivity, focusing in particular on organic charge transfer solids. Our work points out the need to go beyond quantum spin liquid (QSL) concepts for highly frustrated organic charge-transfer solids such as kappa-(BEDT-TTF)_2Cu_2(CN)_3 and EtMe_3Sb[Pd(dmit)_2]_2, which we believe show frustration-induced charge disproportionation at low temperatures. We discuss possible application to layered cobaltates and 1/4-filled band spinels., Comment: 12 pages, 7 figures

We consider the simplest example of lattice frustration in the 1/4-filled band, a one-dimensional chain with next-nearest neighbor interactions. For this zigzag ladder with electron-electron as well as electron-phonon interactions we present numerical results for ground state as well as thermodynamic properties. In this system the ground state bond distortion pattern is independent of electron-electron interaction strength. The spin gap in the ground state of the zigzag ladder increases with the degree of frustration. Unlike in one-dimension, where the spin-gap and charge ordering transitions can be distinct, we show that in the ladder they occur simultaneously. We discuss spin gap and charge ordering transitions in 1/4-filled materials with one, two, or three dimensional crystal structures. We show empirically that regardless of dimensionality the occurrence of simultaneous or distinct charge and magnetic transitions can be correlated with the ground state bond distortion pattern., Comment: 12 pages, 8 eps figures

Forty adult patients of pityriasis versicolor were treated with either topical 2% ketoconazole cream (20 patients) or topical 1% clotrimazole cream (20 patients). In global assessment of treatment after 2 weeks, 18 (90%) out of 20 patients treated with ketoconazole cream were cured while 2 cases had considerable residual lesions. In clotrimazole treated group, 17 (85%) out of 20 patients were cured and 3 still had considerable lesions. No significant difference was observed in response rates in the two groups. No side effects were reported in either groups.

Adenosine deaminase (ADA) activity was measured in serum and lymphocytes of 25 untreated patients with multibacillary leprosy. Both serum and lymphocyte ADA levels were significantly high in multibacillary leprosy patients compared to healthy controls. The results obtained did not establish any significant relationship between ADA activity and the type of leprosy.

Serum lipids and lipoproteins were assessed in 40 patients of leprosy and 20 healthy controls (agesex matched). The leprosy cases included 20 cases each of paucibacillary and multibacillary leprosy.

A 24-year old female developed late onset solitary mastocytoma on the left forearm. She complained of intense pruritus off and on which was not associated with flushing of face and blister formation over the nodule. Darier's sign was positive. Excisional biopsy was done and histopathology confirmed the diagnosis.

We report two cases of Vohwinkel's syndrome in son and mother presenting with a progressive palmoplantar keratoderma with 'honeycomb' appearance associated with constricting bands encircling digits of hands and feet along with keratotic plaques on dorsum of hands and feet. Both had associated sensorineural deafness.

Syphilis is a preventable and curable multi-organ disease caused byTreponema pallidumthat may also affect the inner ear. First reported in 1887 by Adam Politzer, luetic endolymphatic hydrops (LEH) is a treatable complication of syphilis which causes a potentially reversible sensorineural hearing loss. Symptoms of LEH include fluctuating hearing loss (often low frequency), tinnitus, and vertigo. Though audiometric parameters have been examined in patients with otosyphilis, few studies have examined the use of otoacoustic emissions (OAEs) as a tool to measure improvement in cochlear function. Here we report an improvement in hearing loss, speech discrimination, and OAEs following treatment of LEH.

Negatively stained preparations of rotavirus imaged with a low dose of electrons provide sufficient contrast to reveal surface projections or spikes. The number of spikes found projecting from different particles indicates that not all 60 peripentonal sites are occupied. Treatment at pH 11.2 with 250 mM ammonium hydroxide specifically removes the spikes, yielding smooth double-shelled particles of the same diameter as that of the native virus. Protein analysis confirms that the released spikes are composed of polypeptide VP4 (or its two cleavage products VP5* and VP8*) and that the smooth particle retains the other major outer shell protein VP7. Spikeless particles can be decorated by a monoclonal antibody specific for the major immunodominant neutralizing domain of VP7, implying that removal of the spikes does not denature the VP7 that is retained on the surface of the smooth particle.

We report the case of a 71-year-old woman with multiple benign lung paragangliomata and a benign glomus jugulare paraganglioma in one temporal bone that mimicked a malignancy. The patient's lung lesions did not regress with chemotherapy. Subsequent histologic markers suggested several very slowly dividing tumors. We review the patient's medical course and pathology from both sites. A finding of multiple lung paragangliomata should raise the suspicion of a multicentric rather than malignant tumor. Before any chemotherapeutic regimen is initiated, a thorough physical examination of the head and neck should be performed, and biopsy material should be tested for markers of cell division.