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Comparison of outcomes between early and delayed weight bearing following lower limb free flaps:an 18-month single-center study

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Plastic and Aesthetic Research 2023年第1期10卷 656-662页

作者： Majid Al-Khalil Manuela Roman Ahmed Emam nicholas marsden Welsh Centre for Burns&Plastic Surgery Morriston HospitalSwansea SA66NLUnited Kingdom Major Trauma Centre University Hospital of WalesCardiff CF144XWUnited Kingdom

Aim:Post-operative protocols following lower limb free flap surgery are not well defined,with a lack of consensus in the literature around limb dependency and weight *** aim was to compare the complication rate for lower limb free flaps before and after the introduction of an enhanced lower limb free flap protocol with earlier dangling(day 3 *** 4)and weight bearing(day 5 *** 14)post lower limb free flap ***:All lower limb free flaps between June 2020-January 2022 were identified from a departmental flap *** data were collected from the comprehensive lower limb free flap database,medical notes,and electronic *** prescribed an extended non-weight-bearing period due to the method of bone fixation were ***:A total of 37 patients,15 pre-and 22 post-enhanced protocol,were identified for *** mean age was 43(17-72)with a M:F of 3:*** was no difference in the type of flap reconstruction between groups,with the anterolateral thigh flap being the most common in both *** differences were identified in the number of complications related to dependency/weight bearing before and after the introduction of the enhanced protocol,with the mean length of stay reduced from 12.1 to 10.6 days(P=0.34).Conclusion:The new enhanced protocol remains the standard of care in our unit,as we demonstrated a reduction in length of stay with no difference in complication rates following early weight bearing after lower limb free flap surgery.

关键词： Lower limb reconstruction free flap free tissue transfer weight bearing post-operative complications

Reply to“Soleus muscle flap for reconstruction of lower extremity *** or glue factory?”

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Plastic and Aesthetic Research 2022年第1期9卷 667-668页

作者： Kareem EL-Shishtawy Zita Jessop nicholas marsden Ahmed Emam Major Trauma Centre University Hospital of WalesCardiff CF144XWUK Welsh Centre for Burns and Plastic Surgery Swansea SA66NLUK Swansea University Medical School Swansea UniversitySwansea SA28PYUK

Dear Editor,We read with interest your recently published article entitled“Soleus muscle flap for reconstruction of lower extremity *** or glue factory?”by Kondra K,Jimenez C,Stanton E,Roohani I,Becerra J,Carey *** in Plast Aesthet Res 2022;9:***://***/10.20517/*** would like to congratulate the authors for their contribution to this field and provide some additional insights from our own clinical practice in a major national trauma centre in the UK.

关键词： trauma horse Work

Numerical simulation of dynamic loss and total loss in the REBCO tapes under perpendicular AC magnetic fields up to 8 T at 20 K and 50 K

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Superconductivity 2024年第3期11卷 80-92页

作者： Yuhui Zhang Yueming Sun nicholas M Strickland Zhenan Jiang Robinson Research Institute Victoria University of WellingtonLower Hutt 5010New Zealand

REBCO tapes carry DC current under AC magnetic fields in proposed HTS fusion applications. AC loss will be generated in the process and it is important to understand the AC loss behaviour for safe operation of the fusion magnets. In this work, magnetisation loss (Qm), dynamic resistance (Rdyn), and total loss (Qtotal) in four different REBCO tapes are numerically studied, using the measured and , for the magnetic field amplitude applied perpendicularly up to 8 T at 20 K and 50 K, where represents the magnetic field and field angle () dependent critical current density. The peak of Theva data is different from that of other tapes. We artificially shifted the ab-plane peak of Theva to the left by 25° to match the peak value. The newly shifted data is named as Theva-shift, which was also investigated to study the influence of the Theva peak shift on AC loss. The normalised DC transport current level (i = It/Ic0) ranges from 0.05 to 0.9, where the DC current amplitude and the self-critical current of the tape are represented by It and Ic0, respectively. The simulation results show that the AC losses deviate significantly from the Brandt-Indenbom (BI) equation at high magnetic fields. Jc and instantaneous loss curves for different tapes show correlation at high magnetic fields. The simulation results also show how different characteristics for different tapes influence AC losses. When AC loss values are scaled by the self-field critical current, Qm without current and Qtotal with current in the different tapes show a good agreement. It implies that the temperature dependence of the two types of loss can be calculated from a known loss at one temperature and the self-field critical current.

关键词： REBCO tapes Magnetisation loss Dynamic resistance Total loss Scaling law

Defining response to radiotherapy in rectal cancer using magnetic resonance imaging and histopathological scales

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World Journal of Gastroenterology 2016年第37期22卷 8414-8434页

作者： Muhammed RS Siddiqui Jemma Bhoday nicholas J Battersby Manish Chand nicholas P West Al-Mutaz Abulafi Paris P Tekkis Gina Brown Department of Colorectal Surgery Croydon University Hospital Croydon London CR7 7YE United Kingdom Department of Radiology Royal Marsden Hospital Sutton SM2 5PT United Kingdom Pathology and Tumour Biology Leeds Institute of Cancer and Pathology St. James's University Hospital Leeds LS9 7TF United Kingdom Department of Surgery Royal Marsden Hospital Fulham Rd London SM2 5PT United Kingdom

AIM To define good and poor regression using pathology and magnetic resonance imaging(MRI) regression scales after neo-adjuvant chemotherapy for rectal *** A systematic review was performed on all studies up to December 2015, without language restriction, t h a t w e r e i d e n t i f i e d f r o m M E D L I N E, C o c h r a n e Controlled Trials Register(1960-2015), and EMBASE(1991-2015). Searches were performed of article bibliographies and conference abstracts. MeS H and text words used included "tumour regression", "mr TRG", "poor response" and "colorectal cancers". Clinical studies using either MRI or histopathological tumour regression grade(TRG) scales to define good and poor responders were included in relation to outcomes [local recurrence(LR), distant recurrence(DR), disease-free survival(DFS), and overall survival(OS)]. There was no age restriction or stage of cancer restriction for patient inclusion. Data were extracted by two authors working independently and using pre-defined outcome *** Quantitative data(prevalence) were extracted and analysed according to meta-analytical techniques using comprehensive meta-analysis. Qualitative data(LR, DR, DFS and OS) were presented as ranges. The overall proportion of poor responders after neo-adjuvant chemoradiotherapy(CRT) was 37.7%(95%CI: 30.1-45.8). There were 19 different reported histopathological scales and one MRI regression scale(mrT RG). Clinical studies used nine and six histopathological scales for poor and good responders, respectively. All studies using MRI to define good and poor response used one scale. The most common histopathological definition for good response was the Mandard grades 1 and 2 or Dworak grades 3 and 4; Mandard 3, 4 and 5 and Dworak 0, 1 and 2 were used for poor response. For histopathological grades, the 5-year outcomes for poor responders were LR 3.4%-4.3%, DR 14.3%-20.3%, DFS 61.7%-68.1% and OS 60.7-69.1. Good pathological response 5-year outcomes were LR

关键词： Tumour regression mrT RG Poor response Neo-adjuvant therapy Rectal cancer

Onset temperature of intrinsic pinning in a REBCO coated conductor from critical current anisotropy

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Superconductivity 2022年第4期4卷 1-6页

作者： nicholas M.Strickland Arya Ambadiyil Soman Martin W.Rupich Stuart C.Wimbush Robinson Research Institute Victoria University of WellingtonWellingtonNew Zealand American Superconductor Corporation AyerMA 01432USA

The field‐angle dependence of the critical current in a REBa_(2)Cu_(3)O_(7) coated conductor has been measured over a fine range of temperatures from 15 K to 80 *** particular sample is demonstrated to have a very low fraction of extrinsic planar defects by its near‐isotropic critical current at 77 *** a representative magnetic field of 3 T we are able to track the emergence of the ab‐plane peak usually associated with intrinsic pinning and quantify its evolution with temperature by fitting to a maximum‐entropy *** are also able to observe the evolution of dip and peak features in the angle dependence of the power‐law index n with decreasing temperature and show that a dip appearing at 65 K is supplanted by a sharper positive peak from 50 *** combination of critical current and power‐law index temperature dependences shows the onset of intrinsic pinning at 50 K.

关键词： Intrinsic pinning REBCO coated conductors Maximum entropy N value

10-Minute Consultation Exploring low mood in a person with cancer

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英国医学杂志中文版 2018年第11期21卷 673-675页

作者： Alexandra Pitman Sahil Suleman nicholas Hyde Andrew Hodgkiss St George's University Hospitals NHS Foundation Trust LondonUK UCL Division of Psychiatry LondonUK Central &North West London NHS Foundation Trust LondonUK The Royal marsden NHS Foundation Trust LondonUK Institute of Psychiatry Psychology &NeuroscienceKings College LondonLondonUK

A 54 year old man asks his doctor for a sleeping tablet. He has recently been diagnosed with a Dukes B adenocarcinoma of the rectum and seems low in mood. Although he has been given a good prognosis,has completed neoadjuvant chemotherapy,and is booked for curative surgery shortly,he expresses doubts that he will live much *** doctor wonders if he might be depressed or anxious,and how best to address this.

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GREENHOUSE GAS AND AMMONIA EMISSION MITIGATION PRIORITIES FOR UK POLICY TARGETS

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Frontiers of Agricultural Science and Engineering 2023年第2期10卷 268-280页

作者： Sarah BUCKINGHAM Cairistiona F.E.TOPP Pete SMITH Vera EORY David R.CHADWICK Christina K.BAXTER Joanna M.CLOY Shaun CONNOLLY Emily C.COOLEDGE nicholas J.COWAN Julia DREWER Colm DUFFY Naomi JFOX Asma JEBARI Becky JENKINS Dominika J.KROL Karina A.marsden Graham A.MCAULIFFE Steven J.MORRISON Vincent O'FLAHERTY Rachael RAMSEY Karl G.RICHARDS Rainer ROEHE Jo SMITH Kate SMITH Taro TAKAHASHI Rachel E.THORMAN John WILLIAMS Jeremy WILTSHIRE Robert M.REES Scotland’s Rural College EdinburghEH93JGUK Institute of Biological&Environmental Sciences AberdeenAB243UUUK School of Natural Sciences Bangor UniversityBangorGwyneddLL572DGUK Agricultural Development and Advisory Service(ADAS) BoxworthCambridgeCB234NNUK School of Biological and Chemical Sciences University of GalwayH91 TK33Ireland Centre for Ecology and Hydrology Bush EstateMidlothianEH260QBUK The James Hutton Institute DundeeDD25DAUK Rothamsted Research North WykeOkehamptonDevonEX202SBUK Ricardo Energy&Environment HarwellOxonOX110QRUK Environment Soils and Land Use DepartmentTeagascCounty WexfordY35 TC97Ireland Agri-food and Biosciences Institute HillsboroughCounty DownBT266DRUK Bristol Veterinary School University of BristolSomersetBS405DUUK

Agriculture is essential for providing food and maintaining food security while concurrently delivering multiple other ecosystem services. However,agricultural systems are generally a net source of greenhouse gases and ammonia. They, therefore, need to substantively contribute to climate change mitigation and net zero ambitions. It is widely acknowledged that there is a need to further reduce and mitigate emissions across sectors, including agriculture to address the climate emergency and emissions gap. This discussion paper outlines a collation of opinions from a range of experts within agricultural research and advisory roles following a greenhouse gas and ammonia emission mitigation workshop held in the UK in March 2022. The meeting identified the top mitigation priorities within the UK's agricultural sector to achieve reductions in greenhouse gases and ammonia that are compatible with policy targets. In addition, experts provided an overview of what they believe are the key knowledge gaps, future opportunities and cobenefits to mitigation practices as well as indicating the potential barriers to uptake for mitigation scenarios discussed.

关键词： agriculture ammonia greenhouse gas mitigation net zero

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癌症患者的抑郁和焦虑

英国医学杂志中文版 2018年第8期21卷 461-468页

作者： Alexandra Pitman Sahil Suleman nicholas Hyde Andrew Hodgkiss 何毅(译) 于欣(校) St George's University Hospitals NHS Foundation Trust London UK UCL Division of Psychiatry London UK Central & North West London NHS Foundation Trust London UK The Royal marsden NHS Foundation Trust London UK Institute of Psychiatry Psychology & NeuroscienceKings College London London UK 北京大学肿瘤医院临床心理科北京大学精神卫生研究所

癌症治疗的进展意味着现在被诊断为癌症的人中有一半可以存活至少10年以上，表明许多癌症是一种长期的状况。精神疾病如抑郁和焦虑是癌症常见的并发症，但往往被忽视，影响生活质量、治疗依从性、癌症生存期以及治疗费用2-30在癌症全程... 详细信息

癌症治疗的进展意味着现在被诊断为癌症的人中有一半可以存活至少10年以上，表明许多癌症是一种长期的状况。精神疾病如抑郁和焦虑是癌症常见的并发症，但往往被忽视，影响生活质量、治疗依从性、癌症生存期以及治疗费用2-30在癌症全程中的任何时点，无论是在治愈性治疗还是缓和治疗中，癌症患者的抑郁和焦虑发生率最高可达20％和10％。

关键词：癌症患者情绪抑郁症

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10分钟会诊探查癌症患者的低落情绪

英国医学杂志中文版 2019年第3期22卷 175-177页

作者： Alexandra Pitman Sahil Suleman nicholas Hyde Andrew Hodgkiss 王雷(译) St George's University Hospitals NHS Foundation Trust London UK UCL Division of Psychiatry London UK Central & North West London NHS Foundation Trust London UK The Royal marsden NHS Foundation Trust London UK Institute of Psychiatry Psychology & Neuroscience Kings College London London UK 药物不良反应杂志社编辑部

一名54岁的男性患者问医生要一片安眠药。他最近被诊断为直肠Ducke B型腺癌,情绪低落:虽然他预后良好,已完成新辅助化疗,并很快就会进行择期根治手术,但他怀疑自己能否获得较长的生存期。他的医生想知道他是否存在抑郁或焦虑,以及如何... 详细信息

一名54岁的男性患者问医生要一片安眠药。他最近被诊断为直肠Ducke B型腺癌,情绪低落:虽然他预后良好,已完成新辅助化疗,并很快就会进行择期根治手术,但他怀疑自己能否获得较长的生存期。他的医生想知道他是否存在抑郁或焦虑,以及如何最好地解决这个问题.抑郁症和焦虑症在癌症患者中更为常见,并且它们与较差的生活质量和癌症生存相关1-2.本文就如何认识这些疾病以及何时转诊提供了专家建议。

关键词：癌症患者情绪低落会诊新辅助化疗男性患者根治手术生活质量焦虑症