bluuebunny/crossref_metadata_2025 huggingface dataset:
Different mechanisms of contextual inference govern associatively learned and sensory-evoked postural responses
Authors: Leeuwis Matto , Asar Yomna , White Joshua J. , Rasman Brandon G. , Forbes Patrick A.
Published: August 2024

Human standing balance relies on the continuous monitoring and integration of sensory signals to infer our body’s motion and orientation within the environment. However, when sensory information is no longer contextually relevant to balancing the body (e.g., when sensory and motor signals are incongruent), sensory-evoked balance responses are rapidly suppressed, much earlier than any conscious perception of changes in balance control. Here, we used a robotic balance simulator to assess whether associatively learned postural responses are similarly modulated by sensorimotor incongruence and contextual relevance to postural control. Twenty-nine participants in three groups were classically conditioned to generate postural responses to whole-body perturbations when presented with an initially neutral sound cue. During catch and extinction trials, participants received only the auditory stimulus but in different sensorimotor states corresponding to their group: 1) during normal active balance, 2) while immobilized, and 3) throughout periods where the computer subtly removed active control over balance. In the balancing and immobilized states, conditioned responses were either evoked or suppressed, respectively, according to the (in)ability to control movement. Following the immobilized state, conditioned responses were renewed when balance was restored, indicating that conditioning was retained but only expressed when contextually relevant. In contrast, conditioned responses persisted in the computer-controlled state even though there was no causal relationship between motor and sensory signals. These findings suggest that mechanisms responsible for sensory-evoked and conditioned postural responses do not share a single, central contextual inference and assessment of their relevance to postural control, and may instead operate in parallel.
Reference-frame-independent quantum key distribution with two-way classical communication
Authors: Zhou 周 Chun 淳 , Wang 汪 Hai-Tao 海涛 , Lu 陆 Yi-Fei 宜飞 , Jiang 姜 Xiao-Lei 晓磊 , Zhao 赵 Yan-Mei 燕美 , Zhou 周 Yu 雨 , Wang 汪 Yang 洋 , Li 李 Jia-Ji 家骥 , Zhou 周 Yan-Yang 砚扬 , Wang 汪 Xiang 翔 , Li 李 Hong-Wei 宏伟 , Bao 鲍 Wan-Su 皖苏
Published: August 2024

The data post-processing scheme based on two-way classical communication (TWCC) can improve the tolerable bit error rate and extend the maximal transmission distance when used in a quantum key distribution (QKD) system. In this study, we apply the TWCC method to improve the performance of reference-frame-independent quantum key distribution (RFI-QKD), and analyze the influence of the TWCC method on the performance of decoy-state RFI-QKD in both asymptotic and non-asymptotic cases. Our numerical simulation results show that the TWCC method is able to extend the maximal transmission distance from 175 km to 198 km and improve the tolerable bit error rate from 10.48% to 16.75%. At the same time, the performance of RFI-QKD in terms of the secret key rate and maximum transmission distance are still greatly improved when statistical fluctuations are considered. We conclude that RFI-QKD with the TWCC method is of practical interest.
Mapping aerotropolis planning: A Bibliometric Analysis
Authors: Iswati T Y , Setyono P , Trinugroho I , Purwani O
Published: August 2024

This study intends to reveal a better mapping of knowledge about aerotropolis referring to global literature reviews in 2007-2023. This study uses a bibliometric approach to find out the trend of publication of articles on aerotropolis using vosviewer for visual analysis, covering several categories of research, namely journal analysis, time analysis, subject area analysis, co-authorship analysis, and keyword analysis. The literature survey used the direction of aerotropolis causality taken from Scopus. The level of research contribution globally has been on a downward trend since 2019. This study suggests that researchers can study more on the aerotropolis topic because there has been a decline in article publications in 2019-2022.
The advance of El Niño phase locking from period 1982–2000 to 2001–2022
Authors: Li Panpan , Zheng Fei , Fang Xiagnhui , Yu Jin-Yi
Published: August 2024

The mature phases of El Niño-Southern Oscillation (ENSO) events exhibit a distinct tendency to peak towards the end of the calendar year, a phenomenon commonly referred to as ENSO phase locking. This phase locking is a fundamental property of the ENSO. The observed characteristics of phase locking are intricately tied to the seasonality of ENSO-related Sea Surface Temperature (SST) growth rate. In this study, notable observational evidence is presented: the strength of phase locking of El Niño weakened, and the phase locking advanced to peak at an earlier time during the period 2001 to 2022 compared to 1982 to 2000. The advancement of El Niño Phase Locking is explored by analyzing the contributions of different oceanic feedbacks to the El Niño phenomenon. Specifically, our findings highlight the significant role of nonlinear advective dynamic heating (NDH), which is influenced by the decrease in equatorial pacific surface zonal current anomaly and the equatorial pacific surface zonal gradient of sea SST anomaly. This investigation enhances our understanding of the evolving dynamics of El Niño phase locking, shedding light on the intricate interplay of oceanic feedbacks in influencing this fundamental aspect of ENSO behavior.
Biomedical prospects and challenges of metal dichalcogenides nanomaterials
Authors: Goswami Preeti , Kumar Videsh , Gupta Govind
Published: August 2024

The biomedical applications of metal dichalcogenides (MDCs) nanomaterials (NMs) are an emerging discipline because of their unique attributes like high surface-to-volume ratio, defect sites, superb catalytic performance, and excitation-dependent emission, which is helpful in bio-imaging and cancer cell killing. Due to the compatibility of sensing material with cells and tissues, MoS2, WS2, and SnS2 NMs have piqued the interest of researchers in various biomedical applications like photothermal therapy used in killing cancer cells, drug delivery, photoacoustic tomography (PAT) used in bio-imaging, nucleic acid or gene delivery, tissue engineering, wound healing, etc. Furthermore, these NMs’ functionalization and defect engineering can enhance therapeutic efficacy, biocompatibility, high drug transport efficiency, adjustable drug release, dispersibility, and biodegradability. Among the aforementioned materials, MoS2 NMs have extensively been explored via functionalization and defects engineering to improve biosensing properties. However, further enhancement is still available. Aside from MoS2, the distinct chemo-physical and optical features of WS2 and SnS2 NMs promise considerable potential in biosensing, nanomedicine, and pharmaceuticals. This article mainly focuses on the challenges and future aspects of two-dimensional MDCs NMs in biomedical applications, along with their advancements in various medical diagnosis processes.
Fuzzy decision-making for cost-effective production planning in manufacturing systems
Authors: Vadivel Kuppulakshmi , Chandrasekar Sugapriya , Deivanayagampillai Nagarajan , Jacob Kavikumar
Published: August 2024

This research addresses the critical issue of production planning through innovative methodologies. By introducing a fresh perspective to the classical Economic Production Quantity (EPQ) model, the study incorporates hexagonal fuzzy numbers to accommodate a single-stage system with rework. In today’s manufacturing landscape, the presence of imperfect items significantly impacts industry operations. The proposed model offers a promising solution by effectively reducing system costs. Central to the study is the enhancement of single-machine maintenance and lifespan, ensuring optimal production costs across both regular production periods and revamp periods. Through meticulous analysis, the research aims to minimize the anticipated annual total cost by evaluating reworkable item costs, disposal costs, and penalty lost sale costs within the realms of fuzzy and Neutrosophic arenas. Furthermore, the consideration of service level constraints is integral, with the research demonstrating the convexity of the proposed model under such constraints. To illustrate the efficacy of the approach, a numerical example based on a uniform distribution is presented. Crucially, the study compares results between traditional crisp cases and uncertain fuzzy environments to validate optimal policies. Additionally, the research proposes novel algorithms to define the total cost function of the production process. By leveraging triangular fuzzy numbers, hexagonal fuzzy numbers, and hexagonal interval-valued Neutrosophic numbers, unexpected cost functions are effectively addressed. An illustrative example further elucidates the application of these algorithms. Simulation analysis is employed to validate its accuracy to ensure the robustness and reliability of the proposed approach. Through these comprehensive methodologies and findings, the research contributes significantly to advancing production planning strategies and optimization techniques in modern manufacturing environments.
Modulation of re-circulation zone behind a square obstruction by single inclined turbulent wall jet with varying angle of attack
Authors: Bhukta Manas Kumar , Singh Santosh Kumar , Majumder Snehamoy , Debnath Koustuv
Published: August 2024

The modulation of the re-circulation region is one of the primary interests of this numerical study. This study investigates the modulation of the re-circulation zone behind a square obstruction by a single inclined turbulent wall jet with varying angles of attack. The flow field is visualized using the post-processing system of the simulation software and the results have been analyzed. The experiments are carried out for different angles of attack of the wall jet and a range of high Reynolds numbers. The results show that the re-circulation zone is significantly affected by the angle of attack of the wall jet. The maximum length of the re-circulation zone decreased with increasing angle of attack. The wall jet angles of attack (AOA) also affect the strength and position of the vortex structures in the re-circulation zone. The results of this study provide insights into the use of inclined wall jets for controlling the flow field behind obstructions in engineering applications such as flow control and mixing enhancement. The numerical simulation is based on a two-phase volume of fluid (VOF) model with open channel boundary conditions. The standard

k
–
ω
 
SST

turbulence model is applied to solve the Reynolds averaged equation.
PLS-based hellinger distance method for fault detection in chemical engineering systems
Authors: Ramakrishna Kini K , Harrou Fouzi , Madakyaru Muddu , Sun Ying , Menon Mukund Kumar
Published: August 2024

Fault detection is vital in chemical engineering systems to maintain operational efficiency, product quality, and safety through timely identification and correction of deviations from expected behavior. Although partial least squares (PLS) has proven effective in monitoring due to its ability to handle highly correlated variables, traditional detection metrics of PLS may fail to identify small abnormal changes as they rely solely on recent observations. This paper integrates PLS modeling framework with Hellinger Distance (HD)-based fault detection index to overcome the limitations of conventional detection metrics. The utilization of HD is motivated by its sensitivity to quantifying any dissimilarity between distributions, which makes it well-suited for detecting small deviations in process behavior. The HD-based index will be computed between the residuals obtained from the model in the offline stage and the online stage. The HD metric involves careful inspection and comparison of the residuals, which enables it to capture the sensitive details in the data, thus, enhancing the detection of faults. For increased flexibility, kernel density estimation is employed to establish the reference threshold of the PLS-HD approach. The performance of this approach will be evaluated using data from simulated Continuous Stirred-Tank Heater (CSTH) and Continuous Stirred-Tank Reactor (CSTR) processes, by considering various fault types such as bias, freezing, and sensor drift faults. The results demonstrate the superior performance of the proposed PLS-HD approach compared to conventional PLS monitoring methods.
A systematic review of the process parameters, mechanical characteristics and applications of polyether ether ketone (PEEK) and its composites by additive manufacturing
Authors: M G VijayKashimatt
Published: August 2024

Additive manufacturing (AM) provides an innovative and reliable method of developing medical products with anatomically relevant geometry and mechanical performance, underscoring its significant potential in the medical field. The design of fused deposition modelling (FDM) parameters has a significant impact on the characteristics of the product fabricated utilizing FDM. Numerous studies have assessed the impact of various FDM process parameters on enhancing the print quality attributes of manufactured components, such as mechanical characteristics, production times, dimensional accuracy, and surface finish. Because of the complex features of the FDM process and the contradicting process parameters, the advancement has been slow and poorly coordinated. This work intends to provide a complete review of recent research on PEEK and CF-PEEK printed parts, where the effect of process factors on tensile strength has been described. Furthermore, PEEK, with its potential applications in medical, aerospace, and chemical sectors, serves as an inspiring material for future innovations, offering a promising outlook.
Concept graph embedding models for enhanced accuracy and interpretability
Authors: Kim Sangwon , Ko Byoung Chul
Published: August 2024

In fields requiring high accountability, it is necessary to understand how deep-learning models make decisions when analyzing the causes of image classification. Concept-based interpretation methods have recently been introduced to reveal the internal mechanisms of deep learning models using high-level concepts. However, such methods are constrained by a trade-off between accuracy and interpretability. For instance, in real-world environments, unlike in well-curated training data, the accurate prediction of expected concepts becomes a challenge owing to the various distortions and complexities introduced by different objects. To overcome this tradeoff, we propose concept graph embedding models (CGEM), reflecting the complex dependencies and structures among concepts through the learning of mutual directionalities. The concept graph convolutional neural network (Concept GCN), a downstream task of CGEM, differs from previous methods that solely determine the presence of concepts because it performs a final classification based on the relationships between con- cepts learned through graph embedding. This process endows the model with high resilience even in the presence of incorrect concepts. In addition, we utilize a deformable bipartite GCN for object- centric concept encoding in the earlier stages, which enhances the homogeneity of the concepts. The experimental results show that, based on deformable concept encoding, the CGEM mitigates the trade-off between task accuracy and interpretability. Moreover, it was confirmed that this approach allows the model to increase the resilience and interpretability while maintaining robustness against various real-world concept distortions and incorrect concept interventions. Our code is available at https://github.com/jumpsnack/cgem.
The effects of higher gas prices on the EU economy: a computable general equilibrium modelling perspective
Authors: Weitzel Matthias , Vandyck Toon , Garaffa Rafael , Temursho Umed , Ordonez Jose A , Tamba Marie
Published: August 2024

Russia’s invasion of Ukraine has led to strong economic repercussions globally. In particular, turbulences on international energy markets and reduced flows of natural gas from Russia to the EU led to a sharp increase of natural gas prices. In this paper, we investigate the effect of higher gas prices on the European economy using the computable general equilibrium model JRC-GEM-E3. Numerical simulations quantify direct and indirect (via spillovers to electricity prices) implications for macro-economic outcomes, sectoral trade and employment, and distributional impacts across household income deciles. Results indicate that the (indirect) macro-economic impacts from electricity price changes induced by higher gas prices are larger than the (direct) impact of the gas price increase. Spatial heterogeneity in gas price impacts across regions globally leads to trade and competitiveness impacts, but has little influence on aggregate GDP impacts. The energy price shock is regressive, and results indicate strong employment impacts in particular sectors. Finally, the scenarios indicate that the macro-economic impact of the same energy price shock would be reduced by more than two thirds, if it were to occur in an economy that has decarbonised to achieve the EU’s 2030 climate targets. This illustrates that decarbonising the economy enhances the resilience to fossil fuel price increases.
Simulation of early season herbivory via mechanical damage affects flower production in pumpkin (Cucurbita pepo ssp. pepo)
Authors: Gray Hannah L , Ivers Nicholas A , Richardson Leeah I , López-Uribe Margarita M , Jha Shalene
Published: August 2024

Background

Damage from insect herbivores can elicit a wide range of plant responses, including reduced or compensatory growth, altered volatile profiles, or increased production of defence compounds. Specifically, herbivory can alter floral development as plants reallocate resources towards defence and regrowth functions. For pollinator-dependent species, floral quantity and quality are critical for attracting floral visitors; thus, herbivore-induced developmental effects that alter either floral abundance or attractiveness may have critical implications for plant reproductive success. Based on past work on resource trade-offs, we hypothesize that herbivore damage-induced effects are stronger in structural floral traits that require significant resource investment (e.g. flower quantity), as plants reallocate resources towards defence and regrowth, and weaker in secondary floral traits that require less structural investment (e.g. nectar rewards).

Methods

In this study, we simulated early-season herbivore mechanical damage in the domesticated jack-o-lantern pumpkin Cucurbita pepo ssp. pepo and measured a diverse suite of floral traits over a 60-d greenhouse experiment.

Key Results

We found that mechanical damage delayed the onset of male anthesis and reduced the total quantity of flowers produced. Additionally, permutational multivariate analysis of variance (PERMANOVA) indicated that mechanical damage significantly impacts overall floral volatile profile, though not output of sesquiterpenoids, a class of compounds known to recruit specialized cucumber beetle herbivores and squash bee pollinators.

Conclusions

We show that C. pepo spp. pepo reduces investment in male flower production following mechanical damage, and that floral volatiles do exhibit shifts in production, indicative of damage-induced trait plasticity. Such reductions in male flower production could reduce the relative attractiveness of damaged plants to foraging pollinators in this globally relevant cultivated species.
Beyond the hype: using AI, big data, wearable devices, and the internet of things for high-throughput livestock phenotyping
Authors: Klingström Tomas , Zonabend König Emelie , Zwane Avhashoni Agnes
Published: August 2024

Phenotyping of animals is a routine task in agriculture which can provide large datasets for the functional annotation of genomes. Using the livestock farming sector to study complex traits enables genetics researchers to fully benefit from the digital transformation of society as economies of scale substantially reduces the cost of phenotyping animals on farms. In the agricultural sector genomics has transitioned towards a model of ‘Genomics without the genes’ as a large proportion of the genetic variation in animals can be modelled using the infinitesimal model for genomic breeding valuations. Combined with third generation sequencing creating pan-genomes for livestock the digital infrastructure for trait collection and precision farming provides a unique opportunity for high-throughput phenotyping and the study of complex traits in a controlled environment. The emphasis on cost efficient data collection mean that mobile phones and computers have become ubiquitous for cost-efficient large-scale data collection but that the majority of the recorded traits can still be recorded manually with limited training or tools. This is especially valuable in low- and middle income countries and in settings where indigenous breeds are kept at farms preserving more traditional farming methods. Digitalization is therefore an important enabler for high-throughput phenotyping for smaller livestock herds with limited technology investments as well as large-scale commercial operations. It is demanding and challenging for individual researchers to keep up with the opportunities created by the rapid advances in digitalization for livestock farming and how it can be used by researchers with or without a specialization in livestock. This review provides an overview of the current status of key enabling technologies for precision livestock farming applicable for the functional annotation of genomes.
71658 - Postoperative chyle leak – Less likely in obese patients and associated with postoperative mortality
Authors: Linder Gustav , Hedberg Jakob , Edholm David , Nilsson Magnus
Published: August 2024

Introduction

Esophagectomy can be complicated by postoperative chyle leak (PCL). PCL is rare and can be challenging to manage. Predisposing factors and the impact of PCL on survival are not fully understood.

This study aimed to investigate risk factors for PCL in a national cohort and its associations with outcomes and survival.

Method

All patients with esophageal cancer in the Swedish Registry for Esophageal and Gastric Cancer (NREV) who underwent esophagectomy between 2006 and 2018 with information on PCL were included in the study. Risk-factors and protective-factors of PCL were explored with multivariable logistic regression and 90-day mortality was described. Survival was studied with Cox-regression and the Kaplan-Meier method.

Result

The study included 1540 patients. 51 patients (3.3%) had PCL of which 32 (62.7%) were managed operatively. Median time-in-hospital increased with 14 days from 15 to 29 days in patients with PCL compared to patients without.

In multivariable logistic regression, overweight (BMI>25) and obese (BMI>30) patients were less likely to suffer from PCL, OR 0.41 (0.19-0.88 95%CI) and OR 0.28 (0.08-0.97) respectively.

In patients with PCL, 90-day mortality was increased three-fold, 15.7% vs 5.0%, and median survival was reduced by six months (28.8 vs 34.8 months) compared to patients without PCL.

PCL was not associated with adjusted long-term survival, HR 1.12 (0.75-1.66 95%CI).

Discussion

This study finds a reduced risk of PCL in obese esophageal cancer patients by unknown mechanisms that should be further explored. Although short-term mortality is clearly affected by PCL, the complication does not seem to impact long-term survival.
72317 - Improved survival but early recurrence, resection of intrahepatic cholangiocarcinoma with high tumour burden – a rationale for neoadjuvant therapy?
Authors: Abdulrazzak Mostafa , Gustafsson-Liljefors Maria , Gilg Stefan , Villard Christina , Jansson Hannes
Published: August 2024

Introduction

Neoadjuvant therapy has not been established as standard of care in intrahepatic cholangiocarcinoma (iCCA). The role of resection surgery in patients with large or multifocal iCCA remains debated. The aim of this study was to examine oncological outcomes in a regional all-comer cohort.

Method

All patients diagnosed with iCCA at the Stockholm regional tumour board (Karolinska University Hospital, 2010-2020) were assessed. Patients without distant lymph node metastasis or metastasis to other organs were included. The primary outcome was overall survival (OS), calculated from date of diagnosis. The secondary outcome was disease-free survival (DFS), calculated from date of surgery.

Result

One-hundred and twenty-eight patients were diagnosed with liver-only iCCA. Approximately half of patients (n=62, 48%) underwent curative intent surgery, while the other half underwent either palliative chemotherapy (n=33, 26%) or best supportive care (n=33, 26%). A majority of patients (n=75, 59%) had an iCCA larger than 5 cm or more than 5 tumours (high tumour burden group). For patients with high tumour burden, OS was significantly better after resection (Figure 1A, P<0.001). After resection, median DFS was shorter in patients with high tumour burden (Figure 1B, 5.5 months vs. 23.5 months, P=0.002).

Discussion

In this regional all-comer cohort, surgical resection of iCCA was associated with improved OS even in patients with high tumour burden. However, median DFS was less than six months in the high tumour burden group. The better survival but high risk of early recurrence indicates that large or multifocal iCCA should be further investigated as possible indications for neoadjuvant therapy.
72320 - External validation of plasma CSF1 as a preoperative prognostic marker in resectable intrahepatic cholangiocarcinoma – a bi-institutional study
Authors: Akiki Antonio , Jacobsson Hanna , Nouairia Ghada , Cornillet Martin , Björkström Niklas K , Sparrelid Ernesto , Taflin Helena , Jansson Hannes
Published: August 2024

Introduction

The long-term prognosis after curative intent resection for intrahepatic cholangiocarcinoma (iCCA) remains poor. Preoperative risk assessment is difficult and neoadjuvant approaches have not yet been established. A previous single-centre study indicated two immune system-related proteins in plasma: colony stimulating factor 1 (CSF1) and TNF-related apoptosis-inducing ligand (TRAIL) as preoperative prognostic factors in iCCA. This study aimed to externally validate CSF1 and TRAIL as prognostic markers for patients with resectable iCCA, in collaboration between two Swedish regional referral centres.

Method

Preoperative plasma CSF1 and TRAIL concentrations were determined, from prospectively collected biobank samples using multiplex immunoanalysis (Proximity Extension Assay), for patients resected for iCCA at Karolinska (2010-2020) and Sahlgrenska (2019-2023) university hospitals. The primary outcome was overall survival (OS), analysed by Kaplan-Meier method and Cox regression.

Result

Sixty-one patients with resected iCCA were included (Karolinska n=45, Sahlgrenska n=16). CSF1 was significantly associated with OS with a hazard ratio (HR) of 1.03 (95% confidence interval [CI] 1.01-1.05). TRAIL showed no significant association with OS (HR 0.997 (95% CI 0.99-1.00). Elevated CSF1 concentrations were associated with poor survival, with a median OS of only 7 months for patients in the upper quartile, compared to an OS of 64 months for patients with CSF1 concentrations in the lower quartile (Figure 1, p<0.001).

Discussion

Plasma CSF1 was validated as a novel preoperative prognostic marker for patients with resectable iCCA, and could assist a preoperative risk stratification. The preoperative identification of high-risk patients could support individualized risk-benefit analyses and patient selection for prospective studies, including neoadjuvant strategies.
71288 - Sentinel lymph node detection with an ultra-low dose of superparamagnetic iron oxide nanoparticles in patients with breast cancer
Authors: Sundh Lovisa , Bagge Roger Olofsson , Mirzaei Nushin , Nyman Per , Karakatsanis Andreas , Eriksson Staffan , Ravichandran Mookaiah , Abuoddos Nizar , Wärnberg Fredrik
Published: August 2024

Introduction

Sentinel lymph node (SLN) detection in patients with breast cancer using 1-2 mL superparamagnetic iron oxide nanoparticles (SPIO) has shown comparable results to Technetium99m (Tc99m)+/-blue dye (BD). In a pilot study, we have shown that an ultra-low dose (0.1 mL) SPIO injected intradermally was feasible. This current study, MagSnow 2.0, aims to validate the ultra-low intradermal SPIO dose in a larger cohort. Preliminary data are presented.

Method

A total of 220 patients scheduled for SLN biopsy will be prospectively enrolled at five Swedish hospitals in this non-inferiority study. All patients receive an intradermal injection of 0.1 mL SPIO up to 30 days before surgery and Tc99m+/-BD according to clinical routine. Primary endpoint is SLN detection. Chi-square test was used to compare proportions and T-test for comparing number of SLNs.

Result

In this interim analysis including 124 patients, with median age of 63 years, BMI 25.1 kg/m2, tumor size 15 mm and predominantly invasive ductal cancers (80.2%), underwent breast conserving surgery (96.0%) or mastectomy. SLN detection with SPIO was 97.6% and with Tc99m+/-BD 98.4% (p=0.65). The mean number of SLNs detected with SPIO was 1.66 (median 1, IQR 1-2) and Tc99m+/-BD 1.72 (median 2, IQR 1-2) (p=0.60).

Discussion

These findings support the non-inferiority of an intradermal ultra-low dose of SPIO compared to Tc99m+/-BD for SLN detection. SPIO can be injected weeks before surgery and no nuclear medicine facilities are needed. Skin discoloration and magnetic resonance imaging artefacts are currently investigated in 50 patients from the pilot study.
71486 - Surgical complications after immediate implant-based breast reconstruction for breast cancer in women ≥ 65 years of age
Authors: Liu Y I hang , Johansson Anna L V , Oikonomou Ira , Frisell Axel , Adam Hannah C , Ansarei Dhirar , Halle Martin , Sackey Helena , de Boniface Jana
Published: August 2024

Introduction

While immediate breast reconstruction (IBR) rates in breast cancer are increasing, they remain low in women ≥65 years. The aim was to investigate surgical outcomes in women ≥65 years receiving implant-based IBR.

Method

The population-based Stockholm Breast Reconstruction Database includes all adult women with breast cancer receiving an implant-based IBR in Stockholm, Sweden, 2005-2015. Primary outcomes within 30 days from IBR were 1) infection requiring antibiotics and 2) reoperation. Implant removal was a secondary outcome. Women aged ≥65 years were compared with younger age groups. Chi-square tests and multivariable logistic regression were applied for the primary outcomes, and Kaplan Meier analysis for the secondary outcome.

Result

Among 1749 cases of IBR, 140 (8.0%) were in women ≥65 years. Median follow-up was 74 months (1-198). Postoperative infection was not more common in women ≥65 years (22 out of 140, 15.7%) than in women <65 years (303 out of 1609, 18.8%; p=0.221). Reoperations were more frequent in women ≥65 years than in other age groups (≥65: 8.6%; 50-64: 6.5%; 40-49: 3.5%; <40: 1.6%; p<0.001), however, age ≥65 years was no independent risk factor in the multivariable analysis (OR 1.00, 95% CI 0.44-2.28).

Overall 6-year probability of implant removal was 11.4%, (8.1% due to complications and 3.3% due to patient preference). There was no statistically significant difference between age groups for either reason (p=0.085 and p=0.794, respectively).

Discussion

Higher age alone was not associated with worse surgical outcomes after implant-based IBR in highly selected patients ≥65 years old when compared with their younger counterparts.
72229 - Ultralow dose of superparamagnetic iron oxide nanoparticles in combination with Magseed for sentinel node detection in nonpalpable breast cancer
Authors: Båtelsson Sarah , AbuOddos Nizar , Mirzaei Nushin , Andersson Yvette , Bagge Roger Olofsson , Wärnberg Fredrik , Eriksson Staffan
Published: August 2024

Introduction

A nonpalpable breast cancer can be localized using a magnetic seed (Magseed). Sentinel lymph node (SLN) detection with superparamagnetic iron oxide (SPIO) nanoparticles is comparable to Technetium (Tc99) +/- blue dye (BD). The study aim was to evaluate the feasibility of the combined use of a Magseed and an ultra-low, intradermal SPIO dose.

Method

Women from the Magsnow 2.0 study with non-palpable breast cancer planned for SLN-biopsy and breast tumour localisation with Magseed were selectively included for this subgroup analysis. The patients received 0.1 mL SPIO up until 30 days prior surgery, as well as Tc99 +/- BD according to routine. SPIO was injected by the surgeons in Gothenburg and by radiologists in Västerås. The SPIO was usually injected more than 2 cm away from the Magseed. Analyses of surgical margins, reoperations and SLN detection were made. Surgeons was asked about their experience with the combination on a scale from 1-10.

Result

In total, 20 women were included. SLN detection was 95% (19/20) with SPIO and 100% with Tc99 +/- BD. The median number of SLNs was three and metastases were found in five patients (25%). Mean minimum surgical margin was 6.5 mm (range 0.36-16 mm) and no reoperations were needed. The feasibility of indication with Magseed in combination with SPIO according to the operating surgeons was high, eight surgeons rated a mean value of 7,8 (1-10).

Discussion

In women with nonpalpable breast cancer undergoing breast conserving surgery, the combination of Magseed and SPIO seems to be feasible even though an ultralow dosage were used.
71670 - Survival and oncological outcomes in colorectal cancer patients undergoing urological resections: A National Study Cohort
Authors: Assi Hanin , Valdimarsson Valentinus , Angenete Eva , Buchwald Pamela , Lydrup Marie-Louise
Published: August 2024

Introduction

Colorectal cancer (CRC) growing into urinary organs may require en-bloc resections such as total cystectomy (TC), partial cystectomy (PC), or ureter resection (UR). This study aimed to investigate survival and oncological outcomes after CRC in patients operated with addition of urological resections.

Method

Patients undergoing CRC resection in Sweden from 2007 until 2018 were collected via the Swedish Colorectal Cancer Registry. The free text variable “resection other organ” was used to identify CRC undergoing urological resections and subdivided to TC, PC and UR.

Result

A total of 57 907 patients underwent primary CRC surgical resection, of these 1093 patients underwent urological resection (Figure 1). TC, PC and UR were performed in 589, 345 and 159 patients respectively. The vast majority of patients undergoing urinary bladder resection were male, especially regarding rectal cancer patients subjected to TC (205 (92%) male patients).

R0 resection was obtained in 86%, 86% and 84% in TC, PC and UR respectively. 30-day mortality did not differ between groups. 5-years OS rates were 61%, 58%, and 53% in TC, PC and UR (p=0.205). For subgroup analysis patients were divided into four equal groups based on surgical period 2007-2009, 2009-2012, 2012-2016 and 2016-2018. Multivariable analyses adjusted for age, ASA classification, cTNM, pTN, surgical period and type (elective/emergency) revealed higher local recurrence rate in the UR group (p=0.016) while 5-year OS and distant metastases rates did not differ between groups.

Discussion

PC may represent an option to TC in selected patients with CRC overgrowth, while maintaining favourable survival and oncological outcomes.
71698 - A multicenter randomized trial: Collagen implant vs myocutaneous flap for reconstruction after extralevator abdominoperineal excision of the rectum
Authors: Rutegård Martin , Rutegård Jörgen , Haapamäki Markku M
Published: August 2024

Introduction

The procedures to address the defect in the lesser pelvis following an ‘extralevator’ abdominoperineal excision (ELAPE) for rectal cancer have been explored only sparsely. The objective was to determine whether a porcine-collagen implant or a gluteus maximus myocutaneous flap for reconstruction is superior.

Method

This study was a multicenter, randomized clinical trial (the NEAPE study). Eligible participants were rectal cancer patients undergoing ELAPE, where the remaining muscles could not be closed in the midline, necessitating adjuncts for closure. Randomization was computer-generated, concealed, and stratified by hospital and preoperative radiotherapy regimen. The experimental arm consisted of a porcine-collagen implant, whilst the control arm comprised a gluteal maximus myocutaneous flap. The primary outcome was physical performance six months after surgery, measured using the timed-stands test (TST). Secondary outcomes included perineal wound healing and sitting ability.

Result

In total, 83 patients (57 men and 26 women) from 8 hospitals were included. The mean age was 68 years (range: 41–93). Some 78 patients had preoperative radiotherapy, 40 had preoperative chemotherapy and 38 had a preoperative combination of both.

The proportion of patients within reference values of TST matched for age and sex was 28.6 per cent for the collagen implant group and 39.4 per cent for the myocutaneous flap group (missing excluded), p=0.44. Results of primary and two secondary outcomes are shown in Table 1.

Discussion

The NEAPE study was unable to show superiority for any of the two reconstructive techniques, which seem equally effective regarding postoperative physical function, wound complications and ability to sit.
71722 - Favourable 5-year survival in patients with isolated colorectal cancer lung metastases treated surgically with curative intent – a retrospective study
Authors: Dahlberg Sofia , Jörgren Fredrik , Buchwald Pamela , Vidarsdottir Halla
Published: August 2024

Introduction

The benefit of surgical resection for colorectal cancer (CRC) lung metastases is unclear. The aim was to investigate the incidence, treatment strategy and overall survival (OS) in CRC patients with isolated lung metastases.

Method

CRC patients with isolated lung metastases following curative resection were retrospectively analysed using data from the Swedish Colorectal Cancer Registry and medical charts. Patients treated within Region Skåne during 2010 – 2016 were eligible. Exclusion criteria were previous or concurrent metastases at other organ sites. Patients were divided into synchronous/metachronous lung metastases and curative/palliative treatment intent. The primary endpoint was OS. Multivariable Cox-regression and Kaplan-Meier survival analysis were performed.

Result

Of 8457 patients, 93 (1.1%) had isolated lung metastases (53 synchronous/40 metachronous). In all, 53 patients were treated with curative intent where most (51/53, 96%) were managed surgically. Forty patients were considered palliative and received either chemotherapy or best supportive care. Five-year OS was 42% (39/93), median 49 months (IQR [22 – 60]) for the entire cohort, and 68% (36/53), median 60 months (IQR [53 – 60]) and 7.5% (3/40), median 22 months (IQR [12 – 33]) for curative and palliative patients, respectively. In multivariable analysis, younger age (hazard ratio (HR) 1.04, confidence interval (CI): 1.01 – 1.07), the number of lung metastases (HR 1.64, CI: 1.08 – 2.47) and unilateral distribution (HR 0.41, CI: 0.20 – 0.84) were associated with better survival.

Discussion

Isolated CRC lung metastases are rare. Patients treated with curative intent undergoing surgical resection had a favourable prognosis, especially if the lung metastases were solitary and distributed unilaterally.
71757 - Identification of diverticular disease in Swedish healthcare registers: A validation study
Authors: Mahmood Wael Mahmood , Schmidt Peter Thelin , Olén Ola , Hellsing Christin , Hjern Fredrik , Abraham-Nordling Mirna
Published: August 2024

Introduction

The Swedish National Patient Register (SNPR) is frequently used in studies of colonic diverticular disease (DD). Despite this, the validity of the coding for this specific disease in the register has not been studied.

Method

From SNPR, 650 admissions were randomly identified encoded with ICD 10, K572-K579. From the years 2002 and 2010, 323 and 327 patients respectively were included in the validation study. Patients were excluded prior to, or up to 2 years after a diagnosis with IBD, Celiac disease, IBS, all forms of colorectal cancer (primary and secondary), and anal cancer. Medical records were collected and data on clinical findings with assessments, X-ray examinations, endoscopies and laboratory results were reviewed. The basis of coding was compared with internationally accepted definitions for colonic diverticular disease. Positive predictive values (PPV) were calculated.

Result

The overall PPV for all diagnoses and both years was 95%. The PPV for the year 2010 was slightly higher (98%) then the year 2002 (91%), which may be due to the increasing use of computed tomography (CT).

Discussion

The validity of DD in SNPR is high, making the SNPR a good source for population-based studies on DD.
71319 - Follow up study after implementation of the VERAS concept
Authors: Ottosson Frida , Leo Jonas , Block Tomas , Kristiansson Anna-Lotta
Published: August 2024

Introduction

Emergency laparotomy (EL) is a common surgical procedure with a 30-day mortality rate in Sweden of approximately 10% over the past five years. Most of these patients are over 65 years and have a higher risk of complications and mortality. Very important ERAS (VERAS) has been introduced to intensify care for high-risk patients undergoing EL. With this concept we are hoping to improve outcomes and reduce complications.

Method

This retrospective cohort study evaluate the outcomes for patients undergoing EL after the introduction of the VERAS concept. All patients undergoing EL between 2019 and 2023 were identified, inclusion criteria for classification as VERAS patients required postoperative values indicating a high relative risk of complications or mortality. The value was derived by multiplying NSQIP morbidity and mortality with a Surgical Apgar Score (SAS) postoperatively. Data were collected through chart review for various outcomes.

Result

A total of 108 patients were included, 63.8% were women and 36% were men. The mean age was 75 years. The median ASA class was 3. 56% of patients underwent EL due to ileus/volvulus. 10 patients died within 30 days postoperatively after acute laparotomy. Of these, 60% were over 80 years old. Among those with a postoperative mortality risk of over 40%, it was observed that out of 17 patients, only 6 (35%) had died within 30 and 90 days.

Discussion

The VERAS concept for EL has clearly shown a reduced risk of mortality. Improvements in postoperative follow-up guidelines should be made.
72001 - Incidence, epidemiology, and management of severe biliary pancreatitis
Authors: Hansson Moa , Högberg Dominika , Katsarelias Dimitrios
Published: August 2024

Introduction

According to Swedish guidelines, more than 4700 individuals are affected by acute pancreatitis yearly, with approximately 6000 admissions. Previous studies show that 7,5-10% of all pancreatitis are severe, defined as persistent organ insufficiency for more than 48 h. Approximately 40% of all cases are caused by gallstones.

The aim of the present study was to investigate the incidence of severe acute biliary pancreatitis (ABP), associated risk factors, impact of minimally invasive treatments on patients outcomes in our institution.

Method

All patients admitted to Sahlgrenska university hospital with ABP between 2018-2022 were included. Data was collected from patient records. Risk factors for severe disease like ASA-classification, age (>65), and gender were analyzed. Hospital stay, additional interventions after discharge and minimally invasive treatment as EUS, ERCP and PTBD were recorded.

Result

Of 242 patients, 24 (9,9%) presented with severe pancreatitis. In a multivariate logistic regression model ASA-classification (OR: 3.21, 95% CI: 1.18-8.68), age (OR: 1.05, 95% CI: 0.39-2.87) and female gender (OR: 2.18, 95% CI: 0.85-5.55) were independently associated with severe pancreatitis.

23 patients were treated using some minimally invasive procedure of whom 43% with EUS, 43% underwent ERCP, and 13% had PTBD. The median time of hospital stay was 46.5 days (4–267) and 16 patients returned for additional intervention after discharge.

Discussion

Severe pancreatitis in our institution is 10% of all ABPs, with high morbidity, leading to prolonged hospital stay and demands great amounts of recourses and interventional methods that require expertise.
72014 - Malignant Large Bowel Obstruction Turned Out To Be Deadly Fungal Infection – A Case Report
Authors: Kaidi Donia , Rosemar Anders , Becker Marie , Lindström Johan , Hammarström Helena , Swartling Torbjörn , Asplund Dan
Published: August 2024

Introduction

This case report highlights the diagnostic and therapeutic challenges of a rare gastrointestinal fungal infection in an immunocompetent patient.

Method

A healthy 49-year-old man presented at the emergency department with abdominal pain and weight loss. The lower abdomen was tender, CRP 79, and CT was inconclusive, suggesting IBD or cancer. A colonoscopy was scheduled but never completed because of insufficient bowel preparation. The clinical condition worsened with increasing pain and peritonitis. MRI revealed obstructive lesions in the ascending and descending colon, which were verified during subacute surgery and a subtotal colectomy with anastomosis was performed. A few days later, the patient was reoperated on suspicion of anastomotic dehiscence, but no leakage was found. After an initial seeming recovery, the clinical condition deteriorated. CT and MRI now indicated peritoneal, liver, and lymph node metastases. Sigmoidoscopy showed fibrotic lesions, with pathology reporting only inflammation. Five weeks post-admission, the patient underwent surgery again. Large parts of the small bowel exhibited fibrotic, ulcerative, necrotic and stricturing lesions, which were resected. Multiple stomas were constructed, and VAC was applied.

Result

Pathology revealed fungal hyphae in colonic tissue. Empirical antimycotic treatment was initiated, including liposomal amphotericin B, with adjustments as Basidiobolus spp. mold was reported on day 45.

Despite efforts to optimize treatment, the patient succumbed shortly after a seventh surgery on day 51.

Discussion

The patient likely acquired the infection in a tropical/subtropical region, where the fungus is ubiquitous.

To the best of our knowledge, this is the first reported case of Basidiobolomycosis in Sweden.