bluuebunny/crossref_metadata_2025 huggingface dataset:
Sustainability monitored through stretchable sensors
Authors: Kearns Sarah
Published: March 2019

Engineered monitors measure the effects of climate change noninvasively — taking shape to fish, skin, and the environment.
How close are we to growing a human heart from stem cells?
Authors: Liebendorfer Adam
Published: March 2019

According to review, we can now grow tissues analogous to heart muscle in utero using stem cells. The next step is to mimic the conditions that cause tissues to mature as they would in full adults.
Measuring heat across atoms
Authors: Kish Stacy W.
Published: March 2019

New paper introduces a novel approach to maximize thermal conductance across gold-gold atomic contacts.
Advances in the study of piezoelectric polymers
Authors: Kaczmarek Halina , Królikowski Bogusław , Klimiec Ewa , Chylińska Marta , Bajer Dagmara
Published: March 2019

The literature review based on the works published over the last decade concerns the progress in research on innovative piezoelectric materials with current or potential practical applications. At the beginning, the nature of piezoelectric phenomenon is clarified. The main emphasis is put on presentation of polymers, biopolymers and polymer composites as well as hybrid materials with piezoelectric properties. Moreover, carbon nanomaterials are also included. These materials have recently become an intensively developing field, as evidenced by numerous scientific publications. Furthermore, the recently reported main methods of characterizations and selected examples of modern applications of piezoelectric materials in various fields (electronics, industry, medicine) have been discussed.

The bibliography includes 217 references.
Local regional workforce returns on investment of a locally governed and delivered general practice vocational training program
Authors: Kitchener Scott
Published: March 2019

This study evaluated a program arising from the Commonwealth policy of regionalised training for general practice with regard to the outcomes for the region investing in the training program. A complete operational audit was performed of the outcomes of a training provider of the Commonwealth program, evaluating workforce contribution and retention in the region during and after training, stratified for the effects of locally contextualising, advanced skill training and origin of trainee. The local regional workforce contribution during training peaked at 130 full-time equivalents in 2015. Cumulatively, 53% of alumni remained in the region, but over 40% moved to practice in metropolitan south-east Queensland and other Australian capital cities. Local contextualising of training, completing additional advanced skills training and being an Australian graduate were associated with increased retention in the region. A regional training program is a significant local asset introducing potential general practitioners (GPs) to the region. However, this regional area has become a ‘rural’ training ground for GPs into metropolitan practice rather than local investment translating as comprehensively as possible into long-term local workforce. The Commonwealth program should focus on local workforce outcomes as an evaluation metric rather than the proportion of trainees in rural training.
What is known about the topic?Retention in regional areas following the Australian General Practice Training (AGPT) program measured on a national basis is greater following regional-based training.
What does this paper add?Local workforce return on investment for training providers in GP is substantial. Contextualised local rural training, Australian graduates and trainees completing advanced rural training improve local return on training investment. A significant proportion of this rural local training program investment provides GPs for metropolitan southeast Queensland.
What are the implications for practitioners?National and regional investment in the AGPT should recognise that despite the lesser supervisory medical workforce and resources, regional training still supports metropolitan GP workforce development. Australian graduates are more likely to remain in a region following local training, as are those who have additionally completed advanced rural skill training.
Robotic colorectal surgery in Australia: a cohort study examining clinical outcomes and cost
Authors: Wilkie Bruce , Summers Zara , Hiscock Richard , Wickramasinghe Nilmini , Warrier Satish , Smart Philip
Published: March 2019

Objective The aim of this study was to compare robotic versus laparoscopic colorectal operations for clinical outcomes, safety and cost. Methods A retrospective cohort study was performed of 213 elective colorectal operations (59 robotic, 154 laparoscopic), matched by surgeon and operation type. Results No differences in age, body mass index, median American Society of Anesthesiologists score or presence of cancer were observed between the laparoscopic or robotic surgery groups. However, patients undergoing robotic colorectal surgery were more frequently male (P = 0.004) with earlier T stage tumours (P = 0.02) if cancer present. Procedures took longer in cases of robotic surgery (302 vs 130 min; P < 0.001), and patients in this group were more frequently admitted to intensive care units (P < 0.001). Overall length of stay was longer (7 vs 5 days; P = 0.03) and consumable cost was A$2728 higher per patient in the robotic surgery group. Conclusion Robotic colorectal surgery appears to be safe compared with current laparoscopic techniques, albeit with longer procedure times and overall length of stay, more frequent intensive care admissions and higher consumables cost. What is known about the topic? Robotic surgery is an emerging alternative to traditional laparoscopic approaches in colorectal surgery. International trials suggest the two techniques are equivalent in safety. What does this paper add? This is an original cohort study examining clinical outcomes in Australian colorectal robotic surgery. The data suggest it may be safe, but this paper demonstrates key issues in the implementation and audit of novel surgical technologies in relatively low-volume centres. What are implications for practitioners? In our study, patients undergoing robotic colorectal surgery at a single centre in Australia had equivalent measured clinical outcomes to those undergoing laparoscopic surgery. However, practitioners may counsel patients that robotic procedures are typically longer and more expensive, with a longer overall hospital admission and a higher likelihood of intensive care admission.
Evaluation of open- and closed-eyed entrances on retention and escape of invasive swimming crabs and associated fauna from pots in their native range
Authors: Vazquez Archdale Miguel , Santos Jorge , Watariguchi Fukunori
Published: March 2019

Fishing trials targeting several invasive swimming crab species in their native habitat were undertaken using two types of collapsible pot, one with open-eyed entrances and the other with closed-eyed entrances, to analyse differences in catch retention between them. The open-eyed pot was dome-shaped with two funnel entrances located at opposite ends, whereas the closed-eyed pot had two soft sleeves that ended in slits and had to be pushed through by organisms to ingress, supposedly reducing escape. Retention fishing trials (100 pot hauls per pot type) using a 1-day soaking and fish bait confirmed no significant difference in crab catches between pot types; differences were only detected for large fish (morays and congers). A second set of 4-day escape trials (20 pots per type) was undertaken to investigate how long organisms would be detained in the pots. Escape was significantly affected, and half-residences were typically delayed by 1–2 days for most crabs and fish in closed-eyed entrance pots because the entrances closed. Closed-eyed entrances hampered escape and may be useful when longer soakings are needed; however, because no differences were detected in crab numbers between the two entrance types for short soakings, we recommend open-eyed entrance pots in order to mitigate possible ghost fishing effects from lost gear.
Lipopolysaccharide reduces gonadotrophin-releasing hormone (GnRH) gene expression: role of RFamide-related peptide-3 and kisspeptin
Authors: Lee Chooi Yeng , Li ShengYun , Li Xiao Feng , Stalker Daniel A. E. , Cooke Claire , Shao Bei , Kelestimur Haluk , Henry Belinda A. , Conductier Gregory , O'Byrne Kevin T. , Clarke Iain J.
Published: March 2019

RFamide-related peptide (RFRP)-3 reduces luteinising hormone (LH) secretion in rodents. Stress has been shown to upregulate the expression of the RFRP gene (Rfrp) with a concomitant reduction in LH secretion, but an effect on expression of the gonadotrophin-releasing hormone (GnRH) gene (Gnrh1) has not been shown. We hypothesised that lipopolysaccharide (LPS)-induced stress affects expression of Rfrp, the gene for kisspeptin (Kiss1) and/or Gnrh1, leading to suppression of LH levels in rats. Intracerebroventricular injections of RFRP-3 (0.1, 1, 5 nmol) or i.v. LPS (15μgkg−1) reduced LH levels. Doses of 1 and 5 nmol RFRP-3 were then administered to analyse gene expression by in situ hybridisation. RFRP-3 (5 nmol) had no effect on Gnrh1 or Kiss1 expression. LPS stress reduced GnRH and Kiss1 expression, without affecting Rfrp1 expression. These data indicate that LPS stress directly or indirectly reduces Gnrh1 expression, but this is unlikely to be due to a change in Rfrp1 expression.
Evidence for high-density liquid water between 0.1 and 0.3 GPa near 150 K
Authors: Stern Josef N. , Seidl-Nigsch Markus , Loerting Thomas
Published: March 2019

Significance

The two-liquid model is appealing to explain the anomalous nature of supercooled water. However, it is still contested whether or not the amorphous polymorphism at cryoconditions develops into a liquid–liquid transition at higher temperatures. While some work has been devoted to this question at ambient pressure conditions, there are barely any experiments at high-pressure conditions. Here we reveal a temperature window, in which bulk high-density liquid water (HDL) can be accessed prior to crystallization at 0.1–0.3 GPa based on path independence. By contrast, at higher pressures crystallization takes place from the amorphous solid state. This paves the way for future exploration of the liquid–liquid transition from HDL to low-density liquid water at thermodynamic equilibrium near 0.1 GPa.
Digital logic for soft devices
Authors: Preston Daniel J. , Rothemund Philipp , Jiang Haihui Joy , Nemitz Markus P. , Rawson Jeff , Suo Zhigang , Whitesides George M.
Published: March 2019

Significance

Soft devices offer many useful characteristics, including safe operation in close proximity to humans, the ability to adapt to their surroundings, ease of sterilization, simplicity, low cost, and light weight. Current soft devices, however, are still actuated by hard valves and electronic controls, and reliance on these components limits the use of soft devices in applications where hard structures or electronics are not compatible. This work demonstrates completely soft digital logic gates that can be integrated into soft devices and that allow computation and control within these devices, without hard valves or electronics. We demonstrate data storage, signal processing, digital-to-analog conversion, environmental sensing, and collaborative interaction between humans and soft devices.
The digital tourism landscape.
Authors: Benckendorff P. J. , Xiang Z. , Sheldon P. J.
Published: March 2019

This chapter examines the digital tourism landscape from different disciplinary perspectives. First, it adopts the analogy of an ecosystem to explore the broader role that information technology (IT) plays to fulfill the functions of inspiration, acquisition, experience and reflection. Second, the chapter explains that socio-technical factors influence technological change and demonstrates how an understanding of economic or industry innovation cycles can help travel organizations make strategic decisions about their technology adoptions. Third, ideas from psychology and consumer behaviour are used to understand how and why travellers use IT. The analysis moves between the macro (economies and industries), the meso (organizations) and the micro (individuals).
Technology-enabled visitor experiences.
Authors: Benckendorff P. J. , Xiang Z. , Sheldon P. J.
Published: March 2019

The application of information technology (IT) in the attraction and events sectors falls into three categories. First, IT is used to attract visitors by providing various electronic channels for information, sales and distribution. Second, IT is used in the staging of memorable visitor experiences. As tourists have come to expect interactive, multimedia entertainment, the attractions industry has responded with a similar level of technological sophistication, particularly in the area of themed entertainment. Third, IT is used to manage visitors by improving admission, orientation, purchasing, crowding and queue management, business intelligence, and safety and security. This chapter addresses these main areas of usage by providing examples from a wide range of different attraction and event settings.
Sustainable tourism and information technology.
Authors: Benckendorff P. J. , Xiang Z. , Sheldon P. J.
Published: March 2019

This chapter identifies some of the information technologies for environmental, socio-cultural and economic sustainability in tourism, and the issues surrounding their implementation in the quest for sustainability. The first section focuses on the use of IT to improve environmental resource efficiency and to educate travellers to travel more responsibly. This section also examines how technology can contribute to environmental purity and physical integrity in nature-based and cultural tourism destinations. It discusses technology's contribution to biodiversity in the context of tourism, and the opportunities to reduce environmental impacts to zero by replacing travel entirely with virtual experiences. The second section discusses the socio-cultural applications of IT, which include applications that help to provide social equity and community wellness in destinations, facilitate local control of the tourism sector, and enhance the cultural richness of host communities. The third section discusses how IT can affect the economic goals of sustainable tourism, including economic viability, local prosperity and employment quality.
The future of information technology and tourism.
Authors: Benckendorff P. J. , Xiang Z. , Sheldon P. J.
Published: March 2019

This chapter explains the virtuous cycle of technological development in travel planning and discusses ten emerging trends in the future of information technology and tourism. The first trend focuses on the development of artificial intelligence and the continuing importance of innovation in computer design; the following four trends focus on the traveller response to various developments; while the last five trends relate to broader technological developments in analytics, mechatronics, material technologies, connectivity and convergence.
Childhood practice and play as determinants of adolescent intrinsic and extrinsic motivation among elite youth athletes
Authors: Thomas Anna , Güllich Arne
Published: March 2019

The study empirically tested the postulate of the Developmental Model of Sport Participation (DMSP; Côté, J., Baker, J., & Abernethy, B. (2007). Practice and play in the development of sport expertise. In R. Eklund & G. Tenenbaum (Eds.), Handbook of sport psychology (pp. 184–202). Hoboken, NJ: Wiley) that diversified childhood self‐led sport play will beneficially affect future, adolescent intrinsic motivation. Participants were 178 elite youth athletes (age 15.3 ± 1.5 years) from several game and non‐game sports; 117 were members of the federal state or national junior squad in their respective sport. A questionnaire measured current (adolescent) intrinsic and extrinsic motivation of the youth athletes using the Sport Motivation Scale (Pelletier, L. G., Fortier, M. S., Vallerand, R. J., Tuson, K. M., Brière, N. M., & Blais, M. R. (1995). Towards a new measure of intrinsic motivation, extrinsic motivation, and amotivation in sports: The sport motivation scale (SMS). Journal of Sport & Exercise Psychology, 17, 35–53) and their earlier volume of childhood engagement (through 12 years) in coach‐led practice and self‐led play in their respective main sport and other sports. Analyses revealed that adolescent intrinsic motivation was not significantly correlated with earlier childhood self‐led sport activities, self‐led play in particular, or childhood sports diversification. Furthermore, considering all different types of childhood sport activities together in multiple regression analyses, they did not provide meaningful explanatory power regarding adolescent intrinsic or extrinsic motivation. In summary, the results did not provide support for the postulate of the DMSP among elite youth athletes. The findings suggest that future research may seek to enable more robust empirical substantiation of the DMSP postulate.
Symmetries and physically realisable ensembles for open quantum systems
Authors: Warszawski Prahlad , Wiseman Howard M
Published: March 2019

A D-dimensional Markovian open quantum system will undergo stochastic evolution which preserves pure states, if one monitors without loss of information the bath to which it is coupled. If a finite ensemble of pure states satisfies a particular set of constraint equations then it is possible to perform the monitoring in such a way that the (discontinuous) trajectory of the conditioned system state is, at all long times, restricted to those pure states. Finding these physically realisable ensembles (PREs) is typically very difficult, even numerically, when the system dimension is larger than 2. In this paper, we develop symmetry-based techniques that potentially greatly reduce the difficulty of finding a subset of all possible PREs. The two dynamical symmetries considered are an invariant subspace and a Wigner symmetry. An analysis of previously known PREs using the developed techniques provides us with new insights and lays the foundation for future studies of higher dimensional systems.
Consensus ranking for multi-objective interventions in multiplex networks
Authors: Pósfai Márton , Braun Niklas , Beisner Brianne A , McCowan Brenda , D’Souza Raissa M
Published: March 2019

High-centrality nodes have disproportionate influence on the behavior of a network; therefore controlling such nodes can efficiently steer the system to a desired state. Existing multiplex centrality measures typically rank nodes assuming the layers are qualitatively similar. Many real systems, however, are comprised of networks heterogeneous in nature, for example, social networks may have both agnostic and affiliative layers. Here, we use rank aggregation methods to identify intervention targets in multiplex networks when the structure, the dynamics, and our intervention goals are qualitatively different for each layer. Our approach is to rank the nodes separately in each layer considering their different function and desired outcome, and then we use Borda count or Kemeny aggregation to identify a consensus ranking—top nodes in the consensus ranking are expected to effectively balance the competing goals simultaneously among all layers. To demonstrate the effectiveness of consensus ranking, we apply our method to a degree-based node removal procedure such that we aim to destroy the largest component in some layers, while maintaining large-scale connectivity in others. For any multi-objective intervention, optimal targets only exist in the Pareto-sense; we, therefore, use a weighted generalization of consensus ranking to investigate the trade-off between the competing objectives. We use a collection of model and real networks to systematically investigate how this trade-off is affected by multiplex network structure. We use the copula representation of the multiplex centrality distributions to generate model multiplex networks with given rank correlations. This allows us to separately manipulate the marginal centrality distribution of each layer and the interdependence between the layers, and to investigate the role of the two using both analytical and numerical methods.
Life cycle expression of inbreeding depression in Eucalyptus regnans and inter-generational stability of its mixed mating system
Authors: Griffin A Rod , Potts Brad M , Vaillancourt René E , Bell J Charles
Published: March 2019

Background and Aims

Many plants exhibit a mixed mating system. Published models suggest that this might be an evolutionarily stable rather than a transitional state despite the presence of inbreeding depression, but there is little empirical evidence. Through field experimentation, we studied the role of inbreeding depression in eliminating inbred progeny from the reproductive cohort of the forest tree Eucalyptus regnans, and demonstrate a stable mixed primary mating system over two successive generations.

Methods

Two field experiments were conducted using seed from natural populations. We sowed open-pollinated seeds to simulate a natural regeneration event and determined isozyme genotypes of dominant and suppressed individuals over 10 years. We also planted a mixture of open-pollinated, outcross and selfed families with common maternal parentage; monitored survival of cross types over 29 years; and determined the percentage of outcrosses in open-pollinated seed from a sample of reproductively mature trees using microsatellite analysis.

Key Results

Both experiments demonstrated progressive competitive elimination of inbred plants. By 29 years, the reproductive cohort in the planted experiment consisted only of outcrosses which produced seed which averaged 66 % outcrosses, similar to the estimate for the parental natural population (74 %).

Conclusions

Selective elimination of inbred genotypes during the intense intra-specific competition characteristic of the pre-reproductive phase of the life cycle of E. regnans results in a fully outcrossed reproductive population, in which self-fertility is comparable with that of its parental generation. The mixed mating system may be viewed as an unavoidable consequence of the species’ reproductive ecology, which includes the demonstrated effects of inbreeding depression, rather than a strategy which is actively favoured by natural selection.
Implementing the FAIR Data Principles in precision oncology: review of supporting initiatives
Authors: Vesteghem Charles , Brøndum Rasmus Froberg , Sønderkær Mads , Sommer Mia , Schmitz Alexander , Bødker Julie Støve , Dybkær Karen , El-Galaly Tarec Christoffer , Bøgsted Martin
Published: March 2019

Compelling research has recently shown that cancer is so heterogeneous that single research centres cannot produce enough data to fit prognostic and predictive models of sufficient accuracy. Data sharing in precision oncology is therefore of utmost importance. The Findable, Accessible, Interoperable and Reusable (FAIR) Data Principles have been developed to define good practices in data sharing. Motivated by the ambition of applying the FAIR Data Principles to our own clinical precision oncology implementations and research, we have performed a systematic literature review of potentially relevant initiatives. For clinical data, we suggest using the Genomic Data Commons model as a reference as it provides a field-tested and well-documented solution. Regarding classification of diagnosis, morphology and topography and drugs, we chose to follow the World Health Organization standards, i.e. ICD10, ICD-O-3 and Anatomical Therapeutic Chemical classifications, respectively. For the bioinformatics pipeline, the Genome Analysis ToolKit Best Practices using Docker containers offer a coherent solution and have therefore been selected. Regarding the naming of variants, we follow the Human Genome Variation Society's standard. For the IT infrastructure, we have built a centralized solution to participate in data sharing through federated solutions such as the Beacon Networks.
PS02.193: A CASE OF LARGE CELL NEUROENDOCRINE CARCINOMA OF THE ESOPHAGOGASTRIC JUNCTION
Authors: Takehana Takuo , Yamamoto Kazuhiro , Kawai Shunsuke
Published: March 2019

Background

The frequency of occurrence of neuroendocrine carcinoma (NEC) in the upper gastrointestinal tract is low, and especially large cell neuroendocrine carcinoma (LCNEC) is extremely rare disease. We report a case of LCNEC of the esophagogastric junction with relapse-free survival in 1 year and 3 months after surgical treatment.

Methods

An 81 - year—old Japanese man was referred to our hospital because of a semicircular ulcerative lesion in the esophagogastric junction (EGJ) by esophagogastroduodenoscopy of routine medical checkup. Biopsy from the lesion showed proliferation of tumor cells with clear nuclear bodies and irregular nuclei. Immunohistochemistry (IHC) demonstrated weakly positive staining of AE1/AE3, and CD3, CD20, S-100 and HMB 45 were negative. Computed tomography (CT) revealed a thickened wall of the EGJ and a lymphadenopathy of the cardiac node without any metastases to other organs. The patient was diagnosed with carcinoma in EJG, Stage III T3N1M0. We performed thoracoscopic esophagectomy with two-filed lymphadenectomy.

Results

Macroscopically, the ulcerative tumor measured 55 × 50mm invaded to the adventitia and was approximately centered in the EGJ. Histologically, the tumor cells showed large nuclei with highly frequent mitoses. IHC revealed that tumor was LCNEC positive for synaptophysin. One lymph node metastasis was found among 39 dissected lymph nodes. Finally, the pathological stage was T3N1M0, IIIA. On postoperative day 7, we performed the drainage for intra-abdominal abscess. He was discharged on postoperative day 44. Adjuvant chemotherapy was not performed, because the patient refused it. He was well and had no evidence of recurrence 15 months after surgery.

Conclusion

LCNECs of the esophagus or stomach are very rare but highly malignant tumors. It is expected that the number of reports of LCNEC in the upper gastrointestinal tract will increase. It is necessary to collect information on more cases to improve prognosis and to establish appropriate treatment guidelines.

Disclosure

All authors have declared no conflicts of interest.
PS02.249: VARIATION IN BODY COMPOSITION IN ESOPHAGEAL CANCER PATIENTS RECEIVING SUPPLEMENTARY JEJUNOSTOMY FEEDING DURING NEOADJUVANT CHEMORADIOTHERAPY
Authors: Boshier Piers R , Seesing M F J , Baracos Vickie E , Low Donald E
Published: March 2019

Background

Cancer of the esophagus has one of the highest known associations with cancer–related malnutrition. The aim of the current study was to investigate variation in the body composition of esophageal cancer patients receiving supplementary jejunostomy feeding during neoadjuvant chemoradiotherapy (nCRT) and to assess its correlation with outcomes.

Methods

Retrospective review of esophageal cancer patient's receiving jejunal feeding during nCRT. Patients selected for jejunal feeding tube placement were considered at high nutritional risk according to ASPEN criteria. Assessment of body composition was performed using L3-axial CT images acquired at diagnosis and after nCRT.

Results

Eighty-one patients were eligible for inclusion (67 M, 65.9 ± 9.7 yrs). Average weight loss and BMI at diagnosis was 11.4 ± 6.5 Kg and 26.1 ± 4.6 Kg/m2 respectively. Failure to complete nCRT as prescribed occurred in one patient. Following nCRT the prevalence of sarcopenia increased significantly in males despite jejunal feeding (69% vs. 87%; P = 0.013) but fell in females (57% vs. 50%; P = 0.705). Patients could be categorized into three distinct groups according to the degree of skeletal muscle loss (ΔSMM) during nCRT: minor-loss/no-change (n = 28; Δ > −6 cm2); moderate loss (n = 27; Δ−17 to −6 cm2), and; severe loss (n = 26; Δ<17 cm2). A female predominance was observed amongst patients with minor-loss/no-change in SMM compared to patients with moderate and severe losses during nCRT (36% vs. 11% vs. 4%; P = 0.005). Visceral obesity was also less common in patients with minor-loss/no-change in SMM compared to patients with moderate and severe losses during nCRT (39% vs. 48% vs. 58%; P = 0.401). Compared to patients with moderate and severe SMM losses patients in whom SMM was persevered by jejunal feeding during nCRT tended to have lower rates of over-all complications (62% vs. 59% vs. 43%; P = 0.318); pneumonia (27% vs. 11% vs. 11%; P = 0.186), and; pulmonary embolism (15% vs. 0% vs. 0%; P = 0.012). Long-term survival was not affected by either sarcopenia or SMM and adipose tissue loss during nCRT (P > 0.05).

Conclusion

This is the first study to report variation in body composition in esophageal cancer patients receiving a defined nutritional intervention during nCRT. In selected patients jejunal feeding appeared to stabilize parameters of body composition whilst other patients experienced significant losses. Observed changes in body composition predominantly reflect sex differences and may offer an opportunity to improve nutritional monitoring and future patient care.

Disclosure

All authors have declared no conflicts of interest.
PS02.250: PREEMPTIVE ENDOSCOPIC VACUUM DRAINAGE TO PREVENT ANASTOMOTIC LEAKAGE IN UPPER-GI SURGERY: A GAME-CHANGING TECHNOLOGY?
Authors: Schmidt Henner M , Vetter Diana , Gubler Christoph , Valli Piero , Morell Bernhard , Raptis Dimitri A , Gutschow Christian A
Published: March 2019

Background

Anastomotic leak (AL) remains a major cause of morbidity in upper-GI surgery. In many centers, endoluminal vacuum drainage (EVD) has become the mainstay of therapy for AL after esophageal and gastric resections. A new idea is to use the EVD technology in a preemptive setting. In this context, we present a case series of patients that received PEVD upon completion of the anastomosis during esophago-gastric surgery.

Methods

Intraoperative PEVD was performed in 10 consecutive patients undergoing minimally invasive esophagectomy with cervical (n = 1) or high intrathoracic (n = 6) anastomosis, and open transhiatally extended (n = 1) or minimally invasive (n = 2) total gastrectomy. The EVD device was removed after three to six (mean 4) days, and the anastomosis was endoscopically inspected for ischemia and AL. Additional contrast radiography, computed tomography, or gastroscopy to exclude AL was performed in seven patients. Primary endpoints in this retrospective series was AL; secondary endpoints were the postoperative morbidity measured by the Clavien-Dindo (CD) classification and the comprehensive complication index (CCI), all at 30 days after surgery.

Results

Perioperative mortality was 0% with uneventful anastomotic healing in all patients of this series (AL rate 0%, anastomotic stenosis 0%). There were no adverse events attributable to PEVD. None of the patients experienced major morbidity (> CD grade IIIa) during the postoperative course. The median postoperative ICU and hospital stay was 1 (IQR 1-1.75) and 14 (IQR 12-16) days, respectively. Five patients (50%) developed at least one complication, mostly related to infection (2 patients) and pulmonary events (2 patients). The mean CCI at 30 days after surgery was 13.7 (range 0-39.5).

Conclusion

PEVD appears to be a safe procedure that may emerge as a groundbreaking technology in patients undergoing esophageal or gastric resection. Further research is needed to elucidate the true potential of this technique.

Disclosure

All authors have declared no conflicts of interest.
Uniform continuity and delay robustness of an adaptive controller for Lagrangian systems
Authors: Nguyen Kim-Doang
Published: March 2019

This paper presents a method based on a continuity argument for analysing the delay robustness of nonlinear control systems with uncertainties. In particular, a delay-dependent stability condition is established in the form of a norm inequality for an adaptive control system with a time delay in the control input. The continuous dependence of the condition on the delay is derived via the uniform continuity in the delay of the fundamental solution of a general linear time-varying delay-differential equation. Since the stability condition holds when the delay is zero, the condition must be true for a certain non-zero positive delay due to continuity. Numerical simulations show the performance and robustness of the control system in the presence of an input delay. Remarkably, the results also illustrate a close agreement with the dependence on control parameters of the transient performance bounds predicted by the theoretical analysis in this paper.
Performance of multiple diagnostic methods in assessing the progression of bovine respiratory disease in calves challenged with infectious bovine rhinotracheitis virus and Mannheimia haemolytica1
Authors: Baruch Joaquin , Cernicchiaro Natalia , Cull Charley A , Lechtenberg Kelly F , Nickell Jason S , Renter David G
Published: March 2019

The objective of this study was to evaluate the diagnostic performance of chute-side diagnostic methods for detecting physiological and pathological changes as indicators of early bovine respiratory disease (BRD) in calves experimentally inoculated with infectious bovine rhinotracheitis virus (IBR) and Mannheimia haemolytica (Mh). A challenge study was performed over 14 d in 30 Holstein steers [average weight (±SEM) = 211 kilograms (kg) ± 2.4 kg] inoculated on day 0 with IBR and on day 6 with Mh. Diagnostic methods included clinical illness scores (CIS), lung auscultation using a computer-aided stethoscope (CAS), rectal temperature, facial thermography, pulse oximetry, and bilateral thoracic ultrasonography. Animals were randomized into 1 of 5 necropsy days (days 6, 7, 9, 11, and 13) when the percentage of lung consolidation was estimated. The effect of study day on the results of the diagnostic methods and associations between each diagnostic method’s values with lung consolidation measured at necropsy were determined with mixed models. Values for all diagnostic methods differed significantly (P < 0.01) by day. During the IBR phase (days 0 to 6) calves had “normal” to “moderate” CIS, whereas during the Mh phase (days 6.5 to 13) scores were predominantly “severe” to “moribund.” Similarly, CAS scores were “normal” and “mild acute” during the IBR phase and “mild acute” to “moderate acute” after the Mh challenge. Oxygen saturation did not differ significantly between days 0, 1, 2, 4, and 6; however, significantly decreased 12 h after inoculation with Mh (P < 0.05). Mean lung consolidation between animal’s right and left side recorded by ultrasound was 0.13% (±0.07) before the inoculation with Mh. However, during the Mh phase, mean consolidation increased significantly over time (P < 0.05). The percentage of lung consolidation at necropsy ranged from 1.7% (±0.82) on day 6 to 55.4% (±7.49) on day 10. Clinical illness scores, rectal temperature, facial thermography, oxygen saturation, and ultrasonography were significantly associated (P < 0.05) with lung consolidation at necropsy. In addition, there was a significant trend (P = 0.07) between CAS and lung consolidation scores at necropsy. These chute-side diagnostic methods are useful for detecting disease progression on animals with early stages of BRD.
High Levels of Knockdown Resistance in Anopheles coluzzii and Anopheles gambiae (Diptera: Culicidae), Major Malaria Vectors in Togo, West Africa: A 2011 Monitoring Report
Authors: Ahadji-Dabla Koffi Mensah , Amoudji Adjovi Djifa , Nyamador Seth Wolali , Apétogbo Georges Yawo , Chabi Joseph , Glitho Isabelle Adolé , Ketoh Guillaume Koffivi
Published: March 2019

A survey of susceptibility to DDT, deltamethrin, bendiocarb, and chlorpyrifos-methyl was conducted in five localities in 2011 in Togo, West Africa, to assess the insecticide resistance status of Anopheles gambiae s.l. (Diptera: Culicidae). Female populations of An. gambaie s.l. emerged from collected larvae (F0) were exposed to insecticide-impregnated papers using World Health Organization test kits for adult mosquitoes; the susceptible reference strain Kisumu was used as a control. Resistance to DDT and deltamethrin was observed within the mosquito populations tested. Anopheles gambiae s.s. and Anopheles coluzzii represented the only species recorded in the study sites. The frequency of knockdown resistance (kdr L1014F) mutation determined using polymerase chain reaction diagnostic tests was lower in An. gambiae than in An. coluzzii in all of the localities except Kolokopé. Further investigations of An. gambiae s.l. resistance are needed in Togo to help the National Malaria Control Programme in vector control decision making and implementation of resistance management strategy.
Potential Influence on Clinical Trials of Long-Term Survivors of Stage IV Non-small cell Lung Cancer
Authors: Davis Jennifer S , Prophet Erin , Peng Ho-Lan , Lee Hwa Young , Tidwell Rebecca S S , Lee J Jack , Thomas Anish , Szabo Eva , Chang Shine
Published: March 2019

Background

New, effective treatments have resulted in long-term survival for small subgroups of metastatic non-small cell lung cancer (NSCLC) patients. However, knowledge of long-term survivor frequency and characteristics prior to modern therapies is lacking.

Methods

Surveillance Epidemiology and End Results (SEER) patients with stage IV NSCLC diagnosed from 1991 to 2007 and followed through 2012 were dichotomized by survival time into the 10% who lived 21 months or longer (long-term survivors) vs the remaining 90% and compared with participants in a representative clinical trial of molecular profiling and targeted therapies (CUSTOM).

Results

Among the 44 387 SEER patients, the 10% identified as long-term survivors were distinguishable from the remaining 90% by younger age, female sex, Asian race, adenocarcinoma histology, tumor grade, tumor site, and surgery. From 1991–1994 to 2003–2007, median survival increased by 6 months from 30 to 36 months among long-term survivors but by only 1 month from 3 to 4 months among the remaining 90%. Among the 165 participants in the CUSTOM trial, 54% met our SEER criterion of long-term survival by living for 21 months or longer.

Conclusions

Among SEER patients with stage IV NSCLC, long-term survivors had a median survival approximately 10 times that of the remaining 90%. Long-term survivors accounted for more than one-half of the participants in a representative clinical trial. Caution is required when extrapolating the outcomes of participants in clinical trials to patients in routine clinical practice.
Dimensions of agency in transnational relations of Afghan migrants and return migrants
Authors: Fischer Carolin , van Houte Marieke
Published: March 2019

This article examines agency unfolding in the relationships that Afghan migrants and return migrants maintain with Afghanistan. Based on qualitative case studies of Afghan diaspora groups in Germany and the UK and Afghan return migrants in Kabul, we focus on how people engage with and position themselves in relation to Afghanistan. Drawing on Emirbayer and Mische’s tri-dimensional concept of agency in combination with Vigh’s idea of social navigation, we approach affective relations and forms of practical (transnational) engagement as expressions of agency. Research on migrants and return migrants is seldom brought together. However, exploring the types of engagement of these two groups with Afghanistan is telling for three reasons. First, it enables us to identify parallels and differences in the way Afghan migrants and return migrants relate to Afghanistan. Secondly, we uncover how ideas of change vary in different settings and under different socio-political conditions. Thirdly, we demonstrate that ties between people and place are not innate but an expression of agency and self-positioning. These in turn are contingent on individual characteristics and the context in which people are embedded. Compared to policy-oriented discussions on the migration-development nexus and on forms and outcomes of migrant engagements, our study yields a more nuanced understanding of entanglements between agency and engagement among Afghan migrants and return migrants.
Teasing the Ever-Expanding Sonnet from Pierre Boulez’s Musical Poetics
Authors: Salem Joseph
Published: March 2019

Pierre Boulez composed several related pieces during the latter half of the 1950s. These pieces all share both serial structures and wholesale notational borrowings. Importantly, when Boulez reused notated material, his focus shifted from executing organizational processes to nuancing the contour, dynamics, and instrumental character of his musical figures, a concern I equate with “revision” in the broadest sense. His habit of revising works in this way altered his stylistic priorities in future works.
Complete remodelling of a displaced odontoid synchondrosis fracture managed conservatively: a case report
Authors: Razii Nima , Sharma Abhishek , Ahuja Sashin
Published: March 2019

Odontoid synchondrosis fractures are the most common cervical fracture in young children, although their overall incidence is rare. Various strategies have been proposed in the management of injuries with significant displacement or angulation. In this report, we present the long-term functional and radiological outcomes following nonoperative treatment of such a fracture in a 5-year-old female. The patient was referred to our tertiary centre with radiological progression of angulation from 10° to 35° within 5 weeks of the injury, despite wearing a rigid collar. She had no neurological compromise. Although we examined the fracture under general anaesthetic, and subsequently applied halo traction, there was no effect on alignment. The halo device was removed after 11 days and a rigid collar was fitted again. The patient had no pain or neurological symptoms out of the collar at 12 weeks after injury (6 weeks after removal of halo), and a computed tomography scan at 15 weeks confirmed that the fracture had united in malalignment. However, serial radiographs and MRI subsequently have shown that the axis has remodelled completely. At 7 years follow-up, there has been no impact on the patient’s functional range of movement or quality of life. This case highlights the preservation of the motion segment and the remarkable remodelling potential of the paediatric cervical spine.
Scoliosis and spinal muscular atrophy in the new world of medical therapy: providing lumbar access for intrathecal treatment in patients previously treated or undergoing spinal instrumentation and fusion
Authors: Labianca Luca , Weinstein Stuart L.
Published: March 2019

This study describes a new procedure for a safer and easier access for the intrathecal injection of the recently approved nusinersen therapy in spinal muscular atrophy. This therapy changed the natural history of the disease, but, to date, scoliosis surgery was an excluding criteria for nusinersen therapy. The bone mass, due to the posterior spinal fusion of the scoliosis surgery, prevents the needle for the nusinersen administration from intervertebral access. This is a single-center, single-surgeon case series descriptive study. A laminotomy at the L3–L4 level was performed to provide safer access for the intrathecal injection. The procedure was carried out during the scoliosis surgery in patients who underwent posterior spinal fusion (PSF) after the nusinersen therapy was introduced, whereas for those who underwent PSF earlier, a second procedure was necessary to perform a laminotomy. A fat grafting was used to prevent bone overgrowth in the laminotomy. Markers were applied as radiographic references for the intrathecal injection. Five patients were enrolled, four females and one male. The mean age of the patients was 11 years. Three patients underwent PSF before the introduction of the nusinersen therapy. Two patients underwent PSF after the nusinersen therapy was available. All of them underwent a laminotomy with a fat grafting at the L3–L4 laminotomy level and received nusinersen therapy without complications. The procedure described is simple and effective in providing safe intrathecal access to make these patients eligible for such important therapy.
Endothelin-1 Activates the Notch Signaling Pathway and Promotes Tumorigenesis in Giant Cell Tumor of the Spine
Authors: Yuan Wei , Qian Ming , Li Zhen-Xi , Zhao Cheng-Long , Zhao Jian , Xiao Jian-Ru
Published: March 2019

Study Design.

Experimental study.

Objective.

To examine the role of endothelin-1 (ET-1) and the Notch signaling pathway in giant cell tumor (GCT) of the spine.

Summary of Background Data.

Previously published studies have shown that the Notch signaling pathway has a role in tumor invasion and that ET-1 is involved in tumor invasion and angiogenesis. However, the roles of both Notch signaling and ET-1 in GCT of the spine remain unknown.

Methods.

Expression of ET-1 in tissue samples from patients with spinal GCT, and adjacent normal tissue, were analyzed by immunohistochemistry and western blot. GCT stromal cells (GCTSCs) were isolated and ET-1 expression was demonstrated by immunofluorescence. Cell viability and cell migration of GCTSCs and human vascular endothelial cells following ET-1 treatment were assessed using the cell counting kit-8 assay and a transwell assay. Receptor activator of nuclear factor kappa-B ligand (RANKL) and osteoprotegerin (OPG) mRNA expression was determined following ET-1 treatment of GCTSCs using quantitative real-time polymerase chain reaction. In GCTSCs treated with ET-1 and the ET-1 signaling antagonist, BQ-123, levels of cyclin D1, vascular endothelial growth factor, matrix metalloproteinase-2 and -9 (MMP-2 and MMP-9), Jagged1, Hes1, Hey2, and Notch intracellular domain were examined by western blot.

Results.

Compared with normal adjacent tissue, ET-1 was highly expressed in GCT tissue. In GCTSCs studied in vitro, treatment with ET-1 significantly increased GCTSC and human vascular endothelial cells growth and migration and increased the expression of RANKL and OPG, meanwhile the ratio of RANKL/OPG was increased, in GCTSCs, it upregulated the production of cyclin D1, vascular endothelial growth factor, MMP-2, MMP-9, Jagged1, Hes1, Hey2, and Notch intracellular domain expression in a dose-dependent manner. Treatment with BQ-123 reversed these effects.

Conclusion.

In GCT of the spine, ET-1 showed increased expression. In cultured GCTSCs, ET-1 treatment activated the Notch signaling pathway.

Level of Evidence: 2
A Strength, Weaknesses, Opportunities and Threats analysis on time lapse
Authors: Basile Natalia , Elkhatib Ibrahim , Meseguer Marcos
Published: March 2019

Purpose of review

The study of embryonic development through conventional microscopy has contributed significantly to the success of IVF. However, clinical pregnancy rates per transfer remain as low as 30% according to the latest records of European society if human reproduction and society if assisted reproduction. Considering the increased need to reduce the number of multiple pregnancies, the embryologist is required to improve embryo selection methods to reduce the number of embryos transferred and identify those with the highest implantation potential. This represents a big challenge considering that applying this strategy could jeopardize the overall success rates. New strategies have been proposed including the use of time-lapse systems among others. Although this technology has been used for a decade in IVF labs controversies still exist regarding its potential to substitute conventional morphology for embryo evaluation.

Recent findings

Lately, different algorithms have been developed correlating embryo kinetics to blastocyst formation, implantation potential, chromosomal content and live birth rate. Moreover, automation and the use of artificial intelligence have recently been introduced to improve this technology.

The present review describes the time-lapse technology and the models available, using a Strength, Weaknesses, Opportunities and Threats analysis based on the clinical experience and published data since 2010.