bluuebunny/crossref_metadata_2025 huggingface dataset:
770 CONSIDERABLE EFFECT OF UPPER MEDIASTINAL LYMPHADENECTOMY UNDER LAPAROSCOPIC ASSISTED SINGLE-PORT INFLATABLE MEDIASTINOSCOPY THROUGH LEFT NECK APPROACH
Authors: Wang Xiaojin , Gan Xiangfeng , Cao Qingdong
Published: September 2021

Conventional minimally invasive esophagectomy requires transthoracic surgery, which could increase the risk of many perioperative complications. Mediastinoscopy-assisted transhiatal esophagectomy has been proposed for years, but the traditional methods have shortcomings, such as unclear vision, especially during the dissection of upper mediastinal lymph nodes. We proposed a novel approach of upper mediastinal lymphadenectomy with mediastinoscopy through a left-neck incision, and investigated the effect of lymphadenectomy and other perioperative outcomes.

Methods

This approach for upper mediastinal lymphadenectomy includes three parts. (I) Lymphadenectomy along the left recurrent laryngeal nerve (RLN) could be accomplished during esophagectomy under mediastinoscopy. (II) At the level of the lower edge of the right subclavian artery (RSA), between the trachea and the esophagus, instruments are used to access the right RLN. Lymphadenectomy of up to 2 cm could be accomplished at the upper edge of the RSA. (III) Between the trachea and esophagus, the left and right main bronchi are exposed along the trailing edge of the trachea down to the carina, and lymphadenectomy can be performed here.

Results

This lymphadenectomy had been completed successfully on 117 patients, and 1 was converted to thoracotomy due to intraoperative tracheal membrane damage. The average operation time was 181.4 ± 43.2 minutes, bleeding volume was 106.4 ± 87.9 mL. The number of dissected LNs of upper mediastinal, the left RLN, the right RLN and the subcarinal was 11.2 ± 6.3, 5.1 ± 2.8, 3.2 ± 1.3 and 3.8 ± 2.1 respectively. 10 cases of (8.5%) anastomotic fistula were resolved with proper drainage and nutritional support. There were 25 cases (21.2%) of anastomotic strictures, 10 cases (8.5%) of pleural effusion, 20 cases (16.9%) of hoarseness. The incidence of hoarseness was 2.5% in three months postoperation.

Conclusion

These results showed that the lymphadenectomy through the left neck approach was not inferior than other surgical approaches in the amount of upper mediastinal LNs resection and perioperative outcome. Further research is needed to discover its impact on the long-term prognosis of ESCC patients.
771 IMPACT OF NATIONWIDE CENTRALIZATION OF ESOPHAGEAL, GASTRIC, AND PANCREATIC SURGERY ON TRAVEL DISTANCE AND EXPERIENCED BURDEN IN THE NETHERLANDS
Authors: Luijten Josianne , Nieuwenhuijzen Grard , Sosef Meindert , Hingh Ignace , Rosman Camiel , Ruurda Jelle , Duijvendijk Peter , Heisterkamp Joos , Steur Wobbe , Laarhoven Hanneke , Besselink Marc , Koerkamp Bas Groot , Santvoort Hjalmar , Lemmens Valery , Vissers Pauline
Published: September 2021

This study aims to assess the impact of nationwide centralization of surgery on travel distance and travel burden among patients with esophageal-, gastric-, and pancreatic cancer according to age in the Netherlands. As centralization of care increases to improve postoperative outcomes, travel distance and experienced burden might increase.

Methods

All patients who underwent surgery between 2006–2017 for esophageal-, gastric- and pancreatic cancer in the Netherlands were included. Travel distance between patient’s home address and hospital of surgery in kilometers was calculated. Questionnaires were used to assess experienced travel burden in a subpopulation (n = 239). Multivariable ordinal logistic regression models were constructed to identify predictors for longer travel distance.

Results

Over 23,838 patients were included, in whom median travel distance for surgical care increased for esophageal cancer (n = 9,217) from 18 to 28 km, for gastric cancer (n = 6,743) from 9 to 26 km and for pancreatic cancer (n = 7,878) from 18 to 25 km (all p < 0.0001). Multivariable analyses showed an increase in travel distance for all cancer types over time. In general, patients experienced a physical and social burden, and higher financial costs, due to travelling extra kilometers. Patients aged >70 years travelled less often independently (56% versus 68%), as compared to patients aged ≤70 years.

Conclusion

With nationwide centralization, travel distance increased for patients undergoing esophageal-, gastric-, and pancreatic cancer surgery. Younger patients travelled longer distances and experienced a lower travel burden, as compared to elderly patients. Nevertheless, on a global scale travel distances in the Netherlands remain limited.
772 TREATMENT DECISION MAKING DURING THE OUTPATIENT CLINIC VISIT IN PATIENTS DIAGNOSED WITH ESOPHAGOGASTRIC CANCER, A MIXED METHOD DESIGN
Authors: Luijten Josianne , Brom Linda , Nieuwenhuijzen Grard , Westerman Marjan , Vissers Pauline , Verhoeven Rob
Published: September 2021

The probability of undergoing treatment with curative intent according to the hospital of diagnosis has been shown to vary considerately for esophagogastric cancer. Little is known about which factors attribute to practice variation. The aim of this study is to investigate the possible differences in treatment decision-making (TDM) after the Multi-Disciplinary Team Meeting (MDTM) advice.

Methods

To gain in-depth understanding of TDM quantitative data was gathered by the Netherlands Cancer Registry (i.e., proposed treatment and received treatment) and clinician’s and patient’s perspectives were assessed. In eight hospitals, 26 outpatient clinic consults were observed, 30 in-depth interviews with clinicians were conducted, and 3 focus groups with patients were conducted. In addition, focus groups with clinicians were held to enrich and further explore the gathered data. Thematic content analysis approach was used.

Results

Surgery with curative intent was proposed during the MDTM in 63%,65% and 72% in patients diagnosed with esophageal cancer in a hospital with respectively low, middle, or a high probability of undergoing treatment with curative intent, respectively. For gastric cancer this was 75%, 82%, 82%, respectively. Changes in the MDTM proposal and received treatment occurred rarely. Clinicians held similar opinions regarding TDM, however its implementation into practice varied. Differences consisted of discussing all treatment options versus only the most fitting treatment option, and the thoroughness of discussing the benefits and harms. Most patients wished to undergo treatment with curative intent.

Conclusion

Differences in the believes and personalities of the attending clinicians might attribute to variation in TDM. Variation in practice according to the hospital of diagnosis was mainly observed in the MDTM proposal as hospitals with a high probability of undergoing treatment with curative intent proposed surgery more often. Changes in the MDTM proposal and received treatment occurred rarely.
773 LAPAROSCOPIC FUNDOPLICATION IN A DOG WITH GASTROESOPHAGEAL REFLUX DISEASE
Authors: Edelmuth Rodrigo , Hyndman Philip , Spector Daniel , Palma Douglas , Greenberg Jacques , Zarnegar Rasa
Published: September 2021

Antireflux procedures in humans are well stablished. However, the veterinarian literature lack of information on antireflux procedures. To our knowledge, this is the first ever documented laparoscopic fundoplication performed on a canine. A one-year male, Belgian Malinois was presented for consultation of progressive chronic regurgitation and hypersalivation. Given the persistent clinical signs despite medical management, laparoscopic fundoplication was recommended and elected.

Methods

Laparoscopic fundoplication was performed. The dog was induced under general anesthesia and prepared for ventral abdominal surgery in dorsal recumbency. A direct approach to the abdominal cavity was made just cranial to the umbilicus on midline and a 5 milimiter port placed routinely with a blunt trocar. Pneumoperitoneum was set at 8 to 10 millimeters of mercury.

Results

The patient was hospitalized postoperatively receiving methadone, maropitant, ondansetron, erythromycin, metoclopramide, pantoprazole and intravenous crystalloid fluid therapy. A liquid/soft diet was offered from 17-hours postoperatively which the dog ate readily with a normal appetite. No vomiting nor regurgitation was noted during the dog’s hospitalization. Patient was discharged 47 hours after surgery. Activity restriction was recommended for 14 days. The owner was recommended to adhere strictly to a diet comprised of a liquid consistency for the first seven days fed over three-to-four meals, followed by a slow gradual increase in consistency to canned soft food by three weeks.

Conclusion

Reflux is probably more prevalent in canines than previously thought and possible implementation of antireflux testing and procedures may need to be considered in this population.

Video

https://drive.google.com/file/d/1-H0rrRhsIXXSVaHM_iU1QVvr_BqPqIg2/view?usp=sharing.
788 VARIABLE GEOGRAPHICAL DIFFERENCES OF AMBULATORY ESOPHAGEAL REFLUX MONITORING IN MEXICO
Authors: Vazquez-Elizondo Genaro , Remes-Troche José María , Coss-Adame Enrique , Suárez-Morán Edgardo , Valdovinos-Díaz Miguel Ángel , Durán-Rosas Cristina , Fuentes-Ernult Victoria , Zamorano-Orozco Yolanda , Molina Angelina , Achem Sami
Published: September 2021

Ambulatory esophageal reflux monitoring (AEpH) is useful in evaluating persistent or refractory esophageal symptoms despite adequate pharmacologic and/or surgical therapy. There is limited information whether there are geographical or regional differences in the diagnostic outcome of this test.

Aim

Characterize the diagnostic outcome of AEpH in a diverse population of Mexico. Analyze whether there is regional geographical diagnostic variability.

Methods

Data was collected from four major referral centers representing diverse geographical areas of Mexico: Mexico City-Central (two centers, years 2016-2020), Veracruz-South (years 2015-2020) and Monterrey-North (years 2013-2020). Consecutive patients undergoing AEpH with persistent GERD symptoms despite PPI therapy and negative upper endoscopy (no erosive disease >C or D LA classification) were entered into a data base and analyzed. Patients were classified as: NERD (acid exposure time (AET > 6.0%); hypersensitive esophagus (normal AET and positive symptom index (SI) or positive symptom association probability [SAP]); functional heartburn (NL AET, neg SI/SAP). Statistics: ANOVA, Chi-square and descriptive methods were used to compare variables among groups.

Results

969 cases met inclusion criteria: 311 (32.1%) Central, 430 (44.3%) South, and 228 (23.5%) North. The results are summarized in the table. There were more women 618(63.8%) than men 351(36.2%); p < 0.001 with a mean age 47.7 ± 14.3. Patients were older in Central-Mexico 49.3 ± 13.6 years vs South 47.5 ± 15 and North 46.1 ± 13.6; p = 0.033. Functional heartburn was the most common diagnosis overall and more prevalent in Central-Mexico 171(55%) vs North 97(42.5%) and South 160(37.2%); p < 0.001. NERD was more predominant in the South 171(39.8%) vs North 72(31.6%) and Central-Mexico 98(31.5%); p = 0.029. Hypersensitive esophagus was more frequent in the North 59(25.9%) vs South 99(23%), and Central 42(13.5%); p < 0.001.

Conclusion

This is the first large data base study to evaluate the outcome of ambulatory esophageal reflux pH testing in Mexico. Our findings indicate a geographical variability of GERD phenotypes and suggest that further investigations are warranted to determine the causes of this distribution.
789 HIGH RESOLUTION ESOPHAGEAL MOTILITY: VARIABLE GEOGRAPHIC DISTRIBUTION IN A LARGE MEXICAN COHORT
Authors: Vazquez-Elizondo Genaro , Remes-Troche José María , Coss-Adame Enrique , Suárez-Morán Edgardo , Valdovinos-Díaz Miguel Ángel , Durán-Rosas Cristina , Fuentes-Ernult Victoria , Zamorano-Orozco Yolanda , Molina Angelina , Achem Sami
Published: September 2021

High resolution esophageal manometry (HREM) has been in use for about a decade. However, there is no available information regarding geographical or regional differences in diagnostic outcome.

Aim

Characterize the indications, demographics and diagnostic outcome of HREM in a diverse population of Mexico.

Methods

Data was collected from four major referral centers representing diverse geographical areas of Mexico: central—Mexico City (two centers, years 2016-2020), south (Veracruz, years 2015-2020) and north (Monterrey, years 2013—2020). All consecutive cases referred for HREM were entered into a data base and analyzed using Chicago 3 classification. Data was evaluated using chi-square to compare frequencies among groups.

Results

2,932 patients included: Central n = 877(29.9), North n = 1003(34.2), South n = 1052(35.9). Mean age 47.9(11-93), women 1,795(61.2), men 1,137(38.8). Nationwide, the most common indications for testing were: GERD n = 1677(57.2), followed by dysphagia 587(20), atypical GERD 244(8.3), post-operative GERD 230(7.9), chest pain 114(3.9), and post-operative dysphagia 78(2.8). HREM was normal in 1,468(49.9) patients. Table shows the diagnostic distribution among centers: Central-Mexico had more abnormal cases 531(60.5) (p < 0.0.001) vs 407(40.6) North and 532(50.6) South. Achalasia was more commonly diagnosed in the South n = 104(19.5) whereas outlet obstruction 39(967) p < 0.001 and spastic disorders were more common in the North 47(11.8) p = 0.002. Weak peristaltic disorders were more common in Central-Mexico 369(78.8) p < 0.001.

Conclusion

This study represents the first large comparative multicenter HREM data base project in Mexico. In this cohort, most patients receiving HREM are women and those whose indication was GERD. These findings indicate variable regional geographical distribution of HERM diagnosis. Our study suggests that further investigation into the causes and epidemiological distribution of motility disorders is warranted.
802 PERIOPERATIVE AND SHORT-TERM OUTCOMES FOR PRIMARY ANTIREFLUX SURGERY: FUNDOPLICATION VS. RNY RECONSTRUCTION
Authors: Razia Deepika , Razia Deepika , Mittal Sumeet K
Published: September 2021

Laparoscopic fundoplication is the gold standard for treatment of gastroesophageal reflux disease (GERD); however, RNY reconstruction may be an alternative option in patients with complex pathophysiology and other risk factors. This study aimed to compare perioperative and short-term outcomes between primary fundoplication and RNY reconstruction.

Methods

After IRB approval, a prospectively maintained esophageal surgery database was retrospectively reviewed to identify patients who underwent primary fundoplication or RNY reconstruction from September 2016 to July 2020. We retrieved perioperative outcomes (operative time, length of hospital stay, intraoperative and postoperative complications) along with GERD-Health-Related Quality of Life (HRQL) scores at annual follow-up.

Results

During the study period, 226 patients underwent surgery (fundoplication: 210; RNY: 16). The most common indication for RNY was severe esophageal dysmotility or morbid obesity. There was only one conversion to open surgery due to adhesions (fundoplication group). The operative time, length of hospital stay, and ICU stay were significantly lower in the fundoplication group. Rates of intraoperative (fundoplication: 3% vs RNY: 0) and postoperative complications (Clavien-Dindo ≥II) (fundoplication: 3% vs RNY: 6%) were not significantly different between groups. Both groups had a significant and similar improvement of GERD-HRQL scores 1 year after surgery (Table 1).

Conclusion

Primary antireflux surgery is associated with low perioperative morbidity and excellent short-term outcomes. RNY reconstruction and fundoplication have similar outcomes. More liberal use of RNY reconstruction as the primary antireflux surgery in patients at high risk of failure with fundoplication should be explored.
810 REPRODUCIBILITY OF REPEATED MEASUREMENTS OF OESOPHAGEAL MOTILITY METRICS WITHIN A STUDY
Authors: Morozov Sergey , Kropochev Vasily , Artemov Alexey
Published: September 2021

To compare reproducibility of repeated measurements of oesophageal motility metrics after 5 wet swallows within a study.

Methods

Patients referred for high-resolution esophageal manometry (HREM) to assess oesophageal motor function were enrolled. Solid-state 36-channel 10 Fr catheter (Unisensor AG) and Solar (MMS) software were used. Minimum 10 water swallows by 5 mL each were obtained. Two operators independently assessed the results of examination. Records of swallows were divided into 2 series by 5 measurements each. These series were compared by key metrics: integrated relaxation pressure (IRP), distal contractile integral (DCI), distal latency (DL), and contractile front velocity (CFV). Non-parametric statistics was used to compare the results.

Results

We enrolled 46 men and 68 women, age (mean ± SD) 48.8 ± 11.5 y.o. Of them, 52 patients had GERD, 25-different types of achalasia and 37 had no oesophageal disorders. The inter-observer agreement between 2 series of measurements reached 98%. No significant difference was found between the mean results of IRP, DCI, DL and CFV in 2 series of measurements (table 1).

Conclusion

No significant differences between studied HREM metrics in two series of measurements were found. The results of two series by 5 measurements within a study are reproducible. This may indicate the possibility of reducing the standard number of measurements. Reduction of time necessary for standard examination may allow additional time for functional tests (solid food swallows, RDC or MRS).
819 INSTITUTIONAL VARIATION IN THE ORGANIZATION OF CLINICAL PATHWAYS IN ESOPHAGOGASTRIC CANCER, A MIXED METHOD MULTIPLE CASE STUDY
Authors: Luijten Josianne , Vissers Pauline , Verhoeven Rob , Nieuwenhuijzen Grard , Westerman Marjan
Published: September 2021

The probability of undergoing treatment with curative intent according to the hospital of diagnosis has been shown to vary considerately for esophagogastric cancer and was related to survival. However, little is known which factors attribute to this variation. In this study we aimed to gain in-depth understanding of the organization of clinical pathways and in particular factors and processes determining the organization of healthcare for esophagogastric cancer patients.

Methods

A mixed method study design consisting of quantitative and qualitative data was conducted. Quantitative data was gathered by the Netherlands cancer registry (e.g., outpatient clinic consultations and performed diagnostics). A thematic content analyses of the current sub-study focused on clinician’s perspectives using semi-structured interviews (n = 30), and observations of outpatient clinic consults (n = 26) as well as multidisciplinary team meetings (n = 16) in eight hospitals.

Results

Quantitative analyses showed that surgeons were more often consulted in hospitals with a high probability whereas geriatricians were more often consulted in hospitals with a low probability of receiving treatment with curative intent. Qualitative analyses showed that the organization of clinical pathways were analyzed according to three levels: regional, local and patient level. Hospitals differed regarding triage, patients discussed during an multidisciplinary team meeting, the revision of radiological images, and restaging after neoadjuvant treatment. Furthermore, assessment of patients physical and cognitive condition by fitness tests, pre-habilitation and/or geriatric assessment differed significantly.

Conclusion

Specific parts of the clinical pathways differed significantly between hospitals such as the consultation of a geriatrician and pre-habilitation. These results might provide implications for further research in order to optimize clinical pathways.
823 INDUCTION CHEMOTHERAPY WITH 2-WEEKLY DCF REGIMEN FOR SQUAMOUS CELL CARCINOMA OF THE ESOPHAGUS
Authors: Kaito Akio , Haruki Shigeo , Tanioka Toshiro , Ito Koji , Hasegawa Fumi , Arita Kaida , Ohata Yoshiteru , Takiguchi Noriaki
Published: September 2021

Tri or 4-weekly Decetaxel, Cisplatin and Fluorouracil (DCF) regimen for esophageal squamous cell carcinoma (ESCC) was reported to be highly effective as a neoadjuvant chemotherapy, however higher hematologic toxicity rate was problematic with this regimen. JCOG0807 study revealed 2-weekly DCF regimen was less toxic and effective for unresectable or metastatic ESCC, however its efficacy for resectable ESCC as an induction chemotherapy is unknown.

Methods

The aim of this study was to clarify the safety and efficacy of 2-weekly DCF regimen for resectable ESCC. We reviewed 94 pts with ESCC who received 2-weekly DCF regimen (30 mg/m2 docetaxel on days 1 and 15, 80 mg/m2 cisplatin on day 1, 800 mg/m2 fluorouracil on days 1–5, repeated every 3 weeks) between Apr. 2010 and Dec. 2019. Clinical stage II, III, IVA and IVB ESCC pts were included. Those with cT4b and cM1 other than No.104 nodes were excluded. The safety, efficacy and survival were retrospectively investigated.

Results

Fifty-eight pts were enrolled. Clinical stage was II in 6, III in 39, IVA in 6 and IVB in 7. Common grade 3/4 adverse events were neutropenia (19%), hyperglycemia (7%), and febrile neutropenia (3%). Treatment related death was occurred in one (2%) for neutropenia. The overall response rate (RR) was 50% and disease control rate was 93%. The R0 resection rate was 81% without in-hospital deaths. Grade 2/3 pathological RR was 38% and pCR rate was 7%. Median survival time (MST) was 84 mts and 5-yr OS was 59% with a median observational period of 37 mts.

Conclusion

The 2-weekly DCF regimen for resectable ESCC showed tolerable hematologic toxicity, relatively better efficacy and survival. This regimen can be an alternative choice as an induction chemotherapy for ESCC.
Deep learning detects heart failure with preserved ejection fraction using a baseline electrocardiogram
Authors: Unterhuber Matthias , Rommel Karl-Philipp , Kresoja Karl-Patrik , Lurz Julia , Kornej Jelena , Hindricks Gerhard , Scholz Markus , Thiele Holger , Lurz Philipp
Published: September 2021

Aims 

Heart failure with preserved ejection fraction (HFpEF) is a rapidly growing global health problem. To date, diagnosis of HFpEF is based on clinical, invasive, and laboratory examinations. Electrocardiographic findings may vary, and there are no known typical ECG features for HFpEF.

Methods and results 

This study included two patient cohorts. In the derivation cohort, we included n = 1884 patients who presented with exertional dyspnoea or equivalent and preserved ejection fraction (≥50%) and clinical suspicion for coronary artery disease. The ECGs were divided in segments, yielding a total of 77 558 samples. We trained a convolutional neural network (CNN) to classify HFpEF and control patients according to European Society of Cardiology (ESC) criteria. An external group of 203 volunteers in a prospective heart failure screening programme served as a validation cohort of the CNN. The external validation of the CNN yielded an area under the curve of 0.80 [95% confidence interval (CI) 0.74–0.86] for detection of HFpEF according to ESC criteria, with a sensitivity of 0.99 (95% CI 0.98–0.99) and a specificity of 0.60 (95% CI 0.56–0.64), with a positive predictive value of 0.68 (95%CI 0.64–0.72) and a negative predictive value of 0.98 (95% CI 0.95–0.99).

Conclusion 

In this study, we report the first deep learning-enabled CNN for identifying patients with HFpEF according to ESC criteria including NT-proBNP measurements in the diagnostic algorithm among patients at risk. The suitability of the CNN was validated on an external validation cohort of patients at risk for developing heart failure, showing a convincing screening performance.
Valuing Life as an Asset, as a Statistic and at Gunpoint
Authors: Hugonnier Julien , Pelgrin Florian , St-Amour Pascal
Published: September 2021

Rationalising the stark differences between the human capital and the statistical values of a human life is complicated by the absence of common foundations. We solve a human capital investment model with longevity risk to characterise the human capital. The associated indirect utility yields the willingness to pay against mortality; the marginal willingness to pay solves the value of a statistical life. Indifference between life and certain death characterises the limiting willingness to pay and provides a gunpoint value. A structural estimation reveals similar human capital (${\$}$300,000) and gunpoint value (${\$}$251,000) and explains a much larger statistical value (${\$}$4.98 million) by a strongly concave willingness to pay.
Using gravity gradient component and their combination to interpret the geological structures in the eastern Tianshan Mountains
Authors: Liu Jinzhao
Published: September 2021

As early as the Palaeozoic era, the Tianshan Mountains constituted a vast tectonic convergent zone within the Eurasian Continent; by this time, they had already experienced multiple intense crustal movements. The Indian Plate is currently advancing northwards by more than 50 mm yr–1; it affects the Tianshan Mountains even though they are located more than 1000 km away. However, many of the geological issues of the Tianshan Mountains, especially in eastern Tianshan, which remains an active tectonic zone today, are not yet fully understood. There have been few studies into the seismogenic characteristics of this intense seismic zone. Here, the full gravity gradient tensor (GGT) within the eastern Tianshan Mountains was calculated using a stable spatial frequency domain algorithm, based on high-spatial resolution (7.2 arcsec or approximately 200 m) Global Gravity Model plus (GGMplus) surface gravity data. In addition, the features of the geological structures in the eastern Tianshan Mountains were interpreted using different combinations of GGT components. Moreover, the possibilities of using different combinations of GGT components to identify the distributions and strikes of faults was discussed regarding the potential earthquake rupture risks in this study area. The results show that (1) the distributions and strikes of the main fault zones in the study area are highly consistent with the linear geological features within the mountains, as extracted from a combination of different GGT components, including terrain effects. (2) Removing the terrain effects revealed that the different components of GGT (derived from the complete Bouguer gravity anomaly) vary gently, showing few linear geological features that could be extracted. This implies that satellite gravity data are not sufficient to analyse the characteristics of small underground geological structures (spatial scales less than ∼10 km). (3) Comparing the spatial distributions of fault traces depicted at different ages with the linear geological features of the study area revealed that discovering more unknown faults increased the coincidence ratio of linear geological features to fault traces in the area (from 27 to 40 per cent). In conclusion, the findings of this study represent a valuable reference for further revealing the seismogenic characteristics of this area, where there is a lack of detailed surface fault structure measurements due to its inaccessibility. The proposed method could also recognize faults in other similar areas with harsh conditions that are not feasible for ground-based surveys, such as forests and glaciers.
Intra- and inter-specific density dependence of body condition, growth, and habitat temperature in chub mackerel (Scomber japonicus)
Authors: Kamimura Yasuhiro , Taga Makoto , Yukami Ryuji , Watanabe Chikako , Furuichi Sho
Published: September 2021

The density dependence of growth and body condition have important impacts on fish population dynamics and fisheries management. Although population density affects habitat selection, which in turn changes habitat temperature, how this affects growth and body condition remains unclear. Here, we investigated annual changes in body condition, habitat temperature, and cohort-specific growth of chub mackerel (Scomber japonicus) in the western North Pacific and examined quarterly changes in the density dependence of body condition. We hypothesized that chub mackerel body condition is affected both directly (e.g. through competition for food) and indirectly (through changes in habitat temperature) by the abundance of both conspecifics (i.e. chub mackerel) and heterospecifics (the Japanese sardine Sardinops melanostictus). Indeed, chub mackerel body condition, habitat temperature, and growth all decreased with increasing conspecific and heterospecific abundance. Mean annual growth rates in chub mackerel were positively corelated with body condition. The final model showed that conspecific and/or heterospecific abundance had strong negative effects on chub mackerel body condition in all seasons, and influenced habitat temperature through habitat selection in some seasons. By contrast, temperature effects on body condition were weak. Therefore, direct effects likely have more impact than indirect effects on density-dependent body condition and growth.
Ecoacoustic indices in marine ecosystems: a review on recent developments, challenges, and future directions
Authors: Minello Murilo , Calado Leandro , Xavier Fabio C
Published: September 2021

Soundscape ecology has gained prominence in the monitoring of marine ecosystems due to its non-invasive characteristics and spatiotemporal efficiency. However, the development of ecoacoustic indices is a recent field that needs to address many challenges to fulfill its great potential, especially in the context of marine ecology. Here, we reviewed the most recent studies that used ecoacoustic indices in marine ecosystems. The literature search was conducted in the Scopus (Elsevier) database and used the chain referral sampling in the list of references of each publication. In total, we identified 27 publications that used ecoacoustic indices in marine environments such as coral reefs, rocky shores, coastal regions, and offshore regions. A total of four major limitations were identified and addressed, including: the challenge to find adequate acoustic bioindicators; the lack of a universal index or standardized protocol; the issue that most acoustic indices applied to marine environments have been developed to be used in terrestrial environments; and the lack of studies that have tested ecoacoustic indices under different environmental conditions. Once these challenges are addressed, the analysis of marine sound based on the interpretation of ecoacoustic indices has a great potential to become one of the most cost-effective tools for monitoring environments.
Reconstruction of the Upper Extremity High-Voltage Electrical Injury: A Pediatric Burn Hospital’s 13-Year Experience
Authors: DePamphilis Matthew A , Cauley Ryan P , Sadeq Farzin , Lydon Martha , Sheridan Robert L , Winograd Jonathan M , Driscoll Daniel N
Published: September 2021

High-voltage electrical injury is a rare yet destructive class of burn injury that persists as a serious public health issue. High-voltage exposure is commonly associated with complex wounds to the upper extremities, which can be a significant challenge for burn and plastic surgeons to reconstruct. This intensive and multistage reconstructive process is especially difficult in the growing child. Maximizing upper extremity function is a top priority, as it can have a significant impact on a patient’s quality of life. Therefore, the purpose of this retrospective review was to describe lessons learned during a 13-year experience at a specialized pediatric burn hospital with reconstruction of the upper extremity after severe high-voltage injury in 37 children. We found that adherence to the following principles can help promote meaningful functional recovery. These include 1) frequent assessment during early acute care for the evolving need of decompression or amputation; 2) serial surgical debridement that follows a tissue-sparing technique; 3) wound closure by skin grafting or use of flaps (particularly groin or abdominal pedicled flaps) when deep musculoskeletal structures are involved; 4) early multidisciplinary intervention for contracture prevention and management, including physical and occupational therapy, splinting, and fixation; 5) reconstructive care that focuses on the simplest possible techniques to repair chronic skin defects such as laser therapy, local tissue rearrangements, and skin grafting; 6) complex reconstruction to address deeper tissue contractures or tendon and peripheral nerve deficits; and 7) amputation with preservation of growth plates, tissue transfer, and long-term prosthetic management when limb salvage is unlikely.
KRAS and BRAF Mutations in Stage II and III Colon Cancer: A Systematic Review and Meta-Analysis
Authors: Formica Vincenzo , Sera Francesco , Cremolini Chiara , Riondino Silvia , Morelli Cristina , Arkenau Hendrik-Tobias , Roselli Mario
Published: September 2021

Background

KRAS and BRAF mutations are well-established predictive and prognostic factors in metastatic colorectal cancer; however, their impact in the adjuvant setting has not yet been established.

Methods

We performed a meta-analysis of adjuvant phase III trials in patients with stage II and III colon cancer with available data on the impact of KRAS or BRAF mutations on both disease-free survival (DFS) and overall survival (OS). Trials were subgrouped based on whether adjustment for microsatellite instability (MSI) was performed and the subgroup effect was analyzed through a meta-regression. To increase the precision of the estimates, a joint DFS–OS (so-called “multivariate”) meta-analysis was performed. All statistical tests were 2-sided.

Results

Nine trials were selected (QUASAR 2, PETACC-8, N0147, CALGB-89803, NSABP-C07, NSABP-C08, PETACC-3, QUASAR, MOSAIC) including a total of 10 893 patients. In the primary meta-analysis, KRAS mutation was associated with poor DFS (pooled hazard ratio [HR] = 1.36, 95% confidence interval [CI] = 1.15 to 1.61, P < .001) and OS (pooled HR = 1.27, 95% CI = 1.03 to 1.55, P = .03) and BRAF mutation was also associated with poor DFS (pooled HR = 1.33, 95% CI = 1.00 to 1.78, P = .05) and OS (pooled HR = 1.49, 95% CI = 1.31 to 1.70, P < .001). The effect of the mutations on outcome was enhanced in the MSI-adjusted subgroup for both the KRAS mutation (pooled HR for DFS = 1.43, 95% CI = 1.15 to 1.79, P = .001; and pooled HR for OS = 1.33, 95% CI = 1.03 to 1.71, P = .03) and the BRAF mutation (pooled HR for DFS = 1.59, 95% CI = 1.22 to 2.07, P = .001; and pooled HR for OS = 1.67, 95% CI = 1.37 to 2.04, P < .001). The interaction between BRAF and MSI adjustment was statistically significant for DFS (Pinteraction = .02). This interaction was even more pronounced in the DFS–OS multivariate meta-analysis.

Conclusions

Both KRAS and BRAF mutations were statistically significantly associated with both DFS and OS, with the mutation effect being enhanced by MSI adjustment. Effective adjuvant treatment for microsatellite-stable BRAF or KRAS-mutated colon cancer represents an unmet clinical need, and exploring the use of recently available BRAF and KRAS inhibitors in this setting would be highly desirable.
The Morphosyntax of Arabic Exceptives: A Minimalist Approach
Authors: Al-Bataineh Hussein
Published: September 2021

Arabic exceptive constructions involve an intricate interaction among word order, negation, and case assignment resulting from syntactic restrictions imposed on the argumental, appositional, and adjunctive functions of exceptive phrases. The morphosyntactic complexities in Arabic exceptives cast doubt on the adequacy of previous analyses that exceptive particles are prepositions, focal adverbs, or coordinating conjunctions, and they also lead the paper to argue for more principled accounts in which exceptive particles are analysed as functional heads that project into an ExP ‘exceptive phrase’ which exists in two distinct configurations. The first includes an exceptive marker carrying [Acc- Case] ‘accusative case’ and [DS] ‘domain subtraction’ features when the ExP is an adjunct introduced by late Merge. The second includes a negative determiner which selects and c-commands the exceptive particle and deactivates/ suspends its [Acc-Case], consequently, the case feature of the ExP-complement is valued by percolation from D which combines with the exceptive marker to form a discontinuous focus particle with a [DR] ‘domain restriction’ feature.
Nisane: The Life of a Mesopotamian Peasant
Authors: Häberl Charles G , Loesov Sergey
Published: September 2021

Nisane Ergün was born in 1933 in Beqŭsyone (Turk. Alagöz). She is a native and fluent speaker of Ṭuroyo, a contemporary form of Eastern Aramaic. Although never formally educated, she is a gifted storyteller. Throughout her entire life, she has been engaged in subsistence farming and animal husbandry, in much the same manner as her Kurdish neighbours and other rural populations throughout northern Mesopotamia. Her life story, here related in her own words, is thus an exercise in narrating history ‘from below’. She is an eyewitness to various dramatic periods in the recent history of Ṭur Abdin.
On the Emergence of the Short Form in Hebrew Names
Authors: Olivero Vladimir
Published: September 2021

This study investigates the emergence of the ending in Hebrew personal names. All available epigraphic evidence is first gathered and then assessed. This source of information is essential to understand when the ending came into use and gained currency and to locate this phenomenon in an absolute chronology. The appearance of the short form receives here a socio-historical explanation. The author believes, in fact, that the shift from the ending to its shorter version should be read against the backdrop of the Assyrian domination during the second half of the eighth century and the seventh century BCE. More specifically, the deportation into the land of Israel of foreign groups of people contributed to the assimilation of the theophoric element in Hebrew names to the hypocoristic ending -īya, attested all over the Ancient Near East.
Narrow-band giant pulses from the Crab pulsar
Authors: Thulasiram Parasar , Lin Hsiu-Hsien
Published: September 2021

We used a new spectral-fitting technique to identify a subpopulation of 6 narrow-band giant pulses from the Crab pulsar out of a total of 1578. These giant pulses were detected in 77 min of observations with the 46-m dish at the Algonquin Radio Observatory at 400–800 MHz. The narrow-band giant pulses consist of both main- and inter-pulses, thereby being more likely to be caused by an intrinsic emission mechanism as opposed to a propagation effect. Fast radio bursts (FRBs) have demonstrated similar narrow-band features, while only little has been observed in the giant pulses of pulsars. We report the narrow-band giant pulses with Δν/ν of the order of 0.1, which is close to the value of 0.05 reported for the repeater FRB 20190711A. Hence, the connection between FRBs and giant pulses of pulsars is further established.
Fundamental parameters of the massive eclipsing binary HM1 8
Authors: Rodríguez C N , Ferrero G A , Benvenuto O G , Gamen R , Morrell N I , Barbá R H , Arias J , Massey P
Published: September 2021

We present a comprehensive study of the massive binary system HM1 8, based on multi-epoch high-resolution spectroscopy, V-band photometry, and archival X-ray data. Spectra from the OWN Survey, a high-resolution optical monitoring of Southern O and WN stars, are used to analyse the spectral morphology and perform quantitative spectroscopic analysis of both stellar components. The primary and secondary components are classified as O4.5 IV(f) and O9.7 V, respectively. From a radial velocity (RV) study, we derived a set of orbital parameters for the system. We found an eccentric orbit (e = 0.14 ± 0.01) with a period of P = 5.87820 ± 0.00008 d. Through the simultaneous analysis of the RVs and the V-band light curve, we derived an orbital inclination of 70.0° ± 2.0 and stellar masses of $M_a=33.6^{+1.4}_{-1.2}~\text{M}_{\odot }$ for the primary, and $M_b=17.7^{+0.5}_{-0.7}~\text{M}_{\odot }$ for the secondary. The components show projected rotational velocities vasin i = 105 ± 14 km s−1 and vbsin i = 82 ± 15 km s−1, respectively. A tidal evolution analysis is also performed and found to be in agreement with the orbital characteristics. Finally, the available X-ray observations show no evidence of a colliding winds region; therefore, the X-ray emission is attributed to stellar winds.
Modulation of the intrinsic chromatin binding property of HIV-1 integrase by LEDGF/p75
Authors: Lapaillerie Delphine , Lelandais Benoît , Mauro Eric , Lagadec Floriane , Tumiotto Camille , Miskey Csaba , Ferran Guillaume , Kuschner Natacha , Calmels Christina , Métifiot Mathieu , Rooryck Caroline , Ivics Zoltan , Ruff Marc , Zimmer Christophe , Lesbats Paul , Toutain Jérôme , Parissi Vincent
Published: September 2021

The stable insertion of the retroviral genome into the host chromosomes requires the association between integration complexes and cellular chromatin via the interaction between retroviral integrase and the nucleosomal target DNA. This final association may involve the chromatin-binding properties of both the retroviral integrase and its cellular cofactor LEDGF/p75. To investigate this and better understand the LEDGF/p75-mediated chromatin tethering of HIV-1 integrase, we used a combination of biochemical and chromosome-binding assays. Our study revealed that retroviral integrase has an intrinsic ability to bind and recognize specific chromatin regions in metaphase even in the absence of its cofactor. Furthermore, this integrase chromatin-binding property was modulated by the interaction with its cofactor LEDGF/p75, which redirected the enzyme to alternative chromosome regions. We also better determined the chromatin features recognized by each partner alone or within the functional intasome, as well as the chronology of efficient LEDGF/p75-mediated targeting of HIV-1 integrase to chromatin. Our data support a new chromatin-binding function of integrase acting in concert with LEDGF/p75 for the optimal association with the nucleosomal substrate. This work also provides additional information about the behavior of retroviral integration complexes in metaphase chromatin and the mechanism of action of LEDGF/p75 in this specific context.
Fifteen-year trends and differences in mortality rates across sex, age, and race/ethnicity in patients with brainstem tumors
Authors: Tomita Yusuke , Tanaka Yoshihiro , Takata Nozomu , Hibler Elizabeth A , Hashizume Rintaro , Becher Oren Josh
Published: September 2021

Background

Localization of tumors to the brainstem carries a poor prognosis, however, risk factors are poorly understood. We examined secular trends in mortality from brainstem tumors in the United States by age, sex, and race/ethnicity.

Methods

We extracted age-adjusted incidence-based mortality rates of brainstem tumors from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2018. Trends in age-adjusted mortality rate (AAMR) were compared by sex and race/ethnicity among the younger age group (0-14 years) and the older age group (>15 years), respectively. Average AAMRs in each 5-year age group were compared by sex.

Results

This study included 2039 brainstem tumor-related deaths between 2004 and 2018. Trends in AAMRs were constant during the study period in both age groups, with 3 times higher AAMR in the younger age group compared to the older age group. Males had a significantly higher AAMR in the older age group, while no racial differences were observed. Intriguingly, AAMRs peaked in patients 5-9 years of age (0.57 per 100 000) and in patients 80-84 years of age (0.31 per 100 000), with lower rates among middle-aged individuals. Among 5-9 years of age, the average AAMR for females was significantly higher than that of males (P = .017), whereas the reverse trend was seen among those 50-79 years of age.

Conclusions

Overall trends in AAMRs for brainstem tumors were constant during the study period with significant differences by age and sex. Identifying the biological mechanisms of demographic differences in AAMR may help understand this fatal pathology.
Stigma Attached to Smoking Pregnant Women: A Qualitative Insight in the General French Population
Authors: Loyal Deborah , Sutter Anne-Laure , Auriacombe Marc , Serre Fuschia , Calcagni Nicolas , Rascle Nicole
Published: September 2021

Introduction

Cigarette consumption during pregnancy has major health consequences for women and unborn children. The stigma of smoking during pregnancy might hinder mothers-to-be’s access to adequate healthcare and smoking cessation, especially in disadvantaged groups. This qualitative study was designed to describe extensively the public stigma associated with smoking during pregnancy.

Aims and Methods

Participants were French adults recruited from the general population through social networks (N = 100). They were asked to answer three pairs of open-ended questions regarding cognitions, emotions, and behaviors elicited in the general population by pregnant smoking women. An inductive thematic analysis was performed and interjudge agreement was computed on 30% of the corpus analyzed deductively. Finally, independence (chi-square) between themes and gender, education, parenthood, and smoking status was tested.

Results

Themes (n = 25) were defined regarding cognitions (n = 9, eg, irresponsible, thoughtless, and unmindful), emotions (n = 8, eg, anger and disgust), and behaviors, (n = 8, eg, inform and persuade, and moralize and blame). Global interjudge agreement was strong (κ = .8). No difference was observed in themes according to gender, parental status, or education, indicating a heterogenous awareness of stigma. However, some differences were observed according to smoking status (χ 2 = 69.59, p = .02) (eg, nonsmokers more frequently stressed immorality).

Conclusions

The stigma associated with smoking during pregnancy includes various components that might be measured and targeted in interventions to improve access to adequate healthcare and smoking cessation in this specific population.

Implications

This qualitative study explores the stigma that the general French population attaches to pregnant women who smoke. Themes regarding cognitions (eg, irresponsible, thoughtless, and unmindful), emotions (eg, anger and disgust), and behaviors (eg, inform and persuade, and moralize and blame) were identified. These themes could guide further research regarding scale development and antistigma interventions to support smoking cessation.