bluuebunny/crossref_metadata_2025 huggingface dataset:
Colloidal and viscoelastic properties of expanded perlite dispersions
Authors: Cabuk Mehmet , Yesil Tolga Acar , Yavuz Mustafa , Unal Halil Ibrahim
Published: March 2017

In this study, structural properties of unexpanded perlite and expanded perlite particles were characterized using Fourier transform infrared spectroscopy, scanning electron microscopy, and thermogravimetric analysis techniques. Electrokinetic properties of unexpanded perlite and expanded perlite particles in polar (water) and non-polar (silicone oil) media were determined using zeta ( ζ)-potential measurements as functions of time, pH, valences of electrolytes, type of surfactants, and temperature. Antisedimentation stabilities of the unexpanded perlite and expanded perlite particles dispersed in silicone oil were determined as a function of temperature at various volume fractions ( ϕ = 5%−25% v/v). Viscoelastic properties of expanded perlite particles dispersed in silicone oil were investigated by creep and creep-recovery tests under externally applied electric field strengths. As a result, the ζ-potential and antisedimentation stability values revealed that colloidal stabilities of the expanded perlite particles were high enough to be used as smart electrorheological material in long time durations. Expanded perlite/silicone oil dispersion behaved as a viscoelastic material and exhibited a reversible nonlinear viscoelastic deformation under applied electric field and showed a vibration damping capability for potential industrial applications.
“Like Holding an Umbrella Before It Rains”: Acceptability of Future Rectal Microbicides Among Men Who Have Sex With Men in India—A Modified Technology Acceptance Model
Authors: Chakrapani Venkatesan , Newman Peter A. , Shunmugam Murali , Mengle Shruta , Nelson Ruban , Rubincam Clara , Kumar Pushpesh
Published: March 2017

Topical rectal microbicides (RMs) are a new prevention technology in development that aims to reduce the risk of HIV acquisition from anal sex. We examined RM acceptability among men who have sex with men (MSM) in India. We conducted a qualitative exploratory study guided by a modified Technology Acceptance Model, with 10 focus groups ( n = 61) of MSM and 10 key informant interviews. Data were explored using framework analysis. RM acceptability was influenced by technological contexts: perceived usefulness of RMs, perceived ease of use of RM and applicator, and habits around condom and lubricant use; individual and interpersonal contexts: perceived relevance and preferences for product formulation and dosing frequency; and MSM community/social contexts: perceived social approval, RM-related stigma, social support. Implementation of RMs for MSM in India may be supported by multi-level interventions that engage community-based organizations in destigmatizing and distributing RMs, ideally gel-based products that enable on-demand use before sex.
The boundary value problem for piezo-electric half space with thin elastic inclusion
Authors: Shavlakadze Nuzgar , Odishelidze Nana , Criado-Aldeanueva Francisco
Published: March 2017

The problem of finding mechanical and electric fields in a piezo-elastic half-space with elastic inclusion is considered. The inclusion is loaded with forces of constant intensity. The tangential contact stresses along the contact surface are determined and the behavior of the contact stresses in the neighborhood of singular points is established. By using methods of the theory of analytic functions, the problem is reduced to a singular integro-differential equation in a finite interval. Using an integral transformation a Riemann problem is obtained, and the solution is presented in its explicit form.
A capitalising foreign policy: Regulatory geographies and transnationalised state projects
Authors: Chacko Priya , Jayasuriya Kanishka
Published: March 2017

Proposals for regional economic integration, namely, the Trans-Pacific Partnership, the Regional Comprehensive Economic Partnership and the One Belt One Road proposal, have recently been driving the security dynamics of the Asian region. To explain the growing ‘economic’ focus of states’ foreign policies, we need to go beyond the dominant approaches in International Relations and International Political Economy, which are limited in their analytical power because they often make a distinction between politics/security and economics, and prioritise one over the other, rather than seeing them as internally related. Drawing on Leon Trotsky’s theory of ‘uneven and combined development’ and Nicos Poulantzas’s notion of ‘internalised transformations’, we develop a ‘Poulantzian-uneven and combined development’ framework to argue that the increased focus on economics in foreign policymaking represents a fundamental change related to the transnationalisation of capitalist state-building projects. The paper argues that while the Trans-Pacific Partnership reflected an attempt by the Obama administration to fashion a new stage in the transnationalisation of American capital, the Regional Comprehensive Economic Partnership and One Belt One Road proposal reflect an emerging China-centred transnationalised state project. We characterise the Trans-Pacific Partnership, Regional Comprehensive Economic Partnership and One Belt One Road proposal as constituting different forms of a particular type of geoeconomic strategy called ‘regulatory geographies’ because they entail the export of distinctive modes of regulatory governance that aim to overcome key contradictions of uneven and combined capitalist development in the US and China. As the recent demise of the Trans-Pacific Partnership with the election of Donald Trump shows, however, these transnationalised state projects generate resistance and contestation within, as well as between, states.
Analyzing the pragmatic structure of dialogues
Authors: Macagno Fabrizio , Bigi Sarah
Published: March 2017

In this article, we describe the notion of dialogue move intended as the minimal unit for the analysis of dialogues. We propose an approach to discourse analysis based on the pragmatic idea that the joint dialogical intentions are also co-constructed through the individual moves and the higher-order communicative intentions that the interlocutors pursue. In this view, our goal is to bring to light the pragmatic structure of a dialogue as a complex net of dialogical goals (such as persuasion, deliberation, information-sharing, etc.), which represent the communicative purposes that the interlocutors intend to achieve through their utterances. Dialogue moves are shown to represent the necessary interpretive link between the general description of the dialogical context or type and the syntactical analysis of the sentences expressed by the individual utterances. In the concluding part of this article, we show how this method can be used and further developed for analyzing various types of real-life dialogues, outlining possible uses and lines of empirical research based thereon.
Tunnel vision in a murder case: Telephone interaction between police detectives and the prime suspect
Authors: Maynard Douglas W , Schelly David
Published: March 2017

The article analyzes an interactional form of tunnel vision or cognitive bias in a series of mundane police–suspect interactions. The data come from a murder case in which the suspect, later convicted and then released from prison with the help of the Wisconsin Innocence Project, frequently calls police detectives to inquire about his confiscated van. As he is operating in a context in which accusations are rarely made explicit, we highlight the suspect’s use of a complaint-denial device to tacitly claim innocence. The police respond by focusing on the complaint rather than the denial part of the device. The use of the complaint-denial device is compared to more formal inquiries in which accusations are overt. We discuss the implications of a sociological understanding of cognitive bias – how it may operate in practices of talk and social interaction during informal encounters – for other criminal justice settings.
Public justification and the reactive attitudes
Authors: Taylor Anthony
Published: March 2017

A distinctive position in contemporary political philosophy is occupied by those who defend the principle of public justification. This principle states that the moral or political rules that govern our common life must be in some sense justifiable to all reasonable citizens. In this article, I evaluate Gerald Gaus’s defence of this principle, which holds that it is presupposed by our moral reactive attitudes of resentment and indignation. He argues, echoing P.F. Strawson in ‘Freedom and Resentment’, that these attitudes are so deep a part of us that we are unable to rationally reject them. I examine and reject this defence of the principle. Considering the nature of our commitment to the moral reactive attitudes, I argue that those attitudes need not be grounded in a commitment to public justification. The availability of alternative grounds for these attitudes shows, contra Gaus, that we can rationally reject the principle of public justification while maintaining a wholehearted commitment to the reactive attitudes.
Tracking modal parameters of building structures from experimental studies and earthquake response measurements
Authors: Chen Jun-Da , Loh Chin-Hsiung
Published: March 2017

Since tracking modal parameters and estimating the structural current state from building seismic response measurement can provide useful information for building safety assessment, online or recursive identification techniques need to be developed and implemented on building seismic response monitoring. In this article, two recursive subspace identification algorithms are developed. One is the recursive subspace identification with BonaFide LQ renewing algorithm (recursive subspace identification BonaFide) incorporated with moving window technique to identify modal parameters at each time instant during the earthquake excitation. Besides, recursive subspace identification based on matrix inversion lemma algorithm (recursive subspace identification Inversion) is also used and keeps the same data window with recursive subspace identification BonaFide only for the initial identification and then appends the following data points to identify modal parameters for the whole excitation time history. A forgetting factor is introduced to emphasize the latest state of system in this method. Two different sets of building seismic response data are used to verify the applicability of the proposed methods. One is the three-story steel structure with abrupt change of story stiffness shaking table test in laboratory, the other is a series of seismic response of a four-story-reinforced concrete elementary school building, including several large seismic events. It is concluded that both methods can detect the time when the floor stiffness was changed but recursive subspace identification Inversion with forgetting factor can provide more accurate estimation of the change of stiffness.
The Issue of Aversion in Lifestyle Treatments
Authors: Arlinghaus Katherine R. , Foreyt John P. , Johnston Craig A.
Published: March 2017

Increasing evidence suggests that vigorous physical activity (PA) is more beneficial than moderate PA for reducing adiposity and improving bone health in youth. However, beginning a vigorous PA program is not an easy behavior adjustment and the change is likely to be aversive for some individuals. In order to benefit from vigorous PA, health care providers need to help individuals increase self-efficacy.
Cost-effectiveness of pharmacist care for managing hypertension in Canada
Authors: Marra Carlo , Johnston Karissa , Santschi Valerie , Tsuyuki Ross T.
Published: March 2017

Background:

More than half of all heart disease and stroke are attributable to hypertension, which is associated with approximately 10% of direct medical costs globally. Clinical trial evidence has demonstrated that the benefits of pharmacist intervention, including education, consultation and/or prescribing, can help to reduce blood pressure; a recent Canadian trial found an 18.3 mmHg reduction in systolic blood pressure associated with pharmacist care and prescribing. The objective of this study was to evaluate the economic impact of such an intervention in a Canadian setting.

Methods:

A Markov cost-effectiveness model was developed to extrapolate potential differences in long-term cardiovascular and renal disease outcomes, using Framingham risk equations and other published risk equations. A range of values for systolic blood pressure reduction was considered (7.6-18.3 mmHg) to reflect the range of potential interventions and available evidence. The model incorporated health outcomes, costs and quality of life to estimate an overall incremental cost-effectiveness ratio. Costs considered included direct medical costs as well as the costs associated with implementing the pharmacist intervention strategy.

Results:

For a systolic blood pressure reduction of 18.3 mmHg, the estimated impact is 0.21 fewer cardiovascular events per person and, discounted at 5% per year, 0.3 additional life-years, 0.4 additional quality-adjusted life-years and $6,364 cost savings over a lifetime. Thus, the intervention is economically dominant, being both more effective and cost-saving relative to usual care.

Discussion:

Across a range of one-way and probabilistic sensitivity analyses of key parameters and assumptions, pharmacist intervention remained both effective and cost-saving.

Conclusion:

Comprehensive pharmacist care of hypertension, including patient education and prescribing, has the potential to offer both health benefits and cost savings to Canadians and, as such, has important public health implications.
Discrepancies Between Blood Glucose and Interstitial Glucose—Technological Artifacts or Physiology: Implications for Selection of the Appropriate Therapeutic Target
Authors: Siegmund Thorsten , Heinemann Lutz , Kolassa Ralf , Thomas Andreas
Published: March 2017

Background:

For decades, the major source of information used to make therapeutic decisions by patients with diabetes has been glucose measurements using capillary blood samples. Knowledge gained from clinical studies, for example, on the impact of metabolic control on diabetes-related complications, is based on such measurements. Different to traditional blood glucose measurement systems, systems for continuous glucose monitoring (CGM) measure glucose in interstitial fluid (ISF). The assumption is that glucose levels in blood and ISF are practically the same and that the information provided can be used interchangeably. Thus, therapeutic decisions, that is, the selection of insulin doses, are based on CGM system results interpreted as though they were blood glucose values.

Methods:

We performed a more detailed analysis and interpretation of glucose profiles obtained with CGM in situations with high glucose dynamics to evaluate this potentially misleading assumption.

Results:

Considering physical activity, hypoglycemic episodes, and meal-related differences between glucose levels in blood and ISF uncover clinically relevant differences that can make it risky from a therapeutic point of view to use blood glucose for therapeutic decisions.

Conclusions:

Further systematic and structured evaluation as to whether the use of ISF glucose is more safe and efficient when it comes to acute therapeutic decisions is necessary. These data might also have a higher prognostic relevance when it comes to long-term metabolic consequences of diabetes. In the long run, it may be reasonable to abandon blood glucose measurements as the basis for diabetes management and switch to using ISF glucose as the appropriate therapeutic target.
A Content Analysis of Psychological Resilience Among First Responders and the General Population
Authors: Crowe Allison , Glass J. Scott , Lancaster Mandee F. , Raines Justin M. , Waggy Megan R.
Published: March 2017

The current study examined how first responders and the general population described the concept of resilience. Categories of resilience were coded a priori using Stemler’s content analysis. For the general population, positive coping was the most frequently occurring category followed by social support and adaptability. The next most frequently occurring terms were societal resources and personal competence. Consistent with the general population, first responders described resilience most frequently with positive coping. Social support was the next most frequently occurring category, followed by personal competence, perseverance, emotional regulation, and physical fitness. Although both the general population and first responder participants highlighted the importance of having a support network, first responders suggested that dealing with traumatic experiences was more of an individual process, and seeking professional help was not common practice. Implications for mental health professionals and future directions for research are offered.
German Heterosexual Women’s Pornography Consumption and Sexual Behavior
Authors: Sun Chyng Feng , Wright Paul , Steffen Nicola
Published: March 2017

This study found that German heterosexual women’s personal and partnered consumption of pornography were positively correlated with their desire to engage in or having previously engaged in submissive (but not dominant) sexual behaviors such as having their hair pulled, having their face ejaculated on, being spanked, choked, called names, slapped, and gagged. The association between women’s partnered pornography consumption and submissive sexual behavior was strongest for women whose first exposure to pornography was at a young age. The findings also indicated that women’s personal and partnered pornography consumption were uniquely related to their engagement in submissive sexual behavior.

Public Health Significance Statement:

This study suggests that greater exposure to pornography among heterosexual German women is associated with their desire to engage in or having previously engaged in submissive sexual behaviors but not dominant behaviors. This pattern of correlations aligns with sexual script theory and content analyses of dominance and submission and gender in pornography. It does not align with the perspective that measures of pornography consumption are simply proxies for factors such as a high sex drive or an adventurous approach to sex.
Ocular safety assessment of sodium iodate in cynomolgus monkeys
Authors: Liu Chang-Ning , Peng Qinghai , Yates David W , Huang Wenhu , Devantier Heather , Aguirre Shirley A
Published: March 2017

Although sodium iodate (NaIO3)-induced retinal injury model has been widely used in rodents, its application in large animal species has encountered variation in retinal toxicity. NaIO3 induced retinal degeneration and functional changes in sheep, but not in swine. In monkeys, administration of NaIO3 via a carotid artery affected only the cell function of ipsilateral retinal pigment epithelium. The aim of the present study was to identify the dosage and route of NaIO3 administration resulting in morphologic and functional retinal changes in cynomolgus monkeys. Separate groups of animals received NaIO3 intravenously in three different dosing paradigms. Vehicle control animals received phosphate-buffered saline. At selected time points following dosing, flash electroretinograms (ERGs) were recorded followed by necropsy. The eyes were examined microscopically post-necropsy and the levels of circulating microRNA-183 cluster were evaluated in the blood samples collected on days 1, 4, and 5 postdose. A statistically significant reduction in both scotopic a-wave and scotopic and photopic b-wave signals ( p < 0.05) were observed between the ERG signals acquired from NaIO3-treated and vehicle control animals, coupled with time-dependent elevations in plasma miR-183 cluster. Mild to moderate retinal degeneration was observed in the outer layer of the retina, which correlated well with the functional and clinical observations. There were no statistically significant differences in scotopic oscillatory potentials. These findings suggest that intravenous injection of sublethal NaIO3 markedly damaged the cone and rod photoreceptors both functionally and morphologically, and plasma miR-183 reflected the retinal toxicity in those animals with moderate retinal damage.
Effects of Vitellaria paradoxa (C.F. Gaertn.) aqueous leaf extract administration on Salmonella typhimurium-infected rats
Authors: Fodouop Siméon Pierre Chegaing , Tala Sedric Donald , Keilah Lunga Paul , Kodjio Norbert , Yemele Mefokou Didiane , Nwabo Kamdje Armel Herve , Nji-kah Bridget , Tchoumboue Joseph , Gatsing Donatien
Published: March 2017

Background

The present study investigates the effects of Vitellaria paradoxa crude extract administration on Salmonella typhimurium infected Wistar rats.

Methods

Rats were infected by single dose oral administration of Salmonella typhimurium (1.5×108 CFU). Negative control groups were infected and treated orally with distilled water (vehicle), neutral control group were not infected, while the four test groups were treated up to 18 days with 55 mg/kg, 110 mg/kg, 220 mg/kg and 440 mg/kg body weight of aqueous extract of V. paradoxa respectively. The effects of this extract administration on serum markers (total protein, creatinine, transaminases, bilirubin and lipid profile) as well as acute toxicity test and phytochemical screening were also investigated.

Results

Following in vivo studies, aqueous extract of V. paradoxa allowed to clear salmonellosis in previously infected rats within twelve days of treatment. Infection has resulted in a significant increase of transaminases activity. Besides, significant decrease was observed in liver and kidney relative weight and their protein content. Nevertheless, administration of this plant extract at higher doses has resulted in the correction of some of these injuries. Results obtained from acute toxicity study showed that mice administered with the aqueous leaf extract exhibited a mild reaction to noise and pinch; excreted watery discharges and the LD50 value was 12.0 g/kg. In addition, the extract showed no toxic effect after 14 days. However, it may have a sedative effect or depressant effect on the central nervous system, may induce a decrease in plasma levels of algogenic substances, and may cause diarrhea at high doses. Phytochemical screening of the extract revealed the presence of flavonoids, alkaloids, tannins, phenols and polyphenols, saponins, anthocyanins, steroids and anthraquinones.

Conclusions

These results support the ethnomedicinal use of V. paradoxa, and suggest that its leave can be used in the management antibacterial phytomedicine.
Seismic facies analysis based on speech recognition feature parameters
Authors: Xie Tao , Zheng Xiaodong , Zhang Yan
Published: March 2017

Seismic facies analysis plays an important role in seismic stratigraphy. Seismic attributes have been widely applied to seismic facies analysis. One of the most important steps is to optimize the most sensitive attributes with regard to reservoir characteristics. Using different attribute combinations in multidimensional analyses will yield different solutions. Acoustic waves and seismic waves propagating in an elastic medium follow the same law of physics. The generation process of a speech signal based on the acoustic model is similar to the seismic data of the convolution model. We have developed the mel-frequency cepstrum coefficients (MFCCs), which have been successfully applied in speech recognition, as feature parameters for seismic facies analysis. Information about the wavelet and reflection coefficients is well-separated in these cepstrum-domain parameters. Specifically, information about the wavelet mainly appears in the low-domain part, and information about the reflection coefficients mainly appeared in the high-domain part. In the forward model, the seismic MFCCs are used as feature vectors for synthetic data with a noise level of zero and 5%. The Bayesian network is used to classify the traces. Then, classification accuracy rates versus different orders of the MFCCs are obtained. The forwarding results indicate that high accuracy rates are achieved when the order exceeds 10. For the real field data, the seismic data are decomposed into a set of MFCC parameters. The different information is unfolded in the parameter maps, enabling the interpreter to capture the geologic features of the target interval. The geologic features presented in the three instantaneous attributes and coherence can also be found in the MFCC parameter maps. The classification results are in accordance with the paleogeomorphy of the target interval as well as the known wells. The results from the synthetic data and real field data demonstrate the information description abilities of the seismic MFCC parameters. Therefore, using the speech feature parameters to extract information may be helpful for processing and interpreting seismic data.
Time-average velocity estimation through surface-wave analysis: Part 1 — S-wave velocity
Authors: Socco Laura Valentina , Comina Cesare , Khosro Anjom Farbod
Published: March 2017

In some areas, the estimation of static corrections for land seismic data is a critical step of the processing workflow. It often requires the execution of additional surveys and data analyses. Surface waves (SWs) in seismic records can be processed to extract local dispersion curves (DCs) that can be used to estimate near-surface S-wave velocity models. Here we focus on the direct estimation of time-average S-wave velocity models from SW DCs without the need to invert the data. Time-average velocity directly provides the value of one-way time, given a datum plan depth. The method requires the knowledge of one 1D S-wave velocity model along the seismic line, together with the relevant DC, to estimate a relationship between SW wavelength and investigation depth on the time-average velocity model. This wavelength/depth relationship is then used to estimate all the other time-average S-wave velocity models along the line directly from the DCs by means of a data transformation. This approach removes the need for extensive data inversion and provides a simple method suitable for industrial workflows. We tested the method on synthetic and field data and found that it is possible to retrieve the time-average velocity models with uncertainties less than 10% in sites with laterally varying velocities. The error on one-way times at various depths of the datum plan retrieved by the time-average velocity models is mostly less than 5 ms for synthetic and field data.
Time-average velocity estimation through surface-wave analysis: Part 2 — P-wave velocity
Authors: Valentina Socco Laura , Comina Cesare
Published: March 2017

Surface waves (SWs) in seismic records can be used to extract local dispersion curves (DCs) along a seismic line. These curves can be used to estimate near-surface S-wave velocity models. If the velocity models are used to compute S-wave static corrections, the required information consists of S-wave time-average velocities that define the one-way time for a given datum plan depth. However, given the wider use of P-wave reflection seismic with respect to S-wave surveys, the estimate of P-wave time-average velocity would be more useful. We therefore focus on the possibility of also extracting time-average P-wave velocity models from SW dispersion data. We start from a known 1D S-wave velocity model along the line, with its relevant DC, and we estimate a wavelength/depth relationship for SWs. We found that this relationship is sensitive to Poisson’s ratio, and we develop a simple method for estimating an “apparent” Poisson’s ratio profile, defined as the Poisson’s ratio value that relates the time-average S-wave velocity to the time-average P-wave velocity. Hence, we transform the time-average S-wave velocity models estimated from the DCs into the time-average P-wave velocity models along the seismic line. We tested the method on synthetic and field data and found that it is possible to retrieve time-average P-wave velocity models with uncertainties mostly less than 10% in laterally varying sites and one-way traveltime for P-waves with less than 5 ms uncertainty with respect to P-wave tomography data. To our knowledge, this is the first method for reliable estimation of P-wave velocity from SW data without any a priori information or additional data.
Patients of Asian descent with gastric cancer treated in the United States: Comparative characteristics and survival outcomes.
Authors: Rhome Ryan , Moshier Erin , Buckstein Michael
Published: March 2017

10

Background: Asian gastric cancer trials often show better outcomes than similar Western trials suggesting a possible difference in disease characteristics or biology. Large databases can be used to assess whether ethnic differences persist in the United States. Methods: The National Cancer Database was queried to examine disease characteristics, treatment utilization, and outcomes for gastric cancer from 2004-2013 for Asian vs. non-Asian patients. Patients were excluded with inadequate follow-up, unknown staging or race. Cox proportional hazards model was used to assess hazard ratio (HR) of death. Results: 101,426 patients were analyzed (6,994 Asians, 94,432 non-Asians). Asian patients were more likely to be female, younger, treated at academic centers, early stage, lower co-morbidity score, and high grade vs. non-Asian (Chi-square, all p<0.001). Asian patients were less likely to receive chemotherapy or radiation or have a positive margin. HRs of death (adjusted for age, sex, facility, histology, insurance, co-morbidity score, margin, grade, surgery, radiation, and chemotherapy) for Asian patients are shown in the table. Further dividing by most represented Asian sub-groups showed differences between countries of origin. Conclusions: Imbalances exist in clinical features and treatment utilization in Asian patients compared to non-Asians. After adjustment, Asian race is associated with higher overall survival. Adjusted sub-group analyses show survival differences by country of origin, suggesting biological variability. [Table: see text]
Post-gastrectomy nutrition risk index can be a good predictive factor for survival.
Authors: Fujiya Keiichi , Kawamura Taiichi , Omae Katsuhiro , Nishiwaki Noriyuki , Kaji Sanae , Hikage Makoto , Makuuchi Rie , Tokunaga Masanori , Tanizawa Yutaka , Bando Etsuro , Terashima Masanori
Published: March 2017

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Background: Preoperative malnutrition worsens morbidity and survival, however the role of post-gastrectomy nutritional status in survival remains unclear. The nutrition risk index (NRI) described by Buzby is a scoring system for identifying patients with preoperative poor nutrition status. However, the significance of NRI in evaluating post-gastrectomy nutritional status has not yet been established. Therefore, we aimed to clarify whether malnutrition condition evaluated by NRI after surgery can be a predictive factor for long-term survival in patients with gastric cancer. Methods: Pathological stage I, II, and III gastric cancer patients who underwent curative gastrectomy between 2002 and 2013 were included in this study. NRI was calculated using the following formula; (1.489 × serum albumin, g/L) + (41.7 × current weight/usual weight), and we defined an NRI of above 97.5 as normal nutrition (N group) and 97.5 or below as malnutrition (M group). NRI was evaluated before gastrectomy and 1, 3 and 12 months after gastrectomy. The correlations of clinicopathological characteristics, surgical treatment and overall survival, with nutritional status were retrospectively evaluated. Results: A total of 2552 patients were enrolled. There were significant differences in age, sex, body mass index, performance status, co-morbidity, histology and malignant stage between the groups before gastrectomy. Overall survival in the M group was significantly poorer, both before gastrectomy (adjusted HR 1.31; p < 0.001) and at 1 month (adjusted HR 1.52; p < 0.001), 3 months (adjusted HR 1.35; p = 0.004) and 12 months (adjusted HR 1.37; p = 0.006) after gastrectomy. In multivariate analysis, low NRI at 12 months after gastrectomy, age, co-morbidity and malignant stage were independently associated with overall survival. Overall survival in patients who fulfilled preoperative normal nutrition status criteria was also significantly poorer at 12 months after gastrectomy in the M group. Conclusions: Malnutrition after surgery, as well as before surgery, had a significant impact on overall survival. Postoperative nutritional statue evaluated by NRI may be a good predictive marker for long-term survival.
Pathologic nodal response in gastric cancer: Do all patients need adjuvant therapy?
Authors: Smaglo Brandon George , Sada Yvonne , Tran Cao Hop Sanderson , Akce Mehmet , Mok Henry , Musher Benjamin Leon , Massarweh Nader Nabile
Published: March 2017

107

Background: Recent data from the MAGIC trial show that pathologically positive lymph nodes (ypN+) despite neoadjuvant (NA) chemotherapy are associated with poorer survival. Although the use of NA therapy has increased, pathologic disease response to multimodality therapy (MMT) and its impact on outcome have not been well-defined. Methods: This retrospective cohort study of the National Cancer Database included patients with cN+ gastric cancer who underwent NA therapy followed by surgical resection between 2006 and 2012. Patients were categorized by NA treatment (chemotherapy or concurrent chemoradiation). Pre-treatment clinical (cN) and pathologic nodal staging (ypN) were used to determine downstaging rates from cN+ to ypN0. The association between overall risk of death and NA treatment, nodal response, and the use of adjuvant therapy was evaluated with multivariable Cox regression. Results: Among 1,489 patients with cN+ gastric cancer receiving NA therapy, 45.5% were treated with chemotherapy and 54.5% with chemoradiation. Rates of nodal downstaging were 29.9% for chemotherapy and 45.4% for chemoradiation. On multivariable analysis, treatment sequence and type were not associated with risk of death. Median survival was significantly lower in patients with ypN+ compared to those with ypN0 disease (27.7 vs 79.7 months; log-rank, p < 0.001).Among patients with ypN+ disease (n = 918), median survival was greater if adjuvant therapy was received (32.6 months vs. 25.3 months, log-rank, p < 0.001); adjuvant therapy was associated with a 19% decreased risk of death (Hazard Ratio [HR] 0.81; 95% CI 0.66-0.99), with further reduction among those who underwent a margin negative resection (HR 0.73; 95% CI 0.58-0.92). In patients with ypN0, adjuvant therapy was not associated with a lower risk of death. Conclusions: Over one third of node-positive gastric cancers demonstrated pathologic nodal downstaging with NA treatment, with chemoradiation yielding a higher response than chemotherapy. Patients with ypN+ had worse survival, and appeared to benefit from adjuvant therapy. Future gastric cancer trials should better define the role for NA chemoradiation and help individualize the use of adjuvant therapy based on nodal response.
Impact of current “insufficient” clinical nodal staging on treatment decisions and response to neoadjuvant chemoradiotherapy in esophageal cancer patients.
Authors: Dijksterhuis Willemieke P.M. , Hulshoff Jan-Binne , van Dullemen Hendrik M. , Kats-Ugurlu Gursah , Burgerhof Johannes G.M. , Korteweg Tijmen , Mul Veronique E.M. , Hospers Geke , Plukker John Theodorus
Published: March 2017

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Background: Although essential in treatment decision making, clinical nodal (cN) staging in esophageal cancer (EC) remains difficult. We assessed the rate of nodal up- and downstaging and its prognostic value on 5-year disease-free survival (DFS) in EC patients treated with surgery-alone or with neoadjuvant chemoradiotherapy (nCRT). Methods: For this retrospective study, we included 395 EC patients who underwent a curative esophagectomy with or without nCRT between 2000 and 2015. The surgery-alone and nCRT group were matched on clinical T-stage (cT), cN-stage, and histopathological type using propensity score matching ( n=270). Staging consisted of PET with CT, or PET/CT, and endoscopic ultrasonography (n = 235). We compared cN and pathological N-stage (pN) and scored correct, down- and upstaging. The prognostic value of nodal up- and downstaging and localization of node metastases on 5-year DFS were assessed with multivariate Cox regression analysis (factors with a P-value <0.1 on univariate analysis). Results: Nodal upstaging (43.0% vs. 16.3%), correct staging (31.9% vs. 28.1%) and downstaging (25.2% vs. 55.6%) differed between the surgery-alone and nCRT group ( P<0.001). Nodal upstaging was commonly present in adenocarcinoma and cT3-4a tumors. Independent prognostic factors for DFS were pN ( P=0.002) and lymph-angioinvasion ( P=0.016) in the surgery and cN metastasis under the diaphragm ( P=0.012) and lymph node ratio ( P=0.034) in the nCRT group. Conclusions: In esophageal cancer, clinical lymph node staging is still insufficient with >25% nodal downstaging. This inaccuracy might impede assessment of true nodal response to nCRT, affording dubious decisions for a ‘wait-and-see’ strategy.
Phase II trial of adjuvant immunotherapy with autologous tumor-derived Gp96 vaccination in patients with gastric cancer.
Authors: Chen Lin , Zhang Kecheng , Peng Zheng , Wei Bo , Xi Hongqing , Wang Xinxin , Wang Ning , Cui Jianxin
Published: March 2017

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Background: Autologous, tumor-derived heat shock protein Gp96 peptides complexes have shown antitumor potential in various cancers. We conducted the first Phase II trial to evaluate the safety and efficacy of Gp96 vaccination in adjuvant settings for patients with gastric cancer. Methods: Consecutive patients from November 2012 to December 2015 were enrolled. Participants were allocated to the experimental group or control group, receiving Gp96 vaccination plus chemotherapy or chemotherapy alone respectively. The primary endpoints were disease-free survival and toxicity. The secondary outcomes were overall survival and tumor-specific immune responses. Results: Thirty-nine and forty patients received Gp96 vaccination plus chemotherapy and chemotherapy alone in the adjuvant settings respectively. Significant increased tumor-specific immune responses were observed after Gp96 vaccination. There were comparable disease-free survival ( p = 0.413; HR: 0.75; 95% CI: 0.37−1.48) and overall survival ( p = 0.485; HR: 0.68; 95% CI: 0.24−1.96) between experimental group and control group. In subgroup of patients with stage II and stage III gastric cancer, patients who have received Gp96 vaccination had improved disease-free survival compared those who have not ( p = 0.044; HR: 0.45; 95% CI: 0.22−0.96). Gp96 vaccination plus chemotherapy was well tolerated and no Gp96-related serious adverse event has been observed. Conclusions: Gp96 vaccination could elicit tumor-specific immune responses and could be safely used in adjuvant settings combined with chemotherapy. Patients with less aggressive diseases might benefit from Gp96 therapy.
Gastrointestinal stromal tumors: Immune protein expression and clinical outcomes.
Authors: Blakely Andrew M. , Matoso Andres , Miner Thomas J.
Published: March 2017

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Background: The immune microenvironment is emerging as an important prognostic factor with potential therapeutic targets for various malignancies. Although programmed death-ligand 1 (PD-L1) and indoleamine 2,3-dioxygenase (IDO) have been studied in some tumor types, significance of their expression in gastrointestinal stromal tumors (GISTs) is largely unknown. Methods: Tissue microarrays at an academic tertiary care center were constructed from pathology files from 1996 to 2016. Immunohistochemistry for PD-L1 and IDO was performed and correlated with tumor size, mitoses, and clinical outcomes. Tumor infiltrating lymphocytes (TILs) were counted using image analysis software. Results: 131 GISTs were analyzed. Median patient age was 64 years (range 30-89); 51.1% were male. Tumor location included 89 stomach (67.9%), 34 small bowel (26.0%), 4 colorectal (3.1%), and 4 other (3.1%). Median follow-up was 58 months. Mean tumor size was 5.6±4.5cm, range 0.5 to 24; mean mitoses were 7.2/50HPF. 19 (14.5%) metastasized to mesentery (n = 8), liver (n = 6), and elsewhere (n = 5). Mean survival was 61 months (range 7-127); 5 patients died of disease (3.8%). PD-L1 immunostain was positive in 89 (67.9%), including 11 of 19 (57.9%) malignant and 78 of 112 (69.6%) benign tumors (p = 0.4). PD-L1 positive tumors were larger (6.3±4.4 vs. 4.4±3.4 cm; p = 0.02) and had more mitoses/50HPF (8.9±5.4 vs. 3.9±3.5; p = 0.006) than PD-L1 negative tumors. IDO immunostain was positive in 116 (88.5%), including 14 of 19 (73.7%) malignant and 102 of 112 (91.1%) benign tumors (p = 0.07). There was no significant difference in size or mitotic count between IDO positive and negative tumors. Mean number of CD8-positive TILs was 168±35/mm2 and mean number of PD-L1 positive TILs was 147±28/mm2 in PD-L1 positive tumors. PD-L1 positive tumors had significantly more TILs than PD-L1 negative tumors (113±21 vs. 104±18; p < 0.001). Conclusions: The majority of GISTs express PD-L1 and IDO. Expression of PD-L1 was associated with increased tumor size and higher mitotic activity. PD-L1 and IDO could play a significant role in the tumor biology of GISTs; immunotherapy targeting one or both may provide novel treatment options.
Attenuation of the volume-outcome relationship for gastrointestinal cancer surgery over time: Is a push towards continued regionalization justified?
Authors: Wasif Nabil , Chang Yu-Hui , Mathur Amit , Pockaj Barbara A. , Gray Richard J. , Etzioni David
Published: March 2017

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Background: Research demonstrating a volume-outcome relationship has resulted in regionalization of complex cancer surgery to high volume hospitals. A simultaneous national trend towards improved surgical outcomes brings into question whether the potential benefits of regionalization are still relevant. We hypothesize that the difference in adjusted post-operative mortality between low and high volume hospitals has decreased over time. Methods: The National Cancer Database (NCDB) was used to identify patients with colon, esophageal, and pancreatic cancer undergoing curative intent surgery from 2003-2011. Hospitals were divided into low ( < 25th percentile), medium (25th-75th) and high ( > 75thpercentile) volume groups depending on annual volume of cancer-specific surgery. Year-specific hospital averaged observed/expected (O/E) ratios were calculated for 90-day mortality. Poisson regression was used to model hospital averaged O/E ratios over time. Results: Our study population included 343,929 patients with colon (88%), esophageal (5%) and pancreatic (7%) cancer. There were significant (p < 0.05) improvements in adjusted 90-day mortality from 2003 and 2011 for all volume categories and cancer types, except in high volume hospitals for esophageal cancer. In 2003, high volume hospitals had significantly better outcomes compared to low volume hospitals for all cancer types, as suggested by lower O/E ratios for 90 day mortality (p < 0.05). However, by 2011 the difference in O/E ratios for 90 day mortality was no longer significantly lower for high compared to low volume hospitals (p > 0.05); this was true for all three cancer types (Figure1). Conclusions: During the period of our study, 90-day mortality following gastrointestinal cancer surgery improved in low, medium and high volume hospitals. However, by 2011 the difference in adjusted post-operative mortality between low and high volume hospitals was not significantly different, likely due to global improvements in operative and peri-operative care. This attenuation of the volume-outcome curve has important implications for policy pertaining to regionalization of cancer care in the US.
Quality of life (QOL) in esophageal cancer patients treated with tri-modality therapy: Is the CROSS protocol better?
Authors: Woo Rachel , Chan Edwin , Vanderwater Catherine , Cho Charles , Wong Jason , Xu Wei , Zhang Qihuang , Liu Geoffrey , Zhang Beibei , Cheung Agnes , Lee Alex , Chacko Pravin Philip , Fadhel Ehab , Kassam Zahra
Published: March 2017

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Background: To investigate the impact of trimodality therapy on QOL in esophageal cancer patients and compare the CROSS regimen to neoadjuvant cisplatin/5FU. Methods: In a non-randomized, prospective cohort study, patients undergoing neoadjuvant chemoradiation (CRT) and esophagectomy between June 2012 and Nov 2015, with esophageal adenocarcinoma or squamous cell cancer, T1-4N0-3 (AJCC 7thEd.), completed the EORTC-QLQ-C30 at baseline, end of RT, 6 months, and then annually. A 10-point difference in QOL scores was considered clinically significant. Results: Of 35 patients, 13 received cisplatin/5FU concurrent with 45-50 Gy/25fr; 22 received carboplatin/paclitaxel with 41.4 Gy/23fr (CROSS). Median follow up was 16 months (range 2-49). Questionnaire compliance ranged from 75-100%. Median differences (MD) for physical, role, cognitive, social, & global function, and fatigue, nausea/vomiting (N/V), pain, appetite, & constipation were clinically worse at the end of RT. Statistical worsening was found at the end of RT for global (MD -17, p = 0.001), physical (-17, p = 0.001), role (-33, p = 0.001), & social function (-17, p = 0.003), and for fatigue (28, p = 0.001), N/V (17, p = 0.003), pain (17, p = 0.01), dyspnea (0, p = 0.015), sleep disorder (0, p = 0.049) & appetite (33.3, p = 0.001). Clinical worsening persisted on several domains at 6 months. All scores at 1 year improved at least to baseline, except role functioning (-17, p = 1.0) and appetite (33, p = 0.5) which were clinically, but not statistically worse. No significant difference in QOL was found between cisplatin/5FU and CROSS groups at baseline or end of RT. At 6 months median scores were statistically significantly better for pain, fatigue, role, social, and global functioning in the CROSS group. Global QOL at 1 year remained significantly better in the CROSS group. Higher baseline global QOL was associated with improved OS (p = 0.04) and DFS (p = 0.02). Conclusions: QOL worsened across several domains until 6 months post-RT. Most scores returned to baseline or improved at 1 year except for role functioning and appetite. A larger cohort or controlled trial is needed to confirm our findings of a better long term QOL with the CROSS regimen.