The authors conducted a study of patients who underwent total gastrectomy for gastric malignancy to elucidate contributing factors that lead to successful management of this disease in geriatric ...patients.
The average mortality rate for patients undergoing stomach surgery due to carcinoma is 7.8% according to the literature overview, still relatively high. Even higher mortality rates are observed for geriatric patients after a total gastrectomy. Because of epidemiologic changes, a total gastrectomy is required with growing frequency in these high-risk patients.
The study involved 380 patients with a gastric malignancy. Risks and benefits of a total gastrectomy with radical lymphadenectomy at an advanced age were analyzed retrospectively in 163 patients older than 70 years of age. The results achieved in these patients were compared with those observed in 217 younger patients.
The 30-day mortality and morbidity rates for the elderly patients were 3% and 33.7%, respectively; for the younger patients, they were 0.46% and 21.2%, respectively. A statistically significant correlation was found between the presence of risk factors, the occurrence of complications, and the mortality rate. No difference was seen between the two age groups when risk factors were absent. The 5-year survival rate was 30%, with no difference between young and elderly patients.
The data prove that a total gastrectomy with a radical lymphadenectomy can be carried out safely in older patients, with long-term results comparable to those achieved in younger patients.
Objectives We determined the outcome of cardiac allografts from multiorgan donors enrolled in a randomized trial of donor pre-treatment with dopamine. Background Treatment of the brain-dead donor ...with low-dose dopamine improves immediate graft function after kidney transplantation. Methods A cohort study of 93 heart transplants from 21 European centers was undertaken between March 2004 and August 2007. We assessed post-transplant left ventricular function (LVF), requirement of a left ventricular assist device (LVAD) or biventricular assist device (BVAD), need for hemofiltration, acute rejection, and survival of recipients of a dopamine-treated versus untreated graft. Results Donor dopamine was associated with improved survival 3 years after transplantation (87.0% vs. 67.8%, p = 0.03). Fewer recipients of a pre-treated graft required hemofiltration after transplant (21.7% vs. 40.4%, p = 0.05). Impaired LVF (15.2% vs. 21.3%, p = 0.59), requirement of a LVAD (4.4% vs. 10.6%, p = 0.44), and biopsy-proven acute rejection (19.6% vs. 14.9%, p = 0.59) were not statistically different between groups. Post-transplant impaired LVF (hazard ratio HR: 4.95; 95% confidence interval CI: 2.08 to 11.79; p < 0.001), requirement of LVAD (HR: 6.65; 95% CI: 2.40 to 18.45; p < 0.001), and hemofiltration (HR: 2.83; 95% CI: 1.20 to 6.69; p = 0.02) were predictive of death. The survival benefit remained (HR: 0.33; 95% CI: 0.12 to 0.89; p = 0.03) after adjustment for various risks affecting mortality, including pre-transplant LVAD/BVAD, inotropic support, and impaired kidney function. Conclusions Treatment of brain-dead donors with dopamine of 4 μg/kg/min will not harm cardiac allografts but appears to improve the clinical course of the heart allograft recipient. (Prospective Randomized Trial to Evaluate the Efficacy of Donor Preconditioning With Dopamine on Initial Graft Function After Kidney Transplantation; NCT00115115 )
Today's energy grids are facing huge challenges caused by the growing diversity of energy consumers and producers as well as an ongoing increase of renewable energy sources and e-mobility. Hence, it ...is essential that the grids continuously evolve by introducing new monitoring, protection and optimization concepts including machine learning (ML) approaches. To overcome the lack of existing monitoring data for rare real-world grid events, this paper presents a concept for generating training data sets for ML approaches based on a multi-modal grid simulation tool. The simulation tool as well as the proposed semi-automated data generation approach are introduced and the concept is verified based on a real-world battery storage maintenance event.
Marine plankton support global biological and geochemical processes. Surveys of their biodiversity have hitherto been geographically restricted and have not accounted for the full range of plankton ...size. We assessed eukaryotic diversity from 334 size-fractionated photic-zone plankton communities collected across tropical and temperate oceans during the circumglobal Tara Oceans expedition. We analyzed 18S ribosomal DNA sequences across the intermediate plankton-size spectrum from the smallest unicellular eukaryotes (protists, >0.8 micrometers) to small animals of a few millimeters. Eukaryotic ribosomal diversity saturated at ~150,000 operational taxonomic units, about one-third of which could not be assigned to known eukaryotic groups. Diversity emerged at all taxonomic levels, both within the groups comprising the ~11,200 cataloged morphospecies of eukaryotic plankton and among twice as many other deep-branching lineages of unappreciated importance in plankton ecology studies. Most eukaryotic plankton biodiversity belonged to heterotrophic protistan groups, particularly those known to be parasites or symbiotic hosts.
Using a nonequilibrium implementation of the Lanczos-based exact diagonalisation technique we study the possibility of the light-induced superconducting phase coherence in a solid state system after ...an ultrafast optical excitation. In particular, we investigate the buildup of superconducting correlations by calculating an exact time-dependent wave function reflecting the properties of the system in non-equilibrium and the corresponding transient response functions. Within our picture we identify a possible transient Meissner effect after dynamical quenching of the non-superconducting wavefunction and extract a characteristic superfluid density that we compare to experimental data. Finally, we find that the stability of the induced superconducting state depends crucially on the nature of the excitation quench: namely, a pure interaction quench induces a long-lived superconducting state, whereas a phase quench leads to a short-lived transient superconductor.
The Earth's mesopause region between about 75 and 105 km is characterised by chemiluminescent emission from various lines of different molecules and atoms. This emission was and is important for the ...study of the chemistry and dynamics in this altitude region at nighttime. However, our understanding of molecular emissions with low intensities and high line densities is still very limited. Based on 10 years of data from the astronomical X-shooter echelle spectrograph at Cerro Paranal in Chile, we have characterised in detail this nightglow (pseudo-)continuum in the wavelength range from 300 to 1,800 nm. We studied the spectral features, derived continuum components with similar variability, calculated climatologies, studied the response to solar activity, and even estimated the effective emission heights. The results indicate that the nightglow continuum at Cerro Paranal essentially consists of only two components, which exhibit very different properties. The main structures of these components peak at 595 and 1,510 nm. While the former was previously identified as the main peak of the FeO 'orange arc' bands, the latter is a new discovery. Laboratory data and theory indicate that this feature and other structures between about 800 and at least 1,800 nm are caused by emission from HO\(_2\). We performed runs with the Whole Atmosphere Community Climate Model (WACCM) with modified chemistry and found that the total intensity, layer profile, and variability indeed support this interpretation, where the excited HO\(_2\) radicals are mostly produced from the termolecular recombination of H and O\(_2\). The WACCM results for the continuum at visual wavelengths show good agreement for FeO from the reaction of Fe and O\(_3\). However, the simulated total emission appears to be too low, which would require additional mechanisms where the variability is dominated by O\(_3\).
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