Background
Careful selection of patients with colorectal peritoneal metastases (PM) for cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is crucial. It remains ...unknown whether the time of onset of colorectal PM (synchronous vs metachronous) influences surgical morbidity and survival outcomes after CRS with HIPEC.
Methods
Patients with histologically proven colorectal PM who underwent CRS with HIPEC between February 2006 and December 2017 in two Dutch tertiary referral hospitals were retrospectively included from a prospectively maintained database. The onset of colorectal PM was classified as synchronous (PM diagnosed at the initiational presentation with colorectal cancer) or metachronous (PM diagnosed after initial curative colorectal resection). Major postoperative complications (Clavien–Dindo grade ≥ 3), overall survival (OS), and disease-free survival (DFS) were compared between patients with synchronous colorectal PM and those with metachronous colorectal PM using Kaplan–Meier analyses, proportional hazard analyses, and a multivariate Cox regression analysis.
Results
The study enrolled 433 patients, of whom 231 (53%) had synchronous colorectal PM and 202 (47%) had metachronous colorectal PM. The major postoperative complication rate and median OS were similar between the patients with synchronous colorectal PM and those with metachronous colorectal PM (26.8% vs 29.7%;
p
= 0.693 and 34 vs 33 months, respectively;
p
= 0.819). The median DFS was significantly decreased for the patients with metachronous colorectal PM and those with synchronous colorectal PM (11 vs 15 months; adjusted hazard ratio, 1.63; 95% confidence interval, 1.18–2.26).
Conclusions
Metachronous onset of colorectal PM is associated with early recurrence after CRS with HIPEC compared with synchronous colorectal PM, without a difference in OS or major postoperative complications. Time to onset of colorectal PM should be taken into consideration to optimize patient selection for this major procedure.
Carcasses of South Polar Skuas (Catharacta maccormicki) and Kelp gulls (Larus dominicanus) were opportunistically collected around of Rothera Research station (67°35′8″S and 68°7′59″W) during the ...2016/2017 austral summer. Samples of their tissues (muscle, liver and subcutaneous fat) were analysed for Persistent Organic Pollutants (POPs). Organochlorine pesticides (OCPs) showed the highest concentrations, notably for pp′-DDE and HCB. The Polychlorinated biphenyls (PCBs)-profiles demonstrated a clear dominance of hexa- and hepta-CBs, while concentrations of polybrominated diphenyl ethers (PBDEs) remained low. The concentrations of some POPs (e.g. HCB) were lower than in past studies on similar species, however others were within the previous range (PCBs) or even higher than previous reported values (DDE). Although no major interspecific differences in the absolute concentrations of POPs were detected, their profiles varied, being likely related to feeding and migration patterns of each species. The current study provides important baseline data for future monitoring of POPs in Antarctica.
•South Polar Skuas and Kelp Gulls of Western Antarctic Peninsula are exposed to Persistent Organic Pollutants during their stay in Antartica and winter migrations.•Concentrations of Persistent Organic Pollutants in these two species have not decreased since 1990s.•Although some OCPs and congeners of PCBs and PBDEs have a distinct accumulation pattern, significant interspecific differences only for PBDEs were discovered.
Abstract
Objective
Old or frail acutely hospitalised patients can benefit from geriatric rehabilitation but criteria concerning referral decisions are unclear. This review presents an overview of ...clinical factors associated with referral to geriatric rehabilitation that may further consensus between hospital and rehabilitation professionals on triage.
Design
Scoping review.
Methods
A review was conducted following Arksey and O’Malley’s framework. The search included literature concerning a broad spectrum of acutely hospitalised patients and factors associated with their referral to geriatric rehabilitation.
Results
Selected abstracts were categorised into distinct geriatric rehabilitation care pathways such as stroke, hip fracture, amputation of lower limb, cardiac and oncologic rehabilitation. Abstracts on internal medical patients were further reviewed and 29 studies were included. A total of 13 studies focused on factors identifying rehabilitation needs and 16 on factors associated with outcome of geriatric rehabilitation. Triage factors were diverse and included frailty status, functional decline, cognitive symptoms and multimorbidity. Mood symptoms and living situation further specified post-acute care needs. In overview, triage factors could be characterised as demographic (n = 4), diagnosis-related (n = 8), mental (n = 6), functional (n = 10) or multi-domain (n = 12) and mapped in a transitional care pathway.
Conclusions and implications
Frailty and functional decline are characteristics frequently associated with referral to geriatric rehabilitation of acutely hospitalised internal medical patients. A comprehensive geriatric assessment or a simpler multi-domain set of tests reveals rehabilitation needs and approximates a functional prognosis. Professional consensus on factors and timing of triage in hospital is within reach.
Abstract Background Volumetric assessment of the liver is essential in the prevention of postresectional liver failure after partial hepatectomy. Currently used methods are accurate but ...time-consuming. This study aimed to test a new automated method for preoperative volumetric liver assessment. Methods Patients who underwent a contrast enhanced portovenous phase CT-scan prior to hepatectomy in 2012 were included. Total liver volume (TLV) and future remnant liver volume (FRLV) were measured using TeraRecon Aquarius iNtuition® (autosegmentation) and OsiriX® (manual segmentation) software by two observers for each software package. Remnant liver volume percentage (RLV%) was calculated. Time needed to determine TLV and FRLV was measured. Inter-observer variability was assessed using Bland-Altman plots. Results Twenty-seven patients were included. There were no significant differences in measured volumes between OsiriX® and iNtuition® . Moreover, there were significant correlations between the OsiriX® observers, the iNtuition® observers and between OsiriX® and iNtuition® post-processing systems (all R2 > 0.97). The median time needed for complete liver volumetric analysis was 18.4 ± 4.9 min with OsiriX® and 5.8 ± 1.7 min using iNtuition® (p < 0.001). Conclusion Both OsiriX® and iNtuition® liver volumetry are accurate and easily applicable. However, volumetric assessment of the liver with iNtuition® auto-segmentation is three times faster compared to manual OsiriX® volumetry.
The Keck II Telescope is the first 8–10 m class telescope equipped with a laser guide star adaptive optics (LGS AO) system. Under normal seeing conditions, the LGS AO system producesK‐band Strehl ...ratios between 30% and 40% using bright tip‐tilt guide stars, and it works well with tip‐tilt guide stars as faint as
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, with partial correction for stars up to a magnitude fainter. This paper presents the algorithms implemented in the LGS AO system, as well as experimental performance results. A detailed error budget shows excellent agreement between the measured and expected image quality for both bright and faint guide stars.
Inflammatory breast cancer (IBC) is an aggressive disease. To date, no molecular feature reliably predicts either the response to chemotherapy (CT) or the survival. Using DNA microarrays, we searched ...for multigene predictors.
The World IBC Consortium generated whole-genome expression profiles of 137 IBC and 252 non-IBC (nIBC) samples. We searched for transcriptional profiles associated with pathological complete response (pCR) to neoadjuvant anthracycline-based CT and distant metastasis-free survival (DMFS) in respective subsets of 87 and 106 informative IBC samples. Correlations were investigated with predictive and prognostic gene expression signatures published in nIBC (nIBC-GES). Supervised analyses tested genes and activation signatures of 19 biological pathways and 234 transcription factors.
Three of five tested prognostic nIBC-GES and the two tested predictive nIBC-GES discriminated between IBC with and without pCR, as well as two interferon activation signatures. We identified a 107-gene signature enriched for immunity-related genes that distinguished between responders and nonresponders in IBC. Its robustness was demonstrated by external validation in three independent sets including two IBC sets and one nIBC set, with independent significant predictive value in IBC and nIBC validation sets in multivariate analysis. We found no robust signature associated with DMFS in patients with IBC, and neither of the tested prognostic GES, nor the molecular subtypes were informative, whereas they were in our nIBC series (220 stage I–III informative samples).
Despite the relatively small sample size, we show that response to neoadjuvant CT in IBC is, as in nIBC, associated with immunity-related processes, suggesting that similar mechanisms responsible for pCR exist. Analysis of a larger IBC series is warranted regarding the correlation of gene expression profiles and DMFS.
Preparation, morphology, and mechanical properties were studied of blends of a thermotropic liquid crystalline polymer (TLCP) with two different grades of polypropylene, one with and one without ...overlap in processing temperatures, using two different blending methods. The highly viscous grade (PP‐1) was of sufficient thermal stability to be blended with the TLCP (Vectra A950) in a single‐screw extruder with an Egan mixing section on the screw. The low viscous grade (PP‐2) could not be processed at the same temperature as the TLCP because of degradation. Its blends were, therefore, prepared by a special coextrusion technique, i.e. feeding the two components from two separate extruders to a Ross static mixer. In both methods drawing of the extrudate is necessary to obtain satisfactory mechanical properties. The PP‐1/TLCP blends had to be extruded twice in order to obtain proper mixing. The morphology of these blends ranges from a pronounced skin‐core morphology at low extrudate draw ratio (DR = 3) to a high‐aspect ratio fiber/matrix morphology at high draw ratio (DR = 15). The morphology of the PP‐2/TLCP blends was always a high‐aspect ratio fiber/matrix morphology even at low draw ratios. The TLCP fibers were generated in this coextrusion process under conditions where the viscosity of the dispersed phase was higher than the viscosity of the matrix. Breakup experiments demonstrate that fibers of a thickness of approximately 1 μm disintegrate into droplets within a few seconds at temperatures above the melting point of the TLCP. This is probably the cause of the skin‐core morphology obtained with single‐screw extrusion. Tensile modulus and strength of all blends increase with extrudate draw ratio. The deformation of the TLCP phase in the drawn blends is less than affine, probably because of slip between the phases. The moduli of the PP‐1/TLCP blends as a function of the draw ratio can be described well by a modified Halpin‐Tsai equation taking into account both changes in aspect ratio and molecular orientation of the TLCP fibers. The level of reinforcement in the PP‐2/TLCP blends is lower than expected, probably because of the low temperature of drawing. This demonstrates a limitation of the coextrusion process: blending at temperatures that are too low reduces mechanical properties.
Post-acute rehabiitation is recommended in the treatment of chronic obstructive pulmonary disease (COPD). It enhances the sense of control by education, which should focus on patient information ...needs. However, it is unknown whether a geriatric rehabilitation programme for older patients with advanced COPD and severely impaired health status (the GR-COPD programme) does fit these patient information needs.
The study aimed to identify the information needs of patients who were eligible for the GR-COPD programme, and investigated if health-related knowledge improved during rehabilitation.
All patients indicated for the GR-COPD programme were eligible for this study. The information needs were measured with the Lung Information Needs Questionnaire (LINQ).
The 158 patients (mean age 70.8 years; FEV1 %predicted: 35.5) showed relatively high baseline information needs (mean LINQ overall score: 8.6 SD 3.1), with the greatest need in the domains 'diet' and 'self-management'. After follow-up, the mean LINQ overall score significantly improved in patients who completed the GR-COPD programme (p=0.001).
Patients' knowledge showed a statistically significant improvement in some areas during the GR-COPD programme.
Effects of insufficient soil aeration on the functioning of plants form an important field of research. A well-known and frequently used utility to express oxygen stress experienced by plants is the ...Feddes-function. This function reduces root water uptake linearly between two constant pressure heads, representing threshold values for minimum and maximum oxygen deficiency. However, the correctness of this expression has never been evaluated and constant critical values for oxygen stress are likely to be inappropriate. On theoretical grounds it is expected that oxygen stress depends on various abiotic and biotic factors. In this paper, we propose a fundamentally different approach to assess oxygen stress: we built a plant physiological and soil physical process-based model to calculate the minimum gas filled porosity of the soil (
ϕ
gas_min) at which oxygen stress occurs.
First, we calculated the minimum oxygen concentration in the gas phase of the soil needed to sustain the roots through (micro-scale) diffusion with just enough oxygen to respire. Subsequently,
ϕ
gas_min that corresponds to this minimum oxygen concentration was calculated from diffusion from the atmosphere through the soil (macro-scale).
We analyzed the validity of constant critical values to represent oxygen stress in terms of
ϕ
gas_min, based on model simulations in which we distinguished different soil types and in which we varied temperature, organic matter content, soil depth and plant characteristics. Furthermore, in order to compare our model results with the Feddes-function, we linked root oxygen stress to root water uptake (through the sink term variable
F, which is the ratio of actual and potential uptake).
The simulations showed that
ϕ
gas_min is especially sensitive to soil temperature, plant characteristics (root dry weight and maintenance respiration coefficient) and soil depth but hardly to soil organic matter content. Moreover,
ϕ
gas_min varied considerably between soil types and was larger in sandy soils than in clayey soils. We demonstrated that
F of the Feddes-function indeed decreases approximately linearly, but that actual oxygen stress already starts at drier conditions than according to the Feddes-function. How much drier is depended on the factors indicated above. Thus, the Feddes-function might cause large errors in the prediction of transpiration reduction and growth reduction through oxygen stress.
We made our method easily accessible to others by implementing it in SWAP, a user-friendly soil water model that is coupled to plant growth. Since constant values for
ϕ
gas_min in plant and hydrological modeling appeared to be inappropriate, an integrated approach, including both physiological and physical processes, should be used instead. Therefore, we advocate using our method in all situations where oxygen stress could occur.
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