Esophageal cancer is one of the most aggressive gastrointestinal cancers. This review focuses on eight topics within the multidisciplinary approach for esophageal cancer. As esophagectomy is highly ...invasive and likely to impair quality of life, the development of less invasive strategies is expected. Endoscopic resection (ER) of early esophageal cancer is a less invasive treatment for early esophageal cancer. A recent phase II trial revealed that combined ER and chemoradiotherapy (CRT) is efficacious as an esophagus-preserving treatment for cT1bN0 squamous cell carcinoma (SCC). Esophagectomy and definitive CRT are equally effective for patients with clinical stage I SCC in terms of long-term outcome. For locally advanced resectable cancers, multidisciplinary treatment strategies have been established through several clinical trials of neoadjuvant or perioperative treatment. Minimally invasive esophagectomy may improve the outcomes of patients and CRT is a curative-intent alternative to esophagectomy. CRT with 50.4 Gy radiotherapy combined with salvage surgery is a promising option to preserve the esophagus. Induction chemotherapy followed by esophagectomy may improve the outcomes of patients with locally advanced unresectable tumors. Immune checkpoint inhibitors are effective for esophageal cancer, and their introduction to clinical practice is awaited.
In the solvent extraction of metal ions, the transport mechanism of metal ions through the liquid–liquid organic/aqueous interface remains unclear. In this study, the adsorption process of trivalent ...lanthanide ions from the aqueous phase to the interface in the solvent extraction of lanthanides with di(2-ethylhexyl)phosphoric acid (HDEHP) extractant is investigated by using a model interfacewater surface covered with HDEHP (air/HDEHP/aqueous interface). As a result, symmetric POO– stretch signals of HDEHP observed by vibrational sum frequency generation spectroscopy and density functional theory calculations show that the stoichiometric ratio of lanthanide–HDEHP complexes formed at the air/HDEHP/aqueous interface is 1:1. The formation of the interfacial 1:1 lanthanide–HDEHP complex could be an elementary chemical process occurring just before the transfer of lanthanide ions to the side of the organic phase.
Understanding the chemistry of elements at the bottom of the periodic table is a challenging goal in chemistry. Observing actinide species at interfaces by using interface-selective second-order ...nonlinear optical spectroscopy, such as vibrational sum frequency generation (VSFG) spectroscopy, is a promising route for developing heavy element chemistry; however, such attempts are scarce. Here, we investigated the phase transfer mechanism of uranyl ions (UO2 2+) in solvent extraction using the di(2-ethylhexyl)phosphoric acid (HDEHP) extractant dissolved in the dodecane organic phase by probing the oil/water liquid–liquid interface using VSFG spectroscopy. The POO– symmetric stretch vibrational signals of the HDEHP ligands clearly demonstrated that uranyl ions form interfacial complexes with HDEHP at the oil/water interface. The interfacial uranyl–HDEHP complexes were formed with uranyl ions coming from both the aqueous and oil phases, strongly suggesting that the interfacial complex is an intermediate to cross the oil/water interface. Density functional theory calculations proposed the molecular structure of the interfacial uranyl–HDEHP complex.
•This paper proposes the new method to determine an optimal size of BESS at minimal total BESS cost by using the proposed PSO-based frequency control of the microgrid.•The impacts of BESS specified ...costs with modern storage technologies are investigated, minimized and compared for 15years installation in the typical microgrid.•The proposed optimal size of BESS based-PSO method is compared with the optimal size of BESS based analytic method and the conventional size of BESS referred from the typical microgrid.
The main challenge in integrating a Battery Energy Storage System (BESS) into a microgrid is to evaluate an optimum size of BESS to prevent the microgrid from instability and system collapse. The installation of BESS at a random size or non-optimum size can increase in cost, system losses and larger BESS capacity. Thus, this paper proposes the new method to evaluate an optimum size of BESS at minimal total BESS cost by using particle swarm optimization (PSO)-based frequency control of the stand-alone microgrid. The research target is to propose an optimum size of BESS by using the PSO method-based frequency control in order to prevent the microgrid from instability and system collapse after the loss of the utility grid (e.g., blackout or disasters) and minimize the total cost of BESS for 15years installation in the microgrid. Then, the economical performance of BESS with modern different storage technologies is investigated and compared in the typical microgrid. Results show that the optimum size of BESS-based PSO method can achieve higher dynamic performance of the system than the optimum size of BESS-based analytic method and the conventional size of BESS. In terms of BESS economical performance with modern storage technologies, the installation of the polysulfide–bromine BESS is likely to be more cost-effective than the installation of the vanadium redox BESS for 15years installation in the typical microgrid. It is concluded that the proposed PSO method-based frequency control can improve significantly power system stability, grid security, and planning flexibility for the microgrid system. At the same time, it can fulfill the frequency control requirements with a high economic profitability.
Spatial perspective taking consists of mental self‐rotation and other cognitive information processing. Mental self‐rotation is a process of rotating an embodied representational self through mental ...simulation of the sensorimotor mechanisms underlying actual self‐movement. It was predicted that physical development would affect the operation of the representational self. One hundred and twenty‐five individuals aged 5–80 years (57 children, 35 students, and 33 elderly people) executed a video game task of spatial perspective taking in three conditions of sensorimotor activation: A restrained, stable, and unstable condition. In the linear function formulas considering the degree of rotation and response times, the gradient represented the theoretical speed of mental self‐rotation and the intercept represented other cognitive processing. A significant interaction was found between age group and condition on the gradients, indicating that the response times in the unstable condition were faster than in the other conditions for the children, the restrained condition was slower than the other conditions for the students, while no difference was found for the elderly adults. The results suggest that the influence of sensorimotor activation on the embodied representational self depends on developmental changes in physical control.
We aimed to elucidate whether minimally invasive esophagectomy (MIE) can be safely performed by reviewing the Japanese National Clinical Database.
MIE is being increasingly adopted, even for advanced ...esophageal cancer that requires various preoperative treatments. However, the superiority of MIE's short-term outcomes compared with those of open esophagectomy (OE) has not been definitively established in general clinical practice.
This study included 24,233 esophagectomies for esophageal cancer conducted between 2012 and 2016. Esophagectomy for clinical T4 and M1 stages, urgent esophagectomy, 2-stage esophagectomy, and R2 resection were excluded. The effects of preoperative treatment and surgery on short-term outcomes were analyzed using generalized estimating equations logistic regression analysis.
MIE was superior or equivalent to OE in terms of the incidence of most postoperative morbidities and surgery-related mortality, regardless of the type of preoperative treatment. Notably, MIE performed with no preoperative treatment was associated with significantly less incidence of any pulmonary morbidities, prolonged ventilation ≥48 hours, unplanned intubation, surgical site infection, and sepsis. However, reoperation within 30 days in patients with no preoperative treatment was frequently observed after MIE. The total surgery-related mortality rates of MIE and OE were 1.7% and 2.4%, respectively (P < 0.001). Increasing age, low preoperative activities of daily living, American Society of Anesthesiologists physical status ≥3, diabetes mellitus requiring insulin use, chronic obstructive pulmonary disease, congestive heart failure, creatinine ≥1.2 mg/dL, and lower hospital case volume were identified as independent risk factors for surgery-related mortality.
The results suggest that MIE can replace OE in various situations from the perspective of short-term outcome.
Maintaining frequency stability of low inertia microgrids with high penetration of renewable energy sources (RESs) is a critical challenge. Solving this challenge, the inertia of microgrids would be ...enhanced by virtual inertia control-based energy storage systems. However, in such systems, the virtual inertia constant is fixed and selection of its value will significantly affect frequency stability of microgrids under different penetration levels of RESs. Higher frequency oscillations may occur due to the fixed virtual inertia constant or unsuitable selection of its value. To overcome such a problem and provide adaptive inertia control, this paper proposes a self-adaptive virtual inertia control system using fuzzy logic for ensuring stable frequency stabilization, which is required for successful microgrid operation in the presence of high RESs penetration. In this concept, the virtual inertia constant is automatically adjusted based on input signals of real power injection of RESs and system frequency deviations, avoiding unsuitable selection and delivering rapid inertia response. To verify the efficiency of the proposed control method, the contrastive simulation results are compared with the conventional method for serious load disturbances and various rates of RESs penetration. The proposed control method shows remarkable performance in transient response improvement and fast damping of oscillations, preserving robustness of operation.
This paper presents robust virtual inertia control of an islanded microgrid considering high penetration of renewable energy sources (RESs). In such microgrids, the lack of system inertia due to the ...replacement of traditional generating units with a large amount of RESs causes undesirable influence to microgrid frequency stability, leading to weakening of the microgrid. In order to handle this challenge, the H robust control method is implemented to the virtual inertial control loop, taking into account the high penetration of RESs, thus enhancing the robust performance and stability of the microgrid during contingencies. The controller's robustness and performance are determined along with numerous disturbances and parametric uncertainties. The comparative study between H and optimal proportionalintegral (PI)-based virtual inertia controller is also presented. The results show the superior robustness and control effect of the proposed H controller in terms of precise reference frequency tracking and disturbance attenuation over the optimal PI controller. It is validated that the proposed H -based virtual inertia controller successfully provides desired robust frequency support to a low-inertia islanded microgrid against high RESs penetration.
Background
Skeletal muscle depletion (sarcopenia) is closely associated with limited physical ability and high mortality. This study was performed to evaluate the prognostic significance of skeletal ...muscle depletion in patients with resectable stage I–III colorectal cancer (CRC).
Methods
We conducted a retrospective analysis of 220 consecutive patients with stage I–III CRC who underwent curative resection. The skeletal muscle cross-sectional area was measured by preoperative computed tomography. The lowest sex-specific quartile of skeletal muscle mass was classified as sarcopenia. Factors contributing to recurrence-free survival (RFS) were analyzed by univariate and multivariate Cox proportional hazard models.
Results
Of 220 patients who met our inclusion criteria, 55 (25 %) had sarcopenia. The median follow-up duration was 41.4 months. Patients with sarcopenia were younger and had higher carcinoembryonic antigen levels than patients without sarcopenia. RFS and overall survival (OS) were significantly shorter in patients with sarcopenia than those without (5-year RFS, 56 vs. 79 %, log-rank
p
= 0.006; 5-year OS, 68 vs. 85 %, log-rank
p
= 0.015). Multivariate Cox regression analysis revealed that sarcopenia was independently associated with shorter RFS (hazard ratio HR 2.176; 95 % confidence interval CI 1.200–3.943;
p
= 0.010) and OS (HR 2.270; 95 % CI 1.147–4.494;
p
= 0.019). The influence of sarcopenia on patient outcome was modified by age at surgery (
p
value for interaction = 0.026); sarcopenia was associated with a poor prognosis, especially in young patients (log-rank
p
< 0.001).
Conclusions
Sarcopenia negatively impacts survival in patients undergoing curative resection for stage I–III CRC.
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