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IntroductionTherapeutic treatment for advanced-stage (T2–T4) gastroesophageal junction (GEJ) and gastric cancer involves neoadjuvant chemotherapy with subsequent surgical intervention.MethodNeoadjuvant oncological treatment for GEJ and gastric cancer previously consisted of the intravenous administration of epirubicin, cisplatin and fluorouracil (ECF) or epirubicin, cisplatin and capecitabine (ECX) combination (Group 1). The new protocol (FLOT, F: 5-FU, L: leucovorin, O: oxaliplatin, T: docetaxel), included patients with resectable GEJ and gastric cancer who had a clinical stage cT2 or higher nodal positive cN+ disease (Group 2). Between 31 December 2008 and 31 October 2022, the effect of different oncological protocols in terms of surgical outcomes in cases of T2–T4 tumours were retrospectively evaluated. Results of randomly assigned patients from the earlier ECF/ECX protocol (n = 36) (Group 1) and the new FLOT protocol (n = 52) (Group 2) were compared. Effect of different neoadjuvant therapies on tumour regression, types of possible side effects, type of surgery, and oncological radicality of surgical procedures were analysed.ResultsWhen comparing the two groups, we found that in case of the FLOT neoadjuvant chemotherapy (Group 2, n = 52), complete regression was achieved in 13.95% of patients, whereas in the case of ECF/ECX (Group 1, n = 36), complete regression occurred in only 9.10% of patients. Furthermore, in the FLOT group, the mean number of lymph nodes removed was slightly higher (24.69 vs. 20.13 in the ECF/ECX group). In terms of the safety resection margin (proximal), no significant difference was found between the two treatment groups. Nausea and vomiting were the most common side effects. The occurrence of diarrhea was significantly higher in the FLOT group (p = 0.006). Leukopenia and nausea occurred more commonly with the old protocol (Group 1). The rate of neutropenia was lower following FLOT treatment (p = 0.294), with the lack of grade II and III cases. Anaemia occured at a significantly higher rate (p = 0.036) after the ECF/ECX protocol.ConclusionsAs a result of the FLOT neoadjuvant oncological protocol for advanced gastro-esophageal junction and gastric cancer, the rate of complete tumour regression increased significantly. The rate of side effects was also appreciably lower following the FLOT protocol. These results strongly suggest a significant advantage of the FLOT neoadjuvant treatment used before surgery.

Background: During the last decade, one of the most important treatment options for locally advanced, potencially resectable rectal tumours was neoadjuvant chemoradiotherapy (CRT) followed by surgery.Methods: Effects of the neoadjuvant treatment on surgical outcomes were retrospectively analysed in 185 patients with stage T2–T4 and N0–2, resectable rectal tumour among two patient groups defined by radiosensitizer agents. Group 1 (n = 94) involved radiotherapy (RT) with 50.4 Gy total dose (25 × 1.8 Gy + 3 × 1.8 Gy tumour bed boost), and intravenous 5-fluorouracil (5-FU) (350 mg/m2) with leucovorin (20 mg/m2) on the 1–5 and 21–25 days, while Group 2 (n = 91) RT and orally administrated capecitabine (daily 2 × 825 mg/m2) on RT days. Surgery was carried out after 8–10 weeks. Side effects, perioperative complications, type of surgery, number of removed regional lymph nodes, resection margins and tumour regression grade (TRG) were analysed.Results: More favourable side effects were observed in Group 2. Despite the same rate of diarrhoea (Group 1 vs. Group 2: 54.3% vs. 56.0%), Grade 2–3 diarrhoea ratio was lower (p = 0.0352) after capecitabine (Group 2). Weight loss occurred in 17.0% and 2.2% (p = 0.00067), while nausea and vomiting was described in 38.3% and 15.4% (p = 0.00045) with 5-FU treatment and capecitabine respectively. Anaemia was observed in 33.0% and 22.0% (p = 0.0941). Complete tumour regression occurred in 25.3% after oral- and 13.8% after intravenous treatment (p = 0.049). Ratio of sphincter preservation was higher with laparoscopy than open surgery (72.3% vs. 39.7%) (p = 0.00001).Conclusion: The study confirms advantages of neoadjuvant chemoradiotherapy with oral capecitabine for rectal tumours, such as more favourable side effect profile and overall clinical outcome, with increased rate of complete tumour regression.

Abstract Background Our aim is to determine the relationships among patient demographics, patient history, surgical experience, and conversion rate (CR) during elective laparoscopic cholecystectomies (LCs). Methods We analyzed data from patients who underwent LC surgery between 2005 and 2014 based on patient charts and electronic documentation. CR (%) was evaluated in 4013 patients who underwent elective LC surgery. The relationships between certain predictive factors (patient demographics, endoscopic retrograde cholangiopancreatography (ERCP), acute cholecystitis (AC), abdominal surgery in the patient history, as well as surgical experience) and CR were examined by univariate analysis and logistic regression. Results In our sample (N = 4013), the CR was 4.2%. The CR was twice as frequent among males than among females (6.8 vs. 3.2%, p 65 years), previous ERCP, and upper abdominal surgery or history of AC affected the likelihood of conversion. More surgical experience and high surgery volume were not associated with a lower CR prevalence.

Abstract Background Leiomyoma is the most common benign oesophageal tumour. Half of all leiomyoma patients have oesophagus-associated complaints, such as dysphagia and epigastric pain, and the other 50% are asymptomatic with a diagnosis made on incidental discovery. Endoscopic ultrasonography is essential for an accurate preoperative workup and can enable guided-tissue acquisition for immunohistochemistry in certain cases. Smaller tumours are amenable to traditional and novel endoscopic removal in specialized centres, but some complex cases require surgical enucleation with a minimally invasive approach. Case presentation An asymptomatic 60-year-old woman was accidentally diagnosed with a bifocal oesophageal mass, which was discovered by chest computed tomography. We report a rare case of a duplicated lower-third oesophageal leiomyoma, which was completely removed via the laparoscopic transhiatal approach. The patient has recovered successfully from the surgery. She has been followed up for six months with a normal oesophagram, adequate oesophageal function and no complaints observed. Pathological examination confirmed the diagnosis of leiomyoma in both lesions. Conclusions To the best of our knowledge, this is the first reported case of duplex oesophageal leiomyomas removed laparoscopically. Using the minimally invasive abdominal technique, the lower oesophagus can be mobilised to the mediastinum without pleura injury and offers a good alternative to the thoracoscopic approach in patients with possible intrathoracic difficulties. At experienced centres, laparoscopic transhiatal enucleation of lower oesophageal leiomyomas and other benign tumours with a combination of intraoperative oesophagoscopy is a safe, fast and effective operation.

This text is based on the recommendations accepted by the 4th Hungarian Consensus Conference on Breast Cancer, modified on the basis of the international consultation and conference within the frames of the Central-Eastern European Academy of Oncology. The recommendations cover non-operative, intraoperative and postoperative diagnostics, determination of prognostic and predictive markers and the content of cytology and histology reports. Furthermore, they address some specific issues such as the current status of multigene molecular markers, the role of pathologists in clinical trials and prerequisites for their involvement, and some remarks about the future.

Abstract Background Treating hernias is one of the oldest challenges in surgery. The gallbladder as content in the case of abdominal hernias has only been reported in a few cases in the current literature. Cholecyst has only been described in the content of an inguinofemoral hernia in one case to date. Case presentation A 73-year-old female patient was admitted to the Emergency Department due to complaints in the right inguinal area, which had started 1 day earlier. The patient complained of cramp-like abdominal pain and nausea. Physical examination confirmed an apple-sized, irreducible hernia in the right inguinal region. Abdominal ultrasound confirmed an oedematous intestinal loop in a 70-mm-long hernial sac, with no circulation detected. Abdominal X-ray showed no signs of passage disorder. White blood cell count and C-reactive protein level were elevated, and hepatic enzymes were normal in the laboratory findings. Exploration was performed via an inguinal incision on the right side, an uncertain cystic structure was found in the hernial sac, and several small abnormal masses were palpated there. The abdominal cavity was explored from the middle midline laparotomy. During the exploration, the content of the hernial sac was found to be the fundus of the significantly ptotic, large gallbladder. Cholecystectomy and Bassini’s repair of the inguinal hernia were performed safely. Conclusions Following a review of the literature, it can be concluded that the finding of incarcerated gallbladder in the content of an inguinal hernia is a rare finding. No other similar emergency case and successful surgical intervention have been reported before.

Abstract Backgrounds The number of appendectomies and cholecystectomies performed is gradually increasing worldwide. An increasing incidence of colorectal cancer (CRC) after appendectomy and cholecystectomy has been reported, but the location of tumors in certain segments of the colon and rectum after appendectomy and cholecystectomy is still uncertain. We aimed to evaluate the distribution of the locations of colorectal cancer after appendectomy and/or cholecystectomy in patients who underwent CRC surgery. Methods We reviewed the medical records of patients who had undergone CRC surgery between 2015 and 2017 for the presence of previous appendectomy/cholecystectomy. Data were collected from the Colorectal Data Base of the University of Szeged, Department of Surgery. Results Surgery for CRC was performed in 640 patients during the study period. Data of 604 patients were analyzed. Appendectomy was performed in 100 patients (16.6%), cholecystectomy in 65 (10.8%), and both interventions in 18 (3%) before the CRC surgery. Out of those patients who underwent appendectomy alone, 92 (92%) had undergone appendectomy more than 10 years before the CRC surgery. Also in these 100 patients, the prevalence of right-sided colon cancer (CC) was 35% (n = 35), in comparison with the prevalence among the 504 other patients (20.4%, n = 103). The prevalence of right-sided CC among patients who underwent cholecystectomy alone was 36.9% (n = 24), in comparison with 21.2% (n = 114) of the 539 other patients. Conclusions A significant left to right side shift in CRC was noted among patients who had previously undergone appendectomy/cholecystectomy. Because right-sided CC has a worse prognosis, the role of incidental appendectomy and routine cholecystectomy seems that need re-evaluation.

Synchronous motors are essential in various industrial and commercial applications because of their efficiency and constant speed operation. Accurate modelling of these motors is crucial for optimizing performance, control, and maintenance. Traditional modelling methods, such as the d-q reference frame method, often fall short in terms of complexity and accuracy, especially under dynamic conditions. This study aims to enhance synchronous motor modelling using machine learning algorithms, specifically focussing on predicting the excitation current, a critical parameter for motor performance. In this research, a dataset comprising synchronous motor operational parameters was analysed using various machine learning techniques. The primary methods evaluated include regression and M5 algorithms. The evaluation criteria were the time required to build and test the models and the accuracy of their predictions. Our findings indicate that both the regression and M5 algorithms significantly outperform traditional methods, providing more precise and efficient models for synchronous motor behaviour under diverse operating conditions.

As a result of the Coronavirus, both supply chain and internal logistics processes at factories have changed a lot. In many areas, the effectiveness of the logistics processes has declined because of the restrictions implemented against the virus. The study lists some adverse effects where logistics processes had to be modified due to the changing and protection measures against or negative effects of the virus. The authors also argue that these restrictions decreased the efficiency of logistics processes and workers' productivity. One option to increase the logistics sector's efficiency is to use air purification technologies, like the ones studied in this paper: UV-C, Bioxygen® or plasma-ion decontamination technologies. These disinfection processes can create a safe indoor environment. The authors analyse the examined technologies with SWOT analysis. The analysis results demonstrate which disinfection application is the most beneficial to help in improving indoor air quality for logistics processes.

Critical thinking disposition (CTD), as a facet of the critical thinking (CT) framework, is regarded as the activation of critical thinking skills (CTS). Although studies regarding gender difference of CTD can be found, there is a scarcity of studies on the relationships among CTD components and their mediating effects concerning gender. Additionally, traditional gender comparison of latent means neglected the influence of scales, which leads to doubt about the results on whether the difference is caused by scales or gender characteristic distinction. Measurement invariance (MI) is suggested to be confirmed before performing comparisons. Previous research has had fewer MI results for CTD inventories. Thus, this study aims to analyze the gender equality of the Employer–Employee–Supported Critical Thinking Disposition Inventory (2ES-CTDI) as well as the moderated mediating effects of gender on the components of CTD among 661 Chinese undergraduates (Mage = 19.57; SD = 1.26) via MI and Partial Least Squares Structural Equation Modeling (PLS-SEM) by Mplus and STATA. The results found that (a) the scale has high reliability and validity for measuring undergraduates’ CTD. MI findings indicated that the configural and metric models were achieved, and the scalar model identified the partial invariance by freeing the intercepts of indicators A5, C7, and C8; (b) Girls have stronger self-efficacy and habitual truth-digging disposition, whereas boys have higher instant judgment; (c) Instant judgment has a negative influence on habitual truth-digging with self-efficacy as the competitive partial mediator, in which, gender moderated the relationship between instant judgment and self-efficacy. These findings, theoretically, proved the stability of the CTD framework of 2ES-CTDI, and practically, call for instructors to pay closer attention to the gender role in CTD cultivation.

Abstract All approaches currently used to study finite baryon density lattice QCD suffer from uncontrolled systematic uncertainties in addition to the well-known sign problem. We formulate and test an algorithm, sign reweighting, that works directly at finite μ = μ B /3 and is yet free from any such uncontrolled systematics. With this algorithm the only problem is the sign problem itself. This approach involves the generation of configurations with the positive fermionic weight |Re det D(μ)| where D(μ) is the Dirac matrix and the signs sign(Re det D(μ)) = ±1 are handled by a discrete reweighting. Hence there are only two sectors, +1 and −1 and as long as the average 〈±1〉 ≠ 0 (with respect to the positive weight) this discrete reweighting by the signs carries no overlap problem and the results are reliable. The approach is tested on N t = 4 lattices with 2 + 1 flavors and physical quark masses using the unimproved staggered discretization. By measuring the Fisher (sometimes also called Lee-Yang) zeros in the bare coupling on spatial lattices L/a = 8, 10, 12 we conclude that the cross-over present at μ = 0 becomes stronger at μ > 0 and is consistent with a true phase transition at around μ B /T ∼ 2.4.

The aims of the study were (1) to develop a domain-general computer-based assessment tool for inductive reasoning and to empirically test the theoretical models of Klauer and Christou and Papageorgiou; and (2) to develop an online game to foster inductive reasoning through mathematical content and to investigate its effectiveness. The sample was drawn from fifth-grade students for the assessment (N = 267) along with the intervention study (N = 122). The online figurative test consisted of 54 items: nine items were developed for each of the six inductive reasoning processes. The digital game-based training program included 120 learning tasks embedded in mathematical content with differential feedback and instructional support. The test had good psychometric properties regarding reliabilities, means, and standard deviations. Confirmatory factor analyses revealed that the six processes of inductive reasoning and the three latent factors of Similarity, Dissimilarity, and Integration could be empirically confirmed. The training program was effective in general (corrected effect size = .38); however, the process of cross-classification was not developed significantly. Findings could contribute to a more detailed understanding of the structure and the modifiability of inductive reasoning processes and could reveal further insights into the nature of fluid intelligence.

The aims of the study are to construct an online instrument to assess different aspects of morphological awareness and to examine its development and its relation to reading comprehension in grades 2–4 in Hungarian children. Altogether, 4134 students were tested. The online test evaluated inflectional, derivational, and compound morphological skills with five subtests. The instrument proved to be reliable. CFA examinations revealed that the five subtests were empirically distinguishable dimensions. Inflectional, derivational, and compound morphology as the three main dimensions of morphological awareness were also empirically supported by our data. Morphological awareness skills improved significantly and developed in parallel with reading skills throughout grades 2–4. The increase in the development of morphological awareness from grade 2 to grade 3 tends to be faster than the growth between grade 3 and 4. Positive moderate correlations were found between morphological skills and reading comprehension and the relationships seem to be stable throughout the three grades. The most significant predictor of reading comprehension is the Affix Identification for Nonwords subtest. Our study showed that morphological awareness could be assessed efficiently through online media and drew attention to the importance of morphological awareness in the development of reading comprehension and linguistic intelligence.

Most lattice studies of hot and dense QCD matter rely on extrapolation from zero or imaginary chemical potentials. The ill-posedness of numerical analytic continuation puts severe limitations on the reliability of such methods. We studied the QCD chiral transition at finite real baryon density with the more direct sign reweighting approach. We simulate up to a baryochemical potential-temperature ratio of $\mu_B/T=2.7$, covering the RHIC Beam Energy Scan range, and penetrating the region where methods based on analytic continuation are unpredictive. This opens up a new window to study QCD matter at finite $\mu_B$ from first principles.

In this study, we examined how situational interest, self-efficacy, and performance predict each other during task engagement, and how they, in turn, contribute to continued interest. Finnish fourth-graders (N = 263) did a computerized inductive reasoning task consisting of two sections. Before and after each section, the students reported their situational interest and self-efficacy, and at the end of the task, students stated whether they would like to do similar tasks again (i.e., continued interest). Students’ domain-specific interest and self-concept in mathematics, and gender differences were controlled. A cross-lagged reciprocal effects model with repeated measures, control variables, and outcomes within the structural equation modeling framework was estimated. The results showed situational interest to have a stronger effect on self-efficacy than vice versa, and that they both partly contributed to task performance. Continued interest was influenced only by situational interest at the end of the task. The patterning of predictions across the different stages of the task suggests these effects to be somewhat sensitive to task characteristics.

Abstract We calculate several diagonal and non-diagonal fluctuations of conserved charges in a system of 2+1+1 quark flavors with physical masses, on a lattice with size 483 × 12. Higher order fluctuations at μ B = 0 are obtained as derivatives of the lower order ones, simulated at imaginary chemical potential. From these correlations and fluctuations we construct ratios of net-baryon number cumulants as functions of temperature and chemical potential, which satisfy the experimental conditions of strangeness neutrality and proton/baryon ratio. Our results qualitatively explain the behavior of the measured cumulant ratios by the STAR collaboration.

In this article we try to show how new devices and methods can help in the education of programming. At Kecskemét College programmable mobile robots and instead of behavioral, the constructivist pedagogical methods were used. Our experiments have proved our hypothesis as the improved new methodical education using devices can give more practical programming knowledge, increases the attitude towards programming and helps to have positive programming self-image. The results of the experimental and control groups were compared at the beginning and at the end of semester, when the programming knowledge and motives were measured. During the learning process only the experimental groups used devices and new methods.

A Reid és a Peace modell összehasonlításával a szerzők áttekintést nyújtanak a kihallgatási módszerekről.

With advances in endoscopic technologies, endoscopic clips have been used widely and successfully in the treatment of various types of oesophageal perforations, anastomosis leakages and fistulas. Our aim was to summarize the experience with two types of clips: The through-the-scope (TTS) clip and the over-the-scope clip (OTSC). We summarized the results of oesophageal perforation closure with endoscopic clips. We processed the data from 38 articles and 127 patients using PubMed search. Based on evidence thus far, it can be stated that both clips can be used in the treatment of early (< 24 h), iatrogenic, spontaneous oesophageal perforations in the case of limited injury or contamination. TTS clips are efficacious in the treatment of 10 mm lesions, while bigger (< 20 mm) lesions can be treated successfully with OTSC clips, whose effectiveness is similar to that of surgical treatment. However, the clinical success rate is significantly lower in the case of fistulas and in the treatment of anastomosis insufficiency. Tough prospective randomized multicentre trials, which produce the largest amount of evidence, are still missing. Based on experience so far, endoscopic clips represent a possible therapeutic alternative to surgery in the treatment of oesophageal perforations under well-defined conditions.