Search

Gastro-oEsophageal Cancers (GECs) are severe diseases whose management is rapidly evolving. The European Society of Surgical Oncology (ESSO) is committed to the generation and spread of knowledge, and promotes the multidisciplinary management of cancer patients through its core curriculum. The present work discusses the approach to GECs, including the management of oligometastatic oesophagogastric cancers (OMEC), the diagnosis and management of peritoneal metastases from gastric cancer (GC), the management of Siewert Type II tumors, the importance of mesogastric excision, the role of robotic surgery, textbook outcomes, organ preserving options, the use of molecular markers and immune check-point inhibitors in the management of patients with GECs, as well as the improvement of current clinical practice guidelines for the management of patients with GECs. The aim of the present review is to provide a concise overview of the state-of-the-art on the management of patients with GECs and, at the same time, to share the latest advancements in the field and to foster the debate between surgical oncologists treating GECs worldwide. We are sure that our work will, at the same time, give an update to the advanced surgical oncologists and help the training surgical oncologists to settle down the foundations for their future practice. [ABSTRACT FROM AUTHOR]

Byline: Hossein Azadi (a), Mansour Shahvali (a), Jan van den Berg (b), Nezamoddin Faghih (c) Keywords: Sustainable rangeland management; Carrying capacity; Multi-fuzzy model; Heterogeneous experts' knowledge; Voting methods Abstract: While fuzzy specialists commonly use homogeneous experts' knowledge to construct fuzzy models, it is much more difficult to deal with knowledge elicited from a heterogeneous group of experts. This issue is exemplified in the area of sustainable rangeland management (SRM). One way to deal with the diversity of opinions is to develop a fuzzy system for all experts and to combine all these, the so-called primary systems, into one multi-fuzzy model. To derive each of the primary fuzzy systems, several semi-structured interviews were held in three different areas of the Fars province in Southwest Iran using the knowledge of a group of administrative experts. To obtain the final output of the multi-fuzzy model, we applied different 'voting' methods. The first method simply uses the arithmetic average of the primary outputs as the final output of the multi-fuzzy model. This final output represents an estimation of the right rate of stocking (RRS). We also propose other (un)supervised voting methods. Most importantly, by harmonising the primary outputs such that outliers get less emphasis, we introduce an unsupervised voting method for calculating a weighted estimate of the RRS. This harmonising method is expected to provide a new useful tool for policymakers dealing with heterogenity in experts' opinions: it is especially useful where limited field data are available and one is forced to rely on experts' knowledge only. By constructing the three fuzzy models based on the elicitation of heterogeneous experts' knowledge, our study shows the multidimensional vaguenesses that exist in SRM. Finally, by comparing the final RRS with its common values, this study strongly points to the existence of overgrazing in pastures in the three regions of the Fars province in Southwest Iran. Author Affiliation: (a) Agricultural Extension and Education Department, Shiraz University, Shiraz, Iran (b) Department of Computer Science, Erasmus University, Rotterdam, The Netherlands (c) Economic Department, Shiraz University, Shiraz, Iran Article History: Received 16 March 2005; Revised 21 March 2006; Accepted 24 March 2006

Background Failed laparoscopic adjustable gastric banding (LAGB) can be converted to laparoscopic Roux-and-Y gastric bypass (LRYGB), which is currently the gold standard for bariatric surgery. Revisional LRYGB (rLRYGB) is associated with inferior results compared with primary LRYGB (pLRYGB), but the exact influence of the initial response to LAGB is unclear. Objectives To compare follow-up outcomes after pLRYGB with rLRYGB in nonresponders of LAGB and rLRYGB in responders of LAGB. Setting General-community teaching hospital, Rotterdam, the Netherlands. Methods All patients who underwent pLRYGB and rLRYGB after LAGB were reviewed in an observational study. Postoperative outcomes, excess weight loss, total weight loss, and success and failure rate were compared in patients after pLRYGB and rLRYGB (both responders and nonresponders of LAGB) at 12, 24, and 36 months. Results A total of 1285 primary patients, 96 nonresponders, and 120 responders were included. The median follow-up was 33.9±18.0 months. After 36 months, the mean percentage excess weight loss was significantly lower in the nonresponding group compared with the responding and primary groups (48.1% versus 58.2% versus 72.8%, P <.001); the total weight loss showed the same trend. The success rate was 38.2% versus 61.0% versus 81.6% respectively, P <.001. The failure rate was significantly higher after rLRYGB compared with pLRYGB (10.9% nonresponders, 8.5% responders, and 2.5% primary, P = .001). Conclusion Nonresponders of LAGB show inferior weight loss results after rLRYGB compared with responders of LAGB and pLRYGB at all moments of follow-up. [ABSTRACT FROM AUTHOR]

Most research in social networks has focused on the assumption that unknown entities are malicious and thus the traditional approach was to detect them and deny their access to sensitive data. In this paper, we propose a new computational model that helps users predict security risks associated with their information sharing on social networks. The model is based on the assumption that a risk indicator value can be predicted by assessing a number of risk attributes using a neuro-fuzzy technique. A disclosure decision is made based on this risk indicator value. The approach was tested in a real prototype of a social mobile service at a university campus. Further, we show how the model can be implemented in a popular social rating site. Results obtained show the relevance and effectiveness of the proposed approach in predicting risks and in deciding up on it about disclosure decisions in social pervasive applications. [ABSTRACT FROM AUTHOR]

Objective: To determine the optimal cutoff scores for the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) with regard to predicting no, poor, limited, notable, or full upper-limb capacity according to frequently used cutoff points for the Action Research Arm Test (ARAT) at 6 months poststroke. Design: Prospective. Setting: Rehabilitation center. Participants: Patients (N = 460) with a first-ever ischemic stroke at 6 months poststroke. Interventions: Not applicable. Main Outcome Measures: Based on the ARAT classification of poor to full upper-limb capacity, receiver operating characteristic curves were used to calculate the area under the curve, optimal cutoff points for the FMA-UE were determined, and a weighted kappa was used to assess the agreement. Results: FMA-UE scores of 0 through 22 represent no upper-limb capacity (ARAT 0--10); scores of 23 through 31 represent poor capacity (ARAT 11-21); scores of 32 through 47 represent limited capacity (ARAT 22-42); scores of 48 through 52 represent notable capacity (ARAT 43-54); and scores of 53 through 66 represent full upper-limb capacity (ARAT 55--57). Overall, areas under the curve ranged from .916 (95% confidence interval [CI], .890-.943) to .988 (95% CI, .978-.998; P<.00\). Conclusions: There is considerable overlap in the area under the curve between the ARAT and FMA-UE. FMA-UE scores >31 points correspond to no to poor arm-hand capacity (ie, ≤21 points) on the ARAT, whereas FMA-UE scores >31 correspond to limited to full arm-hand capacity (ie, ≥22 points) on the ARAT. [ABSTRACT FROM AUTHOR]

Summary: Background: No consensus exists on the exact treatment of pneumothorax (PTX). Some guidelines are proposing manual aspiration (MA) to be preferred over tube thoracostomy (TT) in uncomplicated primary spontaneous pneumothorax (PSP). However, only a few studies reported a direct comparison of both methods. Our aim was to re-evaluate this with a randomised trial in a single centre in the Netherlands. Methods: Patients with a first episode of symptomatic PTX admitted to the ER or asymptomatic PTX with a size of ≥20% were recruited during 2007–2009 and followed-up for one year. Randomisation between MA and TT was balanced by a computer minimisation program for cause of PTX, smoking and gender. When first MA attempt failed, a second attempt was not undertaken and patients underwent TT. (registered at ClinicalTrials.gov (NCT00556335). Results: 56 patients were included. Baseline characteristics were similar. Immediate success rates were 68.0% for MA versus 80.6% for TT (p = 0.28). Two week success rates were 100% in both groups. There was a significant difference in hospital stay in favour of MA: 2.4 ± 2.6 versus 4.4 ± 3.3 days (p = 0.02). One year recurrence rates in MA were lower than in TT, although not statistically significant (4.0% and 12.9% p = 0.37). Predictors of immediate success were traumatic PTX and female sex. One patient died during follow-up due to heart failure. Conclusion: MA is simple, safe, cheap, minimal invasive in uncomplicated PSP/traumatic PTX with similar success and recurrence rates and a shorter hospital stay in comparison to TT and therefore the treatment of choice. [Copyright &y& Elsevier]

Abstract: Velthuis MJ, Peeters PH, Gijsen BC, van den Berg JP, Koppejan-Rensenbrink RA, Vlaeyen JW, May AM. Role of fear of movement in cancer survivors participating in a rehabilitation program: a longitudinal cohort study. Objective: To study the relationship between fear of movement and perceived global health status and the role of rehabilitation with graded activity in cancer survivors. Design: Longitudinal cohort study. Setting: Rehabilitation centers. Participants: Cancer survivors (N=1236). Intervention: Twelve-week graded activity rehabilitation program. Main Outcome Measures: Fear of movement (Modified Tampa Scale for Kinesiophobia-Fatigue), fatigue (Functional Assessment of Cancer Therapy-Fatigue), and perceived global health status (European Organisation Research and Treatment of Cancer Quality of Life Questionnaire C30) were measured at baseline and after rehabilitation. We performed multiple linear regression analyses to examine the association between fear of movement and perceived global health status at baseline. Differences between baseline and postintervention scores were assessed with a paired t test and effect sizes (ESs). Hierarchical multiple regression analyses were used to investigate whether changes in fear of movement were associated with perceived global health status. Results: Fear of movement was associated with perceived global health status prior to rehabilitation (P=.001). Only participants with high scores on baseline fear of movement showed a considerable decrease in fear of movement after rehabilitation (ES=–.69; 95% confidence interval [CI], −.80 to −.57); the reduction was largest for fears because of a somatic focus (ES=–.57; 95% CI, −.68 to −.45). Changes in fear of movement because of a somatic focus were related to perceived global health status postintervention (P=.001). Conclusions: Fear of movement is associated with the perceived global health status of cancer survivors. Fear of movement decreases after rehabilitation with graded activity in high scorers on baseline fear of movement. [Copyright &y& Elsevier]

Abstract: An important paradigm in decision-making models is utility-maximization where most models do not include actors’ motives. Fuzzy set theory on the other hand offers a method to simulate human decision-making. However, the literature describing expert-driven fuzzy logic models, rarely gives precise details on the methodology (to be) used. To fill the gap, this paper describes a methodology of 10 steps to model individual actor’s drivers, motives, hereby taking into account the ecological, social and economic context. Testing the methodology on the composition of mixed farming systems in the Mekong Delta, Vietnam, showed that manual model development is not a waterfall approach but requires feedback loops, except for model implementation. Using feed-back loops, the proposed 10 step method allowed to include human drivers and motives other than utility-maximization and to maintain a degree of transparency hard to achieve when using automated procedures. [Copyright &y& Elsevier]

• Computational Chemistry can be used to identify alternative catalysts materials. • The NiCo 3 alloy is electronically similar to pure Co. • Co-Ni alloy catalysts for Fischer-Tropsch synthesis were made and characterized. • Co-Ni alloy catalysts perform similar to Co up to 25% Ni content. The low temperature Fischer-Tropsch (FT) synthesis reaction is commercially performed on either Fe- or Co-based systems, while Ni-based systems are not considered due to a poor selectivity profile. This study focuses on alternative bimetallic catalytic materials for FT in which both Co and Ni are present. Co-Ni based alloys have been identified as a possible FT synthesis catalyst through a separate, DFT based computational chemistry screening approach of various bimetallic alloys based on the similarity of their underlying calculated electronic structures to that of Co. Based on this screening result and a cost filtering, several supported catalysts have been prepared with varying Co:Ni ratios. These catalysts have been characterised with various techniques (TPR, EDS, EELS, Magnetic measurements) to assess whether these catalysts indeed show Co-Ni alloy formation. These materials were also tested for FT synthesis activity, showing that the selectivities of the Co-Ni alloys are similar to that of pure Co up to a nickel content of 25%. It was also concluded that the computational screening approach can be used to execute predictive metal screening. [ABSTRACT FROM AUTHOR]

Background Despite growing evidence on safe and feasible outpatient treatment for acute pulmonary embolism (PE), the majority of patients is still treated in an inpatient setting. This is probably due to a lack of clear guidelines on this subject. Objectives To evaluate safety and patient reported outcome measures (PROM) on outpatient treatment of acute PE. Methods We conducted a prospective cohort study. 250 patients presenting with acute PE and Pulmonary Embolism Severity Index (PESI) class I or II were enrolled. Safety of outpatient treatment was assessed by measuring all-cause mortality, recurrent venous thromboembolism (VTE) and episodes of relevant bleeding, with a follow-up period of four weeks and six months. Additionally, PROM's on outpatient treatment were evaluated by repeatedly measuring VAS-scores for pain and dyspnea during the recovery, and by assessing the improvement in SF-36 scores between admission and after six months. Results We found an all-cause mortality rate of 0.4% (95% CI 0.07–2.23), rate of recurrent VTE of 0% (95% CI 0–1.51) and rate of relevant bleeding episodes of 6.4% (95% CI 3.98–10.14). VAS-scores improved significantly during the first 24-h after admission, and continued to improve significantly after five days of home treatment. SF-36 scores on 6 out of 8 domains improved significantly between admission and after six months. Conclusions Our study shows that outpatient treatment is safe in selected low-risk patients based on their PESI score. Additionally, our data on patient reported outcome measures support the presumption of a good course of recovery during outpatient treatment. [ABSTRACT FROM AUTHOR]

The article applies an incentive-motivation model to sexual violence. It suggests that insights can be gained by looking at the biopsychological processes that underlie ‘conventional behavior’. It argues that sexual violence, as in rape, arises from a fusion between (i) sexual motivation and (ii) sensation-seeking and varying strengths of dominance/aggression motivations. The excitatory part of the motivational system is rooted in brain dopamine and sexual violence is expressed in behavior when excitation exceeds inhibition. The assumptions are framed within the principle of the hierarchical control of behavior. The incentive-motivation and hierarchical framework can yield insights into such phenomena as planning and impulsivity, future discounting, habituation and escalation, violence as addiction, the role of fetishes, sexual fantasy, stress, drugs and brain development. [ABSTRACT FROM AUTHOR]

We live in a world that is being driven by data. This leads to challenges of extracting and analyzing knowledge from large volumes of data. An example of such a challenge is intrusion detection. Intrusion detection data sets are characterized by huge volumes, which affects the learning of the classifier. So there is a need to reduce the size of the training sets. Fortunately, inspection and analysis of available intrusion detection data sets showed that many instances are very similar and do not provide relevant information to the classification process. This prompted to look for possibilities to use a fast algorithm that, as much as possible, removes similar instances in intrusion detection data sets while enforcing the detection rate. In this work, a new fast instance reduction algorithm is presented. The proposed algorithm provides greater efficiency during the training stage, without significantly affecting the efficacy during the intrusion detection task. [Display omitted] • A novel fast instance reduction algorithm for intrusion detection is presented. • Includes the k-Means algorithm as part of the strategy to select similar instances. • Efficiently identifies similar instances to be removed from the data set. • Provides better efficacy and efficiency than other reported algorithms. • Shows good performance with low computing resources. [ABSTRACT FROM AUTHOR]

Abstract: One of the factors negatively influencing the outcome after kidney transplantation is ischemia-reperfusion (I/R) injury. Preoperative fasting is able to confer protection against I/R injury. We hypothesized that the protection imposed by preoperative fasting is mediated by increased levels of acylated ghrelin. Male C57BL/6 mice, 10 to 12 weeks old, were fasted for 1, 2, or 3 days, after which, acylated ghrelin levels were determined. Ad libitum fed mice were injected with acylated ghrelin or phosphate-buffered saline before renal I/R injury. Furthermore, mice were fasted for 3 days during which they were injected with a growth hormone secretagogue receptor antagonist, to block the effects of ghrelin, or a vehiculum. Bilateral renal I/R injury was induced by clamping the artery and vein of the left and right kidney simultaneously for 37 minutes. Kidney function was assessed by means of serum urea values determined at 24 and 48 hours after reperfusion. Fasting significantly increased acylated ghrelin serum levels. Ghrelin suppletion in ad libitum fed animals or ghrelin receptor blockade in fasted animals did not affect renal function after I/R injury. Our data suggest that the increased levels of acylated ghrelin induced by fasting do not mediate its protection against renal I/R injury. [ABSTRACT FROM AUTHOR]

Context: Metastatic lung cancer is an incurable disease that results in a high burden of symptoms, a poor quality of life, and an expected prognosis of less than one year after diagnosis. Treatment shortly before death may result in potential burdensome and inappropriate hospital admissions and hospital deaths. Dying at home is, at a population level, considered a quality for good end-of-life care.Objectives: We examined what percentage of patients with metastatic lung cancer died inside the hospital and if hospital death, or other characteristics of the patient, oncologist or health care, were associated with treatment in the last month of life.Methods: This retrospective cohort study evaluated the medical records of 1322 patients with metastatic lung cancer who received care at one of 10 hospitals across The Netherlands and died between 1/6/2013 and 31/7/2015. Demographic and clinical characteristics were obtained from the medical records.Results: In total, 18% of the patients died during a hospital admission. This percentage was higher for patients who received chemotherapy (42%) or targeted therapy with tyrosine kinase inhibitors (25%) in the last month of life. Patients younger than 60 years of age, patients who received chemotherapy in the last month of life, and patients in whom tyrosine kinase inhibitors were started in the last month of life were more likely to die inside the hospital.Conclusion: In The Netherlands, fewer than one in five patients with metastatic lung cancer died in the hospital and in-hospital death was associated with the relatively late use of chemotherapy or targeted therapy. Careful selection of patients for disease-modifying therapy might enhance the opportunity for patients to die at their preferred place. [ABSTRACT FROM AUTHOR]

In the last few years, the telecommunications scenario has experienced an increase in the volume of information generated, as well as in the execution of malicious activities. In order to complement Intrusion Detection Systems (IDSs), data mining techniques have begun to play a fundamental role in data analysis. On the other hand, the presence of useless information and the amount of data generated by telecommunication services (leading to a huge dimensional problem), can affect the performance of traditional IDSs. In this sense, a data preprocessing strategy is necessary to reduce data, but reducing data without affecting the accuracy of IDSs represents a challenge. In this paper, we propose a new data preprocessing strategy which reduces the number of features and instances in the training collection without greatly affecting the achieved accuracy of IDSs. Finally, our proposal is evaluated using four different rule-based classifiers, which are tested on real scan and backscatter data collected by a network telescope. [ABSTRACT FROM AUTHOR]

The incidence of skin cancers of the basal and squamous cell types is extremely low among genetically black-skinned human beings, whereas these types of skin cancers are common among Caucasians, especially those who live in geographic areas of high sun exposure. Ultraviolet B light (UVB) is thought to be the primary oncogenic agent in sunlight. We have recently demonstrated that acute, low-dose exposure of Caucasian skin to UVB impairs the inducting of contact hypersensitivity to dinitrochlorobenzene (DNCB) in approximately 40% of normal individuals. Importantly, this trait -- termed UVB susceptibility--was found to be characteristic of virtually 100% of patients with a history of biopsy-proved skin cancer, implying that UVB susceptibility may be a risk factor for this disease. Because melanin pigment is thought to he protective of some of the deleterious effects Of UVB radiation, we have examined the capacity of a low-dose regimen of UVB to alter induction of contact hypersensitivity in individuals with genetically melanized or heavily tanned skin. Our results indicate that UVB radiation depletes heavily pigmented skin of Langerhans cells, just as it does in Caucasian skin. Moreover, UVB-susceptibility exists as a polymorphic trait in individuals with genetically determined black skin, as well as in individuals with heavily tanned skin, and the incidence of this trait is similar to that found among normal Caucasian subjects. Thus, melanin does not appear to protect against the deleterious effects of an acute, low-dose regimen of UVB on induction of cutaneous immunity, and the UVB susceptibility trait is equally well-represented in both black- and Caucasian-skinned individuals. We conclude that although UVB susceptibility may function as a risk factor for skin cancer in Caucasians, it does not function similarly in black-skinned human beings, probably because melanin effectively protects against the mutagenic properties of UVB radiation. [ABSTRACT FROM AUTHOR]

Normal, healthy human volunteers and patients with proved history of non-melanoma skin cancer have been tested for their capacity to develop contact hypersensitivity to dinitrochlorobenzene (DNCB) following exposure of buttock skin to acute, low-dose ultraviolet B (UVB) radiation. Using a radiation protocol that achieves virtually complete depletion of normal-appearing Langerhans cells from irradiated skin, it was learned that approximately 60% of healthy volunteers developed vigorous contact hypersensitivity (CH) when 2000 μg DNCB was painted on the irradiated site. These individuals were designated UVB-resistant, and were distinguished from other individuals, designated UVB-susceptible, who failed to develop contact hypersensitivity following an identical treatment protocol. It was then discovered that virtually all (92%) skin cancer patients exposed to UVB and DNCB failed to develop CH, i.e., were UVB-susceptible. In subsequent experiments, epicutaneous application of 2000 μg DNCB to unirradiated skin of UVB-susceptible individuals revealed a further distinction between normal persons and skin cancer patients. Approximately 45%ot the latter (and none of the former) remained unresponsive (failed to develop contact hypersensitivity following this second attempt at sensitization), implying that they had been rendered immunologically tolerant. These tolerant individuals responded normally to the unrelated hapten, diphencyprone. We conclude that human beings resemble inbred strains of laboratory mice in that some individuals are UVB- susceptible, whereas others are UVB-resistant. Because the incidence of UVB-susceptibility was significantly higher in skin cancer patients, and as specific unresponsiveness could be demonstrated only in these patients, we propose that UVB- susceptibility, as we define it in this hapten system, may be a risk factor for the development of skin cancer. [ABSTRACT FROM AUTHOR]

Older patients with chronic obstructive pulmonary disease (COPD), hospitalized for an acute exacerbation, often do not receive recommended post-acute pulmonary rehabilitation. This underuse might be related to the impaired clinical and functional status of these patients, who are more likely to present with frailty, comorbidities, and disability. Having developed and implemented a geriatric rehabilitation program for these patients (GR_COPD), the primary aim of this study was to investigate the effectiveness of this program. A prospective cohort study with a 3-month follow-up period. Patients who declined the GR_COPD program were considered as controls. The study was conducted at the pulmonary department of 2 hospitals. Patients were eligible when hospitalized as a result of an acute exacerbation of COPD and indicated for the GR_COPD program based on standardized criteria. Primary outcome was defined as change in disease-specific health status measured with the clinical COPD questionnaire (CCQ), secondary outcome as the exacerbation rate ratio during follow-up. To balance potential confounders between the intervention and control group, propensity score–based weighted linear regression analyses were performed. Of the 158 included patients [78 (49.4%) male, mean age 70.8 (±8.1) years, mean forced expiratory volume in 1 second: 35.5 (±12.8) as % of predicted], 78 received the GR_COPD program. The results of the CCQ showed a significant and clinically relevant treatment effect of −0.56 points [95% confidence interval (CI) −0.89, −0.23; P =.001). Patients in the control group had 2.77 times more exacerbations compared with the intervention group (95% CI 2.13, 3.58; P <.001). This study shows a clinically relevant effect of the GR_COPD program on disease-specific health status and exacerbation rate. Implementation of the program for older patients with severe COPD hospitalized for an acute exacerbation is recommended. [ABSTRACT FROM AUTHOR]