Navigating complexities and considerations for suspected anastomotic leakage in the upper gastrointestinal tract:A state of the art review

This state-of-the-art review explores the intricacies of anastomotic leaks following oesophagectomy and gastrectomy, crucial surgeries for globally increasing esophageal and gastric cancers. Despite advancements, anastomotic leaks occur in up to 30 % and 10 % of oesophagectomy and gastrectomy cases, respectively, leading to prolonged hospital stays, substantial impact upon short- and long-term health-related quality of life and greater mortality. Recognising factors contributing to leaks, including patient characteristics and surgical techniques, are vital for preoperative risk stratification. Diagnosis is challenging, involving clinical signs, biochemical markers, and various imaging modalities. Management strategies range from non-invasive approaches, including antibiotic therapy and nutritional support, to endoscopic interventions such as stent placement and emerging vacuum-assisted closure devices, and surgical interventions, necessitating timely recognition and tailored interventions. A step-up approach, beginning non-invasively and progressing based on treatment success, is more commonly advocated. This comprehensive review highlights the absence of standardised treatment algorithms, emphasizing the importance of individualised patient-specific management

A systematic review of participant descriptors reported in studies of adhesive small bowel obstruction

Aim: Reporting of participant descriptors in studies of adhesive small bowel obstruction (ASBO) can help identify characteristics associated with favourable outcomes and allow comparison with other studies and real-world clinical populations. The aim was to identify the pattern of participant descriptors reported in studies assessing interventions for ASBO.Method: This systematic review was registered with PROSPERO (CRD42021281031) and reported in line with the PRISMA checklist. Systematic searches of Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) were undertaken to identify studies assessing operative and non-operative interventions for adults with ASBO. Studies were dual screened for inclusion. Descriptors were categorised into conceptual domains by the research team.Results: Searches identified 2648 studies, of which 73 were included. A total of 156 unique descriptors were identified. On average, studies reported 12 descriptors. The most frequently reported descriptors were sex, age, SBO aetiology, history of abdominal surgery, BMI and ASA classification. The highest number of descriptors in a single study was 34, compared to the lowest number of descriptors which was one. Pathway factors were the least frequently described domain. Overall, 37 descriptors were reported in just one study.Conclusion: There is a lack of consistency in participant descriptors reported in studies of SBO. Furthermore, a significant proportion of the descriptors were used infrequently. This makes it challenging to assess whether study participants are representative of the wider population. Further work is required to develop a Core Descriptor Set to standardise the reporting of patient characteristics and reduce heterogeneity between studies

Analysing the Effects of Congestion on Hybrid Order Picking Systems using a Discrete-Event Simulator

In hybrid order-picking systems (OPSs), human workers collaborate alongside autonomous guided vehicles (AGVs) to pick up and transport items in a warehouse. Congestion occurs when multiple humans and AGVs operate in an area simultaneously. Congestion decreases AGV navigation performance and may cause queuing delays at packing stations. In this paper, we study the impact of congestion on the performance of hybrid OPSs. We simulate a hybrid OPS using a discrete-event simulator and evaluate the throughput under different levels of congestion and the number of AGVs. Using 10 AGVs under no congestion, we observe a throughput increase of 105% compared to a manual OPS with zero AGVs. However, this improvement decreases as the effects of congestion become stronger. Under our heaviest congestion model, there was only a 3% throughput increase for 10 AGVs. We also analyse the economic impact of adding AGVs to a hybrid OPS. Under medium congestion, the optimal number of AGVs for maximising long-term profit is 20

Safety and efficacy of subcutaneous iscalimab (CFZ533) in two distinct populations of patients with Sjögren’s disease (TWINSS):Week 24 results of a randomised, double-blind, placebo-controlled, phase 2b dose-ranging study

Background: Sjögren's disease is a chronic autoimmune disease with an unmet need for targeted therapies. The aim of the TWINSS study is to evaluate the safety and efficacy of iscalimab, a monoclonal antibody against CD40, in patients with active Sjögren's disease.Methods: This randomised, double-blind, placebo-controlled, phase 2b study, conducted at 71 sites in 23 countries, enrolled patients aged 18 years or older fulfilling the American College of Rheumatology/European Alliance of Associations for Rheumatology (EULAR) 2016 criteria. In the dose-ranging cohort 1, patients with a EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI) score of 5 or higher and a EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI) score of 5 or higher were randomly assigned (1:1:1:1) to subcutaneous iscalimab 150 mg, 300 mg, 600 mg, or placebo. In the proof-of-concept cohort 2, patients with an ESSDAI score of less than 5, ESSPRI (dryness or fatigue) score of 5 or higher, and Impact of Dry Eye on Everyday Life score of 30 or higher were randomly assigned (1:1) to iscalimab 600 mg or placebo. The sponsor, investigator, site personnel, and patients were masked to the treatment assignment. The primary objectives were to demonstrate a dose–response relationship of iscalimab based on the change in ESSDAI from baseline to week 24 in cohort 1 by Multiple Comparison Procedure—Modelling (MCP-Mod), and to assess the effect of iscalimab 600 mg on ESSPRI at week 24 in cohort 2. All the efficacy analyses included all patients who were randomly assigned, and safety analysis included all patients who received at least one dose of study drug. This trial is registered with ClinicalTrials.gov (NCT03905525), and is complete.Findings: Between Oct 1, 2019, and Feb 28, 2022, 460 patients were screened; 173 patients were assigned to cohort 1 (44 to iscalimab 150 mg, 43 to 300 mg, 43 to 600 mg, and 43 to placebo) and 100 to cohort 2 (50 to each group). In cohort 1, the MCP step showed a significant dose–response relationship for placebo-adjusted ESSDAI change from baseline in one of four models (Linlog model, one-sided p=0·0041). ESSDAI decreased from baseline to week 24 with all three doses of iscalimab; 150 mg and 600 mg doses showed statistically significant improvement (placebo-adjusted least squares [LS] mean difference –3·0 [95% CI –4·9 to –1·1]; p=0·0025 for 150 mg and –2·9 [–4·9 to –1·0]; p=0·0037 for 600 mg). In cohort 2, ESSPRI showed a trend towards improvement with iscalimab 600 mg (placebo-adjusted LS mean change from baseline –0·57 points [95% CI –1·30 to 0·15]; p=0·12). Serious adverse events were reported in nine patients in cohort 1 (one [2%] of 43 in the placebo group, one [2%] of 44 in the iscalimab 150 mg group, three [7%] of 42 in the 300 mg group, four [9%] of 44 in the 600 mg group) and four patients in cohort 2 (two [4%] of 50 in each group). No deaths occurred over the 24-week period.Interpretation: The study met the primary objective of demonstrating a significant dose–response relationship with iscalimab in terms of disease activity at week 24. Iscalimab was well tolerated and showed initial clinical benefit over placebo in two distinct populations of patients with Sjögren's disease, to be confirmed in larger trials.Funding: Novartis Pharma.</div

The effect of photoinitiator type and filler load on physicochemical and mechanical properties of experimental light-cured resin cements through lithium disilicate ceramics of different shades and thicknesses

Objective: This study investigated the influence of photoinitiator types on degree of conversion (DC), rate of polymerization (RP), flexural strength (FS), flexural modulus (FM), and light transmittance (LT) of filled and unfilled light-curable resin cements through different thicknesses and shades of lithium disilicate ceramics.Methods: Lithium disilicate ceramic discs (IPS Emax Press, background [0.0], 0.5, 1.0, 2.0, 3.0, and 4.0 mm, shades A1 and BL3) were prepared. Experimental resin-based cements [TEGDMA/BisGMA (50/50 mass%)] were prepared using either camphorquinone (CQ)/amine (0.44/1.85 mol%) or TPO (0.44 mol%)], and a micro and nanofiller loads of nil (unfilled); 40/10 mass%; and 50/10 mass%). Resin cements (0.2 mm thick) were placed on the lower surface of the ceramic specimens and light-activated for 30 s from the upper surface using a Bluephase Style curing light (exitance at tip: 1236 mW/cm2 ± 1.20). LT and distribution of irradiance through the ceramics were measured using a UV–vis spectrometer and a beam profile camera, respectively (n = 3). The DC and RP were measured in real-time using mid infrared spectroscopy in attenuated total reflectance (ATR) mode (n = 3). FS and FM were measured using a universal testing machine (n = 5). Statistical analyses were performed on LT, DC, RP, FS, and FM data using a general linear model, and supplementary ANOVA and post hoc Tukey multiple comparison test were also performed (α = .05).Results: Thicknesses, shades, photoinitiator type, and fillers load significantly influenced the optical and mechanical characteristics of the resin-based materials (p &lt; 0.05). The BL3 shade ceramic provided higher values of DC, RP, FS, FM, and LT compared with the A1 shade (p &lt; 0.05). Increasing ceramic thickness decreased the properties of the resin-based materials (p &lt; 0.05). Generally, TPO improved mechanical properties of the resin cement compared with CQ (p &lt; 0.05).Significance: The luting process of indirect restorations may be improved by using high molar absorptivity, more reactive, and more efficient photoinitiators such as TPO, as opposed to conventional CQ. The use of such initiator may allow the placement of thicker and more opaque indirect restorations

Impact of Electron Beam Welding on the Microstructure of PM2000 ODS Steel

This work investigated the impact of electron beam (EB) welding, using various traverse speeds of the electron beam (1200-2200 mm/min), on the microstructure of PM2000 ODS steel which was characterized using analytical electron microscopy and microhardness. The different heat inputs during welding explored in this study (72-39 J/mm), related to the traverse speed used, correlated with small differences in the widths of the fusion zone. Only minor differences in local microstructures and hardness of the fusion zones were detected amongst the four butt welds produced. The fusion zone is characterized by large columnar grains in the ferritic matrix, together with a coarsened Y-Al-O particle distribution and a reduction in its particle number density as compared to the base material. There is also a sharp border between the fusion zone and base material, with the joint showing little evidence of a heat-affected zone. These changes in microstructure during welding led to a hardness reduction of approx. 30% in the fusion zone of the welds with respect to the base material

Self-certified Tuple-wise Deep Learning

Tuple-wise learning maps a tuple of input points to a label. A typical application is object re-identification, for which empirically successful algorithms have been recently proposed. However, individual tuples do not bring independent information, as their component points participate in multiple tuples. Hence, one may expect needing a larger sample size to learn effectively. To make the most of the available labelled tuples, we turn to the idea of learning with self-certification based on PAC-Bayes bounds. While existing results are not applicable directly to our case, we generalize the self-certified learning paradigm to tuple-wise neural networks, by using U-statistics. The obtained new PAC-Bayes bound confirms the increasing sample complexity for tuple-wise learning as a function of the tuple size. We then conduct an empirical study to evaluate the tuple-wise objective functions obtained from the bound. As an illustrative example, we train the PAC-Bayes posterior distribution of a stochastic neural network using pairwise stochastic gradient descent. Our results demonstrate non-vacuous risk bounds in tuple-wise deep learning on the task of person re-identification (Re-ID), using several real-world datasets

Capacity sharing between competing manufacturers:a collective good or a detrimental effect?

Capacity sharing has become a prevalent solution for addressing the supply-demand mismatch by optimizing capacity allocation among participating manufacturers. However, effective coordination and cooperation are required among involved parties, particularly if capacity sharing occurs between competing manufacturers. This paper investigates capacity sharing between competing manufacturers and examines optimal sharing service fee policy, taking into consideration of external market, internal operational, and relationship-specific factors. Our study incorporates product substitution rate, information symmetry (or asymmetry), and interfirm power relationship to go beyond the immediate direct cost-benefit analysis of capacity sharing and evaluates the trade-off between capacity sharing associated benefits and costs. Our analysis results illustrate how the market and relationship-specific factors interact with operational factors such as production cost difference and capacity constraints to influence firms' capacity sharing decisions. The broad set of decision outcomes derived from our comprehensive analyses is beneficial for companies of all sizes and shapes to make informed strategic and operational decisions according to their own circumstances

Dynamic train-track interactions over track stiffness discontinuities in railway track transitions mitigated by resilient materials

Railway track transitions, where abrupt changes between different track sections lead to differential settlement and increased maintenance costs, pose a significant challenge. This often results in considerable track damage and elevated maintenance expenses. In Thailand, the early stages of the high-speed rail project integrate a slab track system from China with conventional ballasted tracks at multiple junctions, underscoring the importance of effectively managing these transition zones. Despite the potential benefits of Under Sleeper Pads (USPs) in ballasted tracks and Under Slab Mats (USMs) in slab tracks for reducing track vibration, impact load, and differential settlement, their usage is not widespread. This paper presents a 3D train-track-soil finite element model that incorporates both USPs and USMs, considering strain-rate effects, to analyze railway track transitions. The model evaluates various pad types across different track locations and train speeds. The results show that USPs can significantly reduce ballast degradation, while USMs help maintain overall track stiffness. The results also show that the combination of USPs and USMs effectively manages track stiffness gradients, achieving a normalized gradient between 0.04 and 0.20, compared to 1.00 in the baseline case. Although the combined use of USPs and USMs offers a promising solution for managing track transitions, careful selection are crucial to avoid potential issues. This research provides a comprehensive framework for understanding and improving the performance of railway track transition zones using resilient materials. It suggests further studies to evaluate the broader applicability of these methods in minimizing track disturbances across various environmental conditions

Effect of Graphene Quantum Dots (GQDs) on the Mechanical, Dynamic, and Durability Properties of Concrete

Addressing ecological concerns stemming from concrete usage is paramount, prompting exploration into additives for mitigation. Graphene quantum dots (GQDs) have been recognized for their potential to improve the mechanical attributes of cement composites. Additionally, the electrochemical reduction of a saturated solution of carbon dioxide (CO2) and monoethanolamine (CO2-MEA) effectively removes CO2 from the atmosphere. This study delves into the influence of GQDs on the mechanical and durability aspects of concrete. It is noted that the control mix of concrete without GQDs was specifically designed for concrete railway sleepers. Varied proportions of GQDs, ranging from 0.3% to 1.2% at 0.3% increments, were incorporated to assess their impact on fresh and hardened concrete properties. Mechanical properties such as compressive strength, splitting tensile strength, flexural strength, and dynamic properties were evaluated. Durability assessments encompassing water absorption and chloride ion penetration were conducted. Microstructural analysis via Field Emission Scanning Electron Microscopy (FESEM) imaging and Energy-dispersive X-ray spectroscopy (EDS) elucidated the concrete's internal composition. Notably, an optimal GQDs percentage of 0.3% was observed, signifying its efficacy in enhancing the performance of concrete. When 0.3% of GQDs was added to concrete, compressive strength, split tensile strength, and flexural strength were enhanced by 10.8%, 23%, and 11% respectively. The incorporation of GQDs resulted in a notable improvement in the fundamental frequencies and dynamic modulus of elasticity. Concurrently, a decrease in the damping ratio was observed for specimens containing GQDs. Additionally, the porosity and chloride penetration depth were lower by 6% and 30% for specimens with 0.3% GQDs. The improvement in workability, mechanical, and dynamic properties of concrete, along with reducing CO2 from the atmosphere, makes GQDs an ideal eco-friendly material. This study is the first to open new pathways for the development of construction materials that are not only structurally superior but also environmentally responsible, marking a significant step forward in the field of civil engineering materials, especially in railway applications