Analysis of reinforced concrete structures with occurrence of discrete cracks at arbitrary positions

A nonlinear analysis of in-plane loaded plates is presented, which eliminates the disadvantages of the smeared crack approach. The elements used and the computational method are discussed. An example is shown in which one or more discrete cracks are dominant

Decreased incidence of isolated tumor cells in lymph nodes after laparoscopic resection for colorectal cancer

Laparoscopic surgery has potential for less tumor cell spread because of the no-touch technique. We assessed the effect of the surgical approach (open versus no-touch laparoscopic) on the presence of tumor cells in sentinel lymph nodes (SN) of patients with stage I and II colorectal cancer. A single-center consecutive prospective series of patients operated on for colorectal cancer was analyzed. After conventional hematoxylin and eosin (H&E) staining, 107 patients without lymphatic metastases were included; 59 patients had open surgery, and 48 patients underwent laparoscopic resection. Patients in the laparoscopic group underwent a no-touch medial to lateral approach, whereas the conventional lateral to medial approach was applied in open surgery. A SN procedure was performed in all patients. The SNs were immunohistochemically analyzed for presence of occult tumor cells (OTC). According to the American Joint Committee on Cancer (AJCC) these tumor cells were divided into micrometastases (0.2-2 mm) or isolated tumor cells (ITC, 3.5 cm. Logistic regression analysis identified lymphovascular invasion as a predictor for micrometastases [odds ratio (OR) 18.4], whereas open resection was predictive for presence of ITC (OR 3.3). No-touch medial to lateral laparoscopic surgery results in less isolated tumor cells in lymph nodes compared with open lateral to medial surgery in patients with stage I and II colorectal cance

WASP-4 Is Accelerating toward the Earth

The orbital period of the hot Jupiter WASP-4b appears to be decreasing at a rate of −8.64 ± 1.26 ms yr⁻¹, based on transit-timing measurements spanning 12 yr. Proposed explanations for the period change include tidal orbital decay, apsidal precession, and acceleration of the system along the line of sight. To investigate further, we performed new radial-velocity measurements and speckle imaging of WASP-4. The radial-velocity data show that the system is accelerating toward the Sun at a rate of −0.0422 ± 0.0028 m s⁻¹ day⁻¹. The associated Doppler effect should cause the apparent period to shrink at a rate of −5.94 ± 0.39 ms yr⁻¹, comparable to the observed rate. Thus, the observed change in the transit period is mostly or entirely produced by the line-of-sight acceleration of the system. This acceleration is probably caused by a wide-orbiting companion of mass 10–300 M_(Jup) and orbital distance 10–100 au, based on the magnitude of the radial-velocity trend and the nondetection of any companion in the speckle images. We expect that the orbital periods of one out of three hot Jupiters will change at rates similar to WASP-4b, based on the hot-Jupiter companion statistics of Knutson et al. Continued radial-velocity monitoring of hot Jupiters is therefore essential to distinguish the effects of tidal orbital decay or apsidal precession from line-of-sight acceleration

Mild hypothermia during cardiopulmonary bypass assisted CABG is associated with improved short- and long-term survival, a 18- year cohort study

Data substantiating the optimal patient body temperature during cooling procedures in cardiac operations are currently unavailable. To explore the optimal temperature strategy, we examined the association between temperature management and survival among patients during cardiopulmonary bypass assisted coronary artery bypass grafting (CABG) procedures on 30-days and 5-year postoperative survival. Adult patients (n = 5,672, 23.6% female and mean (SD) age of 66 (10) years) operated between 1997 and 2015 were included, with continuous measured intraoperative nasopharyngeal temperatures. The association between mortality and patient characteristics, laboratory parameters, the lowest intraoperative plateau temperature and intraoperative cooling/rewarming rates were examined by multivariate Cox regression analysis. Machine learning-based cluster analysis was used to identify patient subgroups based on pre-cooling parameters and explore whether specific subgroups benefitted from a particular temperature management. Mild hypothermia (32- 35°C) was independently associated with improved 30-days and 5-year survival compared to patients in other temperature categories regardless of operation year. 30 days and 5-year survival were 98% and 88% in the mild hypothermia group, whereas it amounted 93% and 80% in the severe hypothermia (<30°C). Normothermia (35-37°C) showed the lowest survival after 30 days and 5 years amounting 93% and 72%, respectively. Cluster analysis identified 8 distinct patient subgroups principally defined by gender, age, kidney function and weight. The full cohort and all patient subgroups displayed the highest survival at a temperature of 32°C. Given these associations, further prospective randomized controlled trials are needed to ascertain optimal patient temperatures during CPB