Operative Therapie des Rektumkarzinoms: Vergleich des offenen und des laparoskopischen Operationszugangs auf Grundlage von bevölkerungsbezogenen Krebsregisterdaten

Hintergrund: Die Anwendung des offenen Zugangs stellte viele Jahre lang den Goldstandard dar und auch heutzutage bevorzugen noch viele Chirurgen den konventionellen Operationszugang. Die kürzlich veröffentlichte randomisierte COLOR II Studie bewies die onkologische Sicherheit der Laparoskopie und immer mehr Patienten mit Rektumkarzinom werden weltweit laparoskopisch operiert. Doch aktuell existiert keine hochwertige retrospektive Arbeit, die das Langzeitüberleben von Patienten mit Rektumkarzinomen nach offener und laparoskopischer Operation vergleicht. Methoden: Primärer Endpunkt der vorliegenden Arbeit ist der Überlebenszeitvergleich zwischen laparoskopisch und offen operierten Patienten mit einem nicht-metastasierten Rektumkarzinom. Hierfür werden Gesamtüberlebensraten, lokal- und gesamtrezidivfreie Überlebenszeit sowie relative Überlebensraten im Zeitraum bis fünf Jahre nach der Operation gegenübergestellt. Als sekundäre Endpunkte werden die perioperative Mortalität und die zwei Qualitätsindikatoren Residualtumor-Status und Anzahl entnommener Lymphknoten betrachtet. Als Grundlage dient das Register des Tumorzentrums Regensburg, welches Tumordaten für die gesamte Region Oberpfalz mit 1,1 Millionen Einwohnern sammelt. Eingeschlossen wurden alle primären rektalen Adenokarzinome mit Stadium I-III, welche zwischen 2004 und 2013 reseziert wurden. Für die statistische Auswertung wurden das Kaplan-Meier-Verfahren, relative Überlebensmodelle, multivariable Cox-Regression sowie eine Sensitivitätsanalyse zur Quantifizierung von Selektionsbias verwendet. Ergebnisse: Das Auswertekollektiv umfasst 1507 Patienten mit einem medianen follow-up von 7,1 Jahren. Die mittlere Laparoskopierate beträgt 28,4% und nimmt im betrachteten Zeitraum zu. Patienten mit Karzinomen im oberen und mittleren Rektumdrittel, jüngere Patienten und Patienten, welche an spezialisierten Darmkrebszentren behandelt werden, werden eher laparoskopisch operiert. Auch bei Rektumresektionen unter Sphinktererhalt wird häufiger das minimalinvasive Verfahren angewendet. Bei beiden Operationszugängen wird die Empfehlung, 12 oder mehr Lymphknoten zu entnehmen, in etwa gleich häufig eingehalten. Ein tumorfreier Resektionsrand wird signifikant häufiger bei laparoskopisch operierten Patienten erreicht (p = 0,04). Die laparoskopische Gruppe weist ein niedrigeres Risiko auf, innerhalb von 90 Tagen zu versterben; dieser Vorteil ist in der multivariablen logistischen Regression jedoch nicht mehr signifikant (OR = 0,59; KI: 0,30 – 1,06). Bezüglich des Langzeitüberlebens zeigt die laparoskopische Gruppe im Vergleich zu den offenen Pendants in den Kaplan-Meier-Analysen signifikant höhere Raten beim Gesamt-, Lokal- und Gesamtrezidivfreien Überleben sowie beim Relativen Überleben. Die 5-Jahres-Gesamtüberlebensrate beträgt 80,4% in der laparoskopischen und 68,6% in der offenen Gruppe (p < 0,001). Beim Lokalrezidivfreien Überleben bleibt dieser Vorteil in der multivariablen Cox-Regression nach Adjustierung für relevante Kovariablen signifikant (HR: 0,70; KI: 0,52 – 0,92). Die Sensitivitätsanalyse zeigt, dass durch unvermeidliche Ausschlüsse kein Selektionsbias zu beobachten ist. Schlussfolgerung: Die Ergebnisse der vorliegenden Studie weisen die Laparoskopie als onkologisch sicheres Verfahren zur Therapie des Rektumkarzinoms aus, das eine geeignete Alternative zum offenen Vorgehen auch außerhalb von randomisierten Studien darstellt. Es werden jedoch in Zukunft weitere bevölkerungsbezogene Studien zum Thema benötigt, um möglicherweise vorhandene lokale und temporäre Störgrößen durch das Gesetz der großen Zahl auszutarieren

Adherence to the Dutch Breast Cancer Guidelines for Surveillance in Breast Cancer Survivors:Real-World Data from a Pooled Multicenter Analysis

BACKGROUND: Regular follow-up after treatment for breast cancer is crucial to detect potential recurrences and second contralateral breast cancer in an early stage. However, information about follow-up patterns in the Netherlands is scarce. PATIENTS AND METHODS: Details concerning diagnostic procedures and policlinic visits in the first 5 years following a breast cancer diagnosis were gathered between 2009 and 2019 for 9916 patients from 4 large Dutch hospitals. This information was used to analyze the adherence of breast cancer surveillance to guidelines in the Netherlands. Multivariable logistic regression was used to relate the average number of a patient’s imaging procedures to their demographics, tumor–treatment characteristics, and individual locoregional recurrence risk (LRR), estimated by a risk-prediction tool, called INFLUENCE. RESULTS: The average number of policlinic contacts per patient decreased from 4.4 in the first to 2.0 in the fifth follow-up year. In each of the 5 follow-up years, the share of patients without imaging procedures was relatively high, ranging between 31.4% and 33.6%. Observed guidelines deviations were highly significant (P < .001). A higher age, lower UICC stage, and having undergone radio- or chemotherapy were significantly associated with a higher chance of receiving an imaging procedure. The estimated average LRR-risk was 3.5% in patients without any follow-up imaging compared with 2.3% in patients with the recommended number of 5 imagings. CONCLUSION: Compared to guidelines, more policlinic visits were made, although at inadequate intervals, and fewer imaging procedures were performed. The frequency of imaging procedures did not correlate with the patients’ individual risk profiles for LRR

Optimasi Portofolio Resiko Menggunakan Model Markowitz MVO Dikaitkan dengan Keterbatasan Manusia dalam Memprediksi Masa Depan dalam Perspektif Al-Qur`an

Risk portfolio on modern finance has become increasingly technical, requiring the use of sophisticated mathematical tools in both research and practice. Since companies cannot insure themselves completely against risk, as human incompetence in predicting the future precisely that written in Al-Quran surah Luqman verse 34, they have to manage it to yield an optimal portfolio. The objective here is to minimize the variance among all portfolios, or alternatively, to maximize expected return among all portfolios that has at least a certain expected return. Furthermore, this study focuses on optimizing risk portfolio so called Markowitz MVO (Mean-Variance Optimization). Some theoretical frameworks for analysis are arithmetic mean, geometric mean, variance, covariance, linear programming, and quadratic programming. Moreover, finding a minimum variance portfolio produces a convex quadratic programming, that is minimizing the objective function ðð¥with constraintsð ð 𥠥 ðandð´ð¥ = ð. The outcome of this research is the solution of optimal risk portofolio in some investments that could be finished smoothly using MATLAB R2007b software together with its graphic analysis

Impacts of the Tropical Pacific/Indian Oceans on the Seasonal Cycle of the West African Monsoon

The current consensus is that drought has developed in the Sahel during the second half of the twentieth century as a result of remote effects of oceanic anomalies amplified by local land–atmosphere interactions. This paper focuses on the impacts of oceanic anomalies upon West African climate and specifically aims to identify those from SST anomalies in the Pacific/Indian Oceans during spring and summer seasons, when they were significant. Idealized sensitivity experiments are performed with four atmospheric general circulation models (AGCMs). The prescribed SST patterns used in the AGCMs are based on the leading mode of covariability between SST anomalies over the Pacific/Indian Oceans and summer rainfall over West Africa. The results show that such oceanic anomalies in the Pacific/Indian Ocean lead to a northward shift of an anomalous dry belt from the Gulf of Guinea to the Sahel as the season advances. In the Sahel, the magnitude of rainfall anomalies is comparable to that obtained by other authors using SST anomalies confined to the proximity of the Atlantic Ocean. The mechanism connecting the Pacific/Indian SST anomalies with West African rainfall has a strong seasonal cycle. In spring (May and June), anomalous subsidence develops over both the Maritime Continent and the equatorial Atlantic in response to the enhanced equatorial heating. Precipitation increases over continental West Africa in association with stronger zonal convergence of moisture. In addition, precipitation decreases over the Gulf of Guinea. During the monsoon peak (July and August), the SST anomalies move westward over the equatorial Pacific and the two regions where subsidence occurred earlier in the seasons merge over West Africa. The monsoon weakens and rainfall decreases over the Sahel, especially in August.Peer reviewe

Search for heavy resonances decaying to two Higgs bosons in final states containing four b quarks

A search is presented for narrow heavy resonances X decaying into pairs of Higgs bosons (H) in proton-proton collisions collected by the CMS experiment at the LHC at root s = 8 TeV. The data correspond to an integrated luminosity of 19.7 fb(-1). The search considers HH resonances with masses between 1 and 3 TeV, having final states of two b quark pairs. Each Higgs boson is produced with large momentum, and the hadronization products of the pair of b quarks can usually be reconstructed as single large jets. The background from multijet and t (t) over bar events is significantly reduced by applying requirements related to the flavor of the jet, its mass, and its substructure. The signal would be identified as a peak on top of the dijet invariant mass spectrum of the remaining background events. No evidence is observed for such a signal. Upper limits obtained at 95 confidence level for the product of the production cross section and branching fraction sigma(gg -> X) B(X -> HH -> b (b) over barb (b) over bar) range from 10 to 1.5 fb for the mass of X from 1.15 to 2.0 TeV, significantly extending previous searches. For a warped extra dimension theory with amass scale Lambda(R) = 1 TeV, the data exclude radion scalar masses between 1.15 and 1.55 TeV

Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes

BACKGROUND: Data are lacking on the long-term effect on cardiovascular events of adding sitagliptin, a dipeptidyl peptidase 4 inhibitor, to usual care in patients with type 2 diabetes and cardiovascular disease. METHODS: In this randomized, double-blind study, we assigned 14,671 patients to add either sitagliptin or placebo to their existing therapy. Open-label use of antihyperglycemic therapy was encouraged as required, aimed at reaching individually appropriate glycemic targets in all patients. To determine whether sitagliptin was noninferior to placebo, we used a relative risk of 1.3 as the marginal upper boundary. The primary cardiovascular outcome was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. RESULTS: During a median follow-up of 3.0 years, there was a small difference in glycated hemoglobin levels (least-squares mean difference for sitagliptin vs. placebo, -0.29 percentage points; 95% confidence interval [CI], -0.32 to -0.27). Overall, the primary outcome occurred in 839 patients in the sitagliptin group (11.4%; 4.06 per 100 person-years) and 851 patients in the placebo group (11.6%; 4.17 per 100 person-years). Sitagliptin was noninferior to placebo for the primary composite cardiovascular outcome (hazard ratio, 0.98; 95% CI, 0.88 to 1.09; P<0.001). Rates of hospitalization for heart failure did not differ between the two groups (hazard ratio, 1.00; 95% CI, 0.83 to 1.20; P = 0.98). There were no significant between-group differences in rates of acute pancreatitis (P = 0.07) or pancreatic cancer (P = 0.32). CONCLUSIONS: Among patients with type 2 diabetes and established cardiovascular disease, adding sitagliptin to usual care did not appear to increase the risk of major adverse cardiovascular events, hospitalization for heart failure, or other adverse events

Search for supersymmetry in events with one lepton and multiple jets in proton-proton collisions at root s=13 TeV

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Measurement of the top quark mass using charged particles in pp collisions at root s=8 TeV

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Search for anomalous couplings in boosted WW/WZ -> l nu q(q)over-bar production in proton-proton collisions at root s=8TeV

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Search for standard model production of four top quarks in the lepton + jets channel in pp collisions at √s = 8 TeV

Open Access, Copyright CERN, for the benefit of the CMS Collaboration. Article funded by SCOAP3.Abstract: A search is presented for standard model (SM) production of four top quarks (Formula presented.) in pp collisions in the lepton + jets channel. The data correspond to an integrated luminosity of 19.6 fb−1 recorded at a centre-of-mass energy of 8 TeV with the CMS detector at the CERN LHC. The expected cross section for SM (Formula presented.) production is (Formula presented.). A combination of kinematic reconstruction and multivariate techniques is used to distinguish between the small signal and large background. The data are consistent with expectations of the SM, and an upper limit of 32 fb is set at a 95% confidence level on the cross section for producing four top quarks in the SM, where a limit of 32 ± 17 fb is expected