Definitive chemoradiotherapy versus neoadjuvant chemoradiotherapy followed by radical surgery for locally advanced oesophageal squamous cell carcinoma:meta-analysis

Background: The literature lacks robust evidence comparing definitive chemoradiotherapy (dCRT) with neoadjuvant chemoradiotherapy and surgery (nCRS) for oesophageal squamous cell carcinoma (ESCC). This study aimed to compare long-term survival of these approaches in patients with ESCC.Methods: A systematic review performed according to PRISMA guidelines included studies identified from PubMed, Scopus, and Cochrane CENTRAL databases up to July 2021 comparing outcomes between dCRT and nCRS for ESCC. The main outcome measure was overall survival (OS), secondary outcome was disease-free survival (DFS). A meta-analysis was conducted using random-effects modelling to determine pooled adjusted multivariable hazard ratios (HRs).Results: Ten studies including 14 092 patients were included, of which 30 per cent received nCRS. Three studies were randomized clinical trials (RCTs) and the remainder were retrospective cohort studies. dCRT and nCRS regimens were reported in six studies and surgical quality control was reported in two studies. Outcomes for OS and DFS were reported in eight and three studies respectively. Following meta-analysis, nCRS demonstrated significantly longer OS (HR 0.68, 95 per cent c.i. 0.54 to 0.87, P < 0.001) and DFS (HR 0.50, 95 per cent c.i. 0.36 to 0.70, P < 0.001) compared with dCRT.Conclusion: Neoadjuvant chemoradiotherapy followed by oesophagectomy correlated with improved survival compared with definitive chemoradiation in the treatment of ESCC; however, there is a lack of literature on RCTs

Electronic and optical properties of LiBC

LiBC, a semiconducting ternary borocarbide constituted of the lightest elements only, has been synthesized and characterized by x-ray powder diffraction, dielectric spectroscopy, and conductivity measurements. Utilizing an infrared microscope the phonon spectrum has been investigated in single crystals. The in-plane B-C stretching mode has been detected at 150 meV, noticeably higher than in AlB2, a non-superconducting isostructural analog of MgB2. It is this stretching mode, which reveals a strong electron-phonon coupling in MgB2, driving it into a superconducting state below 40 K, and is believed to mediate predicted high-temperature superconductivity in hole-doped LiBC [H. Rosner, A. Kitaigorodsky, and W. E. Pickett, Phys. Rev. Lett. 88, 127001 (2002)].Comment: 4 pages, 4 figure

Carfree and low-car development

© 2014 by Emerald Group Publishing Limited All rights of reproduction in any form reserved. Purpose-This chapter defines and describes the different types of carfree and low-car development found in the United Kingdom and continental Europe, analysing the benefits and problems they bring and their implications for parking policy. Methodology/approach-The chapter draws on the literature on UK and European carfree developments, including primary research conducted by the author into the potential for carfree development in the United Kingdom. It is also informed by a series of observational visits to some of the principal carfree developments around Europe. Findings-The UK concepts of car-free and low-car housing are limited in scope, defined by the absence or reduced level of parking. The European concept of carfree development is broader, bringing greater benefits to the immediate residents. All have led to lower traffic generation. European carfree developments bring other benefits to their residents such as more socialisation between neighbours and earlier independence for children. The potential demand for car-free and low-car housing is greatest in the inner areas of larger cities. These are also the places which offer the most suitable development locations. The most common problems encountered relate to parking and/or management of vehicular access. To avoid overspill problems, parking needs to be controlled on the streets surrounding carfree or low-car developments. Practical implications-The benefits of carfree development are greatest in urban areas where road capacity and/or parking are under the greatest pressure. Thus carfree development is a useful tool for cities undergoing urban intensification. Originality/value of paper-The chapter is the first to analyse carfree and low-car development from a parking perspective and to demonstrate their implications for parking policy

Disinfection of the Access Orifice in NOTES: Evaluation of the Evidence Base

Introduction. Appropriate prevention of infection is a key area of research in natural orifice translumenal endoscopic surgery (NOTES), as identified by the Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR). Methods. A review of the literature was conducted evaluating the evidence base for access orifice preparation/treatment in NOTES procedures in the context of infectious complications. Recommendations based on the Oxford Centre for Evidence-Based Medicine guidelines were made. Results. The most robust evidence includes several experimental randomised controlled trials assessing infectious complications in the transgastric approach to NOTES. Transvaginal procedures are long established for accessing the peritoneal cavity following disinfection with antiseptic. Only experimental case series for transcolonic and transvesical approaches are described. Conclusion. Grade C recommendation requiring no preoperative preparation can be made for the transgastric approach. Antiseptic irrigation is recommended for transvaginal (grade C) NOTES access, as is current practice. Further human trials need to be conducted to corroborate the current evidence base for transgastric closure. It is important that future trials are conducted in a methodologically robust fashion, with emphasis on clinical outcomes and standardisation of enterotomy closure and postoperative therapy

Association of Upper Gastrointestinal Surgery of Great Britain and Ireland (AUGIS)/Perioperative Quality Initiative (POQI) consensus statement on intraoperative and postoperative interventions to reduce pulmonary complications after oesophagectomy

BACKGROUND: Pulmonary complications are the most common morbidity after oesophagectomy, contributing to mortality and prolonged postoperative recovery, and have a negative impact on health-related quality of life. A variety of single or bundled interventions in the perioperative setting have been developed to reduce the incidence of pulmonary complications. Significant variation in practice exists across the UK. The aim of this modified Delphi consensus was to deliver clear evidence-based consensus recommendations regarding intraoperative and postoperative care that may reduce pulmonary complications after oesophagectomy. METHODS: With input from a multidisciplinary group of 23 experts in the perioperative management of patients undergoing surgery for oesophageal cancer, a modified Delphi method was employed. Following an initial systematic review of relevant literature, a range of anaesthetic, surgical, and postoperative care interventions were identified. These were then discussed during a two-part virtual conference. Recommendation statements were drafted, refined, and agreed by all attendees. The level of evidence supporting each statement was considered. RESULTS: Consensus was reached on 12 statements on topics including operative approach, pyloric drainage strategies, intraoperative fluid and ventilation strategies, perioperative analgesia, postoperative feeding plans, and physiotherapy interventions. Seven additional questions concerning the perioperative management of patients undergoing oesophagectomy were highlighted to guide future research. CONCLUSION: Clear consensus recommendations regarding intraoperative and postoperative interventions that may reduce pulmonary complications after oesophagectomy are presented

Neighbourhood, Route and Workplace-Related Environmental Characteristics Predict Adults' Mode of Travel to Work

Commuting provides opportunities for regular physical activity which can reduce the risk of chronic disease. Commuters' mode of travel may be shaped by their environment, but understanding of which specific environmental characteristics are most important and might form targets for intervention is limited. This study investigated associations between mode choice and a range of objectively assessed environmental characteristics.Participants in the Commuting and Health in Cambridge study reported where they lived and worked, their usual mode of travel to work and a variety of socio-demographic characteristics. Using geographic information system (GIS) software, 30 exposure variables were produced capturing characteristics of areas around participants' homes and workplaces and their shortest modelled routes to work. Associations between usual mode of travel to work and personal and environmental characteristics were investigated using multinomial logistic regression.Of the 1124 respondents, 50% reported cycling or walking as their usual mode of travel to work. In adjusted analyses, home-work distance was strongly associated with mode choice, particularly for walking. Lower odds of walking or cycling rather than driving were associated with a less frequent bus service (highest versus lowest tertile: walking OR 0.61 [95% CI 0.20–1.85]; cycling OR 0.43 [95% CI 0.23–0.83]), low street connectivity (OR 0.22, [0.07–0.67]; OR 0.48 [0.26–0.90]) and free car parking at work (OR 0.24 [0.10–0.59]; OR 0.55 [0.32–0.95]). Participants were less likely to cycle if they had access to fewer destinations (leisure facilities, shops and schools) close to work (OR 0.36 [0.21–0.62]) and a railway station further from home (OR 0.53 [0.30–0.93]). Covariates strongly predicted travel mode (pseudo r-squared 0.74).Potentially modifiable environmental characteristics, including workplace car parking, street connectivity and access to public transport, are associated with travel mode choice, and could be addressed as part of transport policy and infrastructural interventions to promote active commuting

Cost-Effectiveness of Haemorrhoidal Artery Ligation versus Rubber Band Ligation for the Treatment of Grade II–III Haemorrhoids: Analysis Using Evidence from the HubBLe Trial

Aim Haemorrhoids are a common condition, with nearly 30,000 procedures carried out in England in 2014/15, and result in a significant quality-of-life burden to patients and a financial burden to the healthcare system. This study examined the cost effectiveness of haemorrhoidal artery ligation (HAL) compared with rubber band ligation (RBL) in the treatment of grade II–III haemorrhoids. Method This analyses used data from the HubBLe study, a multicentre, open-label, parallel group, randomised controlled trial conducted in 17 acute UK hospitals between September 2012 and August 2015. A full economic evaluation, including long-term cost effectiveness, was conducted from the UK National Health Service (NHS) perspective. Main outcomes included healthcare costs, quality-adjusted life-years (QALYs) and recurrence. Costeffectiveness results were presented in terms of incremental cost per QALY gained and cost per recurrence avoided. Extrapolation analysis for 3 years beyond the trial follow-up, two subgroup analyses (by grade of haemorrhoids and recurrence following RBL at baseline), and various sensitivity analyses were undertaken. Results In the primary base-case within-trial analysis, the incremental total mean cost per patient for HAL compared with RBL was £1027 (95% confidence interval [CI] £782– £1272, p\0.001). The incremental QALYs were 0.01 QALYs (95% CI -0.02 to 0.04, p = 0.49). This generated an incremental cost-effectiveness ratio (ICER) of £104,427 per QALY. In the extrapolation analysis, the estimated probabilistic ICER was £21,798 per QALY. Results from all subgroup and sensitivity analyses did not materially change the base-case result. Conclusions Under all assessed scenarios, the HAL procedure was not cost effective compared with RBL for the treatment of grade II-III haemorrhoids at a cost-effectiveness threshold of £20,000 per QALY; therefore

Outcome trends and safety measures after 30 years of laparoscopic cholecystectomy:a systematic review and pooled data analysis

BACKGROUND: Laparoscopic cholecystectomy (LC), one of the most commonly performed surgical procedures, remains associated with significant major morbidity including bile leak and bile duct injury (BDI). The effect of changes in practice over time, and of interventions to improve patient safety, on morbidity rates is not well understood. The aim of this review was to describe current incidence rates and trends for BDI and other complications during and after LC, and to identify risk factors and preventative measures associated with morbidity and BDI. METHODS: PubMed, MEDLINE, and Web of Science database searches and data extraction were conducted for studies which reported individual complications and complication rates following laparoscopic cholecystectomy in a representative population. Outcomes data were pooled. Meta-regression analysis was performed to assess factors associated with conversion, morbidity, and BDI rates. RESULTS: One hundred and fifty-one studies reporting outcomes for 505,292 patients were included in the final quantitative synthesis. Overall morbidity, BDI, and mortality rates were 1.6-5.3%, 0.32-0.52%, and 0.08-0.14%, respectively. Reported BDI rates reduced over time (1994-1999: 0.69(0.52-0.84)% versus 2010-2015 0.22(0.02-0.40)%, p = 0.011). Meta-regression analysis suggested higher conversion rates in developed versus developing countries (4.7 vs. 3.4%), though a greater degree of reporting bias was present in these studies, with no other significant associations identified. CONCLUSIONS: Overall, trends suggest a reduction in BDI over time with unchanged morbidity and mortality rates. However, data and reporting are heterogenous. Establishment of international outcomes registries should be considered

Inhabiting infrastructure: exploring the interactional spaces of urban cycling

Contemporary cities are thick with infrastructure. In recognition of this fact a great deal of recent work within urban studies and urban geography has focused on transformations in the governance and ownership of infrastructural elements within cities. Less attention has been paid to the practices through which urban infrastructures are inhabited by urban dwellers. Yet in all sorts of ways infrastructures are realised through their use and inhabitation. This paper argues for the importance of attending to the ways that infrastructures are reinterpreted through use. Focusing on a case study of commuter cyclists in London, it explores the ways in which cyclists accommodate themselves to (and are in turn accommodated by) the infrastructural orderings of London’s streets. Confronted by the obduracy of a road infrastructure designed primarily for motorised traffic, cyclists show a diverse range of approaches to negotiating movement through the city on bikes. The paper describes how this negotiation can be understood in terms of the more or less skilful processes of navigation, rule following, rule making, and rule bending. This involves a polymorphous mix of practices, some common to driving, others to walking, and yet others unique to cycling. In conclusion, the paper suggests that transformations of infrastructures found within cities need to be understood as much through emergent changes between their elements, and that close attention to how infrastructures come to be inhabited offers productive avenues for thinking about ways to improve them

Assessment of the Degree of Willingness to Change from Motorized Travel Modes to Walking or Cycling

This paper presents an analysis of the degree of willingness to change from motorized travel modes to walking or cycling. The aim of the analysis is to reduce uncertainty between stated willingness to change and real shifts from car or transit to nonmotorized transportation modes. Data were collected in the city of Valencia, Spain, through a novel data collection effort based on multiple survey methods. Respondents traveling by car or transit were asked about their willingness to change to walking or cycling under the implementation of improvement measures to be selected. Then a hypothetical scenario was presented to respondents who stated a willingness to change; in the scenario, the previously selected measures were implemented and respondents were supposed to be cycling or walking. In addition, the costs of their usual travel mode were gradually reduced until they gave up cycling or walking. Those who decided to keep on walking or cycling were assumed to have a strong willingness to change. A statistical analysis performed with Heckman's sample selection model permitted identification of demographic, socioeconomic, and travel-related factors influencing the degree of willingness to change. Results revealed that car users presented a stronger willingness to switch to walking or cycling than transit users. In addition, older respondents showed a stronger willingness to change to both walking and cycling. Work- and school-related journeys were less associated with walking than noncommuting journeys, but they were more related to cycling. Policy implications of the results are highlighted.Ferrer, S.; Ruiz Sánchez, T. (2013). Assessment of the Degree of Willingness to Change from Motorized Travel Modes to Walking or Cycling. Transportation Research Record. (2382):112-120. doi:10.3141/2382-13S112120238