Surgery during holiday periods and prognosis in oesophageal cancer: a population-based nationwide Swedish cohort study

OBJECTIVE: Previous studies indicate an increased short-term and long-term mortality from major cancer surgery performed towards the end of the working week or during the weekend. We hypothesised that the prognosis after major cancer surgery is also negatively influenced by surgery conducted during holiday periods. SETTING: Population-based nationwide Swedish cohort study. PARTICIPANTS: Patients undergoing oesophagectomy for oesophageal cancer between 1987 and 2010. Among 1820 included patients, 206 (11.3%) and 373 (20.5%) patients were operated on during narrow and wide holiday periods, respectively. INTERVENTIONS: Narrow (7 weeks) and wide (14 weeks) Swedish holiday periods. PRIMARY AND SECONDARY OUTCOME MEASURES: 90-day all-cause, 5-year all-cause and 5-year disease-specific mortality. RESULTS: Narrow holiday period did not increase all-cause 90-day (HR=0.84, 95% CI 0.53 to 1.33), all-cause 5-year (HR=1.01, 95% CI 0.85 to 1.21) or disease-specific 5-year mortality (HR=1.04, 95% CI 0.87 to 1.26). Similarly, wide holiday period did not increase the risk of 90-day (HR=0.79, 95% CI 0.55 to 1.13), all-cause 5-year (HR=0.96, 95% CI 0.84 to 1.1) or disease-specific 5-year mortality (HR=1.03, 95% CI 0.89 to 1.19). CONCLUSIONS: No measurable effects of holiday periods on short-term or longer term mortality following surgery for oesophageal cancer were observed in this population-based study, indicating that an adequate surgical experience was maintained during holiday periods

Intense Mass Loss from C-rich AGB Stars at low Metallicity?

We argue that the energy injection of pulsations may be of greater importance to the mass-loss rate of AGB stars than metallicity, and that the mass-loss trend with metallicity is not as simple as sometimes assumed. Using our detailed radiation hydrodynamical models that include dust formation, we illustrate the effects of pulsation energy on wind properties. We find that the mass-loss rate scales with the kinetic energy input by pulsations as long as a dust-saturated wind does not occur, and all other stellar parameters are kept constant. This includes the absolute abundance of condensible carbon (not bound in CO), which is more relevant than keeping the C/O-ratio constant when comparing stars of different metallicity. The pressure and temperature gradients in the atmospheres of stars, become steeper and flatter, respectively, when the metallicity is reduced, while the radius where the atmosphere becomes opaque is typically associated with a higher gas pressure. This effect can be compensated for by adjusting the velocity amplitude of the variable inner boundary (piston), which is used to simulate the effects of pulsation, to obtain models with comparable kinetic-energy input. Hence, it is more relevant to compare models with similar energy-injections than of similar velocity amplitude. Since there is no evidence for weaker pulsations in low-metallicity AGB stars, we conclude that it is unlikely that low-metallicity C-stars have a lower mass-loss rate, than their more metal-rich counterparts with similar stellar parameters, as long as they have a comparable amount of condensible carbon.Comment: 4 pages, 3 figures. Accepted for publication in A&A. Updated after language editing. Additional typos fixe

The Abundance of Elements in Cool Stars, as Determined from High-Resolution, 1-5 Micron Spectroscopy

We review the field of abundance determinations of elements in cool stars, with special interest paid to determinations based on analyses of high-resolution, 1-5 micron spectra. We discuss the current status, problems, and challenges of exploring high-resolution, near-infrared spectra. In particular, advantages and drawbacks are pointed out. A few examples of current, chemical-abundance determinations are high-lighted and, finally, we discuss the developmentComment: To appear in the proceedings of the ESO Workshop on High Resolution Infrared Spectroscopy in Astronomy held in Garching, Germany, 18-21 November 200

Fetal electrocardiogram: ST waveform analysis in intrapartum surveillance

ST waveform analysis of fetal electrocardiogram (ECG) for intrapartum surveillance (STAN) is a newly introduced method for fetal surveillance. The purpose of this commentary is to assist in the proper use of fetal ECG in combination with cardiotocography (CTG) during labour. Guidelines and recommendations concerning CTG and ST waveform interpretation and classification are stated that were agreed on by the European experts on ST waveform analysis for intrapartum surveillance during a meeting in Utretcht, the Netherlands in January 2007

UK experience of liver transplantation for erythropoietic protoporphyria

Erythropoietic protoporphyria (EPP) is characterised by excess production of free protoporphyrin from the bone marrow, most commonly due to deficiency of the enzyme ferrochelatase. Excess protoporphyrin gives rise to the cutaneous photosensitivity characteristic of the disease, and in a minority of patients leads to end-stage liver disease necessitating liver transplantation (LT). There is limited information regarding the timing, impact and long-term outcome of LT in such patients, thus we aimed to identify the indications and outcomes of all transplants performed for EPP in the UK using data from the UK Transplant Registry. Between 1987 and 2009, five patients underwent LT for EPP liver disease. Median follow-up was 60 months, and there were two deaths at 44 and 95 months from causes unrelated to liver disease. The remaining recipients are alive at 22.4 years, 61 months and 55 months after transplant. A high rate of postoperative biliary stricturing requiring multiple biliary interventions was observed. Recurrent EPP-liver disease occurred in 4/5 (80%) of patients but graft failure has not been observed. Given the role of biliary obstruction in inducing EPP-mediated liver damage, we suggest that consideration should be given for construction of a Roux loop at the time of transplant. Thus we demonstrate that although EPP liver transplant recipients have a good long-term survival, comparable to patients undergoing LT for other indications, biliary complications and disease recurrence are almost universal, and bone marrow transplantation should be considered where possible

The puzzling dredge-up pattern in NGC 1978

Low-mass stars are element factories that efficiently release their products in the final stages of their evolution by means of stellar winds. Since they are large in number, they contribute significantly to the cosmic matter cycle. To assess this contribution quantitatively, it is crucial to obtain a detailed picture of the stellar interior, particularly with regard to nucleosynthesis and mixing mechanisms. We seek to benchmark stellar evolutionary models of low-mass stars. In particular, we measure the surface abundance of ^{12}C in thermally pulsing AGB stars with well-known mass and metallicity, which can be used to infer information about the onset and efficiency of the third dredge-up. We recorded high-resolution near-infrared spectra of AGB stars in the LMC cluster NGC 1978. The sample comprised both oxygen-rich and carbon-rich stars, and is well-constrained in terms of the stellar mass, metallicity, and age. We derived the C/O and ^{12}C/^{13}C ratio from the target spectra by a comparison to synthetic spectra. Then, we compared the outcomes of stellar evolutionary models with our measurements. The M stars in NGC 1978 show values of C/O and ^{12}C/^{13}C that can best be explained with moderate extra-mixing on the RGB coupled to a moderate oxygen enhancement in the chemical composition. These oxygen-rich stars do not seem to have undergone third dredge-up episodes (yet). The C stars show carbon-to-oxygen and carbon isotopic ratios consistent with the occurrence of the third dredge-up. We did not find S stars in this cluster. None of the theoretical schemes that we considered was able to reproduce the observations appropriately. Instead, we discuss some non-standard scenarios to explain the puzzling abundance pattern in NGC 1978.Comment: 16 pages, 9 figures, 4 tables, accepted for publication in A&A, language revise

Comparing the effect of STan (cardiotocographic electronic fetal monitoring (CTG) plus analysis of the ST segment of the fetal electrocardiogram) with CTG alone on emergency caesarean section rates: study protocol for the STan Australian Randomised controlled Trial (START).

BACKGROUND: Cardiotocography is almost ubiquitous in its use in intrapartum care. Although it has been demonstrated that there is some benefit from continuous intrapartum fetal monitoring using cardiotocography, there is also an increased risk of caesarean section which is accompanied by short-term and long-term risks to the mother and child. There is considerable potential to reduce unnecessary operative delivery with up to a 60% false positive diagnosis of fetal distress using cardiotocography alone. ST analysis of the fetal electrocardiogram is a promising adjunct to cardiotocography alone, and permits detection of metabolic acidosis of the fetus, potentially reducing false positive diagnosis of fetal distress. METHODS: This study will be a single-centre, parallel-group, randomised controlled trial, conducted over 3 years. The primary hypothesis will be that the proportion of women with an emergency caesarean section on ST analysis will not equal that for women on cardiotocography monitoring alone. Participants will be recruited at the Women's and Children's Hospital, a high-risk specialty facility with approximately 5000 deliveries per annum. A total of 1818 women will be randomised to the treatment or conventional arm with an allocation ratio of 1:1, stratified by parity. The primary outcome is emergency caesarean section (yes/no). Statistical analysis will follow standard methods for randomised trials and will be performed on an intention-to-treat basis. Secondary maternal and neonatal outcomes will also be analysed. Additional study outcomes include psychosocial outcomes, patient preferences and cost-effectiveness. DISCUSSION: Approximately 20% of Australian babies are delivered by emergency caesarean section. This will be the first Australian trial to examine ST analysis of the fetal electrocardiogram as an adjunct to cardiotocography as a potential method for reducing this proportion. The trial will be among the first to comprehensively examine ST analysis, taking into account the impact on psychosocial well-being as well as cost-effectiveness. This research will provide Australian evidence for clinical practice and guideline development as well as for policy-makers and consumers to make informed, evidence-based choices about care in labour. TRIAL REGISTRATION: ANZCTR, ACTRN1261800006268 . Registered on 19 January 2018

Gender Asymmetry in Okun's Law in the Four PIGS Countries

AbstractCentred on the four PIGS countries (Portugal, Italy, Greece and Spain) and using the quarterly data from Q2/1998 until Q4/2014, the paper investigates whether there exists gender asymmetries in Okun's law and whether male unemployment reacts identically to economic fluctuations as female unemployment does. Whilst the trend components of output, male and female unemployment are estimated with the aid of the HP filter, Okun's relationships are modelled in the SVAR framework assuming that cyclical fluctuations of the economy and the labour market with both male and female labour force are endogenous. It is established that gender is indeed a factor that makes the respective segments of the labour market respond slightly differently to changes in real output

An overview of the cutaneous porphyrias

This is an overview of the cutaneous porphyrias. It is a narrative review based on the published literature and my personal experience; it is not based on a formal systematic search of the literature. The cutaneous porphyrias are a diverse group of conditions due to inherited or acquired enzyme defects in the porphyrin–haem biosynthetic pathway. All the cutaneous porphyrias can have (either as a consequence of the porphyria or as part of the cause of the porphyria) involvement of other organs as well as the skin. The single commonest cutaneous porphyria in most parts of the world is acquired porphyria cutanea tarda, which is usually due to chronic liver disease and liver iron overload. The next most common cutaneous porphyria, erythropoietic protoporphyria, is an inherited disorder in which the accumulation of bile-excreted protoporphyrin can cause gallstones and, rarely, liver disease. Some of the porphyrias that cause blistering (usually bullae) and fragility (clinically and histologically identical to porphyria cutanea tarda) can also be associated with acute neurovisceral porphyria attacks, particularly variegate porphyria and hereditary coproporphyria. Management of porphyria cutanea tarda mainly consists of visible-light photoprotection measures while awaiting the effects of treating the underlying liver disease (if possible) and treatments to reduce serum iron and porphyrin levels. In erythropoietic protoporphyria, the underlying cause can be resolved only with a bone marrow transplant (which is rarely justifiable in this condition), so management consists particularly of visible-light photoprotection and, in some countries, narrowband ultraviolet B phototherapy. Afamelanotide is a promising and newly available treatment for erythropoietic protoporphyria and has been approved in Europe since 2014