Hospital variation and outcomes after repeat hepatic resection for colorectal liver metastases:a nationwide cohort study

Background: Approximately 70% of patients with colorectal liver metastases (CRLM) experiences intrahepatic recurrence after initial liver resection. This study assessed outcomes and hospital variation in repeat liver resections (R-LR).Methods: This population-based study included all patients who underwent liver resection for CRLM between 2014 and 2022 in the Netherlands. Overall survival (OS) was collected for patients operated on between 2014 and 2018 by linkage to the insurance database. Results: Data of 7479 liver resections (1391 (18.6%) repeat and 6088 (81.4%) primary) were analysed. Major morbidity and mortality were not different. Factors associated with major morbidity included ASA 3+, major liver resection, extrahepatic disease, and open surgery. Five-year OS after repeat versus primary liver resection was 42.3% versus 44.8%, P = 0.37. Factors associated with worse OS included largest CRLM &gt;5 cm (aHR 1.58, 95% CI: 1.07–2.34, P = 0.023), &gt;3 CRLM (aHR 1.33, 95% CI: 1.00–1.75, P = 0.046), extrahepatic disease (aHR 1.60, 95% CI: 1.25–2.04, P = 0.001), positive tumour margins (aHR 1.42, 95% CI: 1.09–1.85, P = 0.009). Significant hospital variation in performance of R-LR was observed, median 18.9% (8.2% to 33.3%).Conclusion: Significant hospital variation was observed in performance of R-LR in the Netherlands reflecting different treatment decisions upon recurrence. On a population-based level R-LR leads to satisfactory survival.</p

Hospital variation and outcomes after repeat hepatic resection for colorectal liver metastases:a nationwide cohort study

Background: Approximately 70% of patients with colorectal liver metastases (CRLM) experiences intrahepatic recurrence after initial liver resection. This study assessed outcomes and hospital variation in repeat liver resections (R-LR).Methods: This population-based study included all patients who underwent liver resection for CRLM between 2014 and 2022 in the Netherlands. Overall survival (OS) was collected for patients operated on between 2014 and 2018 by linkage to the insurance database. Results: Data of 7479 liver resections (1391 (18.6%) repeat and 6088 (81.4%) primary) were analysed. Major morbidity and mortality were not different. Factors associated with major morbidity included ASA 3+, major liver resection, extrahepatic disease, and open surgery. Five-year OS after repeat versus primary liver resection was 42.3% versus 44.8%, P = 0.37. Factors associated with worse OS included largest CRLM &gt;5 cm (aHR 1.58, 95% CI: 1.07–2.34, P = 0.023), &gt;3 CRLM (aHR 1.33, 95% CI: 1.00–1.75, P = 0.046), extrahepatic disease (aHR 1.60, 95% CI: 1.25–2.04, P = 0.001), positive tumour margins (aHR 1.42, 95% CI: 1.09–1.85, P = 0.009). Significant hospital variation in performance of R-LR was observed, median 18.9% (8.2% to 33.3%).Conclusion: Significant hospital variation was observed in performance of R-LR in the Netherlands reflecting different treatment decisions upon recurrence. On a population-based level R-LR leads to satisfactory survival.</p

Evolution in the orbital structure of quiescent galaxies from MAGPI, LEGA-C, and SAMI surveys: direct evidence for merger-driven growth over the last 7 Gyr

We present the first study of spatially integrated higher-order stellar kinematics over cosmic time. We use deep rest-frame optical spectroscopy of quiescent galaxies at redshifts z = 0.05, 0.3, and 0.8 from the SAMI, MAGPI, and LEGA-C surveys to measure the excess kurtosis h4 of the stellar velocity distribution, the latter parametrized as a Gauss-Hermite series. Conservatively using a redshift-independent cut in stellar mass (⁠⁠) and matching the stellar-mass distributions of our samples, we find 7σ evidence of h4 increasing with cosmic time, from a median value of 0.019 ± 0.002 at z = 0.8 to 0.059 ± 0.004 at z = 0.06. Alternatively, we use a physically motivated sample selection based on the mass distribution of the progenitors of local quiescent galaxies as inferred from numerical simulations; in this case, we find 10σ evidence. This evolution suggests that, over the last 7 Gyr, there has been a gradual decrease in the rotation-to-dispersion ratio and an increase in the radial anisotropy of the stellar velocity distribution, qualitatively consistent with accretion of gas-poor satellites. These findings demonstrate that massive galaxies continue to accrete mass and increase their dispersion support after becoming quiescent

Different higher order kinematics between star-forming and quiescent galaxies based on the SAMI, MAGPI, and LEGA-C surveys

We present the first statistical study of spatially integrated non-Gaussian stellar kinematics spanning 7 Gyr in cosmic time. We use deep, rest-frame optical spectroscopy of massive galaxies (stellar mass ⁠) at redshifts z = 0.05, 0.3, and 0.8 from the SAMI, MAGPI, and LEGA-C surveys, to measure the excess kurtosis h4 of the stellar velocity distribution, the latter parametrized as a Gauss–Hermite series. We find that at all redshifts where we have large enough samples, h4 anticorrelates with the ratio between rotation and dispersion, highlighting the physical connection between these two kinematic observables. In addition, and independently from the anticorrelation with rotation-to-dispersion ratio, we also find a correlation between h4 and M⋆, potentially connected to the assembly history of galaxies. In contrast, after controlling for mass, we find no evidence of independent correlation between h4 and aperture velocity dispersion or galaxy size. These results hold for both star-forming and quiescent galaxies. For quiescent galaxies, h4 also correlates with projected shape, even after controlling for the rotation-to-dispersion ratio. At any given redshift, star-forming galaxies have lower h4 compared to quiescent galaxies, highlighting the link between kinematic structure and star-forming activity

Urban surface water pollution problems arising from misconnections

The impacts of misconnections on the organic and nutrient loadings to surface waters are assessed using specific household appliance data for two urban sub-catchments located in the London metropolitan region and the city of Swansea. Potential loadings of biochemical oxygen demand (BOD), soluble reactive phosphorus (PO4-P) and ammoniacal nitrogen (NH4-N) due to misconnections are calculated for three different scenarios based on the measured daily flows from specific appliances and either measured daily pollutant concentrations or average pollutant concentrations for relevant greywater and black water sources obtained from an extensive review of the literature. Downstream receiving water concentrations, together with the associated uncertainties, are predicted from derived misconnection discharge concentrations and compared to existing freshwater standards for comparable river types. Consideration of dilution ratios indicates that these would need to be of the order of 50–100:1 to maintain high water quality with respect to BOD and NH4-N following typical misconnection discharges but only poor quality for PO4-P is likely to be achievable. The main pollutant loading contributions to misconnections arise from toilets (NH4-N and BOD), kitchen sinks (BOD and PO4-P) washing machines (PO4-P and BOD) and, to a lesser extent, dishwashers (PO4-P). By completely eliminating toilet misconnections and ensuring misconnections from all other appliances do not exceed 2%, the potential pollution problems due to BOD and NH4-N discharges would be alleviated but this would not be the case for PO4-P. In the event of a treatment option being preferred to solve the misconnection problem, it is shown that for an area the size of metropolitan Greater London, a sewage treatment plant with a Population Equivalent value approaching 900,000would be required to efficiently remove BOD and NH4-N to safely dischargeable levels but such a plant is unlikely to have the capacity to deal satisfactorily with incoming PO4-P loads from misconnections

UNCOVER: A NIRSpec Census of Lensed Galaxies at z=8.50-13.08 Probing a High AGN Fraction and Ionized Bubbles in the Shadow

We present JWST NIRSpec prism spectroscopy of gravitationally lensed galaxies at $z\gtrsim9$ found behind the massive galaxy cluster Abell 2744 in the UNCOVER Cycle 1 Treasury Program. We confirm the source redshift via emission lines and/or the Ly$\alpha$ break feature for ten galaxies at z=8.50-13.08 down to $M_{\rm UV}=-17.3$. We achieve a high confirmation rate of 100\% for $z>9$ candidates reported in Atek et al. (2023). Using six sources with multiple emission line detections, we find that the offset of the redshift estimates between the lines and the Ly$\alpha$ break alone with prism can be as large as $\pm0.2$, raising caution in designing future follow-up spectroscopy for the break-only sources. With spec-$z$ confirmed sources in UNCOVER and the literature, we derive lower limits on the rest-frame ultraviolet (UV) luminosity function (LF) at $z\simeq9$-12 and find these lower limits to be consistent with recent photometric measurements. We identify at least two unambiguous and several possible active galactic nucleus (AGN) systems based on X-ray emission, broad line (BL) H$\beta$, high ionization line (e.g., NIV]1487, CIV1549) detections, and excess in UVLF. This requires the AGN LFs at $z\simeq$ 9-10 to be comparable or even higher than the X-ray AGN LF estimated at $z\sim6$ and indicates a plausible cause of the high abundance of $z>9$ galaxies claimed in recent photometric studies may be AGNs. One UV-luminous source is confirmed at the same redshift as a dusty BL AGN at $z=8.50$ with a physical separation of 380 kpc in the source plane. These two sources show blueward Ly$\alpha$ line or continuum emission, suggesting that they reside in the same ionized bubble with a radius of $7.69\pm0.18$ pMpc. Our results imply that AGNs have a non-negligible contribution to cosmic reionization.Comment: 27 pages, 11 figures, 4 tables, submitted to ApJ (See also arXiv:2308.11610

Globally distributed iridium layer preserved within the Chicxulub impact structure

The Cretaceous-Paleogene (K-Pg) mass extinction is marked globally by elevated concentrations of iridium, emplaced by a hypervelocity impact event 66 million years ago. Here, we report new data from four independent laboratories that reveal a positive iridium anomaly within the peak-ring sequence of the Chicxulub impact structure, in drill core recovered by IODP-ICDP Expedition 364. The highest concentration of ultrafine meteoritic matter occurs in the post-impact sediments that cover the crater peak ring, just below the lowermost Danian pelagic limestone. Within years to decades after the impact event, this part of the Chicxulub impact basin returned to a relatively low-energy depositional environment, recording in unprecedented detail the recovery of life during the succeeding millennia. The iridium layer provides a key temporal horizon precisely linking Chicxulub to K-Pg boundary sections worldwide