Ecological impact and cost-effectiveness of wildlife crossings in a highly fragmented landscape:A multi-method approach

Context: Road infrastructure construction is integral to economic development, but negatively affects biodiversity. To mitigate the negative impacts of infrastructure, various types of wildlife crossings are realized worldwide, but little is known about their effectiveness, and cost-effectiveness. Objective: The paper contributes to the methodological and empirical discussion on the effectiveness of wildlife crossings for enhancing the quality of surrounding nature and its cost-effectiveness by analyzing a large-scale wildlife-crossings program in the Netherlands. Method: A multi-criteria cost–benefit analysis is applied, comprised of monetary and non-monetary measures, and a mixed-method approach is used to determine ecological effects. Ecological effects are expressed in the standardized weighted hectare measurement of threat-weighted ecological quality area (1 T-EQA = 1 ha of 100% ecological quality, averagely threatened). Cost-effectiveness is calculated comparing the monetary costs of intervention with ecological benefits (Euro costs/T-EQA), for different types of wildlife crossings and for two other nature policies. Results: The Dutch habitat defragmentation program has induced an increase in nature value of 1734 T-EQA at a cost of Euro 283 million. Ecological gains per hierarchically ordered groups of measures differ strongly: The most effective are ecoducts (wildlife crossing bridges) followed by shared-use viaducts and large fauna tunnels. Ecoducts generated the largest gain in nature value, but were also the most costly measures. In terms of cost-effectiveness, both large fauna tunnels and shared-use viaducts for traffic and animals outperformed ecoducts. Conclusions: Ecoducts deliver ecologically, but their cost-effectiveness appears modest. Purchasing agricultural land for restoration of nature appears more cost-effective than building wildlife crossings. Yet, reducing environmental pressures or their effects on existing nature areas is likely to be most cost-effective.</p

Body Composition Is a Predictor for Postoperative Complications After Gastrectomy for Gastric Cancer:a Prospective Side Study of the LOGICA Trial

PURPOSE: There is a lack of prospective studies evaluating the effects of body composition on postoperative complications after gastrectomy in a Western population with predominantly advanced gastric cancer. METHODS: This is a prospective side study of the LOGICA trial, a multicenter randomized trial on laparoscopic versus open gastrectomy for gastric cancer. Trial patients who received preoperative chemotherapy followed by gastrectomy with an available preoperative restaging abdominal computed tomography (CT) scan were included. The CT scan was used to calculate the mass (M) and radiation attenuation (RA) of skeletal muscle (SM), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT). These variables were expressed as Z-scores, depicting how many standard deviations each patient’s CT value differs from the sex-specific study sample mean. Primary outcome was the association of each Z-score with the occurrence of a major postoperative complication (Clavien-Dindo grade ≥ 3b). RESULTS: From 2015 to 2018, a total of 112 patients were included. A major postoperative complication occurred in 9 patients (8%). A high SM-M Z-score was associated with a lower risk of major postoperative complications (RR 0.47, 95% CI 0.28–0.78, p = 0.004). Furthermore, high VAT-RA Z-scores and SAT-RA Z-scores were associated with a higher risk of major postoperative complications (RR 2.82, 95% CI 1.52–5.23, p = 0.001 and RR 1.95, 95% CI 1.14–3.34, p = 0.015, respectively). VAT-M, SAT-M, and SM-RA Z-scores showed no significant associations. CONCLUSION: Preoperative low skeletal muscle mass and high visceral and subcutaneous adipose tissue radiation attenuation (indicating fat depleted of triglycerides) were associated with a higher risk of developing a major postoperative complication in patients treated with preoperative chemotherapy followed by gastrectomy. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11605-022-05321-0

In vivo quantification of photosensitizer fluorescence in the skin-fold observation chamber using dual-wavelength excitation and NIR imaging

A major challenge in biomedical optics is the accurate quantification of in vivo fluorescence images. Fluorescence imaging is often used to determine the pharmacokinetics of photosensitizers used for photodynamic therapy. Often, however, this type of imaging does not take into account differences in and changes to tissue volume and optical properties of the tissue under interrogation. To address this problem, a ratiometric quantification method was developed and applied to monitor photosensitizer meso-tetra (hydroxyphenyl) chlorin (mTHPC) pharmacokinetics in the rat skin-fold observation chamber. The method employs a combination of dual-wavelength excitation and dualwavelength detection. Excitation and detection wavelengths were selected in the NIR region. One excitation wavelength was chosen to be at the Q band of mTHPC, whereas the second excitation wavelength was close to its absorption minimum. Two fluorescence emission bands were used; one at the secondary fluorescence maximum of mTHPC centered on 720 nm, and one in a region of tissue autofluorescence. The first excitation wavelength was used to excite the mTHPC and autofluorescence and the second to excite only autofluorescence, so that this could be subtracted. Subsequently, the autofluorescence-corrected mTHPC image was divided by the autofluorescence signal to correct for variations in tissue optical properties. This correction algorithm in principle results in a linear relation between the corrected fluorescence and photosensitizer concentration. The limitations of the presented method and comparison with previously published and validated techniques are discussed

Laparoscopic versus open gastrectomy for gastric cancer

General introduction and thesis outline Gastric and esophageal cancer are the third and sixth more common causes of cancer-related death worldwide. In addition, the incidence of adenocarcinoma of the proximal stomach, gastroesophageal junction (GEJ) and distal esophagus is increasing, especially in Western populations. Unfortunately, only slightly over 50% of patients are diagnosed with potentially curable disease. Treatment with curative intent generally consists of surgical resection and chemo(radio)therapy. However, this treatment can lead to major morbidity and less than 40% of patients undergoing this treatment are cured. In addition, for the majority of patients, the current optimal treatment is relatively similar. Ultimately, to improve outcomes, treatment should be further tailored to the individual patient. The first aim of this thesis was to compare the two most important approaches of curative surgery for the relatively common gastric adenocarcinoma: laparoscopic versus open gastrectomy (part I). The second aim of this thesis was to evaluate treatment for less common subtypes of gastroesophageal cancer and treatment in patients at high risk for postoperative complications, to work towards a more personalized treatment of gastroesophageal cancer (part II). Conclusion Results from the multicenter randomized LOGICA-trial, performed in a Western population with mainly locally advanced gastric adenocarcinoma, demonstrated that postoperative complications, postoperative recovery, quality of life and oncological efficacy were comparable between laparoscopic and open gastrectomy. In laparoscopic gastrectomy, adequate pain control was achieved, generally without epidural analgesia. In addition, fewer patients used oral opioids at discharge, compared to the open gastrectomy. Differences in costs were limited between both treatments, though they might slightly favor open gastrectomy. These results support centers to choose, based upon their own preference, whether or not to (de)implement laparoscopic gastrectomy as an alternative to open gastrectomy. Three nationwide retrospective studies were performed in patients with less common subtypes of gastroesophageal cancer: diffuse type carcinoma (including SRCC), (MA)NEC and gastroesophageal cancer with hepatic or pulmonary oligometastases. The results provide insights that can help guide treatment decisions at multidisciplinary tumor boards. Two new clinical trials were designed and initiated as part of this thesis. The CARDIA-trial includes patients with Siewert type 2 GEJ cancer and the ISCON-trial includes patients with esophageal cancer selected on preoperative CT-scan to be at high risk for postoperative morbidity. Once completed, the results will help guide and further improve surgical treatment strategies for these patients

Laparoscopic versus open gastrectomy for gastric cancer

General introduction and thesis outline Gastric and esophageal cancer are the third and sixth more common causes of cancer-related death worldwide. In addition, the incidence of adenocarcinoma of the proximal stomach, gastroesophageal junction (GEJ) and distal esophagus is increasing, especially in Western populations. Unfortunately, only slightly over 50% of patients are diagnosed with potentially curable disease. Treatment with curative intent generally consists of surgical resection and chemo(radio)therapy. However, this treatment can lead to major morbidity and less than 40% of patients undergoing this treatment are cured. In addition, for the majority of patients, the current optimal treatment is relatively similar. Ultimately, to improve outcomes, treatment should be further tailored to the individual patient. The first aim of this thesis was to compare the two most important approaches of curative surgery for the relatively common gastric adenocarcinoma: laparoscopic versus open gastrectomy (part I). The second aim of this thesis was to evaluate treatment for less common subtypes of gastroesophageal cancer and treatment in patients at high risk for postoperative complications, to work towards a more personalized treatment of gastroesophageal cancer (part II). Conclusion Results from the multicenter randomized LOGICA-trial, performed in a Western population with mainly locally advanced gastric adenocarcinoma, demonstrated that postoperative complications, postoperative recovery, quality of life and oncological efficacy were comparable between laparoscopic and open gastrectomy. In laparoscopic gastrectomy, adequate pain control was achieved, generally without epidural analgesia. In addition, fewer patients used oral opioids at discharge, compared to the open gastrectomy. Differences in costs were limited between both treatments, though they might slightly favor open gastrectomy. These results support centers to choose, based upon their own preference, whether or not to (de)implement laparoscopic gastrectomy as an alternative to open gastrectomy. Three nationwide retrospective studies were performed in patients with less common subtypes of gastroesophageal cancer: diffuse type carcinoma (including SRCC), (MA)NEC and gastroesophageal cancer with hepatic or pulmonary oligometastases. The results provide insights that can help guide treatment decisions at multidisciplinary tumor boards. Two new clinical trials were designed and initiated as part of this thesis. The CARDIA-trial includes patients with Siewert type 2 GEJ cancer and the ISCON-trial includes patients with esophageal cancer selected on preoperative CT-scan to be at high risk for postoperative morbidity. Once completed, the results will help guide and further improve surgical treatment strategies for these patients