Geomechanics contribution to CO2 storage containment and trapping mechanisms in tight sandstone complexes: A case study on Mae Moh Basin

Recognized as a not-an-option approach to mitigate the climate crisis, carbon dioxide capture and storage (CCS) has a potential as much as gigaton of CO2 to sequestrate permanently and securely. Recent attention has been paid to store highly concentrated point-source CO2 into saline formation, of which Thailand considers one onshore case in the north located in Lampang - the Mae Moh coal-fired power plant matched with its own coal mine of Mae Moh Basin. Despite a large basin and short transport route from the source, target sandstone reservoir buried at deeper than 1000 m is of tight nature and limited data, while question on storing possibility has thereafter risen. The current study is thus aimed to examine the influence of reservoir geomechanics on CO2 storage containment and trapping mechanisms, with co-contributions from geochemistry and reservoir heterogeneity, using reservoir simulator - CMG-GEM. With the injection rate designed for 30-year injection, reservoir pressure build-ups were ∼77 % of fracture pressure but increased to ∼80 % when geomechanics excluded. Such pressure responses imply that storage security is associated with the geomechanics. Dominated by viscous force, CO2 plume migrated more laterally while geomechanics clearly contributed to lesser migration due to reservoir rock strength constraint. Reservoir geomechanics contributed to less plume traveling into more constrained spaces while leakage was secured, highlighting a significant and neglected influence of geomechanical factor. Spatiotemporal development of CO2 plume also confirms the geomechanics-dominant storage containment. Reservoir geomechanics as attributed to its respective reservoir fluid pressure controls development of trapping mechanisms, especially into residual and solubility traps. More secured storage containment after the injection was found with higher pressure, while less development into solubility trap was observed with lower pressure. The findings reveal the possibility of CO2 storage in tight sandstone formations, where geomechanics govern greatly the plume migration and the development of trapping mechanisms.

A rare case of mycotic aortic aneurysm with Clostridium perfringens culture

Key Clinical Message

As only early diagnosis, prompt surgical intervention, and appropriate antibiotic therapy can decrease clostridial MAA mortality rate; keeping in mind a broad differential diagnosis in a patient with sepsis and unusual vascular symptoms is important.

Abstract

Mycotic aortic aneurysm (MAA) is an infrequent but very consequential condition characterized by the pathological disruption of the aorta due to infection. Clostridium perfringens is a bacterium that falls under the taxonomic classification of the genus Clostridium. Although mycotic aneurysm is often not commonly linked with this infection, there are instances when it may function as a causative agent for MAA. Timely diagnosis and thorough therapeutic techniques, including surgical intervention and quick administration of appropriate antibiotics, can potentially reduce the mortality rate associated with clostridial MAA. In this study, we presented a clinical report detailing the diagnosis of a mycotic aneurysm caused by C. perfringens in the thoracic aorta in a 66-year-old male patient with a history of diabetes mellitus and a recent prostate biopsy. Furthermore, we discussed the surgical approach and overall management strategy to address this case.

Interfacial Tension-Temperature-Pressure-Salinity Relationship for the Hydrogen-Brine System under Reservoir Conditions: Integration of Molecular Dynamics and Machine Learning

Hydrogen (H2) underground storage has attracted considerable attention as a potentially efficient strategy for the large-scale storage of H2. Nevertheless, successful execution and long-term storage and withdrawal of H2 necessitate a thorough understanding of the physical and chemical properties of H2 in contact with the resident fluids. As capillary forces control H2 migration and trapping in a subsurface environment, quantifying the interfacial tension (IFT) between H2 and the resident fluids in the subsurface is important. In this study, molecular dynamics (MD) simulation was employed to develop a data set for the IFT of H2-brine systems under a wide range of thermodynamic conditions (298-373 K temperatures and 1-30 MPa pressures) and NaCl salinities (0-5.02 mol·kg-1). For the first time to our knowledge, a comprehensive assessment was carried out to introduce the most accurate force field combination for H2-brine systems in predicting interfacial properties with an absolute relative deviation (ARD) of less than 3% compared with the experimental data. In addition, the effect of the cation type was investigated for brines containing NaCl, KCl, CaCl2, and MgCl2. Our results show that H2-brine IFT decreases with increasing temperature under any pressure condition, while higher NaCl salinity increases the IFT. A slight decrease in IFT occurs when the pressure increases. Under the impact of cation type, Ca2+ can increase IFT values more than others, i.e., up to 12% with respect to KCl. In the last step, the predicted IFT data set was used to provide a reliable correlation using machine learning (ML). Three white-box ML approaches of the group method of data handling (GMDH), gene expression programming (GEP), and genetic programming (GP) were applied. GP demonstrates the most accurate correlation with a coefficient of determination (R2) and absolute average relative deviation (AARD) of 0.9783 and 0.9767%, respectively.

Spirituality as a Neglected Core in Occupational Therapy Practice: An Iranian Exploratory Survey

Spirituality has received more attention in recent decades from different health disciplines. Occupational Therapy (OT), as a health discipline, believes that all aspects of human experience, including physical, psychological, social, and spiritual, are considered essential aspects of health. OT supports the fact that incorporating spirituality can promote health, well-being, and quality of life. Various researchers have attempted to investigate and explain occupational therapists' views on spirituality. In Iran's OT curriculum, spirituality has not been incorporated directly. The purpose of this study is to acquire information about the knowledge and opinions of Iranian occupational therapists about spirituality. This is a cross-sectional exploratory descriptive survey study in which 125 occupational therapists participated through convenience sampling. Inclusion criteria were, namely (a) at least one-year clinical experience of OT, (b) being educated in Iran, and (c) working in Iran. The Occupational Therapy Assessment of Spirituality (OTAS) questionnaire was used for data collection. The answers to the quantitative questions were analyzed through descriptive statistics. Most of the participants believed that spirituality should be incorporated by occupational therapists, but more than half of the participants disagreed that formal education prepared them to pay any attention to spirituality in their practice. Analyzing qualitative data by frequencies of their repetitions, led to four categories and sixteen subcategories, accordingly. The four categories are (1) the barriers to applying spirituality in OT, (2) the need to acquire knowledge and apply spirituality in OT, (3) the benefits of incorporating spirituality for a client, and (4) the benefits of incorporating spirituality for the occupational therapist. The findings indicate that academic education has failed to prepare Iranian occupational therapists to meet spiritual needs of their clients. However, OTs tend to get information about spirituality from other sources and find it helpful for themselves and their clients. There are also barriers to applying spirituality; therefore, an educational package is needed to address these problems.

Automated segmentation and morphological characterization of placental intervillous space based on a single labeled image

In this study, a novel method of data augmentation has been presented for the segmentation of placental histological images when the labeled data are scarce. This method generates new realizations of the placenta intervillous morphology while maintaining the general textures and orientations. As a result, a diversified artificial dataset of images is generated that can be used for training deep learning segmentation models. We have observed that on average the presented method of data augmentation led to a 42% decrease in the binary cross-entropy loss of the validation dataset compared to the common approach in the literature. Additionally, the morphology of the intervillous space is studied under the effect of the proposed image reconstruction technique, and the diversity of the artificially generated population is quantified. We have demonstrated that the proposed method results in a more accurate morphological characterization of the placental intervillous space with an average feature relative error of 6.5%, which is significantly lower than the 11.5% error observed with conventional augmentation techniques. Due to the high resemblance of the generated images to the real ones, applications of the proposed method may not be limited to placental histological images, and it is recommended that other types of tissue be investigated in future studies.

Functional requirements of a mobile‐based application for stroke self‐management: A Delphi study

This study aimed to determine the functional requirements of a self‐management mobile application for stroke survivors. For extracting the initial functional requirements, a literature review as well as interviews with 17 patients and caregivers were done. The results were analyzed using the content analysis method. The initial extracted requirements were then provided to the specialists by the Delphi technique to determine the final functional requirements. Content validity ratio (CVR) and content validity index (CVI) were calculated according to the Lawshe model. Criteria for item approval included CVR > 0.49 and CVI > 0.79. Finally, the approved items were turned into a five‐point Likert scale questionnaire and were then provided to 53 experts and items with a mean score higher than 3.75 were approved. Functional requirements including creating a user account, educational material, support services, providing reminders and alerts for drugs administration and physician appointments, and rehabilitation exercises (to improve balance, upper and lower extremities rehabilitation, and activities of daily living (ADLs)) were approved. Most of the approved functional requirements were related to rehabilitation exercises for improving upper limb motor function. The experts did not approve the requirements for using splints and slings or the recommendation to take some medications.

Nanoparticle transport within non-Newtonian fluid flow in porous media

Control over dispersion of nanoparticles in polymer solutions through porous media is important for subsurface applications such as soil remediation and enhanced oil recovery. Dispersion is affected by the spatial heterogeneity of porous media, the non-Newtonian behavior of polymer solutions, and the Brownian motion of nanoparticles. Here, we use the Euler-Lagrangian method to simulate the flow of nanoparticles and inelastic non-Newtonian fluids (described by Meter model) in a range of porous media samples and injection rates. In one case, we use a fine mesh of more than 3 million mesh points to model nanoparticles transport in a sandstone sample. The results show that the velocity distribution of nanoparticles in the porous medium is non-Gaussian, which leads to the non-Fickian behavior of nanoparticles dispersion. Due to pore-space confinement, the long-time mean-square displacement of nanoparticles depends nonlinearly on time. Additionally, the gradient of shear stress in the pore space of the porous medium dictates the transport behavior of nanoparticles in the porous medium. Furthermore, the Brownian motion of nanoparticles increases the dispersion of nanoparticles along the longitudinal and transverse direction.

Dissolution and remobilization of NAPL in surfactant-enhanced aquifer remediation from microscopic scale simulations

In this paper, the dissolution and mobilization of non-aqueous phase liquid (NAPL) blobs in the Surfactant-Enhanced Aquifer Remediation (SEAR) process were upscaled using dynamic pore network modeling (PNM) of three-dimensional and unstructured networks. We considered corner flow and micro-flow mechanisms including snap-off and piston-like movement for two-phase flow. Moreover, NAPL entrapment and remobilization were evaluated using force analysis to develop the capillary desaturation curve (CDC) and predict the onset of remobilization. The corner diffusion mechanism was also applied in the modeling of interphase mass transfer to represent NAPL dissolution as the dominant mass transfer process. In addition, the effect of pore-scale heterogeneity on mass transfer rate coefficient and recovered residual NAPL was considered in the simulations. Sodium dodecyl sulfate (SDS) and Triton X-100 were used as the surfactant for the SEAR process. The results indicate that although surfactants enhance NAPL recovery during two-phase flow, surfactant-enhanced remediation of residual NAPL through dissolution is highly dependent on surfactant type. When SDS ─as a surfactant with high critical micelle concentration (CMC) and low micelle partition coefficient (K_m)─ was injected into a NAPL contaminated site, the mass transfer rate coefficient decreased (due to considerable changes in interface chemical potentials) which leads to a significant reduction in NAPL recovery after the end of two-phase flow. In contrast, Triton X-100 (with low CMC and high K_m) improved NAPL recovery, by enhancing solubility at surfactant concentrations greater than CMC which overcompensates the interphase mass transfer reduction.

Pore network and Darcy scale modelling of DNAPL remediation using ethanol flushing: Study of physical properties in DNAPL remediation

Co-solvent flushing into contaminated soils is one of the most effective techniques for Dense Non-Aqueous Phase Liquid (DNAPL) remediation. In addition to the increase of DNAPL solubility, co-solvents (e.g. ethanol) can alter the viscosity and density of aqueous phase and diffusion coefficient of solute. Any changes in these parameters can change the flow behaviour and alter the upscaled DNAPL mass transfer coefficient which is a key parameter controlling soil and groundwater remediation at Darcy-scale. While numerous studies have investigated DNAPL remediation using co-solvents at the Darcy scale, pore-scale modelling of co-solvent enhanced DNAPL remediation has not been well investigated. In this work, a three-dimensional pore-network model was developed to simulate the 1,2-dichlorobenzene (DCB) remediation experiments using ethanol-water flushing solution. The model simulates the effect of changes in solubility, viscosity, density, and diffusion coefficient during co-solvent flushing of the DNAPL. The results of pore network modelling for ethanol-water flushing for the DCB remediation were also validated using the experimental data. In addition to pore-scale modelling, a continuum scale modelling (Darcy-scale) was used for the DCB remediation using ethanol-water flushing. The results of both pore network and continuum scale modelling demonstrated that the ethanol content and flushing velocity influence the interphase mass transfer and DNAPL dissolution process. The results indicated while the mass transfer coefficient decreased in the presence of ethanol, the process of NAPL remediation was improved due to the substantial increase of solubility in the presence of co-solvent. The large scale modelling showed that NAPL bank can be formed in the front of ethanol-water mixture flushing.

Occupational Therapy Assessment of Spirituality questionnaire: translation into Persian and psychometric testing

Background/aims

Occupational therapy is a profession that uses holistic and person-centered approaches that deal with all aspects of daily life. Clients' needs fall into four areas, and one of them is spirituality. Therefore, occupational therapists should pay attention to this area, but there is little information on the status of occupational therapists' knowledge and use in clinical practice. The aim of this study was to translate the occupational therapy assessment of spirituality questionnaire into Persian and determine its validity, factor analysis and reliability.

Methods

This is a psychometric study that was conducted between June and September 2018. The Occupational Therapy Assessment of Spirituality is a self-report, 25-item questionnaire, with self-exploratory scoring that investigates occupational therapists' views on four factors: spirituality in the scope of practice following its addition in the theoretical framework; formal education and training on spirituality; need for future educational opportunities and training to address spirituality; and awareness of assessments and evaluations in occupational therapy that incorporate clients' spirituality. The International Quality of Life Assessment approach was used for translation. Content validity was performed with 10 occupational therapists regarding qualitative content validity, content validity index and content validity ratio. Exploratory factor analysis and internal consistency with a sample size of 125 people and test–retest coefficient with a sample size of 25 people were computed for reliability.

Results

Qualitative content validity was confirmed, with content validity index greater than 0.79 and content validity ratio greater than 0.62. During the exploratory factor analysis process, the number of factors was reduced to three factors and the number of questions were reduced from 21 to 15 questions. Internal consistency was good (0.88). Test–retest coefficient was 0.96, with a high level of significance (P<0.001).

Conclusions

The Persian version of the Occupational Therapy Assessment of Spirituality is a reliable and valid questionnaire and can be used among Iranian occupational therapists in different clinical settings.

Experiments and sensitivity coefficients analysis for multiphase flow model calibration of enhanced DNAPL dissolution

Multiphase flow modeling is often used for the comparison and optimization of subsurface nonaqueous phase liquid (NAPL) remediation schemes. The calibration of such models is a challenging task due to the lack of detailed data describing the initial NAPL spatial distribution and the processes governing the fate and transport of NAPLs in porous media. In this study laboratory scale experiments were conducted to evaluate reagent-enhanced dense nonaqueous phase liquid (DNAPL) solubilization in saturated heterogeneous media. The DNAPL consisted of both pooled and residual saturation forms. To gain insight into the influence of various input parameters on effluent concentrations, the multiphase flow program was used to compute the sensitivity coefficients of key parameters, relating to the flow, flushing solution properties, soil parameters, NAPL distribution and mass transfer coefficient. The sensitivity coefficients were, in turn, used to aid in the model calibration and to underline the difficulties associated with the calibration of multiphase flow models, most notably the non-uniqueness of the calibration process when complete information is lacking. To alleviate this uncertainty and provide additional constraints, the conducted flushing experiments were jointly used to calibrate the multiphase flow model. The results of the model calibration suggest that the interphase mass transfer coefficient is dependent on the properties of the reagent aqueous solution used for DNAPL remediation, most notably the viscosity and interfacial tension.

Phenotyping and long-term follow up of patients with hyper IgE syndrome

INTRODUCTION AND OBJECTIVES

Long-term follow up of patients with hyper IgE syndrome (HIES), as a primary immunodeficiency disorder, has been poorly investigated. This study describes common clinical and immunological features of patients with HIES in the last 10 years in Shiraz University of Medical Sciences, Shiraz, Iran.

METHODS AND PATIENTS

In this cross-sectional study, the symptoms and medical records of 18 patients, who were diagnosed with HIES, were observed. Genetic and immunologic study was also performed.

RESULTS

Eighteen patients with the mean age of 13 years old were investigated. Ten patients were detected to have mutations in DOCK8 gene and autosomal recessive HIES (AR-HIES); and four patients were found with STAT3 mutation and autosomal dominant HIES (AD-HIES). So, 14 patients with known genetic results were considered for further data analysis. Food allergy, eczema, viral and skin infections were the major complications of AR-HIES patients. The major clinical complications of AD-HIES patients were pneumonia, skin infections and eczema. Food allergy and viral infection were significantly higher in DOCK8 deficient patients. The most common causes of hospitalization in both AR-HIES and AD-HIES patients were pneumonia, skin infections and sepsis. The most common cause of death was found to be sepsis.

CONCLUSIONS

AD-HIES and AR-HIES cannot be differentiated only based on the clinical presentations. Genetic features are also necessary for better diagnosis. This study, summarizing the clinical, immunological and genetic information of the patients with AD-HIES and AR-HIES, may open a way for better diagnosis and management of HIES.

Numerical modelling of the impact of surfactant partitioning on surfactant-enhanced aquifer remediation

The partitioning of surfactants into non-aqueous phase liquids (NAPLs) during Surfactant-Enhanced Aquifer Remediation (SEAR) is potentially an important and non-negligible phenomenon that can strongly impact remediation efficiency. This paper numerically investigates the impact of surfactant partitioning on the enhanced NAPL dissolution and mobilization mechanisms and the overall NAPL removal from the subsurface. For demonstration, a multiphase model is used to simulate a hypothetical SEAR consisting of Triton X100 surfactant solution for the removal of perchloroethylene (PCE) entrapped in contaminated porous medium at the core/column scale. The simulations are conducted for two-dimensional homogenous and three-dimensional heterogeneous systems. By simultaneously incorporating spatial heterogeneity of porous media, injection rate, and endpoint mobility ratio into the model, we delineate the interplay of surfactant partitioning with flow and transport dynamics. Our results show that surfactant partitioning from the aqueous phase across the interface to the NAPL phase can undermine both efficiency of the enhanced dissolution and mobilization of NAPL species. This undermining is more pronounced for when aqueous phase mobility is less than the mobility of the NAPL phase. For such conditions interfacial tension between the two phases is reduced less for partitioning than non-partitioning cases (due to loss of surfactant into NAPL phase) and a secondary water front is formed due to partitioning that makes aqueous phase breaks through earlier.

Resection of pancreatic cancer in Europe and USA: an international large-scale study highlighting large variations

OBJECTIVE

Resection can potentially cure resectable pancreatic cancer (PaC) and significantly prolong survival in some patients. This large-scale international study aimed to investigate variations in resection for PaC in Europe and USA and determinants for its utilisation.

DESIGN

Data from six European population-based cancer registries and the US Surveillance, Epidemiology, and End Results Program database during 2003-2016 were analysed. Age-standardised resection rates for overall and stage I-II PaCs were computed. Associations between resection and demographic and clinical parameters were assessed using multivariable logistic regression models.

RESULTS

A total of 153 698 records were analysed. In population-based registries in 2012-2014, resection rates ranged from 13.2% (Estonia) to 21.2% (Slovenia) overall and from 34.8% (Norway) to 68.7% (Denmark) for stage I-II tumours, with great international variations. During 2003-2014, resection rates only increased in USA, the Netherlands and Denmark. Resection was significantly less frequently performed with more advanced tumour stage (ORs for stage III and IV versus stage I-II tumours: 0.05-0.18 and 0.01-0.06 across countries) and increasing age (ORs for patients 70-79 and ≥80 versus those <60 years: 0.37-0.63 and 0.03-0.16 across countries). Patients with advanced-stage tumours (stage III-IV: 63.8%-81.2%) and at older ages (≥70 years: 52.6%-59.5%) receiving less frequently resection comprised the majority of diagnosed cases. Patient performance status, tumour location and size were also associated with resection application.

CONCLUSION

Rates of PaC resection remain low in Europe and USA with great international variations. Further studies are warranted to explore reasons for these variations.

Importance of tumor location and histology in familial risk of upper gastrointestinal cancers: a nationwide cohort study

Background

Familial clustering of upper gastrointestinal (UGI) cancers and the significance of family history has been addressed previously. We aimed to elucidate the familial risk based on the specified tumor location and histology.

Method

In the Swedish Family-Cancer Database, we determined the familial risk of UGI cancer patients diagnosed (1958-2015) with esophageal and gastric cancer by tumor location using standardized incidence ratios (SIRs).

Results

Risk of esophageal cancer in first-degree relatives (FDRs) of patients with esophageal cancer increased 2.4-fold (SIR 95% CI 2.0-2.8), whereas risk of esophageal cancer in cases with family history of cancer in the middle third of the esophagus increased 3.4-fold (SIR 95% CI 2.1-5.1). Risk of gastric cancer in FDRs increased 1.6-fold (SIR 95% CI 1.5-1.7), occurrence of concordant subsite gastric cancer in the antrum, body, and cardia was 5.5-fold (SIR 95% CI 2.4-11), 4.6-fold (SIR 95% CI 2.6-7.4), and 1.7-fold (SIR 95% CI 1.1-2.5), respectively. Familial risk of concordant histological subtype in esophageal cancer was 4.1-fold for squamous cell carcinoma (SIR 95% CI 3.2-5.2) and 3.6-fold for adenocarcinoma (SIR 95% CI 2.5-5.1). The risk of concordant gastric adenocarcinoma was 1.6-fold for one affected FDR (SIR 95% CI 1.5-1.7), 6.1-fold for two FDRs (SIR 95% CI 4.4-8.4), and 8.6-fold among twins (SIR 95% CI 2.3-22).

Conclusion

Family history of cancer in the lower third of the esophagus and stomach cancer in specific locations such as the antrum, body, and cardia can be considered as important predictive evidence for cancer in the same location in relatives. Our findings might guide endoscopy-based surveillance by introducing subgroups of populations with a higher risk for UGI cancer with particular attention to concordance of location of lesions, which could be a reasonable strategy for early detection, and thus help save more lives.

Stratified survival of resected and overall pancreatic cancer patients in Europe and the USA in the early twenty-first century: a large, international population-based study

BACKGROUND

The prognosis of pancreatic cancer (PaC) strongly varies across different stages and age groups, which has unfortunately not been well recorded in the literature. This international population-based study aimed to provide tumor-node-metastasis (TNM) stage- and age-specific survival estimates and trends in resected and overall (resected and unresected) PaC in the early twenty-first century.

METHODS

Using data from the US Surveillance, Epidemiology, and End Results-18 Program and the national cancer registries of the Netherlands, Belgium, Norway, and Slovenia, short-term and long-term overall survival results stratified by TNM stage and age in resected and overall primary PaC, irrespective of being microscopically confirmed or not, in 2003-2014 were computed using the Kaplan-Meier method. The temporal survival trends over three predefined periods (2003-2005, 2006-2008, and 2009-2011) were further examined using the log-rank test.

RESULTS

In total, data for 125,183 patients were analyzed. Overall, age-stratified 3-year survival was 20-34% (< 60 years), 14-25% (60-69 years), and 9-13% (≥ 70 years) in stages I-II PaC; and 2-5% (< 60 years), 1-2% (60-69 years), and < 1-1% (≥ 70 years) in stages III-IV cancer. Patients who underwent operation had higher 3-year survival in each stage and age group (stages I-II: 23-39% (< 60 years), 16-31% (60-69 years), and 17-30% (≥ 70 years); stages III-IV: 5-19% (< 70 years) and 2-14% (≥ 70 years)). Perioperative survival also decreased with advancing stage and older age (stages I-II: 98-100% (< 60 years), 97-99% (60-69 years), and 94-99% (≥ 70 years); stages III-IV: 94-99% (< 70 years) and 81-96% (≥ 70 years)). Between 2003 and 2005 and 2009-2011, for overall PaC, both short-term and long-term survival improvements were observed in all countries except Belgium; for resected disease, short-term improvements were present only in the USA and Slovenia, but long-term improvements were observed in all countries except Slovenia, with stage-specific variations.

CONCLUSIONS

Our large international study provides TNM stage- and age-specific population-based survival in overall and resected PaC that will facilitate clinical counseling. While the survival expectations for patients with resected PaC are substantially higher than the widely available and known dismal survival predictions for overall patients, conclusions on the benefits of resection cannot be made from this observational study. Patients with advanced-stage disease and/or older age should undergo careful risk assessment before treatment. Limited but inspiring improvement in survival is observed.

Neoadjuvant Therapy in Rectal Cancer Patients With Clinical Stage II to III Across European Countries: Variations and Outcomes

BACKGROUND

Neoadjuvant therapy improves survival of patients with clinical stage II and III rectal cancer in clinical trials. In this study, we investigated the administration of neoadjuvant radiotherapy (neo-RT) and neoadjuvant chemoradiotherapy (neo-CRT) and its association with survival in resected patients in 2 European countries (The Netherlands and Sweden) and at 3 specialist centers.

MATERIALS AND METHODS

Administration of neoadjuvant treatment (all registries) and overall survival after surgery in The Netherlands and Sweden were assessed. Hazard ratios (HRs) were obtained using Cox regression adjusted for potential confounders.

RESULTS

A total of 16,095 rectal cancer patients with clinical stage II and III were eligible for analyses. Large variations in administration of neo-RT and neo-CRT were observed. Elderly patients less often received neo-RT and neo-CRT. Patients with stage III disease received neo-CRT more frequently than neo-RT. Administration of neo-RT versus surgery without neoadjuvant treatment was significantly associated with improved survival in The Netherlands (HR, 0.62; 95% confidence interval [CI], 0.53-0.73) as well as in Sweden (HR, 0.79; 95% CI, 0.69-0.90). Administration of neo-CRT was associated with enhanced survival in The Netherlands (HR, 0.62; 95% CI, 0.50-0.78) but not in Sweden (HR, 0.97; 95% CI, 0.80-1.18). The mortality of patients treated with neo-CRT compared with neo-RT showed inconsistent results in population-based centers.

CONCLUSIONS

Our results support an association of neo-RT with enhanced survival among stage II and III rectal cancer patients. Comparing neo-CRT with neo-RT, larger variations and inconsistent results with respect to survival were observed across centers.

Administration of adjuvant chemotherapy for stage II-III colon cancer patients: An European population-based study

The advantage of adjuvant chemotherapy (ACT) for treating Stage III colon cancer patients is well established and widely accepted. However, many patients with Stage III colon cancer do not receive ACT. Moreover, there are controversies around the effectiveness of ACT for Stage II patients. We investigated the administration of ACT and its association with overall survival in resected Stage II (overall and stratified by low-/high-risk) and Stage III colon cancer patients in three European countries including The Netherlands (2009-2014), Belgium (2009-2013) and Sweden (2009-2014). Hazard ratios (HR) for death were obtained by Cox regression models adjusted for potential confounders. A total of 60244 resected colon cancer patients with pathological Stages II and III were analyzed. A small proportion (range 9-24%) of Stage II and over half (range 55-68%) of Stage III patients received ACT. Administration of ACT in Stages II and III tumors decreased with higher age of patients. Administration of ACT was significantly associated with higher overall survival in high-risk Stage II patients (in The Netherlands (HR; 95%CI = 0.82 (0.67-0.99), Belgium (0.73; 0.59-0.90) and Sweden (0.58; 0.44-0.75)), and in Stage III patients (in The Netherlands (0.47; 0.43-0.50), Belgium (0.46; 0.41-0.50) and Sweden (0.48; 0.43-0.54)). In Stage III, results were consistent across subgroups including elderly patients. Our results show an association of ACT with higher survival among Stage III and high-risk Stage II colon cancer patients. Further investigations are needed on the selection criteria of Stages II and III colon cancer patients for ACT.

The gross anatomy of the male reproductive system of the European hedgehog (Erinaceus Europaeus)

Hedgehogs are small spiny-coated insectivores. Due to their low body weight, calm character, and easy maintenance, they are kept as pets. It is therefore worthwhile to care about hedgehogs' health problems and to provide pet owners with information about their reproduction. Moreover, it is necessary to be familiar with their anatomy so as to satisfy the need to improve nutrition and medical care, even surgery. This study was carried out on five adult male European hedgehogs euthanased in a chloroform chamber. The European hedgehog's oval testes are invisible in inguinal region because they have no true scrotal sac. The testes are located in the craniocaudal direction with dorsolateral epididymal attachments. The vesicular glands, the European hedgehog's largest accessory sex glands, are lobulated structures containing dorsomedial and ventrolateral parts on each side. The prostate is an oval gland with right and left lobes. The paired bulbourethral glands are laid on the ischiocavernosus muscle. Histologically the vesicular, prostate gland ducts and ductus deferens as well as urethra separately were discharged in a diverticlum at the level of the pelvic urethra end. A sigmoid flexure exists in the proximal part of shaft body of the penis. There are two retractor penile muscles. In dorsal end of the penile glans, there is a small urethral process with two nail- -like, needle-shaped structures. They are on both sides of the urethral process. Furthermore, there are two intromittent sacs (Sacculus urethralis) in the ventral part of the end of the penis. (Folia Morphol 2018; 77, 1: 36-43).

Exploring and Exploiting the Effect of Solvent Treatment in Membrane Separations

It is well-known that solvent treatment and preconditioning play an important role in rejection and flux performance of membranes due to solvent-induced swelling and solvent adsorption. Investigations into the effect of solvent treatment are scarce and application specific, and were limited to a few solvents only. This study reveals the trend in solvent treatment based on solvent polarity in a systematic investigation with the aim to harness such effect for intensification of membrane processes. Nine solvents with polarity indices ranging from 0.1 to 5.8 (hexane to acetonitrile) were used as treatment and process solvents on commercial Borsig GMT-oNF-2, Evonik Duramem 300, and emerging tailor-made polybenzimidazole membranes. TGA-GCMS, HS-GC-FID, and NMR techniques were employed to better understand the effect of solvent treatment on the polymer matrix of membranes. In this work, apart from the solvent treatment's direct effect on the membrane performance, a subsequent indirect effect on the ultimate separation process was observed. Consequently, a pharmaceutical case study employing chlorhexidine disinfectant and antiseptic was used to demonstrate the effect of solvent treatment on the nanofiltration-based purification. It is shown that treatment of polybenzimidazole membranes with acetone resulted in a 25% increase in product recovery at 99% impurity removal. The cost of the process intensification is negligible in terms of solvent consumption, mass intensity, and processing time.

Promising gene delivery system based on polyethylenimine-modified silica nanoparticles

This article reports on the synthesis and full characterization of innovative silica-based nanoparticle composed of fumed silica as a core decorated with polyethylenimine (PEI) with different molecular weights (25, 10 and 1.8 kDa). Wide range of analytical, spectroscopic, and microscopic methods (TEM, DLS, ζ potential, elemental analysis (EA), TNBS and FTIR) were used to characterize the nanoparticles. Furthermore, transfection efficiency of these nanoparticles as non-viral vector was examined. The silica-PEI conjugates retained both the ability of PEI to fully condense plasmid DNA at low N/P ratios and suitable buffering capacity at the endosomal pH range. PEI-functionalized silica remarkably enhanced EGFP-N1 gene expression in murine neuroblastoma (Neuro-2A) cells up to 38 folds compared to PEI 25 kDa. Meanwhile the results of the cytotoxicity assays indicated that these silica-PEI conjugates have acceptable level of viability.

Estimating the Esophagus Cancer Incidence Rate in Ardabil, Iran: A Capture-Recapture Method

Background:

Accurate cancer registry and awareness of cancer incidence rate is essential in order to define strategies for cancer prevention and control programs. Capture-recapture methods have been recommended for reducing bias and increase the accuracy of cancer incidence estimation.

Objectives:

This study aimed to estimate the esophagus cancer incidence by capture-recapture method based on Ardabil population-based cancer registry data.

Patients and Methods:

Total new cases of esophagus cancer reported by three sources of pathology reports, medical records, and death certificates to Ardabil province cancer registry center in 2006 and 2008 were enrolled in the study. All duplicated cases between three sources were identified and removed using Excel software. Some characteristics such as name, surname, father’s name, date of birth and ICD codes related to their cancer type were used for data linkage and finding the common cases among three sources. The incidence rate per 100,000 was estimated based on capture-recapture method using the log-linear models. We used BIC, G² and AIC statistics to select the best-fit model.

Results:

After removing duplicates, total 471 new cases of esophagus cancer were reported from three sources. The model with linkage between pathology reports, medical record sources and independence with the death certificates source was the best fitted model. The reported incidence rate for the years 2006 and 2008 was 18.77 and 18.51 per 100,000, respectively. In log-linear analysis, the estimated incidence rate for the years 2006 and 2008 was 49.71 and 53.87 per 100,000 populations, respectively.

Conclusions:

Based on the obtained results, it can be concluded that none of the sources of pathology reports, death certificates and medical records individually or collectively were fully covered the incidence cases of esophagus cancer and need to apply some changes in data abstracting and case finding.

Minimally Invasive Colorectal Cancer Surgery in Europe: Implementation and Outcomes

Minimally invasive surgery (MIS) of colorectal cancer (CRC) was first introduced over 20 years ago and recently has gained increasing acceptance and usage beyond clinical trials. However, data on dissemination of the method across countries and on long-term outcomes are still sparse.In the context of a European collaborative study, a total of 112,023 CRC cases from 3 population-based (N = 109,695) and 4 institute-based clinical cancer registries (N = 2328) were studied and compared on the utilization of MIS versus open surgery. Cox regression models were applied to study associations between surgery type and survival of patients from the population-based registries. The study considered adjustment for potential confounders.The percentage of CRC patients undergoing MIS differed substantially between centers and generally increased over time. MIS was significantly less often used in stage II to IV colon cancer compared with stage I in most centers. MIS tended to be less often used in older (70+) than in younger colon cancer patients. MIS tended to be more often used in women than in men with rectal cancer. MIS was associated with significantly reduced mortality among colon cancer patients in the Netherlands (hazard ratio [HR] 0.66, 95% confidence interval [CI] (0.63-0.69), Sweden (HR 0.68, 95% CI 0.60-0.76), and Norway (HR 0.73, 95% CI 0.67-0.79). Likewise, MIS was associated with reduced mortality of rectal cancer patients in the Netherlands (HR 0.74, 95% CI 0.68-0.80) and Sweden (HR 0.77, 95% CI 0.66-0.90).Utilization of MIS in CRC resection is increasing, but large variation between European countries and clinical centers prevails. Our results support association of MIS with substantially enhanced survival among colon cancer patients. Further studies controlling for selection bias and residual confounding are needed to establish role of MIS in survival of patients.

Critical Role of the Immobile Zone in Non-Fickian Two-Phase Transport: A New Paradigm

Using a visualization setup, we characterized the solute transport in a micromodel filled with two fluid phases using direct, real-time imaging. By processing the time series of images of solute transport (dispersion) in a two fluid-phase filled micromodel, we directly delineated the change of transport hydrodynamics as a result of fluid-phase occupancy. We found that, in the water saturation range of 0.6-0.8, the macroscopic dispersion coefficient reaches its maximum value and the coefficient was 1 order of magnitude larger than that in single fluid-phase flow in the same micromodel. The experimental results indicate that this non-monotonic, non-Fickian transport is saturation- and flow-rate-dependent. Using real-time visualization of the resident concentration (averaged concentration over a representative elementary volume of the pore network), we directly estimated the hydrodynamically stagnant (immobile) zones and the mass transfer between mobile and immobile zones. We identified (a) the nonlinear contribution of the immobile zones to the non-Fickian transport under transient transport conditions and (b) the non-monotonic fate of immobile zones with respect to saturation under single and two fluid-phase conditions in a micromodel. These two findings highlight the serious flaws in the assumptions of the conventional mobile-immobile model (MIM), which is commonly used to characterize the transport under two fluid-phase conditions.

Estimating the completeness of gastric cancer registration in Ardabil/Iran by a capture-recapture method using population-based cancer registry data

BACKGROUND

Knowledge of cancer incidences is essential for cancer prevention and control programs. Capture-recapture methods have been recommended for reducing bias and increasing the accuracy of cancer incidence estimations. This study aimed to estimate the completeness of gastric cancer registration by the capture-recapture method based on Ardabil population-based cancer registry data.

MATERIALS AND METHODS

All new cases of gastric cancer reported by three sources, pathology reports, death certificates and medical records that reported to Ardabil population-based cancer registry in 2006 and 2008 were enrolled in the study. The duplicate cases based on the similarity of first name, surname and fathers names were identified between sources. The estimated number of gastric cancers was calculated by the log-linear method using Stata 12 software.

RESULTS

A total of 857 new cases of gastric cancer were reported from three sources. After removing duplicates, the reported incidence rates for the years 2006 and 2008 were 35.3 and 32.5 per 100,000 population, respectively. The estimated completeness calculated by log-linear method for these years was 36.7 and 36.0, respectively.

CONCLUSIONS

These results indicate that none of the sources of pathology reports, death certificates and medical records individually or collectively fully cover the incident cases of gastric cancer. We can obtain more accurate estimates of incidence rates using the capture-recapture method.

Gastric cancer mortality in a high incidence area: long-term follow-up of Helicobacter pylori-related precancerous lesions in the general population

BACKGROUND

Due to a lack of clear criteria for recognizing subjects at risk of progression to gastric cancer (GC), this cohort study seeks to identify predictors of GC death in a high-risk population.

METHODS

During 2000-2001, 1011 randomly selected residents of Ardabil, Iran without a history of gastrointestinal diseases, underwent upper endoscopy with targeted biopsy sampling. Until 2013, cancer mortality data were obtained using cancer and death registry data and verbal autopsy reports. Cox regression was used to estimate hazard ratios (HR).

RESULTS

A total of 3.95% of the participants [mean age: 53.1 ± 9.9 years, 49.8% males, and 88.2% Helicobacter pylori (H. pylori-positive)] died of GC. In the multivariate model, precancerous lesions at the beginning of follow-up were associated with increased GC mortality. The HR [95% confidence interval (CI)] was 7.4 (1.6-33.8) for atrophic gastritis (AG) and 23.6 (5.5-102.3) for intestinal metaplasia (IM). Age over 50 (HR = 4.4; 1.3-14.2), family history of GC (HR = 6.8; 3.3-13.8), smoking (HR = 7.4; 3.2-17.3), and endoscopically confirmed gastric ulcer (GU, HR = 6.5; 2.5-16.4) were independently associated with GC mortality. The concomitant presence of a precancerous lesion increased the HR to 46.5 (10.8-198.6) for a family history of GC, 27.6 (6.5-116.4) for smoking, and 25.1 (6.3-105.3) for age >50 years.

CONCLUSIONS

In this population with a high rate of H. pylori infection, age over 50 years, smoking, family history of GC, IM, AG, and in particular, an undiagnosed GU were significant independent risk factors for mortality due to GC. The assessment of a combination of these risk factors might identify individuals at risk of GC who could possibly benefit from regular surveillance.

A form of the metabolic syndrome associated with mutations in DYRK1B

BACKGROUND

Genetic analysis has been successful in identifying causative mutations for individual cardiovascular risk factors. Success has been more limited in mapping susceptibility genes for clusters of cardiovascular risk traits, such as those in the metabolic syndrome.

METHODS

We identified three large families with coinheritance of early-onset coronary artery disease, central obesity, hypertension, and diabetes. We used linkage analysis and whole-exome sequencing to identify the disease-causing gene.

RESULTS

A founder mutation was identified in DYRK1B, substituting cysteine for arginine at position 102 in the highly conserved kinase-like domain. The mutation precisely cosegregated with the clinical syndrome in all the affected family members and was absent in unaffected family members and unrelated controls. Functional characterization of the disease gene revealed that nonmutant protein encoded by DYRK1B inhibits the SHH (sonic hedgehog) and Wnt signaling pathways and consequently enhances adipogenesis. Furthermore, DYRK1B promoted the expression of the key gluconeogenic enzyme glucose-6-phosphatase. The R102C allele showed gain-of-function activities by potentiating these effects. A second mutation, substituting proline for histidine 90, was found to cosegregate with a similar clinical syndrome in an ethnically distinct family.

CONCLUSIONS

These findings indicate a role for DYRK1B in adipogenesis and glucose homeostasis and associate its altered function with an inherited form of the metabolic syndrome. (Funded by the National Institutes of Health.).

Serum ghrelin; a new surrogate marker of gastric mucosal alterations in upper gastrointestinal carcinogenesis

Background

A few studies have indicated inverse relationships between serum ghrelin and gastric and esophageal cancers but those associations have been restricted to specific populations, including smokers and overweight individuals. We examined the association between ghrelin and gastroesophageal cancers and atrophic gastritis in a population-based setting.

Methods

In total 220 gastroesophageal cancers, comprising non-cardia and cardia gastric cancer, esophageal adenocarcinoma, esophageal squamous cell carcinoma (SCC) and age and gender-matched controls were recruited. Serum ghrelin, pepsinogen I/II ratio (PGI/II) and anti-H.pylori IgG antibodies were measured. Relationships between ghrelin and gastroesophageal cancers, after adjustment for PGI/II ratio, H.pylori status and smoking, were tested using logistic regression. Furthermore, in 125 endoscopically normal volunteers, with and without histological atrophic gastritis, the relationship with ghrelin was compared.

Results

Serum ghrelin (lowest vs. highest quintile) was inversely associated with gastric cancer: OR (95% CI) 8.71 (1.70–44.59) for cardia and 6.58 (1.26–34.46) for non-cardia cancer. Lower serum ghrelin was also associated with esophageal SCC: OR (95% CI) 5.69 (1.36–23.78), but not with esophageal adenocarcinoma. A similar association was observed between gastric cancer (cardia and non-cardia) and esophageal SCC when serum ghrelin was analysed as a continuous scaled variable. In endoscopically-normal volunteers, extensive atrophic gastritis was associated with low serum ghrelin [OR (95% CI) 0.25 (0.10–0.64)].

Conclusion

Inverse associations between ghrelin and some gastroesophageal cancers suggest a potential role for serum ghrelin as a biomarker of upper gastrointestinal cancers and atrophic gastritis. In areas with a high incidence of gastric and/or esophageal cancer, screening might be more effectively targeted to individuals with low serum ghrelin in addition to the PGI/II ratio.

Neglected role of hookah and opium in gastric carcinogenesis: a cohort study on risk factors and attributable fractions

A recent study showed an association between hookah/opium use and gastric cancer but no study has investigated the relationship with gastric precancerous lesions. We examined the association between hookah/opium and gastric precancerous lesions and subsequent gastric cancer. In a population-based cohort study, 928 randomly selected, healthy, Helicobacter pylori-infected subjects in Ardabil Province, Iran, were followed for 10 years. The association between baseline precancerous lesions and lifestyle risk factors (including hookah/opium) was analyzed using logistic regression and presented as odds ratios (ORs) and 95% confidence intervals (CIs). We also calculated hazard ratios (HRs) and 95% CIs for the associations of lifestyle risk factors and endoscopic and histological parameters with incident gastric cancers using Cox regression models. Additionally, the proportion of cancers attributable to modifiable risk factors was calculated. During 9,096 person-years of follow-up, 36 new cases of gastric cancer were observed (incidence rate: 3.96/1,000 persons-years). Opium consumption was strongly associated with baseline antral (OR: 3.2; 95% CI: 1.2-9.1) and body intestinal metaplasia (OR: 7.3; 95% CI: 2.5-21.5). Opium (HR: 3.2; 95% CI: 1.4-7.7), hookah (HR: 3.4; 95% CI: 1.7-7.1) and cigarette use (HR: 3.2; 95% CI: 1.4-7.5), as well as high salt intake, family history of gastric cancer, gastric ulcer and histological atrophic gastritis and intestinal metaplasia of body were associated with higher risk of gastric cancer. The fraction of cancers attributable jointly to high salt, low fruit intake, smoking (including hookah) and opium was 93% (95% CI: 83-98). Hookah and opium use are risk factors for gastric cancer as well as for precancerous lesions. Hookah, opium, cigarette and high salt intake are important modifiable risk factors in this high-incidence gastric cancer area.

The effect of supplementation of calcium, vitamin D, boron, and increased fluoride intake on bone mechanical properties and metabolic hormones in rat

Evidence indicates that optimal nutrition plays a role in bone formation and maintenance. Besides major components of mineralization such as calcium, phosphorus, and vitamin D, other nutrients like boron and fluoride have beneficial role, too. In this study, 34 male Wistar rats were divided into five groups: control diet, fluoride, fluoride + boron, fluoride + calcium + vitamin D, and flouride + boron + calcium + vitamin D. Boron equal to 1.23 mg, calcium and vitamin D equal to 210 mg + 55 IU and fluoride equal to 0.7 mg/rat/day was added to their drinking water for 8 weeks. Plasma blood samples and bones were collected. Findings are evidence that fluoride + boron intake revealed significant positive effects on bone mechanical properties and bone metabolic hormones. These findings suggest that combined intake of these two elements has beneficial effects on bone stiffness and breaking strength comparing to even calcium + vitamin D supplementation. This evidence dealing with health problems related to bone and skeletal system in humans should justify further investigation of the role of boron and fluoride with other elements in relation to bone.

Risk factor investigation for cardiovascular health through WHO STEPS approach in Ardabil, Iran

Objectives:

Reliable evidence is the keystone for any noncommunicable disease (NCD) prevention plan to be initiated. In this study we carried out a risk factor investigation based on the WHO Stepwise approach to Surveillance (STEPS).

Methods:

The study was conducted on 1000 adults between 15 and 64 years of age living in Ardabil province, north-west Iran during 2006, based on the WHO STEPS approach to surveillance of risk factors for NCD. At this stage only the first and second steps were carried out. Data were collected through standard questionnaires and methods analyzed using STATA version 8 statistical software package.

Results:

29.0% of men and 2.6% of women were current daily tobacco smokers. The mean number of manufactured cigarettes smoked per day was 18.9 among current daily smokers. Smoking was most prevalent among men of low-income families and those of lower education. The mean body mass index (BMI) was 26.6 kg/m², and was significantly correlated with systolic blood pressure. 58.9% were overweight or obese; 18.0% had raised blood pressure and 3.7% had isolated systolic hypertension. The mean number of servings of fruit consumed per day was 1.1; 33.1% had low levels of activity. Combined risk factor analysis showed that 4.1% of participants were in the low-risk group (up to 5.1% among men and 3.2% among women). Those in the high-risk group comprised 25.6% in the 25- to 44-year age group and 49.7% in the 45- to 64-year age group. Mean BMI increased by age in both sexes at least at the first three decades of adult life.

Conclusion:

Based on observed status of risk for cardiovascular health, burden of cardiovascular diseases is expected to increase if an effective prevention strategy is not undertaken.