Impact of neoadjuvant chemoradiotherapy on postoperative outcomes after esophageal cancer resection: results of a European multicenter study.

OBJECTIVES: To assess the impact of neoadjuvant chemoradiotherapy (NCRT) on anastomotic leakage (AL) and other postoperative outcomes after esophageal cancer (EC) resection. BACKGROUND: Conflicting data have emerged from randomized studies regarding the impact of NCRT on AL. METHODS: Among 2944 consecutive patients operated on for EC between 2000 and 2010 in 30 European centers, patients treated by NCRT after surgery (n = 593) were compared with those treated by primary surgery (n = 1487). Multivariable analyses and propensity score matching were used to compensate for the differences in some baseline characteristics. RESULTS: Patients in the NCRT group were younger, with a higher prevalence of male sex, malnutrition, advanced tumor stage, squamous cell carcinoma, and surgery after 2005 when compared with the primary surgery group. Postoperative AL rates were 8.8% versus 10.6% (P = 0.220), and 90-day postoperative mortality and morbidity rates were 9.3% versus 7.2% (P = 0.110) and 33.4% versus 32.1% (P = 0.564), respectively. Pulmonary complication rates did not differ between groups (24.6% vs 22.5%; P = 0.291), whereas chylothorax (2.5% vs 1.2%; P = 0.020), cardiovascular complications (8.6% vs 0.1%; P = 0.037), and thromboembolic events (8.6% vs 6.0%; P = 0.037) were higher in the NCRT group. After propensity score matching, AL rates were 8.8% versus 11.3% (P = 0.228), with more chylothorax (2.5% vs 0.7%; P = 0.030) and trend toward more cardiovascular and thromboembolic events in the NCRT group (P = 0.069). Predictors of AL were high American Society of Anesthesiologists scores, supracarinal tumoral location, and cervical anastomosis, but not NCRT. CONCLUSIONS: Neoadjuvant chemoradiotherapy does not have an impact on the AL rate after EC resection (NCT 01927016).

Intra-Party Democracy and middle-level elites in Spain

The gradual implementation of new, more participatory and thus, more democratic mechanisms of intra-party decision-making has been pointed out by several party politics scholars. This phenomenon has been studied as the party elite’s reactions to a widespread trend in Western countries: the party membership decline. Spain is still a deviant case in both the party membership decline trend, and with regards to the introduction of more participatory and democratic decision-making mechanisms. However, the paper point out that support for intra-party democracy is quite widespread within Spanish party middle elites (party delegates). That is why the aim of this paper is to explain which factors are underpinning the supports for intra-party democracy amongst Spanish party delegates. After conducting a multivariate analysis, the results show that ideology, the involvement in intra-party experiences and the degree of pragmatism, amongst others, are factors strongly associated with the support for intraparty democracy in Spanish party middle elites.

Etiology of first-ever ischaemic stroke in European young adults: the 15 cities young stroke study.

BACKGROUND AND PURPOSE: Risk factors for IS in young adults differ between genders and evolve with age, but data on the age- and gender-specific differences by stroke etiology are scare. These features were compared based on individual patient data from 15 European stroke centers. METHODS: Stroke etiology was reported in detail for 3331 patients aged 15-49 years with first-ever IS according to Trial of Org in Acute Stroke Treatment (TOAST) criteria: large-artery atherosclerosis (LAA), cardioembolism (CE), small-vessel occlusion (SVO), other determined etiology, or undetermined etiology. CE was categorized into low- and high-risk sources. Other determined group was divided into dissection and other non-dissection causes. Comparisons were done using logistic regression, adjusting for age, gender, and center heterogeneity. RESULTS: Etiology remained undetermined in 39.6%. Other determined etiology was found in 21.6%, CE in 17.3%, SVO in 12.2%, and LAA in 9.3%. Other determined etiology was more common in females and younger patients, with cervical artery dissection being the single most common etiology (12.8%). CE was more common in younger patients. Within CE, the most frequent high-risk sources were atrial fibrillation/flutter (15.1%) and cardiomyopathy (11.5%). LAA, high-risk sources of CE, and SVO were more common in males. LAA and SVO showed an increasing frequency with age. No significant etiologic distribution differences were found amongst southern, central, or northern Europe. CONCLUSIONS: The etiology of IS in young adults has clear gender-specific patterns that change with age. A notable portion of these patients remains without an evident stroke mechanism according to TOAST criteria.

Break zones in the distributions of alleles and species in alpine plants

Aim  We test for the congruence between allele-based range boundaries (break zones) in silicicolous alpine plants and species-based break zones in the silicicolous flora of the European Alps. We also ask whether such break zones coincide with areas of large elevational variation.Location  The European Alps.Methods  On a regular grid laid across the entire Alps, we determined areas of allele- and species-based break zones using respective clustering algorithms, identifying discontinuities in cluster distributions (breaks), and quantifying integrated break densities (break zones). Discontinuities were identified based on the intra-specific genetic variation of 12 species and on the floristic distribution data from 239 species, respectively. Coincidence between the two types of break zones was tested using Spearman's correlation. Break zone densities were also regressed on topographical complexity to test for the effect of elevational variation.Results  We found that two main break zones in the distribution of alleles and species were significantly correlated. Furthermore, we show that these break zones are in topographically complex regions, characterized by massive elevational ranges owing to high mountains and deep glacial valleys. We detected a third break zone in the distribution of species in the eastern Alps, which is not correlated with topographic complexity, and which is also not evident from allelic distribution patterns. Species with the potential for long-distance dispersal tended to show larger distribution ranges than short-distance dispersers.Main conclusions  We suggest that the history of Pleistocene glaciations is the main driver of the congruence between allele-based and species-based distribution patterns, because occurrences of both species and alleles were subject to the same processes (such as extinction, migration and drift) that shaped the distributions of species and genetic lineages. Large elevational ranges have had a profound effect as a dispersal barrier for alleles during post-glacial immigration. Because plant species, unlike alleles, cannot spread via pollen but only via seed, and thus disperse less effectively, we conclude that species break zones are maintained over longer time spans and reflect more ancient patterns than allele break zones.Conny Thiel-Egenter and Nadir Alvarez contributed equally to this paper and are considered joint first authors.

Colite à Clostridium difficile: nouvelles recommandations de prise en charge [Clostridium difficile infections: update on new European recommendations].

Clostridium difficile infections: update on new European recommandations While metronidazole and vancomycin have been the only drug options to date for the treatment of C. difficile infection, new therapeutic approaches with promising results have recently emerged for the treatment of the first episode and relapses. Fidaxomicin is a new macrocyclic antibiotic more active against C. difficile and with a narrow spectrum allowing preservation of the intestinal microbiota. While having the same efficacy as vancomycin for the treatment of the first episode, this agent is associated with a lower rate of relapse. The highest relapse-free cure rate is achieved through fecal microbiota transplantation, which should be considered for patients with multiple relapses.

Information Mobility: Information Dissemination in Mobile Networks

En el nostre projecte, considerem un escenari urbà o interurbà on persones amb dispositius mòbils (smartphones) o vehicles equipats amb interfícies de comunicació, estan interessats en compartir fitxers entre ells o descarregar-los al creuar Punts d’Accés (APs) propers a la carretera. Estudiem la possibilitat d’utilizar la cooperació en les trobades casuals entre nodes per augmentar la velocitat de descàrrega global. Amb aquest objectiu, plantejem algoritmes per a la selecció de quins paquets, per a quins destins i quins transportistes s’escullen en cada moment. Mitjançant extenses simulacions, mostrem com les cooperacions carry&forward dels nodes augmenten significativament la velocitat de descàrrega dels usuaris, i com aquest resultat es manté per a diversos patrons de mobilitat, col•locacions d'AP i càrregues de la xarxa. Per altra banda, aparells com els smartphones, on la targeta de WiFi està encesa contínuament, consumeixen l'energia de la bateria en poques hores. En molts escenaris, una targeta WiFi sempre activa és poc útil, perque sovint no hi ha necessitat de transmissió o recepció. Aquest fet es veu agreujat en les Delay Tolerant Networks (DTN), on els nodes intercanvien dades quan es creuen i en tenen l’oportunitat. Les tècniques de gestió de l’estalvi d’energia permeten extendre la duració de les bateries. El nostre projecte analitza els avantatges i inconvenients que apareixen quan els nodes apaguen períodicament la seva targeta wireless per a estalviar energia en escenaris DTN. Els nostres resultats mostren les condicions en que un node pot desconnectar la bateria sense afectar la probabilitat de contacte amb altres nodes, i les condicions en que aquesta disminueix. Per exemple, es demostra que la vida del node pot ser duplicada mantenint la probabilitat de contacte a 1. I que aquesta disminueix ràpidament en intentar augmentar més la vida útil.

Association of adiposity genetic variants with menarche timing in 92,105 women of European descent.

Obesity is of global health concern. There are well-described inverse relationships between female pubertal timing and obesity. Recent genome-wide association studies of age at menarche identified several obesity-related variants. Using data from the ReproGen Consortium, we employed meta-analytical techniques to estimate the associations of 95 a priori and recently identified obesity-related (body mass index (weight (kg)/height (m)(2)), waist circumference, and waist:hip ratio) single-nucleotide polymorphisms (SNPs) with age at menarche in 92,116 women of European descent from 38 studies (1970-2010), in order to estimate associations between genetic variants associated with central or overall adiposity and pubertal timing in girls. Investigators in each study performed a separate analysis of associations between the selected SNPs and age at menarche (ages 9-17 years) using linear regression models and adjusting for birth year, site (as appropriate), and population stratification. Heterogeneity of effect-measure estimates was investigated using meta-regression. Six novel associations of body mass index loci with age at menarche were identified, and 11 adiposity loci previously reported to be associated with age at menarche were confirmed, but none of the central adiposity variants individually showed significant associations. These findings suggest complex genetic relationships between menarche and overall obesity, and to a lesser extent central obesity, in normal processes of growth and development.

Satellizing Galileo? Non-state Authority and Interoperability Standards in the European Global Navigation Satellite System

This paper explores the extent and limits of non-state authority in international affairs. While a number of studies have emphasised the role of state support and the ability of strategically situated actors to capture regulatory processes, they often fail to unpack the conditions under which this takes place. In order to probe the assumption that structural market power, backed by political support, equates regulatory capture, the article examines the interplay of political and economic considerations in the negotiations to establish worldwide interoperability standards needed for the development of Galileo as a genuinely European global navigation satellite system under civil control. It argues that industries supported and identified as strategic by public actors are more likely to capture standardisation processes than those with the largest market share expected to be created by the standards. This suggests that the influence of industries in space, air and maritime traffic control closely related to the militaro-industrial complex remains disproportionate in comparison to the prospective market of location-based services expected to vastly transform business practices, labour relations and many aspects of our daily life.

European Home and Leisure Accident Surveillance System report for Ireland 2001

EHLASS provides a harmonised approach throughout the EU to facilitate the analyses of intercountry differences in modes and distributions of home and leisure accidents. EHLASS contributes to the formulation of EU policies and initiatives on accidents and product safety. EHLASS is the only source of detailed information on home and leisure accidents in Ireland. Some general information is available through the Hospital In-Patient Enquiry (HIPE) system but this concentrates on medical diagnoses rather than on specific causes of accidents.This report is the eleventh national EHLASS report for Ireland. Download document here