Selection criteria for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in gastric cancer

Peritoneal carcinomatosis in gastric cancer is associated with a dismal prognosis.Systemic chemotherapy is not effective because of the existence of a blood-peritoneal barrier.Cytoreductive surgery and intraperitoneal chemotherapy can improve survival and quality of life in selected patients.Patient selection for this multimodal approach is one of the most critical issues,and calls for interdisciplinary evaluation by radiologists,medical and surgical oncologists,and anaesthetists.This article sets forth criteria for selection of gastric cancer patients suffering from peritoneal carcinomatosis.

Inflammatory markers as selection criteria of hepatocellular carcinoma in living-donor liver transplantation

AIM: To investigate that inflammatory markers can predict accurately the prognosis of hepatocelluar carcinoma (HCC) patients in living-donor liver transplantation (LDLT).

Expanding the selection criteria of laparoscopic hepatectomy for hepatocellular carcinoma

The introduction of laparoscopic procedures is one of the milestones of surgical innovation over the past few decades. The advantages of minimally invasive approach have been gradually accepted owing to its less postoperative pain, reduced morbidity and faster recovery. Also, since the introduction of laparoscopic approach of liver surgery in 1955 （1）, the benefit of the procedure had long been questioned but expected.

An investigation of several typical model selection criteria for detecting the number of signals

Based on the problem of detecting the number of signals,this paper provides a systematic empirical investigation on model selection performances of several classical criteria and recently developed methods(including Akaike’s information criterion(AIC),Schwarz’s Bayesian information criterion,Bozdogan’s consistent AIC,Hannan-Quinn information criterion,Minka’s(MK)principal component analysis(PCA)criterion,Kritchman&Nadler’s hypothesis tests(KN),Perry&Wolfe’s minimax rank estimation thresholding algorithm(MM),and Bayesian Ying-Yang(BYY)harmony learning),by varying signal-to-noise ratio(SNR)and training sample size N.A family of model selection indifference curves is defined by the contour lines of model selection accuracies,such that we can examine the joint effect of N and SNR rather than merely the effect of either of SNR and N with the other fixed as usually done in the literature.The indifference curves visually reveal that all methods demonstrate relative advantages obviously within a region of moderate N and SNR.Moreover,the importance of studying this region is also confirmed by an alternative reference criterion by maximizing the testing likelihood.It has been shown via extensive simulations that AIC and BYY harmony learning,as well as MK,KN,and MM,are relatively more robust than the others against decreasing N and SNR,and BYY is superior for a small sample size.

A preliminary study on criteria weights for a library's digital resource selection:From the viewpoints of both users and librarians

Through investigating both users' and librarians' perceptions of the relative importance of the major criteria governing the selection of digital resources, we attempted to develop a criterion weight framework for a library's selection of digital resources, which can meet both the users' requirements and the library's goal of developing digital collections. The respective weight of each specific criterion is decided through the Analytic Hierarchy Process(AHP) Method. The findings of this study indicate that, when assigning weights to the selection criteria, it is important to consult the opinions of a wide crosssection of people, especially the views of different users. As a result, the digital resource selection system characterized by the criteria weights can reflect more comprehensively the users' requirements, and meanwhile it enables librarians' more rational selection of digital resources.

Evaluation of alternative criteria for determining the optimal location of RWIS stations

This article presents a comprehensive framework for determining the location of road weather information system （RWIS） stations over a regional road network. In the proposed methodology, the region is divided into a grid of equal-sized zones which are considered as the minimum spatial unit for allocating a candidate set of RWIS stations. These zones are ranked according to a set of pre-specified criteria that reflect the needs for, and potential benefits from, real-time RWIS, including road surface temperature variability, precipitation, network traffic, and collision patterns. A case study based on the existing RWIS network in the province of Ontario was conducted to illustrate the major features of the proposed method and evaluate the implications of alternative loca- tion selection criteria. The findings of the study suggest that it is feasible to develop a systematic process for locating RWIS stations using an integrated location criterion to capture multiple factors being considered in prac- tice. The study has also revealed the need to establish quantitative models for estimating the benefit of real-time information from RWIS stations, which is the foundation of a cost-benefit-based RWIS location optimization model.

Optimum mining method selection using fuzzy analytical hierarchy process–Qapiliq salt mine,Iran

Mining method selection is the first and the most critical problem in mine design and depends on some parameters such as geotechnical and geological features and economic and geographic factors. In this paper, the factors affecting mining method selection are determined. These factors include shape, thick- ness, depth, slope, RMR and RSS of the orebody, RMR and RSS of the hanging wall and footwall. Then, the priorities of these factors are calculated. In order to calculate the priorities of factors and select the best mining method for Qapiliq salt mine, Iran, based on these priorities, fuzzy analytical hierarchy process （AHP） technique is used. For this purpose, a questionnaire was prepared and was given to the associated experts. Finally, after a comparison carried out based on the effective factors, between the four mining methods including area mining, room and pillar, cut and fill and stope and pillar methods, the stope and nillar mining method was selected as the most suitable method to this mine.

Liver transplantation as an alternative for the treatment of neuroendocrine liver metastasis: Appraisal of the current evidence

Background:Liver transplantation(LT)for neuroendocrine liver metastases(NELM)is still in debate.Studies comparing LT with liver resection(LR)for NELM are scarce,as patient selection is heterogeneous and experience is limited.The goal of this review was to provide a critical analysis of the evidence on LT versus LR in the treatment of NELM.Data sources:A scoping literature search on LT and LR for NELM was performed with PubMed,including English articles up to March 2023.Results:International guidelines recommend LR for NELM in resectable,well-differentiated tumors in the absence of extrahepatic metastatic disease with superior results of LR compared to systemic or liver-directed therapies.Advanced liver surgery has extended resectability criteria whilst entailing increased perioperative risk and short disease-free survival.In highly selected patients(based on the Milan criteria)with unresectable NELM,oncologic results of LT are promising.Prognostic factors include tumor biology(G1/G2)and burden,waiting time for LT,patient age and extrahepatic spread.Based on low-level evi-dence,LT for low-grade NELM within the Milan criteria resulted in improved disease-free survival and overall survival compared to LR.The benefits of LT were lost in patients beyond the Milan NELM-criteria.Conclusions:With adherence to strict selection criteria especially tumor biology,LT for NELM is becoming a valuable option providing oncologic benefits compared to LR.Recent evidence suggests even stricter selection criteria with regard to tumor biology.

Screening Methods for Waterlogging Tolerance at Maize (Zea mays L.) Seedling Stage

Waterlogging strongly affects agronomic performance of maize （Zea mays L.）. In order to investigate the suitable selection criteria of waterflooding tolerant genotypes, and identify the most susceptible stage and the best continuous treatment time to waterlogging, 20 common maize inbred lines were subjected to successive artificial waterflooding at seedling stage, and waterlogging tolerance coefficient （WTC） was used to screen waterflooding tolerant genotypes. In addition, peroxidase （POD） activities and malondialdehyde （MDA） contents were measured for 6 of 20 lines. The results showed that the second leaf stage （V2） was the most susceptible stage, and 6 d after waterflooding was the best continuous treatment time. Dry weight （DW） of both shoots and roots of all lines were significantly reduced at 6 d time-point of waterlogging, compared to control. POD activities and MDA contents were negatively and significantly correlated, and the correlation coefficient was -0.9686 （P 〈 0.0001）. According to the results, WTC of shoot DW can be used for practical screening as a suitable index, which is significantly different from control and waterlogged plants happened 6 d earlier. Furthermore, leaf chlorosis, MDA content and POD activities could also be used as reference index for material screening. The implications of the results for waterlogging-tolerant material screening and waterlogging-tolerant breeding have been discussed in maize.

Clinical analysis of patients with hepatocellular carcinoma recurrence after living-donor liver transplantation

AIM: To evaluated patterns and outcomes of hepatocellular carcinoma (HCC) recurrence after living donor liver transplantation (LDLT).METHODS: From 2001 to 2014, 293 patients underwent LDLT for HCC at our transplant center. We retrospectively reviewed 54 (18.4%) patients with HCC recurrence after LDLT. We evaluated patterns and outcomes of HCC recurrence after LDLT, with particular attention to the Milan criteria at transplantation, treatments for HCC-recurrent patients, and factors related to survival after HCC recurrence. Furthermore, we evaluated the efficacy of combination treatment of sorafenib and an mTOR inhibitor.RESULTS: The 1-, 2-, and 3-year overall survival rates after HCC recurrence were 41.1%, 20.5%, and 15.4%, respectively. The median time interval between LDLT and HCC recurrence was 6.5 mo. Although recurrence rates according to the Milan criteria at LDLT were significantly different, HCC recurrence patterns and survival rates after HCC recurrence were not significantly different between the two groups. Time to recurrence < 12 mo (P = 0.048), multiple recurrences at HCC recurrence (P = 0.038), and palliative treatment for recurrent tumors (P = 0.003) were significant independent prognostic factors for poor survival after HCC recurrence in a multivariate analysis. The combination treatment of sorafenib and sirolimus showed survival benefits in the palliative treatment group (P = 0.005).CONCLUSION: Curative treatment for recurrent HCC after LDLT is the most important factor in survival rates after HCC recurrence and combination treatments of sorafenib and an mTOR inhibitor could have survival benefits in patients with HCC recurrence after LT in the palliative treatment group.

Radiological response and inflammation scores predict tumour recurrence in patients treated with transarterial chemoembolization before liver transplantation

To investigate the prognostic value of the radiological response after transarterial chemoembolization (TACE) and inflammatory markers in patients affected by hepatocellular carcinoma (HCC) awaiting liver transplantation (LT).METHODSWe retrospectively evaluated the preoperative predictors of HCC recurrence in 70 patients treated with conventional (n = 16) or doxorubicin-eluting bead TACE (n = 54) before LT. The patient and tumour characteristics, including the static and dynamic alpha-fetoprotein, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio (PLR) measurements, were recorded. Treatment response was classified according to the modified Response Evaluation Criteria in Solid Tumours (mRECIST) and the European Association for the Study of the Liver (EASL) criteria as complete response (CR), partial response (PR), stable disease or progressive disease. After examination of the explanted livers, histological necrosis was classified as complete (100% of the cumulative tumour area), partial (50%-99%) or minimal (< 50%) and was correlated with the preoperative radiological findings.RESULTSAccording to the pre-TACE radiological evaluation, 22/70 (31.4%) and 12/70 (17.1%) patients were beyond Milan and University of San Francisco (UCSF) criteria, respectively. After TACE procedures, the objective response (CR + PR) rates were 71.4% and 70.0% according to mRECIST and EASL criteria, respectively. The agreement between the two guidelines in defining the radiological response was rated as very good both for the overall and target lesion response (weighted k-value: 0.98 and 0.93, respectively). Complete and partial histological necrosis were achieved in 14/70 (20.0%) and 28/70 (40.0%) patients, respectively. Using histopathology as the reference standard, mRECIST criteria correctly classified necrosis in 72.9% (51/70) of patients and EASL criteria in 68.6% (48/70) of cases. The mRECIST non-response to TACE [Exp(b) = 9.2, p = 0.012], exceeding UCSF criteria before TACE [Exp(b) = 4.7, p = 0.033] and a preoperative PLR > 150 [Exp(b) = 5.9, p = 0.046] were independent predictors of tumour recurrence.CONCLUSIONThe radiological response and inflammatory markers are predictive of tumour recurrence and allow the proper selection of TACE-treated candidates for LT.

Liver transplantation for hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is the commonest primary malignancy of the liver. It usually occurs in the setting of chronic liver disease and has a poor prognosis if untreated. Orthotopic liver transplantation (OLT) is a suitable therapeutic option for early,unresectable HCC particularly in the setting of chronic liver disease. Following on from disappointing initial results,the seminal study by Mazzaferro et al in 1996 established OLT as a viable treatment for HCC. In this study,the "Milan criteria" were applied achieving a 4-year survival rate similar to OLT for benign disease. Since then various groups have attempted to expand these criteria whilst maintaining long term survival rates. The technique of living donor liver transplantation has evolved over the past decade,particularly in Asia,and published outcome data is comparable to that of OLT. This article will review the evidence,indications,and the future direction of liver transplantation for liver cancer.

Oil-Price Forecasting Based on Various Univariate Time-Series Models

Time-series-based forecasting is essential to determine how past events affect future events. This paper compares the performance accuracy of different time-series models for oil prices. Three types of univariate models are discussed: the exponential smoothing (ES), Holt-Winters (HW) and autoregressive intergrade moving average (ARIMA) models. To determine the best model, six different strategies were applied as selection criteria to quantify these models’ prediction accuracies. This comparison should help policy makers and industry marketing strategists select the best forecasting method in oil market. The three models were compared by applying them to the time series of regular oil prices for West Texas Intermediate (WTI) crude. The comparison indicated that the HW model performed better than the ES model for a prediction with a confidence interval of 95%. However, the ARIMA (2, 1, 2) model yielded the best results, leading us to conclude that this sophisticated and robust model outperformed other simple yet flexible models in oil market.

Tree growth performance and estimation of wood quality in plantation trials for Maesopsis eminii and Shorea spp.

Plantations of tropical species axe becoming an increasingly important source of wood. However, it is important that research trials focus not only on tree growth performance, but also on wood quality. The aims of this study were to assess the growth performance of six commercially and ecologically important tree species from separate plantation trials in Indonesia and to determine the relationships between tree growth and wood quality in terms of the dynamic modulus of elasticity （MOE） and wood density. Forty-eight 7-year Maesopsis eminii Engl. and thirty-five 9-year specimens （7 each of 5 Shorea spp.） were selected from two trials. The MOE, based on acoustic velocity, was indirectly measured to evaluate wood stiffness. Tree-growth performance was evaluated, and correlations between growth traits and acoustic velocity as well as density and wood stiffness properties were estimated. The growth performance of M. eminii in terms of tree volume was significantly different in three different cate- gories of growth （i.e. fast, medium, slow）. Of the five Shorea spp. studied, Shorea leprosula Miq. had the highest growth rate, as expected since it is known to be a fastgrowing Shorea species. Indirect measurement of wood quality by means of non-destructive ultrasonic methods showed a weak negative correlation between tree volume and acoustic velocity and dynamic MOE. Although each fast-growing tree could reach a merchantable size faster than other varieties or species, wood traits of various species tested were not significantly different based on tree growth rate performance. The findings from this study could be used to improve selection criteria in future breeding trials; indirect measurements of the dynamic modulus of elasticity can be used in mass pre-selection of genetic materials, to choose the most-promising material for in-depth evaluation.

Selecting flagship species to solve a biodiversity conservation conundrum

The difficulty of effectively monitoring and managing the environment to conserve biodiversity is as yet an unsolved conundrum.A project of the Chinese Academy of Sciences has concluded that progress can be made through the use of flagship species selected using criteria drawn from conservation biology,ecosystem function,socio-economics,and cultural importance.Inclusion of the latter three criteria will help attract and maintain the commitment of the public to play full parts in carrying out any conservation measures needed.A system is proposed for scoring species to select those that are most suitable as flagships.This method can be used regardless of the size of the area chosen for attention,whether it is a region,a country,or a particular protected area.

Diagnosis of morbid obesity may not impact healthcare utilization for orthotopic liver transplantation:A propensity matched study

AIM To study mortality, length of stay, and total charges in morbidly obese adults during index hospitalization for orthotopic liver transplantation.METHODS The Nationwide Inpatient Sample was queried to obtain demographics, healthcare utilization, post orthotopic liver transplantation(OLT) complications, and short term outcomes of OLT performed from 2003 to 2011(n = 46509). We divided patients into those with [body mass index(BMI) ≥ 40] and without(BMI < 40) morbid obesity. Multivariable logistic regression analysis was performedto characterize differences in in-hospital mortality, length of stay(LOS), and charges for OLT between patients with and without morbid obesity after adjusting for significant confounders. Additionally, propensity matching was performed to further validate the results.RESULTS Of the 46509 patients who underwent OLT during the study period, 818(1.8%) were morbidly obese. Morbidly obese recipients were more likely to be female(46.8% vs 33.4%, P = 0.002), Caucasian(75.2% vs 67.8%, P = 0.002), in the low national income quartile(32.3% vs 22.5%, P = 0.04), and have ≥ 3 comorbidities(modified Elixhauser index; 83.9% vs 45.0%, P < 0.001). Morbidly obese patient also had an increase in procedure related hemorrhage(P = 0.028) and respiratory complications(P = 0.043). Multivariate and propensity matched analysis showed no difference in mortality(OR: 0.70; 95%CI: 0.27-1.84, P = 0.47), LOS(β:-4.44; 95%CI:-9.93, 1.05, P = 0.11) and charges for transplantation(β: $15693; 95%CI:-51622-83008, P = 0.64) between the two groups. Morbidly obese patients were more likely to have transplants on weekdays(81.7%) as compared to those without morbid obesity(75.4%, P = 0.029).CONCLUSION Morbid obesity may not impact in-hospital mortality and health care utilization in OLT recipients. However, morbidly obese patients may be selected after careful assessment of co-morbidities.

Characteristics of Supply Logistics： A Research on Mersin Free Zone

This study investigates the relationship between demographic characteristics （company type, company ownership, company operating years, and sector） and supply logistics characteristics （source of supplies, average number of suppliers for their products, replenishment frequency for their orders, and relationship with their suppliers） of companies that are operating in Mersin Free Zone along with their supplier selection criteria based on the 36 companies selected through convenience sampling. The finding implies that the relationships of company type---replenishment frequency, company type---relationship among suppliers, and company ownership---source of supplies are significant at the 95% confidence level. Besides, the most significant three supplier selection criteria are found to be quality, price, and delivery time respectively, while the least important three ones appear to be nationality （foreign/domestic） and the reputation of the supplier respectively.

Study on Breeding Practices and Reproductive Performance of Black-Head Somali Sheep under Traditional Management System: The Case of Awbarre District, Eastern Ethiopia

The study was conducted in the Awbarre district of the Fafen zone of the Somali regional state of Ethiopia. The objective of the study was to assess the breeding practices and reproductive performance of Black-head Somali sheep under a traditional management system. Purposive and simple random sampling techniques were used to select targeted kebeles and households, respectively. A total of 120 households were selected from four kebeles, each of 30 households, based on the production system and sheep population. Semi-structured questionnaires, group discussions, key informants interviews and field observations were used to generate the required data. The primary purpose of keeping sheep was for income generation, followed by saving as a future asset. The majority (89.2%) of the respondents separated male and female animals during herding. The selection criteria for breeding rams were appearance, growth, pedigree, and color while for breeding ewes were appearance, adaptability, pedigree, color, and lamb growth. The overall weaning age of Black-head Somali sheep in the study area was 3.7 months for both males & females. The castration of male sheep was common for the purpose of fattening, fattening with breeding control and breeding control as well. The castration is mainly performed during the summer and autumn and the methods of castration were both traditional and modern methods, the traditional castration method being the most important one in pastoral areas. The age of sexual maturity was 7.64 months for rams and 8.97 months for ewe’s male and female lambs in the pastoral area and 8.42 & 8.38 for rams & ewes in agro-pastoral and overall lambing interval was 11 months. On average, the ewe of Black-head Somali sheep in pastoral & agro-pastoral could produce 9.49 & 9.57 lambs, respectively in their lifetime. As the pastoralists and agro-pastoralists indicated the source of the breeding ram was their own, so the exchange of breeding ram is recommended to minimize the risk of inbreeding and further studies of on-farm performance investigation would be necessary to be carried out so as to understand the uniqueness of the breed better.

Experience after 100 patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

AIM:To investigate perioperative patient morbidity/mortality and outcome after cytoreductive surgery(CRS) and hyperthermic intraperitoneal chemotherapy(HIPEC).METHODS:Of 150 patients 100 were treated with cytoreductive surgery and HIPEC and retrospectively analyzed.Clinical and postoperative follow-up data were evaluated.Body mass index(BMI),age and peritoneal carcinomatosis index(PCI) were chosen as selection criteria with regard to tumor-free survival and perioperative morbidity for this multimodal therapy.RESULTS:CRS with HIPEC was successfully performed in 100 out of 150 patients.Fifty patients were excluded because of intraoperative contraindication.Median PCI was 17(1-39).In 89% a radical resection(CC0/CC1) was achieved.One patient died postoperatively due to multiorgan failure.Neither PCI,age nor BMI was a risk factor for postoperative complications/outcome according to the DINDO classification.In 9% Re-CRS with HIPEC was performed during the follow-up period.CONCLUSION:Patient selection remains the most important issue.Neither PCI,age nor BMI alone should be an exclusion criterion for this multimodal therapy.

Reasons to pursue a career in medicine:a qualitative study in Sierra Leone

Background:Many low-income and crises-affected countries like Sierra Leone struggle with the recruitment and retention of their health professionals,particularly nurses and doctors.There are multiple factors that influence the‘recruitment to retention’pipeline.The first stage of an exploration into the issues influencing the availability of qualified health care workers may focus on the aspects which influence their entry into relevant educational programmes.This paper explores the reasons given by junior doctors in Sierra Leone for wanting to become a doctor.It also describes entry procedures into undergraduate medical education.Methods:In-depth interviews were conducted with purposively sampled junior doctors(n=15)from the only medical school in Sierra Leone in October 2013.Digital diaries and two follow-up interviews were used to explore their evolving career experiences and aspirations until November 2016.In addition,semi-structured interviews with key informants(n=20),including senior teaching staff at the medical school(n=7),were conducted.Thematic analysis was used to explore linkages and themes across cases.Results:Six themes were identified.The most commonly mentioned reasons for wanting to become a doctor were a desire to help(theme 4)and the influence of family and friends,via role modelling(theme 2)and verbal encouragement(theme 3).Other motives were an interest from a young age(theme 1),being attracted by the job prospects(theme 5),and having an intellectual and science capacity(theme 6).Junior doctors gave at least two and up to six reasons for applying to enter the medical profession.Doctors were allowed entry to the medical school largely based on their previous academic performance.Conclusions:This study showed that multiple reasons underlie the decision to apply for entrance to medical school and the decision to enter medicine is complex.These findings may inform the review of future admission procedures by the medical school in Sierra Leone and similar settings,which is a crucial step in addressing the human resource needs for healthcare that currently exist.