Long-term Analysis Research Articles

Adagrasib (Ada) + cetuximab (Cetux) for KRAS G12C -mutated metastatic colorectal cancer (mCRC): Longer follow-up analysis from KRYSTAL-1.

131 Background: KRAS G12C mutations occur in 3%–4% of CRC cases and are associated with poor prognosis. In the phase 1/2 KRYSTAL-1 study (NCT03785249), at a median follow-up of 11.9 months (mo), Ada (irreversible inhibitor of KRAS G12C ) in combination with Cetux (anti-EGFR antibody) demonstrated promising clinical activity (objective response rate [ORR] of 34% per blinded independent central review [BICR] and 43% per investigator [INV]) and was well tolerated in patients (pts) with previously treated KRAS G12C -mutated mCRC. Based on these findings, Ada + Cetux was granted accelerated approval in the United States for these pts. Here, we present longer-term follow-up analyses from this study. Methods: Adults with previously treated KRAS G12C -mutated mCRC and ECOG performance status of 0 or 1 were treated with Ada (600 mg BID) in combination with Cetux (400 mg/m 2 followed by 250 mg/m 2 QW or 500 mg/m 2 Q2W) until disease progression, unacceptable toxicity, withdrawal of consent, or death, in separate phase 1 and phase 2 cohorts. Primary endpoints were safety (phase 1) and ORR per BICR (phase 2). Secondary endpoints were duration of response (DOR), progression-free survival (PFS), overall survival (OS), and safety (phase 2). Results: A total of 94 pts received Ada + Cetux. The median number of prior lines of systemic therapy was 3 (range, 1–9); 23 pts (24%) had received ≥ 4 prior lines of systemic therapy. The most frequent sites of metastases at baseline were the lung (71%) and liver (64%). At a median follow-up of 20.4 mo, ORR per INV was 43% (95% CI 32–53) and all were partial responses; median DOR was 5.9 (95% CI 5.5–7.6) mo. Disease control rate per INV was 86% (95% CI 78–92). Median PFS per INV was 6.9 (95% CI 5.9–7.4) mo; 6- and 12-mo PFS rates were 61% and 19%, respectively. Median OS was 16.0 (95% CI 13.3–18.8) mo; 6- and 12-mo OS rates were 88% and 66%, respectively. Any-grade treatment-related adverse events (TRAEs) were reported in 100% of pts, 28% of which were grade 3/4. TRAEs led to discontinuation in 10% of pts. Efficacy analyses by BICR, subgroup analyses, and additional safety results will be presented. Conclusions: In heavily pretreated pts with KRAS G12C -mutated mCRC, Ada + Cetux continued to demonstrate clinically meaningful activity and tolerable safety with longer follow-up. These updated results are consistent with those from the primary analysis and constitute the longest duration of follow-up for dual KRAS G12C /EGFR blockade in this setting. Efficacy of second-line Ada + Cetux vs chemotherapy in KRAS G12C -mutated mCRC is being investigated in the phase 3 KRYSTAL-10 study (NCT04793958). Clinical trial information: NCT03785249 .

292 Long-term clinical outcomes and survival analysis of robotic-assisted versus conventional total knee arthroplasty: an 8-year propensity-matched cohort study

292 Long-term clinical outcomes and survival analysis of robotic-assisted versus conventional total knee arthroplasty: an 8-year propensity-matched cohort study

Expanding the flooding in Landsat across tidal systems model to Landsat 5-9 imagery for long-term marsh inundation analysis.

Tidal flooding can significantly impact vegetation pixel reflectance of coastal salt marshes, presenting a problem for remote sensing studies of these highly productive ecosystems. The current study aimed to spatially and temporally expand our previously developed Flooding in Landsat Across Tidal Systems (FLATS) model to detect and analyze the long-term changes in flooded marsh pixels in Landsat 5-9 imagery. As the FLATS index is only calibrated for Landsat 8, our goal was to expand the use of FLATS to a greater range of Landsat imagery and facilitate the masking of flooded pixels in long-term time series of vegetation indices. Using areas of salt marsh in the Georgia Coastal Ecosystems (GCE) Long Term Ecological Research (LTER) site, images from Landsat 5 through 9 were paired with near-coincident Landsat 7 images for a novel cross-calibration. Indices in the FLATS algorithm (Normalized Difference Water Index, NDWI and the Enhanced Vegetation Index, EVI) were calibrated for each image pair using linear regression models, and an adjusted FLATS index (FLATS+) was created to be used on a substantially expanded Landsat dataset from 1984 to 2023. The R2 scores for the vegetation index calibrations ranged from 0.78 to 0.87 for EVI, and 0.73-0.82 for NDWI. Additionally, this study sought to monitor changes in flooding patterns at the study site, utilizing the expanded temporal range of FLATS+. The trend in FLATS+ value exhibited significant spatial autocorrelation at three LTER sites, with areas of marsh experiencing significant changes in inundation over the 39-year period (Moran's I, p<0.01 at all sites). The FLATS+ index is a tool that is able to identify flooded pixels in Landsat 5-9. The index can be used to study salt marsh productivity, carbon uptake, flooding, and resiliency in response to sea level rise.

Enhancing Long-Term Viability of Energy Pile with Heat Sink Systems in Tropical Monsoon Climates: Implementation Strategies and Performance Analysis

Energy piles, a form of ground-source heat pump system integrated into building foundations, show great potential for reducing building energy consumption associated with fossil fuels. While it excels in climates where cooling demand matches heating, its effectiveness faces challenges in tropical monsoon regions characterized by hot summers and cool winters. In such climates, cooling demand dominates, leading to significant thermal accumulation over time, which diminishes the long-term viability of energy pile systems. This study focuses on the long-term thermal behavior analysis of an energy pile system installed in a representative office building. Our approach begins with an examination of short-term behavior, followed by the creation of a simplified model. Using this model, we analyze the long-term behavior of different systems, including the standard energy pile and combinations with various solutions: natural groundwater flow and synthetic heat sink systems. Key outcomes are evaluated based on entering water temperature (EWT), soil temperature, and energy efficiency ratio (EER), while also comparing energy savings with conventional air conditioning systems. Major findings include: (1) Standard energy pile systems without any mitigation measures achieve only a 15.3% energy savings initially and may cease functioning after approximately 10 years, (2) Energy pile systems using specific solutions can achieve a maximum saving ratio of 50%, typically ranging from 30% to 45%, while maintaining stability over the designated lifespan, (3) Higher EER and saving ratios correlate with increased groundwater flow and larger heat sink systems, however, the relationship is nonlinear, emphasizing the need for tailored design under varying geology and climate conditions. This study provides essential insights into energy pile systems design and practical guidance, along with expected energy savings in tropical monsoon climates for future application.

Robot-assisted esophagectomy with extended mediastinal lymph node dissection: The learning curve and surgical outcomes.

457 Background: We have performed thoracoscopic surgery (TMIE) and robot-assisted surgery (RAMIE) for esophageal cancer with extensive mediastinal lymph node dissection, including resection of the sympathetic nerve layers and the thoracic duct. We studied the learning curve, short-term results, and mid-to-long-term outcomes of RAMIE for esophageal cancer at our institution. Methods: We compared surgical times at different stages of the procedure. For mid to long-term outcomes, we analyzed 360 cases of TMIE/RAMIE performed between January 2009 and June 2022, comparing the incidence of postoperative complications, recurrence-free survival, and patterns of recurrence between RAMIE and TMIE. Recurrent laryngeal nerve palsy (C-D I) was evaluated using postoperative endoscopy or contrast swallowing tests to assess even mild paralysis. Results: The average console time in the thoracic procedure was 234.4 minutes, with Group A (294.5 minutes, range: 211-397 minutes) showing significantly longer times compared to Group B (190.5 minutes, range: 130-257 minutes). Blood loss was almost 0ml in 10 cases (50%) in Group A and 25 cases (62.5%) in Group B. Postoperative complications included pneumonia in 5 cases (8.3%) and recurrent laryngeal nerve palsy (C-D III) in 5 cases (8.3%), with no significant difference between the groups. However, surgical time for lymph node dissection around the recurrent laryngeal nerve was significantly shorter in Group B compared to Group A. Long-term analysis included 326 TMIE and 34 RAMIE cases. Mild recurrent laryngeal nerve palsy (&gt;C-D I) was observed in 92 cases (28%) of TMIE and 7 cases (21%) of RAMIE, showing a lower tendency in the RAMIE group (p=0.338). Pneumonia (&gt;C-D II) occurred in 57 cases (18%) in the TMIE group and 3 cases (9%) in the RAMIE group, with a relatively lower incidence in the RAMIE group (p=0.178). For patients with cT1N0M0 who did not receive preoperative chemotherapy, the 3-year recurrence-free survival rates were 95% for TMIE and 93% for RAMIE. Conclusions: RAMIE demonstrated a significant reduction in operative time due to the standardization of the procedure, particularly in the dissection of recurrent laryngeal nerve lymph nodes and other upper mediastinal maneuvers. RAMIE also showed a potential reduction in the incidence of recurrent laryngeal nerve palsy and pneumonia compared to TMIE. In terms of long-term outcomes, RAMIE maintained local control similar to TMIE, with further improvements in safety expected.

Integrating AI and climate change scenarios for multi-risk assessment in the coastal municipalities of the Veneto region.

Global climate is experiencing exceptional warming, leading to a rise in extreme events worldwide. Coastal regions are particularly vulnerable to climate change (CC), due to dense populations, interconnected economies, and fragile ecosystems. These areas face escalating risks as CC intensifies the severity and frequency of extreme weather phenomena, like heavy precipitation, sea-level rise (SLR), storm surges. Integrated approaches are crucial to assess the combined impacts of atmospheric and marine hazards at the land-sea interface. Machine Learning (ML) offer innovative solutions to analyse multi-risk events, leveraging large and heterogeneous datasets and modelling complex, non-linear interactions. This study introduces a two-tier ML approach to estimate risks associated with extreme weather events for the Veneto coastal municipalities under current and future scenarios. The model, tested and validated with present-day data, showed satisfactory performance (error margin ∼20%). The model was applied to mid-term (until 2045) and long-term (until 2100) periods under different CC scenarios, represented by various Representative Concentration Pathways (RCP). Mid-term analysis reveals an increasing risk trend, driven by SLR under RCP8.5, underscoring the significance of considering non-linear interactions between multiple marine and atmospheric hazards. Long-term analysis highlights how future risks depend mainly on precipitation and SLR across the analysed CC scenarios (RCP2.6/4.5/8.5). Results indicate a gradual increase in the expected annual risk trend, with RCP8.5 scenario showing the most severe outcomes. By 2100, the risks under RCP8.5 are projected to be ten times higher than those observed during the historical period, highlighting the importance of developing effective strategies to address these challenges.

Pain and Functional Outcome After Microsurgical Decompression of Lumbar Spinal Stenosis: Very Short- and Long-Term Postoperative Analysis.

Multicenter, prospective observational cohort study. 109 patients with lumbar spine stenosis (LSS) undergoing minimally invasive decompression in 6 different centers (Germany, Italy, USA). The demographic, surgical and clinical data was collected. Patients were examined preoperatively, immediately postoperatively, at 6 and 12 months after surgery with regard to pain (back and legs) and functional outcomes (ODI, SF-36, EQ5D). The mean age of the cohort was 67 ± 11 years, with a BMI of 31.8 ± 6.6kg/m². Most patients (93%) underwent single-level decompression, and postoperative adverse events occurred in 17% of cases. Significant initial reductions in back (6.0 ± 2.8 to 2.4 ± 2.1) and leg pain (6.4 ± 2.1 to 2.1 ± 2.5) were observed (P < 0.001). However, pain levels increased significantly by the 12-month period, reaching 3.9 ± 2.7 for back pain and 3.9 ± 2.4 for leg pain (P < 0.001). Functional scores (ODI) improved from 43 ± 18 at baseline to 36 ± 18 post-treatment but showed no further significant change (P = 0.509) by 12 months. Health status (EQ5D index) improved from 0.53 ± 0.33 to 0.82 ± 0.16 immediately post-treatment but declined to 0.75 ± 0.21 by 12 months (P = 0.011). SF36 physical scores also showed initial improvement but plateaued at follow-ups. Notably, high BMI and prior spine surgery were associated with worse outcomes. Although minimally invasive decompression without fusion initially led to a significant improvement in patients with LSS, the results deteriorated significantly over the course of the observation period. Future studies should focus on strategies to ensure sustained improvement in symptoms in patients with lumbar stenosis undergoing decompression procedure.

Improving outcomes with early and intensive metabolic control in patients with type 2 diabetes: a long-term modeling analysis of clinical and cost outcomes in Italy

ObjectivesThis analysis quantifies the potential long-term clinical and cost benefits of early and intensive metabolic control (EIMC) versus conventional management in patients newly diagnosed with type 2 diabetes in Italy.MethodsThe PRIME T2D Model was used to project clinical and cost outcomes over long-term time horizons for a newly diagnosed cohort of patients receiving EIMC or conventional management. EIMC was associated with a mean glycated hemoglobin reduction of 0.6% from baseline and a mean weight loss of 9.5 kg (8.2%) for a duration of 6 years, before gradually returning to the same levels as the conventional management arm over 6 years. Modifiable risk factors were assumed to progress over time based on published regression functions. Direct and indirect costs associated with diabetes-related complications were accounted in 2021 Euros (EUR), with unit costs and health state utilities derived from published sources. Future costs and clinical benefits were discounted at 3% annually.ResultsFor the population diagnosed with type 2 diabetes in 2021 (estimated at 216,417 cases), EIMC was projected to add approximately 33,112 years of life and 55,403 quality-adjusted life years versus conventional management. Cost savings with EIMC were estimated at EUR 494 million, EUR 608 million and EUR 628 million in the incident population at 10- and 20- and 50-year time horizons, respectively.ConclusionsAccording to this modeling study, early and intensive metabolic control has the potential to substantially improve clinical outcomes and reduce economic burden compared with conventional management of patients with type 2 diabetes in Italy.

P-547. Efficacy and Safety of B/F/TAF in Treatment-Naïve People With HIV Aged ≥ 50 Years: 5-Year Follow-Up From Two Phase 3 Studies

Abstract Background An increasing proportion of people with HIV (PWH) are aged ≥ 50 years, with a greater burden of age-related comorbidities; however, long-term analyses of this population are limited. We present key treatment outcomes through 5 years of first-line therapy with bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) in PWH ≥ 50 vs &amp;lt; 50 years. Methods Studies 1489 (NCT02607930; B/F/TAF vs dolutegravir/abacavir/lamivudine [DTG/ABC/3TC]) and 1490 (NCT02607956; B/F/TAF vs DTG+F/TAF) were randomized, double-blind, multicenter Phase 3 studies in adult PWH. This pooled analysis reports outcomes for participants ≥ 50 vs &amp;lt; 50 years who received B/F/TAF in the 144-week (W) randomization phase and the 96W open-label extension. Baseline demographics and clinical characteristics; proportion of participants with HIV-1 RNA &amp;lt; 50 copies/mL (missing=excluded); adherence; changes in CD4 cell count and metabolic, renal, and bone parameters; and treatment-emergent adverse events (TEAEs) are presented. Results Overall, 634 participants received B/F/TAF up to W240; 96 (15.1%) were ≥ 50 years and 538 (84.9%) were &amp;lt; 50 years. Baseline demographics, clinical characteristics, and outcomes are shown in the Table. Higher rates of baseline comorbidities were observed in those aged ≥ 50 vs &amp;lt; 50 years. Both groups had high rates of HIV suppression at W240. A greater proportion of participants aged ≥ 50 vs &amp;lt; 50 years had ≥ 95% adherence (82.8% vs 66.3%; P=0.0015). Changes in CD4 count, weight, eGFR, fasting total cholesterol to high-density lipoprotein ratio, and hip and spine bone mineral density were similar between groups. Proportions of participants with study drug-related TEAEs were similar between groups, with few participants experiencing a TEAE leading to study drug discontinuation. Proportions of TE hypertension and diabetes were modestly higher in the ≥ 50 group vs the &amp;lt; 50 group. Conclusion Over 5 years, participants ≥ 50 years were more likely to have high adherence to B/F/TAF treatment vs those &amp;lt; 50 years, with low rates of discontinuations due to AEs in both groups. B/F/TAF maintained high rates of virologic suppression, was well tolerated, and resulted in similar changes in metabolic, renal, and bone parameters in both groups, supporting its use for long-term management of HIV in older PWH. Disclosures Cissy Kityo, MD, MSc, PhD, Gilead Sciences, Inc.: Medical writing support provided by Aspire Scientific (Bollington, UK)|Janssen Pharma: Grant/Research Support Samir K. Gupta, MD, Gilead Sciences, Inc.: Advisor/Consultant|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support Princy N. Kumar, MD, Gilead Sciences, Inc.: Advisor/Consultant|Gilead Sciences, Inc.: Board Member|Gilead Sciences, Inc.: Grant/Research Support|Gilead Sciences, Inc.: Medical writing support provided by Aspire Scientific (Bollington, UK)|Gilead Sciences, Inc.: Stocks/Bonds (Public Company)|Johnson &amp; Johnson: Stocks/Bonds (Public Company)|Merck: Advisor/Consultant|Merck: Board Member|Merck: Grant/Research Support|Merck: Stocks/Bonds (Public Company)|Moderna: Stocks/Bonds (Public Company)|Pfizer: Stocks/Bonds (Public Company)|Theratechnologies: Grant/Research Support|ViiV/GSK: Advisor/Consultant|ViiV/GSK: Board Member|ViiV/GSK: Grant/Research Support|ViiV/GSK: Stocks/Bonds (Public Company) Amy Weinberg, DNP, MS, Gilead Sciences, Inc.: Employee|Gilead Sciences, Inc.: Stocks/Bonds (Private Company) Bhumi Gandhi-Patel, PharmD, Gilead Sciences, Inc.: Employee; Medical writing support provided by Aspire Scientific (Bollington, UK)|Gilead Sciences, Inc.: Stocks/Bonds (Private Company) Hui Liu, PhD, Gilead Sciences, Inc.: Employee; Medical writing support provided by Aspire Scientific (Bollington, UK)|Gilead Sciences, Inc.: Stocks/Bonds (Private Company) Jason Hindman, PharmD, MBA, Gilead Sciences, Inc.: Employee; Medical writing support provided by Aspire Scientific (Bollington, UK)|Gilead Sciences, Inc.: Stocks/Bonds (Private Company) Jürgen Rockstroh, Prof, AbbVie: Advisor/Consultant|AbbVie: Honoraria|Boehringer: Advisor/Consultant|Boehringer: Honoraria|Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Gilead: Honoraria|Gilead Sciences, Inc.: Medical writing support provided by Aspire Scientific (Bollington, UK)|Janssen: Honoraria|Merck: Advisor/Consultant|Merck: Honoraria|ViiV: Advisor/Consultant|ViiV: Honoraria

Presidential Speeches in Chile (1832–2021): A Methodological Approach

In many countries, presidents offer annual addresses to their respective legislatures or citizens. These speeches serve as a platform for leaders to communicate their vision, achievements, and priorities. Presidential speeches are key instruments of political power, serving as tools for agenda-setting and public engagement. However, studies on presidential rhetoric are often limited by traditional methodologies that focus on specific leaders or short periods. This article addresses these limitations by applying Latent Dirichlet Allocation to analyze Chilean presidential speeches from 1832 to 2021, uncovering thematic patterns and their evolution over nearly two centuries. Chile’s case, with its stable democratic tradition and rich history of presidential messages, demonstrates Latent Dirichlet Allocation’s utility for comprehensive, long-term discourse analysis. Our findings highlight Latent Dirichlet Allocation’s effectiveness in capturing thematic shifts that reflect broader socio-political changes, showcasing its potential for studying executive speeches across various political systems. This methodology bridges computational analysis and qualitative inquiry, offering a replicable framework for comparative research. We conclude by discussing its broader implications for future studies on political communication and cross-national analysis.

Long-Term Spatiotemporal Analysis of Crop Water Supply–Demand Relationship in Response to Climate Change and Vegetation Greening in Sanjiang Plain, China

The Sanjiang Plain (SJP) in Northeast China, a crucial black soil region, serves as a quintessential example of a high-intensity agricultural development zone and stands as China’s largest commercial grain production base. In the context of global climate change, pronounced global warming and increased vegetation greening are expected to significantly impact the agricultural water resource supply and its alignment with crop water requirements in the SJP. This study assesses how climate change and vegetation greening affect the crop water supply–demand relationship in the SJP, addressing the critical question of whether natural precipitation can sustain regional agricultural development. Using the extensively validated ESSI-3 distributed hydrological model, integrated with reanalysis and multi-source satellite data, we analyzed data from 1982 to 2018. The results indicate a statistically significant rise in the regional temperature and leaf area index (p &lt; 0.05), with a notable shift around 2000. Key findings include (1) an increase in crop irrigation water requirements (IWR) post-2000, with significant spatial variation; the central and western regions experienced the highest increases, while the eastern region saw reduced risk to crop water security. Furthermore, (2) climate change accounted for approximately 37.9% of the increased IWR in central and western regions, with vegetation greening contributing about 21.2%. Conversely, in the eastern region, vegetation dynamics had a more pronounced effect (28.6%), while climate change contributed less (12.3%). These results suggest a shift in crop water deficit risk boundaries toward the east and north. To optimize water use, expanding high-water-demand crops in the eastern regions and reducing their cultivation in the west is recommended, enhancing alignment between natural precipitation and crop water needs.

The impact of vapes and electronic cigarettes on the oral mucosa: a literature review

Relevance. Over the past few years, electronic cigarettes have gained popularity as an alternative means of nicotine consumption. In Russia, the number of individuals using vapes has reached 4.2 million. According to studies by Russian addiction specialists, 8.5% of adolescents aged 13–15 in Russia use electronic cigarettes, with prevalence rates of 10.3% among boys and 6.8% among girls. The oral tissues, particularly the mucosa, are the first point of contact with electronic cigarettes, directly exposed to the adverse effects of vape liquid components.Objective. To investigate the effects of vapes on oral health, with a particular focus on the oral mucosa and associated structures.Materials and methods. A total of 37 sources were selected for analysis, including 16 articles from the eLibrary database, 5 from CyberLeninka, and 4 from databases such as Wiley, Taylor &amp; Francis Online, and ScienceDirect. The search was conducted using the query "the impact of vapes on the oral mucosa" and keywords such as "electronic cigarette", "vapes," "oral health," "oral mucosa", and "smoking," in both Russian and English. Preference was given to materials published between 2014 and 2023 that directly addressed the topic, described conducted studies, and provided conclusions. Additionally, a manual search was performed within the reference lists of relevant articles to identify suitable publications.Results. A review of the literature revealed that electronic cigarettes adversely affect oral health, causing irritation of the mucosa and periodontium, salivary gland disorders, demineralization of dental hard tissues, and alterations in the pH of oral fluids.Conclusion. The impact of vapes on oral health remains insufficiently studied. Further experiments and long-term analyses are necessary to more accurately assess the effects of vape chemical components on oral tissues.

Desalination for Food Security in Tunisia: Harnessing Renewable Energy to Address Water Scarcity and Climate Change by Using ARDL Approach and VECM Technical

This study employs the Autoregressive Distributed Lag (ARDL) model to investigate the short-term and long-term effects of independent variables, including Agricultural output (A), Renewable energy consumption (REC), Non-renewable energy consumption (NREC), CO2E emissions, Climate change (CC) and Financial (FD), on food security (FS) in Tunisia during the 1990–2023 period. After confirming the stationarity of the variables and the existence of long-run cointegration, the ARDL model was employed. The short-term ARDL estimates revealed mixed results. While some variables had positive effects, others exhibited negative influences on FS. For instance, A positively impacted FS, while REC, NREC, CO2E, CC, and FD had negative effects. The long-term ARDL analysis indicates that A, NREC, CC, and FD have significant effects on FS. A and NREC positively influence FS, while CC and FD have negative impacts. REC’s effect on FS is uncertain due to its marginal significance, and CO2E shows no significant relationship with FS in the long run. This study provides valuable insights into the short-term and long-term relationships between FS and its influencing factors. The findings can inform policy decisions and future research in this area.

Spatiotemporal dynamics and driving factors of energy-related carbon emissions in the Yangtze River Delta region based on nighttime light data

Owing to China’s massive area and vastly differing regional variations in the types and efficiency of energy, the spatiotemporal distributions of regional carbon emissions (CE) vary widely. Regional CE study is becoming more crucial for determining the future course of sustainable development worldwide. In this work, two types of nighttime light data were integrated to expand the study’s temporal coverage. On this basis, the distribution of energy-related CE in the Yangtze River Delta (YRD) region of China was estimated at a multispatial scale. Then the spatiotemporal dynamics of CE were explored based on the estimated results. The findings showed that the growth rate of CE in the YRD displayed three stages, and the total CE fluctuated upward. The spatial pattern of CE demonstrated a step-like decline from east to west. However, the Gini coefficient indicated that the differences in CE between cities gradually decreased since the CE had a strong spatial positive correlation in the YRD. Multiple factors affected the spatial variation of CE in the YRD, with economic level and population as the “critical” influencing elements, which determined the absolute amount of CE. This study provides a long-term analysis of CE dynamics while enhancing explanatory accuracy. The methods offer novel perspectives and tools for regional CE research. The results reveal spatial heterogeneity and clustering patterns of CE within regions, contributing valuable scientific evidence for monitoring regional CE and formulating emission reduction policies.

The dynamic impact of trade openness on industrialization in Sub-Saharan Africa

ABSTRACT Few studies attempt to consider a differential effect in the relationship between trade openness and industrialization; meanwhile effects may differ in signs and magnitudes, in the short term and also in the long term. In this regard, the present work explores the dynamic impact of trade openness on industrialization for 31 sub-Saharan African countries, over the period 1990–2018. A new measure of trade openness and three main proxies of industrialization are used for the empirical statement. Unlike previous studies, the dynamic common correlated effect mean group method is used to properly address issues like heterogeneity, cross sectional dependence and structural breaks in the short- and long-term analysis. In the long run, results indicate that trade openness retards industrialization in sub-Saharan Africa. The impact of trade openness on industrialization in the short run is not significant. This results comfort the hypothesis that trade liberalization increases uncertainty and exposure to foreign shocks. In the short run, more incentives should be put in place, to boost infant industries, especially through private investment and human capital promotion. In the long run, sub-Saharan Africa should be very selective on the type of products intended for trade, in order to improve its industrialization.

Long-Term Clinical Outcomes and Risk Indicator Analyses of Narrow-Diameter Implants in the Posterior Jaw: A Retrospective Cohort Study of 10 to 27 Years.

To assess the long-term clinical outcomes and patient satisfaction with narrow-diameter implants (NDIs) in the posterior jaws and to identify the risk indicators for NDI failure. This retrospective study reviewed 479 patients with 666 NDIs (diameter ≤ 3.5 mm) -supported fixed prostheses in posterior jaws, with a minimum 10-year follow-up. Implant survival, success, complications, demographics, and implantation characteristics were collected. Risk indicators for posterior NDI failure were analyzed using multilevel Cox regression analyses with mixed effects. Patient satisfaction and oral health impact profile (OHIP) were surveyed in a random 10% sample. Over a mean follow-up of 14.0 ± 3.6 years, implant survival was 95.9% at the implant level and 94.6% at the patient level. Success rates were 93.5% at the implant level and 91.6% at the patient level. Multilevel Cox regression analysis identified an implant length of 10 mm or less (p = 0.001) and the use of single crowns (p = 0.005) as significant risk indicators for posterior NDI failure. Patients showed high satisfaction (4.54/5) with posterior NDIs, and the mean OHIP score of 1.15 reflected an acceptable level of oral health. NDIs in the posterior jaws demonstrated robust long-term success and high patient satisfaction. An implant length of 10 mm or less and the use of single crowns are potential risk indicators for posterior NDI failure. Chinese Clinical Trial Registry: ChiCTR2200062337 on 2022/08/02.

Laparoscopic approach for rectal cancer surgery: Triumph of reason or necessity of evolution?

The role of laparoscopy in rectal cancer surgery has evolved considerably since the early 2000s. Initial randomized trials, such as COLOR II and COREAN, indicated that laparoscopic approaches offered similar pathological outcomes with better postoperative recovery than open surgery. In contrast, trials like ACOSOG Z6051 and ALaCaRT suggested noninferiority could not be established. Variability in trial outcomes, focusing on either disease-free survival or pathological measures, initially hindered consensus. Long-term analyses have shown no significant difference in disease-free survival between laparoscopic and open approaches. Meta-analyses have reinforced the benefits of laparoscopic surgery, with reduced mortality and similar oncologic effectiveness to open surgery. However, new techniques like transanal TME (TaTME) and robotic approaches have introduced alternatives, though each presents unique challenges, from recurrence rates in TaTME to costs in robotics. While laparoscopy remains the preferred method due to accessibility and outcomes, robotic surgery is expected to gain traction in high-volume centers.

Real-world evidence of yellow Fever vaccination data-driven study.

Yellow Fever (YF), a mosquito-borne viral disease caused by yellow fever virus (YFV), remains endemic in tropical Sub-Saharan Africa and South America. The 17D live-attenuated vaccine has significantly reduced YF incidence with minimal risk of vaccine-associated adverse events, including Yellow Fever Vaccine-fever-associated Neurotropic Disease (YEL-AND) and Yellow Fever Vaccine-Associated Viscerotropic Disease (YEL-AVD). This study investigates the potential of Real-World Evidence (RWE) to enhance vaccine surveillance by analyzing electronic health records (EHRs) from the TriNetX platform, which identified a total of 15,835 individuals who were vaccinated with the Stamaril® YF vaccine between 2017 and 2021 in the United States. We compared adverse event rates obtained from RWE with those reported by the manufacturer in a recent study of Stamaril® used in the United States during this period. Our findings were consistent with those published previously and suggest no significant increase in adverse medical outcomes post-vaccination across all age groups, particularly in long-term analysis. This proof-of-concept study underscores the value of RWE in monitoring vaccine safety and supports its potential to complement traditional surveillance methods, offering a robust tool for continuous post-marketing vaccine evaluation.

Long-term survival analysis based on tumor location in patients with pancreatic ductal adenocarcinoma who underwent pancreatectomy following neoadjuvant chemoradiotherapy

BackgroundThe study aimed at assessing whether long-term survival outcomes were different based on tumor location in pancreatic ductal adenocarcinoma (PDAC) patients who underwent pancreatectomy following neoadjuvant chemoradiotherapy (CRT).MethodsFollowing CRT, resection rate was 60.5% (286/473) and the resected patients had pancreatic head (n = 218), body (n = 34) and tail (n = 34) tumors. Survival analyses were conducted, independent predictors of disease-free survival (DFS) and overall survival (OS) were identified, and then survival outcomes were stratified by the predictors of DFS and OS.ResultsResection rates were; 64.7% (head) vs. 46.6% (body) and 54.0% (tail) cases, p = 0.009. Among these cases, pancreatic head patients exhibited a higher incidence of initial clinical stage 3 tumors; 48.2% (head) vs. 29.4% (body) and 0% (tail) cases, p < 0.001 with more unresctable-locally advanced tumors; 22.0% (head) vs. 11.8% (body) and 0% (tail), p < 0.001, but demonstrated a better response to CRT; Evans grades 3/4 in 49.1% (head) vs. 23.5% (body) and 26.5% (tail), p = 0.012. Five-year DFS rates were; 19.9% (head) vs. 11.8% (body) vs. 24.6% (tail), p = 0.565 and OS rates; 25.4% (head) vs. 27.7% (body) vs. 32.0% (tail), p = 0.341. Significant predictors of DFS and OS included post-CRT CA19-9 levels, tumor differentiation, resection margins and pathological portal vein invasion. Based on these predictors, survival outcomes were also comparable. Pathological nodal invasion influenced DFS, while pathological stage impacted OS.ConclusionPancreatic head patients had the best resection rate and long-term survival outcomes were comparable, attributable to the better response to CRT by pancreatic head than the body and tail PDAC patients.

P0329 Clostridium difficile infection associates with the need for biologics: a retrospective long-term analysis in a cohort of 102 ibd patients

Abstract Background Gastrointestinal Infections (GIs) pose a significant challenge in patients with inflammatory bowel diseases (IBD), complicating its management and triggering IBD relapses. The overlap in clinical symptoms makes complex differentiating GIs from IBD flares, impacting therapeutic decisions. This study aims at evaluating the long-term impact of GIs in IBD patients. Methods From January 2020 to September 2024, 102 IBD patients (mean age 45±16 yrs; 78 ulcerative colitis, UC and 24 Crohn’s disease, CD) experiencing a clinical relapse according to ECCO guidelines, were retrospectively evaluated. GIs were established via stool immunochromatography and multiplex molecular assay. Demographic, clinical and laboratory findings along with the treatment were noticed at the time of flare, 6 and 12 months later. Statistical analysis was performed by Mann-Witney and chi-square test as appropriate (p&amp;lt;0.05). Results Nineteen patients tested GIs positive (GIs+): 14 out of 78 (18%) UC and 5 out of 24 CD (21%) patients. Clostridium difficile infection (CDI) was found in 11 patients while non-CDI enteric pathogens (EP+) in the remaining 8 patients. All CDI patients received a first-line antibiotic treatment while no treatment was offered to EP+ patients. By stratifying for GIs at the flare time, there were no differences between GIs+ and GIs- patients with regard to age (45±16 vs46±17 yrs, p=ns), disease duration (11±9 vs 12±10 yrs, p=ns), disease activity score (Mayo score 5±2 vs 5±2, p=ns and Harvey Bradshaw index 8±4 vs 8±4, p=ns) and inflammation biomarkers (C-reactive protein 21±41 vs 22±42 mg/dl, p=ns and fecal calprotectin 1446±1751 vs 1452±1714 mcg/gr, p=ns). At 12 months after flare, the number of patients being treated with biologics increased only in GIs+ IBD patients, from 3 out 19 (16%) to 10 out 19 (53%) (Figure 1). All the 7 IBD patients who have got biologics were CDI+. Conclusion This study confirms that distinguishing a disease flare from the presence of superimposed GIs remains challenging. Notably, only in patients with CDI there was an increased use of biologics later after the flare onset. This suggest that CDI may serve as a marker of a more aggressive disease course in IBD patients.