Narrow Margin Research Articles

Local recurrence after endoscopic submucosal dissection of gastric neoplastic lesions: special attention should be given also to safety margins

Introduction The incidence of local recurrence following gastric endoscopic submucosal dissection (ESD) remains a clinical concern. We aimed to evaluate the impact of narrow safety margin (< 1 mm) on the recurrence rate. Methods A retrospective cohort study was conducted across two centers. Cases of R0-ESD with subsequent recurrence were compared to matched controls in a 1:2 ratio in a case-cohort analysis. Results Over a median period of 25 months (IQR 14-43), a recurrence rate of 3% (95%CI 1.7-4.3) was observed, predominantly (13/21) following R0 resections with favourable histology. Endoscopic retreatment was feasible in 18 of 21 recurrences. The proportion of R0-cases where the safety margin in both horizontal (HM) and vertical (VM) margin exceeded 1 mm was similarly distributed in the recurrence and non-recurrence group, representing nearly 20% of cases. However, cases with HM less than 1 mm, despite VM greater than 1 mm, nearly doubled in the recurrence group (7.7% vs. 3.9%), and tripled when both margins were under 1 mm (23.1% vs. 7.7%). Despite this trend, statistical significance was not achieved (p = 0.05). In the overall cohort, the only independent risk factor significantly associated with local recurrence was the presence of residual tumor at the HM (HM1) or not assessable HM (HMx) (OR 16.5 (95%CI 4.4-61.7), and OR 11.7 (95%CI 1.1-124.1), respectively). Conclusions While not common or typically challenging to manage, recurrence post-ESD warrants attention and justifies rigorous post-procedural surveillance, especially in patients with HM1, HMx, and probably also in those with R0 resections but narrow safety margin.

New Agents Are Coming, and So Is the Resistance.

Antimicrobial resistance is a global threat that requires urgent attention to slow the spread of resistant pathogens. The United States Centers for Disease Control and Prevention (CDC) has emphasized clinician-driven antimicrobial stewardship approaches including the reporting and proper documentation of antimicrobial usage and resistance. Additional efforts have targeted the development of new antimicrobial agents, but narrow profit margins have hindered manufacturers from investing in novel antimicrobials for clinical use and therefore the production of new antibiotics has decreased. In order to combat this, both antimicrobial drug discovery processes and healthcare reimbursement programs must be improved. Without action, this poses a high probability to culminate in a deadly post-antibiotic era. This review will highlight some of the global health challenges faced both today and in the future. Furthermore, the new Infectious Diseases Society of America (IDSA) guidelines for resistant Gram-negative pathogens will be discussed. This includes new antimicrobial agents which have gained or are likely to gain FDA approval. Emphasis will be placed on which human pathogens each of these agents cover, as well as how these new agents could be utilized in clinical practice.

The role of continental heterogeneity on the evolution of continental plate margin topography at subduction zones

The nature of the overriding plate plays a major role for subduction zone processes. In particular, the highly heterogeneous continental lithosphere modulates intra-plate tectonics and the surface evolution of our planet. However, the role of continental heterogeneity is relatively under-explored for the dynamics of subduction models. We investigate the influence of rheological and density variations across the overriding plate on the evolution of continental lithosphere and slab dynamics in the upper mantle. We focus on the effects of variations in continental plate margin and keel properties on deformation, topographic signals, and basin formation. Our results show that the thickness, extent, and strength of the continental plate margin and subcontinental keel play a crucial role for the morphology and topography of the overriding plate, as well as the retreat of the subducting slab. We show that this lateral heterogeneity can directly influence the coupling between the subducting and overriding plate and determine the partitioning of plate velocities across the overriding plate. These findings suggest that back-arc extension and subsidence are not solely controlled by slab dynamics but are also influenced by continental plate margin and keel properties. Large extended back-arc regions, such as the Pannonian and Aegean basins, may result from fast slab rollback combined with a weak continental plate margin and a strong and extended continental keel. Narrow margins, like the Okinawa Trough in NE Japan, may indicate a comparatively stronger continental plate margin and weaker or smaller continental keel. Additionally, continental keel properties may affect the overall topography of the continental lithosphere, leading to uplift of the deformation front and the formation of intermontane basins.

Lean Blowout Proximity Sensing in a Low Emission Liquid-Fueled Combustor

ABSTRACT Advanced aircraft engine combustor designs, intended for achieving low NOx emissions, necessitate lean combustion with small operating margins above the LBO boundary, posing a high risk of exhibiting lean blowout (LBO) problems. Employing active LBO controllers receiving input from LBO proximity sensors can allow for narrower margins, thereby yielding multiple performance gains. Although several previous studies investigated LBO proximity sensing, they predominantly focused on premixed gas-fueled combustors. The application of proximity sensing approaches to liquid-fueled combustor designs, relevant to aircraft engines have not received adequate attention. Therefore, this study investigates LBO proximity sensing in a low emission lean direct injection (LDI) liquid-fueled combustor design developed by NASA. The combustor operates at atmospheric pressure with preheated air. The proximity sensing is examined by analyzing both OH* and CH* chemiluminescence signals, with a focus on assessing their relative performances. The signal analysis approaches include spectral, partial extinction event (LBO precursor) detection, signal RMS, and the CH*/OH* ratio, with an emphasis on the first two methods. Both steady-state and transient operating conditions have been examined. The combustor did not exhibit large-scale flame partial extinction and re-ignition events near LBO, as commonly observed in gas-fueled combustors. However, an increase in flame unsteadiness and partial extinction events with very subtle signatures in optical signals, have been observed. Low-pass filtering has been observed to considerably enhance the precursor signatures enabling their improved detection. With a reduction in LBO margin, an increase in signal low-frequency power, RMS, and precursor event occurrence rate have been observed, which were utilized for providing LBO proximity measures. A key finding from this study is that CH* signals provide significantly superior performance compared to OH* for the proximity sensing in all the approaches, and the potential reasons are discussed.

Predictors of Local Invasion in Infiltrative Basal Cell Carcinoma: Tumour Budding Outperforms the WHO Subtyping.

Tumour budding (TB) correlates with increased local invasion in various neoplasms. Certain basal cell carcinomas (BCCs) exhibit local aggressiveness. Detecting adverse prognostic factors in partial biopsies could aid in identifying cases with heightened local risk. The absolute number of TB (≤ 3 tumour cells) in excision specimens of 271 infiltrative BCCs (0: absent; 1: 1-2 foci; 2: ≥ 3 foci; 3: ≥ 10 foci), the histopathological subtype and depth of infiltration, perineural invasion, and other histological features were evaluated. A significant correlation was found between TB and both depth of infiltration (rho 0.445, p < 0.001) and perineural invasion (p = 0.009). In the multivariate analysis of depth and perineural invasion (multiple regression, stepwise), TB was identified as a significant covariate together with diameter, inflammation, and perineural invasion for the former, and depth for the latter. Conversely, no correlation existed between the WHO histological subtypes (infiltrating, sclerosing, and micronodular), and depth of infiltration or perineural invasion. This study demonstrates the value of TB as a biomarker for local invasiveness in BCC. In routine practice, a count of ≥ 3 TB foci in lesions incompletely excised or with narrow tumour-free surgical margins would be a straightforward and reproducible method to guide BCC treatment.

Impact of Vancomycin trough levels monitoring on uncomplicated methilcillin-resistant Staphylococcus aureus bacteremia in chronic kidney disease on hemodialysis, retrospective cohort

BackgroundCKD patients on hemodialysis (HD) with Staphylococcus aureus (SA) bacteremia present high morbidity, mortality and increased risk of MRSA. Vancomycin is the antibiotic of choice in these cases, it has a narrow therapeutic margin and inadequate dosage generates a risk of toxicity, therefore, the recommendation is to dosage it through serum levels.MethodsThis is a retrospective cohort study in 3 hospitals of third level of complexity in the city of Medellin in which there were differences in the measurement and implementation of vancomycin25 dosage based on trough levels (VL) in patients with chronic kidney disease on hemodialysis (CKD- HD) with uncomplicated bacteremia based infection by methilcillin-resistant Staphyloccocus aureus (MRSA). The primary outcome was the composite of hospital mortality, clinical response (fever, hemodynamic instability and altered consciousness), complications associated with bacteremia, or bacteriological response failure (positive cultures at first week follow-up) at 7 days. The composite variables were analyzed individually as secondary outcomes.ResultsThe main unadjusted outcome (OR 1.3, CI 0.6 - 2.7) and adjusted for age, Charlson index, loading dose, initial dose, dosing frequency and MIC to vancomycin (OR 1.2, CI 0.5 - 2.7). Regarding adjusted secondary outcomes: clinical response (OR 1.4 CI 0.3 - 5.8), death (OR 1.3 CI 0.3 - 4.6) and complications (OR 0.9, CI 0.37 - 2.2).ConclusionsWe conclude that the measurement of trough levels in patients with HD-CKD does not modify the composite outcome. The main limitation is the sample size and type of study, randomized control trials may be required to confirm the results presented.

The relationship between professional moral courage and individual characteristics among emergency medical services providers

PurposeEmergency Medical Services (EMS) providers are often faced with a range of ethical dilemmas in their line of work that require moral courage to make a quick and ethical decision. The purpose of this study is to investigate the level of professional moral courage (PMC) in EMS providers and its relationship with their demographic characteristics.Design/methodology/approachIn 2022, a cross-sectional descriptive study was conducted on 175 EMS providers at the Hamadan Emergency Medical Center. The study utilized an available sampling method. Data was collected using a demographic information form and Sekerka's moral courage questionnaire, which was distributed electronically. The collected data was analyzed using SPSS 26 software with descriptive and analytic tests.FindingsAccording to the findings, the average age of the participants was 34.57 ± 3.46 years. The majority of participants were married (50.3%), had work experience ranging from 8 to 14 years (49.7%), and held a degree in emergency medicine (52.6%). The participants displayed a high level of PMC, with an average score of 62.5 ± 8.14. Notably, age, work experience, educational level, and employment status were all found to have a significant relationship with moral courage (p < 0.05) among the demographic characteristics.Research limitations/implicationsThe study has a limitation in terms of the sampling method employed, which may impact the generalizability of the results. Another limitation, by a narrow margin, is that the sample size is smaller than what was estimated. Furthermore, using various measurement tools to assess PMC might lead to varying outcomes. Consequently, it is recommended that future research incorporates random sampling and devises a dedicated psychometric instrument to assess the PMC of EMS providers.Originality/valueThe results revealed a positive correlation between work experience and PMC among providers. This can be attributed to the challenges and outcomes they have encountered throughout their careers. Moreover, EMS providers with higher educational qualifications and job stability demonstrated higher levels of moral courage.

Sinobdella longitubulus, a new species of spiny eel (Pisces, Mastacembelidae) from the Zhu-Jiang Basin, with a note on the type locality of S. sinensis (Bleeker, 1870)

The spiny eel genus Sinobdella belongs to the family Mastacembelidae of the order Synbranchiformes. Kottelat and Lim (1994) utilised Rhynchobdella sinensis as the type species to propose the genus. Currently, it contains a single species widespread in eastern and southern China and northern Vietnam. Sinobdella longitubulus, a new species of spiny eel, is here described from the Xi-Jiang of the Zhu-Jiang Basin in Guangxi Zhuang Autonomous Region, southern China. It differs from the single congeneric species S. sinensis in having a more or less white-brown reticulated pattern on the flank, two tubular anterior nostrils longer than or equal to the rostral appendage, an anal fin heavily mottled with dark brown markings and white spots and bearing a narrow white distal margin; shorter pre-anal length; and fewer abdominal vertebrae. The validity of this new species is corroborated by its monophyly recovered in a COI gene-based phylogenetic analysis and its significant sequence divergence with S. sinensis. A note on the type locality of S. sinensis is also given; its type specimen is possibly from mountain streams of Jiangxi Province, in the lower Chang-Jiang Basin.

Identity preserved plant molecular farming offers value-added opportunity for farmers.

Bulk commodity row crop production in the United States is frequently subject to narrow profit margins, often complicated by weather, supply chains, trade, and other factors. Farmers seeking to increase profits and hedge against market volatility often seek to diversify their operations, including producing more lucrative or productive crop varieties. Recombinant plants producing animal or other non-native proteins (commonly referred to as plant molecular farming) present a value-added opportunity for row crop farmers. However, these crops must be produced under robust identity preserved systems to prevent comingling with bulk commodities to maintain the value for farmers, mitigate against market disruptions, and minimize any potential food, feed, or environmental risks.

Coping with inter-observer variability when assessing AI for scoring of HER2-stained whole slides.

e12571 Background: Around 15% of breast carcinomas exhibit Human Epidermal growth factor receptor 2 (HER2) overexpression due to gene amplification. HER2 protein levels are assessed by Immunohistochemistry (IHC) with 4 scores (0, 1+, 2+, 3+). Only score 3+ (IHC) cases and score 2+ (IHC) with proven HER2 gene amplification are eligible for targeted anti-HER2 therapies; others are HER2-negative. However, tumors with score 1+ and 2+ not amplified could benefit from treatment with the new HER2-based antibody-drug conjugates, requiring an accurate HER2 scoring, which is challenged by interobserver variability. This drawback is challenging for AI-based HER2 scoring assessment, and it is thus important to understand this inter-variability and then be able to propose a probabilistic framework which quantifies and explains the discrepancy between the AI analysis and the pathologist scoring. Methods: We introduce a novel probabilistic framework designed to assign probabilities to scores generated by AI algorithms. To the best of our knowledge, this represents the pioneering effort to quantify the uncertainty surrounding AI predictive models for HER2 scores. The methodology relies on a high-dimensional multivariate Gaussian approximation of the HER2 scoring process, hinting on the precise identification of marked cells to a specified category based on membrane completeness and staining intensity. Introducing uncertainty in the categorical identification enables the quantification of uncertainty in the overall AI-scoring at the whole slide image (WSI) level. Consequently, instead of offering a singular score, we can allocate a probability of belonging to a particular category (0, 1+, 2+, or 3+) for the global score. This approach enables a comparison of the predicted likelihood with the distribution of scores among pathologists, rather than relying on a "hypothetical" ground truth, often determined by a majority-voting which can be noise-sensitive or which excludes ambiguous cases when an agreement is hard to reach. Results: For illustration, we use the Kwant HER2 algorithm developed by DiaDeep on a validation set of 68 HER2 cases, previously scored by three expert pathologists. The framework allows us to understand the discrepancy between pathologists as we introduce nuance to the AI scoring and underlines narrow probability margins in borderline cases, therefore depicting the inherent challenge for pathologists to draw a clear demarcation between closely aligned scores categories. Conclusions: The proposed framework underscores the intrinsic variability of HER2 scoring between pathologists and allows to analyze the AI predictions for HER2 scoring with more nuance, consequently enabling a more critical analysis of the results compared to a singular raw output. As we enter a new era of AI-assisted diagnosis, such a method could improve the way of assessing new AI tools and help interpret their results.

Retrospective study on the profile of patients undergoing intraoperative radiotherapy with INTRABEAM for breast cancer treatment at a Brazilian cancer center.

e12538 Background: Conservative breast therapy combined with adjuvant radiotherapy has been the preferred treatment for early-stage breast cancer for many decades. Considering that most breast cancer recurrences occur near the original tumor site, partial breast radiotherapy has become an alternative for patients in this scenario, allowing for a single-dose radiation application directly to the tumor site. This technique has advantages such as reducing local toxicity and improving the quality of life for treated patients, in addition to decreasing the waiting time for radiotherapy treatment in developing countries like ours. Our case series is the largest in Latin America to date, and we believe that reporting the results of our experience will be valuable for the scientific community and aid in treatment decision-making in low- and middle-income countries. Methods: This is a retrospective study based on data from the medical records of 209 patients with early-stage breast cancer undergoing conservative surgery and intraoperative radiotherapy at A.C. Camargo Cancer Center (São Paulo, Brazil) from 2016 to 2023. Results: In our cohort, 88.5% of tumors were invasive ductal carcinomas. The majority were T1b (41.8%), had histological grade 2 (45.4%), nuclear grade 2 (62.7%), and showed no axillary involvement (87.6%). All patients received intraoperative radiotherapy in a single dose of 20 Gy radiation at the tumor site with a voltage of 50 kV. In our study, 17.7% of patients required additional external radiotherapy due to postoperative histopathological findings inconsistent with treatment indication criteria, including 35.3% for micrometastasis and 32.4% for nodal macrometastasis, 10.8% for narrow or compromised margins, 10.8% for histological types not covered in the final report, 2.7% for multifocality, 2.7% for extensive ductal carcinoma in situ, 2.7% for negative progesterone receptor, and 2.7% for the presence of lymphatic vascular invasion. The average follow-up time for patients was 36 months. The local recurrence rate was 0.5%. Conclusions: The results of this study support established data indicating the efficacy of intraoperative radiotherapy in early-stage breast cancer treatment. Therefore, for carefully selected patients, this technique with should be considered as a treatment option. We will continue to follow this patient cohort to identify the occurrence of late recurrences and publish long-term follow-up data.

HPLC Method for Better Separation of THC Isomers to Ensure Safety and Compliance in the Hemp Market.

The 2018 Farm Bill dictates that delta-9-tetrahydrocannabinol (Δ9-THC) concentrations must not exceed 0.3% in hemp and hemp-derived products in order to be "compliant." This narrow margin of error necessitates very precise testing methods throughout every facet of the hemp industry. Though gas chromatography has become the industry's gold standard, many hemp laboratories still use high-performance liquid chromatography (HPLC) to quantify cannabinoids, and thus there exists a need for HPLC methods that can separate delta-8-tetrahydrocannabinol (Δ8-THC) and Δ9-THC-a notoriously difficult task. This article details one such method, while simultaneously acknowledging the inevitable limits of using HPLC to separate cannabinoids. The method was also used to test Δ8-THC samples that were marketed as compliant, and it was found that all of the samples contained well over 0.3% Δ9-THC. The use of refined testing methodologies is crucial for hemp companies to ensure compliance, prevent adverse health effects, and provide consumers with accurate cannabinoid profiles of the products that they purchase.

Collecting and Delivering Fattened Pigs to the Abattoir.

In the context of pig farming, this paper addresses the optimization problem of collecting fattened pigs from farms to deliver them to the abattoir. Assuming that the pig sector is organized as a competitive supply chain with narrow profit margins, our aim is to apply analytics to cope with the uncertainty in production costs and revenues. Motivated by a real-life case, the paper analyzes a rich Team Orienteering Problem (TOP) with a homogeneous fleet, stochastic demands, and maximum workload. After describing the problem and reviewing the related literature, we introduce the PJS heuristic. Our approach is first compared with exact methods, which are revealed as computationally unfeasible. Later, a scenario analysis based on a real instance was performed to gain insight into the practical aspects. Our findings demonstrate a positive correlation between the number of alternative routes explored, the number of trips, the transportation cost, and the maximum reward. Regarding the variability in the number of pigs to collect, when a truck can visit more than one farm, better solutions can be found with higher variability since the load can be combined more efficiently.

Investment incentives attract foreign direct investment: evidence from the great recession

Do investment incentives influence private firms’ location decisions? Whereas prior research emphasizes tax incentives, we focus on incentives that require real-time government spending including job training and infrastructure. Real incentives influence where firms invest by resolving costly information asymmetries, and are subject to budget constraints that give rise to political targeting. This paper evaluates how real incentives shape the location decisions of foreign firms, investors who suffer from acute information asymmetries. We leverage features of the Great Recession and the 2009 American Recovery and Reinvestment Act stimulus, which temporarily increased states’ fiscal capacity to fund real incentives. During the narrow stimulus spending window, states that received more federal Medicaid stimulus—instrumented with the exogenous component of the Act’s funding formula—attracted more foreign direct investment (FDI) and increased state spending on real incentives. The stimulus window approximately coincides with FDI’s temporary geographic expansion into US counties that lacked a history of these investments. On average, these counties had narrow vote margins in the prior gubernatorial election and garnered more state real incentive spending. These correlates are pronounced in counties with idle industrial capacity and in states whose governors sought re-election. Tax incentives had no effect on FDI. These findings have important implications for the efficacy of investment incentives and the political economy of industrial policy.

Effect of blockchain technology adoption on construction supply chain: a structural equation modelling (SEM) approach

Purpose The construction industry is frequently scrutinised by the public for a variety of issues, including waste, inefficiency, narrow profit margins, scheduling setbacks, budget overruns, quality concerns, trust deficits, transparency issues, coordination challenges, communication issues and fraud. The purpose of this paper is to assess the effect of blockchain technology adoption on the construction supply chain. Design/methodology/approach This study used a quantitative research approach through a questionnaire survey that was conducted among professionals in the Nigerian construction industry using the snowball sampling method, which resulted in a selection of 155 respondents. The collected data were analysed using partial least squares structural equation modelling, enabling a thorough assessment of the proposed relationships and offering valuable insights specific to the construction industry. Findings The study’s findings validated the conceptual framework established. The results indicated that implementing blockchain across all stages of the construction supply chain has the potential to improve the construction process. The study also revealed that blockchain technology will significantly affect the construction supply chain in a positive manner. Research limitations/implications This research was carried out in the South-western region which is one of the six geo-political zones in Nigeria using a cross-sectional survey method. The study holds implications not only for local construction practices but will also contribute to the broader discourse on national construction sector challenges and possible solutions. Practical implications The findings of this study will be immensely beneficial to both professionals, practitioners and stakeholders in the Nigerian construction industry in learning about the potential of blockchain technology application in improving the construction supply chain. Originality/value The study in this paper constructed and evaluated a conceptual framework by exploring the connections between the variables. The results have significant implications for the construction sector, as they provide avenues for enhancing the construction process and the overall supply chain. These findings are valuable for researchers examining the potential effects of blockchain technology on the construction supply chain.

Model-Based input energy control for reproducible AISI 316L laser deposited tracks

In the Directed Energy Deposition (DED) process, when the mass flow of metal particles is relatively high, the thickness of the layers increases, leading to a more productive process. The higher the mass flow is, the more difficult it becomes to get a stable melt pool. The accumulation of residual heat in the previously consolidated material constitutes a thermal input affecting the balance at the laser-material interaction zone. An accurate control of the temperature of the laser-material interaction zone is critical to maintain the dynamic viscosity of the liquid metal within the narrow margin in which it can be managed in a stable way. The present work introduces a thermal model in which domains with tunable properties are considered to reproduce the growing of the manufactured sample. Concurrently, a virtual closed-loop PID regulator has been implemented in order to calculate suitable values of laser power to compensate the heat accumulated in the material, offering the results from the model as input process parameters to be directly applied in the real process. The levels of laser power proposed by the model have been experimentally applied, leading to a stable process capable of carrying out in reality the desired component.

The Impact of Climate Change on Work: Lessons for Developing Countries

Abstract We identify five areas where climate change may impact work and draw lessons for developing countries by reviewing the evidence. Firstly, demand for labor is unevenly affected, with agriculture, heat-exposed manufacturing, and the brown energy sector experiencing downturns, while other sectors may see a rise, resulting in an uncertain overall impact. Secondly, climate change impacts labor supply through absenteeism, shirking, and altering work-time patterns, depending on the activity and sector. Thirdly, productivity may decline, especially in heat-exposed industries, primarily due to health reasons. Fourthly, heightened earnings variability likely increases vulnerability among the self-employed. Fifthly, climate change can influence labor allocation and catalyze sectoral reallocation. Higher temperatures are also linked to increased migration. But caution is needed in interpreting these findings, as studies across these topics predominantly use fixed effect estimation and concentrate on short-term impacts, neglecting adaptation. Emerging research on adaptation indicates that workplace cooling is unappealing for firms with narrow profit margins, while coping strategies of farms and households have unclear optimality due to adoption barriers. Government responses remain understudied, with six potential areas identified: green jobs, green skills, labor-oriented adaptation, flexible work regulation, labor market integration, and social protection. We conclude by outlining future research directions.

Importance of resection margin after resection of colorectal liver metastases in the era of modern chemotherapy: population-based cohort study.

Resection margin has been associated with overall survival following liver resection for colorectal liver metastasis. The aim of this study was to examine how resection margins of 0.0 mm, 0.1-0.9 mm and ≥1 mm influence overall survival in patients resected for colorectal liver metastasis in a time of modern perioperative chemotherapy and surgery. Using data from the national registries Swedish Colorectal Cancer Registry and Swedish National Quality Registry for Liver, Bile Duct and Gallbladder Cancer, patients that had liver resections for colorectal liver metastasis between 2009 and 2013 were included. In patients with a narrow or unknown surgical margin the original pathological reports were re-reviewed. Factors influencing overall survival were analysed using a Cox proportional hazard model. A total of 754 patients had a known margin status, of which 133 (17.6%) patients had a resection margin <1 mm. The overall survival in patients with a margin of 0 mm or 0.1-0.9 mm was 42 (95% c.i. 31 to 53) and 48 (95% c.i. 35 to 62) months respectively, compared with 75 (95% c.i. 65 to 85) for patients with ≥1 mm margin, P < 0.001. Margins of 0 mm or 0.1-0.9 mm were associated with poor overall survival in the multivariable analysis, HR 1.413 (95% c.i. 1.030 to 1.939), P = 0.032, and 1.399 (95% c.i. 1.025 to 1.910), P = 0.034, respectively. Despite modern chemotherapy the resection margin is still an important factor for the survival of patients resected for colorectal liver metastasis, and a margin of ≥1 mm is needed to achieve the best possible outcome.

Investigating the sorption behavior of selenite on commercial partially oxidized magnetite nanopowder under aerobic conditions: Characterization and mechanisms

Selenium, which belongs to essential elements, has a narrow margin between necessity and toxicity. Anthropogenic activities may lead to its elevated concentrations in aquatic ecosystems, particularly in the undesirable form of toxic selenite, due to its high environmental mobility. Hence, it is imperative to devise effective technologies to limit its potential migration through the environment. Therefore, the development and evaluation of new adsorbents for its effective removal from selenium-contaminated waters are crucial for both human health and environmental stability in affected areas. Specifically, magnetite-based nanomaterials showed promise as sorbents due to their capacity to immobile contaminants through reductive transformation or adsorption, but there is a lack of comprehensive understanding regarding the sorption mechanisms and the factors influencing the efficiency of this process. A deeper understanding of these factors is crucial for developing sustainable and efficient water treatment strategies. This study focuses on magnetite nanopowder’s sorptive properties, examining critical factors such as pH, ionic strength, and competing anions that affect selenite removal. Sorption kinetics revealed an initial rapid selenite removal followed by a slower, time-dependent phase, suggesting a complex sorption mechanism. Chemisorption was considered the primary sorptive interaction, with diffusion playing a minor role, and was best described by the pseudo-second order kinetic model. Notably, pH significantly affected sorption efficiency and the suggested sorptive mechanism. Acidic conditions favored selenite removal due to formation of inner-sphere complexes, while alkaline conditions reduced efficiency due to repulsive interactions. Equilibrium sorption data were best fitted by the Langmuir model, with maximum sorption at pH 3, indicating that acidic conditions favor selenite removal. X-ray photoelectron spectroscopy (XPS) analysis ruled out the formation of reduced selenium compounds on the magnetite nanopowder surfaces. Additionally, Mössbauer spectrometry revealed that the nanopowder is not homogeneous and contains both magnetite and maghemite phases. Ionic strength and co-occurring ions showed minimal chloride impact but significant phosphate competitiveness due to its affinity for iron oxides. In conclusion, this study sheds light on the complex selenite sorptive interactions with magnetite nanopowder, emphasizing the dominance of chemisorption, especially in acidic solutions.

Tellurium and Nano-Tellurium: Medicine or Poison?

Tellurium (Te) is the heaviest stable chalcogen and is a rare element in Earth's crust (one to five ppb). It was discovered in gold ore from mines in Kleinschlatten near the present-day city of Zlatna, Romania. Industrial and other applications of Te focus on its inorganic forms. Tellurium can be toxic to animals and humans at low doses. Chronic tellurium poisoning endangers the kidney, liver, and nervous system. However, Te can be effective against bacteria and is able to destroy cancer cells. Tellurium can also be used to develop redox modulators and enzyme inhibitors. Soluble salts that contain Te had a role as therapeutic and antimicrobial agents before the advent of antibiotics. The pharmaceutical use of Te is not widespread due to the narrow margin between beneficial and toxic doses, but there are differences between the measure of toxicity based on the Te form. Nano-tellurium (Te-NPs) has several applications: it can act as an adsorptive agent to remove pollutants, and it can be used in antibacterial coating, photo-catalysis for the degradation of dyes, and conductive electronic materials. Nano-sized Te particles are the most promising and can be produced in both chemical and biological ways. Safety assessments are essential to determine the potential risks and benefits of using Te compounds in various applications. Future challenges and directions in developing nano-materials, nano-alloys, and nano-structures based on Te are still open to debate.