Capecitabine or Capecitabine Plus Oxaliplatin Versus Fluorouracil Plus Cisplatin in Definitive Concurrent Chemoradiotherapy for Locally Advanced Esophageal Squamous Cell Carcinoma (CRTCOESC): A Multicenter, Randomized, Open-Label, Phase 3 Trial.

PURPOSE: This phase 3 trial aimed to compare the efficacy and safety of capecitabine or capecitabine plus oxaliplatin (XELOX) with those of fluorouracil plus cisplatin (PF) in definitive concurrent chemoradiotherapy (DCRT) for inoperable locally advanced esophageal squamous cell carcinoma (ESCC). METHODS: Patients were randomly assigned to receive two cycles of capecitabine, XELOX, or PF along with concurrent intensity-modulated radiation therapy. Patients in each arm were again randomly assigned to receive two cycles of consolidation chemotherapy or not. The primary end points were 2-year overall survival (OS) rate and incidence of grade ≥3 adverse events (AEs). RESULTS: A total of 246 patients were randomly assigned into the capecitabine (n = 80), XELOX (n = 85), and PF (n = 81) arms. In capecitabine, XELOX, and PF arms, the 2-year OS rate was 75%, 66.7%, and 70.9% (capecitabine v PF: hazard ratio [HR], 0.91 [95% CI, 0.61 to 1.35]; nominal P = .637; XELOX v PF: 0.86 [95% CI, 0.58 to 1.27]; P = .444); the median OS was 40.9 (95% CI, 34.4 to 49.9), 41.9 (95% CI, 28.6 to 52.1), and 35.4 (95% CI, 30.4 to 45.4) months. The incidence of grade ≥3 AEs during the entire treatment was 28.8%, 36.5%, and 45.7%, respectively. Comparing the consolidation chemotherapy with the nonconsolidation chemotherapy groups, the median OS was 41.9 (95% CI, 34.6 to 52.8) versus 36.9 (95% CI, 28.5 to 44) months (HR, 0.71 [95% CI, 0.52 to 0.99]; nominal P = .0403). CONCLUSION: Capecitabine or XELOX did not significantly improve the 2-year OS rate over PF in DCRT for inoperable locally advanced ESCC. Capecitabine showed a lower incidence of grade ≥3 AEs than PF did.

Frozen Section Histoanatomy of the Peritarsal Eyelid.

BACKGROUND: Mohs surgery of eyelid skin cancers requires detailed knowledge of anatomy for precise surgery and accurate evaluation of histology. OBJECTIVE: To review the histology of the peritarsal eyelid using frozen sections as encountered intraoperatively by Mohs surgeons. METHODS: The authors review the literature describing the anatomy and histology of the peritarsal eyelid from the lens of a Mohs surgeon. Histology from select Mohs cases is used to frame the discussion of the microanatomy of this region. RESULTS: The peritarsal eyelids contain a unique mixture of skin, muscle, tarsus, glandular tissue, and conjunctiva. The histologic appearance of many of these structures differs from skin found outside of this anatomic region. Tumors of the eyelid and periocular region may mimic normal histologic structures found within the peritarsal eyelid. CONCLUSION: The peritarsal eyelids have unique anatomy and associated histologic structures. Knowledge of the detailed histoanatomy is required for confident execution of Mohs surgery in this anatomic region.

Historical and dispersal processes drive community assembly of multiple aquatic taxa in glacierized catchments in the Qinghai-Tibet plateau.

Understanding the relative role of dispersal dynamics and niche constraints is not only a core task in community ecology, but also becomes an important prerequisite for bioassessment. Despite the recent progress in our knowledge of community assembly in space and time, patterns and processes underlying biotic communities in alpine glacierized catchments remain mostly ignored. To fill this knowledge gap, we combined the recently proposed dispersal-niche continuum index (DNCI) with traditional constrained ordinations and idealized patterns of species distributions to unravel community assembly mechanisms of different key groups of primary producers and consumers (i.e., phytoplankton, epiphytic algae, zooplankton, macroinvertebrates, and fishes) in rivers in the Qinghai-Tibet Plateau, the World's Third Pole. We tested whether organismal groups with contrasting body sizes differed in their assembly processes, and discussed their applicability in bioassessment in alpine zones. We found that community structure of alpine river biotas was always predominantly explained in terms of dispersal dynamics and historical biogeography. These patterns are most likely the result of differences in species-specific functional attributes, the stochastic colonization-extinction dynamics driven by multi-year glacier disturbances and the repeated hydrodynamic separation among alpine catchments after the rising of the Qilian mountains. Additionally, we found that the strength of dispersal dynamics and niche constraints was partially mediated by organismal body sizes, with dispersal processes being more influential for microscopic primary producers. Finding that zooplankton and macroinvertebrate communities followed clumped species replacement structures (i.e., Clementsian gradients) supports the notion that environmental filtering also contributes to the structure of high-altitude animal communities in glacierized catchments. In terms of the applied fields, we argue that freshwater bioassessment in glacierized catchments can benefit from incorporating the metacommunity perspective and applying novel approaches to (i) detect the optimal spatial scale for species sorting and (ii) identify and eliminate the species that are sensitive to dispersal-related processes.

Anticipated Versus Unanticipated Incomplete Mohs Micrographic Surgery for Keratinocyte Carcinomas: Impact on Treatment Delays and Final Margin Status.

BACKGROUND: Mohs micrographic surgery may be discontinued with positive margins as an anticipated strategy for multidisciplinary care or as an unanticipated occurrence. Management of primary tumors has not been compared after anticipated versus unanticipated incomplete Mohs micrographic surgery (iMMS). OBJECTIVE: To compare rates and timing of adjuvant surgery after iMMS and final margin status when iMMS is anticipated versus unanticipated. Secondary outcomes were preoperative and intraoperative clinicopathologic factors associated with iMMS. METHODS: Cases of iMMS of keratinocyte carcinomas at a tertiary academic center between 2005 and 2022 were classified as anticipated (preoperative assembly of multidisciplinary teams) or unanticipated (ad hoc management of positive margins). Rate, timing, and final margin status of adjuvant surgery was compared between anticipated and unanticipated iMMS cohorts using χ2/Fisher exact test for categorical variables and t-test for continuous variables. RESULTS: Of 127 iMMS cases, 51.2% (65/127) were anticipated. Anticipated iMMS cases were more likely to undergo additional resection (98.5% vs 72.6%, p < .001), with fewer delays (3.9 vs 13.2 days, p < .001) and higher rates of final margin clearance (84.6% vs 59.7%, p < .001). CONCLUSION: When iMMS is anticipated as part of multidisciplinary care, patients are more likely to undergo additional resection, with fewer delays to next surgery and higher final margin clearance rates.

Patient Preferences for Pain Control After Mohs Micrographic Surgery: A Single-Center Discrete Choice Experiment.

Importance: Patient preferences for pain medications after Mohs micrographic surgery are important to understand and have not been fully studied. Objective: To evaluate patient preferences for pain management with only over-the-counter medications (OTCs) or OTCs plus opioids after Mohs micrographic surgery given varying levels of theoretical pain and opioid addiction risk. Design, Setting, and Participants: This prospective discrete choice experiment was conducted in a single academic medical center from August 2021 to April 2022 among patients undergoing Mohs surgery and their accompanying support persons (≥18 years). A prospective survey was administered to all participants using the Conjointly platform. Data were analyzed from May 2022 to February 2023. Main outcome and measure: The primary outcome was the pain level at which half of the respondents chose OTCs plus opioids equally to only OTCs for pain management. This pain threshold was determined for varying opioid addiction risk profiles (low, 0%; low-moderate, 2%; moderate-high, 6%; high, 12%) and measured via a discrete choice experiment and linear interpolation of associated parameters (pain levels and risk of addiction). Results: Of the 295 respondents (mean [SD] age, 64.6 [13.1] years; 174 [59%] were female; race and ethnicity were not considered) who completed the discrete choice experiment, 101 (34%) stated that they would never consider opioids for pain management regardless of the pain level experienced, and 147 (50%) expressed concern regarding possible opioid addiction. Across all scenarios, 224 respondents (76%) preferred only OTCs vs OTCs plus opioids after Mohs surgery for pain control. When the theoretical risk of addiction was low (0%), half of the respondents expressed a preference for OTCs plus opioids given pain levels of 6.5 on a 10-point scale (90% CI, 5.7-7.5). At higher opioid addiction risk profiles (2%, 6%, 12%), an equal preference for OTCs plus opioids and only OTCs was not achieved. In these scenarios, patients favored only OTCs despite experiencing high levels of pain. Conclusion and relevance: The findings of this prospective discrete choice experiment indicate that the perceived risk of opioid addiction affects the patient's choice of pain medications after Mohs surgery. It is important to engage patients undergoing Mohs surgery in shared decision-making discussions to determine the optimal pain control plan for each individual. These findings may encourage future research on the risks associated with long-term opioid use after Mohs surgery.

Anthropogenic impacts on multiple facets of macroinvertebrate α and ß diversity in a large river-floodplain ecosystem.

Anthropogenic disturbances have become one of the primary causes of biodiversity decline in freshwater ecosystems. Beyond the well-documented loss of taxon richness in increasingly impacted ecosystems, our knowledge on how different facets of α and ß diversity respond to human disturbances is still limited. Here, we examined the responses of taxonomic (TD), functional (FD) and phylogenetic (PD) α and ß diversity of macroinvertebrate communities to human impact across 33 floodplain lakes surrounding the Yangtze River. We found that most pairwise correlations between TD and FD/PD were low and non-significant, whereas FD and PD metrics were instead positively and significantly correlated. All facets of α diversity decreased from weakly to strongly impacted lakes owing to the removal of sensitive species harboring unique evolutionary legacies and phenotypes. By contrast, the three facets of ß diversity responded inconsistently to anthropogenic disturbance: while FDß and PDß showed significant impairment in moderately and strongly impacted lakes as a result of spatial homogenization, TDß was lowest in weakly impacted lakes. The multiple facets of diversity also responded differently to the underlying environmental gradients, re-emphasizing that taxonomic, functional and phylogenetic diversities provide complementary information on community dynamics. However, the explanatory power of our machine learning and constrained ordination models was relatively low and suggests that unmeasured environmental features and stochastic processes may strongly contribute to macroinvertebrate communities in floodplain lakes suffering from variable levels of anthropogenic degradation. We finally suggested guidelines for effective conservation and restoration targets aimed at achieving healthier aquatic biotas in a context of increasing human impact across the 'lakescape' surrounding the Yangtze River, the most important being the control of nutrient inputs and increased spatial spillover effects to promote natural metasystem dynamics.

Merkel Cell Carcinoma.

Merkel cell carcinoma (MCC) is a neuroendocrine carcinoma that typically presents as a rapidly enlarging violaceous papulonodule on sun-damaged skin in elderly patients. MCC has high rates of local recurrence, metastasis, and poor survival. Treatment of the primary tumor involves surgical excision with possible adjuvant radiation therapy, whereas regional nodal disease is treated with some combination of lymph node dissection and radiation therapy. Immune checkpoint inhibitors, such as avelumab and pembrolizumab, are first-line agents for metastatic MCC. Monitoring for recurrence can be aided by Merkel cell polyomavirus oncoprotein antibody titers.

Life history and population ecology of Radix swinhoei (Lymnaeidae) in nearshore regions of a hypereutrophic plateau lake.

Accurate assessment of life history and population ecology of widespread species in ultra-eutrophic freshwater lakes is a prerequisite for understanding the mechanisms by which widespread species respond to eutrophication. Freshwater pulmonate (Radix swinhoei) is widespread and abundant in many eutrophic water bodies in Asia. Despite its key roles in eutrophic lake systems, the information on life history and population ecology of R. swinhoei is lacking, especially in ultra-eutrophic freshwater plateau lakes. Here, we conducted a 1-year survey of R. swinhoei with monthly collections to measure the life history traits (life span and growth), annual secondary production, and population size structure of R. swinhoei in nearshore regions with a high seasonally variation of nutrients in Lake Dianchi, a typic hypereutrophic plateau lake in Southwest China. Our results showed that R. swinhoei had the highest biomass in autumn and had the lowest in winter. Its maximum potential life span was 2.5 years, with three recruitment periods (November, March, and July) within a year. Its annual secondary production and P/B ratio were 137.19 g WW/m2 and 16.05, respectively. Redundancy analysis showed that eutrophication-related environmental factors had weak correlations with population size structure of R. swinhoei. Our results suggested that R. swinhoei is a typical r-strategist with high secondary production and thrive in eutrophic environment. Our study can help better understand the mechanisms for widespread species to survive eutrophication and could also be relevant for biodiversity conservation and management of eutrophic ecosystems.

An Improved Experiment for Measuring Lithium Concentration-Dependent Material Properties of Graphite Composite Electrodes.

The in situ curvature measurement of bilayer beam electrodes is widely used to measure the lithium concentration-dependent material properties of lithium-ion battery electrodes, and further understand the mechano-electrochemical coupling behaviors during electrochemical cycling. The application of this method relies on the basic assumption that lithium is uniformly distributed along the length and thickness of the curved active composite layer. However, when the electrode undergoes large bending deformation, the distribution of lithium concentration in the electrolyte and active composite layer challenges the reliability of the experimental measurements. In this paper, an improved experiment for simultaneously measuring the partial molar volume and the elastic modulus of the graphite composite electrode is proposed. The distance between the two electrodes in the optical electrochemical cell is designed and graphite composite electrodes with four different thickness ratios are measured. The quantitative experimental data indicate that the improved experiment can better satisfy the basic assumptions. The partial molar volume and the elastic modulus of the graphite composite electrode evolve nonlinearly with the increase of lithium concentration, which are related to the phase transition of graphite and also affected by the other components in the composite active layer. This improved experiment is valuable for the reliable characterization of the Li concentration-dependent material properties in commercial electrodes, and developing next-generation lithium batteries with more stable structures and longer lifetimes.

Mechanics-based design of lithium-ion batteries: a perspective.

From the overall framework of battery development, the battery structures have not received enough attention compared to the chemical components in batteries. The mechanical-electrochemical coupling behavior is a starting point for investigation on battery structures and the subsequent battery design. This perspective systematically reviews the efforts on the mechanics-based design for lithium-ion batteries (LIBs). Two typical types of mechanics-based LIB designs, namely the design at the preparation stage and that at the cycling stage, have been discussed, respectively. The former systemizes the structure design of multiscale battery components from the particle level to the cell level. The latter focuses on the external mechanics-related control, including external pressures and charge-discharge protocols, of in-service LIBs. Moreover, the general problems currently being faced in the mechanics-based LIB design are summarized, followed by the outlook of possible solutions.

Experimental measurement of electro-chemo-mechanical properties of a composite silicon electrode in lithium ion batteries.

The applications of silicon (Si)-based electrodes in lithium ion batteries have been impeded by mechanical degradation caused by lithiation/delithiation-induced volume changes. Understanding the evolution of mechanical behavior and properties of Si composite electrodes during electrochemical cycling is indispensable to develop coping strategies and predict battery life. In this study, we optimized an in situ method for measuring electro-chemo-mechanical properties, including partial molar volume, elastic modulus, and electrochemical reaction-induced stress, based on the curvature changes of cantilever electrodes. We found that the swell strain and partial molar volume of Si electrodes increase with the Li concentration. The elastic modulus generally decreases with the Li concentration. The in-plain stress transforms from tensile stress to compressive stress and showed an increasing tendency during further lithiation, while it shows a reverse trend during delithiation. The stress evolution correlates well with the "opening" and "closing" of micro-cracks in Si composite electrodes during cycling. These findings provide not only input parameters for battery modeling but also help understand the capacity fading of Si electrodes. Furthermore, the in situ measurement methodology developed in this study is readily applied to other battery electrodes.

Deformation of Copper Nanowire under Coupled Tension-Torsion Loading.

Metallic nanowires (NWs) are essential building blocks for flexible electronics, and experience different deformation modes due to external mechanical loading. Using atomistic simulations, this work investigated the deformation behavior of copper nanowire under coupled tension-torsion loading. A transition in both yielding pattern and dislocation pattern were observed with varying torsion/tension strain ratios. Specifically, increasing the torsion/tension strain ratio (with larger torsional strain) triggered the nucleation of different partial dislocations in the slip system. At low torsion/tension strain ratios, plastic deformation of the nanowire was dominated by stacking faults with trailing partial dislocations pinned at the surface, shifting to two partial dislocations with stacking faults as the strain ratio increases. More interestingly, the NW under tension-dominated loading exhibited a stacking fault structure after yielding, whereas torsion-dominated loading resulted in a three-dimensional dislocation network within the structure. This work thus suggests that the deformation behavior of the NW varies depending on the coupled mechanical loading, which could be beneficial for various engineering applications.

One- and two-staged Pacman V-Y advancement flaps for defects of the head and neck: A review of 29 cases.

BACKGROUND: When traditional V-Y advancement flaps cannot span cutaneous defects, the modified Pacman™ V-Y advancement flap (Pacman™ VYAF) design increases its utility for challenging facial defects. OBJECTIVE: To describe the usage and surgical outcomes of Mohs micrographic surgery (MMS) defects repaired with the Pacman™ VYAF. METHODS: A retrospective review was performed on MMS defects repaired with the Pacman™ VYAF in the division of dermatologic surgery at a large academic institution between January 01, 2013 and August 01, 2019. RESULTS: Twenty-nine instances of Pacman™ VYAF reconstructions were identified. Reconstruction of the cheek (22/29, 76%) was the most common, followed by the temple (4/29, 14%), and the post-auricular neck (3/29, 10%). Distal flap necrosis occurred more frequently in large Pacman™ VYAF repairs (6/29, 21% of cases), requiring surgical revision in 1 case. Surgical scars from the Pacman™ VYAF are rated favorably by dermatologic surgeons. CONCLUSION: The Pacman™ VYAF is a useful reconstruction option for surgical defects of the head and neck, and it is advantageous compared to traditional V-Y advancement flaps for defects with length greater than width.

N2O and NO production and functional microbes responding to biochar aging process in an intensified vegetable soil.

Vegetable soils with high nitrogen input are hotspots of nitrous oxide (N2O) and nitric oxide (NO), and biochar amended to soil has been documented to effectively decrease N2O and NO emissions. However, the aging effects of biochar on soil N2O and NO production and the relevant mechanisms are not thoroughly understood. A15N tracing microcosm study was conducted to clarify the responses of N2O and NO production pathways to the biochar aging process in vegetable soil. The results showed that autotrophic nitrification was the predominant source of N2O production. Biochar aging increased the O-containing functional groups while lowering the aromaticity and pore size. Fresh biochar enhanced the AOB-amoA gene abundance and obviously stimulated N2O production by 15.5% via autotrophic nitrification and denitrification. In contrast, field-aged biochar markedly weakened autotrophic nitrification and denitrification and thus decreased N2O production by 17.0%, as evidenced by the change in AOB-amoA and nosZI gene abundances. However, the amendment with artificially lab-aged biochar had no effect on N2O production. With the extension of aging time, biochar application reduced the soil NO production dominated by nitrification. Changes in the N2O and NO fluxes were closely associated with soil NH4+-N and NO2--N contents, indicating that autotrophic nitrification played a critical role in NO production. Overall, our study demonstrated that field-aged biochar suppressed N2O production via autotrophic nitrification and denitrification by regulating associated functional genes, but not for lab-aged biochar or fresh biochar. These findings improved our insights regarding the implications of biochar aging on N2O and NO mitigation in vegetable soils.

A Robust Fire Detection Model via Convolution Neural Networks for Intelligent Robot Vision Sensing.

Accurate fire identification can help to control fires. Traditional fire detection methods are mainly based on temperature or smoke detectors. These detectors are susceptible to damage or interference from the outside environment. Meanwhile, most of the current deep learning methods are less discriminative with respect to dynamic fire and have lower detection precision when a fire changes. Therefore, we propose a dynamic convolution YOLOv5 fire detection method using a video sequence. Our method first uses the K-mean++ algorithm to optimize anchor box clustering; this significantly reduces the rate of classification error. Then, the dynamic convolution is introduced into the convolution layer of YOLOv5. Finally, pruning of the network heads of YOLOv5's neck and head is carried out to improve the detection speed. Experimental results verify that the proposed dynamic convolution YOLOv5 fire detection method demonstrates better performance than the YOLOv5 method in recall, precision and F1-score. In particular, compared with three other deep learning methods, the precision of the proposed algorithm is improved by 13.7%, 10.8% and 6.1%, respectively, while the F1-score is improved by 15.8%, 12% and 3.8%, respectively. The method described in this paper is applicable not only to short-range indoor fire identification but also to long-range outdoor fire detection.