A programmable two-qubit quantum processor in silicon.

Now that it is possible to achieve measurement and control fidelities for individual quantum bits (qubits) above the threshold for fault tolerance, attention is moving towards the difficult task of scaling up the number of physical qubits to the large numbers that are needed for fault-tolerant quantum computing. In this context, quantum-dot-based spin qubits could have substantial advantages over other types of qubit owing to their potential for all-electrical operation and ability to be integrated at high density onto an industrial platform. Initialization, readout and single- and two-qubit gates have been demonstrated in various quantum-dot-based qubit representations. However, as seen with small-scale demonstrations of quantum computers using other types of qubit, combining these elements leads to challenges related to qubit crosstalk, state leakage, calibration and control hardware. Here we overcome these challenges by using carefully designed control techniques to demonstrate a programmable two-qubit quantum processor in a silicon device that can perform the Deutsch-Josza algorithm and the Grover search algorithm-canonical examples of quantum algorithms that outperform their classical analogues. We characterize the entanglement in our processor by using quantum-state tomography of Bell states, measuring state fidelities of 85-89 per cent and concurrences of 73-82 per cent. These results pave the way for larger-scale quantum computers that use spins confined to quantum dots.

Ultrasound as the first line investigation for midgut malrotation: a UK tertiary centre experience.

AIM: To present the first 22-months experience of transitioning to an ultrasound-first pathway for suspected midgut malrotation. MATERIALS AND METHODS: An "ultrasound-first" imaging pathway was initiated in October 2021. Twenty-two-months later, a search was undertaken of all <1-year-old patients with "bilious", "malrotation," or "volvulus" as the imaging indication. Reports and images from upper gastrointestinal fluoroscopy (UGI) and ultrasound were reviewed, and diagnoses and outcomes were documented. RESULTS: The search yielded 101 eligible cases between October 2021 and July 2023. Of the patients, 63/101 (62%) had both ultrasound and UGI: 47/63 (75%) ultrasound first, 16/63 (25%) UGI first. Thirty-one per cent (31/101) had ultrasound only and 7/70 (10%) UGI only. The pathway diagnosed 7/8 (88%) infants with midgut malrotation with or without volvulus and one infant who had an inconclusive ultrasound examination with a suspected an internal hernia and who was found to have malrotation volvulus at surgery. Twenty-one infants who had confidently normal ultrasound examinations and who also had UGI all had a normal duodenojejunal flexure position. Ultrasound detected alternative pathology in eight children. Duodenal visualisation improved with time: 6/15 (40%) in the first 6 months to 23/34 (68%) after the first year. CONCLUSION: The transition to ultrasound as the first diagnostic test for midgut malrotation can be done safely and effectively in a UK centre, which previously relied solely on UGI.

Effects of two wintering practices on behavioral and physiological indicators of welfare of non-lactating, pregnant dairy cattle in a pasture-based system.

In countries with pasture-based dairy systems and relatively cold winters, such as New Zealand, it is common to manage pregnant, nonlactating cows on forage crop paddocks rather than pasture due to slow pasture growth rates. Wintering dairy cattle on grazed crops can compromise welfare if wet and muddy underfoot conditions occur, which can reduce lying. This study investigated behavioral and physiological indicators of welfare of cows under 2 wintering practices: cows managed on and grazed kale crop (Brassica oleracea), and cows managed on pasture with baled hay. Following dry-off (d 0), 80 cows were randomly assigned to one of the 2 wintering practices (40 cows/practice) and monitored between d 4 and d 32 (phase 1). During this period, lying and stepping behavior was continuously recorded using leg-based accelerometers. Blood samples were obtained at d 0 and 32 for measurements of thyroxine (T4), nonesterified fatty acids (NEFA), white blood cells (WBC), and red blood cells (RBC). All data for phase 1 were presented descriptively due to the lack of treatment replication. Daily mean air temperature during this period was 5.2°C (range: 0.0 to 10.7°C), and rainfall was 1.1mm/d (range: 0 to 5.6mm/d). Between d 4 and 32, cows in both groups spent similar amounts of time lying (pasture with hay cows: 8.9h/24h ± 2.57, kale crop cows: 8.7h/24h ± 3.06, mean ± SEM). Both groups reduced their lying on wet and cold days and there was evidence of rebound lying once unfavorable weather conditions stopped. Cows on kale crop had numerically higher NEFA and lower WBC compared with cows managed on pasture, although most physiological values were within normal ranges. In a second phase of the study (d 34 and 35), cows were managed under controlled, replicated conditions in the 2 wintering practices using typical on-farm stocking rates (2 or 4 cows per group in the pasture with hay and kale crop treatments, respectively; n = 10 groups/treatment). During this period, cow behavior, skin and surface temperatures, hygiene scores, feed intakes and ground conditions were measured. Weather conditions during the 48-h exposure were mostly cold and dry (mean air temperature: 7.8°C, range: -2.2 to 20.5°C). Cows managed on pasture with hay spent more time lying down on the first day of exposure, however, this was likely due to less space being available to kale cows on this day. Cows managed on pasture with hay ruminated more than cows on kale crop on both days of observations (Day 1: 37.9% vs 30.9% of observations, Day 2: 36.8% vs 28.7% of observations for pasture with hay and kale crop groups, respectively) and were lying more often in postures indicative of greater thermal comfort. Cows managed on pasture with hay had higher skin and surface temperatures compared with cows on kale crop, whereas cows on kale crop had dirtier coats. Results suggest that opportunities for thermal comfort were greater for cows managed on pasture with hay bales, which may be due to increased rumination activities and more insulated lying areas.

Relationship between climate change and skin cancer and implications for prevention and management: a scoping review.

OBJECTIVES: This study aimed to explore the published research on the relationship between climate change and skin cancer and the implications for prevention, management and further research. STUDY DESIGN: Scoping review. METHODS: This scoping review following JBI methodology reviewed English articles identified in searches of MEDLINE, Embase, CINAHL, Web of Science and Scopus on 14 April 2023. The screening of articles was completed by two independent reviewers. Data were extracted by a single reviewer and checked by another. A causal pathway diagram was iteratively developed throughout the review and was used to categorise the findings. RESULTS: The search identified 1376 papers, of which 45 were included in the final review. Nine papers reported primary research, and 36 papers were reviews, perspectives, commentaries, editorials, or essays. The papers examined climate change influencing behaviours related to ultraviolet exposure (30 papers), ambient temperature (21 papers) and air pollution (five papers) as possible risk factors; occupational, rural, and contextual factors affecting skin cancer (11 papers); and prevention and access to health care in the context of climate change (seven papers). Most papers were published in journals in subject areas other than health. CONCLUSIONS: This review identified ultraviolet radiation, occupation, rising temperature, individual behaviour and air pollution as possible influences on skin cancer rates. Furthermore, it highlights the complexity and uncertainties in the relationship between climate change and skin cancer and the need for further research on this relationship, including primary epidemiological research and reviews that follow recognised review guidelines and include assessment of health services and social determinants in the causal pathways of this relationship.

Changes in Tooth Mobility and Position in an Established Dentition Following Placement of a New Restoration.

The aim of this study is to examine and evaluate physiologic tooth mobility and movement in different groups of patients. Four groups of patients were examined and recordings were taken. Group A1 consisted of 12 undergraduate students under the age of 30, A2 consisted of 11 members of staff over the age of 30 and A3 consisted of 9 patients with periodontal disease between the ages of 40-65 years old. The fourth Group B, 14 patients between 30-70 years old, received single-tooth restorations and recordings were taken immediately after, a month and four months following the cementation of the restoration. Patients in the first 3 groups showed no significant change in tooth mobility and movement between appointments. The fourth group demonstrated a non-statistically significant increase in tooth mobility following the cementation of the restoration due to the force applied on the occlusal surface of the tooth during the cementation process, while tooth movement was not observed beyond that of physiological tooth migration. Regardless of the age or the restorations a patient receives over the years, with careful occlusal consideration, no significant changes in tooth mobility and movement should be observed.

Real-Time Optical Vascular Imaging, a new method for the diagnosis and monitoring of oral diseases.

INTRODUCTION: Real-Time Optical Vascular Imaging (RTOVI) is a technology developed in the Centre for Oral Clinical & Translational Sciences, within the Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, that allows rapid and preparation free, in vivo imaging of the microvascular anatomy of the human oral cavity. Microvascular changes are known to be related to disease subtypes, in particular cancer. This makes in vivo microvascular examination clinically valuable. However, at present there is lack of any analytical method able to objectively assess microvascular morphology images. DISCUSSION: The assessment of microvascular morphology based on a subjective evaluation was proven to be unreliable. There was a need to develop a software-based analysis for in vivo microvascular images to support the validation of RTOVI. This paper reviews the authors work to develop and test an automated microvascular analysis method for RTOVI based on ImageJ, an open-source software. This allowed to determined which parameters offered a more robust mathematical representation of the microvascular anatomy of the gingival margin, such as the mean area per capillary and mean aspect ratio. However, in vivo microvascular images from elsewhere within the oral cavity posed a bigger challenge to the analysis procedure due to the microvascular architectural complexity and poorer contrast. Angiogenesis Analyzer, a well-known ImageJ plugin used for the quantification of in vitro microvascular images, is under development in collaboration with the University of Paris Est Créteil. The aim of this work is to obtain an automated analysis method for in vivo microvascular images able to offer a solid foundation for the diagnostic potential of RTOVI and subsequent clinical integration of this technology. CONCLUSION: An automated analysis method for in vivo microvascular images is paramount before any attempt to clinically validate RTOVI. Our initial work of testing a software-based analysis demonstrated the effectiveness of some parameters, which is valuable for future work, and led us to move into a more sophisticated method involving customising the Angiogenesis Analyzer plugin. This is an essential step, aiming to extend the potential of in vivo microscopy with the clinical integration of RTOVI. LAY DESCRIPTION: This article summarises the initial research work done in the field on in vivo microvascular imaging aiming to develop a technique for the diagnosis of oral diseases based on the shape of small blood vessels found just below the surface of the "skin" inside the mouth. This offers the potential to examine lesions without the need to take a sample (biopsy/cutting tissue) to observe it microscopically. This ultimately offers a potential to accelerate diagnostic decision making, avoid unpleasant and often deterrent surgical procedures and reducing diagnostic laboratory time and cost burdens. However, in order to assess images of small blood vessels obtained in clinic, we needed to develop and test a software-based analysis to avoid the subjective human interpretation, known not to work. This article describes the authors journey to achieve an automated and sophisticated analysis method unique in the world for in vivo microvascular images derived from real-time optical vascular imaging.

Evaluating networked drug checking services in Toronto, Ontario: study protocol and rationale.

BACKGROUND: The increasing incidence of fatal opioid overdose is a public health crisis in Canada. Given growing consensus that this crisis is related to the presence of highly potent opioid adulterants (e.g., fentanyl) in the unregulated drug supply, drug checking services (DCS) have emerged as part of a comprehensive approach to overdose prevention. In Canada's largest city, Toronto, a network of DCS launched in 2019 to prevent overdose and overdose-related risk behaviors. This network employs mass spectrometry technologies, with intake sites co-located with supervised consumption services (SCS) at three frontline harm reduction agencies. The protocol and rationale for assessing the impact of this multi-site DCS network in Toronto is described herein. The aims of this study are to (1) evaluate the impact of DCS access on changes in and factors influencing overdose and related risk behaviors, (2) investigate the perceived capacity of DCS to prevent overdose, and (3) identify composition (qualitative and quantitative) trends in Toronto's unregulated drug supply. METHODS: We will use a parallel-mixed-methods design with complementary data sources (including data from chemical analysis of drug samples, quantitative intake and post-test surveys, SCS, coroners, paramedic services, and qualitative interviews), followed by a meta-inference process wherein results from analyses are synthesized. RESULTS: Whereas most DCS globally target "recreational drug users," in Toronto, this networked DCS will primarily target marginalized people who use drugs accessing frontline services, many of whom use drugs regularly and by injection. This evolution in the application of DCS poses important questions that have not yet been explored, including optimal service delivery models and technologies, as well as unique barriers for this population. Increasing information on the unregulated drug supply may modify the risk environment for this population of people who use drugs. CONCLUSIONS: This study addresses evidence gaps on the emerging continuum of overdose prevention responses and will generate critical evidence on a novel approach to reducing the ongoing high incidence of drug-related morbidity and mortality in Canada and elsewhere.

Polymer-free biolimus-A9-coated stent for primary percutaneous coronary intervention.

BACKGROUND: The polymer-free biolimus-A9 drug-coated stent (DCS) was reported to have superior safety and efficacy outcomes compared with a bare metal stent in the LEADERS FREE trial of high-bleeding-risk patients with acute coronary syndrome and on dual antiplatelet treatment (DAPT) for 1 month. The aim of this investigation was to evaluate the DCS in a consecutive cohort of patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI). METHODS: We analyzed data from 164 consecutive STEMI patients who underwent PPCI using the DCS at our institution. The primary efficacy endpoint was clinically indicated target lesion revascularization (ciTLR); the primary safety endpoint was a composite of cardiac death, myocardial infarction, and definite/probable stent thrombosis. Clinical outcomes at 1 year are presented here. RESULTS: The mean age of the patients was 61.5 ± 15.5 years, and 86.6% were male. The median symptom-to-balloon-time was 55 min. In 57.9% of patients (n = 95), the infarct had an anterior location. PPCI achieved Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow in 163 of 164 patients (99.4%). All patients were prescribed DAPT for 1 year. At 1 year, ciTLR occurred in 1.2% of patients, the primary safety endpoint was reached in 4.3% of patients, and definite stent thrombosis was noted in 0.6% of patients. CONCLUSION: In this consecutive real-world cohort of patients, the DCS was safe and efficacious when used for PPCI in patients with STEMI.

Treatment with 48-mm everolimus-eluting stents : Procedural safety and 12-month patient outcome.

BACKGROUND: Lesion length is a major predictor of adverse outcomes after percutaneous coronary intervention. Long lesions often require multiple stents with variable overlap, which increases the probability of geographical miss and the incidence of mechanical complications, such as side-branch occlusion, restenosis, and stent thrombosis. These pitfalls may be avoided by use of an ultra-long device. METHODS: We retrospectively assessed the performance of the 48-mm Xience Xpedition everolimus-eluting stent (EES) at our institution. RESULTS: A total of 123 patients (mean age: 60.94 years, n = 93 [76%] male) with 129 lesions were identified. Lesions (n = 69, 53.5%) were located in the left anterior descending artery, the right coronary artery (n = 47, 36.4%), and the circumflex artery (n = 8, 6.2%); 83 lesions involved a major side branch. The majority were treated with a provisional single-stent strategy. Other characteristics included significant tortuosity in 15 lesions (11.6%) and moderate-to-heavy calcification in 46 lesions (35.7%). In all cases, balloon pre-dilatation was performed before stent insertion. Successful delivery and deployment of the 48-mm EES device was achieved in 100% of the patients. The mean number of stents per lesion was 1.4, while the mean total stent length was 58 ± 17.3 mm and mean stent diameter, 3.00 ± 0.67 mm. The procedural success rate was 99.2%. The 30-day major cardiac adverse event (MACE) rate was 0.8%, while the 12-month MACE was 3.3%. CONCLUSION: The Xience 48-mm EES device appears to be safe and efficacious with a low clinical event rate at the 12-month follow-up. Where feasible, this would support the use of the ultra-long 48-mm platform in lieu of multiple overlapping shorter devices.

All is not lost: Post-saccadic contributions to the perceptual omission of intra-saccadic streaks.

Saccades rapidly jerk the eye into new positions, yet we rarely experience the motion streaks imposed on the retinal image. Here we examined spatial and temporal properties of post-saccadic masking-one potential explanation of this perceptual omission. Observers judged the motion direction of a target stimulus, a Gaussian blob, that moved vertically upwards or downwards and then back to its initial position, just as observers made a saccade. We manipulated the onset and offset of the target and of distractors in various spatial relations to the target, and assessed their effect on performance and subjective confidence. Although the presence of the target after the saccade caused the strongest omission, the offset of spatially distant distractor stimuli upon saccade offset also impaired performance. The temporal properties of these two separate effects suggest that, in addition to masking, an independent effect of attentional distraction further accentuates perceptual omission of intra-saccadic motion streaks.

Quantitative bowel apparent diffusion coefficient measurements in children with inflammatory bowel disease are not reproducible.

AIM: To investigate the intra-observer and interobserver variability of quantitative apparent diffusion coefficient (ADC) measurements in children with inflammatory bowel disease. MATERIALS AND METHODS: Nine readers were recruited. Six magnetic resonance imaging (MRI) enterography cases with known active disease in the jejunum, terminal ileum, or colon were analysed. Readers measured repeat ADC values from the known diseased site and an unaffected site, at two sittings. RESULTS: Seven readers completed the study. The Lin concordance coefficient for intra-observer agreement was poor (0.844, 95% confidence interval [CI]: 0.77, 0.896). Bland-Altman limits of agreement for intra-observer agreement were 0.66×10-3 mm2/s (95% CI: 0.46, 0.86), and -0.56×10-3 mm2/s (95% CI: -0.36, -0.76). Therefore, a single measured value would be compatible with no disease, superficial ulceration, or deep ulceration according to published thresholds. Interobserver variability was poor to moderate across all observers (intraclass correlation coefficient [ICC]: 0.51, 95% CI: 0.27, 0.77). Between the two best-agreeing observers, agreement was good using the ICC (ICC 0.85, 95% CI: 0.43, 1.0), but poor using the Lin correlation coefficient (Lin 0.83, 95% CI: 0.65, 0.93), and Bland-Altman. CONCLUSION: The intra-observer and interobserver agreement is inadequate to allow accurate characterisation of disease activity using previously published thresholds. Qualitative ADC assessment may be preferable.

Abnormalities of the craniovertebral junction in the paediatric population: a novel biomechanical approach.

The craniovertebral junction (CVJ) is the bony transition between the cranium and cervical spine. It is a biomechanically complex articulation comprising the occipital condyles (Oc) the atlas (C1) and axis (C2). Pathologies affecting the CVJ in children are myriad with clinical features resulting from biomechanical instability, deformity, or neuraxial compression. Establishing the natural history and clinical burden of a condition is challenging in infants and young children, often complicated by co-existing neuromuscular and cognitive impairment. This makes investigation and treatment planning difficult. Each disease entity has a predilection for a particular biomechanical abnormality. Investigation using dynamic imaging is most appropriate in instability, computed tomography examination in abnormalities of deformity and magnetic resonance imaging examination in neuraxial compression. Treatment comprises reduction and immobilisation of instability, re-alignment of deformity, or decompression of the neuraxis. We present a review of disease entities affecting the CVJ in children categorised according to a simple mechanistic approach to aid investigation and treatment planning.

High-Fidelity Single-Shot Singlet-Triplet Readout of Precision-Placed Donors in Silicon.

In this work we perform direct single-shot readout of the singlet-triplet states in exchange coupled electrons confined to precision-placed donor atoms in silicon. Our method takes advantage of the large energy splitting given by the Pauli-spin blockaded (2,0) triplet states, from which we can achieve a single-shot readout fidelity of 98.4±0.2%. We measure the triplet-minus relaxation time to be of the order 3 s at 2.5 T and observe its predicted decrease as a function of magnetic field, reaching 0.5 s at 1 T.

Probing the degradation and homogeneity of embedded perovskite semiconducting layers in photovoltaic devices by Raman spectroscopy.

The key challenges for perovskite solar cells include their poor stability and film homogeneity. Studying the degradation and homogeneity of perovskite layers within device structures can be challenging but critical to the understanding of stability and effect of processing in real life conditions. We show that Raman spectroscopy (RS) is a unique and powerful method (simple and fast) to probe the degradation of the perovskite film within the device structure and image perovskite formation. We demonstrate that RS can be used to directly probe chemical (PbI2) and physical (dihydrated phase) degradation of a perovskite film, and estimate the relative amount of the degradation species formed, mapping its distribution with ∼1 µm spatial resolution. This has been applied to mapping a large area perovskite module to characterise the efficacy of PbI2 to perovskite conversion. We also use RS to study the degradation species and kinetics under diverse accelerated degradation conditions (temperature and humidity) in situ. These capabilities are difficult to achieve with other methods, presenting RS as an important tool to gain understanding of the degradation and effect of processing on perovskite-based photovoltaic devices.

Distal longitudinal deformation of a Synergy stent by jailed Rotawire guidewire.

Recent advances in stent technology have led to the development of thin strut platforms with fewer connectors. This has improved delivery but compromised strength, as illustrated by recent cases of longitudinal compression. We present an unusual case of longitudinal shortening at the distal end of a Synergy stent.

Safety of bailout stenting after paclitaxel-coated balloon angioplasty.

BACKGROUND: Bailout stenting after suboptimal paclitaxel-coated balloon (PCB) angioplasty is required in up to 28% of cases. We sought to compare the safety of bailout stenting with drug-eluting stents (DES) compared with the more established combination of PCB with bare metal stents (BMS). METHODS: We retrospectively evaluated all patients who had stents implanted owing to suboptimal PCB angioplasty results between January 2010 and April 2015. Endpoints analyzed were major adverse cardiac events (MACE) - defined as cardiovascular death, nonfatal myocardial infarction (MI), and target lesion revascularization (TLR) - as well as major and minor bleeding. RESULTS: Baseline clinical characteristics were comparable with a high proportion of diabetics in both groups (50.0% vs. 45.8%, p = 0.74). BMS and DES sizes were similar (mean diameter 2.72 ± 0.50 mm vs. 2.89 ± 0.56 mm, p = 0.20, length 25.22 ± 13.47 mm vs. 28.08 ± 9.08 mm, p = 0.47). Outcomes were comparable at the end of 1 year (MACE 12.2% vs. 9.5%, p = 1.00, TLR 6.1% vs. 4.8%, p = 1.00, MI 0% vs. 4.8%, p = 0.30). There was no case of stent thrombosis or major bleeding, and the rates of minor bleeding were similar (4.2% vs. 4.8%, p = 1.00). CONCLUSION: Our initial experience using DES instead of BMS as a bailout after suboptimal PCB results shows that the procedure is safe and effective at 1 year.

Eosinophilic myocarditis: characteristics, diagnostics and outcomes of a rare condition.

Eosinophilic myocarditis is a rare and potentially fatal condition characterised by eosinophilic inflammatory infiltration of myocardium. We report seven consecutive cases of eosinophilic myocarditis at our centre and discuss the important characteristics, investigation and management of this disease.

Worldwide Esophageal Cancer Collaboration: pathologic staging data.

We report data-simple descriptions of patient characteristics, cancer categories, and non-risk-adjusted survival-for patients with pathologically staged cancer of the esophagus and esophagogastric junction after resection or ablation with no preoperative therapy from the Worldwide Esophageal Cancer Collaboration (WECC). Thirty-three institutions from six continents submitted de-identified data using standard definitions: demographics, comorbidities, clinical cancer categories, and all-cause mortality from first management decision. Of 13,300 patients, 5,631 had squamous cell carcinoma, 7,558 adenocarcinoma, 85 adenosquamous carcinoma, and 26 undifferentiated carcinoma. Patients were older (62 years) men (80%) with normal body mass index (51%), little weight loss (1.8 kg), 0-2 ECOG performance status (83%), and a history of smoking (70%). Cancers were pT1 (24%), pT2 (15%), pT3 (50%), pN0 (52%), pM0 (93%), and pG2-G3 (78%); most involved distal esophagus (71%). Non-risk-adjusted survival for both squamous cell carcinoma and adenocarcinoma was monotonic and distinctive across pTNM. Survival was more distinctive for adenocarcinoma than squamous cell carcinoma when pT was ordered by pN. Survival for pTis-1 adenocarcinoma was better than for squamous cell carcinoma, although monotonic and distinctive for both. WECC pathologic staging data is improved over that of the 7th edition, with more patients studied and patient and cancer variables collected. These data will be the basis for the 8th edition cancer staging manuals following risk adjustment for patient, cancer, and treatment characteristics, and should direct 9th edition data collection. However, the role of pure pathologic staging as the principal point of reference for esophageal cancer staging is waning.

Worldwide Esophageal Cancer Collaboration: clinical staging data.

To address uncertainty of whether clinical stage groupings (cTNM) for esophageal cancer share prognostic implications with pathologic groupings after esophagectomy alone (pTNM), we report data-simple descriptions of patient characteristics, cancer categories, and non-risk-adjusted survival-for clinically staged patients from the Worldwide Esophageal Cancer Collaboration (WECC). Thirty-three institutions from six continents submitted data using variables with standard definitions: demographics, comorbidities, clinical cancer categories, and all-cause mortality from first management decision. Of 22,123 clinically staged patients, 8,156 had squamous cell carcinoma, 13,814 adenocarcinoma, 116 adenosquamous carcinoma, and 37 undifferentiated carcinoma. Patients were older (62 years) men (80%) with normal body mass index (18.5-25 mg/kg2 , 47%), little weight loss (2.4 ± 7.8 kg), 0-1 ECOG performance status (67%), and history of smoking (67%). Cancers were cT1 (12%), cT2 (22%), cT3 (56%), cN0 (44%), cM0 (95%), and cG2-G3 (89%); most involved the distal esophagus (73%). Non-risk-adjusted survival for squamous cell carcinoma was not distinctive for early cT or cN; for adenocarcinoma, it was distinctive for early versus advanced cT and for cN0 versus cN+. Patients with early cancers had worse survival and those with advanced cancers better survival than expected from equivalent pathologic categories based on prior WECC pathologic data. Thus, clinical and pathologic categories do not share prognostic implications. This makes clinically based treatment decisions difficult and pre-treatment prognostication inaccurate. These data will be the basis for the 8th edition cancer staging manuals following risk adjustment for patient characteristics, cancer categories, and treatment characteristics and should direct 9th edition data collection.