Risk Factor Analysis for Developing Major Complications Following Esophageal Surgery-A Two-Center Study.

BACKGROUND: Esophagectomy carries a high risk of morbidity and mortality compared to other major surgeries. With the aim of creating an easy-to-use clinical preoperative risk assessment tool and to validate previously described risk factors for major complications following surgery, esophagectomies at two tertiary medical centers were analyzed. METHODS: A total of 450 patients who underwent esophagectomy for esophageal carcinoma at the University Medical Centre, Hamburg, or at the Medical Center University Duisburg-Essen, Germany (January 2008 to January 2020) were retrospectively analyzed. Epidemiological and perioperative data were analyzed to identify the risk factors that impact major complication rates. The primary endpoint of this study was to determine the incidence of major complications. RESULTS: The mean age of the patients was 63 years with a bimodal distribution. There was a male predominance across the cohort (81% vs. 19%, respectively). Alcohol abuse (p = 0.0341), chronic obstructive pulmonary disease (p = 0.0264), and cardiac comorbidity (p = 0.0367) were associated with a significantly higher risk of major complications in the multivariate analysis. Neoadjuvant chemotherapy significantly reduced the risk of major postoperative complications (p < 0.0001). CONCLUSIONS: Various patient-related risk factors increased the rate of major complications following esophagectomy. Patient-tailored prehabilitation programs before esophagectomy that focus on minimizing these risk factors may lead to better surgical outcomes and should be analyzed in further studies.

Aquatic methane dynamics in a human-impacted river-floodplain of the Danube.

River-floodplain systems are characterized by changing hydrological connectivity and variability of resources delivered to floodplain water bodies. Although the importance of hydrological events has been recognized, the effect of flooding on CH4 concentrations and emissions from European, human-impacted river-floodplains is largely unknown. This study evaluates aquatic concentrations and emissions of CH4 from a highly modified, yet partly restored river-floodplain system of the Danube near Vienna (Austria). We covered a broad range of hydrological conditions, including a 1-yr flood event in 2012 and a 100-yr flood in 2013. Our findings demonstrate that river-floodplain waters were supersaturated with CH4, hence always serving as a source of CH4 to the atmosphere. Hydrologically isolated habitats in general have higher concentrations and produce higher fluxes despite lower physically defined velocities. During surface connection, however, CH4 is exported from the floodplain to the river, suggesting that the main channel serves as an "exhaust pipe" for the floodplain. This mechanism was especially important during the 100-yr flood, when a clear pulse of CH4 was flushed from the floodplain with surface floodwaters. Our results emphasize the importance of floods differing in magnitude for methane evasion from river-floodplains; 34% more CH4 was emitted from the entire system during the year with the 100-yr flood compared to a hydrologically "normal" year. Compared to the main river channel, semiisolated floodplain waters were particularly strong sources of CH4. Our findings also imply that the predicted increased frequency of extreme flooding events will have significant consequences for methane emission from river-floodplain systems.

Detection of high-dimensional genuine multipartite entanglement of mixed states.

We derive a general framework to identify genuinely multipartite entangled mixed quantum states in arbitrary-dimensional systems and show in exemplary cases that the constructed criteria are stronger than those previously known. Our criteria are simple functions of the given quantum state and detect genuine multipartite entanglement that had not been identified so far. They are experimentally accessible without quantum state tomography and are easily computable as no optimization or eigenvalue evaluation is needed.

Different types of signal coupling in the visual cortex related to neural mechanisms of associative processing and perception.

The hypothesis of object representation by synchronization in the visual cortex has been supported by our recent experiments in monkeys. They demonstrated local synchrony among gamma activities (30-90 Hz) and their perceptual modulation, according to the rules of figure-ground segregation. However, gamma-synchrony in primary visual cortex is restricted to few mm, challenging the synchronization hypothesis for larger cortical object representations. The restriction is due to randomly changing phase relations among locally synchronized patches which, however, form continuous waves of gamma-activity, traveling across object representations. The phase continuity of these waves may support coding of object continuity. Interactions across still larger distances, measured among cortical areas in human data, involve amplitude envelopes of gamma signals. Based on models with spiking neurons we discuss potentially underlying mechanisms. Most important for gamma synchronization are local facilitatory connections with distance-dependent delays. They also explain the occurrence of gamma waves and the restriction of gamma-synchrony. Fast local feedback inhibition generates gamma oscillations and supports local synchrony, while slow shunting inhibitory feedback supports figure-ground segregation. Finally, dispersion in inter-areal far projections destroys coherence of gamma signals, but preserves their amplitude modulations. In conclusion, we propose that the hypothesis of associative processing by gamma synchronization be extended to more general forms of signal coupling.

Neural mechanisms of visual associative processing.

This is a review of our work on multiple microelectrode recordings from the visual cortex of monkeys and subdural recordings from humans--related to the potential underlying neural mechanisms. The former hypothesis of object representation by synchronization in visual cortex (or more generally: of flexible associative processing) has been supported by our recent experiments in monkeys. They demonstrated local synchrony among rhythmic or stochastic gamma-activities (30-90 Hz) and perceptual modulation, according to the rules of figure-ground segregation. However, gamma-synchrony in primary visual cortex is restricted to few millimeters, challenging the synchronization hypothesis for larger cortical object representations. We found that the spatial restriction is due to gamma-waves, traveling in random directions across the object representations. It will be argued that phase continuity of these waves can support the coding of object continuity. Based on models with spiking neurons, potentially underlying neural mechanisms are proposed: (i) Fast inhibitory feedback loops can generate locally synchronized gamma-activities; (ii) Hebbian learning of lateral and feed forward connections with distance-dependent delays can explain the stabilization of cortical retinotopy, the limited size of synchronization, the occurrence of gamma-waves, and the larger receptive fields at successive levels; (iii) slow inhibitory feedback can support figure-ground segregation; (iv) temporal dispersion in far projections destroys coherence of fast signals but preserves slow amplitude modulations. In conclusion, it is proposed that the hypothesis of flexible associative processing by gamma-synchronization, including coherent representations of visual objects, has to be extended to more general forms of signal coupling.

A multi-channel correlation method detects traveling gamma-waves in monkey visual cortex.

Correlations among simultaneously recorded signals are mostly analyzed pairwise and include temporal averaging. However, pairwise methods are not suitable for characterizing relationships among multiple channels for signals which vary temporally in an unpredictable way. Here we develop a time-resolved spatio-temporal correlation (STC) measure among simultaneously recorded signals. We demonstrate the capabilities of the method with artificial data sets and with multiple-channel recordings from striate cortex of awake monkeys. We concentrate on correlations in the gamma-frequency range (gamma: 30-90 Hz) because they were prominent in the analyzed recordings and gained high interest in the recent years due to their assumed role in associative processing, including perceptual binding. Former analyses of gamma-activities in visual cortex, using pairwise correlation methods, mostly revealed zero-delay correlation, indicating synchrony. In cat and monkey visual cortex this gamma-synchrony is restricted to 1.5-3.0 mm (half-height decline). However, our spatio-temporal correlation (STC)-method demonstrates for striate cortex from awake monkeys that gamma-synchrony is a local phenomenon of more global traveling plane waves that appear stimulus-induced at randomly varying orientations. These gamma-waves are coupled over much larger cortical distances (approximately 7 mm half-height decline) than the gamma-synchrony ranges obtained by pairwise correlation analyses from the same data. Our STC-method therefore suggests that the previously reported results of short-range and zero-delay correlations were often due to temporal averaging of traveling gamma-waves.