Surgical treatment of esophago-tracheobronchial fistulas after esophagectomy

The aim of this study was to evaluate the surgical treatment of esophago-tracheobronchial fistulas (ETBFs) that occurred after esophagectomy with gastric conduit reconstruction in a tertiary referral center for esophageal surgery. All patients who underwent surgical repair for an ETBF after esophagectomy with gastric conduit reconstruction were included in a tertiary referral center. The primary outcome was successful recovery after surgical treatment for ETBF, defined as a patent airway at 90 days after the surgical fistula repair. Secondary outcomes were details on the clinical presentation, diagnostics, and postoperative course after fistula repair. Between 2007 and 2022, 14 patients who underwent surgical repair for an ETBF were included. Out of 14 patients, 9 had undergone esophagectomy with cervical anastomosis and 5 esophagectomy with intrathoracic anastomosis after which 13 patients had developed anastomotic leakage. Surgical treatment consisted of thoracotomy to cover the defect with a pericardial patch and intercostal flap in 11 patients, a patch without interposition of healthy tissue in 1 patient, and fistula repair via cervical incision with only a pectoral muscle flap in 2 patients. After surgical treatment, 12 patients recovered (86%). Mortality occurred in two patients (14%) due to multiple organ failure. This study evaluated the techniques and outcomes of surgical repair of ETBFs following esophagectomy with gastric conduit reconstruction in 14 patients. Treatment was successful in 12 patients (86%) and generally consisted of thoracotomy and coverage of the defect with a bovine pericardial patch followed by interposition with an intercostal muscle.

Idiographic Ising and Divide and Color Models: Encompassing Networks for Heterogeneous Binary Data

The Ising model is a graphical model that has played an essential role in network psychometrics. It has been used as a theoretical model to conceptualize psychological concepts and as a statistical model to analyze psychological data. Using graphical models such as the Ising model to analyze psychological data has been heavily critiqued since these data often come from cross-sectional applications. An often voiced concern is the inability of the Ising model to express heterogeneity in the population. The idiographic approach has been posed as an alternative and aims to infer individual network structures. While idiographic networks overcome population heterogeneity, it is unclear how they aggregate into established cross-sectional phenomena. This paper establishes a formal bridge between idiographic and cross-sectional network approaches of the Ising model. We ascertain unique topological structures that characterize individuals and aggregate into an Ising model cross-sectionally. This new formulation supports population heterogeneity while being consistent with cross-sectional phenomena. The proposed theory also establishes a new statistical framework for analyzing populations of idiographic networks for binary variables. The Ising model and the divide and color model are special cases of this new framework. We introduce a Gibbs sampling algorithm to estimate models from this new framework.

A Note on the Structural Change Test in Highly Parameterized Psychometric Models

Equal parameter estimates across subgroups is a substantial requirement of statistical tests. Ignoring subgroup differences poses a threat to study replicability, model specification, and theory development. Structural change tests are a powerful statistical technique to assess parameter invariance. A core element of those tests is the empirical fluctuation process. In the case of parameter invariance, the fluctuation process asymptotically follows a Brownian bridge. This asymptotic assumption further provides the basis for inference. However, the empirical fluctuation process does not follow a Brownian bridge in small samples, and this situation is amplified in large psychometric models. Therefore, common methods of obtaining the sampling distribution are invalid and the structural change test becomes conservative. We discuss an alternative solution to obtaining the sampling distribution-permutation approaches. Permutation approaches estimate the sampling distribution through resampling of the dataset, avoiding distributional assumptions. Hereby, the tests power are improved. We conclude that the permutation alternative is superior to standard asymptotic approximations of the sampling distribution.

Objective Bayesian Edge Screening and Structure Selection for Ising Networks

The Ising model is one of the most widely analyzed graphical models in network psychometrics. However, popular approaches to parameter estimation and structure selection for the Ising model cannot naturally express uncertainty about the estimated parameters or selected structures. To address this issue, this paper offers an objective Bayesian approach to parameter estimation and structure selection for the Ising model. Our methods build on a continuous spike-and-slab approach. We show that our methods consistently select the correct structure and provide a new objective method to set the spike-and-slab hyperparameters. To circumvent the exploration of the complete structure space, which is too large in practical situations, we propose a novel approach that first screens for promising edges and then only explore the space instantiated by these edges. We apply our proposed methods to estimate the network of depression and alcohol use disorder symptoms from symptom scores of over 26,000 subjects.

Modeling alcohol use disorder as a set of interconnected symptoms - Assessing differences between clinical and population samples and across external factors

Alcohol use disorder is argued to be a highly complex disorder influenced by a multitude of factors on different levels. Common research approaches fail to capture this breadth of interconnecting symptoms. To address this gap in theoretical assumptions and methodological approaches, we used a network analysis to assess the interplay of alcohol use disorder symptoms. We applied the exploratory analysis to two US-datasets, a population sample with 23,591 individuals and a clinical sample with 483 individuals seeking treatment for alcohol use disorder. Using a Bayesian framework, we first investigated differences between the clinical and population sample looking at the symptom interactions and underlying structure space. In the population sample the time spent drinking alcohol was most strongly connected, whereas in the clinical sample loss of control showed most connections. Furthermore, the clinical sample demonstrated less connections, however, estimates were too unstable to conclude the sparsity of the network. Second, for the population sample we assessed whether the network was measurement invariant across external factors like age, gender, ethnicity and income. The network differed across all factors, especially for age subgroups, indicating that subgroup specific networks should be considered when deriving implications for theory building or intervention planning. Our findings corroborate known theories of alcohol use disorder stating loss of control as a central symptom in alcohol dependent individuals.

Paravertebral catheter versus EPidural analgesia in Minimally invasive Esophageal resectioN: a randomized controlled multicenter trial (PEPMEN trial)

BACKGROUND

Thoracic epidural analgesia is the standard postoperative pain management strategy in esophageal cancer surgery. However, paravertebral block analgesia may achieve comparable pain control while inducing less side effects, which may be beneficial for postoperative recovery. This study primarily aims to compare the postoperative quality of recovery between paravertebral catheter versus thoracic epidural analgesia in patients undergoing minimally invasive esophagectomy.

METHODS

This study represents a randomized controlled superiority trial. A total of 192 patients will be randomized in 4 Dutch high-volume centers for esophageal cancer surgery. Patients are eligible for inclusion if they are at least 18 years old, able to provide written informed consent and complete questionnaires in Dutch, scheduled to undergo minimally invasive esophagectomy with two-field lymphadenectomy and an intrathoracic anastomosis, and have no contra-indications to either epidural or paravertebral analgesia. The primary outcome is the quality of postoperative recovery, as measured by the Quality of Recovery-40 (QoR-40) questionnaire on the morning of postoperative day 3. Secondary outcomes include the QoR-40 questionnaire score Area Under the Curve on postoperative days 1-3, the integrated pain and systemic opioid score and patient satisfaction and pain experience according to the International Pain Outcomes (IPO) questionnaire, and cost-effectiveness. Furthermore, the groups will be compared regarding the need for additional rescue medication on postoperative days 0-3, technical failure of the pain treatment, duration of anesthesia, duration of surgery, total postoperative fluid administration day 0-3, postoperative vasopressor and inotrope use, length of urinary catheter use, length of hospital stay, postoperative complications, chronic pain at six months after surgery, and other adverse effects.

DISCUSSION

In this study, it is hypothesized that paravertebral analgesia achieves comparable pain control while causing less side-effects such as hypotension when compared to epidural analgesia, leading to shorter postoperative length of stay on a monitored ward and superior quality of recovery. If this hypothesis is confirmed, the results of this study can be used to update the relevant guidelines on postoperative pain management for patients undergoing minimally invasive esophagectomy.

TRIAL REGISTRATION

Netherlands Trial Registry, NL8037. Registered 19 September 2019.

Bayesian rank-based hypothesis testing for the rank sum test, the signed rank test, and Spearman's ρ

Bayesian inference for rank-order problems is frustrated by the absence of an explicit likelihood function. This hurdle can be overcome by assuming a latent normal representation that is consistent with the ordinal information in the data: the observed ranks are conceptualized as an impoverished reflection of an underlying continuous scale, and inference concerns the parameters that govern the latent representation. We apply this generic data-augmentation method to obtain Bayes factors for three popular rank-based tests: the rank sum test, the signed rank test, and Spearman's ρs.

Characterizing the Manifest Probability Distributions of Three Latent Trait Models for Accuracy and Response Time

In this paper we study the statistical relations between three latent trait models for accuracies and response times: the hierarchical model (HM) of van der Linden (Psychometrika 72(3):287-308, 2007), the signed residual time model (SM) proposed by Maris and van der Maas (Psychometrika 77(4):615-633, 2012), and the drift diffusion model (DM) as proposed by Tuerlinckx and De Boeck (Psychometrika 70(4):629-650, 2005). One important distinction between these models is that the HM and the DM either assume or imply that accuracies and response times are independent given the latent trait variables, while the SM does not. In this paper we investigate the impact of this conditional independence property-or a lack thereof-on the manifest probability distribution for accuracies and response times. We will find that the manifest distributions of the latent trait models share several important features, such as the dependency between accuracy and response time, but we also find important differences, such as in what function of response time is being modeled. Our method for characterizing the manifest probability distributions is related to the Dutch identity (Holland in Psychometrika 55(6):5-18, 1990).

Epidural analgesia after minimally invasive esophagectomy: efficacy and complication profile

Adequate postoperative pain management is essential to facilitate uneventful recovery after esophagectomy. Although epidural analgesia is the gold standard, it is not satisfactory in all patients. The aim of this study is to describe the efficacy and complication profile of epidural analgesia after minimally invasive esophagectomy (MIE). A total of 108 patients who underwent a robot-assisted (McKeown) MIE for esophageal cancer were included from a single center prospective database (2012-2015). The number of patients that could receive epidural analgesia, the sensory block range per day, the number of epidural top-ups, the need for escape pain mediation (i.e. intravenous opioids), the highest pain score per day (numeric rating scale: 0-10), and epidural-related complications were assessed until postoperative day (POD) 4. Epidural catheter placement was achieved in 101 patients (94%). A complete sensory block was found in 49% (POD1), 42% (POD 2), 20% (POD3), and 30% (POD4) of patients. An epidural top-up was performed in 26 patients (24%), which was successful in 22 patients. Escape pain medication in the form of intravenous opioids was given at least once in 49 out of 108 patients (45%) on POD 1, 2, 3, or 4. Overall median highest pain scores on the corresponding days were 2.0 (range: 0-10), 3.5 (range: 0-9), 3.0 (range: 0-8), and 4.0 (range: 0-9). Epidural related complications occurred in 20 patients (19%) and included catheter problems (n = 11), hypotension (n = 6), bradypnea (n = 2), and reversible tingling in the legs (n = 1). In conclusion, in this study epidural analgesia was insufficient and escape pain medication was necessary in nearly half of patients undergoing MIE.

Charge self-consistent many-body corrections using optimized projected localized orbitals

In order for methods combining ab initio density-functional theory and many-body techniques to become routinely used, a flexible, fast, and easy-to-use implementation is crucial. We present an implementation of a general charge self-consistent scheme based on projected localized orbitals in the projector augmented wave framework in the Vienna Ab Initio Simulation Package. We give a detailed description on how the projectors are optimally chosen and how the total energy is calculated. We benchmark our implementation in combination with dynamical mean-field theory: first we study the charge-transfer insulator NiO using a Hartree-Fock approach to solve the many-body Hamiltonian. We address the advantages of the optimized against non-optimized projectors and furthermore find that charge self-consistency decreases the dependence of the spectral function-especially the gap-on the double counting. Second, using continuous-time quantum Monte Carlo we study a monolayer of SrVO₃, where strong orbital polarization occurs due to the reduced dimensionality. Using total-energy calculation for structure determination, we find that electronic correlations have a non-negligible influence on the position of the apical oxygens, and therefore on the thickness of the single SrVO₃ layer.

An Introduction to Network Psychometrics: Relating Ising Network Models to Item Response Theory Models

In recent years, network models have been proposed as an alternative representation of psychometric constructs such as depression. In such models, the covariance between observables (e.g., symptoms like depressed mood, feelings of worthlessness, and guilt) is explained in terms of a pattern of causal interactions between these observables, which contrasts with classical interpretations in which the observables are conceptualized as the effects of a reflective latent variable. However, few investigations have been directed at the question how these different models relate to each other. To shed light on this issue, the current paper explores the relation between one of the most important network models-the Ising model from physics-and one of the most important latent variable models-the Item Response Theory (IRT) model from psychometrics. The Ising model describes the interaction between states of particles that are connected in a network, whereas the IRT model describes the probability distribution associated with item responses in a psychometric test as a function of a latent variable. Despite the divergent backgrounds of the models, we show a broad equivalence between them and also illustrate several opportunities that arise from this connection.

Postoperative pain management after esophagectomy: a systematic review and meta-analysis

Effective pain management after esophagectomy is essential for patient comfort, early recovery, low surgical morbidity, and short hospitalization. This systematic review and meta-analysis aims to determine the best pain management modality focusing on the balance between benefits and risks. Medline, Embase, and the Cochrane library were systematically searched to identify all studies investigating different pain management modalities after esophagectomy in relation to primary outcomes (postoperative pain scores at 24 and 48 hours, technical failure, and opioid consumption), and secondary outcomes (pulmonary complications, nausea and vomiting, hypotension, urinary retention, and length of hospital stay). Ten studies investigating systemic, epidural, intrathecal, intrapleural and paravertebral analgesia involving 891 patients following esophagectomy were included. No significant differences were found in postoperative pain scores between systemic and epidural analgesia at 24 (mean difference (MD) 0.89; 95% confidence interval (CI) -0.47-2.24) and 48 hours (MD 0.15; 95%CI -0.60-0.91), nor described for systemic and other regional analgesia. Also, no significant differences in pulmonary complication rates were identified between systemic and epidural analgesia (relative risk (RR) 1.69; 95%CI 0.86-3.29), or between systemic and paravertebral analgesia (RR 1.49; 95%CI 0.31-7.12). Technical failure ranged from 17% to 22% for epidural analgesia. Sample sizes were too small to draw inferences on opioid consumption, the risk of nausea and vomiting, hypotension, urinary retention, and length of hospital stay when comparing the different pain management modalities including systemic, epidural, intrathecal, intrapleural, and paravertebral analgesia. This systematic review and meta-analysis shows no differences in postoperative pain scores or pulmonary complications after esophagectomy between systemic and epidural analgesia, and between systemic and paravertebral analgesia. Further randomized controlled trails are warranted to determine the optimal pain management modality after esophagectomy.

Surface-Sensitive Microwear Texture Analysis of Attrition and Erosion

Scale-sensitive fractal analysis of high-resolution 3-dimensional surface reconstructions of wear patterns has advanced our knowledge in evolutionary biology, and has opened up opportunities for translatory applications in clinical practice. To elucidate the microwear characteristics of attrition and erosion in worn natural teeth, we scanned 50 extracted human teeth using a confocal profiler at a high optical resolution (X-Y, 0.17 µm; Z < 3 nm). Our hypothesis was that microwear complexity would be greater in erosion and that anisotropy would be greater in attrition. The teeth were divided into 4 groups, including 2 wear types (attrition and erosion) and 2 locations (anterior and posterior teeth; n = 12 for each anterior group, n = 13 for each posterior group) for 2 tissue types (enamel and dentine). The raw 3-dimensional data cloud was subjected to a newly developed rigorous standardization technique to reduce interscanner variability as well as to filter anomalous scanning data. Linear mixed effects (regression) analyses conducted separately for the dependent variables, complexity and anisotropy, showed the following effects of the independent variables: significant interactions between wear type and tissue type ( P = 0.0157 and P = 0.0003, respectively) and significant effects of location ( P < 0.0001 and P = 0.0035, respectively). There were significant associations between complexity and anisotropy when the dependent variable was either complexity ( P = 0.0003) or anisotropy ( P = 0.0014). Our findings of greater complexity in erosion and greater anisotropy in attrition confirm our hypothesis. The greatest geometric means were noted in dentine erosion for complexity and dentine attrition for anisotropy. Dentine also exhibited microwear characteristics that were more consistent with wear types than enamel. Overall, our findings could complement macrowear assessment in dental clinical practice and research and could assist in the early detection and management of pathologic tooth wear.

Maximally localized Wannier functions in LaMnO3 within PBE + U, hybrid functionals and partially self-consistent GW: an efficient route to construct ab initio tight-binding parameters for eg perovskites

Using the newly developed VASP2WANNIER90 interface we have constructed maximally localized Wannier functions (MLWFs) for the e(g) states of the prototypical Jahn-Teller magnetic perovskite LaMnO(3) at different levels of approximation for the exchange-correlation kernel. These include conventional density functional theory (DFT) with and without the additional on-site Hubbard U term, hybrid DFT and partially self-consistent GW. By suitably mapping the MLWFs onto an effective e(g) tight-binding (TB) Hamiltonian we have computed a complete set of TB parameters which should serve as guidance for more elaborate treatments of correlation effects in effective Hamiltonian-based approaches. The method-dependent changes of the calculated TB parameters and their interplay with the electron-electron (el-el) interaction term are discussed and interpreted. We discuss two alternative model parameterizations: one in which the effects of the el-el interaction are implicitly incorporated in the otherwise 'noninteracting' TB parameters and a second where we include an explicit mean-field el-el interaction term in the TB Hamiltonian. Both models yield a set of tabulated TB parameters which provide the band dispersion in excellent agreement with the underlying ab initio and MLWF bands.

Accurate surface and adsorption energies from many-body perturbation theory

Kohn-Sham density functional theory is the workhorse computational method in materials and surface science. Unfortunately, most semilocal density functionals predict surfaces to be more stable than they are experimentally. Naively, we would expect that consequently adsorption energies on surfaces are too small as well, but the contrary is often found: chemisorption energies are usually overestimated. Modifying the functional improves either the adsorption energy or the surface energy but always worsens the other aspect. This suggests that semilocal density functionals possess a fundamental flaw that is difficult to cure, and alternative methods are urgently needed. Here we show that a computationally fairly efficient many-electron approach, the random phase approximation to the correlation energy, resolves this dilemma and yields at the same time excellent lattice constants, surface energies and adsorption energies for carbon monoxide and benzene on transition-metal surfaces.

Accurate band gaps and dielectric properties from one-electron theories (abstract only)

For semiconductor modeling, a major shortcoming of density functional theory is that the predicted band gaps are usually significantly too small. It is generally argued that this shortcoming is related to the fact that density functional theory is a ground state theory, and as a result, one is not allowed to associate the one-electron energies with the energies of quasi-particles. Although this fundamental objection is certainly correct, the modeling of the positioning of donor and acceptor levels in semiconductors faces serious limitations with present density functionals. Several solutions to this problem have been suggested. A particular attractive and fairly simple one is the inclusion of a small fraction of the non-local exchange in the Hamiltonian (hybrid functionals). This approach leads to sensible band gaps for most semiconductors, but fails for ionic solids. A more reliable approach is via many-electron Green's function techniques, which have made tremendous advances in recent years. Here GW calculations in various flavors are presented for small gap and large gap systems, comprising typical semiconductors (Si, SiC, GaAs, GaN, ZnO, ZnS, CdS and AlP), small gap semiconductors (PbS, PbSe, PbTe), insulators (C, BN, MgO, LiF) and noble gas solids (Ar, Ne). The general finding is that single-shot G(0)W(0) calculations based on wavefunctions obtained from conventional density functional theory yield too small band gaps, whereas G(0)W(0) calculations following hybrid functional calculations tend to overestimate the band gaps by roughly the same amount. This is at first sight astonishing, since the hybrid functionals yield very good band gaps themselves. The contradiction is resolved by showing that the inclusion of the attractive electron-hole interactions (excitonic effects) is required to obtain good static and dynamic dielectric functions using hybrid functionals. The corrections are usually incorporated in GW calculations using 'vertex corrections', and in fact inclusion of these vertex corrections rectifies the predicted band gaps. Finally, in order to remove the dependence on the initial wavefunctions, self-consistent GW calculations are presented, again including an approximate treatment of vertex corrections. The results are in excellent agreement with experiment, with a few per cent deviation for all materials considered. We conclude that predictive band gap engineering is now possible with the theoretical description approaching experimental accuracy.

Hybrid functionals applied to extended systems

We present an overview of the description of structural, thermochemical, and electronic properties of extended systems using several well known hybrid Hartree-Fock/density-functional-theory functionals (PBE0, HSE03, and B3LYP). In addition we address a few aspects of the evaluation of the Hartree-Fock exchange interactions in reciprocal space, relevant to all methods that employ a plane wave basis set and periodic boundary conditions.

Accurate quasiparticle spectra from self-consistent GW calculations with vertex corrections

Self-consistent GW calculations, maintaining only the quasiparticle part of the Green's function G, are reported for a wide class of materials, including small gap semiconductors and large gap insulators. We show that the inclusion of the attractive electron-hole interaction via an effective nonlocal exchange correlation kernel is required to obtain accurate band gaps in the framework of self-consistent GW calculations. If these are accounted for via vertex corrections in W, the band gaps are found to be within a few percent of the experimental values.

Relaxed core projector-augmented-wave method

We extend the full-potential projector-augmented-wave method beyond the frozen core approximation, i.e., include the self-consistent optimization of the core charge density, in such a manner that the valence wave functions remain orthogonal to the core. The method consists of an on-the-fly repseudization of the all-electron problem, solving for the self-consistent core charge density within a spherical approximation. The key ideas in our procedure are to keep the projector functions fixed throughout the electronic minimization and to derive the new pseudopartial waves from these original projector functions, at each step of the electronic minimization procedure. Results of relaxed core calculations for atomic interconfigurational energies, structural energy differences between bulk phases of Fe, atomization energies of a subset of Pople's G2-1 set, and the Rh 3d surface core level shifts for the (log3 x log3)-Rh(111) surface at 1/3 CO coverage are presented.

Screened hybrid density functionals applied to solids

Hybrid Fock exchange/density functional theory functionals have shown to be very successful in describing a wide range of molecular properties. For periodic systems, however, the long-range nature of the Fock exchange interaction and the resultant large computational requirements present a major drawback. This is especially true for metallic systems, which require a dense Brillouin zone sampling. Recently, a new hybrid functional [HSE03, J. Heyd, G. E. Scuseria, and M. Ernzerhof, J. Chem. Phys. 118, 8207 (2003)] that addresses this problem within the context of methods that evaluate the Fock exchange in real space was introduced. We discuss the advantages the HSE03 functional brings to methods that rely on a reciprocal space description of the Fock exchange interaction, e.g., all methods that use plane wave basis sets. Furthermore, we present a detailed comparison of the performance of the HSE03 and PBE0 functionals for a set of archetypical solid state systems by calculating lattice parameters, bulk moduli, heats of formation, and band gaps. The results indicate that the hybrid functionals indeed often improve the description of these properties, but in several cases the results are not yet on par with standard gradient corrected functionals. This concerns in particular metallic systems for which the bandwidth and exchange splitting are seriously overestimated.

High-coverage oxygen structures on Rh111: adsorbate repulsion and site preference is not enough

A new O induced structure on Rh(111) displaying a (2 sqaureroot[3] x 2sqaureroot[3])R30 degrees periodicity with an oxygen coverage of 2/3 has been studied by high resolution core level spectroscopy, scanning tunneling microscopy, and density functional theory. Although O favors fcc hollow sites in all other known phases, it occupies both fcc and hcp sites in this structure, which cannot be explained by pairwise adsorbate repulsion only. Both the (2sqaureroot[3] x 2sqaureroot[3])R30 degrees and (2 x 2)-3O structures also exemplify that density-of-states contrast can lead to oxygen adatoms appearing as protrusions in scanning tunneling microscopy images.

The Rab7 effector protein RILP controls lysosomal transport by inducing the recruitment of dynein-dynactin motors

Many intracellular compartments, including MHC class II-containing lysosomes, melanosomes, and phagosomes, move along microtubules in a bidirectional manner and in a stop-and-go fashion due to the alternating activities of a plus-end directed kinesin motor and a minus-end directed dynein-dynactin motor. It is largely unclear how motor proteins are targeted specifically to different compartments. Rab GTPases recruit and/or activate several proteins involved in membrane fusion and vesicular transport. They associate with specific compartments after activation, which makes Rab GTPases ideal candidates for controlling motor protein binding to specific membranes. We and others [7] have identified a protein, called RILP (for Rab7-interacting lysosomal protein), that interacts with active Rab7 on late endosomes and lysosomes. Here we show that RILP prevents further cycling of Rab7. RILP expression induces the recruitment of functional dynein-dynactin motor complexes to Rab7-containing late endosomes and lysosomes. Consequently, these compartments are transported by these motors toward the minus end of microtubules, effectively inhibiting their transport toward the cell periphery. This signaling cascade may be responsible for timed and selective dynein motor recruitment onto late endosomes and lysosomes.