Search

Background: Unstable “extralateral” fractures of the distal clavicle (lateral to the coracoclavicular ligaments) are not distinguished in the Neer classification system and are commonly included with Neer IIb fractures. In the literature, there is no optimal surgical technique for managing unstable fractures of the distal clavicle, nonetheless for unique “extra-lateral” patterns. The aim of this study is to evaluate the effectiveness and safety of existing coracoclavicular fixation techniques for managing unstable Neer IIb and extralateral (IIc) fractures of the distal clavicle. Methods: We performed a systematic search of the literature to capture all studies evaluating the safety and effectiveness of existing coracoclavicular loop techniques for unstable Neer IIb and extralateral (IIc) fractures of the distal clavicle. We searched the PubMed (MEDLINE and PubMed Central), Scopus, Web of Science, Google Scholar, and Cochrane Central Register of Controlled Trials electronic databases to retrieve studies published between January 2000 and November 2020. Our study was guided by a prospectively developed protocol and reported in accordance with the latest Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: Our database search yielded a total of 564 records; of which, 21 were deemed appropriate for inclusion in our qualitative synthesis. The total number of reported IIb/c fractures managed with a coracoclavicular stabilization technique in all studies was 421. In total, 139 (33%) patients received arthroscopic-assisted treatment, and 282 (67%) patients were managed with open coracoclavicular stabilization. The reported clinical results were very good to excellent in most studies, whereas the overall major and minor complication rate was 2.6% and 12.8%, respectively. Major complications were more frequent in arthroscopic-assisted techniques (4.3%) compared with open (1.8%). Conclusion: The present systematic review of coracoclavicular stabilization techniques for unstable Neer IIb and extralateral fractures of the distal clavicle demonstrates promising clinical outcomes, including effectiveness and safety. We support the previously proposed modification of the Neer classification to include this unique type of unstable extralateral fracture (type IIc) to allow for targeted surgical management.

Transforming intersections into roundabouts has shown that a sufficient degree of road safety and traffic capacity can be achieved. Because of the lower speeds at the area of a roundabout, drivers tend to become more easily adaptive to any kind of conflict with the surrounding environment. Despite the contribution to safety, the design elements of roundabouts are not uniformly fixed on a worldwide scale because of different traffic volumes, vehicle dimensions, drivers’ attitude, etc. The present study provides a brief overview of the contribution of roundabouts to road safety and the interactions between safety and the design elements of roundabouts. In addition, discussion points about current challenges and prospects are elaborated, including findings from the environmental assessment of roundabouts; their use and performance on the era of autonomous vehicles that will dominate in the near future; as well as the role and importance of simulation studies towards the improvement of the design and operation of roundabouts in favor of safer vehicle movement. The criticality of roundabouts, in terms of their geometric design as well as the provided road safety, lies upon the fact that roundabouts are currently used for the conventional vehicle fleet, which will be gradually replaced by new vehicle technologies. Such an action will directly impact the criteria for road network design and/or redesign, thereby continuously fostering new research initiatives.

We studied the influence of the Planetary Boundary Layer (PBL) on the air masses sampled at the mountaintop Hellenic Atmospheric Aerosol and Climate Change station ((HAC)2) at Mount Helmos (Greece) during the Cloud-AerosoL InteractionS in the Helmos background TropOsphere (CALISTHO) Campaign from September 2021 to March 2022. The PBL Height (PBLH) was determined from the standard deviation of the vertical wind velocity (σw) measured by a wind Doppler lidar (over a 30-min time window with 30 m spatial resolution); the height for which σw drops below a characteristic threshold of 0.1 m s–1 corresponds to the PBLH. The air mass characterization is independently carried out using in situ measurements sampled at (HAC)2 (equivalent black carbon, eBC; fluorescent particle number, aerosol size distributions, absolute humidity). We found that a distinct diurnal cycle of aerosol properties is seen when the station is inside the PBL (i.e., PBLH exceeds the (HAC)2 altitude); and a complete lack thereof when it is in the Free Tropospheric Layer (FTL). Additionally, we identified transition periods where the (HAC)2 site location alternates between the FTL (usually during the early morning hours) and the PBL (usually during the midday and late afternoon hours), during which the concentration and characteristics of the aerosols vary the most. Transition periods are also when orographic clouds are formed. The highest PBLH values occur in September [400 m above (HAC)2] followed by a transition period in November, while the lowest ones occur in January [200 m below (HAC)2]. We found also that the PBLH increases by 16 m per 1°C increase of the ground temperature.

Abstract Background Hip fractures are an increasingly common consequence of falls in older people that are associated with a high risk of death and reduced function. The vast majority of intertrochanteric fractures require surgical treatment to withstand early mobilization and weight bearing, which prevents complications due to prolonged bed rest and aids in fracture healing. Methods This study is compromised by two parts, the experimental study and the clinical part. In the first part, a standard 130° nail will be used with the appropriate lag screw(s) and dynamic distal locking in synthetic osteoporotic femurs and the transmission of forces in the proximal femur, measured by a cortical surface-strain distribution, will be evaluated using digital image correlation. Finite element parametric models of the bone, the nails and their interface will be also developed. Finite element computations of surface strains in implanted femurs, after being validated against biomechanical testing measurements, will be used to assist the comparison of the nails by deriving important data on the developed stress and strain fields, which cannot be measured through biomechanical testing. In the other part, will set up a prospective, randomized, comparative clinical study among the Gamma3 and IT cephalomedullary nailing, in order to investigate if there are any statistical important differences in the main radiological measurements and functional status in closed unstable intertrochanteric fractures (A21-3) in patients aged over 70 years old at the 24-week follow-up evaluation using patient reported disease-specific outcomes. Discussion This study will be the first to compare clinical, radiological and biomechanical measurements of the two different cephalomedullary nails. Our main hypothesis is that the IT nail would provide better radiological outcome and probably better clinical results than the Gama3 nail. Clinical trial registration International Standard Randomized Controlled Trial Number (ISRCTN): https://doi.org/10.1186/ISRCTN15588442 , registered on 19/4/2022.

Mesopelagic fish are considered a possible future fisheries resource, but the biological sustainability of their potential exploitation has not yet been assessed. Sustainability should be evaluated at the population level, for which accurate stock-specific life-history parameters are required. Here, we use a length-based model to estimate life-history parameters related to growth and natural mortality, and their uncertainty, for the assessment of Northeast Atlantic populations of Maurolicus muelleri (Gmelin, 1789, Mueller’s Pearlside) and Benthosema glaciale (Reinhardt, 1837, glacier lantern fish). We compare three different approaches to estimate natural mortality rates and provide recommendations for future data collection and monitoring programs. For M. muelleri, we estimated an asymptotic length of 57.98 mm and a von Bertalanffy growth constant of 1.28 year−1, while for B. glaciale, we estimated an asymptotic length of 78.93 mm and a von Bertalanffy growth constant of 0.41 year−1. Estimates of natural mortality rates for M. muelleri were around 1.29 year−1 and 1.80 year−1 based on empirical formulae with the estimated growth parameters and maximum age, respectively, and around 1.51 year−1 with the length-converted catch curve method for B. glaciale estimates ranged between 0.5, 0.68, and 0.75 year−1, with the three respective methods. Due to limited data availability, the estimated uncertainty of the provided life-history parameters is large and should be considered in the evaluation of the sustainability of potential mesopelagic exploitation following the precautionary approach.

Introduction Monteggia-like lesions are rare injuries in adults that include a wide spectrum of complex fracture-dislocations of the proximal ulna and radius. In this retrospective study, we performed a modified Boyd approach and a standard surgical protocol for the treatment of these lesions. Our aim was to evaluate the results of the operative treatment for patients with Monteggia-like lesions, using a modified Boyd approach. Materials and Methods We present a retrospective study of 14 patients who underwent surgical treatment for Monteggia-like lesions. Preoperative clinical and radiological evaluation was performed. In 5 cases radial head prosthesis was placed, and in 3 cases the radial fracture was stabilized with the use of interfragmental screws. Regarding the proximal ulnar fracture, ORIF-anatomical plate and ORIF-straight plate was used in 12 and 2 cases, respectively. Results Average clinical follow up was 16.9 months. Postoperatively, the mean Mayo Elbow Performance score was 83.4 points (range 70-100) and the mean visual analog scale was 1.7 (range 0-14). Mean flexion and loss of extension were 122.1° (range 80°-140°) and 21.4° (range 5°-40°), respectively. Mean supination of the forearm was 66.8° (range 50°-80°) and the mean pronation was 67.5° (range 60°-75°). Heterotopic ossification was observed in 3 patients (21.4%) and 1 patient developed stiffness (7.1%). The patient who developed stiffness underwent reoperation for plate removal and arthrolysis, with satisfactory results. Conclusions The surgical treatment of Monteggia-like lesions in adults remains a challenge. In the present study, the use of a standard surgical protocol, with a modified Boyd approach, successfully restores the movement and stability of the elbow, with a low complication rate.

A rare event of mixed biomass-burning and polluted dust aerosols was observed over Athens, Greece (37.9° N, 23.6° E), during 21–26 May 2014. This event was studied using a synergy of a 6-wavelength elastic-Raman-depolarization lidar measurements, a CIMEL sun photometer, and in situ instrumentation. The FLEXPART dispersion model was used to identify the aerosol sources and quantify the contribution of dust and black carbon particles to the mass concentration. The identified air masses were found to originate from Kazakhstan and Saharan deserts, under a rare atmospheric pressure system. The lidar ratio (LR) values retrieved from the Raman lidar ranged within 25–89 sr (355 nm) and 35–70 sr (532 nm). The particle linear depolarization ratio (δaer) ranged from 7 to 28% (532 nm), indicating mixing of dust with biomass-burning particles. The aerosol optical depth (AOD) values derived from the lidar ranged from 0.09–0.43 (355 nm) to 0.07–0.25 (532 nm). An inversion algorithm was used to derive the mean aerosol microphysical properties (mean effective radius (reff), single scattering albedo (SSA), and mean complex refractive index (m)) inside selected atmospheric layers. We found that reff was 0.12–0.51 (±0.04) µm, SSA was 0.94–0.98 (±0.19) (at 532 nm), while m ranged between 1.39 (±0.05) + 0.002 (±0.001)i and 1.63 (±0.05) + 0.008 (±0.004)i. The polarization lidar photometer networking (POLIPHON) algorithm was used to estimate the vertical profile of the mass concentration for the dust and non-dust components. A mean mass concentration of 15 ± 5 μg m−3 and 80 ± 29 μg m−3 for smoke and dust was estimated for selected days, respectively. Finally, the retrieved aerosol microphysical properties were compared with column-integrated sun photometer CIMEL data with good agreement.

SCLC is an aggressive cancer type with high metastatic potential and bad prognosis. CTCs are a valuable source of tumor cells in blood circulation and are among the major contributors to metastasis. In this study we evaluated the number of CTCs that express PD-L1 in treatment-naïve ES-SCLC patients receiving ICI in a front-line setting. Moreover, we explored the percentages of different immune T-cell subsets in circulation to assess their potential role in predicting responses. A total of 43 patients were enrolled—6 of them with LS-SCLC, and 37 with ES-SCLC disease. In addition, PBMCs from 10 healthy donors were used as a control group. Different T-cell subtypes were examined through multicolor FACS analysis and patients’ CTCs were detected using immunofluorescence staining. SCLC patients had higher percentages of PD-1-expressing CD3+CD4+ and CD3+CD8+ T-cells, as well as elevated PD-1 protein expression compared to healthy individuals. Additionally, in ES-SCLC patients, a positive correlation between CD3+CD8+PD-1+ T-cells and PD-L1+ CTCs was detected. Importantly, patients harboring higher numbers of CD3+CD8+PD-1+ T-cells together with PD-L1+CTCs had a survival advantage when receiving front-line immunotherapy. Thus, this study proposes, for first time possible, immune cell–CTCs interaction, as well as a potential novel clinical biomarker for ICI responses in ES-SCLC patients.

Abstract Background The purpose of the present study was to systematically review the current treatment strategies for the treatment of Neer type IIB distal clavicle fractures in terms of functional outcome and complication rates and to examine the most appropriate surgical method by comparing all the available surgical techniques and implants. Methods We performed a systematic review of the existing literature (2000–2021) in accordance with the PRISMA statement. We searched PubMed, Scopus, Web of Science, Research Gate and Google Scholar using the general terms ‘distal AND clavicle AND fracture’ to capture as many reports as possible. The MINORS tool was used to assess the risk of bias of the nonrandomized studies. We categorized the reported surgical techniques into four main types: open or arthroscopic coracoclavicular (CC) stabilization, locking plate fixation with or without CC augmentation, hook plate fixation and acromioclavicular joint (ACJ) transfixation. We reported findings for two main outcomes: clinical results and complication rates categorized into major and minor. Results Our database search yielded a total of 630 records; 34 studies were appropriate for qualitative analysis. There were 790 patients, with a mean age of 40.1 years, a female percentage of 37% and a mean follow-up period of 29.3 months. In total, 132 patients received a hook plate, 252 received a locking plate, 368 received CC stabilization and 41 received transacromial transfixation. All studies were retrospective and had fair MINORS scores. Locking plate, CC stabilization and ACJ transfixation showed similar clinical results but were much better than hook plate fixation; CC augmentation did not significantly improve the outcome of locking plate fixation. The rate of major complications was similar among groups; hook plate and AC joint transfixation had the worst rates of minor complications. Open CC techniques were slightly better than arthroscopic techniques. Conclusions The present systematic review for the optimal fixation method for Neer type IIB fractures of the distal clavicle showed similar major complication rates among techniques; the hook plate technique demonstrated inferior clinical results to other techniques. Open CC stabilization and locking plate fixation without CC augmentation seem to be the best available treatment options.

The assessment of the status of fisheries resources is pivotal due to the importance of marine resources in global food security and to halt the ongoing decline in marine biodiversity. Norway lobster (Nephrops norvegicus) is one of the most valuable resources in the Northeast Atlantic. However, overfishing has caused the decline of several Nephrops stocks over the last decades, particularly in the Nephrops Functional Units (FUs) 25 (NW Spain), 26-27 (NW Spain and North Portugal) and 31 (Cantabrian Sea, North Spain). Since 2003, the information provided by the very low level of landings and fishing effort of these three stocks was insufficient to carry out an adequate analytical assessment, so the base of the assessment has been the trends from commercial catch per unit effort (CPUE). The objective of this study was to carry out the first assessment of these three stocks with an analytical MSY-based model. A review of the available data was made and the stochastic Surplus Production Model in Continuous Time (SPiCT) was fitted for each FU. The results indicate an extremely low biomass for FUs 25 and 26-27 since the mid-nineties well below the reference points. For FU 31, on the other hand, estimated biomass is larger. Our findings also identified long-term temporal and spatial changes in the population dynamic of Nephrops in the Northwest Iberian coast. The results were compare with those obtained in the same stocks with other data-limited methods. Also the role of abiotic factors on the observed dynamic of the stocks was explored. The results of this study are not only relevant for the sustainable exploitation of Norway lobster stocks off the Northwest Iberian coast but provide valuable insights into the suitability and limitations of production models for the assessment of crustacean stocks in general.

Introduction: Real-world evidence regarding molecular epidemiology and management patterns of patients with EGFR exon-20 mutated, advanced NSCLC outside the context of clinical trials is lacking. Methods: We created a European registry for patients with advanced EGFR exon 20-mutant NSCLC diagnosed from January 2019 to December 2021. Patients enrolled in clinical trials were excluded. Clinicopathologic and molecular epidemiology data were collected, and treatment patterns were recorded. Clinical end points according to treatment assignment were assessed using Kaplan-Meier curves and Cox regression models. Results: Data on 175 patients from 33 centers across nine countries were included in the final analysis. Median age was 64.0 (range: 29.7–87.8) years. Main features included female sex (56.3%), never or past smokers (76.0%), adenocarcinoma (95.4%), and tropism for bone (47.4%) and brain (32.0%) metastases. Mean programmed death-ligand 1 tumor proportional score was 15.8% (range: 0%–95%) and mean tumor mutational burden was 7.06 (range: 0–18.8) mutations per megabase. Exon 20 was detected in the tissue (90.7%), plasma (8.7%), or both (0.6%), using mostly targeted next-generation sequencing (64.0%) or polymerase chain reaction (26.0%). Mutations were mainly insertions (59.3%), followed by duplications (28.1%), deletions-insertions (7.7%), and the T790M (4.5%). Insertions and duplications were located mainly in the near loop (codons 767–771, 83.1%) and the far loop (codons 771–775, 13%) and only in 3.9% within the C helix (codons 761–766). Main co-alterations included mutations in TP53 (61.8%) and MET amplifications (9.4%). Treatment on mutation identification included chemotherapy (CT) (33.8%), CT-immunotherapy (IO) (18.2%), osimertinib (22.1%), poziotinib (9.1%), mobocertinib (6.5%), mono-IO (3.9%), and amivantamab (1.3%). Disease control rates were 66.2% with CT plus or minus IO, 55.8% with osimertinib, 64.8% with poziotinib, and 76.9% with mobocertinib. Corresponding median overall survival was 19.7, 15.9, 9.2, and 22.4 months, respectively. In multivariate analysis, type of treatment (new targeted agents versus CT ± IO) affected progression-free survival (p = 0.051) and overall survival (p = 0.03). Conclusions: EXOTIC represents the largest academic real-world evidence data set on EGFR exon 20-mutant NSCLC in Europe. Indirectly compared, treatment with new exon 20-targeting agents is likely to confer survival benefit than CT plus or minus IO.

Remote sensing has been a key resource for developing extensive and detailed datasets for studying and constraining aerosol-cloud-climate interactions. However, aerosol-cloud collocation challenges, algorithm limitations, as well as difficulties in unraveling dynamic from aerosol-related effects on cloud microphysics, have long challenged precise retrievals of cloud droplet number concentrations. By combining a series of remote sensing techniques and in situ measurements at ground level, we developed a semi-automated approach that can address several retrieval issues for a robust estimation of cloud droplet number for non-precipitating Planetary Boundary Layer (PBL) clouds. The approach is based on satellite retrievals of the PBL cloud droplet number (Ndsat) using the geostationary meteorological satellite data of the Optimal Cloud Analysis (OCA) product, which is obtained by the Spinning Enhanced Visible and InfraRed Imager (SEVIRI) of the European Organization for the Exploitation of Meteorological Satellites (EUMETSAT). The parameters of the retrieval are optimized through closure with droplet number obtained from a combination of ground-based remote sensing data and in situ observations at ground level. More specifically, the remote sensing data are used to retrieve cloud-scale vertical velocity, and the in situ aerosol measurements at ground level were used constrain as input to a state-of-the-art droplet activation parameterization to predict the respective Cloud Condensation Nuclei (CCN) spectra, cloud maximum supersaturation and droplet number concentration (Nd), accounting for the effects of vertical velocity distribution and lateral entrainment. Closure studies between collocated Nd and Ndsat are then used to evaluate exising droplet spectral width parameters used for the retrieval of droplet number, and determine the optimal values for retrieval. This methodology, used to study aerosol-cloud interactions for non-precipitating clouds formed over the Athens Metropolitan Area (AMA), Greece, during the springtime period from March to May 2020, shows that droplet closure can be achieved to within ±33.4%, comparable to the level of closure obtained in many in situ studies. Given this, the ease of applying this approach with satellite data obtained from SEVIRI with high temporal (15 min) and spatial resolution (3.6 km × 4.6 km), opens the possibility of continuous and reliable Ndsat, giving rise to high value datasets for aerosol-cloud-climate interaction studies.

We empirically examine the role of board gender diversity in influencing stock price crash risk at the firm-level in twelve (12) Asia-Pacific Markets. Using a dataset comprising data from 1021 listed firms over the period 2006–2016, we employ a random effect model in a regression setting. Controlling for the firm and market-level variables, we find that board gender diversity results in lowering the stock price crash risk of the firm. Bifurcating women directors on corporate board into numerical representation (token and critical mass representation), the results support our main conjectures and suggest that the economic significance of this relationship is higher for firms that have three or more women directors on the board as compared to the firms that have less than three women directors on the corporate board. Our results are robust to alternative measures of stock price crash risk, potential endogeneity and selection biases.

Black spot identification, a spatiotemporal phenomenon, involves analysing the geographical location and time-based occurrence of road accidents. Typically, this analysis examines specific locations on road networks during set time periods to pinpoint areas with a higher concentration of accidents, known as black spots. By evaluating these problem areas, researchers can uncover the underlying causes and reasons for increased collision rates, such as road design, traffic volume, driver behaviour, weather, and infrastructure. However, challenges in identifying black spots include limited data availability, data quality, and assessing contributing factors. Additionally, evolving road design, infrastructure, and vehicle safety technology can affect black spot analysis and determination. This study focused on traffic accidents in Greek road networks to recognize black spots, utilizing data from police and government-issued car crash reports. The study produced a publicly available dataset called Black Spots of North Greece (BSNG) and a highly accurate identification method.

Abstract Background Bullous pemphigoid is the most common bullous chronic autoimmune skin disease. Recent studies have suggested dipeptidyl-peptidase 4 inhibitors as possible predisposing agents of bullous pemphigoid. The objective of our study was to prospectively estimate the association between gliptins and the development of bullous pemphigoid. Methods We conducted a prospective study which included all patients diagnosed with biopsy-proven bullous pemphigoid in the Dermatology Department of our hospital between April 1, 2009 and December 31,2019. The diagnosis of bullous pemphigoid was based on specific clinical, histological and immunological features. Results Overall 113 consecutive patients (age 75 ± 13 years, 62 females) with the diagnosis of bullous pemphigoid were enrolled. Seventy-six patients (67.3%) suffered from type 2 Diabetes and 52 (46%) were treated with dipeptidyl-peptidase 4 inhibitors. The most frequent prescribed gliptin was vildagliptin, being administered to 45 cases (39.8% of total patients enrolled, 86.5% of the patients treated with gliptins). Gliptins were withdrawn immediately after the diagnosis of bullous pemphigoid, which together with steroid administration led to remission of the rash. Conclusions This study revealed that treatment with dipeptidyl-peptidase 4 inhibitors, especially vildagliptin, is significantly associated with an increased risk of bullous pemphigoid development.

In this study, we report on the retrieval of aerosol extinction profiles from ground-based scattered sunlight multi-axis differential optical absorption spectroscopy (MAX-DOAS) measurements, carried out at Athens, Greece. It is the first time that aerosol profiles are retrieved from MAX-DOAS measurements in Athens. The reported aerosol vertical distributions at 477 nm are derived from the oxygen dimer (O4) differential-slant-column-density observations at different elevation angles by applying the BRemen Optimal estimation REtrieval for Aerosol and trace gaseS (BOREAS) retrieval algorithm. Four case studies have been selected for validation purposes; the retrieved aerosol profiles and the corresponding aerosol optical depths (AODs) from the MAX-DOAS are compared with lidar extinction profiles and with sun-photometric measurements (Aerosol Robotic Network, AERONET, observations), respectively. Despite the different approach of each method regarding the retrieval of the aerosol information, the comparison with the lidar measurements at 532 nm reveals a very good agreement in terms of vertical distribution, with r>0.90 in all cases. The AODs from the MAX-DOAS and the sun photometer (the latter at 500 nm) show a satisfactory correlation (with 0.45 < r < 0.7 in three out of the four cases). The comparison indicates that the MAX-DOAS systematically underestimates the AOD in the cases of large particles (small Ångström exponent) and for measurements at small relative azimuthal angles between the viewing direction and the sun. Better agreement is achieved in the morning, at large relative azimuthal angles. Overall, the aerosol profiles retrieved from MAX-DOAS measurements are of good quality; thus, new perspectives are opened up for assessing urban aerosol pollution on a long-term basis in Athens from continuous and uninterrupted MAX-DOAS measurements.

Introduction Complex fractures of the proximal humerus with splitting-head component and metaphyseal propagation are very rare injuries that are difficult to treat. Preservation of the humeral head is always considered except in cases with severe comminution and compromised vascularity where shoulder hemiarthroplasty is an alternative option. Case Report We present two male patients, 57- and 62-years-old who sustained such a complex proximal humeral fracture after a high-energy injury. They both managed with long-stemmed shoulder hemiarthroplasty and cerclage wiring of the metaphyseal area. They both demonstrated good clinical and radiological outcome at 32- and 24-months postoperatively. Conclusion We report the functional and radiological outcomes of two cases of a rare proximal humeral fracture's pattern - combination of splitting-head and metaphyseal comminution – that were managed with long-stemmed hemiarthroplasty and cerclage wire and demonstrated good midterm clinical outcome.

Abstract Background A metastatic lesion located in the ampulla of Vater is considered extremely rare, with only 32 cases reported globally. Case A 65‐year‐old patient was primarily diagnosed with a rectal adenocarcinoma. Twenty‐four months later as part of the oncological follow‐up, the patient was diagnosed with a single secondary tumor in the ampulla of Vater. After undergoing a pancreaticoduodenectomy (Whipple procedure), the patient experienced an uneventful recovery and received adjuvant chemotherapy. Sixteen months later the patient remained disease‐free. Conclusion To the best of our knowledge, the present case represents the first reported metastatic tumor in the ampulla of Vater, originating from a rectal adenocarcinoma. This case underlines the critical role of immunohistochemistry in arriving at a correct diagnosis in order to guide clinical decision‐making.

Remote sensing measurements of aerosols using depolarization Raman lidar systems from four EARLINET (European Aerosol Research Lidar Network) stations are used for a comprehensive analysis of Saharan dust events over the Mediterranean basin in the period 2014–2017. In this period, 51 dust events regarding the geometrical, optical and microphysical properties of dust were selected, classified and assessed according to their radiative forcing effect on the atmosphere. From west to east, the stations of Granada, Potenza, Athens and Limassol were selected as representative Mediterranean cities regularly affected by Saharan dust intrusions. Emphasis was given on lidar measurements in the visible (532 nm) and specifically on the consistency of the particle linear depolarization ratio (δp532), the extinction-to-backscatter lidar ratio (LR532) and the aerosol optical thickness (AOT532) within the observed dust layers. We found mean δp532 values of 0.24±0.05, 0.26±0.06, 0.28±0.05 and 0.28±0.04, mean LR532 values of 52±8, 51±9, 52±9 and 49±6 sr and mean AOT532 values of 0.40±0.31, 0.11±0.07, 0.12±0.10 and 0.32±0.17, for Granada, Potenza, Athens and Limassol, respectively. The mean layer thickness values were found to range from ∼ 1700 to ∼ 3400 m a.s.l. Additionally, based also on a previous aerosol type classification scheme provided by airborne High Spectral Resolution Lidar (HSRL) observations and on air mass backward trajectory analysis, a clustering analysis was performed in order to identify the mixing state of the dusty layers over the studied area. Furthermore, a synergy of lidar measurements and modeling was used to analyze the solar and thermal radiative forcing of airborne dust in detail. In total, a cooling behavior in the solar range and a significantly lower heating behavior in the thermal range was estimated. Depending on the dust optical and geometrical properties, the load intensity and the solar zenith angle (SZA), the estimated solar radiative forcing values range from −59 to −22 W m−2 at the surface and from −24 to −1 W m−2 at the top of the atmosphere (TOA). Similarly, in the thermal spectral range these values range from +2 to +4 W m−2 for the surface and from +1 to +3 W m−2 for the TOA. Finally, the radiative forcing seems to be inversely proportional to the dust mixing ratio, since higher absolute values are estimated for less mixed dust layers.

A new method, called ElEx (elastic extinction), is proposed for the estimation of extinction coefficient lidar profiles using only the information provided by the elastic and polarization channels of a lidar system. The method is applicable to lidar measurements both during daytime and nighttime under well-defined aerosol mixtures. ElEx uses the particle backscatter profiles at 532 nm and the vertically resolved particle linear depolarization ratio measurements at the same wavelength. The particle linear depolarization ratio and the lidar ratio values of pure aerosol types are also taken from literature. The total extinction profile is then estimated and compared well with Raman retrievals. In this study, ElEx was applied in an aerosol mixture of marine and dust particles at Finokalia station during the CHARADMExp campaign. Any difference between ElEx and Raman extinction profiles indicates that the nondust component could be probably attributed to polluted marine or polluted continental aerosols. Comparison with sun photometer aerosol optical depth observations is performed as well during daytime. Differences in the total aerosol optical depth are varying between 1.2 % and 72 %, and these differences are attributed to the limited ability of the lidar to correctly represent the aerosol optical properties in the near range due to the overlap problem.

Introduction Failure after operative treatment of complex proximal humeral fractures (PHF) can prove challenging even for experienced surgeons. Reverse shoulder arthroplasty (RSA) seems to offer a satisfactory revision procedure with good clinical outcomes. Materials and Methods We present a case series of 14 patients, who were treated during a 3.5 years period (from 01/2016 until 06/2019). They all underwent revision surgery with RSA for failed operative treatment of PHF. Their mean age was 68 years (range, 51-84 years). 2 patients (14.3%) had been primarily treated with open reduction and internal fixation (ORIF), 5 patients (35.7%) with hemiarthroplasty, 3 patients (21.4%) with closed reduction and percutaneous fixation and 4 patients (28.6%) with transosseous suture fixation (TSF). We evaluated their absolute Constant score (CS), Visual Analogue Scale (VAS) score, and Range of Motion at their final follow-up, and we made a full clinical and radiological assessment to detect any postoperative complications. Results The mean absolute CS, VAS score, active anterior elevation, active abduction significantly improved compared with the preoperative status. Less significant difference was found in external rotation when comparing with the preoperative status ( P = .0304). No significant differences were found when comparing RSA for different failed primary techniques ( P > .05). No complications were detected following the revision surgeries of all patients. Conclusion RSA is an appropriate treatment as a revision technique for failed primary surgical treatment of PHFs. Though challenging it can offer good clinical results and pain relief.

The goal of this study is to validate and analyze NASA’s Soil Moisture Active Passive (SMAP) products over the desert of Kuwait. The study period was between April 2015 and April 2020. The study domain includes a mission candidate calibration/validation (Cal/Val) site that comprises six permanent soil moisture stations used to verify SMAP estimates. In addition, intensive field campaigns were conducted within and around the candidate Cal/Val site during the study period to collect additional thermogravimetric samples. The mean difference (MD), root mean squared difference (RMSD), unbiased root mean square difference (ubRMSD), and correlation coefficient (R) were computed to assess the agreement between SMAP SM products and in situ observations. The comparison of the six ground station sensors’ observations with the thermogravimetric samples led to an absolute mean bias (AMB) of 0.034 m3 m−3, which was then used to calibrate the sensors and bias-correct their measurements. The temporal consistency of the readings from the test site and calibrated sensors was assessed using the mean relative difference (MRD) and its standard deviation of relative difference (SDRD). Using a sampling density analysis, it was determined that a minimum of four ground stations would be required to validate the test site. Furthermore, the consistency between SMAP satellite soil moisture data and those derived from the Soil Moisture and Ocean Salinity (SMOS) satellite operated by the European Space Agency, and their agreement with in situ samples, was analyzed. The comparison of SMAP and SMOS soil moisture data with in situ observations showed that both satellites successfully captured the spatial and temporal distribution of soil moisture. For SMAP and SMOS, the lowest ubRMSE statistics were 0.043 m3 m−3 and 0.045 m3 m−3, respectively, which are slightly higher than the mission target of 0.04 m3 m−3.

In the present study, we present the aerosol optical properties and radiative forcing (RF) of the tropospheric and stratospheric smoke layers, observed by the Cloud-Aerosol Lidar and Infrared Pathfinder Satellite Observation (CALIPSO) satellite, during the extraordinary Australian biomass burning (BB) event in 2019–2020. These BB layers were studied and analyzed within the longitude range 140° E–20° W and the latitude band 20°–60° S, as they were gradually transported from the Australian banks to the South American continent. These layers were found to be trapped within the Andes circulation, staying for longer time periods in the same longitude region. The BB aerosols reached altitudes even up to 22 km amsl., and regarding their optical properties, they were found to be nearly spherical (particle linear depolarization ratio (PLDR) < 0.10) in the troposphere; while, in the stratosphere, they were more depolarizing with PLDR values reaching up to 0.20. Fine and ultrafine smoke particles were dominant in the stratosphere, according to the observed Ångström exponent, related to the backscatter coefficients obtained by the pair of wavelengths 532 and 1064 nm (Åb up to 3), in contrast to the Åb values in the troposphere (Åb < 1) indicative of the presence of coarser particles. As the aerosols fend off the source, towards North America, a slightly descending trend was observed in the tropospheric Åb values, while the stratospheric ones were lightly increased. A maximum aerosol optical depth (AOD) value of 0.54 was recorded in the lower troposphere over the fire spots, while, in the stratosphere, AOD values up to 0.29 were observed. Sharp changes of carbon monoxide (CO) and ozone (O3) concentrations were also recorded by the Copernicus Atmosphere Monitoring Service (CAMS) in various atmospheric heights over the study region, associated with fire smoke emissions. The tropospheric smoke layers were found to have a negative mean radiative effect, ranging from −12.83 W/m2 at the top of the atmosphere (TOA), to −32.22 W/m2 on the surface (SRF), while the radiative effect of the stratospheric smoke was estimated between −7.36 at the TOA to −18.51 W/m2 at the SRF.