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Objective Robotic distal pancreatectomy (DP) is emerging as the preferred treatment for body and tail tumors of the pancreas. To enable conclusive comparisons with the standard open or laparoscopic approaches and robotic surgery among centers, novel benchmark outcome values are urgently needed. Therefore, the aim of this study was to identify benchmark values from expert centers beyond the learning curve. Methods This multicenter study analyzed outcomes from consecutive patients undergoing robotic DP for resectable malignant or benign lesions from 14 international expert centers. After the learning curve, defined as the first 10 cases of robotic DP, all consecutive patients were included from the start of the program up to June 2020 with a minimum follow-up of 1 year. Benchmark patients were those without significant comorbidities including obesity (BMI >35 kg/m2) cardiac disease, chronic pulmonary disease. Benchmark cutoff values were derived from the 75th or the 25th percentile of the median values of all benchmark centers. Results After reaching the learning curve, 289 (47%) of a total of 614 consecutive patients qualified as benchmark cases. The proportion of benchmark patients varied between 24%-64% per center. Benchmark cut-offs showed a low 6 month- postoperative mortality ( 19 with an R0 resection rate of > 85%, and an overall survival of >86% and >52% after 1- and 5-years, respectively. Centers with a low cohort of benchmark patients (more difficult cases) had less clinically relevant pancreatic fistula (9% vs. 23%) and less overall complications (32% vs. 48%). Conclusion This benchmark analysis sets novel reference values for robotic DP, indicating favorable outcomes as compared to laparoscopic and open DP. These references values may serve for quality control of surgery in centers embarking in robotic DP, and include the procedure in the standard of care.

Die primare Behandlung des Analkarzinoms stellt die Radiochemotherapie dar. Ein komplettes Ansprechen steht in 2 Drittel der Falle zu erwarten. Die Indikation zur Salvage-Operation ergibt sich bei Tumorprogress, -persistenz oder -rezidiv. Der aktuelle Standard zur Indikationsstellung und Ansatze zur Reduktion der fruh- und spatoperativen Morbiditat der Salvage-Operation sollen dargestellt werden. Es erfolgte eine selektive Literaturrecherche und Zusammenfassung der derzeitigen Evidenz zur sekundaren Therapie des Analkarzinoms im Hinblick auf Indikationsstellung und chirurgische Techniken der Salvage-Operation. Die Salvage-Therapie des Analkarzinoms besteht in der abdominoperinealen Rektumexstirpation mit totaler mesorektaler Exzision, ggf. mit Erweiterung bis hin zur Exenteration. Die Senkung der Morbiditat erfolgt durch abdominelle minimalinvasive Technik, myokutane Lappenplastiken und Omentumplastik. Neben Lymphknoten- und HPV-Status (humanes Papillomvirus) bestimmt die R0-Situation die onkologische Prognose. Die Salvage-Operation des Analkarzinoms sollte an Zentren mit minimalinvasiver kolorektaler und rekonstruktiver Expertise durchgefuhrt werden.

The term neuroendocrine neoplasms (NEN) encompasses a molecularly and biologically very heterogeneous group of tumors, which have in common their origin in neuroendocrine cells. The also very heterogeneous subgroup of gastroenteropancreatic neuroendocrine neoplasms (GEP-NEN) is the best classified and investigated group. This article provides a systematic review of the current classification, diagnostics and treatment options of GEP-NEN. In order to achieve a better overview, it was consciously decided not to use an approach based on the primary localization. Instead, a thematic organization according to classification, clinical phenotype, diagnostics and treatment was chosen.

Regional academic conferences provide a variety of benefits to attendants, but hosting them can be costly. Here, we share benefits and drawbacks of hosting regional evolution meetings from the vantages of a tenured associate professor, a tenure-track assistant professor, and a doctoral student. We use experiences of hosting the NorthEastern Evolutionary Psychology Society (NEEPS), the Southeastern Evolutionary Perspectives Society (SEEPS), and the Mid-Atlantic Bioanthropology Interest Group (MABIG) as cases to address the benefits and costs. We highlight what are likely universal benefits and costs of hosting evolution conferences while also discussing the risks of excess service to women and underrepresented faculty members. We also draw attention to personal and circumstantial contingencies that evolution conference hosts may encounter.

We present the first measurement of the Michel parameters η ‾ and ξκ in the radiative leptonic decay of the τ lepton using 703 fb-1 of data collected with the Belle detector at the KEKB e + e − collider. The Michel parameters are measured by an unbinned maximum likelihood fit to the kinematic information of e + e − → τ + τ − → ( π + π 0 ν ‾ ) ( l − ν ν ‾ γ ) ( l = e or μ ) . The preliminary values of the measured Michel parameters are η ‾ = − 2.0 ± 1.5 ± 0.8 and ξ κ = 0.6 ± 0.4 ± 0.2 , where the first error is statistical and the second is systematic.

We report an improved measurement of D0 – D‾0 mixing and a search for CP violation in D0 decays to CP -even final states K+K− and π+π− . The measurement is based on the final Belle data sample of 976 fb −1 . The results are yCP=(1.11±0.22±0.09)% and AΓ=(−0.03±0.20±0.07)% , where the first uncertainty is statistical and the second is systematic.

In this paper we report the implementation of a global vertex fitting algorithm within the Belle II analysis software environment, which was originally developed for BaBar (Hulsbergen, 2005). We explore the impact of global vertex fitting algorithms for flavour physics analyses with the Belle II detector at the SuperKEKB e + e − collider, such as in the reconstruction of final states with neutral particles, and in fits with geometrical constraints from SuperKEKB’s nano-beam interaction region. The algorithm is compared to the standard vertex fitting algorithm employed by the Belle experiment. We have developed the fitting framework to utilise the EIGEN library for linear algebra operations, reducing the computation time for vertex fitting operations by an order of magnitude over previous methods. This has a significant impact on physics analysis computing efficiency, where vertex fitting over large combinations of final state particles is one of the most CPU intensive operations at Belle II.

The Full Event Interpretation is presented: a new exclusive tagging algorithm used by the high-energy physics experiment Belle II. The experimental setup of Belle II allows the precise measurement of otherwise inaccessible $B$ meson decay-modes. The Full Event Interpretation algorithm enables many of these measurements. The algorithm relies on machine learning to automatically identify plausible $B$ meson decay chains based on the data recorded by the detector. Compared to similar algorithms employed by previous experiments, the Full Event Interpretation provides a greater efficiency, yielding a larger effective sample size usable in the measurement., 11 pages, 7 figures, 1 table

The leptonic decays of charged \(\mathrm{B}\) mesons belong to the golden decay-channels at \(\mathrm{B}\) factories. The expected branching fractions in the Standard Model of particle physics (SM) are small, hence leptonic decays are so-called rare-decays. The theoretical uncertainties on the predicted branching fraction are small and the possible influence of physics beyond the Standard Model (BSM) can be large.

During this thesis, the full \(\Upsilon (4\text {S})\) dataset of the Belle experiment and large amounts of the available Monte Carlo data were converted into the new data-format used by Belle II. Therefore, it is possible to evaluate the reliability and performance of the newly developed analysis methods, in particular data-driven techniques, before a comparable dataset from the Belle II experiment is available.

The Full Event Interpretation (FEI) is a tagging algorithm based on machine learning. It exploits the unique experimental setup of \(\text {B}\) factory experiments such as the Belle and Belle II experiment. Both experiments operate on the \(\Upsilon (4\text {S})\) resonance, which decays at least \(96 \%\) of the time into exactly two \(\text {B}\) mesons. Conceptually, the event is divided into two sides: The signal-side containing the tracks and clusters compatible with the assumed signal \(\text {B}_{\mathrm {sig}} \) decay the physicist is interested in, e.g. \(\text {B}^{+}\rightarrow \tau ^{+}\nu _{\tau }\); and the tag-side containing the remaining tracks and clusters compatible with an arbitrary \(\text {B}_{\mathrm {tag}} \) meson decay. Figure 4.1 depicts this situation.

We describe the conversion of simulated and recorded data by the Belle experiment to the Belle~II format with the software package \texttt{b2bii}. It is part of the Belle~II Analysis Software Framework. This allows the validation of the analysis software and the improvement of analyses based on the recorded Belle dataset using newly developed analysis tools.

In recent years, the field of multivariate analysis and machine learning evolved rapidly, and provided powerful techniques, which are currently adopted in all fields of science. Prominent use-cases include: image and speech recognition, stock market trading, fraud detection, and medical diagnosis.

Quality indicators are by definition indirect measures of quality. The selection for the field of pancreatic surgery was based on the clinical relevance and controllability, scientific evidence and the practicability of data acquisition. In terms of outcome quality, hospital mortality, the composite endpoint MTL30 (mortality-transfer-length of stay), and major complications (Clavien-Dindo classification grades 3b and 4) were chosen as being essential. With respect to structural quality, the presence of interventional radiology with constant availability was considered essential. To evaluate target values two strategies were used: a systematic literature search and evaluation of the current numbers from the German Society for General and Visceral Surgery (DGAV) StuDoQ|Pancreas registry for the years 2014-2016. The results are presented in the following consensus statement.

We present the results of a search for the rare decays $B\ensuremath{\rightarrow}h\ensuremath{\nu}\overline{\ensuremath{\nu}}$, where $h$ stands for ${K}^{+},{K}_{\mathrm{S}}^{0},\phantom{\rule{0ex}{0ex}}{{K}^{*}}^{+},{{K}^{*}}^{0},{\ensuremath{\pi}}^{+},{\ensuremath{\pi}}^{0},{\ensuremath{\rho}}^{+}$ and ${\ensuremath{\rho}}^{0}$. The results are obtained with $772\ifmmode\times\else\texttimes\fi{}{10}^{6}\text{ }\text{ }B\overline{B}$ pairs collected with the Belle detector at the KEKB ${e}^{+}{e}^{\ensuremath{-}}$ collider. We reconstruct one $B$ meson in a semileptonic decay and require a single $h$ meson but nothing else on the signal side. We observe no significant signal and set upper limits on the branching fractions. The limits set on the ${B}^{0}\ensuremath{\rightarrow}{K}_{\mathrm{S}}^{0}\ensuremath{\nu}\overline{\ensuremath{\nu}}$, ${B}^{0}\ensuremath{\rightarrow}{{K}^{*}}^{0}\ensuremath{\nu}\overline{\ensuremath{\nu}}$, ${B}^{+}\ensuremath{\rightarrow}{\ensuremath{\pi}}^{+}\ensuremath{\nu}\overline{\ensuremath{\nu}}$, ${B}^{0}\ensuremath{\rightarrow}{\ensuremath{\pi}}^{0}\ensuremath{\nu}\overline{\ensuremath{\nu}}$, ${B}^{+}\ensuremath{\rightarrow}{\ensuremath{\rho}}^{+}\ensuremath{\nu}\overline{\ensuremath{\nu}}$, and ${B}^{0}\ensuremath{\rightarrow}{\ensuremath{\rho}}^{0}\ensuremath{\nu}\overline{\ensuremath{\nu}}$ channels are the world's most stringent.

Stochastic gradient-boosted decision trees are widely employed for multivariate classification and regression tasks. This paper presents a speed-optimized and cache-friendly implementation for multivariate classification called FastBDT. The concepts used to optimize the execution time are discussed in detail in this paper. The key ideas include: an equal-frequency binning on the input data, which allows replacing expensive floating-point with integer operations, while at the same time increasing the quality of the classification; a cache-friendly linear access pattern to the input data, in contrast to usual implementations, which exhibit a random access pattern. FastBDT provides interfaces to C/C++, Python and TMVA. It is extensively used in the field of high energy physics (HEP) by the Belle II experiment.

Despite being technically challenging, laparoscopic surgical procedures are increasingly being used also in pancreatic surgery. This review attempts to evaluate these procedures based on the currently available literature against the background of the high mortality of pancreatic surgery observed nationwide and the as yet unclear oncological validation of these procedures.Recently published retrospective cohort and register trials have evaluated not only perioperative outcome but also long-term survival after laparoscopic pancreatic resection.Laparoscopic interventions are increasingly being used for treatment of malignant tumors of the pancreas. The advantages of laparoscopy, such as less intraoperative blood loss, reduced postoperative pain and a shorter duration of hospital stay, have all been demonstrated in retrospective trials. Equivalent long-term survival after oncological laparoscopic pancreatic surgery compared to open procedures was also observed in these trials; however, mortality even after laparoscopic pancreatic surgery was found to be significantly increased in low-volume centers. Prospective trials are still needed to prove adequate oncological treatment. Laparoskopische Verfahren haben sich in den letzten Jahren in fast allen Bereichen der Chirurgie quasi zum Standard entwickelt und werden von Patienten zunehmend nachgefragt. Die kosmetischen Ergebnisse sind deutlich besser als bei konventionellem Vorgehen und sie reduzieren unter anderem den postoperativen Schmerz, Schmerzmittelbedarf sowie den Krankenhausaufenthalt [29]. Daher ist es wenig überraschend, dass minimal-invasive Verfahren auch bei technisch hochkomplexen Eingriffen, wie z. B. am Pankreas, zunehmend eingesetzt werden. Allerdings wird ihr Einsatz hier noch immer kontrovers diskutiert.

Die mesenteriale Ischamie wird durch eine akute arterielle Embolie oder Thrombose, eine Mesenterialvenenthrombose und die non-okklusive mesenteriale Durchblutungsstorung hervorgerufen. Das initiale Bild ist das eines akuten Abdomens; die Patienten sind in den meisten Fallen uber 70 Jahre alt. Zu den Risikofaktoren zahlen kardiale Erkrankungen, Aneurysmata der Aorta und der Viszeralarterien, eine arterielle Verschlusskrankheit, Kompressionen durch Tumoren und verschiedene andere Erkrankungen die eine Herabsetzung des Blutvolumens und der Flusgeschwindigkeit im Versorgungsgebiet der Arteria mesenterica superior zur Folge haben. Der Goldstandard in der Diagnostik ist die CT-Angiographie mit 3D-Rekonstruktion. Die Therapie erfolgt angepasst an die jeweils zugrunde liegende Pathologie. Eine signifikant erhohte Letalitat von uber 95 % ist mit einem Intervall zwischen Einsetzen der akuten abdominellen Schmerzen von mehr als 12 Stunden sowie mit der non-okklusiven Durchblutungsstorung assoziiert ist, bleibt die Zeit bis zur Therapie der uberlebensentscheidende Faktor. Aufgrund des Alters und der Begleiterkrankungen der Patienten ist bei Fehlen von Peritonitis und Darmnekrosen eine interventionelle Therapie einer Laparotomie in der zeitlichen Abfolge vorzuziehen.

The basic idea of Voxel2MCNP is to provide a framework supporting users in modeling radiation transport scenarios using voxel phantoms and other geometric models, generating corresponding input for the Monte Carlo code MCNPX, and evaluating simulation output. Applications at Karlsruhe Institute of Technology are primarily whole and partial body counter calibration and calculation of dose conversion coefficients. A new generic data model describing data related to radiation transport, including phantom and detector geometries and their properties, sources, tallies and materials, has been developed. It is modular and generally independent of the targeted Monte Carlo code. The data model has been implemented as an XML-based file format to facilitate data exchange, and integrated with Voxel2MCNP to provide a common interface for modeling, visualization, and evaluation of data. Also, extensions to allow compatibility with several file formats, such as ENSDF for nuclear structure properties and radioactive decay data, SimpleGeo for solid geometry modeling, ImageJ for voxel lattices, and MCNPX's MCTAL for simulation results have been added. The framework is presented and discussed in this paper and example workflows for body counter calibration and calculation of dose conversion coefficients is given to illustrate its application.

Pancreaticojejunostomy and pancreaticogastrostomy are the two techniques for pancreatic anastomosis that are widely established for the reconstruction after pancreaticoduodenectomy. Pancreaticogastrostomy is the most recent and to date less frequently performed method, the history, techniques and indications of which are presented.Review of the literature and current evidence.Current evidence from randomized controlled trials and meta-analyses does not demonstrate significant differences in complication rates or pancreatic function after pancreaticogastrostomy versus pancreaticojejunostomy.Pancreaticogastrostomy is the technically less demanding procedure, offering at least the same level of safety as pancreaticojejunostomy. Minimally invasive and parenchyma-sparing procedures provide new areas of application for this anastomotic technique.

Summary Background Treatment guidelines for aphasia recommend intensive speech and language therapy for chronic (≥6 months) aphasia after stroke, but large-scale, class 1 randomised controlled trials on treatment effectiveness are scarce. We aimed to examine whether 3 weeks of intensive speech and language therapy under routine clinical conditions improved verbal communication in daily-life situations in people with chronic aphasia after stroke. Methods In this multicentre, parallel group, superiority, open-label, blinded-endpoint, randomised controlled trial, patients aged 70 years or younger with aphasia after stroke lasting for 6 months or more were recruited from 19 inpatient or outpatient rehabilitation centres in Germany. An external biostatistician used a computer-generated permuted block randomisation method, stratified by treatment centre, to randomly assign participants to either 3 weeks or more of intensive speech and language therapy (≥10 h per week) or 3 weeks deferral of intensive speech and language therapy. The primary endpoint was between-group difference in the change in verbal communication effectiveness in everyday life scenarios (Amsterdam–Nijmegen Everyday Language Test A-scale) from baseline to immediately after 3 weeks of treatment or treatment deferral. All analyses were done using the modified intention-to-treat population (those who received 1 day or more of intensive treatment or treatment deferral). This study is registered with ClinicalTrials.gov, number NCT01540383. Findings We randomly assigned 158 patients between April 1, 2012, and May 31, 2014. The modified intention-to-treat population comprised 156 patients (78 per group). Verbal communication was significantly improved from baseline to after intensive speech and language treatment (mean difference 2·61 points [SD 4·94]; 95% CI 1·49 to 3·72), but not from baseline to after treatment deferral (−0·03 points [4·04]; −0·94 to 0·88; between-group difference Cohen's d 0·58; p=0·0004). Eight patients had adverse events during therapy or treatment deferral (one car accident [in the control group], two common cold [one patient per group], three gastrointestinal or cardiac symptoms [all intervention group], two recurrent stroke [one in intervention group before initiation of treatment, and one before group assignment had occurred]); all were unrelated to study participation. Interpretation 3 weeks of intensive speech and language therapy significantly enhanced verbal communication in people aged 70 years or younger with chronic aphasia after stroke, providing an effective evidence-based treatment approach in this population. Future studies should examine the minimum treatment intensity required for meaningful treatment effects, and determine whether treatment effects cumulate over repeated intervention periods. Funding German Federal Ministry of Education and Research and the German Society for Aphasia Research and Treatment.