Search Results (33)

Background: Management of lateral pelvic lymph node (LPLN) metastasis in advanced lower rectal cancer has historically exemplified a fundamental East–West divide. In Japan, the Japanese Society for Cancer of the Colon and Rectum (JSCCR) considers LPLN metastasis a regional manifestation requiring lateral pelvic lymph node dissection (LPLND). In contrast, Western practice has long approached LPLN disease as systemic, prioritizing neoadjuvant chemoradiotherapy (nCRT) followed by total mesorectal excision (TME) without additional lateral clearance. Recent Advances: Evidence generated from the JCOG0212 trial and subsequent multicenter cohorts has firmly demonstrated that LPLND markedly reduces lateral local recurrence, particularly in patients with radiologically enlarged nodes. These findings have contributed to a paradigm shift: the 2025 European Society for Medical Oncology (ESMO) Guidelines now endorse selective LPLND for suspicious nodes following neoadjuvant therapy, indicating an emerging convergence between Eastern surgical philosophy and Western multimodal treatment strategies. Surgical Innovation: Robotic surgery has transformed the technical execution of LPLND. Its stable, high-definition three-dimensional visualization, wristed instruments, and enhanced precision enable meticulous dissection across four anatomically defined planes: the medial plane (uretero-hypogastric fascia), intermediate plane (vesico-hypogastric fascia), lateral plane (pelvic sidewall), and dorsal plane (pelvic floor and lumbosacral trunk/sacral plexus). These features facilitate consistent nerve-sparing surgery, reduce blood loss, and improve postoperative urinary and sexual function compared with conventional laparoscopy or open approaches. Robotic LPLND therefore represents a contemporary synthesis of Eastern surgical precision and Western evidence-based multimodal therapy—offering an integrated pathway toward optimized oncologic control and enhanced functional outcomes. Full article

This article explains why the European Union has not replicated Central and Eastern Europe’s (CEE) transformation in the Western Balkans (WB6). Drawing on the original External Incentives Model (EIM) conditions, the article argues that a different political climate in the WB6 requires attention to additional contextual conditions within the EIM framework to show how the weakened linkage between compliance and rewards emerges. Geopolitical enlargement and the presence of rival powers, a stability-over-democracy approach, bilateral vetoes, and the EU’s ongoing “permacrisis” negatively impact determinacy and EU credibility, while also increasing adoption costs. At the WB6 level, reforms become partial and reversible/at-risk, and even in cases of real progress (Montenegro and Albania), institutions remain fragile. The current arrangement serves both Brussels and local elites, providing short-term stability and keeping the WB6 on the EU path at the price of tolerating domestic capture and reforms without transformation. Yet, this arrangement carries a long-term risk of eroding the EU’s transformative power, as public dissatisfaction with local elites is not met with EU support, and rival powers exploit identity ties and elite channels. Full article

For the first time, the same fish species is recorded from Triassic rocks at both ends of the Tethys, namely, Thoracopterus wushaensis Tintori et al., 2012. First described from the southwestern China Xingyi Fauna (late Ladinian, Middle Triassic), it is now also known from a coeval site in the Dolomites in northern Italy. T. wushaensis is considered a flying fish, owing to its elongated pectoral and pelvic fins, tail with a ventral lobe much larger than the dorsal one, and peculiar enlarged neural spines in the caudal region. Taxonomical problems among Peltopleuriformes are also discussed on the basis of an improved comparison between eastern and western Tethys fish assemblages. This finding bolsters the marine vertebrate similarity between China and Europe during the Middle Triassic. Furthermore, because T. wushaensis from the Pelsa/Vazzoler is part of a very rich assemblage yielding several fishes, and also dozens of invertebrate taxa, it also supports the hypothesis of a global bioevent among marine fauna during the late Ladinian, well before the San Cassiano Fauna or the Carnian Pluvial Episode. Full article

Background and Objectives: Atrial fibrillation (AF) carries a huge socioeconomic burden as it is the most encountered cardiac arrhythmia with a significant morbidity. Echocardiographic (Echo) imaging is of monumental value in providing insight into assessing the cardiac function and anatomy, etiology, and risk stratification of AF patients, which will ultimately lead to the best management plan. Materials and Methods: A total of 2160 adult patients diagnosed with AF in 18 hospitals and 30 out-patient cardiology clinics in Jordan and 1 hospital in the Palestinian Territories were enrolled in this study from May 2019 to January 2021. Ultimately, 1776 patients were included in the analysis after going through the exclusion criteria. Results: The majority of our participants were found to have normal EF at the time of enrollment, with only 31.6% exhibiting a decreased EF. Only 40% of overall patients had Echo evidence of left ventricular hypertrophy (LVH). These patients were older (70.27 ± 10.1 vs. 66.0 ± 14.3, p < 0.001), more obese (45.2% vs. 37.3%, p-value < 0.001), and had a more frequent occurrence of HTN (89.0% vs. 65.6%, p < 0.001) and DM (49.2% vs. 40.1%, p < 0.001) when compared to patients without LVH. A proportion of 84.2% of female patients had abnormal left atrial (LA) size (>3.8 cm), in contrast to only 53.4% of males (LA > 4.2 cm). Pulmonary hypertension (PH) was only observed in 27.9% of our patients, and when comparing patients with PH vs. patients without PH, decreased EF (<50%) (36.9% vs. 20.6%, p = 0.001), a higher prevalence of OSA (6.7% vs. 3.8%, p = 0.009), female predominance (60.3% vs. 39.7%, p < 0.001), and older age (70.2 ± 10.7 vs. 66.7 ± 13.6, p < 0.001) were observed in patients with PH. Conclusion: This study provides the first reported insights on the atrial fibrillation-related echocardiographic findings in a Middle Eastern population. Notably, our study demonstrates that the majority of the studied population have no evidence of LVH and have preserved EF on baseline. However, LA enlargement was extremely frequent among females but not in males, warranting further evaluation to determine the factors contributing to such a difference. Full article

Lindera benzoin is a dioecious understory shrub native to eastern North America. Northern spicebush is a beautiful shrub with a natural round shrub shape, golden-yellow fall foliage, attractive bright red drupes, and precocious yellow flowers in early spring; however, its market value as an ornamental value has been overlooked. To improve the ornamental values of this under-cultivated nursery crop, breeding for a better compact form, larger leaves, enlarged flower clusters and fruit, and increased stress tolerances could all be beneficial. Polyploidy manipulation is a valuable method to improve such traits for many ornamental plants. This study established the genome doubling method by oryzalin-infused solid agar treatment on young northern spicebush seedlings. The seedlings of two wild populations in North Carolina were collected and used. A total of 288 seedlings were treated with solid agar containing 150 µM oryzalin for 24, 72, and 120 h. The results were sporadic in their survival ratios and tetraploid conversion ratios between different treatments; however, a total of 16 tetraploid L. benzoin plants were produced in this study. The 24-h treatment showed the optimal result, with 7.1% of total treated seedlings or 15.2% of surviving seedlings converted into tetraploids. Tetraploid plants had visible differences in leaf morphology, a statistically significant enlarged stomata size, and reduced stomatal density compared to diploid plants. This research provides ploidy manipulation information for all future breeding processes of L. benzoin and related species. Full article

The origin of highly permeable flow paths in carbonate-siliciclastic rocks, such as large-aperture fractures in aquifers in the Eastern Bohemian Cretaceous Basin (EBCB), is poorly understood. The karst potential was assessed from the rock carbonate content and the degree of disintegration after leaching in HCl. Surprisingly, dissolution of calcite in EBCB usually did not lead to rock disintegration until calcite > 78%. Instead, porosity increased significantly. High-porosity rock is held together by microns-thick secondary silica cement with a foam-like structure and considerable tensile strength. Three types of conduits occur in the EBCB: (i) bedding-parallel conduits associated with calcite-rich layers, (ii) subvertical fracture swarm conduits that develop on damaged zones of fracture swarms, and (iii) conduits formed by dissolution of calcite veins by groundwater flow. These are ghost-rock karst features where calcite is leached from the rock in the first phase and the residue is washed out by conduits under steep hydraulic gradients in the second phase. Very similar features have been described in Minnesota and Wisconsin, USA. Research has shown that fractures with sharp-edged walls that give the impression of an extensional tectonics origin may actually be ghost-rock karst features in which dissolution and piping have played an important role in their enlargement. Full article

Warm water inflow from the Northeast Pacific has always been considered a crucial factor in early winter freeze-up in the Bering Sea. There is a strong correlation between changes in sea surface temperature (SST) on the eastern Bering Sea shelf and sea ice area in December. However, there is still limited research on the impact of Pacific inflow on SST on the eastern Bering Sea shelf, resulting in insufficient measurements of the impact of Pacific inflow on early freeze-up. In this article, the definition of marine heatwaves (MHW) is used to extract warm events (with a threshold of the 70th percentile) and cold events (with a threshold of the 30th percentile) from the eastern Bering Sea shelf in November. Self-organizing map (SOM) technology is utilized to classify extracted cold and warm events and the mixed-layer heat budget is ultimately used to explore the factors that generate and maintain these cold and warm events. Between 1993 and 2021, a total of 12 warm and 12 cold events are extracted and their cumulative intensity is found to be strongly correlated with the interannual variation in SST by 99.8%, indicating that these warm and cold events are capable of characterizing the interannual variation in SST. Among the 12 warm events, 9 of them can be attributed to abnormal warming of seawater before November and only 3 events are attributed to warm water inflow from the Northeast Pacific. During the development of warm events, there are only two events in which the warm inflow from the Northeast Pacific has a more profound regulatory effect on warm events in November. Moreover, both generation and regulatory factors of cold events are the net air–sea heat flux. Statistics indicate that the warm water inflow from the Northeast Pacific has a limited effect on SST on the eastern Bering Sea shelf during the early freeze-up period. Changes in local SST are more influenced by the residual heat before November and by local net air–sea heat flux. However, we highlight that long-term ocean heatwaves occurring in the Northeast Pacific can enlarge the residual heat of seawater in the eastern Bering Sea shelf before November, thereby impacting early freeze-up. The frequency of such events has significantly increased in the past decade, causing notable changes in the climate and ecosystem of the Bering Sea. Therefore, it is crucial to continue closely monitoring the occurrence and development of such events in the future. Full article

Economic development in China has been severely restricted by environmental problems such as carbon emissions. Improving green total factor productivity (GTFP) is an extremely important pathway to realizing carbon peak and carbon neutrality. Nevertheless, existing studies on China’s urban GTFP under the carbon emissions constraint are still insufficient. In this context, this study adopts the directional distance function (DDF), includes carbon emissions in the undesirable output, combines the global Malmquist–Luenberger (GML) productivity index, and calculates the GTFP of China’s cities. On this basis, the Dagum Gini coefficient, kernel density estimation, and convergence model are employed to explore the regional differences, distribution dynamics, and convergence in China and in three subdivision regions of east, center, and west. The core conclusions are as follows: (1) the average annual growth rate of GTFP in China’s cities is about 0.7064%, which is relatively low, but there is great room for improvement. The growth trend of GTFP in the three subdivision regions of east, center and west is obvious, presenting a spatial distribution characteristic of “high in the east and low in the west”; (2) the regional differences in GTFP of these cities are enlarging, with the largest gap in the eastern region and the smallest in the western region. Intraregional difference is the primary source of regional differences; (3) the imbalance in urban GTFP in China is prominent, with noticeable gradient differences, making it difficult to achieve hierarchical crossing. The central and western regions even have multilevel differentiation problems; (4) there is an absolute $\mathsf{\beta }$ convergence and conditional $\mathsf{\beta }$ convergence of China’s GTFP, but no $\mathsf{\sigma }$ convergence. As a result, it is necessary to comprehensively consider and actively implement the concept of shared development, enhance technological progress, focus on narrowing the differences in GTFP, and facilitate coordinated green development within the regions. Full article

The Castle of Melfi is placed on a hilltop overlooking the modern town and it includes many buildings that have been modified and expanded over time. Its Norman-era core was probably built between the end of the 11th and the start of the 12th century on top of an earlier Byzantine castrum; it was enlarged during the reign of Frederick II and additional alterations were undertaken during the reigns of the Angevin and Aragonese. Integrated ground-penetrating radar (GPR) and electrical resistivity tomography (ERT) surveys were carried out inside two courtyards of the westernmost part of the castle, the Cortile degli Armigeri and the Cortile del Mortorio, and in an external eastern wall area in order to identify ancient buried structures through two different methods of investigation and to compare the results. Full article

Pathogenic variants in the SLC26A4, FOXI1, and KCNJ10 genes are associated with hearing loss (HL) and specific inner ear abnormalities (DFNB4). In the present study, phenotype analyses, including clinical data collection, computed tomography (CT), and audiometric examination, were performed on deaf individuals from the Sakha Republic of Russia (Eastern Siberia). In cases with cochleovestibular malformations, molecular genetic analysis of the coding regions of the SLC26A4, FOXI1, and KCNJ10 genes associated with DFNB4 was completed. In six of the 165 patients (3.6%), CT scans revealed an incomplete partition of the cochlea (IP-1 and IP-2), in isolation or combined with an enlarged vestibular aqueduct (EVA) anomaly. Sequencing of the SLC26A4, FOXI1, and KCNJ10 genes was performed in these six patients. In the SLC26A4 gene, we identified four variants, namely c.85G>C p.(Glu29Gln), c.757A>G p.(Ile253Val), c.2027T>A p.(Leu676Gln), and c.2089+1G>A (IVS18+1G>A), which are known as pathogenic, as well as c.441G>A p.(Met147Ile), reported previously as a variant with uncertain significance. Using the AlphaFold algorithm, we found in silico evidence of the pathogenicity of this variant. We did not find any causative variants in the FOXI1 and KCNJ10 genes, nor did we find any evidence of digenic inheritance associated with double heterozygosity for these genes with monoallelic SLC26A4 variants. The contribution of biallelic SLC26A4 variants in patients with IP-1, IP-2, IP-2+EVA, and isolated EVA was 66.7% (DFNB4 in three patients, Pendred syndrome in one patient). Seventy-five percent of SLC26A4-biallelic patients had severe or profound HL. The morphology of the inner ear anomalies demonstrated that, among SLC26A4-biallelic patients, all types of incomplete partition of the cochlea are possible, from IP-1 and IP-2, to a normal cochlea. However, the dominant type of anomaly was IP-2+EVA (50.0%). This finding is very important for cochlear implantation, since the IP-2 anomaly does not have an increased risk of “gushers” and recurrent meningitis. Full article

Poyang Lake is the largest freshwater lake in China and is characterized by significant intra-annual variation, with higher water levels and area in the wet season compared to the dry season. However, the effects of the seasonal variation in Poyang Lake on the local weather are still not well-recognized. With the help of the weather research and forecasting (WRF) model, we designed one control experiment (CTL) using the default Poyang Lake level and area data and two sensitivity experiments, EXPT1 and EXPT2, the former representing the higher lake level and the greater area of Poyang Lake in the wet season and the latter representing the lower lake level and the smaller area of Poyang Lake in the dry season, to assess how these changes affect the local weather. The results of EXPT1 show that, as the lake’s level and area increase, the latent heat flux (LH), the sensible heat flux (SH), and the land surface temperature (LST) in the lake area decrease compared to those of the CTL. Meanwhile, the planetary boundary layer height (PBL), the convective available potential energy (CAPE), the wind speed, and the vapor flux over the lake decrease as well, indicating increased atmospheric stratification stability and resulting in a domain-averaged decline in precipitation of −22.3 mm. However, the low lake level and less area in EXPT2 show increasing SH, LST, PBL, and wind speed, and decreasing LH and CAPE compared to those of the CTL. The increasing SH and weakened atmospheric stratification stability in EXPT2 cause a significantly higher wind speed over the eastern part of the lake. As a result, more water vapor is transported to the east side of the lake by westerly upper winds, leading to a decreasing precipitation on the western side of the lake and a slightly increasing precipitation on the eastern side, resulting ultimately in a domain-averaged decline in precipitation of −23.8 mm in the simulation of the low level and less area of Poyang Lake. Although the LH and CAPE decline both in EXPT1 and EXPT2, the main cause is the higher water thermal capacity and lower lake-surface temperature with more lake water for EXPT1 and the lower evaporation with less lake water for EXPT2. Overall, a deeper and larger Poyang Lake will reduce the local temperature, inhibit water evaporation from the lake surface, and make the near-surface atmosphere more stable, resulting in restrained local precipitation. A shrinking lake level and area will raise the local temperature and the instability of the near-surface atmosphere but reduce water vapor and enlarge local wind and circulation, resulting in declining precipitation and a changing fall zone. Full article

Barhal Valley belongs to the Çoruh Valley System in the Kaçkar Mountains of northeastern Anatolia. This 13 km long valley is located to the south of the main weather divide and to the east of Mt. Kaçkar, with the highest peak of the mountain range being 3932 m. Today, source of an average yearly precipitation of 2000 mm of moisture is the Black Sea, situated approximately 40 km to the north of the study site. Glaciers of the Last Glacial Maximum (LGM) descended directly from Mt. Kaçkar and reached an altitude of ca. 1850 m a.s.l. (above sea level). In this study, we are exploring whether the position of Barhal Valley to the south of the main weather divide and its east–west orientation have an influence on the existence and expansion of paleoglaciers. Here, we present 32 new cosmogenic ³⁶Cl dates on erratic boulders from the Çoruh Valley System. We reconstructed three geomorphologically well-contained glacier advances in the Barhal Valley, namely at 34.0 ± 2.3 ka, 22.2 ± 2.6 ka, and 18.3 ± 1.7 ka within the time window of the global LGM. Field evidence shows that the glacier of the 18.3 ± 1.7 ka advance disappeared rapidly and that by the latest time, at 15.6 ± 1.8 ka, the upper cirques were ice-free. No evidence for Lateglacial glacier fluctuations was found, and the Neoglacial activity is restricted to the cirques with rock glaciers. A range of 2700 to 3000 m for the Equilibrium Line Altitude (ELA) at the LGM was reported based on modeling of the glacial morphology. We determined that the most likely position of the LGM ELA in the Çoruh Valley System was at 2900 m a.s.l. We suggest an alternative moisture source to the direct transport from the Black Sea for the ice accumulation in the Eastern Black See Mountains. The shift of the Polar Front and of the Siberian High Pressure System to the south during the LGM resulted in the domination of easterly airflow to the Caucasus and Kaçkar Mountains with moisture from expanded lakes in central–western Siberia and from the enlarged Aral- and Caspian Seas. Full article

Since the enlargement of the European Union, the CEE (Central and Eastern European) countries have brought a larger share of agricultural and forest land with high potential for biomass and bioenergy. The progress of bioeconomy is intercorrelated with the dimension of agriculture, which is the major provider of biomass for food and feed and for other bio-based industries. This research aims to assess the dimension of agriculture-based and food-based bioeconomy, with focus on the production and use of biomass. Conducted over the 2008–2019 period with data from the EU and OECD, the study pointed out the role of CEE countries in the European bioeconomy. Thus, we estimated that the bioeconomy market reached, in 2019, a turnover of almost EUR 324 billion (around 14% of the EU level), respectively, EUR 79 billion from agriculture-based sectors and EUR 116.8 billion from food-based sectors. The number of employees has decreased; in 2019, in bioeconomy sectors were employed 6.9 million people (almost 40% of the EU bioeconomy employment). Regarding the production of biomass, the study has revealed an increase of the share in EU production from 25.7% in 2008 to 27.8% in 2019, due to a growth of biomass by 7.1%. With this study, we emphasize the need to support more sustainable demand of biomass and to make the bioeconomy market more competitive. In addition, we point out several problems of the bioeconomy sector, such as insufficient data, low productivity, and the unused or underused sources of biomass. Full article

Species conservation actions are guided by available information on the biogeography of the protected species. In this study, we integrated the occurrence data of Siberian musk deer (Moschus moschiferus L.) collected from 2019 to 2021 with species distribution models to estimate the species’ potential distribution in Northeast China. We then identified conservation priority areas using a core-area zonation algorithm. In addition, we analyzed core patch fragmentation using FRAGSTATS. Lastly, we identified potential connectivity corridors and constructed a potential protection network based on the least-cost path and the circuit theory. The results showed concentrations of M. moschiferus in the northern Greater Khingan Mountains, the southeastern Lesser Khingan Mountains, and the eastern Changbai Mountains, with a potential distribution area of 127,442.14 km². Conservation priority areas included 41 core patches with an area of 106,306.43 km². Patch fragmentation mainly occurred in the Changbai Mountains and the Lesser Khingan Mountains. We constructed an ecological network composed of 41 core patches and 69 linkages for M. moschiferus in Northeast China. The results suggest that the Greater Khingan Mountains represent the most suitable area to maintain the stability of M. moschiferus populations in Northeast China. Considering the high habitat quality requirements of M. moschiferus and its endangered status, we propose that the Chinese government accelerates the construction of the Greater Khingan Mountains National Park and the Lesser Khingan Mountains National Park and enlarges the Northeast China Tiger and Leopard National Park to address the fragmentation of protected areas and the habitat of M. moschiferus. Full article

The Pilot-Mission Exploitation Platform (Pi-MEP) for salinity is an ESA initiative originally meant to support and widen the uptake of Soil Moisture and Ocean Salinity (SMOS) mission data over the ocean. Starting in 2017, the project aims at setting up a computational web-based platform focusing on satellite sea surface salinity data, supporting studies on enhanced validation and scientific process over the ocean. It has been designed in close collaboration with a dedicated science advisory group in order to achieve three main objectives: gathering all the data required to exploit satellite sea surface salinity data, systematically producing a wide range of metrics for comparing and monitoring sea surface salinity products’ quality, and providing user-friendly tools to explore, visualize and exploit both the collected products and the results of the automated analyses. The Salinity Pi-MEP is becoming a reference hub for the validation of satellite sea surface salinity missions by providing valuable information on satellite products (SMOS, Aquarius, SMAP), an extensive in situ database (e.g., Argo, thermosalinographs, moorings, drifters) and additional thematic datasets (precipitation, evaporation, currents, sea level anomalies, sea surface temperature, etc.). Co-localized databases between satellite products and in situ datasets are systematically generated together with validation analysis reports for 30 predefined regions. The data and reports are made fully accessible through the web interface of the platform. The datasets, validation metrics and tools (automatic, user-driven) of the platform are described in detail in this paper. Several dedicated scienctific case studies involving satellite SSS data are also systematically monitored by the platform, including major river plumes, mesoscale signatures in boundary currents, high latitudes, semi-enclosed seas, and the high-precipitation region of the eastern tropical Pacific. Since 2019, a partnership in the Salinity Pi-MEP project has been agreed between ESA and NASA to enlarge focus to encompass the entire set of satellite salinity sensors. The two agencies are now working together to widen the platform features on several technical aspects, such as triple-collocation software implementation, additional match-up collocation criteria and sustained exploitation of data from the SPURS campaigns. Full article