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Inicio Cirugía Española (English Edition) Postoperative Complications and Survival Rate of Esophageal Cancer: Two-period A...
Cirugía Española, an official body of the Asociación Española de Cirujanos (Spanish Association of Surgeons), will consider original articles, reviews, editorials, special articles, scientific letters, letters to the editor, and medical images for publication; all of these will be submitted to an anonymous external peer review process. There is also the possibility of accepting book reviews of recent publications related to General and Digestive Surgery. The articles published in Cirugía Española can be found summarised and indexed in Science Citation Index Expanded, Journal Citation Reports, Index Medicus/MEDLINE, Scopus, EMCare, Scirus, IBECS and IME.
Index Medicus/Medline, IBECS, IME
Vol. 96. Issue 8.
Pages 473-481 (October 2018)
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Statistical study
Authorship/collaborators
DOI: 10.1016/j.cireng.2018.09.012
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Postoperative Complications and Survival Rate of Esophageal Cancer: Two-period Analysis
Complicaciones postoperatorias y supervivencia del cáncer de esófago: análisis de dos periodos distintos
Gregorio Isaías Moral Moral
gregoriomoral@gmail.com
, Mar Viana Miguel, Óscar Vidal Doce, Rosa Martínez Castro, Romina Parra López, Alberto Palomo Luquero, María José Cardo Díez, Isabel Sánchez Pedrique, Jorge Santos González, Jesús Zanfaño Palacios
Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Burgos, Burgos, Spain
Table 1. Esophagectomies: Characteristics and Complications (Clavien–Dindo>II).
Table 2. Complications of Esophagectomies According to the Low Classification.
Table 3. Prognostic Factors for Complications of Esophagectomies (Clavien–Dindo>II).
Table 4. Esophagectomies: Prognostic Factors for Survivala
Nowadays, treatment of esophageal cancer requires a multidisciplinary approach, in which esophagectomy remains the mainstay. The aim of this report is to assess whether multimodal treatment and minimally invasive surgery have led to a lower morbidity rate and an improvement in survival rates.
Retrospective evaluation of 318 patients diagnosed with esophageal cancer including 81 esophagectomies. The periods of 2000–2007 and 2008–2015 were compared, analyzing the prognostic factors that may have an impact in morbidity and survival rate.
Major postoperative complications according to the Clavien–Dindo classification accounted for 35%, showing a decrease between the 1st and 2nd period: 41% morbidity vs 30%, 27% mortality vs 9% (P<.001) and 13.5% fistulas vs 7%. The implementation of thoracoscopic esophagectomy contributed to the outcome improvement, as shown by 19% morbidity and 5% mortality rates, with triangularized mechanical anastomosis showing 9% fistula and 5% stenosis. The overall 5-year survival rate was 19%, with a significant increase from 11% in the 1st period to 28% in the 2nd (P<.001).
Multidisciplinary assessment of patients with esophageal cancer, as well as better selection and indication of treatment and the introduction of new minimally invasive techniques (thoracoscopy and triangularized mechanical anastomosis), have improved the morbidity and mortality rates of esophagectomies, resulting in increased survival rates of these patients.
Thoracoscopic esophagectomy
Hybrid minimally invasive esophagectomy
Mechanical cervical triangular anastomosis
Prognostic factors
Actualmente el tratamiento del cáncer de esófago requiere un enfoque multidisciplinar en el que la esofaguectomía sigue siendo su pilar básico. El objetivo del estudio es analizar si el tratamiento multimodal y la introducción de nuevas técnicas quirúrgicas menos invasivas ha supuesto una disminución de las complicaciones de la esofaguectomía y una mayor supervivencia del cáncer de esófago.
Estudio retrospectivo de 318 pacientes con cáncer de esófago que incluyen 81 esofaguectomías. Se comparan los periodos 2000-2007 y 2008-2015 y se analizan los factores pronósticos que pueden influir en las complicaciones y supervivencia.
Las complicaciones postoperatorias mayores según la clasificación de Clavien-Dindo fueron globalmente 35%, mostrando una disminución entre el 1.° y 2.° periodo: 41% de morbilidad vs 30%, 27% de mortalidad vs 9% (p < 0,001) y 13,5% de fístulas vs 7%. La incorporación de la esofaguectomía toracoscópica con 19% de complicaciones y 5% de mortalidad y la anastomosis mecánica triangularizada con 5% de fístulas y 9% de estenosis contribuyeron a estos resultados. La supervivencia global a los 5 años fue del 19%, con una mejoría significativa entre el 1.° y 2.° periodo: 11 vs 28% (p < 0,001).
La valoración multidisciplinar de los pacientes, con una mejor selección e indicación del tratamiento multimodal, y la introducción de nuevas técnicas quirúrgicas menos invasivas y más depuradas, como la toracoscopia y la anastomosis mecánica triangularizada, se ha traducido en una disminución de la morbimortalidad de las esofaguectomías y en un aumento significativo de la supervivencia de los pacientes con CE.
Esofaguectomía
Esofaguectomía toracoscópica
Esofaguectomía mínimamente invasiva híbrida
Anastomosis cervical mecánica triangularizada
Factores pronósticos
In recent decades, we have witnessed a rapid increase in adenocarcinoma (ADC) of the distal esophagus with a decrease in squamous cell carcinoma (SCC) of the mid-esophagus in western countries.1 Five-year survival of esophageal cancer (EC) remains low, with a global average2 of 10%–20% and 30% after resection.3 However, due to advances made in multimodal treatment4 and surgical technique,5 current rates have reached 40%–57% in esophagectomies. As part of multimodal therapy, esophagectomy is the basic pillar for the treatment of locoregional EC.2 Nonetheless, there continues to be a high rate of major complications (40%–60%)6,7 and a significant risk of mortality (8%–23%)8 depending on the surgical volume of the hospital, although this has been reduced to <2%9 in highly specialized hospitals.
Given the complexity of EC treatment, the assessment of these patients by a multidisciplinary tumor board (MTB) is very useful for better patient selection and correct indication of multimodal treatment.10,11 The creation of Esophageal-Gastric Surgery Units and the application of less invasive surgical techniques, such as thoracoscopy,12 have been able to reduce the morbidity and mortality of this challenging surgery.
The main objective of this study is to retrospectively analyze patients diagnosed with EC at our hospital in order to determine whether current multimodal treatment, with the application of neoadjuvant therapy and the introduction of new less invasive and more refined surgical techniques, such as thoracoscopy and triangulating stapled anastomosis, have been a benefit to reduce complications and increase survival.
MethodsPatients and Methods
We conducted a retrospective study of patients diagnosed with squamous EC at our hospital from 2000 to 2015. Twenty-nine patients were excluded from the study due to lack of pathology confirmation, 11 due to lack of CT, and 8 due to follow-up <1 year. The study included a total of 318 patients with adenocarcinoma, squamous cell carcinoma or undifferentiated carcinoma of the carcinoma, including Siewert type I.
Esophagectomy was performed in 89 patients. In order to establish homogeneous groups with similar postoperative risks and a minimum number of patients, excluded from the study were 4 gastrectomies with distal esophagectomy (whose risk of complications is similar to total gastrectomy and not esophagectomy), 2 esophagectomies performed in two operations and without reconstruction due to early cancer recurrence, and 2 esophagectomies using left thoracotomy. Thus, 81 patients remained with standard esophagectomies for the analysis of complications.
The patients were divided into two 8-year periods, coinciding with the formation in 2008 of the Esophageal-Gastric Surgery Unit and the MTB: 2000–2007 (Period 1) with 157 patients; and 2008–2015 (Period 2) with 161. The observation time was until March 2017, with an average follow-up time of 20 months (0.1–205).
Preoperative characteristics were analyzed, while comorbidity, surgical technique, complications and survival were studied in detail. For the study of possible prognostic factors for complications and survival, the different variables were correlated by univariate and multivariate analyses.
All patients underwent barium swallow testing, endoscopy, biopsy, CT scan and, since 2008, endoscopic ultrasound. If the CT was inconclusive, PET was ordered; if the tumors were of the middle third, bronchoscopy was used.
Since 2008, the MTB have evaluated all cases of EC. Based on the extension study results (TNM-7th Edition),13 the following approaches were indicated14: "limited disease" (≤T2/N0/M0), indication for direct surgery; "locally advanced disease" (T3–4/y/o/N+, M0), candidate for neoadjuvant therapy and re-evaluation with CT/PET with subsequent esophagectomy; and "metastatic disease" (M1), chemotherapy or support measures. Neoadjuvant therapy for SCC consisted of preoperative chemotherapy, mainly TPF (docetaxel/cisplatin/5-fluorouracil) with concomitant radiotherapy (45–50, 4Gy), followed by esophagectomy 4–6 weeks later; for ADC, perioperative chemotherapy was used (based on a doublet or triplet combination of platinum/fluoropyrimidines/taxanes) with the possibility of postoperative radiotherapy if R1/2 or N+.
Prior to 2008, esophagectomy was performed if there was no preoperative evidence of metastatic disease or involvement of unresectable organs. Adjuvant therapy (similar regimen of doublets or triplets with postoperative radiotherapy) was indicated when the pathological anatomy confirmed a locally advanced stage.
The procedures were performed by two surgeons of the unit, currently G.M. and M.V. The standard esophagectomy techniques used were: right transthoracic (Ivor-Lewis), tri-incisional (McKeown), transhiatal (Orringer) and, in recent years, hybrid minimally invasive esophagectomy (hybrid MIE)15 using right thoracoscopy in prone position, laparotomy and cervicotomy. The lymphadenectomy performed in the transthoracic and thoracoscopic esophagectomy was standard two-field, and in the transhiatal it was considered incomplete in the thoracic region.
Narrow gastroplasty with pyloroplasty were usually performed, except for 4 coloplasties in patients whose stomach could not be used. The anastomosis at the mediastinum was supra-azygos, with circular mechanical suture (end-to-side). In the cervical region, various techniques were used, generally mechanical. Currently, the standard anastomosis we use is the totally mechanical triangulating method (end-to-side) by Singh,16 which we performed with an endostapler (60×3.5) by means of a suture on the posterior side and two cross-linked sutures on the anterior side. A feeding jejunostomy was routinely created.
Comorbidity is expressed by the Charlson comorbidity index, adjusted for age17 (CCI+A) and slightly modified,18 excluding EC itself and metastases from the comorbidities, and accepting for a score: myocardial infarction, congestive heart failure (CHF), peripheral vascular, cerebrovascular, chronic pulmonary, connective tissue or benign liver disease, peptic ulcer, diabetes without organ involvement, and dementia=1; hemiplegia, moderate/severe renal disease, diabetes with organ involvement, other active cancers=2; moderate/severe liver disease=3; AIDS=6; <50 years=0; 50–59=1; 60–69=2; 70–79=3; 80–89=4; ≥90=5. The CCI+A was divided into three grades19: low (0–2), medium (3–4) and high (≥5) risk.
Postoperative complications are described according to the Clavien–Dindo classification,20 considering major the following degrees21: III (endoscopic, radiological or surgical intervention with/without general anesthesia), IV (ICU admission due to single/multiple organ failure) and V (death), and also by the international consensus classification by Low.22,23 Both morbidity and mortality were considered during the total post-operative period (in-hospital), even if there was re-admission shortly after discharge (90 days). The survival studied was cancer-specific, assessing the period of time from diagnosis until death of the patient that was esophageal cancer-related. For patients who died from other causes that were not related to esophageal cancer, their follow-up observations until exiting the study were taken into consideration.
For the descriptive analysis of the qualitative variables, we used the number and percentage, and for the quantitative variables the mean, standard deviation and range. The study of the prognostic factors of the complications was carried out by means of a univariate analysis for hypothesis contrast with the Chi-square test, and the variables with a significant tendency were analyzed according to a multivariate logistic regression model, adjusted by the Hosmer–Lemeshow test, to determine the independent contribution of each. Survival was calculated according to the Kaplan–Meyer method, conducting the univariate analysis with the Log-Rank test and the multivariate analysis using Cox regression.
The statistically significant P-value as well as the confidence interval of the odds ratio was 95% (P<.05). The analysis of the data was done with the SPSS for Windows version 21.0 (Chicago, Illinois, USA).
Out of the 318 patients, 294 (92.5%) were men and 24 (7.5%) women, with an average age of 65 years (34–87) and no significant differences in either period. The majority were SCC, 228 (71.8%), 80 adenocarcinomas (25.2%) and 10 undifferentiated carcinomas (3.1%). There was a non-significant increase (P=.507) of adenocarcinomas in Period 2: 45 patients (28%) compared to 35 (22.3%) in Period 1. The locations were 23 cervical (7.2%), 32 upper thoracic third (10.1%), 130 mid-thoracic third (40.9%), 127 lower third (39.9%) and 6 multicentric (1.9%). In Period 2, the location in the lower third increased to 68 patients (42.2%), compared to 59 (37.6%) in Period 1, with no significant value. Barrett's esophagus had a lower incidence in Period 2, with 18 (11.2%), compared to 28 (17.8%) in Period 1.
Staging was clinical (cTNM) in 225 patients who were not resected, pathological (pTNM) in 76 who were resected without prior neoadjuvant therapy and pre-neoadjuvant clinical (cTNM) in 17 patients who underwent esophagectomy after neoadjuvant therapy, because it more precisely reflects the advanced nature of the disease than the post-neoadjuvant pathological (ypTNM). The distribution by stages was as follows: Stage 0, 2 patients (0.6%); Stage I, 29 (9.1%); Stage II, 28 (8.8%); Stage III, 172 (54.1%); and Stage IV, 87 (27.4%). There were no significant differences in either period (P=.373).
The tumor was resected in 93 patients (29.2%): 4 endoscopically and 89 by total or partial esophagectomy. The tumor was not resected in 179 cases (56.3%), but these patients were treated with chemotherapy and/or radiotherapy with different therapeutic intentions. The tumors of 46 patients (14.5%) were not resected, and these individuals only received supportive care.
The characteristics of the 81 standard esophagectomies and the major complications of the Clavien–Dindo classification are shown in Table 1. In Period 2, more transhiatal esophagectomies were performed (and, consequently, more incomplete lymphadenectomies) in an attempt to avoid the serious complications of transthoracic esophagectomy, as the introduction of the thoracoscopic approach was progressive. Table 2 demonstrates the complications according to the standardized Low classification. Out of the 8 anastomotic leaks (10%), 7 were type II fistulae, with no need for surgical treatment; the remaining one was due to a necrosis of the plasty (type III), treated by resection and esophageal exclusion, despite which the patient died a few days after the reoperation. Fourteen patients (17%) died as a result of the intervention: one intraoperatively, due to intractable bleeding during transhiatal esophagectomy, and 13 (16%) in the immediate postoperative period. Six patients (7%) were re-operated, 4 of them due to acute complications: one aforementioned necrosis of the plasty, one tracheal fistula treated with pleuroplasty, one chylothorax (type IIIB) with ligation of the thoracic duct and one abdominal abscess with drainage. Two patients were re-operated later due to bowel obstruction and eventration. There were 6 recurrent lesions (7%), all of them transient type I with no need for ENT surgery, and 11 anastomotic stenoses (14%) requiring several endoscopic dilatations.
Esophagectomies: Characteristics and Complications (Clavien–Dindo>II).
Global 2000–2015 (n=81)
Period 1 2000–2007 (n=37)
n(%)
Sex .237
Males 74(91) 32(86.5) 42(95.5)
Females 7(9) 5(13.5) 2(4.5)
Mean agea±SDb(range) 63±10 (39–81) 63±9 (45–79) 62±11 (39–81) .651
Stage .541
Stage 0/I 21(26) 7(19) 14(32)
Stage II 13(16) 7(19) 6(14)
Stage III 44(54) 22(60) 22(50)
Stage IV 3(4) 1(3) 2(6)
ASA .102
ASA I 15(19) 9(24) 6(14)
ASA II 44(54) 22(60) 22(50)
ASA III 22(27) 6(16) 16(36)
Comorbidity (Charlson+age) .684
Mean index (range) 2.9 (0–8) 2.7 (0–7) 3.1 (0–8)
Esophagectomies <.001
Transthoracic (Ivor-Lewis) 23(28) 22(59.5) 1(2)
Tri-incisional (Mckeown) 10(12) 5(13.5) 5(11)
Transhiatal (Orringer) 27(33) 9(24) 18(41)
Thoracoscopic (hybrid MIE)c 21(26) 1(3) 20(45.5)
Anastomosis (80)d <.001
Circular mechanical, CEEA 22(27.5) 21(57) 1(2)
Mechanical terminalized side-to-side 6(7.5) 2(5) 4(9)
Manual componente 9(11) 7(19) 2(5)
Triangulating mechanical 43(54) 7(19) 36(84)
Lymphadenectomy .243
Standard 2-field 53(65) 27(73) 26(59)
Incomplete 28(35) 10(27) 18(41)
Mean n lymphadenopathies (range) 11 (1–33) 9 (1–23) 12 (2–33) .300
Resectionf .407
R 0 (complete) 65(80) 28(76) 37(84)
R 1/2 (incomplete) 16(20) 9(24) 7(16)
Clavien–Dindo complications>II .353
Grade III 10(12) 5(13.5) 5(11)
Grade IVg 4(5) 0(0) 4(9)
Grade V (Exitus) 14(17) 10(27) 4(9)
Fistulae 8(10) 5(13.5) 3(7) .459
Anastomotic stenosis 11(14) 6(16) 5(11) .537
Hospital stayhmean±SDb, (range) 23±17 (8–91) 24±19 (8–91) 22±16 (10–85)
Follow-upimean±SD (range) 36±40 (0.1–205) 40±53 (0.6–205) 32±25 (0.1–98)
Age in years.
SD: standard deviation.
Hybrid MIE hybrid: esophagectomy by thoracoscopy, laparotomy and cervicotomy.
80 anastomoses were created and one patient died intraoperatively.
If one or more sides of the anastomosis was done with manual sutures.
Complete resection: R0; incomplete resection: R1 if microscopic remains, R2 if macroscopic remains.
Most patients with multiple-organ failure died, and in that case they were classified as Grade V.
Hospital stay in days.
Follow-up in months.
Complications of Esophagectomies According to the Low Classification.
Patientsawith complications 42 (52)
Respiratory 30 (37)
Pneumonia 16 (20)
Pleural effusion+drainage 16 (20)
Respiratory distress 5 (6)
Prolonged intubation 4 (5)
Empyema 1 (1)
Bronchoaspiration 1 (1)
Tracheobronchial lesion 2 (2)
Fistulae 8 (10)
Fistulae according to level of anastomosis
Cervical 5/58 (9)
Mediastinal 3/23 (13)
Fistulae according to anastomosis
Circular mechanical CEEA 3/22 (17)
Side-to-side terminalized mechanical 0/6 (0)
Manual component 3/9 (33)
Triangulating mechanical 2/43 (5)
Chylothorax 4 (5)
Other complications 21 (26)
Cardiac 1 (1)
Hemorrhage 4 (5)
Pulmonary thromboembolism 2 (2)
Multiple-organ failure 8 (10)
Sepsis 8 (10)
Intra-abdominal abscess 1 (1)
Recurrent lesion 6 (7)
Hospital mortality 14 (17)
Intraoperative 1 (1)
Postoperative 13 (16)
Mortality according to esophagectomy technique
Transthoracic (Ivor-Lewis) 7/23 (30)
Tri-incisional (Mckeown) 4/10 (40)
Transhiatal (Orringer) 2/27 (7)
Thoracoscopic (hybrid MIE) 1/21 (5)
Anastomotic stenosis (80 anastomoses) 11 (14)
Mechanical side-to-side terminalized 3/6 (50)
Reoperations 6 (7)
Early post-op 4 (5)
Late 2 (2)
One patient may have had several serious complications.
The prognostic factors for postoperative complications (Clavien–Dindo>II) are described in Table 3. Location and ASA significantly influenced the appearance of complications and comorbidity, expressed by the CCI+A, and had a very high significant value (P<.001), but only location and CCI+A were independent factors to predict complications.
Prognostic Factors for Complications of Esophagectomies (Clavien–Dindo>II).
Univariate analysis (Chi-squared)
n=81
Age .457
<50 yrs 11 2 (18)
50–70 yrs 50 19 (38)
>70 yrs 20 7 (35)
Males 74 26 (35)
Females 7 2 (29)
Histology .254
Squamous 39 16 (41)
Adenocarcinoma 42 12 (29)
Location .049
Mid-esophagus 28 14 (50)
Lower esophagus 53 14 (26)
ASA I 15 1 (7)
ASA II 44 16 (36)
ASA III 22 11 (50)
Comorbiditya .001
Low grade (0–2) 37 6 (16)
Medium grade (3–4) 26 10 (38.5)
High grade (≥5) 18 12 (67)
Stage 0/I 21 9 (43)
Stage II 13 3 (23)
Stage III 44 16 (36)
Stage IV 3 0 (0)
Neoadjuvant therapy .572
No 64 21 (32)
Yes 17 7 (41)
Esophagectomy .160
Ivor Lewis 23 8 (35)
Mckeown 10 6 (60)
Orringer 27 10 (37)
Hybrid MIEb 21 4 (19)
Periods .353
2000–2007 37 15 (41)
Multivariate analysis (logistic regression)
Variable predictor
Coefficient beta
Odds ratio (95% CI)
Lower esophagus 1
Mid-esophagus 1.523 0.591 .010 4.584 (1.440–14.599)
Charlson Index+age
Low grade 1
Medium grade 1.365 0.647 .035 3.914 (1.100–13.919)
High grade 2.766 0.749 <.001 15.898(3.661–69.039)
Charlson Index+age expressed in comorbidity grades.
Hybrid MIE: esophagectomy using thoracoscopy, laparotomy and cervicotomy.
The overall 5-year survival of the 318 patients was 19%, with a mean survival of 41 months. The most influential factor was tumor stage, as it reflected the advanced nature of the disease at the time of diagnosis: Stage 0/I, 72% 5-year survival; Stage II, 35%; Stage III, 18%; and Stage IV, 0% (P<.001). The therapeutic approach adopted, which logically is closely related to the stage, also had a very significant value: the 5-year survival for esophagectomy with curative intention was 54%, local resection (4 cases) 100%, palliative esophagectomy 0%, not resected but oncological treatment with any intention 8.5%, and not resected with only support measures 0% (P<.001). Five-year survival was 11% in Period 1, with a mean survival of 29 months, and 28% and 36 months Period 2, respectively (P<.001).
By analyzing the factors that contributed to greater survival in the 81 patients with standard esophagectomies (Table 4), we found that, in addition to stage (P=.046), perioperative oncological treatment was significant (P=.044), especially the type of resection performed (P<.001), which was the only independent factor in the multivariate analysis.
Esophagectomies: Prognostic Factors for Survivala
Univariate analysis (Kaplan–Meier)
Patients n=81
Mean months
5 yrs (%)
Log-rank P
<50 yrs 11 103 (66)
>70 yrs 20 113 (71)
Males 74 112 (55)
Females 7 86 (69)
Lower esophagus 53 132 (60)
Stage 0/I 21 134 (75)
Stage II 13 79 (45)
Stage IV 3 14 (0)
Ivor Lewis 23 93 (39)
Mckeown 10 97 (87)
MIE hybrid 21 67 (50)
Perioperative treatment .044
Adjuvant 18 53 (30)
Neoadjuvantb 17 89 (78)
Standard 2-field 53 109 (53)
Incomplete 28 81 (60)
Resection <0.001
R 0 65 135 (66)
R 1/2 16 33 (21)
Complicationsc .689
No 53 110 (56)
Yes 28 75 (53)
Multivariate analysis (Cox regression)
Hazard ratio (95% CI)
Complete vs incomplete resection
R "1/2" 1.989 0.414 <.001 7.305 (3.246–16.442)
Prognostic factors related with the probability of dying due to the evolution of esophageal cancer.
Including only patients with neoadjuvant therapy who underwent esophagectomy, excluding those who progressed rapidly and surgery was ruled out. Follow-up time was shorter than in patients with adjuvant therapy.
Clavien–Dindo complications>II.
The epidemiology of EC is changing in western countries, with an increase in ADC located in the distal esophagus and a decrease in SCC located in the mid-upper esophagus.1 The causes are not well known, but a correlation has been suggested with increased gastroesophageal reflux disease, Barrett's esophagus and obesity.1,2 Our data confirm this progressive trend, reaching 44% distal ADC and 60% distal EC in 2015, but have not been able to associate it with the increased incidence of Barrett's esophagus. The technique and approach of esophagectomies are continuously being debated to try to reduce the complications of this complex surgery. In our country, groups24,25 that advocate the use of minimally invasive esophagectomy have delighted many esophagogastric surgeons by demonstrating that thoracoscopy is a possible and safe approach. Currently, there is a trend favoring intrathoracic anastomosis in distal EC using the Ivor-Lewis technique with MIE,9,26,27 avoiding cervical anastomosis, with the justification that it is not necessary for oncological criteria to resect the entire esophagus, decreasing recurrent lesions and fistulae. This may be true, but in our opinion performing the mediastinal anastomosis by MIE is complex and not without complications. Robotic surgery28 is an alternative, although its availability and the operative time required limit its use. We think that it is fundamental in CE surgery to avoid the serious complications of esophagectomy, due in large part to thoracotomy, and that thoracoscopy has many advantages, especially in reducing respiratory complications,11,24 which are the main cause of death in this surgery.29,30 Abdominal time with the open approach (hybrid MIE) makes it easier to perform a large Kocher maneuver to obtain a gastroplasty long enough to reach the neck, a pyloroplasty and a feeding jejunostomy. Cervical triangulating stapled anastomosis16 has been confirmed as a very safe technique that minimizes the manipulation of the ends used to create the anastomosis, which is the main cause of fistulae due to the precarious vascularization of the plasty, and provides a wide anastomotic surface resulting in few cases of postoperative stenosis.16,31
It is necessary to define the postoperative complications in an objective and comparable manner in order to evaluate the results of the surgery. The morbidity of esophagectomies is usually reported as major complications of the Clavien–Dindo classification.17,21 Following this criterion, out of the 81 esophagectomies analyzed, 28 (35%) had major complications, leading to exitus in 14 (17%). This classification of complications, based on the therapeutic effort necessary to treat them, has been proven useful and objective in retrospective studies, but it does not include all the serious complications that actually occur in esophagectomies; therefore, it must be complemented with the standardized classification by Low.22,23 According to this classification, we had 42 patients (52%) with serious complications, the most frequent of which were respiratory complications (30; 37%) and fistulae (8; 10%). If no invasive treatment measures are required, some may not be considered major complications in the Clavien–Dindo classification, as it actually minimizes the morbidity of an operation as complex as esophagectomy. When studying the factors that can influence the complications of esophagectomies, we found that only the location (P=.049) and comorbidity (P<.001), expressed by the CCI+A, had significant independent values. The correct indication of an esophagectomy in a patient with EC is essential because, although a reduction in mortality has been achieved, morbidity remains very high.6,7,29 For this reason, multiple scales have been developed to assess surgical risk, the most accepted of which is Charlson's age-adjusted scale.32 CCI + A is an objective criterion to consider when indicating esophagectomy,18 and postoperative clinical pathways33 are also very useful.
The surgical technique and approach influenced the complications, although not at a significant level in our study (P=.160): out of the 21 hybrid thoracoscopic esophagectomies, 4 (19%) had major complications and only one (5%) died compared to 35% complications in the Ivor-Lewis study and 60% reported by Mckeow. The type of anastomosis at the cervical level also influenced the appearance of fistulae and stenosis: out of the 43 triangulating mechanical anastomoses, 2 (5%) presented fistulae and 4 (9%) had postoperative stenosis, compared to 33% and 11%, respectively, with the manual technique.
The 5-year overall survival of the 318 patients was 19%, similar to publications by other authors.2 This is evidence of the aggressiveness of EC, which in most cases is detected in advanced stages.2,34 Age, histological type and, logically, the stage and therapeutic approach used significantly influenced survival. However, the period analyzed was also a factor: 28% 5-year survival in Period 2 compared to 11% in Period 1 (P<.001). It is difficult to demonstrate which changes contributed to this improvement, but multidisciplinary assessment and better patient selection for multimodal treatment were among the modifications that had been made.
The factors that significantly influenced the survival after esophagectomy, in addition to the stage, were the perioperative treatment and the type of tumor resection that was performed. Neoadjuvant therapy provided surprisingly good results, with a 78% 5-year survival rate versus 30% with adjuvant therapy (P=.044). We believe that these results, although true, are not valid for comparing adjuvant vs neoadjuvant treatment due to selection bias since several patients, who were initially indicated neoadjuvant therapy, presented disease progression before being able to perform surgery and therefore could not be included in this survival analysis, which includes only esophagectomies. In addition, the follow-up time for patients with neoadjuvant therapy was shorter than the follow-up of patients with adjuvant therapy. There are several patients in the first group with disease recurrence who would probably have died from EC given a longer observation time. Complete tumor resection (R0) reached a 5-year survival rate of 66%, versus 21% in incomplete resections (P<.001), and in the multivariate analysis it was the only independent protective factor. The main benefit of neoadjuvant treatment35 is to achieve a higher rate of complete resections and avoid esophagectomies in patients who were likely to progress anyway.
Currently the real issue to achieve greater survival in EC is not the surgical technique (except as a means to avoid morbidity and mortality), but instead multimodal treatment.36 Chemotherapy37 with specific therapeutic targets (HER2 and EGFR), immunotherapy and radiotherapy with protons,38 increasingly selective and with less damage to the surrounding tissues, are important fields of future research.
The main inconsistencies of our study are due to the fact that it is a retrospective analysis with non-randomized groups, analyzing long periods of time with different treatment regimens and follow-up times. This, as we saw earlier, may give inconclusive results. The general group of 318 patients with EC is not small, but the number of esophagectomies analyzed (81) is, and the subgroups are even smaller. In conclusion, we believe that this study, despite its methodological limitations, may be useful to confirm that the multidisciplinary assessment of patients with EC, with better selection and indication for multimodal treatment, and the introduction of new less invasive, refined surgical techniques, such as thoracoscopy and triangulating mechanical anastomosis, result in reduced esophagectomy morbidity and mortality and in a significant increase in the survival of patients with EC.
Main researcher: G.I. Moral Moral, study design, data collection, analysis and interpretation of the results, article composition, critical review and approval of the final version
Secondary researchers: M. Viana Miguel, O. Vidal Doce, R. Martínez Castro, R. Parra López, A. Palomo Luquero, M.J. Cardo Díez, I. Sánchez Pedrique, J. Santos González, J. Zanfaño Palacios: study design, data collection, analysis and interpretation of the results, article composition, critical review and approval of the final version.
The authors have no conflict of interests to declare.
Dr. José Cordero Guevara, healthcare technician at the Primary Care Administration in Burgos, Spain (Gerencia de Atención Primaria), for his assistance in the statistical analysis of the study.
Dr. Ana López Muñoz of the Medical Oncology Department and Dr. Eva Corrales García of the Radiotherapeutic Oncology Department, for their continued participation in the Multidisciplinary Digestive Tumor Committee at the Hospital Universitario de Burgos.
Dr. Juan Luís Seco Gil, former Director of the General Surgery Department, for his decisive contribution to the training and development of the Esophagogastric Surgery Unit and the Multidisciplinary Digestive Tumor Committee at the Hospital Universitario de Burgos.
Dr. José L. Elorza Orúe, Dr. José I. Asensio Gallego and Dr. Santiago Larburu Etxaniz of the Hospital de Donostia in San Sebastián for their instruction in thoracoscopic surgery for esophageal cancer.
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F. Lordick, C. Mariette, K. Haustermans, R. Obermannová, D. Arnol, on behalf of the ESMO guidelines committee.
Oesophageal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up.
Ann Oncol, 27 (2016), pp. 50-57
S.N. Mokanu, M.C. Balagué, E.M. Targarona, M. Roque, M. Trias.
La influencia del tipo de abordaje torácico sobre el desarrollo de complicaciones respiratorias tras la esofaguectomía.
D. Singh, R.H. Maley, T. Santucci, R.S. Macherey, S. Bartley, R.J. Weyant, et al.
Experience and technique of stapled mechanical cervical esophagogastric anastomosis.
M. Charlson, T.P. Szatrowski, J. Peterson, J. Gold.
Validation of a combined comorbidity index.
J Clin Epidemiol, 47 (1994), pp. 1245-1251
L. Backemar, P. Lagergren, A. Johar, J. Lagergren.
Impact of co-morbidity on mortality after oesophageal cancer surgery.
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R.F. Goldberg, S.P. Bowers, M. Parker, J.A. Stauffer, H.J. Asbun, C.D. Smith.
Technical and perioperative outcomes of minimally invasive esophagectomy in the prone position.
Surg Endosc, 27 (2013), pp. 553-557
D. Dindo, N. Demartines, P.A. Clavien.
Classification of surgical complications. A new proposal with evaluation in a cohort of 6336 patients and results of a survey.
A.J.E. Seely, J. Ivanovic, J. Threader, A. Al-Hussaini, D. Al-Shehab, T. Ramsay, et al.
Systematic classification of morbidity and mortality after thoracic surgery.
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D.E. Low, D. Alderson, I. Cecconello, A.C. Chang, G.E. Darling, X.B. D'Journo, et al.
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M. Pera, D.E. Low.
Consenso para definir y dar a conocer las complicaciones de la esofaguectomía: un paso importante para la utilización de un lenguaje común.
J.L. Elorza-Orúe, S. Larburu-Etxaniz, J.I. Asensio-Gallego, J.M. Enríque-Navascués, M. Echeniquez-Elizondo.
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J. Roig-García, J. Gironés-Vilà, E. Garsot-Savall, M. Puig-Costa, J. Rodríguez-Hermosa, A. Codina-Cazador.
Esofaguectomía trasnstorácica y transhiatal mediante técnicas mínimamente invasivas. Experiencia en 50 pacientes.
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Please cite this article as: Moral Moral GI, Viana Miguel M, Vidal Doce Ó, Martínez Castro R, Parra López R, Palomo Luquero A, et al. Complicaciones postoperatorias y supervivencia del cáncer de esófago: análisis de dos periodos distintos. Cir Esp. 2018;96:473–481.
Part of the information in this article was presented at the 19th Congress of the Association of Surgeons of Castilla y León, held in Burgos, Spain on June 8–9, 2017.
Copyright © 2018. AEC
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This article discusses the human consequences - labor and environmental impacts - of free trade, and the impact of possible standards for addressing those consequences.
Editor (2000) "Trends. Labor and Environmental Standards and Human Welfare: Global Prescriptions," International Bulletin of Political Psychology: Vol. 8 : Iss. 9 , Article 6.


I saw a lot of club XP up.
there is an order? or a request to make?
after ! I FEEL to lose my club on the PTS or Live.
Why ? because going on the pts the day after the opening I became vp of my club.
Class XP level 30. how to increase the class level 30?
should I test the class level 15 and radiant?
we will not farm 2 days so that in the end we may not be able to test.
I have a similar question. Just what are the / commands that you can use on the PTS? I cant find anything with google, and I get no responce from fellow players when I whisper or ask in global chat. I would like to try some things on the PTS, but I't impossible without having some sort of guide for what the commands are.
Please put up a list and stikkie it for the rest of us.
If you type /help it lists all the commands. It would be nice if it listed the variables as well, but at least it prints them all. I don't think there are any specific to PTS that aren't on live.
I was thinking more specifically of the command to make the class level 30. If as you say the commands listed are all in Live, then there isnt anythign there that I am looking for.


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INVALID DEPENDENCIES: The following dependencies of the DCs in this request are being marked as invalid as they refer to non-existent public parts.
We have a DC sap.com/utilities which has dependencies with other DCs.
The status of all these used DCs is in Red under Used DC section.
Thus it is resulting in Broken DC for sap.com/utilities.
Do I need to add some SC in my track ?
It seems these Dcs are not available on server.
first you have to tell us what you are doingare you creating track?you have to add dependent sc to your track and import them.
interestingly these DCs are not 700 DCs.
These are all DCs from SCAs higher than 710.
Now as mentioned you want to use 700 but these DCs are all in release higher than 700.
The SCs SAP_BUILDT, SAP-JEE and SAP_JTECHS are all 700.
Problem is that the architecture significantly changed as of 710 even most of the SCA names are different, e.g. there is no more SAP_JTECHS or SAP-JEE as of 710, and also the other way round, on 700 there is no WD-RUNTIME, and so on.
2. Trigger Restore System State (You do this in CMS webui -- Transport Studio -- Development tab -- button "Restore..." (button "Restore System State" on lower releases).
4. If you would somehow still have broken DCs (which are all higher than 710) then please attept "Initialize Compartment..." which you can trigger in the CBS webui -- Compartment View.
Maybe your buildspace needs to be re-created/re-built?
Yes, as Dao said, if the unwanted DCs are still somehow there, then delete the CBS buildspaces (both DEV and CONS) and resave the track, and do the import afterwards. This will ensure that before you do the import the CBS buildspaces are really empty, but do this only if my above suggestion would not help.


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text:
Q: Boot freeze on asus vivobook s530f nvidia mx150 on ubuntu 18.04 Computer Specs
Asus Vivobook s530f
8GB RAM DDR4
Nvidia MX150 (!)

Background
Successfully installed Ubuntu 18.04 on my computer (specs above). Secure boot off, fast boot off. Partitioned around 230GB for Ubuntu. Used minimum install and option to install 3rd party drivers.
Problem
After selecting ubuntu from three options ( ubuntu, advanced options, system setup ) appears blank screen with ubuntu color.
Boot options: nomodeset ( quiet splash doesn't make a difference )
Most of the solutions advise nomodeset but I already did that... Any help would be appreciated.
And also this laptop doesn't have a LAN port to connect to a network and install graphics drivers from grub terminal.

A: CHECK ASUS WEBSITE FOR FIRMWARE UPDATE!!!
Here is a complete video about this problem, actually for an Asus Zenbook: https://www.youtube.com/watch?v=NbxrSaclKRc
Summary of the fix:
add the boot parameter: dis_ucode_ldr to /etc/default/grub
then: update-grub
More info here: https://bugs.launchpad.net/ubuntu/+source/linux/+bug/1829620

redpajama_set_name: RedPajamaStackExchange


Peter Zoller (born 16 September 1952) is a theoretical physicist from Austria. He is Professor at the University of Innsbruck and works on quantum optics and quantum information and is best known for his pioneering research on quantum computing and quantum communication and for bridging quantum optics and solid state physics.
Peter Zoller studied physics at the University of Innsbruck, obtained his doctorate there in February 1977, and became a lecturer at their Institute of Theoretical Physics. For 1978/79, he was granted a Max Kade stipend to research with Peter Lambropoulos at the University of Southern California. In 1980, he stayed at the University of Waikato in Hamilton, New Zealand, as a researcher with the group around Dan Walls. In 1981, Peter Zoller handed in his book "Über die lichtstatistische Abhängigkeit resonanter Multiphoton-Prozesse" at the University of Innsbruck to qualify as a professor by receiving the "venia docendi". He spent 1981/82 and 1988 as Visiting Fellow at the Joint Institute for Laboratory Astrophysics (JILA) of the University of Colorado, Boulder, and 1986 as guest professor at the Université de Paris-Sud 11, Orsay. In 1991, Peter Zoller was appointed Professor of Physics and JILA Fellow at JILA and at the Physics Department of the University of Colorado, Boulder. At the end of 1994, he accepted a chair at the University of Innsbruck, where he has worked ever since. From 1995 to 1999, he headed the Institute of Theoretical Physics, from 2001 to 2004, he was vice-dean of studies. Peter Zoller continues to keep in close touch with JILA as Adjoint Fellow. Numerous guest professorships have taken him to all major centers of physics throughout the world. He was Loeb lecturer in Harvard, Boston, MA (2004) and Yan Jici chair professor at the University of Science and Technology of China, Hefei, chair professor at Tsinghua University, Beijing (2004), Lorentz professor at the University of Leiden in the Netherlands (2005), Distinguished Lecturer at the Technion in Haifa (2007), Moore Distinguished Scholar at Caltech (2008/2010) and Arnold Sommerfeld Lecturer at LMU München (2010). In 2012/13 he was "Distinguished Fellow" at the Max Planck Institute of Quantum Optics in Garching, Munich. In 2014 he has been elected as an "External Scientific Member" at the Max Planck Institute of Quantum Optics. In 2015 he held the International Jacques Solvay Chair in Physics at the University of Brussels . Since 2003, Peter Zoller has also held the position of Scientific Director at the Institute for Quantum Optics and Quantum Information (IQOQI) of the Austrian Academy of Sciences.
As a theoretician, Peter Zoller has written major works on the interaction of laser light and atoms. In addition to fundamental developments in quantum optics he has succeeded in bridging quantum information and solid state physics. The model of a quantum computer, suggested by him and Ignacio Cirac in 1995, is based on the interaction of lasers with cold ions confined in an electromagnetic trap. The principles of this idea have been implemented in experiments over recent years and it is considered one of the most promising concepts for the development of a scalable quantum computer. Zoller and his researcher colleagues have also managed to link quantum physics with solid state physics. One of his suggestions has been to build a quantum simulator with cold atoms and use it to research hitherto unexplained phenomena in high temperature superconductors. Zoller's ideas and concepts attract widespread interest within the scientific community and his works are highly cited.
Crispin Gardiner and Peter Zoller: The Quantum World of Ultra-Cold Atoms and Light Book I: Foundations of Quantum Optics, Imperial College Press, London and Singapore 2014.
Crispin Gardiner and Peter Zoller: The Quantum World of Ultra-Cold Atoms and Light Book II: Physics of Quantum Optical Devices, Imperial College Press, London and Singapore 2015.
Crispin Gardiner and Peter Zoller: The Quantum World of Ultra-Cold Atoms and Light Book III: Ultra-Cold Atoms, World Scientific, London and Singapore 2014.
Peter Zoller has received numerous awards for his achievements in the field of quantum optics and quantum information and especially for his pioneering work on quantum computers and quantum communication. These include the Willis E. Lamb Award for Laser Science and Quantum Optics (2018), Herbert Walther Award from the OSA (2016), the Wolf Prize in Physics (with Juan Ignacio Cirac) (2013), the "Hamburger Preis für theoretische Physik" (2011), the Blaise Pascal Medal in Physics (2011), The Franklin Institute's 2010 Benjamin Franklin Medal in Physics (with Juan Ignacio Cirac and David Wineland), the 2008 BBVA Foundation Frontiers of Knowledge Award, in the Basic Sciences category (ex aequo with Ignacio Cirac), the Dirac Medal (2006), the 6th International Quantum Communication Award (2006), the Niels Bohr/UNESCO Gold Medal (2005), the Max Planck Medal (2005) of the Deutsche Physikalische Gesellschaft, the Humboldt Research Award (2000), the Schrödinger Prize (1998) of the Austrian Academy of Sciences, the Max Born Award (1998) of the Optical Society of America, as well as the Wittgenstein Award (1998), Austria's highest scientific accolade, the Ludwig Boltzmann Prize (1983) of the Austrian Physical Society. In 2001, Peter Zoller became full member of the Austrian Academy of Sciences, in 2008 he was elected to the United States National Academy of Sciences and the Royal Netherlands Academy of Arts and Sciences, in 2009 to the Spanish Royal Academy of Sciences, in 2010 to the German Academy of Sciences Leopoldina, in 2012 to the European Academy of Sciences, and in 2013 to the Academia Europaea. In 2012 he has received the honorary doctorate of the University of Amsterdam.
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^ "Google Scholar Citations". Google Scholar. Retrieved 10 April 2014.
^ "The Willis E. Lamb Award for Laser Science and Quantum Optics". Physics of Quantum Electronics (PQE) conference. Retrieved 16 January 2018.
^ "The Optical Society and DPG Name Peter Zoller Winner of the 2016 Herbert Walther Award". The Optical Society. 7 December 2015. Retrieved 11 December 2015.
^ "Herbert Walther Award". The Optical Society. Retrieved 29 February 2016.
^ "Peter Zoller erhält Hamburger Preis für theoretische Physik" (PDF). University of Hamburg. Retrieved 10 April 2014.
^ "The Blaise Pascal Medals 2011". European Academy of Sciences. Retrieved 10 April 2014.
^ "Franklin Laureate Database - Peter Zoller". The Franklin Institute. Retrieved 10 April 2014.
^ "Dirac Medallist 2006". Abdus Salam International Centre for Theoretical Physics (ICTP). Retrieved 10 April 2014.
^ "2006 International Quantum Communications Award". National Institute of Information and Communications Technology. Retrieved 10 April 2014.
^ "DPG Preisträgerinnen und Preisträger 2005". Deutsche Physikalische Gesellschaft. Retrieved 10 April 2014.
^ "Max Born Award". The Optical Society. Retrieved 10 April 2014.
^ "Wittgenstein Award Laureate 1998 Univ. Prof. Dr. Peter Zoller". Wittgensteinpreis TrägerInnen Club. Retrieved 10 April 2014.
^ "Member Directory: Peter Zoller". Austrian Academy of Sciences. Retrieved 10 April 2014.
^ "Member Directory: Peter Zoller". United States National Academy of Sciences. Retrieved 10 April 2014.
^ "Foreign Members: Peter Zoller". Royal Netherlands Academy of Arts and Sciences. Retrieved 10 April 2014.
^ "Académicos Correspondientes Extranjeros". Spanish Royal Academy of Sciences. Retrieved 10 April 2014.
^ "List of Members: Peter Zoller". German Academy of Sciences Leopoldina. Retrieved 10 April 2014.
^ "Peter Zoller". The Academy of Europe. Retrieved 10 April 2014.
^ "Honorary doctorate for Prof. Peter Zoller". University of Amsterdam. Retrieved 10 April 2014.
This page was last edited on 16 March 2019, at 01:14 (UTC).


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"He's hot, I guess is the best way to say it."
Listen to this Mark Richt interview with Ivan Maisel to hear an explanation of what happened on the game-tying touchdown pass against Tennessee. Good stuff.
October 9, 2013 · 12:38 PM
(A nuanced) Fourth and Todd
To be fair to Todd Grantham, there's a more fleshed-out version of his fourth-down comment that made the rounds the other day:
"Because of our team, you're going to have some fourth-down opportunities, so you're going to have to stop them on four downs. They went for it three times on fourth-down. If we stop any of those, it's less points. In fact, if we stop the two they went for it on our side, the game is probably over because we're going to get a field goal and it's (now) a two possession game. That's the big thing: You've got to finish people off. To do that, it takes some dueling. That's where we are. We've got to learn to finish people off."
That makes some sense, honestly. The defense doesn't need to be shutdown good every play. But it needs to win enough key plays to lock a game down after the offense has done its job. The point being that you're trying to sell inexperienced players on a level of effectiveness that will win you a game. Style points don't matter.
That's probably small consolation to some. But I'll take a season full of one big stop, three-point win sort of games, regardless of the opponent, pretty or otherwise.
Beyond Logan Gray
Kirk Ferentz, burned by a Michigan State fake punt, is ready to take measures that sound both extreme and familiar (if you're a Georgia fan, at least):
"If you pressed me today, I'd say we may never return a punt again, just because when you do that, you have to turn and go with those guys to shadow them," he said. "When you do that, you open the door (to a fake). Michigan State did a pretty good job of taking advantage of it, to their credit.
"What helped us a couple of weeks ago we paid for on Saturday and cost us a field goal and a possession. So, yeah, I may be leaning towards where you never see us try to return one again. We may just try to catch it and keep it off the ground."
Maybe Richt's started a trend.
UPDATE: On a related note, catch Spencer Hall's attribution to Logan Gray in this post. LOL.
Filed under Strategery And Mechanics
"It just seems like we're kind of keeping things on edge."
Why does everybody looking at Georgia's season keep talking about their hearts?
"I may have some heart issues after this season," senior offensive guard Chris Burnette said.
Georgia's thrilling victories the past two weeks — 44-41 over LSU and 34-31 against Tennessee — haven't gone unnoticed nationally.
"Cardiac Dawgs! Dawgs!" ESPN's Pardon The Interruption Host Michael Wilbon said on Monday.
Oh, yeah. That.
I do think Lynch puts his finger on something of value from the experience, though.
"I don't know if we're going to be that team that just blows somebody out of the water," Lynch said. "I just think for us, when push comes to shove, we know how to win close ballgames. We almost pulled it out against Clemson … and we've pulled it out these past four and we'll continue to do so as long as we play within ourselves, we prepare every day in practice and we know what's coming before it hits us."
They certainly don't have everything else figured out, but they've been through enough to know what to expect and how to execute in a tight finish.
"You've got to expect every SEC game to be close, and you've got to be ready for every situation," Morgan said. "That was my first overtime situation at Tennessee, and I'm glad that we got that done."
There's something to be said for been there, done that.
You just got lesson number one: don't think; it can only hurt the ball club.
Quayvon Hicks channels his inner Crash Davis: "Thinking, that's a part of football that really doesn't matter."
Settling it in the conference room is the new settling it on the field.
Give Bill Hancock and the rest of the BCS brain trust credit for one thing: they've managed to shift the debate away from who gets picked for the playoff field to who does the picking.
Filed under BCS/Playoffs
Wednesday morning buffet
The buffet did not undergo surgery this morning.
But several Dawgs have or will.
One thing Georgia is doing very well is not turning the ball over against BCS opponents.
Mark Stoops claims to have gotten an acknowledgement from Steve Shaw that the officiating crew screwed up a call in the UK-SCar game.
Murray and Conley are spending extra time with the newbie receivers this week.
Roy Adams is one creepy dude.
That 57-yard run Aaron Murray had in the Tennessee game? Only nine quarterbacks nationally have a longer run this season and none in the Southeastern Conference.
Stephen Garcia offers some advice to everyone on Jadeveon Clowney's back.
"We've just got some young guys, and they've gotta stop playing like they're in high school and grow up," senior defensive lineman Garrison Smith said. "It ain't got nothing to do with coaching."
Filed under 'Cock Envy, Because Nothing Sucks Like A Big Orange, Georgia Football, SEC Football, Stats Geek!, The Body Is A Temple

redpajama_set_name: RedPajamaCommonCrawl


Different working principles of different metal detectors are discussed briefly discussed in the following sections. Balanced coil metal detector: The working principle of balanced coil metal detector is based on the balance of current flowing in three coils.
metal grinding in working principle metal grinding in working principle metal or singlelayer bond systems for superabrasiv Chat Now Principles of development of grinding media with increased Principles of development of grinding media with increased wear resistance. Part 2.
working principle of pneumatic grinding machines. working principle of hydraulic grinding machine CGM mining, Grinding Mills working Principle,, Metal Working. More Info working principle of a grinding machine lenins.
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BASIC PRINCIPLE OF GRINDING by. Harikesh Divedi on. December 20, We have discussed in our previous post about the working principle of milling operation, Diamond grinding wheel is also used rarely and best suited for hard non metal and non ferrous materials.
Grinding Roughs Out a New Niche Tyrolit Advoes a Patented Grinding Process for Rough and Finish Machining of Aerospace Parts. In the past, grinding has been a process that was primarily relegated to machining for final dimension accuracy and surface finish.
Grinding robots remove excess material from the surface of machined parts and products quickly and efficiently. These robots save time and production costs while improving the integrity and uniformity of each work piece.
Centreless (Centerless) Grinding Principle. It is also possible to grind small work pieces with this method. In this case, several work pieces are ground same time in the machine and high throughput can be achieved. Advantages of centreless (centerless) Grinding Machines.
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Roofer Joe to the Rescue! Heavy snow and ice dams causing havoc on your house? Don't let Mother Nature ruin your roof. Prevent damage due to heavy snow loads piled onto your roof and save on costly repairs with Snow Joe® ROOFER JOE - a handy, easy-to-use and affordable roof rake that quickly lets you remove snow, wet leaves and other debris from your roof while standing safely on solid ground. Roofer Joe Model RJ205M boasts an innovative Twist-n-Lock telescoping pole that quickly and easily adjusts from 6.2 feet to a whopping 21 feet for even greater overhead reach to quickly and safely lighten the load without the need for a ladder. And at just 5.7 lbs, Roofer Joe is ultra-lightweight, durable and easy to handle. Its oversized aluminum blade rake head measures 6-inches wide by 25-inches long for maximum clearing power with each pass. Get Equipped® for winter cleanup with Roofer Joe and defend your home when winter strikes!


Does your organisation acquire, store, process, distribute any data which can be used to identify EU citizens?
With the 26th May 2018 date looming, Digital Leaders Wales looks to explode the myths surrounding the General Data Protection Regulation.
Join us at the fabulous National Cyber Security Academy for expert speakers and welsh cakes!
Hear from our lead discussants including David Teague ICO Regional Manager (Wales) and John Davies Chair of South Wales Cyber Security Cluster as they explode the myths of GDPR.


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West Newton is a ghost town in section 30 of West Newton Township in Nicollet County, Minnesota, United States, along the Minnesota River, near New Ulm.

History
West Newton was named in part to honor James Newton, an early settler who emigrated from Kentucky, and partly to honor the steamboat West Newton, which was built in 1852 and sunk at Alma, Wisconsin, in September 1853.  The community had a post office from 1862 until 1910. Harkin's General Store is listed on the National Register of Historic Places.

Notable people
John Hubert Peschges, second Roman Catholic Bishop of the Diocese of Crookston

References

External links
Harkins Store at Minnesota River Valley
Minnesota Historic Sites: Harkin Store

Former populated places in Minnesota
Former populated places in Nicollet County, Minnesota

redpajama_set_name: RedPajamaWikipedia


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How To Fix Werfault.exe Application Error In Windows 7/8/10
By Ron Bloom Last updated Mar 15, 2020
In the Windows operating system, service or process malfunction may occur intermittently.
This is due to many factors, but the main is the pirated assembly. In this article, we will explain how to fix the WerFault.exe application error.
But beyond that, let us see what this application is and what role it plays in the system.
Users of the operating system often encounter a Werfault.exe application error and do not know how to fix it.
The first thought that occurs to a newbie is the presence of viruses on the computer. But the reason may be as in the third-party programs that were installed.
In this article, we will look at how to resolve the Werfault.exe Windows 10 application error in a few steps.
But first, you need to figure out what kind of program it is. We immediately say that the Werfault.exe application error was encountered on the Windows 7 operating system, and is found on Windows 10.
First of all, we recommend installing the latest system updates.
If we talk about the operating system Windows 7, it can help get rid of the application error without using the suggested methods.
1 Werfault.exe what is it
2 How to troubleshoot Werfault.exe application error Windows 10
3 How to disable the Werfault.exe service
Werfault.exe what is it
How to fix werfault.exe application error windows 10
The first case
The second case
How to disable the service Werfault.exe
To begin with, it will be wise to understand the application itself, because you need to know what we are dealing with.
So, Werfault.exe is a special Windows service developed directly by Microsoft. Its main task is to collect reports on all system failures that occur.
Information about them is collected in a special file on the disk and can be not only read by the user but also sent to Microsoft technical support.
Werfault.exe monitors error messages and sends error data to Microsoft. That, in turn, allows Microsoft to quickly solve problems in the operating system using the following updates.
This technology has been used since the days of the Windows Vista operating system.
It was not for nothing that at the beginning of the article we said that errors often happen because the user uses an unlicensed version of the operating system.
So, in such builds, reports are not sent (for obvious reasons) and the Werfault.exe service is unstable.
Most often, the Werfault.exe application error appears when the computer starts or when the installed programs start.
The service or process, like anyone, runs in the background and only starts if a system crashes.
She collects information about this to everyone and places it in a special report.
Often only one process works, and in this case, the load on the system is minimal.
But in some cases, several can be started at once, which leads to overloading of the central process and causes an error of the Werfault.exe application. How to eliminate it, we now will tell.
The first thing to do to troubleshoot the Werfault.exe application error on the computer is to make a diagnostic system start, which only loads the main drivers and starts the main services.
A diagnostic start is something similar to running the system in safe mode.
Run the Msconfig command in the Win + R window.
In the general tab, select the Diagnostic start item and click OK to apply the changes.
If you ask what it will give us, then everything is simple.
The next time the system is restarted, if the error of the Werfault.exe application disappears, this means that the problem lies in the installed programs.
If not, then it will be a little more difficult. Do not forget to disable diagnostic system startup in the future. So, we analyze two cases:
The error does not appear after the diagnostic system startup.
The first thing we check your operating system for viruses or malware in any way.
If you are using the latest version of the Windows 10 operating system, then you can even use Windows antivirus protection tool.
Then you need to clean the computer from the tails of remote programs. To do this, you can use specialized programs, such as CCleaner.
Next, to solve the problem, you need to remove unnecessary programs.
It should start with the ones you installed last. To do this, you can also use CCleaner or the built-in tool for removing Windows 10 programs.
The error also appears during diagnostic system startup.
Here you need to check to verify the integrity of Windows 10 system files.
Run the command prompt as administrator.
Run the sfc / scannow command and wait for the process to complete.
After the process is completed, you will receive data on the results of the verification. If problems are found, then the system will automatically repair them.
The second way for this case is to roll back the system to the previous version or to completely reset the operating system settings since not everyone will be able to restore the previous version.
This method is relevant in cases where after the update, for example, to Windows 10, this error appeared.
If nothing has helped and you do not want to do a reset, then you can try to disable the application service completely.
In the Windows 10 operating system, due to repeated updates, the service is displayed as a Windows information collector whose name is WerSvc.exe.
If we talk about previous versions, such as Windows 7, then you can come across the name Windows Error Reporting Service.
Run the services.msc command in the Win + R window.
In the list of services, we are looking for the WerSvc.exe or Werfault.exe service (whose display name is Windows Information Collector or Windows Error Reporting Service).
Open the service and change its startup type to Disabled.
Disabling the service on the Windows 10 operating system helps very rarely, this method is more suitable for users of the Windows 7 operating system.
Therefore, if the application error has not disappeared, then you still have to use the method suggested above.
Werfault.exe application error is very common for both Windows 10 users and previous operating systems. Therefore, we have collected ways to solve the problem so that you can fix the error yourself.
How To Hide Taskbar In Windows 10 When Watching Full Screen Video
IDP.ALEXA.51 Trojan Or False Positive?[Removal Guide]


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ACCEPTED

#### According to
The Catalogue of Life, 3rd January 2011

#### Published in
Dela Slov. Akad. Znan Umet. Prirod. Med. , 4, 150.

#### Original name
null

### Remarks
null

redpajama_set_name: RedPajamaGithub


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By Rachel Hanson Choreographer
Louis van Amstel is a ballroom dancer hailing from Holland, but naturalized as an American citizen in 2008 and currently appearing on Dancing with the Stars and So You Think You Can Dance. In addition, he works doing choreography and dance production work.
Early Dance Career
Graduating from the University of the Arts in Amsterdam at the end of the 1980s, van Amstel was already on his way to a successful ballroom dancing career. In his early years of competition, he very frequently competed with Julie Fryer--they were a dynamic pair that could easily combine technique and charm the audience at the same time. Van Amstel has won seven Dutch nationals and three world championships for ballroom dancing over the years; this amount of championship winning has catapulted him into all aspects of the performance world, from competition to Broadway, and on to television in America.
Louis van Amstel's Television Appearances
Louis van Amstel began appearing on Dancing with the Stars in the first season of the show, but was eliminated in the first round. He became well-known though in the second season when he was paired with Lisa Rinna and the two managed to finish in fourth place. From that moment, he has been a loved and admired American ballroom dancing champion. However, long before he was on national television, he was already one of the most talented and most medalled ballroom champions in America. In 1996, van Amstel was a finalist in the world competitions with Karina Smirnoff, and in 2000, he won the US Nationals Latin Dance competition with Joanna Leunis. It took television though to bring his name to the public.
In addition to appearing all the time on Dancing with the Stars, van Amstel began working to choreograph and train dancers on So You Think You Can Dance. Van Amstel coached Dmitry Chaplin, a loved top-ten finalist on the show. Though van Amstel's television dance pursuits have been considerable, he's still found time for Broadway and for choreography.
Beyond Ballroom Dance Competition
Van Amstel had a cameo television appearance on the soap opera All My Children, in which he appeared as a dance teacher. On Broadway, he had a very considerable role in the show Latin Fusion; the show was not only choreographed by him, but also produced and directed by van Amstel. He also appeared himself in the show, bringing his magnetic dance personality into the spotlight once again.
Van Amstel started his own company, VanDance LLC, where he is able to do independent work. At this time, he still does a lot of work in a lot of different dance realms. Living in New York for a long time, van Amstel has now relocated to Utah and occasionally teaches at the famous studio, Center Stage Performing Arts, where several famous dancers are known to have trained, including Julianne Hough.
Van Amstel Dancing Videos
Several videos of the dance star can be found on YouTube. Catch a performance with Karina Smirnoff or his samba with Kelly Osbourne. He finished closer to the top with Kelly than with any other dance partner that he had on Dancing with the Stars. For an innovative and inspiring dance performance, as well as live music, check out this special performance from Dancing with the Stars, in which he performs alongside Cheryl Burke, Dmitry Chaplin, and Anna Trebunskaya while Joss Stone performs a passionate version of Son of a Preacher Man.
All of these videos show van Amstel's incredible dance talents and style.
Philippine Folk Dance History By Benna Crawford
Basic Jazz Dance Steps By Rachel Hanson
Glossary of Dance Moves By Tamara Warta
Ballet Leaps By Benna Crawford


It's hard to believe in the 21st century, but there has been a significant, recent decline in the number of women in Executive roles in FTSE 250 companies, and no progress among the FTSE 100. These data are shown in the latest update to the Cranfield University FTSE Women on Boards report, released last month.
Progressive organisations are routinely looking for a significant edge over the competition that can enable increased market share, fertile revenue streams and sustainable growth. Such objectives highlight the need for astute OD practitioners who can rise above the 'corporate noise.
A new study carried out at Rotterdam School of Management, Erasmus University (RSM) states four key steps internal communicators need to take during organisational change processes.
Resistance to change is seen as a major challenge to organisational initiatives. According to Sarah Lewis M.Sc. C.Psychol, of Appreciating Change, before we think about how to reduce it, we need to understand why people resist change.
I stared at the blank screen in disbelief. I prodded the power button, it burst into life and then died again. It was 9.30pm at night, dark and I was somewhere deep in the Provence countryside. Article by Dominic Irvine, founder of Epiphanies LLP.
As the cardamom flavoured milk was passed to me to try my heart sank. I don't like the mouth feel of milk and am indifferent to its flavour. I had little choice, I was surrounded by delegates at a workshop in Saudi Arabia where we were testing new juice and dairy products and they were looking at me expectantly. Article by Dominic Irvine, founder of Epiphanies LLP.
Too many organisational development initiatives blow out before they've had a chance to impact on anything. Ray McGrath, Execution Practice Leader at FranklinCovey (UK and Ireland), explains how to apply some key principles to start your next programme and keep it on track.


The Department of Marketing – College of Business will hold its Fall 2017 Advisory Board meeting on November 2, 2017. Meeting will be held in the Afni Executive Board Room – SFHB 412 from 9:15 am to 2:30 pm. For more information, please contact the Department of Marketing at (309) 438-7261.


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Roxette in live chat - Technical problems again
Written by roxeteer on September 28, 1999 to Misc.
Roxette chatted for a moment on the Internet. As I feared beforehand, Aftonbladet's "unique multimedia chat" was way too ambitious to be usable. At least in IE5/Windows 98 there was no sound in the streaming video interview and some of the pages were unreachable. The previous Roxette chats have also suffered from technical problems.
In the text chat there wasn't anything new. "Kikki" (probably Per with wrong user name) said about the US record deal that "Take it easy. It will happen eventually. Trust us." Per said his favourite solo track is "Stupid" and Marie said her favourite is "Tro". There wasn't more than 26 questions in total.
Chat log
Video interview (requires RealPlayer)