Massive Upper Gastrointestinal Bleeding Secondary to Duodenal Metastasis of Transitional Cell Carcinoma of the Urinary Bladder

Acute upper gastrointestinal (UGI) bleeding is a common problem in our clinical practice and is often due to peptic ulcer diseases. Occasionally, malignancy may be implicated in these situations. Here we report a rare case of UGI bleeding secondary to metastatic transitional cell carcinoma (TCC) of the urinary bladder. A 62-year-old man with a history of stage IIIb TCC of the urinary bladder presented with hematemesis. Endoscopy showed a large tumor in the second stage of the duodenum that occupied 40% of the duodenal circumference, over 7 cm in length. Biopsies revealed a poorly differentiated malignant neoplasm consistent with metastasis from urothelial carcinoma that was identical to the previous surgical specimen of the urinary bladder. He was treated with supportive therapy and intravenous proton pump inhibitor and was discharged home 2 weeks later. Two weeks after discharge, the patient returned to the hospital with a painful swelling of the floor of his mouth. Biopsy again showed the same cancer type. He had unremitting bleeding from his mouth requiring multiple transfusions and a course of palliative radiation therapy. He progressively deteriorated in his cardiopulmonary and neurological functions and expired with cardiopulmonary arrest one month later

Focus Point SUSY at the LHC Revisited

The estimation of the backgrounds for gluino signals in focus point supersymmetry is extended by including the backgrounds from the production of four third generation quarks in the analysis. We find that these backgrounds are negligible if one uses the strong selection criteria proposed in the literature (including this analysis) for heavy gluino searches. Softer selection criteria often recommended for lighter gluino searches yield backgrounds which are small but numerically significant. We have also repeated the more conventional background calculations and compared our results with the other groups. We find that the size of the total residual background estimated by different groups using different event generators and hard kinematical cuts agree approximately. In view of the theoretical uncertainties in the leading order signal and background cross sections mainly due to the choice of the QCD scale, the gluino mass reach at the LHC cannot be pinpointed. However, requiring a signal with $\rm\geq 3$ tagged b-jets (instead of the standard choice of $\rm\geq 2$) it is shown that gluino masses close to 2 TeV can be probed at the LHC for a range of reasonable choices of the QCD scale for an integrated luminosity of 300 fb$^{-1}$.Comment: 17 pages, 4 figures, minor typos correctio

Patient Empowerment Programme (PEP) in Primary Care Reduced All-cause Mortality and Cardiovascular Diseases in Patients with Type 2 Diabetes Mellitus: A Population-based Propensity Matched Cohort Study

Running title: PEP reduced death and CVD events Clinical trial number and registry: NCT01935349, ClinicalTrials.gov PEP DM CVD Manuscript 20140917 Page 1 of 15 patients treated at primary care outpatient clinics through community trained professional educators. Non-PEP participants were matched one-to-one with the PEP participants using propensity score method with respect to their baseline covariates. Cox proportional hazard regressions were performed to estimate the associations of PEP with the occurrence of first CVD event, coronary heart disease, stroke, heart failure and death from any cause, controlling for baseline characteristics. Conclusions: Enrolment in PEP was associated with reduced all-cause mortality and first CVD events among T2DM patients. The CVD benefit of PEP might be attributable to improving metabolic control through empowerment of self-care and enhancement of quality of diabetes care in primary care. Word Count: 25

General Brane Geometries from Scalar Potentials: Gauged Supergravities and Accelerating Universes

We find broad classes of solutions to the field equations for d-dimensional gravity coupled to an antisymmetric tensor of arbitrary rank and a scalar field with non-vanishing potential. Our construction generates these configurations from the solution of a single nonlinear ordinary differential equation, whose form depends on the scalar potential. For an exponential potential we find solutions corresponding to brane geometries, generalizing the black p-branes and S-branes known for the case of vanishing potential. These geometries are singular at the origin with up to two (regular) horizons. Their asymptotic behaviour depends on the parameters of the model. When the singularity has negative tension or the cosmological constant is positive we find time-dependent configurations describing accelerating universes. Special cases give explicit brane geometries for (compact and non-compact) gauged supergravities in various dimensions, as well as for massive 10D supergravity, and we discuss their interrelation. Some examples lift to give new solutions to 10D supergravity. Limiting cases with a domain wall structure preserve part of the supersymmetries of the vacuum. We also consider more general potentials, including sums of exponentials. Exact solutions are found for these with up to three horizons, having potentially interesting cosmological interpretation. We give several additional examples which illustrate the power of our techniques.Comment: 54 pages, 6 figures. Uses JHEP3. Published versio

Prediction of Breast Cancer-Related Lymphedema By Dermal Backflow Detected With Near-infrared Fluorescence Lymphatic Imaging

PURPOSE: Mild breast cancer-related lymphedema (BCRL) is clinically diagnosed as a 5%-10% increase in arm volume, typically measured no earlier than 3-6 months after locoregional treatment. Early BCRL treatment is associated with better outcomes, yet amid increasing evidence that lymphedema exists in a latent form, treatment is typically delayed until arm swelling is obvious. In this study, we investigated whether near-infrared fluorescence lymphatic imaging (NIRF-LI) surveillance could characterize early onset of peripheral lymphatic dysfunction as a predictor of BCRL. METHODS: In a prospective, longitudinal cohort/observational study (NCT02949726), subjects with locally advanced breast cancer who received axillary lymph node dissection and regional nodal radiotherapy (RT) were followed serially, between 2016 and 2021, before surgery, 4-8 weeks after surgery, and 6, 12, and 18 months after RT. Arm volume was measured by perometry, and lymphatic (dys) function was assessed by NIRF-LI. RESULTS: By 18 months after RT, 30 of 42 study subjects (71%) developed mild-moderate BCRL (i.e., ≥ 5% arm swelling relative to baseline), all manifested by dermal backflow of lymph into lymphatic capillaries or interstitial spaces. Dermal backflow had an 83% positive predictive value and 86% negative predictive value for BCRL, with a sensitivity of 97%, specificity of 50%, accuracy of 83%, positive likelihood ratio of 1.93, negative likelihood ratio of 0.07, and odds ratio of 29.00. Dermal backflow appeared on average 8.3 months, but up to 23 months, before the onset of mild BCRL. CONCLUSION: BCRL can be predicted by dermal backflow, which often appears months before arm swelling, enabling early treatment before the onset of edema and irreversible tissue changes

Mass predictions based on a supersymmetric SU(5) fixed point

I examine the possibility that the third generation fermion masses are determined by an exact fixed point of the minimal supersymmetric SU(5) model. When one-loop supersymmetric thresholds are included, this unified fixed point successfully predicts the top quark mass, 175 +(-) 2 GeV, as well as the weak mixing angle. The bottom quark mass prediction is sensitive to the supersymmetric thresholds; it approaches the measured value for mu <0 and very large unified gaugino mass. The experimental measurement of the tau lepton mass determines tan(beta), and the strong gauge coupling and fine structure constant fix the unification scale and the unified gauge coupling.Comment: 40 pages, 9 figures, 9 tables, Revtex

Proposing new variables for the identification of strategic groups in franchising

The identification of strategic groups in the Spanish franchising area is the main aim of this study. The authors have added some new strategic variables (not used before) to the study and have classified franchisors between sectors and distribution strategy. The results reveal the existence of four perfectly differentiated strategic groups (types of franchisors). One of the major implications of this study is that the variables that build a strategic group vary depending on the respective sector the network operates in and its distribution strategy. This fact indicates that including sector and distribution strategy is absolutely necessary to achieve good classifications of franchisor type

An Integrated TCGA Pan-Cancer Clinical Data Resource to Drive High-Quality Survival Outcome Analytics

For a decade, The Cancer Genome Atlas (TCGA) program collected clinicopathologic annotation data along with multi-platform molecular profiles of more than 11,000 human tumors across 33 different cancer types. TCGA clinical data contain key features representing the democratized nature of the data collection process. To ensure proper use of this large clinical dataset associated with genomic features, we developed a standardized dataset named the TCGA Pan-Cancer Clinical Data Resource (TCGA-CDR), which includes four major clinical outcome endpoints. In addition to detailing major challenges and statistical limitations encountered during the effort of integrating the acquired clinical data, we present a summary that includes endpoint usage recommendations for each cancer type. These TCGA-CDR findings appear to be consistent with cancer genomics studies independent of the TCGA effort and provide opportunities for investigating cancer biology using clinical correlates at an unprecedented scale. Analysis of clinicopathologic annotations for over 11,000 cancer patients in the TCGA program leads to the generation of TCGA Clinical Data Resource, which provides recommendations of clinical outcome endpoint usage for 33 cancer types