Malignant gastric outlet obstruction: Which is the best therapeutic option?

Malignant gastric outlet obstruction (MGOO) is a clinical condition characterized by the mechanical obstruction of the pylorus or the duodenum due to tumor compression/infiltration, with consequent reduction or impossibility of an adequate oral intake. MGOO is mainly secondary to advanced pancreatic or gastric cancers, and significantly impacts on patients' survival and quality of life. Patients suffering from this condition often present with intractable vomiting and severe malnutrition, which further compromise therapeutic chances. Currently, palliative strategies are based primarily on surgical gastrojejunostomy and endoscopic enteral stenting with self-expanding metal stents. Several studies have shown that surgical approach has the advantage of a more durable relief of symptoms and the need of fewer re-interventions, at the cost of higher procedure-related risks and longer hospital stay. On the other hand, enteral stenting provides rapid clinical improvement, but have the limit of higher stent dysfunction rate due to tumor ingrowth and a subsequent need of frequent re-interventions. Recently, a third way has come from interventional endoscopic ultrasound, through the development of endoscopic ultrasound-guided gastroenterostomy technique with lumen-apposing metal stent. This new technique may ideally encompass the minimal invasiveness of an endoscopic procedure and the long-lasting effect of the surgical gastrojejunostomy, and brought encouraging results so far, even if prospective comparative trial are still lacking. In this Review, we described technical aspects and clinical outcomes of the above-cited therapeutic approaches, and discussed the open questions about the current management of MGOO

Super selective arterial embolization to treat radiation-induced hemorrhagic gastritis: a case report and review of the literature

Radiation-induced hemorrhagic gastritis (RIHG) is a rare but potentially fatal event following radiotherapy for locally advanced gastric cancer; the treatment of this condition is not standardized. Only few cases of RIHG have been reported, treated with different therapeutic approaches. Here we report the case of a 79-year-old patient who underwent subtotal gastrectomy for gastric cancer, followed by adjuvant chemo-radiotherapy. Approximately 3 months after the end of the treatment, she developed recurrent diffuse bleeding originating from the entire mucosa of the gastric pouch and from a marginal ulcer. As the bleeding was refractory to several endoscopic treatments and surgery was not indicated, the patient underwent two sessions of transcatheter selective arterial embolization, with resolution of bleeding. Arterial embolization has already been reported for the treatment of hemorrhagic cystitis, developing after irradiation of the pelvis for prostate, bladder, rectum, and cervix cancer. However, to our knowledge, it has never been reported as a treatment for hemorrhagic gastritis. Based on this case, we suggest arterial embolization as an option in the management of RIHG, when standard endoscopic treatment fails

Efficacy of hemostatic powders as monotherapy or rescue therapy in gastrointestinal bleeding related to neoplastic or non-neoplastic lesions

Background Hemostatic powder (HP) in gastrointestinal bleeding (GIB) is mainly used as rescue therapy after failure of conventional hemostatic procedures (CHP). Aim To define the best field of application and the efficacy of HP as first choice monotherapy or rescue therapy. Methods We compared the efficacy of HP monotherapy, HP rescue therapy, and CHP in the management of active GIB due to neoplastic and non-neoplastic lesions. Results A total of 108 patients, 43 treated with HP as either first choice or rescue therapy and 65 with CHP, were included in the study. The most frequent sources of bleeding were peptic ulcer and malignancy. Immediate hemostasis rates were: HP monotherapy = 100% in peptic ulcer and 100% in malignancy; HP rescue therapy = 93.2% in peptic ulcer and 85.7% in malignancy; CHP = 77.9% in peptic ulcer and 41.7 in malignancy. Definitive hemostasis rates were: HP monotherapy = 50% in peptic ulcer and 45.5% in malignancy; HP rescue therapy = 73.3% in peptic ulcer and 85.7% in malignancy; CHP = 69.1% in peptic ulcer and 33.3% in malignancy. No difference was found in terms of additional intervention between the three groups. Conclusions HP is highly effective as monotherapy and rescue therapy in GIB. GIB related to malignancy may be the best field of application of HP, but confirmatory studies are necessary

Binary metal oxides for composite ultrafiltration membranes

A new ultrafiltration membrane was developed by the incorporation of binary metal oxides inside polyethersulfone. Physico-chemical characterization of the binary metal oxides demonstrated that the presence of Ti in the TiO2?ZrO2 system results in an increase of the size of the oxides, and also their dispersity. The crystalline phases of the synthesized binary metal oxides were identified as srilankite and zirconium titanium oxide. The effect of the addition of ZrO2 can be expressed in terms of the inhibition of crystal growth of anocrystalline TiO2 during the synthesis process. For photocatalytic applications the band gap of the synthesized semiconductors was determined, confirming a gradual increase (blue shift) in the band gap as the amount of Zr loading increases. Distinct distributions of binary metal oxides were found along the permeation axis for the synthesized membranes. Particles with Ti are more uniformly dispersed throughout the membrane cross-section. The physico-chemical characterization of membranes showed a strong correlation between some key membrane properties and the spatial particle distribution in the membrane structure. The proximity of metal oxide fillers to the membrane surface determines the hydrophilicity and porosity of modified membranes. Membranes incorporating binary metal oxides were found to be promising candidates for wastewater treatment by ultrafiltration, considering the observed improvement influx and anti-fouling properties of doped membranes. Multi-run fouling tests of doped membranes confirmed the stability of permeation through membranes embedded with binary TiO2?ZrO2 particles

Costos y viabilidad económica de la producción y comercialización de la conserva de trucha (Oncorhynchus mykiss) en escabeche

Puno is the first rainbow trout producing region in Peru. The objective of the study was to study the feasibility of giving added value to trout. The cost analysis and financial viability of the production of six types of canned pickled trout preserves were considered. The fillets were obtained from trout fed with three commercial foods (Salmofood®, Naltech® and Tomasino®) and the preserves had two presentations (can vs. glass). The production costs were calculated through a documented record of data at market prices. The general theory of production costs was applied and through the cash flow financial tool the profitability indicators were found. The financial net present value (NPVf) was positive for all six presentations. The internal rate of return (IRR), both for canning (34.5, 37.5 and 42.8%) and for glass canning (34.7, 38.2 and 44.3%) was higher than the opportunity cost of capital (COK) and in both cases, the benefit-cost ratio (B/C) was similar and greater than one (1.05, 1.06 and 1.07) for the three commercial foods, respectively. The capital recovery period was between 5 and 6 years for the two types of preserves. In conclusion, the pickled trout canning project is profitable and, therefore, its investment is recommended to contribute to the sustainability of production and improve the income of producers in the region.Puno es la primera región productora de truchas arcoíris en el Perú. El estudio tuvo como objetivo estudiar la factibilidad de dar valor agregado a la trucha. Se consideró el análisis de costos y la viabilidad financiera de la producción de seis tipos de conservas de trucha en escabeche. Los filetes fueron obtenidos de truchas alimentadas con tres alimentos comerciales (Salmofood®, Naltech® y Tomasino®) y las conservas tuvieron dos presentaciones (lata vs. vidrio). Los costos de producción se calcularon mediante un registro documentado de datos a precios de mercado. Se aplicó la teoría general de costos de producción y mediante la herramienta financiera de flujo de caja se hallaron los indicadores de rentabilidad. El valor actual neto financiero (VANf) fue positivo para las seis presentaciones. La tasa interna de retorno (TIR), tanto para la conserva de lata (34.5, 37.5 y 42.8%) como para la conserva en vidrio (34.7, 38.2 y 44.3%) fue mayor al costo de oportunidad del capital (COK) y en ambos casos la ratio beneficio-costo (B/C) fue similar y mayor a uno (1.05, 1.06 y 1.07) para los tres alimentos comerciales, respectivamente. El periodo de recuperación del capital estuvo entre 5 y 6 años para los dos tipos de conservas. En conclusión, el proyecto de elaboración de conservas de trucha en escabeche es rentable y, por tanto, es recomendable su inversión para contribuir con la sostenibilidad de la producción y mejorar los ingresos de los productores de la región

Long-Term Carbon Sequestration in Pine Forests under Different Silvicultural and Climatic Regimes in Spain

Proactive silviculture treatments (e.g., thinning) may increase C sequestration contributing to climate change mitigation, although, there are still questions about this effect in Mediterranean pine forests. The aim of this research was to quantify the storage of biomass and soil organic carbon in Pinus forests along a climatic gradient from North to South of the Iberian Peninsula. Nine experimental Pinus spp trials were selected along a latitudinal gradient from the pre-Pyrenees to southern Spain. At each location, a homogeneous area was used as the operational scale, and three thinning intensity treatments: unthinned or control (C), intermediate thinning (LT, removal of 30–40% of the initial basal area) and heavy thinning (HT, removal of 50–60%) were conducted. Growth per unit area (e.g., expressed as basal area increment-BAI), biomass, and Soil Organic Carbon (SOC) were measured as well as three sets of environmental variables (climate, soil water availability and soil chemical and physical characteristics). One-way ANOVA and Structural Equation Modelling (SEM) were used to study the effect of thinning and environmental variables on C sequestration. Biomass and growth per unit area were higher in the control than in the thinning treatments, although differences were only significant for P. halepensis. Radial growth recovered after thinning in all species, but it was faster in the HT treatments. Soil organic carbon (SOC10, 0–10 cm depth) was higher in the HT treatments for P. halepensis and P. sylvestris, but not for P. nigra. SEM showed that Pinus stands of the studied species were beneficed by HT thinning, recovering their growth quickly. The resulting model explained 72% of the variation in SOC10 content, and 89% of the variation in silvicultural condition (basal area and density) after thinning. SOC10 was better related to climate than to silvicultural treatments. On the other hand, soil chemical and physical characteristics did not show significant influence over SOC10- Soil water availability was the latent variable with the highest influence over SOC10. This work is a new contribution that shows the need for forest managers to integrate silviculture and C sequestration in Mediterranean pine plantations

An advanced Bayesian model for the visual tracking of multiple interacting objects

Visual tracking of multiple objects is a key component of many visual-based systems. While there are reliable algorithms for tracking a single object in constrained scenarios, the object tracking is still a challenge in uncontrolled situations involving multiple interacting objects that have a complex dynamics. In this article, a novel Bayesian model for tracking multiple interacting objects in unrestricted situations is proposed. This is accomplished by means of an advanced object dynamic model that predicts possible interactive behaviors, which in turn depend on the inference of potential events of object occlusion. The proposed tracking model can also handle false and missing detections that are typical from visual object detectors operating in uncontrolled scenarios. On the other hand, a Rao-Blackwellization technique has been used to improve the accuracy of the estimated object trajectories, which is a fundamental aspect in the tracking of multiple objects due to its high dimensionality. Excellent results have been obtained using a publicly available database, proving the efficiency of the proposed approach

The second flight of the SUNRISE balloon-borne solar observatory: overview of instrument updates, the flight, the data and first results

The SUNRISE balloon-borne solar observatory, consisting of a 1~m aperture telescope that provided a stabilized image to a UV filter imager and an imaging vector polarimeter, carried out its second science flight in June 2013. It provided observations of parts of active regions at high spatial resolution, including the first high-resolution images in the Mg~{\sc ii}~k line. The obtained data are of very high quality, with the best UV images reaching the diffraction limit of the telescope at 3000~\AA\ after Multi-Frame Blind Deconvolution reconstruction accounting for phase-diversity information. Here a brief update is given of the instruments and the data reduction techniques, which includes an inversion of the polarimetric data. Mainly those aspects that evolved compared with the first flight are described. A tabular overview of the observations is given. In addition, an example time series of a part of the emerging active region NOAA AR~11768 observed relatively close to disk centre is described and discussed in some detail. The observations cover the pores in the trailing polarity of the active region, as well as the polarity inversion line where flux emergence was ongoing and a small flare-like brightening occurred in the course of the time series. The pores are found to contain magnetic field strengths ranging up to 2500~G and, while large pores are clearly darker and cooler than the quiet Sun in all layers of the photosphere, the temperature and brightness of small pores approach or even exceed those of the quiet Sun in the upper photosphere.Comment: Accepted for publication in The Astrophysical Journa

SilvAdapt.Net: A Site-Based Network of Adaptive Forest Management Related to Climate Change in Spain

[EN] Adaptive forest management (AFM) is an urgent need because of the uncertainty regarding how changes in the climate will affect the structure, composition and function of forests during the next decades. Current research initiatives for the long-term monitoring of impacts of silviculture are scattered and not integrated into research networks, with the consequent losses of opportunities and capacity for action. To increase the scientific and practical impacts of these experiences, it is necessary to establish logical frameworks that harmonize the information and help us to define the most appropriate treatments. In this context, a number of research groups in Spain have produced research achievements and know-how during the last decades that can allow for the improvement in AFM. These groups address the issue of AFM from different fields, such as ecophysiology, ecohydrology and forest ecology, thus resulting in valuable but dispersed expertise. The main objective of this work is to introduce a comprehensive strategy aimed to study the implementation of AFM in Spain. As a first step, a network of 34 experimental sites managed by 14 different research groups is proposed and justified. As a second step, the most important AFM impacts on Mediterranean pines, as one of the most extended natural and planted forest types in Spain, are presented. Finally, open questions dealing with key aspects when attempting to implement an AFM framework are discussed. This study is expected to contribute to better outlining the procedures and steps needed to implement regional frameworks for AFM.A.J. Molina is beneficiary of an "APOSTD" fellowship (APOSTD/2019/111) funded by the Generalitat Valenciana. M. Moreno-de las Heras is beneficiary of a Serra Hunter fellowship (UB-LE-9055) funded by the Generalitat de Catalunya. F.J. Ruiz-Gomez is supported by a postdoctoral fellowship of the Junta de Andalucia (Sevilla, Spain), and the European Social Fund 2014-2020 Program (DOC_0055). The authors received national and international funding through the following projects: SILVADAPT.NET (RED2018-102719-T), ESPECTRAMED (CGL2017-86161-R), Life-FOREST CO2 (LIFE14 CCM/ES/001271), ALTERACLIM (CGL2015-69773-C2-1-P), INERTIA (PID2019-111332RB-C22-BDV), CEHYRFO-MED (CGL2017-86839-C3-2-R), DEHESACLIM (IB16185), RESILIENTFORESTS (LIFE17 CCA/ES/000063), Rhysotto (PID2019-106583RB-I00), AGL2017-83828C2-2-R, RTI2018-096884-B-C31, ESPAS (CGL2015-65569-R), and caRRRascal (RTI2018-095037-B-I00).Molina Herrera, A.; Navarro Cerrillo, R.; Pérez-Romero, J.; Alejano, R.; Bellot, JF.; Blanco, JA.; Camarero, JJ.... (2021). SilvAdapt.Net: A Site-Based Network of Adaptive Forest Management Related to Climate Change in Spain. Forests. 12(12):1-27. https://doi.org/10.3390/f12121807127121

Accidental Inflation in String Theory

We show that inflation in type IIB string theory driven by the volume modulus can be realized in the context of the racetrack-based Kallosh-Linde model (KL) of moduli stabilization. Inflation here arises through the volume modulus slow-rolling down from a flat hill-top or inflection point of the scalar potential. This situation can be quite generic in the landscape, where by uplifting one of the two adjacent minima one can turn the barrier either to a flat saddle point or to an inflection point supporting eternal inflation. The resulting spectral index is tunable in the range of 0.93 < n_s < 1, and there is only negligible production of primordial gravitational waves r < 10^{-6}. The flatness of the potential in this scenario requires fine-tuning, which may be justified taking into account the exponential reward by volume factors preferring the regions of the universe with the maximal amount of slow-roll inflation. This consideration leads to a tentative prediction of the spectral index $n_s\approx 0.95$ or $n_s \approx 0.93$ depending on whether the potential has a symmetry phi -> - phi or not.Comment: 15 pages, 6 figures, LaTeX, uses RevTex