Multi-modality curative treatment of salivary gland cancer liver metastases with drug-eluting bead chemoembolization, radiofrequency ablation, and surgical resection: a case report

<p>Abstract</p> <p>Introduction</p> <p>Liver metastases are rare in salivary gland tumors and have been reported only once to be the first manifestation of the disease. They are usually treated with surgical resection of the primary tumor and systemic chemotherapy. Drug-eluting bead chemoembolization has an evolving role in the treatment of hepatocellular carcinoma, as well as in the treatment of metastatic disease of the liver. Nevertheless, it has never been used in a patient with salivary gland liver metastases.</p> <p>Case presentation</p> <p>We report a case of a 51-year-old Caucasian Greek woman who presented to our hospital with liver metastases as the first manifestation of an adenoid cystic carcinoma of the left submandibular gland. The liver lesions were deemed inoperable because of their size and multi-focality and proved resistant to systemic chemotherapy. She was curatively treated with a combination of doxorubicin eluting bead (DC Beads) chemoembolization, intra-operative and percutaneous radiofrequency ablation, and radiofrequency-assisted surgical resection. The patient remained disease-free one year after the surgical resection.</p> <p>Conclusion</p> <p>In conclusion, this complex case is an example of inoperable liver metastatic disease from the salivary glands that was refractory to systemic chemotherapy but was curatively treated with a combination of locoregional therapies and surgery. A multi-disciplinary approach and the adoption of modern radiological techniques produced good results after conventional therapies failed and there were no other available treatment modalities.</p

Ab initio studies of structures and properties of small potassium clusters

We have studied the structure and properties of potassium clusters containing even number of atoms ranging from 2 to 20 at the ab initio level. The geometry optimization calculations are performed using all-electron density functional theory with gradient corrected exchange-correlation functional. Using these optimized geometries we investigate the evolution of binding energy, ionization potential, and static polarizability with the increasing size of the clusters. The polarizabilities are calculated by employing Moller-Plesset perturbation theory and time dependent density functional theory. The polarizabilities of dimer and tetramer are also calculated by employing large basis set coupled cluster theory with single and double excitations and perturbative triple excitations. The time dependent density functional theory calculations of polarizabilities are carried out with two different exchange-correlation potentials: (i) an asymptotically correct model potential and (ii) within the local density approximation. A systematic comparison with the other available theoretical and experimental data for various properties of small potassium clusters mentioned above has been performed. These comparisons reveal that both the binding energy and the ionization potential obtained with gradient corrected potential match quite well with the already published data. Similarly, the polarizabilities obtained with Moller-Plesset perturbation theory and with model potential are quite close to each other and also close to experimental data.Comment: 33 pages including 10 figure

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Development of a middleware layer for the support of multi-tenant databases

123 σ.Οι αρχιτεκτονικές πολλαπλών ενοίκων χρησιμοποιούνται συχνά στις υπηρεσίες Software as a Service(SaaS), τόσο στο επίπεδο της εφαρμογής όσο και στις βάσεις δεδομένων που τις υποστηρίζουν. Στις αρχιτεκτονικές αυτές, πολλαπλοί πελάτες-ένοικοι μοιράζονται τους ίδιους υπολογιστικούς πόρους με αποτέλεσμα τη μείωση του κόστους των υπηρεσιών και την αυξημένη αξιοποίηση του διαθέσιμου υλικού(hardware). Παράλληλα, όμως, συνήθως αυξάνεται το αρχικό κόστος των εφαρμογών αυτών καθώς απαιτείται η ανάπτυξη πολύπλοκου κώδικα για την υποστήριξη πολλαπλών ενοίκων από το ίδιο στιγμιότυπο της εφαρμογής και από την ίδια βάση δεδομένων. Στην παρούσα διπλωματική εργασία εστιάζουμε στις βάσεις δεδομένων πολλαπλών ενοίκων και αρχικά κάνουμε μια επισκόπηση διαφόρων τεχνικών που έχουν προταθεί για την υλοποίηση τους. Στη συνέχεια, συνδυάζοντας και τροποποιώντας κάποιες από τις τεχνικές αυτές, προτείνουμε μια τεχνική που προσπαθεί να αντιμετωπίσει το πρόβλημα της αντιστοίχισης των δεδομένων πολλαπλών ενοίκων σε κοινούς πίνακες μιας σχεσιακής βάσης δεδομένων. Ιδιαίτερη έμφαση δίνεται στην υποστήριξη της δυνατότητας για επεκτασιμότητα και προσαρμογή του σχήματος της βάσης στις ιδιαίτερες ανάγκες κάθε ενοίκου. Τέλος, χρησιμοποιώντας την τεχνική αυτή, αναπτύσσουμε ένα σύστημα που επιτρέπει την υποστήριξη βάσεων δεδομένων πολλαπλών ενοίκων από ένα σχεσιακό Σύστημα Διαχείρισης Βάσεων Δεδομένων.Multi-tenancy is often employed in Software as a Service applications, in both the application layer and the database layer. With multi-tenancy, multiple customers(tenants) share the same resources lowering operational costs and increasing the utilization of the available hardware. Nonetheless, the initial cost of deploying the application is often higher as complicated software structures need to be developed to support multiple tenants in the same application and database instance. In this thesis, we focus on multi-tenant databases and start by examining several of the techniques used in implementing them. Then, combining and modifying some of those techniques, we present a schema-sharing technique that attempts to solve the problem of mapping the data of multiple tenants to the shared tables of a relational database. Particular emphasis is placed on the extensibility and customizability of the database schema to meet the demands of each tenant. Finally, using this technique, we develop a middleware layer that can be used to enable multi-tenancy in a standard relational database management system.Σταύρος Ι. Μαρούλη

A gene expression analysis system for medical diagnosis

In this paper we present a novel system that utilizes molecular-level information for medical diagnosis. It accepts high dimensional vectors of gene expressions, quantified by means of microarray image analysis, as input. The proposed system incorporates various data pre-processing methods, such as missing values estimation and data normalization. A novel approach to the classification of gene expression vectors in multiple classes that embodies vari-ous gene selection methods has been adopted for diagnostic purposes. The pro-posed system has been extensively tested on various, publicly available data-sets. We demonstrate its performance for prostate cancer diagnosis and corn-pare its performance with a well established multiclass classification scheme. The results show that the proposed system could be proved a valuable diagnostic aid in medicine. © 2006 International Federation for Information Processing