Case Report: A difficult diagnosis to swallow

No Abstrac

Divacancy superstructures in thermoelectric calcium-doped sodium cobaltate

We have grown single crystals of Na$_x$Ca$_y$CoO$_2$ and determined their superstructures as a function of composition using neutron and x-ray diffraction. Inclusion of Ca$^{2+}$ stabilises a single superstructure across a wide range of temperatures and concentrations. The superstructure in the Na$^+$ layers is based on arrays of divacancy clusters with Ca$^{2+}$ ions occupying the central site, and it has an ideal concentration Na$_{4/7}$Ca$_{1/7}$CoO$_2$. Previous measurements of the thermoelectric properties on this system are discussed in light of this superstructure. Na$_{4/7}$Ca$_{1/7}$CoO$_2$ corresponds to the maximum in thermoelectric performance of this system.Comment: Produced using Revtex 4.1 and pdflatex. 7 Pages, 6 figure

Imbalanced gut microbiota fuels hepatocellular carcinoma development by shaping the hepatic inflammatory microenvironment

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths worldwide, and therapeutic options for advanced HCC are limited. Here, we observe that intestinal dysbiosis affects antitumor immune surveillance and drives liver disease progression towards cancer. Dysbiotic microbiota, as seen in Nlrp6(-/-) mice, induces a Toll-like receptor 4 dependent expansion of hepatic monocytic myeloid-derived suppressor cells (mMDSC) and suppression of T-cell abundance. This phenotype is transmissible via fecal microbiota transfer and reversible upon antibiotic treatment, pointing to the high plasticity of the tumor microenvironment. While loss of Akkermansia muciniphila correlates with mMDSC abundance, its reintroduction restores intestinal barrier function and strongly reduces liver inflammation and fibrosis. Cirrhosis patients display increased bacterial abundance in hepatic tissue, which induces pronounced transcriptional changes, including activation of fibro-inflammatory pathways as well as circuits mediating cancer immunosuppression. This study demonstrates that gut microbiota closely shapes the hepatic inflammatory microenvironment opening approaches for cancer prevention and therapy. Steatohepatitis is a chronic hepatic inflammation associated with increased risk of hepatocellular carcinoma progression. Here the authors show that intestinal dysbiosis in mice lacking the inflammasome sensor molecule NLRP6 aggravates steatohepatitis and accelerates liver cancer progression, a process that can be delayed by antibiotic treatment.Peer reviewe

Plasma Levels of Middle Molecules to Estimate Residual Kidney Function in Haemodialysis without Urine Collection

© 2015 Vilar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, (http://creativecommons.org/Licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.BACKGROUND: Residual Kidney Function (RKF) is associated with survival benefits in haemodialysis (HD) but is difficult to measure without urine collection. Middle molecules such as Cystatin C and β2-microglobulin accumulate in renal disease and plasma levels have been used to estimate kidney function early in this condition. We investigated their use to estimate RKF in patients on HD. DESIGN: Cystatin C, β2-microglobulin, urea and creatinine levels were studied in patients on incremental high-flux HD or hemodiafiltration(HDF). Over sequential HD sessions, blood was sampled pre- and post-session 1 and pre-session 2, for estimation of these parameters. Urine was collected during the whole interdialytic interval, for estimation of residual GFR (GFRResidual = mean of urea and creatinine clearance). The relationships of plasma Cystatin C and β2-microglobulin levels to GFRResidual and urea clearance were determined. RESULTS: Of the 341 patients studied, 64% had urine output>100 ml/day, 32.6% were on high-flux HD and 67.4% on HDF. Parameters most closely correlated with GFRResidual were 1/β2-micoglobulin (r2 0.67) and 1/Cystatin C (r2 0.50). Both these relationships were weaker at low GFRResidual. The best regression model for GFRResidual, explaining 67% of the variation, was: GFRResidual = 160.3 · (1/β2m) - 4.2. Where β2m is the pre-dialysis β2 microglobulin concentration (mg/L). This model was validated in a separate cohort of 50 patients using Bland-Altman analysis. Areas under the curve in Receiver Operating Characteristic analysis aimed at identifying subjects with urea clearance≥2 ml/min/1.73 m2 was 0.91 for β2-microglobulin and 0.86 for Cystatin C. A plasma β2-microglobulin cut-off of ≤19.2 mg/L allowed identification of patients with urea clearance ≥2 ml/min/1.73 m2 with 90% specificity and 65% sensitivity. CONCLUSION: Plasma pre-dialysis β2-microglobulin levels can provide estimates of RKF which may have clinical utility and appear superior to cystatin C. Use of cut-off levels to identify patients with RKF may provide a simple way to individualise dialysis dose based on RKF.Peer reviewe

A branch-and-cut algorithm for a multi-item inventory distribution problem

This paper considers a multi-item inventory distribution problem motivated by a practical case occurring in the logistic operations of an hospital. There, a single warehouse supplies several nursing wards. The goal is to define a weekly distribution plan of medical products that minimizes the visits to wards, while respecting inventory capacities and safety stock levels. A mathematical formulation is introduced and several improvements such as tightening constraints, valid inequalities and an extended reformulation are discussed. In order to deal with real size instances, an hybrid heuristic based on mathematical models is introduced and the improvements are discussed. A branch-and-cut algorithm using all the discussed improvements is proposed. Finally, a computational experimentation is reported to show the relevance of the model improvements and the quality of the heuristic scheme

Synthesis of Petri net based model of a discrete event manufacturing system for nonlinear process plan

This work presents a modelling approach for nonlinear process plan (NLPP) implementation in discrete event manufacturing system (DEMS). NLPP is used for the building of the modular structure of an Object Observable Petri Net model of DEMS. The general capabilities of DEMS are defined by resources’ operation templates and the transition incidence relation. Based on system specification and NLPP executed in the system, the modular model of DEMS is defined. The required steps for constructing a modular model through the integration of resource models are presented. The proposed approach to modular modelling is illustrated by means of a sample DEMS and an example of NLPP

Dispersion management and cascade compression of femtosecond nonautonomous soliton in birefringent fiber

In this paper, we investigated the nonlinear tunneling of soliton in coupled higher order nonlinear Schrödinger (CHNLS) equations. Corresponding Lax pair for this equation is acquired through the Ablowitz-Kaup-Newell-Segur (AKNS) method and two soliton solutions is derived using Darboux transformation. Using two soliton solution of CHNLS equation, nonlinear tunneling of soliton has been investigated. Ultimately, cascade compressions of optical soliton have been investigated by soliton passing through number of nonlinear tunneling barrier. The obtained results may have promising applications in all-optical devices based on optical solitons