Surgical approach for cardiac surgery in a patient with tracheostoma

The thoracic approach for cardiac surgery in a patient with a tracheostoma can result in difficult problems, such as mediastinitis, stoma necrosis or inadequate operative exposure. We present a distinct approach consisting of an incision at the second intercostal space, transverse sternum transection and longitudinal median sternotomy to the xiphoid process, performed for coronary artery bypass grafting and aortic valve replacement, in a patient with previous tracheotomy. This approach permitted adequate surgical exposure for cardiopulmonary bypass, aortic valve replacement and coronary revascularization procedures

Nuclear Effects on the UHE Neutrino-Nucleon Deep Inelastic Scattering Cross Section

Using a recent parametrization of nuclear effects in parton distribution functions we calculate the neutrino-nucleon cross section at energies relevant for ultra high energy neutrino telescopes. The modification of the cross section in comparison with the calculation using parton densities in free nucleons is of the order of few per cent for the parameter range of interest in neutrino telescopes (A=10 and E=10$^6$ GeV) and it reaches 20 % at the highest energies (E=10$^{12}$ GeV) and for the largest nuclear size (A=190) considered.Comment: 7 pages, Latex, figures as 3 postscript file

Changes in plasma fatty acid composition are associated with improvements in obesity and related metabolic disorders: A therapeutic approach to overweight adolescents

Background & aims: In recent years, obesity has reached alarming levels among children and adolescents. The study of plasma fatty acid (FA) composition, as a reflection of diet, and its associations with other parameters, that are closely linked to obesity and the cardiometabolic profile, may be useful for setting nutritional goals for obesity treatment and prevention. This study explored the relationship between plasma FA levels and body fat and cardiometabolic risk markers, in overweight adolescents. Methods: A multidisciplinary weight loss program was followed by 127 overweight and obese adolescents aged 12-17 years old. Plasma FA composition, anthropometric indicators of adiposity and biochemical parameters were analyzed at baseline, two months (the end of the intensive intervention phase) and six months (the end of the extensive phase). Results: While saturated fatty acid (SFA) and n-6 polyunsaturated fatty acid (PUFA) levels decreased significantly during the intervention, monounsaturated fatty acid (MUFA) and n-3 PUFA showed the opposite trend. The decrease in SFA C14:0 was associated with a reduction in total and LDL cholesterol, apolipoprotein B and insulin. The increase in MUFAs, especially C18:1n-9, was related to a reduction in weight, fat mass, fat mass index and glucose. Regarding PUFAs, changes in the n-3 series were not associated with any of the parameters studied, whereas the reduction in n-6 PUFA5 was directly related to weight, fat mass, total and HDL cholesterol, apolipoprotein Al, glucose and insulin, and inversely associated with diastolic blood pressure. The adolescents with greater weight loss presented significant changes in MUFAs, n-6 PUFA5 and C14:0. Conclusions: Modifications in plasma FA composition were associated with adiposity reduction and cardiometabolic profile improvement in an anti-obesity program aimed at adolescents. The changes observed in FA composition were related to the success of the treatment, since the individuals most affected by these variations were those who presented the greatest weight loss

Super-conservative interpretation of muon g-2 results applied to supersymmetry

The recent developments in theory and experiment related to the anomalous magnetic moment of the muon are applied to supersymmetry. We follow a very cautious course, demanding that the supersymmetric contributions fit within five standard deviations of the difference between experiment and the standard model prediction. Arbitrarily small supersymmetric contributions are then allowed, so no upper bounds on superpartner masses result. Nevertheless, non-trivial exclusions are found. We characterize the substantial region of parameter space ruled out by this analysis that has not been probed by any previous experiment. We also discuss some implications of the results for forthcoming collider experiments.Comment: 10 pages, latex, 3 fig

Nivolumab and sunitinib combination in advanced soft tissue sarcomas : A multicenter, single-arm, phase Ib/II trial

Sarcomas exhibit low expression of factors related to immune response, which could explain the modest activity of PD-1 inhibitors. A potential strategy to convert a cold into an inflamed microenvironment lies on a combination therapy. As tumor angiogenesis promotes immunosuppression, we designed a phase Ib/II trial to test the double inhibition of angiogenesis (sunitinib) and PD-1/PD-L1 axis (nivolumab). This single-arm, phase Ib/II trial enrolled adult patients with selected subtypes of sarcoma. Phase Ib established two dose levels: level 0 with sunitinib 37.5 mg daily from day 1, plus nivolumab 3 mg/kg intravenously on day 15, and then every 2 weeks; and level-1 with sunitinib 37.5 mg on the first 14 days (induction) and then 25 mg per day plus nivolumab on the same schedule. The primary endpoint was to determine the recommended dose for phase II (phase I) and the 6-month progression-free survival rate, according to Response Evaluation Criteria in Solid Tumors 1.1 (phase II). From May 2017 to April 2019, 68 patients were enrolled: 16 in phase Ib and 52 in phase II. The recommended dose of sunitinib for phase II was 37.5 mg as induction and then 25 mg in combination with nivolumab. After a median follow-up of 17 months (4-26), the 6-month progression-free survival rate was 48% (95% CI 41% to 55%). The most common grade 3-4 adverse events included transaminitis (17.3%) and neutropenia (11.5%). Sunitinib plus nivolumab is an active scheme with manageable toxicity in the treatment of selected patients with advanced soft tissue sarcoma, with almost half of patients free of progression at 6 months

Knowledge, attitudes and preventive practices of primary health care professionals towards alcohol use: A national, cross-sectional study

Introduction Primary care (PC) professionals' knowledge about alcohol use has been identified as one of the barriers PC providers face in their clinic. Both PC professionals' level of training and attitude are crucial in the clinical practice regarding alcohol use. Objective To evaluate the knowledge, attitude, and preventive practices of Spanish PC physicians and nurses towards alcohol use. Design An observational, descriptive, cross-sectional, multi-center study. Methodology Location: PC centers of the Spanish National Health System (NHS). Participants: PC physicians and nurses selected randomly from health care centers, and by sending an e-mail to semFYC and SEMERGEN members. Healthcare providers completed an online survey on knowledge, attitude, and follow-up recommendations for reducing alcohol intake. A descriptive, bivariate, and multivariate statistical analysis was conducted (p<0.05). Results Participants: 1, 760 healthcare providers completed the survey (75.6% [95% CI 73.5-77.6] family physicians; 11.4% [95% CI 9.9-12.9] medical residents; and 12.5% [95% CI 10.9-14.1] nurses), with a mean age of 44.7 (SD 11.24, range: 26-64, 95% CI: 47.2-48.2). Knowledge was higher in family physicians (p<0.001), older professionals (Spearman's r = 0.11, p<0.001), and resident trainers (p<0.001). The PC professional most likely to provide advice for reducing alcohol use was: a nurse (p<0.001), female (p = 0.010), between 46 and 55 years old (p <0.001). Conclusions PC providers' knowledge and preventive practices regarding alcohol use are scarce, hence specific training strategies to increase their knowledge and improve their attitude and skills with regard to this health problem should be considered a healthcare policy priority

Bounds on the tau and muon neutrino vector and axial vector charge radius

A Majorana neutrino is characterized by just one flavor diagonal electromagnetic form factor: the anapole moment, that in the static limit corresponds to the axial vector charge radius . Experimental information on this quantity is scarce, especially in the case of the tau neutrino. We present a comprehensive analysis of the available data on the single photon production process $e^+ e^- -> \nu \bar\nu \gamma$ off Z-resonance, and we discuss the constraints that these measurements can set on for the tau neutrino. We also derive limits for the Dirac case, when the presence of a vector charge radius is allowed. Finally, we comment on additional experimental data on $\nu_\mu$ scattering from the NuTeV, E734, CCFR and CHARM-II collaborations, and estimate the limits implied for and for the muon neutrino.Comment: 20 pages, 2 eps figures. CCFR data included in the analysis. Conclusion unchange

Low-scale supersymmetry breaking: effective description, electroweak breaking and phenomenology

We consider supersymmetric scenarios in which the scale of SUSY breaking is low, sqrt{F}=O(TeV). Instead of studying specific models of this type, e.g. those with extra dimensions and low fundamental scale, we follow a model-independent approach based on a general effective Lagrangian, in which the MSSM supermultiplets are effectively coupled to a singlet associated to SUSY breaking. Our goal is to analyse the interplay bewteen SUSY breaking and electroweak breaking, generalizing earlier results. The conventional MSSM picture can be substantially modified, mainly because the Higgs potential contains additional effective quartic terms and resembles that of two-Higgs-doublet models, with an additional singlet. Novel opportunities to achieve electroweak breaking arise, and the electroweak scale may be obtained in a less fine-tuned way. Also the Higgs spectrum can be strikingly changed, and the lightest state can be much heavier than in usual supersymmetric scenarios. Other effects appear in the chargino and neutralino sectors, which contain the goldstino. Finally, we discuss the role of electroweak breaking in processes in which two goldstinos could be emitted, such as fermion-antifermion annihilation and the invisible decay of a Z boson or of neutral Higgs bosons.Comment: LaTeX, 47 pages, 5 figures; typos corrected, to appear in Nucl. Phys.

Phase II randomized study of Plitidepsin (Aplidin), alone or in association with L-carnitine, in patients with unresectable advanced renal cell carcinoma

This randomized phase II study evaluated two schedules of the marine compound Plitidepsin with or without co-administration of L-carnitine in patients with renal cell carcinoma. Patients had adequate performance status and organ function. The primary endpoint was the rate of disease control ( no progression) at 12 weeks (RECIST). Other endpoints included the response rate and time dependent efficacy measures. The trial also assessed the efficacy of L-carnitine to prevent Plitidepsin-related toxicity. The two regimes given as 24 hour infusion every two weeks showed hints of antitumoral activity. Disease control at 12 weeks was 15.8% in Arm A (5mg/m2, no L-carnitine) and 11,1% in Arm B (7mg/m2 with L-carnitine). Two partial responses were observed in Arm A ( 19 patients), none in Arm B ( 20 patients). Both schedules had the same progression-free interval (2.1 months). The median overall survival was 7.0 and 7.6 months. The safety profile was similar in both arms of the trial and adverse events were mainly mild to moderate (NCI CTC version 2.0). Increasing the dose to 7mg/m2 did not increase the treatment efficacy but the incidence of transaminase and CPK elevations and serious AEs. Coadministration of L-carnitine did not prevent muscular toxicity or CPK-elevation associated with Plitidepsin