Experiencia en el salvamento de extremidades en una unidad de tumores óseos

Los autores exponen su experiencia en el tratamiento quirúrgico de 26 casos de tumores malignos primarios de los huesos largos de las extremidades en estadio II.B. El diagnóstico era de osteosarcoma en 12 casos, sarcoma de Ewing en 3, condrosarcoma de bajo grado en 4, sarcomas osteogénicos paraostales en 3, mieloma en 1, adamantinoma en 1, y tumor de células gigantes (TCG) en otro caso. Se trataba de tumores controlados mediante la aplicación de protocolos de Quimioterapia como son el T-10 de Rosen para con el osteosarcoma y el T-9 para el sarcoma de Ewing, consiguiendo necrosis tumorales del orden entre el 75% y el 85%, con buena respuesta de compartimentación y de esclerosis. Todos los tumores se encontraban en estadio H-BNo,Mo, respetando los vasos de la extremidad, según el Divas practicado. En los 26 casos se han seguido los postulados de la ISOLS, para realizar las técnicas de salvamento de extremidad. Estas técnicas consistieron, entre otras, en el implante de prótesis o a medida (12 casos) o bien modulares. Se efectuaron tratamientos mixtos como aloinjertos criopreservados en Banco de Hueso + Endoprótesis en 10 casos. En 2 casos, se realizó artrodesis de rodilla con enclavado de Kunstcher femorotibial y aloinjerto. En otros 2 casos la Osteosíntesis endomedular y cortical fue el método de fijación del aloinjerto. Se hace una valoración crítica de cada caso, del tipo de resección, su resultado funcional, complicaciones, recidivas, metástasis, y el grado de satisfacción personal del pacienteThe experience on the surgical treatment of 26 patients with a Primary Malignant Bone Tumor of the long bones in stage II-B is reported. There weve 12 osteosarcomas, 3 Ewing's sarcoma, 4 low-grade chondrosarcoma, 3 paraosteal sarcoma, 1 myeloma, 1 Adamantinoma and 1 Giant-Cell tumor. Tumors were treated by chemotherapy protocols such as Rosen T-10 for osteosarcomas and T-9 for Ewing's sarcoma, with 75-80% of tumor necrosis disclosing a good response and sclerosis. All tumors were staged as II-BNoMo with vessels preservation according to the DIVAS test. Sugery for limb salvage was performed in all these patients based on ISOLS criteria. Costum-made or modular prosthetic implantation was the surgical technique in 12 cases. Mixed methods susch as cryopreserved allografts they Endoprosthesis was applied in 10 patients, two cases were treated by knee arthrodesis with a femorotibial endomedulary Kunstcher's nail and an allograft. Other 2 cases received endomedular and cortical osteosyntesis to stabilize the allograft. The paper describes the functional evaluation of each patient depending on the type of tumor, the size of the bone resection, complications, recurrences, metastases, surgical revisions and also level of subjective personal satisfaction of each patient

Lipid phenotype and heritage pattern in families with genetic hypercholesterolemia not related to LDLR, APOB, PCSK9, or APOE

Background: A substantial proportion of individuals clinically diagnosed as familial hypercholesterolemia (FH) do not carry pathogenic mutations in candidate genes. Whether in them the high cholesterol trait is transmitted monogenically has not been studied. Objectives: We assessed the inheritance pattern, penetrance, and expression of high low-density lipoprotein (LDL)-cholesterol (LDLc) in families with genetic hypercholesterolemia (GH) without known causative mutations (non-FH-GH). Methods: The study included probands with a clinical diagnosis of FH and their families attending 2 lipid clinics in Spain. Inclusion criteria for probands were LDLc >95th percentile, triglycerides 90th percentile, >5 points in the Dutch Lipid Clinic Network criteria score, and absence of mutations in LDLR, APOB, PCSK9 or APOE. Eleven FH families with a LDLR mutation were also examined for comparison. Results: We analyzed 49 non-FH-GH probands and 277 first-and second-degree relatives. LDLc was >90th percentile in 37.8% of blood relatives, at concentrations similar to those of probands. LDLc had a normal distribution in non-FH-GH families, in contrast with a bimodal distribution in FH families. When a dominant model was tested, family-based association tests gave much lower heritability values for total cholesterol and LDLc in non-FH-GH (0.39 and 0.32, respectively) than in FH (0.78 and 0.61, respectively). Conclusions: Non-FH-GH families have a milder lipid phenotype than genetically defined FH. The heritage pattern of LDLc in non-FH-GH does not fit with a monogenic disorder. Our findings support the concept that most non-FH-GHs are polygenic hypercholesterolemias

Fracturas de extremidad proximal de cubito en el niño

Las fracturas y epifisiolisis proximales de cubito, son lesiones raras y cuando se producen suelen estar mínimamente ó no desplazadas, pudiendo ser tratadas de forma conservadoras. En los casos en que existe desplazamiento significativo, requieren reducción abierta y osteosíntesis. Independientemente del tipo de tratamiento utilizado, el resultado final suele ser satisfactorio. Realizamos un estudio retrospectivo de 13 casos de fractura-epifisiolisis de extremo proximal de cubito, ocurridas durante el periodo 1992-2001. Nuestro objetivo es analizar los resultados obtenidos en el tratamiento de las lesiones y realizar una revisión bibliográfica, teniendo en cuenta los distintos métodos de clasificación, valoración de resultados y las valoraciones descritas para la iniciación de tratamiento quirúrgico de estas lesiones.The epiphysiolisis and proximal lunar fractures in children rare injuries and usually the aren't displaced. In these cases they can be managed nonoperatively. If there's a marked displacement, open reduction and internal fixation is mandatory. The final outcome uses to be successful despite the management; 13 patients with epiphysiolisis or fracture of the proximal ulna between 1992-2001 ere revised. Our aim is to evaluate our outcomes and reviewed the literatur

Overlapping communication and computation by using a hybrid MPI/SMPSs approach

A previous version of this document was submitted for publication by october 2008.Communication overhead is one of the dominant factors that affect performance in high-performance computing systems. To reduce the negative impact of communication, programmers overlap communication and computation by using asynchronous communication primitives. This increases code complexity, requiring more effort to write parallel code and making less readable code. This paper presents the hybrid use of MPI and SMPSs (SMP superscalar), a task-based shared-memory programming model, enhanced with a restart mechanism allowing the programmer to introduce the asynchronism that is necessary to enable the effective communication/computation overlap in a productive way. We demonstrate the hybrid use of MPI/SMPSs with the high-performance LINPACK benchmark, which uses the lookahead technique to overlap communication and computation. MPI/SMPSs improves the performance of a pure MPI with look-ahead by 7,6% on a 1024 processors machine. In addition to better performance, hybrid MPI/SMPSs substantially reduces code complexity, it is less sensitive to network bandwidth and operating system noise, and improves the use of main memory.Postprint (published version

Persistence in complex systems

Persistence is an important characteristic of many complex systems in nature, related to how long the system remains at a certain state before changing to a different one. The study of complex systems’ persistence involves different definitions and uses different techniques, depending on whether short-term or long-term persistence is considered. In this paper we discuss the most important definitions, concepts, methods, literature and latest results on persistence in complex systems. Firstly, the most used definitions of persistence in short-term and long-term cases are presented. The most relevant methods to characterize persistence are then discussed in both cases. A complete literature review is also carried out. We also present and discuss some relevant results on persistence, and give empirical evidence of performance in different detailed case studies, for both short-term and long-term persistence. A perspective on the future of persistence concludes the work.This research has been partially supported by the project PID2020-115454GB-C21 of the Spanish Ministry of Science and Innovation (MICINN). This research has also been partially supported by Comunidad de Madrid, PROMINT-CM project (grant ref: P2018/EMT-4366). J. Del Ser would like to thank the Basque Government for its funding support through the EMAITEK and ELKARTEK programs (3KIA project, KK-2020/00049), as well as the consolidated research group MATHMODE (ref. T1294-19). GCV work is supported by the European Research Council (ERC) under the ERC-CoG-2014 SEDAL Consolidator grant (grant agreement 647423)

Persistence in complex systems

Persistence is an important characteristic of many complex systems in nature, related to how long the system remains at a certain state before changing to a different one. The study of complex systems' persistence involves different definitions and uses different techniques, depending on whether short-term or long-term persistence is considered. In this paper we discuss the most important definitions, concepts, methods, literature and latest results on persistence in complex systems. Firstly, the most used definitions of persistence in short-term and long-term cases are presented. The most relevant methods to characterize persistence are then discussed in both cases. A complete literature review is also carried out. We also present and discuss some relevant results on persistence, and give empirical evidence of performance in different detailed case studies, for both short-term and long-term persistence. A perspective on the future of persistence concludes the work.This research has been partially supported by the project PID2020-115454GB-C21 of the Spanish Ministry of Science and Innovation (MICINN). This research has also been partially supported by Comunidad de Madrid, PROMINT-CM project (grant ref: P2018/EMT-4366). J. Del Ser would like to thank the Basque Government for its funding support through the EMAITEK and ELKARTEK programs (3KIA project, KK-2020/00049), as well as the consolidated research group MATHMODE (ref. T1294-19). GCV work is supported by the European Research Council (ERC) under the ERC-CoG-2014 SEDAL Consolidator grant (grant agreement 647423)

A multistate model and its standalone tool to predict hospital and ICU occupancy by patients with COVID-19

Objective: This study aims to build a multistate model and describe a predictive tool for estimating the daily number of intensive care unit (ICU) and hospital beds occupied by patients with coronavirus 2019 disease (COVID-19). Material and methods: The estimation is based on the simulation of patient trajectories using a multistate model where the transition probabilities between states are estimated via competing risks and cure models. The input to the tool includes the dates of COVID-19 diagnosis, admission to hospital, admission to ICU, discharge from ICU and discharge from hospital or death of positive cases from a selected initial date to the current moment. Our tool is validated using 98,496 cases positive for severe acute respiratory coronavirus 2 extracted from the Aragón Healthcare Records Database from July 1, 2020 to February 28, 2021. Results: The tool demonstrates good performance for the 7- and 14-days forecasts using the actual positive cases, and shows good accuracy among three scenarios corresponding to different stages of the pandemic: 1) up-scenario, 2) peak-scenario and 3) down-scenario. Long term predictions (two months) also show good accuracy, while those using Holt-Winters positive case estimates revealed acceptable accuracy to day 14 onwards, with relative errors of 8.8%. Discussion: In the era of the COVID-19 pandemic, hospitals must evolve in a dynamic way. Our prediction tool is designed to predict hospital occupancy to improve healthcare resource management without information about clinical history of patients. Conclusions: Our easy-to-use and freely accessible tool (https://github.com/peterman65) shows good performance and accuracy for forecasting the daily number of hospital and ICU beds required for patients with COVID-19

A mixture of experts model for predicting persistent weather patterns

Weather and atmospheric patterns are often persistent. The simplest weather forecasting method is the so-called persistence model, which assumes that the future state of a system will be similar (or equal) to the present state. Machine learning (ML) models are widely used in different weather forecasting applications, but they need to be compared to the persistence model to analyse whether they provide a competitive solution to the problem at hand. In this paper, we devise a new model for predicting low-visibility in airports using the concepts of mixture of experts. Visibility level is coded as two different ordered categorical variables: Cloud height and runway visual height. The underlying system in this application is stagnant approximately in 90% of the cases, and standard ML models fail to improve on the performance of the persistence model. Because of this, instead of trying to simply beat the persistence model using ML, we use this persistence as a baseline and learn an ordinal neural network model that refines its results by focusing on learning weather fluctuations. The results show that the proposal outperforms persistence and other ordinal autoregressive models, especially for longer time horizon predictions and for the runway visual height variable