Thymoma metastatic to liver and pancreas: case report and review of the literature

A 71-year-old man presented with a thymic mass involving the superior vena cava. A mediastinoscopical biopsy initially suggested a diagnosis of type A thymoma. After neoadjuvant chemotherapy, the patient underwent en-bloc thymectomy and vascular resection for a pathology-confirmed type B3 thymoma involving the superior vena cava, the left brachiocephalic vein and the distal part of the right brachiocephalic vein. Adjuvant radiotherapy was administered. Two years after the primary surgery, abdominal computed tomography (CT) and whole body fluorodeoxyglucose (18-FDG) positron emission tomography (PET) scans showed a single hepatic lesion that was treated with wedge liver resection. Pathological examination confirmed metastatic type B3 thymoma. Almost 4 years later, abdominal CT and 18-FDG PET revealed a 2.9-cm solid mass involving the body of the pancreas. Distal pancreatectomy with lymph node dissection was performed. Pathological examination showed a pancreatic metastasis from a type B3 thymoma, without lymph node involvement. The patient is alive and free of disease 6 months after the pancreatectomy (68 months after the initial thymectomy surgery). Intra-abdominal recurrence and pancreatic metastases are very uncommon manifestations of thymoma, but this event should be kept in mind when an abdominal mass is seen during follow-up

Propuesta de un modelo de idoneidad pata la gestión de lodos procedentes de la depuración de aguas residuales

El crecimiento de la población y de la industria ha implicado un aumento de los residuos, entre ellos los lodos procedentes de la depuración de las aguas residuales. Nace así la necesidad de generar modelos que gestionen este tipo de residuos, apostando principalmente por una gestión sostenible que se comprometa a su revalorización. La presente comunicación muestra la propuesta de un modelo de idoneidad para la gestión de lodos en su principal aprovechamiento, como fertilizante agrícola. Para ello se ha desarrollado un prototipo que combina criterios medioambientales, sociales y económicos para la determinación de las áreas más adecuadas a la aplicación de los lodos. Las técnicas de evaluación multicriterio (EMC) y la elaboración de un Índice de Calidad (IC) se han entrelazado mediante un SIG, lo que ha permitido la representación espacial de las áreas agrícolas más idóneas, para el caso de estudio de Cataluña.Population growth and industrial development has leaded to an increased production of residues; such as the sewage sludge from waste water treatment. This fact leads to the necessity of generating models to manage this waste. Through a sustainable management strategies. The present communication shows a suitability model to manage sewage sludge in his principal disposal option, as agricultural fertilizer. For that, a model that combines environmental, social and economic criteria to determine the most suitability area for the sewage sludge application is developed. The Multi-criteria Decision Analysis techniques (MCDA) for the elaboration of a Quality Index (QI) have been integrated in the GIS platform, that which allowed the spatial representation of the best suitability agricultural areas in Catalonia

PET/CT incidental detection of second tumor in patients investigated for pancreatic neoplasms

Positron Emission Tomography/computed tomography (PET/CT) is an imaging technique which has a role in the detection and staging malignancies (both in first diagnosis and follow-up). The finding of an unexpected region of FDG (Fluorodeoxyglucose) uptake can occur when performing whole-body FDG-PET, raising the possibility of a second primary tumor. The aim of this study was to evaluate our experience of second primary cancer incidentally discovered during PET/CT examination performed for pancreatic diseases, during the initial work-up or follow-up after surgical resection

Para-aortic node involvement is not an independent predictor of survival after resection for pancreatic cancer

AIM To analyze the importance of para-aortic node status in a series of patients who underwent pancreaticoduodenectomy (PD) in a single Institution. METHODS Between January 2000 and December 2012, 151 patients underwent PD with para-aortic node dissection for pancreatic adenocarcinoma in our Institution. Patients were divided into two groups: patients with negative PALNs (PALNs-), and patients with metastatic PALNs (PALNs+). Pathologic factors, including stage, nodal status, number of positive nodes and lymph node ratio, invasion of para-aortic nodes, tumor\u2019s grading, and radicality of resection were studied by univariate and multivariate analysis. Survival curves were constructed with Kaplan-Meier method and compared with Log-rank test: significance was considered as P < 0.05. RESULTS A total of 107 patients (74%) had nodal metastases. Median number of pathologically assessed lymph nodes was 26 (range 14-63). Twenty-five patients (16.5%) had para-aortic lymph node involvement. Thirty-three patients (23%) underwent R1 pancreatic resection. One-hundred forty-one patients recurred and died for tumor recurrence, one is alive with recurrence, and 9 are alive and free of disease. Overall survival was significantly influenced by grading (P = 0.0001), radicality of resection (P = 0.001), stage (P = 0.03), lymph node status (P = 0.04), para-aortic nodes metastases (P = 0.02). Multivariate analysis showed that grading was an independent prognostic factor for overall survival (P = 0.0001), while grading (P = 0.0001) and radicality of resection (P = 0.01) were prognostic parameters for disease-free survival. Number of metastatic nodes, node ratio, and para-aortic nodes involvement were not independent predictors of disease-free and overall survival. CONCLUSION In this experience, lymph node status and para-aortic node metastases were associated with poor survival at univariate analysis, but they were not independent prognostic factors

Displacement power spectrum measurement of a macroscopic optomechanical system at thermal equilibrium

The mirror relative motion of a suspended Fabry-Perot cavity is studied in the frequency range 3-10 Hz. The experimental measurements presented in this paper, have been performed at the Low Frequency Facility, a high finesse optical cavity 1 cm long suspended to a mechanical seismic isolation system identical to that one used in the VIRGO experiment. The measured relative displacement power spectrum is compatible with a system at thermal equilibrium within its environmental. In the frequency region above 3 Hz, where seismic noise contamination is negligible, the measurement distribution is stationary and Gaussian, as expected for a system at thermal equilibrium. Through a simple mechanical model it is shown that: applying the fluctuation dissipation theorem the measured power spectrum is reproduced below 90 Hz and noise induced by external sources are below the measurement.Comment: 11 pages, 9 figures, 2 tables, to be submitte

A Randomised, Blinded, Placebo-Controlled, Dose Escalation Study of the Tolerability and Efficacy of Filgrastim for Haemopoietic Stem Cell Mobilisation in Patients With Severe Active Rheumatoid Arthritis

Autologous haemopoietic stem cell transplantation (HSCT) represents a potential therapy for severe rheumatoid arthritis (RA). As a prelude to clinical trails, the safety and efficacy of haemopoietic stem cell (HSC) mobilisation required investigation as colony-stimulating factors (CSFs) have been reported to flare RA. A double-blind, randomised placebo-controlled dose escalation study was performed. Two cohorts of eight patients fulfilling strict eligibility criteria for severe active RA (age median 40 years, range 24-60 years; median disease duration 10.5 years, range 2-18 years) received filgrastim (r-Hu-methionyl granulocyte(G)-(SF) at 5 and 10 microg/kg/day, randomised in a 5:3 ratio with placebo. Patients were unblinded on the fifth day of treatment and those randomised to filgrastim underwent cell harvesting (leukapheresis) daily until 2 X 10^6/kg CD34+ cells (haemopoietic stem and progenitor cells) were obtained. Patients were assessed by clinical and laboratory parameters before, during and after filgrastim administration. RA flare was defined as an increase of 30% or more in two of the following parameters: tender joint count, swollen joint count or pain score. Efficacy was assessed by quantitation of CD34+ cells and CFU-GM. One patient in the 5 microg/kg/day group and two patients in the 10 microg/kg/day group fulfilled criteria for RA flare, although this did not preclude successful stem cell collection. Median changes in swollen and tender joint counts were not supportive of filgrastim consistently causing exacerbation of disease, but administration of filgrastim at 10 microg/kg/day was associated with rises in median C-reactive protein and median rheumatoid factor compared with placebo. Other adverse events were well recognised for filgrastim and included bone pain (80%) and increases in alkaline phosphatase (four-fold) and lactate dehydrogenase (two-fold). With respect to efficacy, filgrastim at 10 microg/kg/day was more efficient with all patients (n = 5) achieving target CD34+ cell counts with a single leukapheresis (median = 2.8, range = 2.3-4.8 X 10^6/kg, median CFU-GM = 22.1, range = 4.2-102.9 X 10^4/kg), whereas 1-3 leukaphereses were necessary to achieve the target yield using 5 microg/kg/day. We conclude that filgrastim may be administered to patients with severe active RA for effective stem cell mobilisation. Flare of RA occurs in a minority of patients and is more likely with 10 than 5 microg/kg/day. However, on balance, 10 microg/kg/day remains the dose of choice in view of more efficient CD34+ cell mobilisation

Exploring the digital servitization capabilities of the firm

Digital servitization is a transition process through which manufacturing firms move from offering products to offering integrated solutions between products, services, and digital technologies. Digital servitization consists of one of the main paradigm changes that manufacturing firms are facing in the current rise of the fourth industrial revolution (Industry 4.0). In this regard, many studies are exploring the capabilities that firms must develop to successfully carry out this transition. However, important research gaps remain, among which stand out: I) How firms can create value through their digital servitization capabilities; II) Which digitial servitization capabilities are required for the offering of smart services and; III) How firms can use their digital servitization capabilities to create value in the different trajectories of the digital servitization paradigm. To cover these gaps, this thesis is organized into three articles. Article I proposes a theoretical framework of four core digital servitization capabilities (Integration, Provision, Orchestration, and Manufacturing), conducts a multiple case study, and applies the fuzzy-set Qualitative Comparative Analysis (fsQCA) to identify configurations of these capabilities for value creation. Article II uses this same framework to identify how firms build digital servitization capabilities for the successful offering of smart services. This is done by applying a mixed-method approach, combining the emerging quantitative technique Necessary Conditions Analysis (NCA) with a qualitative multiple case study. Article III uses the framework to explore how firms following different digital servitization trajectories can configure their capabilities to create value. To do so, a cluster analysis is applied, followed by the fsQCA. Together, the results of the three articles demonstrate that integration and manufacturing capabilities, as well as their interaction, is the basis of value creation through digital servitization. Provision and orchestration capabilities are only secondary in this regard, but they have multiple interchangeable elements that confer different options for firms to configure them in order to create value.A servitização digital consiste em um processo de transição, através do qual firmas de setores industriais transitam da oferta de produtos para a oferta de soluções integradas entre produtos, serviços e tecnologias digitais. O fenômeno da servitização digital está altamente associado à atual quarta revolução industrial (Indústria 4.0), iniciada a partir do advento de tecnologias digitais diruptivas, como a Internet das Coisas, Computação em Nuvem, Análise de Big Data, Aprendizado de Máquina e Inteligência Artificial. Tais tecnologias têm imposto novas formas de produção e de criação de valor às firmas industriais, dentre as quais a servitização digital se destaca como uma das principais mudanças de paradigma enfrentadas. Por esta razão, muitos estudos tem explorado as capacidades (conjuntos de conhecimentos, recursos, rotinas e habilidades) que as firmas precisam desenvolver para transitarem com sucesso para servitização digital. Porém, importantes lacunas de pesquisa permanecem, dentre as quais se destacam: I) Como as capacidades de servitização digital criam valor para firma; II) Quais capacidades de servitização digital são necessárias para a oferta de serviços inteligentes e; III) Como as firmas usam suas capacidades de servitização digital para criarem valor nas diferentes trajetórias do paradigma da servitização digital. Com o objetivo de preencher estas lacunas, a presente tese propõe-se a responder à seguinte pergunta de pesquisa: Como as firmas utilizam suas capacidades de servitização digital para criarem valor? Para tanto, a tese foi estruturada em três artigos. O Artigo I – Explorando Configurações de Capacidades de Servitização Digital para Criação de Valor, propõe um modelo teórico de quatro capacidades centrais de servitização digital da firma (Integração, Provisão, Orquestração e Manufatura), conduz um estudo de múltiplos casos, e aplica a Análise Comparativa Qualitativa de Conjuntos Fuzzy (do inglês: Fuzzy-Set Qualitative Comparative Analysis, fsQCA) para identificar configurações dessas capacidades que criam valor. Os resultados mostram que as firmas podem criar valor através de duas configurações de capacidades: integração, provisão e manufatura (CI*CP*CM), ou integração, orquestração e manufatura (CI*CO*CM). O Artigo II – Construindo Capacidades de Servitização Digital para a Oferta de Serviços Inteligentes, utiliza o mesmo modelo de capacidades proposto no Artigo I, e aplica o método misto, combinando a técnica quantitativa emergente Análise de Condições Necessárias (do inglês: Necessary Conditions Analysis, NCA) com um estudo qualitativo de múltiplos 7 casos. Os resultados identificam que empresas de setores industriais seguem três etapas na construção de capacidades de servitização digital visando a oferta de serviços inteligentes: Implementação, Otimização e Customização. O Artigo III – Configurando as Capacidades de Servitização Digital da Firma para Criação de Valor em Diferentes Trajetórias, também utiliza o modelo de capacidades desenvolvido no Artigo I, conduz uma análise de cluster para identificar as trajetórias de servitização digital das firmas, e aplica o fsQCA para identificar as configurações de capacidades que resultam em criação de valor em cada trajetória. Os resultados demonstram que as firmas seguem quatro trajetórias de servitização digital (Tradicional, Digitalização, Servitização e Convergência), e que, em cada trajetória, diferentes configurações de capacidades são utilizadas para criação de valor. Juntos, os três artigos da tese demonstram que as capacidades de integração e de manufatura, bem como a interação entre elas, é a base da criação de valor através da servitização digital. As capacidades de provisão e de orquestração possuem apenas um papel secundário neste sentido, porém, a intercambialidade entre seus elementos confere diferentes opções para as firmas configurá-las a fim de criarem valor

Sensitivity Studies for Third-Generation Gravitational Wave Observatories

Advanced gravitational wave detectors, currently under construction, are expected to directly observe gravitational wave signals of astrophysical origin. The Einstein Telescope, a third-generation gravitational wave detector, has been proposed in order to fully open up the emerging field of gravitational wave astronomy. In this article we describe sensitivity models for the Einstein Telescope and investigate potential limits imposed by fundamental noise sources. A special focus is set on evaluating the frequency band below 10Hz where a complex mixture of seismic, gravity gradient, suspension thermal and radiation pressure noise dominates. We develop the most accurate sensitivity model, referred to as ET-D, for a third-generation detector so far, including the most relevant fundamental noise contributions.Comment: 13 pages, 7 picture

Orbital effects of a monochromatic plane gravitational wave with ultra-low frequency incident on a gravitationally bound two-body system

We analytically compute the long-term orbital variations of a test particle orbiting a central body acted upon by an incident monochromatic plane gravitational wave. We assume that the characteristic size of the perturbed two-body system is much smaller than the wavelength of the wave. Moreover, we also suppose that the wave's frequency is much smaller than the particle's orbital one. We make neither a priori assumptions about the direction of the wavevector nor on the orbital geometry of the planet. We find that, while the semi-major axis is left unaffected, the eccentricity, the inclination, the longitude of the ascending node, the longitude of pericenter and the mean anomaly undergo non-vanishing long-term changes. They are not secular trends because of the slow modulation introduced by the tidal matrix coefficients and by the orbital elements themselves. They could be useful to indepenedently constrain the ultra-low frequency waves which may have been indirectly detected in the BICEP2 experiment. Our calculation holds, in general, for any gravitationally bound two-body system whose characteristic frequency is much larger than the frequency of the external wave. It is also valid for a generic perturbation of tidal type with constant coefficients over timescales of the order of the orbital period of the perturbed particle.Comment: LaTex2e, 24 pages, no figures, no tables. Changes suggested by the referees include