Metastatic tumors to the stomach: clinical and endoscopic features.

AIM: To evaluate the clinical and endoscopic patterns in a large series of patients with metastatic tumors in the stomach. METHODS: A total of 64 patients with gastric metastases from solid malignant tumors were retrospectively examined between 1990 and 2005. The clinicopathological findings were reviewed along with tumor characteristics such as endoscopic pattern, location, size and origin of the primary sites. RESULTS: Common indications for endoscopy were anemia, bleeding and epigastric pain. Metastases presented as solitary (62.5%) or multiple (37.5%) tumors were mainly located in the middle or upper third of stomach. The main primary metastatic tumors were from breast and lung cancer and malignant melanoma. CONCLUSION: As the prognosis of cancer patients has been improving gradually, gastrointestinal (GI) metastases will be encountered more often. Endoscopic examinations should be conducted carefully in patients with malignancies, and endoscopic biopsies and information on the patient's clinical history are useful for correct diagnosis of gastric metastases

The limits of the rotating wave approximation in the electromagnetic field propagation in a cavity

We consider three two-level atoms inside a one-dimensional cavity, interacting with the electromagnetic field in the rotating wave approximation (RWA), commonly used in the atom-radiation interaction. One of the three atoms is initially excited, and the other two are in their ground state. We numerically calculate the propagation of the field spontaneously emitted by the excited atom and scattered by the second atom, as well as the excitation probability of the second and third atom. The results obtained are analyzed from the point of view of relativistic causality in the atom-field interaction. We show that, when the RWA is used, relativistic causality is obtained only if the integrations over the field frequencies are extended to $-\infty$; on the contrary, noncausal tails remain even if the number of field modes is increased. This clearly shows the limit of the RWA in dealing with subtle problems such as relativistic causality in the atom-field interaction.Comment: 13 pages, 6 figure

A System for Optimizing Fertilizer Dosing in Innovative Smart Fertigation Pipelines: Modeling, Construction, Testing and Control

Smart fertigation is a topic of great interest in the effort to optimize different activities involved in local and extensive agriculture for assisting crops, optimizing production by using wireless technologies, data-processing electronic boards and sensors network. With the advent of Agriculture 4.0, similar to Industry 4.0, Information Communication Technology (ICT), associated with mechatronics, is giving an added value to this technique allowing optimization of water, fertilizers, control of water flow in pipes and period of irrigation. This paper intends to illustrate findings related to an innovative low cost system for assisting crops and achieving an accurate farming by investigating on the design, construction, testing and control of dosing system for liquid and granular fertilizers. Four different dosage systems have been designed, realized and tested with different granular and liquid fertilizers; the analysis of an extensive experimental campaign allows to define the characteristic and the mathematical expressions for each analyzed fertilizer and for each dosage system. The accurate modeling allows to control with extreme precision the realized dosing systems after estimating the quantity of fertilizer which the crop needs by means of the smart fertigation system. The obtained results permit the optimization of the fertilizer dosage in terms of quantity, which at the same time translates into lower production costs, greater environmental sustainability and optimization of production in terms of quantity and quality

Postnatal survival after endoscopic equatorial laser for the treatment of twin-to-twin transfusion syndrome

Background Endoscopic laser coagulation of placental anastomoses is the first-line treatment for severe twin-to-twin transfusion syndrome. A recent randomized controlled trial reported that laser coagulation along the entire vascular equator was associated with a similar dual survival and survival of at least 1 twin compared with the group that was treated with the selective technique. In addition, there was a significantly lower incidence of postoperative recurrence of twin-to-twin transfusion syndrome and the development of twin anemia-polycythemia sequence in the equatorial group. Objective The purpose of this study was to report on neonatal survival in twin-to-twin transfusion syndrome pregnancies that were treated with endoscopic laser therapy with the use of the equatorial technique and to examine the relationship between preoperative factors and twin loss. Study Design Endoscopic equatorial laser therapy was carried out as the primary treatment for twin-to-twin transfusion syndrome in all consecutive monochorionic diamniotic twin pregnancies that were referred at a single fetal surgery Center over a 4-year period. All visible placental anastomoses were coagulated; additional laser ablation of the placental tissue between the coagulated vessels was carried out. Pre-laser ultrasound data, periprocedural complications, pregnancy outcome, and postnatal survival at hospital discharge were recorded and analyzed. Results A total of 106 pregnancies were treated during the study period. Median gestational age at laser therapy was 19.7 weeks (range, 15.1-27.6 weeks). There was postoperative recurrence of twin-to-twin transfusion syndrome or the development of twin anemia-polycythemia sequence in 2 (1.9%) and 2 (1.9%) cases, respectively. The survival rates of both and at least 1 twin were 56.6% and 83.0%, respectively. Donor survival was significantly lower compared with the recipient co-twin (64.2% vs 75.5%, respectively; P <.05). The rate of fetal death, which was the most common cause of twin loss, was significantly higher in donors compared with recipient fetuses (23.6% vs 10.4%, respectively; P <.05). In cases with absent or reversed end-diastolic velocity in the donor umbilical artery, dual and donor survival rates were significantly lower compared with the remaining twin-to-twin transfusion syndrome pregnancies (40.0% vs 64.8% and 40.0% vs 76.1%, respectively; P <.05). There were no significant differences between the 2 groups in the survival of at least 1 twin and in the recipient survival. Conclusions Endoscopic equatorial laser therapy was associated with a survival of both and at least 1 twin of approximately 55% and 83%, respectively, with a low rate of recurrent twin-to-twin transfusion syndrome and twin anemia-polycythemia sequence. In addition, the preoperative finding of abnormal donor umbilical artery Doppler on ultrasound identified a subgroup of twin-to-twin transfusion syndrome pregnancies with a lower dual survival rate caused by increased intrauterine deaths of donor twins

A convenient decontraction procedure of internally contracted state-specific multireference algorithms

Internally contracted state-specific multireference MR algorithms, either perturbative such as CASPT2 or NEVPT2, or nonperturbative such as contracted MR configuration interaction or MR coupled cluster, are computationally efficient but they may suffer from the internal contraction of the wave function in the reference space. The use of a low dimensional multistate model space only offers limited flexibility and is not always practicable. The present paper suggests a convenient state-specific procedure to decontract the reference part of the wave function from a series of state-specific calculations using slightly perturbed zero-order wave functions. The method provides an orthogonal valence bond reading of the ground state and an effective valence Hamiltonian, the excited roots of which are shown to be relevant. The orthogonal valence bond functions can be considered quasidiabatic states and the effective valence Hamiltonian gives therefore the quasidiabatic energies and the electronic coupling among the quasidiabatic states. The efficiency of the method is illustrated in two case problems where the dynamical correlation plays a crucial role, namely, the LiF neutral/ionic avoided crossing and the F2 ground state wave functio

Polypoid vascular malformation of the small intestine.

A 56-year-old man underwent capsule endoscopy because of obscure GI bleeding. Capsule endoscopy showed a pink and somewhat nodular polypoid lesion of the small bowel partially obstructing the intestinal lumen (A). The patient underwent an ileal resection and the operative specimen showed loss of mucosal folds and the presence of an erythematous area with a polypoid formation of 3.5 × 3 cm (B). Histologic examination revealed the presence of numerous ectatic thin-walled blood vessels and a small number of thick-walled vessels in the submucosa (C and D, arrows; H&E, orig. mag. ×4), surrounded by hypertrophic muscularis mucosae and a chronic inflammatory infiltrate that infiltrated the muscularis propria; the diagnosis of polypoid angiodysplasia was suggested. There has been no recurrence of GI bleeding 14 months after the ileal resection

Gpr investigation at the archaeological site of le cesine, lecce, italy

In this contribution, we present some results achieved in the archaeological site of Le Cesine, close to Lecce, in southern Italy. The investigations have been performed in a site close to the Adriatic Sea, only slightly explored up to now, and where the presence of an ancient Roman harbour is alleged on the basis of remains visible above all under the current sea level. This measurement campaign has been performed in the framework of a short-term scientific mission (STSM) performed in the framework of the European Cost Action 17131 (acronym SAGA), and has been aimed to identify possible points where future localized excavation might and hopefully will be performed in the next few years. Both a traditional elaboration and an innovative data processing based on a linear inverse scattering model have been performed on the data

Screening for Common Fetal Trisomies in Twin Pregnancies : First-Trimester Combined, Cell-Free DNA, or Both?

Objective: To examine the distribution of risks for fetal trisomies after first-trimester combined screening in twins and to investigate different strategies for clinical implementation of cell-free DNA (cfDNA) testing. Methods: We retrospectively analyzed all twin pregnancies undergoing first-trimester combined screening over a 10 years' period. The population was stratified according to various risk cut-offs, and we examined different screening strategies for implementation of cfDNA testing in terms of impact on invasive testing rate, cfDNA test failure rate, and economic costs. Results: We included 572 twin pregnancies: 480 (83.92%) dichorionic and 92 (16.08%) monochorionic. Performing a first-line combined screening and offering cfDNA testing to the group with a risk between 1 in 10 and 1 in 1,000, would lead to an invasive testing rate of 2.45%, and cfDNA testing would be performed in 22.20% of the population. This strategy would be cost-neutral compared to universal combined screening alone. Conclusions: First-trimester combined screening results can be used to stratify twin pregnancies into different risk categories and select those that could be offered cfDNA testing. A contingent screening strategy would substantially decrease the need for invasive testing in twins and it would be cost-neutral compared to combined testing alone

Fetal Doppler changes one week after endoscopic equatorial laser for twin-to-twin transfusion syndrome: a longitudinal study

Objective: To investigate sequential Doppler changes in donors and recipients before and 1 week after endoscopic laser for twin\u2010to\u2010twin transfusion syndrome (TTTS) and to examine factors that may be associated with such changes. Methods: In TTTS pregnancies undergoing laser treatment, we examined fetal Doppler changes before and 1 week postintervention. Intrauterine death rates and preoperative factors were analyzed in relation to Doppler changes. Results: Among 129 (85.4%) donors surviving at 1 week after laser, there was normalization of umbilical artery flow in 26 (72.2%) of 36 cases with preoperative abnormal Dopplers. In the remaining 10 (27.8%) fetuses, abnormal findings persisted. The rate of later intrauterine death was significantly higher in the latter group (6 of 10, 60.0%) compared with fetuses in which Doppler findings normalized (4 of 26, 15.4%; P < .05), with no difference in the rate of severe donor growth restriction between the 2 groups (80.0% vs 65.4%, respectively; P = .688). Conclusions: In about 70% of TTTS donors with preoperative abnormal umbilical artery Doppler, there was normalization 1 week after endoscopic laser. The incidence of fetal growth restriction was not significantly different in donors with persistence of Doppler abnormalities compared with those with normalized findings

METIS D3.4: Final workshops packages: workshops for different educational levels and education contexts

Several decades of research in technology-enhanced learning (TEL) have clearly demonstrated the potential of digital technology to transform education. Yet the impact of TEL research on daily teaching-learning practices is still far from fulfilling this potential. Arguably, this is a gap in the capacity for learning design: educators need the tools and competencies which would allow them to identify educational challenges, describe the context in which they arise, identify the opportunities afforded by technology, project the insights derived from research, and devise new learning experiences. To address this gap, educators need tools and practices. Tools that would support them through the cycle of learning design – from conception to deployment and evaluation of techno-educational innovations. Professional practices that use such tools to ensure the robustness and effectiveness of their innovations and make learning design a daily habit and part of their professional identity. The METIS project (http://metis-project.org/) aims to contribute to this aim, by providing educators with an Integrated Learning Design Environment (ILDE) (Hernández-Leo, Asensio-Pérez, Derntl, Prieto, & Chacón, 2014; Hernández-Leo et al., 2015) and a workshop package for training educators in using the ILDE to support effective learning design. Work Package 3, led by the OU (UK), is concerned with the design and development of the workshop package. This deliverable is the final version of the METIS workshop package. It includes • a meta-design for METIS workshops that provides a flexible reusable structure so that workshops can be customised to meet different needs , • a description of the rationale and pedagogical methodology on which the meta-design is based • guidance for instantiating the meta-design in different contexts and • example workshop packages based on the meta-design for three different educational sectors. This document provides educators with a basis for delivering workshops about using the ILDE to support effective learning design. To create and run a workshop suitable for your own context, please proceed in the following way. Firstly, consider the meta-design; then choose one of the example workshop packages closest to your context; finally, use the guidelines to adapt it for your needs