Soret driven convection in a colloidal solution heated from above at very large solutal Rayleigh number

Convection in a colloidal suspension with a large negative separation ratio is studied experimentally by heating from above. Shadowgraph observation at very large solutal Rayleigh numbers are reported as a function of time. Fast relaxation oscillations are reported for the root mean square value of the shadowgraph intensity. While pure fluids exhibit a transition to turbulent convection for Rayleigh number of about 10^6, stable spoke-pattern planform with up and down columnar flows are observed up to solutal Rayleigh numbers of the order of 10^9. It is suggested that the surprising stability of the planform against turbulence is due to nonlinear focusing arising from the concentration dependence of the diffusion coefficient.Comment: 10 pages, 4 figure

Single-center experience in the treatment of visceral artery aneurysms

Background: Visceral artery aneurysms (VAAs), although rare, represent a life-threatening disease with high mortality rates. With the more frequent use of diagnostic tests, there has been an incidental detection of these lesions which are mostly asymptomatic. It follows that surgeons are increasingly called to decide on the most appropriate management of VAAs between an open surgical or endovascular approach and among the different endovascular options currently available. The aim of this retrospective study was to evaluate the results of open surgery and interventional endovascular strategies of visceral artery aneurysms with respect to technical success, therapy-associated complications, and postinterventional follow-up in the elective and emergency situation. Methods: From January 1992 to January 2017, 125 open surgical or endovascular interventions for VAA were performed at our institution. Once the VAA was diagnosed and the indication for treatment was assessed, the preoperative diagnostic work-up consisted of contrast computed tomography (CT) or magnetic resonance imaging (MRI) and, in some patients, digital subtraction angiography. Follow-up included clinical and duplex ultrasound scan (DUS) and contrast-enhanced ultrasound to assess the treated vessel patency and organ perfusion after 1, 6, and 12 months, and yearly thereafter. CT or MRI controls were also performed at 1 year of follow-up and only when DUS was not diagnostic or showed a complication thereafter. After the first 5 years of follow-up, the status of the patient was obtained by a structured telephone survey. Results: The treatment option was endovascular in 56 of 125 cases (44.8%). Technical success was 98.3%. In one case, the procedure was interrupted for the extensive dissection of the afferent vessel. Twenty-six patients were treated by coil embolization while 29 with covered stenting. The endovascular approach was in emergency in two cases (3.6%). In the endovascular group, mortality was nil. Complications occurred in 5 cases (8.9%): 1 subacute intestinal ischemia caused by superior mesenteric artery dissection, 2 aneurysm reperfusion, 1 stent thrombosis, and 1 massive splenic hematoma. In 69 (55.2%) cases, surgical treatment was preferred, with 24 VAA resections and 45 arterial reconstructions. In 20 cases (29%), open surgery was performed in emergency conditions. In the surgical group, 8 emergency patients (40%) died intraoperatively. The mortality after elective surgical interventions was nil. Complications after surgery were 4 graft late thrombosis (5.8%): asymptomatic in three cases and requiring splenectomy in one. Conclusions: There is no overall consensus regarding the indications for treatment of VAA. Currently in emergent setting, the endovascular approach should be considered as the first choice because of its reduced invasiveness, faster way to access and bleeding control; this accounts for the lower morality of the interventional therapy than open surgery. Endovascular approach is effective for elective repair of VAAs, but procedure-related complications may occur in a not negligible number of patients. Given comparable mortality rates and low procedure-related complication rate, surgical approach still has space in the elective management of VAAs, especially for aneurysms unsuitable or challenging for the endovascular option in patients with low surgical risk. The size, location, and morphology of VAAs, systemic or local comorbidities, and specific anatomical situations such as previous abdominal surgery should dictate treatment choice

MicroRNA-551b expression profile in low and high-grade cervical intraepithelial neoplasia

OBJECTIVE: To evaluate the expression of microRNA (miR)-551b in patients with low and high grade cervical intraepithelial neoplasia (CIN) and to find an association with high-risk Human Papillomavirus (HR-HPV) infection-related prognostic biomarkers. PATIENTS AND METHODS: The expression level of miR-551b was determined in 50 paraffin-embedded cervical specimens (10 normal squamous epithelium, 18 condylomas, 8 CIN1, and 14 CIN2-3) using quantitative Real-time polymerase chain reaction (qRT-PCR). χ2-test compared miR-551b expression in different diagnosis groups. An Ordered Logistic Regression and a Probit correlation were made to correlate miR-551b expression levels with the cervical tissue histological findings. The immunohistochemical distribution of p16 and Ki-67 according to histopathological findings was also assessed. RESULTS: The distribution of the miR-551b expression profile was significantly lower in CIN1-3 samples compared to other histological diagnosis groups (condyloma and negative). The expression levels were inversely correlated to the cervical pathological grade, from negative to CIN2-3. A 1% increase in miR-551b expression level produced an increase of 19% to the probability of a minor histological grade diagnosis in a range from negative to CIN2-3 and an increase of 13% to the probability of a negative histological grade diagnosis. Among the cases with miR-551b expression < 0.02 (considered as cut-off value) a significant statistical correlation was found between p16 and Ki-67 expression and the diagnosis of CIN2-3. CONCLUSIONS: O ur d ata s howed a s ignificant inverse correlation between miR-551b expression and the histological grading of the lesions, suggesting a tumor suppressive function in the different stages of cervical dysplasia

Evolución de la atención en una sala de cuidados intensivos neonatales

Se estudiaron los resultados de la atención en una sala de Cuidados Intensivos Neonatales de un Hospital Pediátrico de alta complejidad (Hospital de Niños "Superiora Sor María Ludovica", La Plata) durante un período de 10 años, según patología asistida, Región Sanitaria de referencia, tiempo de internación y mortalidad. Para el análisis de mortalidad neonatal (MNN) se distribuyó la población en cinco categorías diagnósticas (1-Patología Quirúrgica. 2-Cardiopatías congénitas. 3-Patología respiratoria, asociada o no a prematurez. 4-Patología infecciosa. 5-Patología clínica) y por peso de ingreso >2501g y < 2500g, fraccionando este último grupo en intervalos de peso de 500g. La MNN global se redujo en un 52,9% comparando la mortalidad de 2004 con la registrada en 1995. La MNN disminuyó significativamente en cada categoría diagnóstica y para cada intervalo de peso. En relación a la referencia, la Región Sanitaria XI determinó el 50% de los ingresos, siguiéndole en frecuencia la Región Sanitaria V y VI, aunque ambas con tendencia decreciente (32% en 1995, 20% en 2004), fundamentalmente de recién nacidos con patología no quirúrgica (68,5% en 1995, 16,2% en 2004). Esto condicionó un cambio en las categorías diagnósticas, no así en la complejidad de la asistencia, como lo evidencia el tiempo de internación y el número de recién nacidos que requirieron asistencia respiratoria mecánica, cifras que se mantuvieron en valores constantes.We are presenting an analysis of the results of the assistance at a Neonatal ICU along 10 years. The material was arranged according to the main pathology, the Sanitary Region of origin, time of admittance, and mortality. For the latter the whole group was divided in five diagnostic categories (1-Surgical; 2- Congenital heart disease; 3- Respiratory disease, associated or not with preterm; 4- Infectious, and 5- Other clinical conditions) and according to weight at admittance > 2500g and < 2500g, the latter divided into intervals of 500g. Global neonatal mortality diminished 52.9% when the numbers of year 2004 was compared with that of 1995. Neonatal mortality diminished significantly for each diagnostic category, and for each weight interval. Sanitary Region X was the site of origin for 50% of the neonates followed by Sanitary Regions V and VI, although both with a reducing frequency (32% in 1995, 20% in 2004) mainly dealing with neonates with non-surgical pathology (68.5% in 1995 and 16.2% in 2004). This resulted in a change in diagnostic categories but not in the complexity of the assistance as is evident from the time-in-Hospital and number of newborns requiring mechanical ventilatory assistance

Afatinib in the first-line treatment of patients with non-small cell lung cancer: clinical evidence and experience

Epidermal growth factor receptor (EGFR) gene mutations identify a molecularly defined subset of non-small cell lung cancer (NSCLC) patients who display an excellent sensitivity to EGFR tyrosine kinase inhibitors (TKIs). First-generation reversible EGFR TKIs, gefitinib and erlotinib have been proven to improve the objective response rate and to prolong the progression-free survival compared with standard chemotherapy in large phase III trials. Unfortunately, virtually all patients develop resistance to treatment, usually within 9–12 months. Afatinib is an irreversible ErbB family inhibitor initially designed to overcome the development of resistance. Compared with gefitinib in a first-line setting, afatinib prolonged progression-free survival and time to treatment failure, without impacting on overall survival in the general population of EGFR-mutant patients. However, afatinib has been shown to prolong overall survival in the subset of patients with an EGFR exon 19 deletion compared with chemotherapy. The aim of this review is to summarize the clinical evidence available to date and to critically discuss the place in therapy of afatinib in the rapidly expanding landscape of EGFR-mutant NSCLC first-line therapy

A Deep Learning Method for Automatic Identification of Drusen and Macular Hole from Optical Coherence Tomography

Deep Learning methods have become dominant in various fields of medical imaging, including ophthalmology. In this preliminary study, we investigated a method based on Convolutional Neural Network for the identification of drusen and macular hole from Optical Coherence Tomography scans with the aim to assist ophthalmologists in diagnosing and assessing retinal diseases

Evaluación de la reactividad alcalina potencial de los agregados gruesos y finos utilizados en la zona de Viedma (prov. de Río Negro)

Con el fin de conocer el comportamiento de los agregados de la zona de Viedma (Prov. de Río Negro) se evaluó la reactividad potencial frente a los álcalis contenidos en el hormigón. Se muestrearon las principales canteras proveedoras de arena y canto rodado evaluando áreas potenciales de extracción. El estudio se realizó utilizando los métodos de ensayo convencionales físico (IRAM 1674), petrográfico (IRAM 1649) y se determinó la sílice disuelta por el método químico (IRAM 1650). En el trabajo se estudian 8 canteras de canto rodado y 3 de arena, la mayoría en explotación. Se efectuó la petrografía de los agregados con estereomicroscopio y microscopía de polarización sobre secciones delgadas y se realizaron las curvas granulométricas normalizadas. Se identificaron rocas volcánicas, la mayoría con pasta vítrea, fresca y alterada, como componentes predominantes tanto de los agregados gruesos como finos. Gran parte de los cantos rodados presentan una pátina de sílice criptocristalina en la superficie. En la composición de la arena se identificó escasa cantidad de vidrio volcánico en clastos individuales y calcedonia. Este método permitió calificar a los materiales estudiados como potencialmente reactivos desde el punto de vista petrográfico. La expansión medida en las barras de mortero entre 0,337 y 0,575 % a los 16 días superan ampliamente los límites establecidos en la norma IRAM 1674 y en el CIRSOC 201 (2005) confirmando la evaluación anterior. Los resultados de sílice disuelta, determinada con el método químico tienen una interpretación coincidente con las anteriores. La reactividad se adjudicó principalmente a las rocas volcánicas con pastas vítreas y a la sílice criptocristalina que cubre gran parte de los cantos rodados

Biomass burning emission inventory with daily resolution: Application to aircraft observations of Asian outflow

Asian outflo

Economic evaluation of sunitinib versus pazopanib and best supportive care for the treatment of metastatic renal cell carcinoma in Chile: cost-effectiveness analysis and a mixed treatment comparison

© 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group. Background: Sunitinib and Pazopanib are two metastatic renal cell carcinoma (MRCC) treatment alternatives, however the health system in Chile does not consider coverage for any. The cost-effectiveness versus relevant comparator was assessed to support evidence-based decision making. Methods: A four health states Markov model was built: first, second line treatments, BSC and death. Benefits were measured in QALYs, and efficacy estimates were obtained from an indirect treatment comparison. A 10-year time horizon and a 3% undifferentiated discount rate were considered. Deterministic and probabilistic sensitivity analyses were performed. Results: The costs of treating MRCC with Sunitinib were higher than Pazopanib and BSC. When comparing Sunitinib versus Pazopanib, the incremental benefit is small favoring Sunitinib (0.03 QALYs). The base case scenario shows an average ICER of PA versus BSC of US$62,327.11/QALY and of US$85,885/QALY for Sunitinib versus Pazopanib. The ICER was most sensitive to the OS relative to BSC, where evidence was associated to important bias. Conclusions: Sunitinib or Pazopanib can be considered cost-effective if a 3 GDP per-capita threshold is assumed. The decision between SU or PA is highly sensitive to the price of the drugs, rather than the outcomes. Therefore, the decision might be made based on cost-minimization exercise

Sequence based typing of Legionella pneumophila sg 1 isolated in nosocomial acquired infections in Apulia, Southern Italy

Objective. The present report aims to molecularly characterize seven clinical L. pneumophila (L. pn.) sg 1 isolated from noso- comial acquired infections in Apulia region, using the European Working Group on Legionella Infections (EWGLI), sequence- based typing (SBT) and amplified fragment length polymorphism (AFLP) protocols and to compare the identified sequence types (STs) with those available in the EWGLI database. Methods. In the period, January 2000 - December 2012, 151 cases (136 of community and 15 of nosocomial origin) of Legion- naires? disease were notified to the Regional Center for Epide- miology. With regard to nosocomial cases, 8 were confirmed by the isolation of Legionella spp. from respiratory secretions. These clinical isolates were characterized by amplified fragment length polymorphism (AFLP) and sequence-based typing (SBT), using the EWGLI standardized protocol. Results. The clinical isolates belong to ST42, ST23 and ST1. The AFLP confirms the SBT results. Comparing the STs herein detected with those already in the EWGLI SBT database, the 3 STs are frequent in other European countries. Conclusions. The molecular analysis demonstrates that the 3 STs are the most frequent in Italy and in Europe, supporting the hypothesis that some specific L. pn. sg 1 clones have gained widespread dissemination probably due to a common ecological niche. Further researches are required to investigate the potential changing incidence of STs and the fitness of emerging strains or clonal groups in environmental strains