Digestive and breast cancer patients managed during the first wave of COVID-19 pandemic:Short and middle term outcomes

BACKGROUND The first wave of coronavirus disease 2019(COVID-19)pandemic in Spain lasted from middle March to the end of June 2020.Spanish population was subjected to lockdown periods and scheduled surgeries were discontinued or reduced during variable periods.In our centre,we managed patients previously and newly diagnosed with cancer.We established a strategy based on limiting perioperative social contacts,preoperative screening(symptoms and reverse transcriptionpolymerase chain reaction)and creating separated in-hospital COVID-19-free pathways for non-infected patients.We also adopted some practice modifications(surgery in different facilities,changes in staff and guidelines,using continuously changing personal protective equipment…),that supposed new inconveniences.AIM To analyse cancer patients with a decision for surgery managed during the first wave,focalizing on outcomes and pandemic-related modifications.METHODS We prospectively included adults with a confirmed diagnosis of colorectal,oesophago-gastric,liver-pancreatic or breast cancer with a decision for surgery,regardless of whether they ultimately underwent surgery.We analysed short-term outcomes[30-d postoperative morbimortality and severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection]and outcomes after 3 years(adjuvant therapies,oncological events,death,SARS-CoV-2 infection and vaccination).We also investigated modifications to usual practice.RESULTS From 96 included patients,seven didn’t receive treatment that period and four never(3 due to COVID-19).Operated patients:28 colon and 21 rectal cancers;laparoscopy 53.6%/90.0%,mortality 3.57%/0%,major complications 7.04%/25.00%,anastomotic leaks 0%/5.00%,3-years disease-free survival(DFS)82.14%/52.4%and overall survival(OS)78.57%/76.2%.Six liver metastases and six pancreatic cancers:no mortality,one major complication,three grade A/B liver failures,one bile leak;3-year DFS 0%/33.3%and OS 50.0%/33.3%(liver metastases/pancreatic carcinoma).5 gastric and 2 oesophageal tumours:mortality 0%/50%,major complications 0%/100%,anastomotic leaks 0%/100%,3-year DFS and OS 66.67%(gastric carcinoma)and 0%(oesophagus).Twenty breast cancer without deaths/major complications;3-year OS 100%and DFS 85%.Nobody contracted SARS-CoV-2 postoperatively.COVID-19 pandemic–related changes:78.2%treated in alternative buildings,43.8%waited more than 4 weeks,two additional colostomies and fewer laparoscopies.CONCLUSION Some patients lost curative-intent surgery due to COVID-19 pandemic.Despite practice modifications and 43.8%delays higher than 4 weeks,surgery was resumed with minimal changes without impacting outcomes.Clean pathways are essential to continue surgery safely.

Rock mass structural recognition from drill monitoring technology in underground mining using discontinuity index and machine learning techniques

A procedure to recognize individual discontinuities in rock mass from measurement while drilling(MWD)technology is developed,using the binary pattern of structural rock characteristics obtained from in-hole images for calibration.Data from two underground operations with different drilling technology and different rock mass characteristics are considered,which generalizes the application of the methodology to different sites and ensures the full operational integration of MWD data analysis.Two approaches are followed for site-specific structural model building:a discontinuity index(DI)built from variations in MWD parameters,and a machine learning(ML)classifier as function of the drilling parameters and their variability.The prediction ability of the models is quantitatively assessed as the rate of recognition of discontinuities observed in borehole logs.Differences between the parameters involved in the models for each site,and differences in their weights,highlight the site-dependence of the resulting models.The ML approach offers better performance than the classical DI,with recognition rates in the range 89%to 96%.However,the simpler DI still yields fairly accurate results,with recognition rates 70%to 90%.These results validate the adaptive MWD-based methodology as an engineering solution to predict rock structural condition in underground mining operations.

Business Intelligence Expert System on SOX Compliance over the Purchase Orders Creation Process

The objective of this work is to define a decision support system over SOX (Sarbanes-Oxley Act) compatibility and quality of the Purchase Orders Creation Process based on Artificial Intelligence and Theory of Argumentation knowledge and techniques. This proposed model directly contributes to both scientific research artificial intelligent area and business practices. From business perspective it empowers the use of artificial intelligent models and techniques to drive decision making processes over financial statements. From scientific and research area the impact is based on the combination of 1) an Information Seeking Dialog Protocol in which a requestor agent inquires the business case, 2) a Facts Valuation based Protocol in which the previously gathered facts are analyzed, 3) the already incorporated initial knowledge of a human expert via initial beliefs, 4) the Intra-Agent Decision Making Protocol based on deductive argumentation and 5) the semi automated Dynamic Knowledge Learning Protocol. Last but not least the suggested way of integration of this proposed model in a higher level multiagent intelligent system in which a Joint Deliberative Dialog Protocol and an Inter-Agent Decision Deductive Argumentation Making Protocol are described.

Brazilian Accommodations:The Search for Leisure Amid the Pandemic of COVID-19

This paper proposes an approach based on the observation of the Brazilian way of conducting the pandemic of COVID-19 in relation to the commercial openings proposed by the state governments and the way how accommodations dealt with the pandemic in the year of 2020.The pandemic generated by the new coronavirus has put the world in front of a reality that reveals the true face of countries’adaptation to the difficulties and the capacity of each place to solve conflicts.Economy was weakened and people’s mobility became limited.In this context,the tourist activity was one of the first to present instabilities,because,as it is an economic activity where one of the characteristics is the displacement of people,the activity was affected in all sectors that are linked to tourism.The hospitality“industry”needed to reinvent itself to think how to restart or continue activities safely,in a scenario of economic uncertainty,even without an expectation of vaccination of the population against the coronavirus until the time of conclusion of this paper,in January/2020―month that the first vaccine arrived in Brazil.However,even under a scenario of instability and health risk,people sought hospitality and leisure services in order to obtain for themselves a mental relaxation that made them escape a desolate reality and have a moment of liberation and relaxation.Although hospitality is important from an economic point of view and beneficial to the individual,the discussion becomes controversial because it analyzes the moment when people seek these services.This study will raise the question about the role of hospitality in this moment of uncertainty worldwide and will discuss some conclusions as the result of this observation.

The ecological scale mediates whether trees experience drought legacies in radial growth

The impact of lag effects produced by disturbances on primary production has been a major concern among ecologists during the last decade.Sudden and extreme climatic events are imposing drastic reductions in radial growth of trees as evidenced in tree-rings series Dendrochronological samples are obtained at tree level but analyzed at an aggregated scale(i.e.,mean chronologies),although aggregating tree-ring chronology on a regional scale may reduce the possibility of studying the variability of individual tree response to drought,by amplifying the average population response.Here,we conducted experimental research in which 370 trees of 5 species were analyzed to assess the potential statistical and scaling issues that may occur when using regressionbased methods to analyze ecosystem responses to disturbances.Drought legacy effects were quantified using individual and aggregated scales.Then,lag effects were validated using confidence and prediction intervals to identify values falling outside the certainty of the climate-growth model Individual scale legacy effects contrasted with confidence intervals were commonly distributed across species but were scarce when compared with prediction intervals.The analysis of aggregated scale legacies detected significant growth reductions when validated using prediction intervals;however,individual scale legacy lag effects were not detected.This finding directly contrasts the results obtained when using an aggregated scale.Our results provide empirical evidence on how aggregating ecological data to infer processes that emerge from an individual scale can lead to distorted conclusions.We therefore encourage the use of individual based statistical and ecological procedures to analyze tree rings as a means of further understanding the ecosystem responses to disturbances.

Pontocerebellar Progressive Multifocal Leukoencephalopathy. Radiological, Clinical, Histological and Immunohistochemical Findings in a Hematological Patient

Objective: To describe the radiological, histological and immunohistochemical findings in a case of Progressive Multifocal Leukoencephalopathy (PML) affecting the cerebellar peduncles in a patient with chronic lymphocytic leukemia. Patient and Methods: Magnetic Resonance Imaging (MRI), histological picture (H.E., Kluver-Barrera) and immunohistochemical picture (GFAP, neurofilaments, CD68, JC virus) were obtained. Results: 1) Magnetic resonance imaging: Asymmetric and progressive lesions on middle cerebellar peduncles, that were hyperintense in T2/FLAIR, extended towards the pons, had no mass effect and were unmodified after intravenous contrast. 2) Histology: Marked reactive gliosis with cytopathic changes suggesting viral infection, plus demyelination areas with axonal preservation. 3) Immunohistochemistry: Marked positivity for viral (polyoma and JC virus) markers in glial cells showing cytopathic changes. Conclusions: The importance of histological and immunohistochemical diagnosis in everyday assistance;of the collaboration between clinicians, radiologists and pathologists;and the validity of postmortem studies as a key element for research and clinical quality assessment must be stressed.

A brief history of the Rheic Ocean

The Rheic Ocean was one of the most important oceans of the Paleozoic Era. It lay between Laurentia and Gondwana from the Early Ordovician and closed to produce the vast Ouachita- Alleghanian-Variscan orogen during the assembly of Pangea. Rifting began in the Cambrian as a continua- tion of Neoproterozoic orogenic activity and the ocean opened in the Early Ordovician with the separation of several Neoproterozoic arc terranes from the continental margin of northern Gondwana along the line of a former suture. The rapid rate of ocean opening suggests it was driven by slab pull in the outboard Iapetus Ocean. The ocean reached its greatest width with the closure of Iapetus and the accretion of the peri- Gondwanan arc terranes to Laurentia in the Silurian. Ocean closure began in the Devonian and continued through the Mississippian as Gondwana sutured to Laurussia to form Pangea. The ocean consequently plays a dominant role in the Appalachian-Ouachita orogeny of North America, in the basement geology of southern Europe, and in the Paleozoic sedimentary, structural and tectonothermal record from Middle America to the Middle East. Its closure brought the Paleozoic Era to an end.

Premature losses of leaf area in response to drought and insect herbivory through a leaf lifespan gradient

Implications of the differences in leaf life span are still subject to debate in the field of ecophysiology.Since leaf traits associated with these differences may be decisive for determining the distribution of tree species,this topic is particularly relevant in the context of climate change.This study analyzes the effects of the differences in leaf life span on premature losses of leaf area owing to insect herbivory and to abiotic stress.Loss of leaf area may be an important determinant of total leaf carbon assimilation.Seven Mediterranean tree species,distributed on four sites with different climates were studied.The species exhibited strong differences in leaf life span and in leaf traits,especially leaf mass per unit area.Premature leaf area losses were estimated in response to insect herbivory and summer drought over two years.The results revealed that,despite having older leaf cohorts with more damage,species with longer leaf duration had lower area lost to herbivores and less damage due to accelerated senescence during the summer drought.With respect to the predicted increase in water stress,deciduous species are at a disadvantage due to their high premature loss of leaf area and thus loss of photosynthetic capacity.

NASH EQUILIBRIA WITHOUT CONTINUITY OF THE CHOICE RULES

The proposal in Alcantud and Alo′s-Ferrer [1], where players that express their tastes according to choice rules facing a competitive situation, is further exploited here. We prove that, under lack of continuity of the choice rules it is also possible to ensure the existence of equilibrium. We shall appeal to general situations that are fulfilled by well-established models, where players have non-transitive preferences of various types.

Cardiocirculatory pathophysiological mechanisms in severe acute pancreatitis

Acute pancreatitis (AP) is a common and potentially lethal acute inflammatory process. Although the majority of patients have a mild episode of AP, 10%-20% develop a severe acute pancreatitis (SAP) and suffer systemic inflammatory response syndrome (SIRS) and/or pancreatic necrosis. The main aim of this article is to review the set of events, f irst localized in the pancreas, that lead to pancreatic inflammation and to the spread to other organs contributing to multiorganic shock. The early pathogenic mechanisms in SAP are not completely understood but both premature activation of enzymes inside the pancreas, related to an impaired cytosolic Ca2+ homeostasis, as well as release of pancreatic enzymes into the bloodstream are considered important events in the onset of pancreatitis disease. Moreover, afferent f ibers within the pancreas release neurotransmitters in response to tissue damage. The vasodilator effects of these neurotransmitters and the activation of pro-inflammatory substances play a crucial role in amplifying the inflammatory response, which leads to systemic manifestation of AP. Damage extension to other organs leads to SIRS, which is usually associated with cardiocirculatoryphysiology impairment and a hypotensive state. Hypotension is a risk factor for death and is associated with a signif icant hyporesponsiveness to vasoconstrictors. This indicates that stabilization of the patient, once this pathological situation has been established, would be a very diff icult task. Therefore, it seems particularly necessary to understand the pathological mechanisms involved in the f irst phases of AP to avoid damage beyond the pancreas. Moreover, efforts must also be directed to identify those patients who are at risk of developing SAP.

Disseminated infection due to Mycobacterium bovis after intravesical BCG instillation

Intravesical bacillus Calmette-Guerin(BCG) instillation has been adopted for the treatment of patients with superficial bladder cancer. Severe adverse events due to local instillation of BCG are uncommon, with an overall rate of serious complications of less than 5%. We report the case of an immunocompetent adult patient with multi-system effects, namely pneumonitis, granulomatous hepatitis and meningitis, who responded well to standard treatment for Mycobacterium bovis. This case highlights the importance of a thorough assessment of this type of patient.

iCEMIGE: Integration of CEll-morphometrics, MIcrobiome, and GEne biomarker signatures for risk stratification in breast cancers

BACKGROUND The development of precision medicine is essential for personalized treatment and improved clinical outcome,whereas biomarkers are critical for the success of precision therapies.AIM To investigate whether iCEMIGE(integration of CEll-morphometrics,MIcro-biome,and GEne biomarker signatures)improves risk stratification of breast cancer(BC)patients.METHODS We used our recently developed machine learning technique to identify cellular morphometric biomarkers(CMBs)from the whole histological slide images in The Cancer Genome Atlas(TCGA)breast cancer(TCGA-BRCA)cohort.Multivariate Cox regression was used to assess whether cell-morphometrics prognosis score(CMPS)and our previously reported 12-gene expression prognosis score(GEPS)and 15-microbe abundance prognosis score(MAPS)were independent prognostic factors.iCEMIGE was built upon the sparse representation learning technique.The iCEMIGE scoring model performance was measured by the area under the receiver operating characteristic curve compared to CMPS,GEPS,or MAPS alone.Nomogram models were created to predict overall survival(OS)and progress-free survival(PFS)rates at 5-and 10-year in the TCGA-BRCA cohort.RESULTS We identified 39 CMBs that were used to create a CMPS system in BCs.CMPS,GEPS,and MAPS were found to be significantly independently associated with OS.We then established an iCEMIGE scoring system for risk stratification of BC patients.The iGEMIGE score has a significant prognostic value for OS and PFS independent of clinical factors(age,stage,and estrogen and progesterone receptor status)and PAM50-based molecular subtype.Importantly,the iCEMIGE score significantly increased the power to predict OS and PFS compared to CMPS,GEPS,or MAPS alone.CONCLUSION Our study demonstrates a novel and generic artificial intelligence framework for multimodal data integration toward improving prognosis risk stratification of BC patients,which can be extended to other types of cancer.

Intercalation of Phenylalanine, Isocoumarin and Ochratoxin A (OTA) into LDH’s

Phenylalanine, isocoumarin and Ochratoxin A (OTA) have been intercalated within the interlayer space of layered double hydroxides. Synthesis of these nanocompounds was achieved via co-precipitation. Their physicochemical properties were studied by element chemical analysis, powder X-ray diffraction, infrared spectroscopy and thermal analyses. The presence of OTA in the interlayer is demonstrated by the study of LC-FD Analysis. On the other hand, these studies allow to check how some of the toxin is on the surface of the nanocomposite.

Donor risk factors in pancreas transplantation

The aim of the work was to analyze and expose the donor and recipient riskfactors in pancreas transplantation. In the following paper, we exposed the 2018Spanish Consensus Document on Donor and Recipient Selection Criteria forPancreas Transplantation. An assessment of the previous Selection Criteria forDonors and Recipients of Pancreas Transplantation, published in 2005 by theSpanish Pancreas Transplant Group (GETP) and the National TransplantOrganization (ONT) was performed. A literature review was performed usingCochrane Library, PubMed and Google Scholar databases. Some of the followingterms were used for the literature search: “Diabetes Mellitus,” “PancreasTransplantation,” “Insulin-Secreting Cells,” “Pancreas Allograft Thrombosis,”“Allograft Pancreatitis,” “Donors’ Risk Factors,” “Recipients’ Risk Factors,”“Pancreas Allograft Rejection” and “Pancreas Allograft Survival.” After anextended search, different inclusion criteria were established. Articles anddocuments with abstracts of full text and in English or Spanish language wereselected. Subsequently, different scientific meetings took place during 2015 and2016 by the GETP. Finally, the updated criteria were published by the GETP andONT in 2018. Several risk factors have been described in pancreas transplantationthat can be divided into donor risk factors: Advanced age (> 50 years);high bodymass index (BMI) (> 30 kg/m2);cause of death (e.g., stroke);previoushyperglycemia;hyperamylasemia;cold ischemia time (greater than 8 or 12 h,depending on the type of donation);the use of vasopressors in the intensive careunit or cardiac arrest;and the macroscopic aspect of the pancreas allograft. Thefollowing are recipient risk factors: Advanced age (> 50 years);active smoking;high BMI (> 30 kg/m2);and peripheral artery disease or sensorimotorpolyneuropathy. Based on the aforementioned parameters, different selectioncriteria have been established for the recipients depending on the type of pancreastransplantation. Knowledge of the risk factors for pancreas transplantation allowsthe establishment of reliable selection criteria for choosing donors and recipients.

Exact Propagator of a Two Dimensional Anisotropic Harmonic Oscillator in the Presence of a Magnetic Field

In this paper we solve exactly the problem of the spectrum and Feynman propagator of a charged particle submitted to both an anharmonic oscillator in the plane and a constant and homogeneous magnetic field of arbitrary strength aligned with the perpendicular direction to the plane. As we shall see in the beginning of the letter, the Hamiltonian, being a quadratic form, is easily diagonalizable and the Classical Action can be used to construct the exact Feynman Propagator using the Stationary Phase Approximation. The result is useful for the treatment of quasi two dimensional samples in the field of magnetic effects in nano-structures and quantum optics. The presented solution, after minor extensions, can also be used for motion in three dimensions, and in fact it has been used for years in such cases. Also it can be used as a good exercise of a Feynman Path Integral that can be calculated easily with just the help of the Classical Action.

Steady-state kinetics of <i>Roystonea regia</i>palm tree peroxidase

Royal palm tree peroxidase (RPTP) has been isolated to homogeneity from leaves of Roystonea regia palm trees. The enzyme purification steps included homogenization, (NH4)SO4 precipitation, extraction of palm leaf colored compounds and consecutive chromatography on Phenyl-Sepharose, TSK-Gel DEAE-5PW and Superdex-200. The novel peroxidase was characterized as having a molecular weight of 48.2 ± 3.0 kDa and an isoelectric point pI 5.4 ± 0.1. The enzyme forms dimers in solution with approximate molecular weight of 92 ± 2 kDa. Here we investigated the steady-state kinetic mechanism of the H2O2-supported oxidation of different organic substrates by RPTP. The results of the analysis of the initial rates vs. H2O2 and reducing substrate concentrations were seen to be consistent with a substrate-inhibited Ping-Pong Bi-Bi reaction mechanism. The phenomenological approach used expresses the peroxidase Ping-Pong mechanism in the form of the Michaelis-Menten equation and affords an interpretation of the effects in terms of the kinetic parameters KmH2O2, KmAH2, kcat, KSIH2O2, KSIAH2 and of the microscopic rate constants k1 and k3 of the shared three-step peroxidase catalytic cycle. Furthermore, the concentration and time-dependences and the mechanism of the suicide inactivation of RPTP by hydrogen peroxide were studied kinetically with guaiacol as co-substrate. The turnover number (r) of H2O2 required to complete the inactivation of the enzyme was 2154 ± 100 and the apparent rate constants of catalysis 185 s–1 and 18 s–1.

A Note on the Lie Algebra of the Invariants in the CBS Nonlinear Equation

In this short note, a particular realization of the vector fields that form a Lie Algebra of symmetries for the Calogero-Bogoyavleskii-Schiff equation is found. The Lie Algebra is examined and the result is a semidirect product of two Lie Groups. The structure of the semidirect product is examined through the table of commutation rules. Two reductions are made with the help of two sets of generators and the final outcome for the solution is related to the elliptic Painlevé P(&xi;)-function.

Extremely Cold and Warm Days in the Spanish Central Plateau: Analysis of Its Evolution from 1961 to 2010

From anomalies of daily data of maximum and minimum temperatures, that have been obtained as difference between the real data of every day and the average data of the corresponding day of the year in each of the 14 observatories of the Spanish Central Plateau (8 in North subplateau and 6 in the South subplateau) between 1961-2010, the extremely cold and warm days are determined, throughout all the year, in all the study area and the two different sub areas. We consider a day as an extremely cold day (ECD) if achieves simultaneously the following conditions: the anomaly of minimum temperature of the day is lower than the value of the P05 percentile of the series of daily anomalies of minimum temperature, and the value of the anomaly of daily maximum temperature is lower, as well, than the P05 percentile of the corresponding series of anomalies. The values of the thresholds determined by these percentiles are obtained considering the complete anomalies daily series of temperature for all the study regions. In order to establish the extremely warm days the methodology is the same but the conditions are: the anomaly of minimum temperature of the day is greater than the value of the P95 percentile of the series of daily anomalies of minimum temperature, and the value of the anomaly of daily maximum temperature is greater as well than the P95 percentile of the corresponding anomalies series. Once the extremely warm and cold days are determined, throughout the year in the period of time considered, for each zone, the corresponding series of annual frequencies are obtained. The analysis of tendency of these series indicates that in all the cases the tendency of the frequency of the extremely cold days is decreasing. Considering a linear model for the temporary behavior of the frequency, the reduce is of the order of 1 day every 10 years. In the case of the extremely warm days its annual frequency presents an increasing tendency, which indicates that the number of extremely warm days per year has been increased during the studied time interval. In agreement with the linear model of behavior, the increase is, approximately, of the order of 1 day per decade.

Stem cell therapy applied for digestive anastomosis: Current state and future perspectives

BACKGROUND Digestive tract resections are usually followed by an anastomosis.Anastomotic leakage,normally due to failed healing,is the most feared complication in digestive surgery because it is associated with high morbidity and mortality.Despite technical and technological advances and focused research,its rates have remained almost unchanged the last decades.In the last two decades,stem cells(SCs)have been shown to enhance healing in animal and human studies;hence,SCs have emerged since 2008 as an alternative to improve anastomoses outcomes.AIM To summarise the published knowledge of SC utilisation as a preventative tool for hollow digestive viscera anastomotic or suture leaks.METHODS PubMed,Science Direct,Scopus and Cochrane searches were performed using the key words“anastomosis”,“colorectal/colonic anastomoses”,“anastomotic leak”,“stem cells”,“progenitor cells”,“cellular therapy”and“cell therapy”in order to identify relevant articles published in English and Spanish during the years of 2000 to 2021.Studies employing SCs,performing digestive anastomoses in hollow viscera or digestive perforation sutures and monitoring healing were finally included.Reference lists from the selected articles were reviewed to identify additional pertinent articles.METHODS Given the great variability in the study designs,anastomotic models,interventions(SCs,doses and vehicles)and outcome measures,performing a reliable meta-analysis was considered impossible,so we present the studies,their results and limitations.RESULTS Eighteen preclinical studies and three review papers were identified;no clinical studies have been published and there are no registered clinical trials.Experimental studies,mainly in rat and porcine models and occasionally in very adverse conditions such as ischaemia or colitis,have been demonstrated SCs as safe and have shown some encouraging morphological,functional and even clinical results.Mesenchymal SCs are mostly employed,and delivery routes are mainly local injections and cell sheets followed by biosutures(sutures coated by SCs)or purely topical.As potential weaknesses,animal models need to be improved to make them more comparable and equivalent to clinical practice,and the SC isolation processes need to be standardised.There is notable heterogeneity in the studies,making them difficult to compare.Further investigations are needed to establish the indications,the administration system,potential adjuvants,the final efficacy and to confirm safety and exclude definitively oncological concerns.CONCLUSION The future role of SC therapy to induce healing processes in digestive anastomoses/sutures still needs to be determined and seems to be currently far from clinical use.