Dragon 1 Protocol Manuscript: Training, Accreditation, Implementation and Safety Evaluation of Portal and Hepatic Vein Embolization (PVE/HVE) to Accelerate Future Liver Remnant (FLR) Hypertrophy.

STUDY PURPOSE: The DRAGON 1 trial aims to assess training, implementation, safety and feasibility of combined portal- and hepatic-vein embolization (PVE/HVE) to accelerate future liver remnant (FLR) hypertrophy in patients with borderline resectable colorectal cancer liver metastases. METHODS: The DRAGON 1 trial is a worldwide multicenter prospective single arm trial. The primary endpoint is a composite of the safety of PVE/HVE, 90-day mortality, and one year accrual monitoring of each participating center. Secondary endpoints include: feasibility of resection, the used PVE and HVE techniques, FLR-hypertrophy, liver function (subset of centers), overall survival, and disease-free survival. All complications after the PVE/HVE procedure are documented. Liver volumes will be measured at week 1 and if applicable at week 3 and 6 after PVE/HVE and follow-up visits will be held at 1, 3, 6, and 12 months after the resection. RESULTS: Not applicable. CONCLUSION: DRAGON 1 is a prospective trial to assess the safety and feasibility of PVE/HVE. Participating study centers will be trained, and procedures standardized using Work Instructions (WI) to prepare for the DRAGON 2 randomized controlled trial. Outcomes should reveal the accrual potential of centers, safety profile of combined PVE/HVE and the effect of FLR-hypertrophy induction by PVE/HVE in patients with CRLM and a small FLR. TRIAL REGISTRATION: Clinicaltrials.gov: NCT04272931 (February 17, 2020). Toestingonline.nl: NL71535.068.19 (September 20, 2019).

Very-high-frequency oscillations in the main peak of a magnetar giant flare.

Magnetars are strongly magnetized, isolated neutron stars1-3 with magnetic fields up to around 1015 gauss, luminosities of approximately 1031-1036 ergs per second and rotation periods of about 0.3-12.0 s. Very energetic giant flares from galactic magnetars (peak luminosities of 1044-1047 ergs per second, lasting approximately 0.1 s) have been detected in hard X-rays and soft γ-rays4, and only one has been detected from outside our galaxy5. During such giant flares, quasi-periodic oscillations (QPOs) with low (less than 150 hertz) and high (greater than 500 hertz) frequencies have been observed6-9, but their statistical significance has been questioned10. High-frequency QPOs have been seen only during the tail phase of the flare9. Here we report the observation of two broad QPOs at approximately 2,132 hertz and 4,250 hertz in the main peak of a giant γ-ray flare11 in the direction of the NGC 253 galaxy12-17, disappearing after 3.5 milliseconds. The flare was detected on 15 April 2020 by the Atmosphere-Space Interactions Monitor instrument18,19 aboard the International Space Station, which was the only instrument that recorded the main burst phase (0.8-3.2 milliseconds) in the full energy range (50 × 103 to 40 × 106 electronvolts) without suffering from saturation effects such as deadtime and pile-up. Along with sudden spectral variations, these extremely high-frequency oscillations in the burst peak are a crucial component that will aid our understanding of magnetar giant flares.

A review of the anatomy of the middle cerebral artery for the era of thrombectomy: A radiologic tool based on CT angiography and perfusion CT.

The middle cerebral artery (MCA) is one of the principal intracranial vessels. It is also the one that is most often involved in ischemic cerebrovascular disease, which accounts for a significant volume of brain imaging tests. With recent updates in the management of ischemic stroke (including intravascular treatment in increasingly distal vessels and in an increasingly widening spectrum of patients), it is becoming more important to know the details of the cerebral vascular anatomy to reach accurate diagnoses quickly and thereby improve patients' prognoses. For these reasons, we present this anatomic review of the MCA, reviewing its segments and anatomic limits, its branching patterns, and its anatomic variants. We also provide a radiologic tool based on correlations between CT angiography and perfusion CT to facilitate the identification of the points of occlusion within the branches of the MCA, taking into account its different variants.

A review of the anatomy of the middle cerebral artery for the era of thrombectomy: a radiologic tool based on CT angiography and perfusion CT. / Repaso anatómico de la arteria cerebral media en la era de la trombectomía: una herramienta radiológica basada en la angio-TC y la TC perfusión.

The middle cerebral artery (MCA) is one of the principal intracranial vessels. It is also the one that is most often involved in ischemic cerebrovascular disease, which accounts for a significant volume of brain imaging tests. With recent updates in the management of ischemic stroke (including intravascular treatment in increasingly distal vessels and in an increasingly widening spectrum of patients), it is becoming more important to know the details of the cerebral vascular anatomy to reach accurate diagnoses quickly and thereby improve patients' prognoses. For these reasons, we present this anatomic review of the MCA, reviewing its segments and anatomic limits, its branching patterns, and its anatomic variants. We also provide a radiologic tool based on correlations between CT angiography and perfusion CT to facilitate the identification of the points of occlusion within the branches of the MCA, taking into account its different variants.

Statistical control of processes applied to geometric uncertainties for CTV expansion margins determination in prostate cancer patients treated with VMAT: a prospective study in 57 patients

Purpose To study the control graphs applicability for the geometric uncertainties of VMAT treatments in prostate cancer patients, and their use to verify the hypothesis of the data obtained randomness, to apply the margins of Van Herk expression. Material and methods During the first 5 days of treatment, and then once a week, a Kv CBCT was performed, compared with the simulation CT and adjusted the displacements, to determine the inter-fraction errors. Immediately after radiation therapy, another CBCT was performed (for intra-fraction errors). With these data, the X, R position control charts have been made. The patients, not maintained the deviations within the charts control limits, were called “anomalies”. Then, we compared the deviations and margins calculated with the van Herk expression for all patients and for those without anomalies. Results The margins determined show appreciable differences if there were calculated for the total set of patients or for the set of them without anomalies in the control charts. For the overall set of patients, the lateral, longitudinal, and vertical margins were 0.45 cm, 0.52 cm, 0.56 cm, while for the set of patients without anomalies were 0.29 cm, 0.35 cm, and 0.38 cm. Conclusions The use of control charts allows tracking geometric deviations both inter and intra-fraction, variability real-time control and to detect situations in which it can change for non-random reasons, and require immediate investigation. Maintaining geometric deviations in the control state decreases the margins needed to administer a high dose to CTV in a high percentage of cancer prostate patients (AU)

Statistical control of processes applied to geometric uncertainties for CTV expansion margins determination in prostate cancer patients treated with VMAT: a prospective study in 57 patients.

PURPOSE: To study the control graphs applicability for the geometric uncertainties of VMAT treatments in prostate cancer patients, and their use to verify the hypothesis of the data obtained randomness, to apply the margins of Van Herk expression. MATERIAL AND METHODS: During the first 5 days of treatment, and then once a week, a Kv CBCT was performed, compared with the simulation CT and adjusted the displacements, to determine the inter-fraction errors. Immediately after radiation therapy, another CBCT was performed (for intra-fraction errors). With these data, the X, R position control charts have been made. The patients, not maintained the deviations within the charts control limits, were called "anomalies". Then, we compared the deviations and margins calculated with the van Herk expression for all patients and for those without anomalies. RESULTS: The margins determined show appreciable differences if there were calculated for the total set of patients or for the set of them without anomalies in the control charts. For the overall set of patients, the lateral, longitudinal, and vertical margins were 0.45 cm, 0.52 cm, 0.56 cm, while for the set of patients without anomalies were 0.29 cm, 0.35 cm, and 0.38 cm. CONCLUSIONS: The use of control charts allows tracking geometric deviations both inter and intra-fraction, variability real-time control and to detect situations in which it can change for non-random reasons, and require immediate investigation. Maintaining geometric deviations in the control state decreases the margins needed to administer a high dose to CTV in a high percentage of cancer prostate patients.

Characterizing the transient electrocardiographic signature of ischemic stress using Laplacian Eigenmaps for dimensionality reduction.

OBJECTIVE: Despite a long history of ECG-based monitoring of acute ischemia quantified by several widely used clinical markers, the diagnostic performance of these metrics is not yet satisfactory, motivating a data-driven approach to leverage underutilized information in the electrograms. This study introduces a novel metric for acute ischemia, created using a machine learning technique known as Laplacian eigenmaps (LE), and compares the diagnostic and temporal performance of the LE metric against traditional metrics. METHODS: The LE technique uses dimensionality reduction of simultaneously recorded time signals to map them into an abstract space in a manner that highlights the underlying signal behavior. To evaluate the performance of an electrogram-based LE metric compared to current standard approaches, we induced episodes of transient, acute ischemia in large animals and captured the electrocardiographic response using up to 600 electrodes within the intramural and epicardial domains. RESULTS: The LE metric generally detected ischemia earlier than all other approaches and with greater accuracy. Unlike other metrics derived from specific features of parts of the signals, the LE approach uses the entire signal and provides a data-driven strategy to identify features that reflect ischemia. CONCLUSION: The superior performance of the LE metric suggests there are underutilized features of electrograms that can be leveraged to detect the presence of acute myocardial ischemia earlier and more robustly than current methods. SIGNIFICANCE: The earlier detection capabilities of the LE metric on the epicardial surface provide compelling motivation to apply the same approach to ECGs recorded from the body surface.

Nonlinear Dynamics of Spinning Bosonic Stars: Formation and Stability.

We perform numerical evolutions of the fully nonlinear Einstein (complex, massive) Klein-Gordon and Einstein (complex) Proca systems, to assess the formation and stability of spinning bosonic stars. In the scalar (vector) case these are known as boson (Proca) stars. Firstly, we consider the formation scenario. Starting with constraint-obeying initial data, describing a dilute, axisymmetric cloud of spinning scalar or Proca field, gravitational collapse toward a spinning star occurs, via gravitational cooling. In the scalar case the formation is transient, even for a nonperturbed initial cloud; a nonaxisymmetric instability always develops ejecting all the angular momentum from the scalar star. In the Proca case, by contrast, no instability is observed and the evolutions are compatible with the formation of a spinning Proca star. Secondly, we address the stability of an existing star, a stationary solution of the field equations. In the scalar case, a nonaxisymmetric perturbation develops, collapsing the star to a spinning black hole. No such instability is found in the Proca case, where the star survives large amplitude perturbations; moreover, some excited Proca stars decay to, and remain as, fundamental states. Our analysis suggests bosonic stars have different stability properties in the scalar (vector) case, which we tentatively relate to its toroidal (spheroidal) morphology. A parallelism with instabilities of spinning fluid stars is briefly discussed.

Leaf biochemical adjustments in two Mediterranean resprouter species facing enhanced UV levels and reduced water availability before and after aerial biomass removal.

Effects of supplemented UV radiation and diminished water supply on the leaf concentrations of phenols and antioxidants of two Mediterranean resprouter species, Arbutus unedo and Quercus suber, were assessed before and after entire aerial biomass removal. Potted seedlings of both species were grown outdoors for 8 months with enhanced UV-A + UV-B, enhanced UV-A or ambient UV, in combination with two watering conditions (field capacity or watering reduction). After this period, all aerial biomass was removed and new shoots (resprouts) developed for a further 8 months under the two treatments. In general, the investment in leaf phenols was substantially greater in A. unedo than in Q. suber, while Q. suber allocated more resources to non-phenolic antioxidants (ascorbate and glutathione). In response to enhanced UV-B radiation, Q. suber leaves rose their UV-screening capacity mainly via accumulation of kaempferols, accompanied by an increased concentration of rutins, being these effects exacerbated under low-watering conditions. Conversely, A. unedo leaves responded to UV-B radiation reinforcing the antioxidant machinery by increasing the overall amount of flavonols (especially quercetins) in seedlings, and of ascorbate and glutathione, along with catalase activity, in resprouts. Nevertheless, UV effects on the amount/activity of non-phenolic antioxidants of A. unedo resprouts were modulated by water supply. Indeed, the highest concentration of glutathione was found under the combination of enhanced UV-B radiation and reduced watering, suggesting an enlargement of the antioxidant response in A. unedo resprouts. Different biochemical responses to enhanced UV and drier conditions in seedlings and resprouts of these two species might modulate their competitive interactions in the near future.

Reduction of Effects of Noise on the Inverse Problem of Electrocardiography with Bayesian Estimation.

To overcome the ill-posed nature of the inverse problem of electrocardiography (ECG) and stabilize the solutions, regularization is used. Despite several studies on noise, effect of prefiltering of ECG signals on the regularized inverse solutions has not been explored. We used Bayesian estimation for solving the inverse ECG problem with and without applying various prefiltering methods, and evaluated our results using experimental data that came from a Langendorff-perfused pig heart suspended in a human-shaped torso-tank. Epicardial electrograms were recorded during RV pacing using a 108-electrode array, simultaneously with ECGs from 128 electrodes embedded in the tank surface. Leave-one-beat-out protocol was used to obtain the prior probability density function (pdf) of electro-grams and noise statistics. Noise pdf was assumed to be zero mean-Gaussian, with covariance assumptions: a) independent and identically distributed (noi-iid), b) correlated (noi-corr). Reconstructed electrograms and activation times were compared to those directly recorded by the sock for 3 beats selected from the recording. Noi-corr is superior to noi-iid when the training set is a good match to data, but for applications requiring activation time derivation, careful selection of preprocessing methods, in particular to adequately remove high-frequency noise, and an appropriate noise model is needed.

Zero-valent iron supported on nitrogen-doped carbon xerogel as catalysts for the oxidation of phenol by fenton-like system.

Nitrogen-free and nitrogen-doped carbon xerogel materials, from urea and melamine precursors, were prepared at different pH and evaluated as adsorbents/catalysts in the removal of phenol. Then, zero-valent iron (ZVI) was supported on these carbon xerogel materials and its activity was again evaluated for phenol removal by adsorption and catalytic wet peroxide oxidation (CWPO). The prepared samples were characterized by N2 adsorption at -196°C, pH at the point of zero charge (pHPZC) and elemental analysis. The textural properties of the N-free and N-doped carbon xerogels are strongly influenced by pH of the preparation solution and precursor used. The presence of ZVI on all carbon xerogel supports improved the phenol removal efficiency. ZVI supported on urea- and melamine-doped carbon xerogels show a good performance, reaching above 87% phenol conversion after 60 min of CWPO. On the contrary, pure adsorption and CWPO using the same materials without the presence of ZVI gives low phenol removal efficiency. A correlation was found between the activity of ZVI catalysts in CWPO and the N-content of the supports.

Effects of ECG Signal Processing on the Inverse Problem of Electrocardiography.

The inverse problem of electrocardiography is ill-posed. Errors in the model such as signal noise can impact the accuracy of reconstructed cardiac electrical activity. It is currently not known how sensitive the inverse problem is to signal processing techniques. To evaluate this, experimental data from a Langendorff-perfused pig heart (n=1) suspended in a human-shaped torso-tank was used. Different signal processing methods were applied to torso potentials recorded from 128 electrodes embedded in the tank surface. Processing methods were divided into three categories i) high-frequency noise removal ii) baseline drift removal and iii) signal averaging, culminating in n=72 different signal sets. For each signal set, the inverse problem was solved and reconstructed signals were compared to those directly recorded by the sock around the heart. ECG signal processing methods had a dramatic effect on reconstruction accuracy. In particular, removal of baseline drift significantly impacts the magnitude of reconstructed electrograms, while the presence of high-frequency noise impacts the activation time derived from these signals (p<0.05).

[Advance directives. Representatives' opinions]. / Los documentos de voluntades anticipadas. La opinión de los representantes.

INTRODUCTION: The use and usefulness of Advance Directives has led to a lot of controversy about their validity and effectiveness. Those areas are unexplored in our country from the perspective of representatives. OBJECTIVE: To determine the opinion of the representatives appointed in a registered Statement of Advance Directives (SAD) on the use of this document. METHODS: Telephone survey of representatives of 146 already dead people and who, since February 2012, had registered a SAD document. RESULTS: More the two-thirds (98) of respondents recalled that the SAD was consulted, with 86 (58.9%) saying that their opinion as representative was consulted, and 120 (82.1%) believe that the patient's will was respected. Of those interviewed, 102 (69.9%) believe that patients who had previously planned their care using a SAD had a good death, with 33 (22.4%) saying it could have been better, and 10 (6.9%) believe they suffered greatly. CONCLUSION: The SAD were mostly respected and consulted, and possibly this is related to the fact that most of the representatives declare that the death of those they represented was perceived as comfortable. It would be desirable to conduct further studies addressed at health personnel in order to know their perceptions regarding the use of Advance Directives in the process of dying.

Production parameters and pig production cost: temporal evolution 2010-2014.

BACKGROUND: The assessment of the cost of production and the relative weight of the different production parameters is very important in pig farming. The goals of the present work were 1) to describe reliable reference values for production parameters and pig production cost from 2010 to 2014, 2) to describe their temporal evolution and 3) to determine the influence of the pig company size on them. Between 61 and 107 pig production companies from Spain were included in this study from 2010 to 2014. These companies sent data on feed consumption, number of pig produced, expenses and census every month. Sip consultors SL standardized collected data and calculate cost and production parameters to obtain values comparables between the different pig production companies. The collected data each month were merged to obtain a yearly average value taking into account the pig production flow each month. A suitable statistical analysis was carried out to tackle the goals. RESULTS: The production performance has been continuously improving in the piglet production and fattening phase from 2010 to 2014. Thus, the number of piglets by sow and year will increase 0.5 pigs by year and the total feed conversion rate will decrease approximately 0.03 kg feed/kg gain by year in the future if the same tendency continues. However, feed price has been steadily increasing from 2010 to 2012 and decreasing afterwards and the total cost per kilogram produced has followed a similar pattern. This result highlights the relevance of the feed price in the final cost in spite of continuous improvement in production performance across years. Finally, pig company size affected most of the production parameters studied. Thus, the best technical parameters were obtained for companies with less than 5000 sows. However, the opposite tendency is observed for feed price where the highest value was observed for the smallest companies. CONCLUSIONS: Pig production parameters have generally improved in the last five years but this improvement did not directly imply a reduction in pig production cost due to the high feed prices during the period 2010-2013.

A novel pre-treatment for the methane production from microalgae by using N-methylmorpholine-N-oxide (NMMO).

The aim of this work was to study the effect of the solvent N-methylmorpholine-N-oxide (NMMO) to pre-treat Nannochloropsis oculata before the anaerobic digestion process. The results indicated that the pre-treatment affects the characteristics of the cell wall, which consequently becomes more susceptible to the microorganisms attack during anaerobic digestion. The methane production was increased by 43% after the pre-treatment, from 238±6mLCH4/gVS until 339±4mLCH4/gVS. On the contrary, the methane production from Chlorella vulgaris decreased after the pre-treatment from 251±4mLCH4/gVS to 231±3mLCH4/gVS. The failure on the pre-treatment was attributed to the particular characteristics of the substrate in consequence of a previous drying step.

A STATISTICAL APPROACH TO INCORPORATE MULTIPLE ECG OR EEG RECORDINGS WITH ARTIFACTUAL VARIABILITY INTO INVERSE SOLUTIONS.

Inverse methods for localization and characterization of cardiac and brain sources from ECG and EEG signals are notoriously ill-conditioned and thus sensitive to SNR in the measurements. Multiple recordings of the same underlying phenomenon are often available, but are contaminated by unmodeled correlated noise such as heart motion from respiration or superposition of atrial activation or on-going EEG in the case of inter-ictal spikes or evoked response in EEG. We address here the open question of how best to incorporate these multiple recordings, comparing standard ensemble averaging, a multichannel non-linear spline-based average designed to be less sensitive to timing variations from motion or modulation, and a probalistic inverse incorporating a data-driven model of the noise correlation and using all recordings jointly. Results are tested on localizations of clincally recorded 120 lead ECGs during ventricular pacing.

Characterization and performance of carbonaceous materials obtained from exhausted sludges for the anaerobic biodecolorization of the azo dye Acid Orange II.

This work presents the preliminary study of new carbonaceous materials (CMs) obtained from exhausted sludge, their use in the heterogeneous anaerobic process of biodecolorization of azo dyes and the comparison of their performance with one commercial active carbon. The preparation of carbonaceous materials was conducted through chemical activation and carbonization. Chemical activation was carried out through impregnation of sludge-exhausted materials with ZnCl2 and the activation by means of carbonization at different temperatures (400, 600 and 800°C). Their physicochemical and surface characteristics were also investigated. Sludge based carbonaceous (SBC) materials SBC400, SBC600 and SBC800 present values of 13.0, 111.3 and 202.0m(2)/g of surface area. Biodecolorization levels of 76% were achieved for SBC600 and 86% for SBC800 at space time (τ) of 1.0min, similar to that obtained with commercial activated carbons in the continuous anaerobic up-flow packed bed reactor (UPBR). The experimental data fit well to the first order kinetic model and equilibrium data are well represented by the Langmuir isotherm model. Carbonaceous materials show high level of biodecolorization even at very short space times. Results indicate that carbonaceous materials prepared from sludge-exhausted materials have outstanding textural properties and significant degradation capacity for treating textile effluents.

Bilateral calcaneal epiphysiolysis in a dog.

A case of bilateral calcaneal epiphysiolysis in a six-month-old female Dobermann Pinscher is described in this report. The absence of a traumatic event and the clinical, radiographic and histopathological abnormalities led us to the diagnosis of simultaneous bilateral epiphysiolysis of the calcaneus. A tension band and a type II transarticular external fixator were placed. The clinical signs were resolved only temporarily because of the gravity of the bone changes.

Asociación entre los niveles de ácido úrico sérico y la prevalencia de síndrome metabólico en pilotos de líneas aéreas / Association between serum uric acid levels and the prevalence of metabolic syndrome in airline pilots

Introducción: La elevación del ácido úrico sérico (AUS) y el síndrome metabólico (SM), son condiciones que se relacionan con la aparición de enfermedades cardiovasculares. Objetivo: Evaluar la prevalencia de SM así como la concentración de AUS en una población de pilotos de líneas aéreas, varones y determinar la relación entre las concentraciones de AUS con respecto a la presencia o ausencia de SM. Métodos: Población de 402 pilotos de líneas aéreas, todos varones. Para diagnóstico de SM se utilizó la definición establecida por la National Cholesterol Education Program (NCEP) Adult Treatment Panel III. Las concentraciones de AUS se consideraron elevadas por encima de 7 mg/dl. Resultados: El 18,7% de los pilotos tuvieron concentraciones elevadas de AUS y el 7,2% de los pilotos presentó SM. El riesgo de presentar SM por tener el AUS elevado frente al riesgo que presentaron los pilotos con AUS normal (razón de prevalencias) fue de 5,4 superior (intervalo de confianza al 95% entre 2,7 y 10,7 y con una significación de p<0,001). La concentración sérica de AU se encuentra incrementada en 1,1 mg/dl (IC95%: 0,7 a 1,5 mg/dl) en los individuos con SM (p<0,001) con respecto a los que no lo presentan. Conclusiones: Nuestros resultados demuestran que los pilotos con niveles de ácido úrico elevado presentan una prevalencia de SM 5,4 veces superior a aquellos con niveles de ácido úrico normal y que existe una correlación lineal positiva entre el aumento de la concentración de AUS y el número de criterios diagnósticos de SM (AU)

Introduction: The increase in the uric acid serum levels and the metabolic syndrome are conditions independently related to cardiovascular disease. Objective: To assess the prevalence of metabolic syndrome and the levels of serum uric acid in a population of airline pilots and to establish possible relationships between levels of uric acid and the presence or absence of metabolic syndrome. Methods: We studied a population of 402 male airline pilots. The diagnosis of metabolic syndrome was established according the definition of National Cholesterol Education Program (NCEP) Adult Treatment Panel III. The serum uric acid was considered elevated when higher than 7 mg/dl. Results: We found that 18.7 % of pilots presented elevated levels of serum uric acid and 7.2 % had metabolic syndrome. The pilots with increased levels of serum uric acid had 5.4 higher risk (prevalence’s ratio) of having metabolic syndrome than those pilots with normal uric acid, (95% confidence interval between 2.7 and 10.7 with a statistical significance of p<0.001). Subjects with metabolic syndrome presented a mean levels of serum uric acid 1.1 mg/dl (IC95%: 0,7 a 1,5 mg/dl) higher than those pilots without the syndrome (p<0.001). Conclusions: Our results show that pilots with uric acid level elevated have a prevalence of metabolic syndrome 5.4 times higher than those with normal level of uric acid, and that there is a positive lineal correlation between the increasing concentrations of serum uric acid and the number of metabolic syndrome diagnostic criteria (AU)