On multistability behavior of unstable dissipative systems.

We present dissipative systems with unstable dynamics called the unstable dissipative systems which are capable of generating a multi-stable behavior, i.e., depending on its initial condition, the trajectory of the system converges to a specific attractor. Piecewise linear (PWL) systems are generated based on unstable dissipative systems, whose main attribute when they are switched is the generation of chaotic trajectories with multiple wings or scrolls. For this PWL system, a structure is proposed where both the linear part and the switching function depend on two parameters. We show the range of values of such parameters where the PWL system presents a multistable behavior and trajectories with multiscrolls.

Generation of multi-scroll attractors without equilibria via piecewise linear systems.

In this paper, we present a new class of dynamical system without equilibria which possesses a multiscroll attractor. It is a piecewise-linear system which is simple, stable, displays chaotic behavior and serves as a model for analogous non-linear systems. We test for chaos using the 0-1 Test for Chaos from Gottwald and Melbourne [SIAM J. Appl. Dyn. Syst. 8(1), 129-145 (2009)].

Forced synchronization of autonomous dynamical Boolean networks.

We present the design of an autonomous time-delay Boolean network realized with readily available electronic components. Through simulations and experiments that account for the detailed nonlinear response of each circuit element, we demonstrate that a network with five Boolean nodes displays complex behavior. Furthermore, we show that the dynamics of two identical networks display near-instantaneous synchronization to a periodic state when forced by a common periodic Boolean signal. A theoretical analysis of the network reveals the conditions under which complex behavior is expected in an individual network and the occurrence of synchronization in the forced networks. This research will enable future experiments on autonomous time-delay networks using readily available electronic components with dynamics on a slow enough time-scale so that inexpensive data collection systems can faithfully record the dynamics.

Multicenter study of anidulafungin and micafungin MIC distributions and epidemiological cutoff values for eight Candida species and the CLSI M27-A3 broth microdilution method.

Since epidemiological cutoff values (ECVs) using CLSI MICs from multiple laboratories are not available for Candida spp. and the echinocandins, we established ECVs for anidulafungin and micafungin on the basis of wild-type (WT) MIC distributions (for organisms in a species-drug combination with no detectable acquired resistance mechanisms) for 8,210 Candida albicans, 3,102 C. glabrata, 3,976 C. parapsilosis, 2,042 C. tropicalis, 617 C. krusei, 258 C. lusitaniae, 234 C. guilliermondii, and 131 C. dubliniensis isolates. CLSI broth microdilution MIC data gathered from 15 different laboratories in Canada, Europe, Mexico, Peru, and the United States were aggregated to statistically define ECVs. ECVs encompassing 97.5% of the statistically modeled population for anidulafungin and micafungin were, respectively, 0.12 and 0.03 µg/ml for C. albicans, 0.12 and 0.03 µg/ml for C. glabrata, 8 and 4 µg/ml for C. parapsilosis, 0.12 and 0.06 µg/ml for C. tropicalis, 0.25 and 0.25 µg/ml for C. krusei, 1 and 0.5 µg/ml for C. lusitaniae, 8 and 2 µg/ml for C. guilliermondii, and 0.12 and 0.12 µg/ml for C. dubliniensis. Previously reported single and multicenter ECVs defined in the present study were quite similar or within 1 2-fold dilution of each other. For a collection of 230 WT isolates (no fks mutations) and 51 isolates with fks mutations, the species-specific ECVs for anidulafungin and micafungin correctly classified 47 (92.2%) and 51 (100%) of the fks mutants, respectively, as non-WT strains. These ECVs may aid in detecting non-WT isolates with reduced susceptibility to anidulafungin and micafungin due to fks mutations.

Interlaboratory variability of Caspofungin MICs for Candida spp. Using CLSI and EUCAST methods: should the clinical laboratory be testing this agent?

Although Clinical and Laboratory Standards Institute (CLSI) clinical breakpoints (CBPs) are available for interpreting echinocandin MICs for Candida spp., epidemiologic cutoff values (ECVs) based on collective MIC data from multiple laboratories have not been defined. While collating CLSI caspofungin MICs for 145 to 11,550 Candida isolates from 17 laboratories (Brazil, Canada, Europe, Mexico, Peru, and the United States), we observed an extraordinary amount of modal variability (wide ranges) among laboratories as well as truncated and bimodal MIC distributions. The species-specific modes across different laboratories ranged from 0.016 to 0.5 µg/ml for C. albicans and C. tropicalis, 0.031 to 0.5 µg/ml for C. glabrata, and 0.063 to 1 µg/ml for C. krusei. Variability was also similar among MIC distributions for C. dubliniensis and C. lusitaniae. The exceptions were C. parapsilosis and C. guilliermondii MIC distributions, where most modes were within one 2-fold dilution of each other. These findings were consistent with available data from the European Committee on Antimicrobial Susceptibility Testing (EUCAST) (403 to 2,556 MICs) for C. albicans, C. glabrata, C. krusei, and C. tropicalis. Although many factors (caspofungin powder source, stock solution solvent, powder storage time length and temperature, and MIC determination testing parameters) were examined as a potential cause of such unprecedented variability, a single specific cause was not identified. Therefore, it seems highly likely that the use of the CLSI species-specific caspofungin CBPs could lead to reporting an excessive number of wild-type (WT) isolates (e.g., C. glabrata and C. krusei) as either non-WT or resistant isolates. Until this problem is resolved, routine testing or reporting of CLSI caspofungin MICs for Candida is not recommended; micafungin or anidulafungin data could be used instead.

Cryptococcus neoformans-Cryptococcus gattii species complex: an international study of wild-type susceptibility endpoint distributions and epidemiological cutoff values for fluconazole, itraconazole, posaconazole, and voriconazole.

Epidemiological cutoff values (ECVs) for the Cryptococcus neoformans-Cryptococcus gattii species complex versus fluconazole, itraconazole, posaconazole, and voriconazole are not available. We established ECVs for these species and agents based on wild-type (WT) MIC distributions. A total of 2,985 to 5,733 CLSI MICs for C. neoformans (including isolates of molecular type VNI [MICs for 759 to 1,137 isolates] and VNII, VNIII, and VNIV [MICs for 24 to 57 isolates]) and 705 to 975 MICs for C. gattii (including 42 to 260 for VGI, VGII, VGIII, and VGIV isolates) were gathered in 15 to 24 laboratories (Europe, United States, Argentina, Australia, Brazil, Canada, Cuba, India, Mexico, and South Africa) and were aggregated for analysis. Additionally, 220 to 359 MICs measured using CLSI yeast nitrogen base (YNB) medium instead of CLSI RPMI medium for C. neoformans were evaluated. CLSI RPMI medium ECVs for distributions originating from at least three laboratories, which included ≥95% of the modeled WT population, were as follows: fluconazole, 8 µg/ml (VNI, C. gattii nontyped, VGI, VGIIa, and VGIII), 16 µg/ml (C. neoformans nontyped, VNIII, and VGIV), and 32 µg/ml (VGII); itraconazole, 0.25 µg/ml (VNI), 0.5 µg/ml (C. neoformans and C. gattii nontyped and VGI to VGIII), and 1 µg/ml (VGIV); posaconazole, 0.25 µg/ml (C. neoformans nontyped and VNI) and 0.5 µg/ml (C. gattii nontyped and VGI); and voriconazole, 0.12 µg/ml (VNIV), 0.25 µg/ml (C. neoformans and C. gattii nontyped, VNI, VNIII, VGII, and VGIIa,), and 0.5 µg/ml (VGI). The number of laboratories contributing data for other molecular types was too low to ascertain that the differences were due to factors other than assay variation. In the absence of clinical breakpoints, our ECVs may aid in the detection of isolates with acquired resistance mechanisms and should be listed in the revised CLSI M27-A3 and CLSI M27-S3 documents.

Wild-type MIC distributions and epidemiological cutoff values for amphotericin B, flucytosine, and itraconazole and Candida spp. as determined by CLSI broth microdilution.

Clinical breakpoints (CBPs) and epidemiological cutoff values (ECVs) have been established for several Candida spp. and the newer triazoles and echinocandins but are not yet available for older antifungal agents, such as amphotericin B, flucytosine, or itraconazole. We determined species-specific ECVs for amphotericin B (AMB), flucytosine (FC) and itraconazole (ITR) for eight Candida spp. (30,221 strains) using isolates from 16 different laboratories in Brazil, Canada, Europe, and the United States, all tested by the CLSI reference microdilution method. The calculated 24- and 48-h ECVs expressed in µg/ml (and the percentages of isolates that had MICs less than or equal to the ECV) for AMB, FC, and ITR, respectively, were 2 (99.8)/2 (99.2), 0.5 (94.2)/1 (91.4), and 0.12 (95.0)/0.12 (92.9) for C. albicans; 2 (99.6)/2 (98.7), 0.5 (98.0)/0.5 (97.5), and 2 (95.2)/4 (93.5) for C. glabrata; 2 (99.7)/2 (97.3), 0.5 (98.7)/0.5 (97.8), and 05. (99.7)/0.5 (98.5) for C. parapsilosis; 2 (99.8)/2 (99.2), 0.5 (93.0)/1 (90.5), and 0.5 (97.8)/0.5 (93.9) for C. tropicalis; 2 (99.3)/4 (100.0), 32 (99.4)/32 (99.3), and 1 (99.0)/2 (100.0) for C. krusei; 2 (100.0)/4 (100.0), 0.5 (95.3)/1 (92.9), and 0.5 (95.8)/0.5 (98.1) for C. lusitaniae; -/2 (100.0), 0.5 (98.8)/0.5 (97.7), and 0.25 (97.6)/0.25 (96.9) for C. dubliniensis; and 2 (100.0)/2 (100.0), 1 (92.7)/-, and 1 (100.0)/2 (100.0) for C. guilliermondii. In the absence of species-specific CBP values, these wild-type (WT) MIC distributions and ECVs will be useful for monitoring the emergence of reduced susceptibility to these well-established antifungal agents.

Multiscroll attractors by switching systems.

In this paper, we present a class of three-dimensional dynamical systems having multiscrolls which we call unstable dissipative systems (UDSs). The UDSs are dissipative in one of its components but unstable in the other two. This class of systems is constructed with a switching law to display various multiscroll strange attractors. The multiscroll strange attractors result from the combination of several unstable "one-spiral" trajectories by means of switching. Each of these trajectories lies around a saddle hyperbolic stationary point. Thus, we describe how a piecewise-linear switching system yields multiscroll attractors, symmetric or asymmetric, with chaotic behavior.

Forced synchronization of a self-sustained chaotic oscillator.

This work presents a forced synchronization phenomenon like the asymptotic correlated behavior between chaotic oscillators forced by an external signal. Different kinds of forced synchronization are presented and given a theoretical justification explaining why it is possible to find some of them. Numerical results are presented for different cases such as antisymmetric, lag, phase, and identical forced synchronization.

Filtering by nonlinear systems.

Synchronization of nonlinear systems forced by external signals is formalized as the response of a nonlinear filter. Sufficient conditions for a nonlinear system to behave as a filter are given. Some examples of generalized chaos synchronization are shown to actually be special cases of nonlinear filtering.

[Laparoscopic cholecystectomy in children]. / Colecistectomía laparoscópica en niños.

BACKGROUND: Laparoscopic cholecystectomy is the standard current treatment in adults with cholelithiasis, the experience in children has been reported recently. OBJECTIVE: To report the utility and results with this new technology in the pediatric age. METHODS: We found six children, 10 to 15 years old, with gallbladder lithiasic disease, all were operated with a modified laparoscopic cholecystectomy technique. RESULTS: The operation was performed without complications, the average surgical time was 90 minutes, and the recover, was short and successful. CONCLUSIONS: Laparoscopic cholecystectomy in children can be safe and effective.

[Medical treatment of colorectal cancer]. / Tratamiento médico del cáncer colorrectal.

Colorectal cancer is the second leading cause of cancer-related death in the US in both sexes after lung cancer. In 1995 colorectal cancer became the third most common neoplasm after lung and prostate cancer in men and after lung and breast carcinomas in women. The etiologic factors related to this disease are unknown although environmental, genetic, dietary and familial factors have been implicated. From the standpoint of the treatment it is important to remark that a high percentage of patients with colorectal cancer are curable if the disease is diagnosed in early stages. Adjuvant therapy with 5-fluorouracil (5-FU) and levamisole (lev) has shown an increase in the cure rate in stage III (Dukes'C) colon cancer patients. In rectal cancer patients adjuvant therapy with chemotherapy and radiation therapy increased the cure rate in stages II (Dukes' B2) and III patients. When colorectal cancer is disseminated (stage IV or Dukes'D), it is incurable in the majority of the patients. In fact, the only curative possibility in this group of patients is, when indicated, surgical resection of the metastatic focus. If resection is unfeasible, palliative treatment with 5-FU-based chemotherapy is the usual approach. Regardless of the advances made in treatment, almost 50% of the colorectal cancer patients still die due to progression of their disease. Better programs of primary and secondary prevention, new therapeutic modalities and better chemotherapeutic agents will be necessary to improve survival in colorectal cancer patients.