Temporal characterization of acute pain and toxicity kinetics during radiation therapy for head and neck cancer. A retrospective study.

Objectives: Pain during Radiation Therapy (RT) for oral cavity/oropharyngeal cancer (OC/OPC) is a clinical challenge due to its multifactorial etiology and variable management. The objective of this study was to define complex pain profiles through temporal characterization of pain descriptors, physiologic state, and RT-induced toxicities for pain trajectories understanding. Materials and methods: Using an electronic health record registry, 351 OC/OPC patients treated with RT from 2013 to 2021 were included. Weekly numeric scale pain scores, pain descriptors, vital signs, physician-reported toxicities, and analgesics were analyzed using linear mixed effect models and Spearman's correlation. Area under the pain curve (AUCpain) was calculated to measure pain burden over time. Results: Median pain scores increased from 0 during the weekly visit (WSV)-1 to 5 during WSV-7. By WSV-7, 60% and 74% of patients reported mouth and throat pain, respectively, with a median pain score of 5. Soreness and burning pain peaked during WSV-6/7 (51%). Median AUCpain was 16% (IQR (9.3-23)), and AUCpain significantly varied based on gender, tumor site, surgery, drug use history, and pre-RT pain. A temporal increase in mucositis and dermatitis, declining mean bodyweight (-7.1%; P < 0.001) and mean arterial pressure (MAP) 6.8 mmHg; P < 0.001 were detected. Pulse rate was positively associated while weight and MAP were negatively associated with pain over time (P < 0.001). Conclusion: This study provides insight on in-depth characterization and associations between dynamic pain, physiologic, and toxicity kinetics. Our findings support further needs of optimized pain control through temporal data-driven clinical decision support systems for acute pain management.

Smart Winery: A Real-Time Monitoring System for Structural Health and Ullage in Fino Style Wine Casks.

The rapid development in low-cost sensor and wireless communication technology has made it possible for a large number of devices to coexist and exchange information autonomously. It has been predicted that a substantial number of devices will be able to exchange and provide information about an environment with the goal of improving our lives, under the well-known paradigm of the Internet of Things (IoT). One of the main applications of these kinds of devices is the monitoring of scenarios. In order to improve the current wine elaboration process, this paper presents a real-time monitoring system to supervise the status of wine casks. We have focused on a special kind of white wine, called Fino, principally produced in Andalusia (Southern Spain). The process by which this kind of wind is monitored is completely different from that of red wine, as the casks are not completely full and, due to the fact that they are not renewed very often, are more prone to breakage. A smart cork prototype monitors the structural health, the ullage, and the level of light inside the cask and the room temperature. The advantage of this smart cork is that it allows winemakers to monitor, in real time, the status of each wine cask so that, if an issue is detected (e.g., a crack appears in the cask), they can act immediately to resolve it. Moreover, abnormal parameters or incorrect environmental conditions can be detected in time before the wine loses its desired qualities. The system has been tested in "Bodegas San Acacio," a winery based in Montemayor, a town in the north of Andalusia. Results show that the use of such a system can provide a solution that tracks the evolution and assesses the suitability of the delicate wine elaboration process in real time, which is especially important for the kind of wine considered in this paper.

Using Wireless Sensor Networks and Trains as Data Mules to Monitor Slab Track Infrastructures.

Recently, slab track systems have arisen as a safer and more sustainable option for high speed railway infrastructures, compared to traditional ballasted tracks. Integrating Wireless Sensor Networks within these infrastructures can provide structural health related data that can be used to evaluate their degradation and to not only detect failures but also to predict them. The design of such systems has to deal with a scenario of large areas with inaccessible zones, where neither Internet coverage nor electricity supply is guaranteed. In this paper we propose a monitoring system for slab track systems that measures vibrations and displacements in the track. Collected data is transmitted to passing trains, which are used as data mules to upload the information to a remote control center. On arrival at the station, the data is stored in a database, which is queried by an application in order to detect and predict failures. In this paper, different communication architectures are designed and tested to select the most suitable system meeting such requirements as efficiency, low cost and data accuracy. In addition, to ensure communication between the sensing devices and the train, the communication system must take into account parameters such as train speed, antenna coverage, band and frequency.

Sensor4PRI: a sensor platform for the protection of railway infrastructures.

Wireless Sensor Networks constitute pervasive and distributed computing systems and are potentially one of the most important technologies of this century. They have been specifically identified as a good candidate to become an integral part of the protection of critical infrastructures. In this paper we focus on railway infrastructure protection and we present the details of a sensor platform designed to be integrated into a slab track system in order to carry out both installation and maintenance monitoring activities. In the installation phase, the platform helps operators to install the slab tracks in the right position. In the maintenance phase, the platform collects information about the structural health and behavior of the infrastructure when a train travels along it and relays the readings to a base station. The base station uses trains as data mules to upload the information to the internet. The use of a train as a data mule is especially suitable for collecting information from remote or inaccessible places which do not have a direct connection to the internet and require less network infrastructure. The overall aim of the system is to deploy a permanent economically viable monitoring system to improve the safety of railway infrastructures.

Influence of the number of malignant regional lymph nodes detected by endoscopic ultrasonography on survival stratification in esophageal adenocarcinoma.

BACKGROUND & AIMS: The nodal staging of esophageal cancer accounts for the absence or presence of metastatic lymph nodes (N0 or N1, respectively). Surgical data suggest that patients have worse survival when esophagectomy specimens contain higher numbers of regional malignant lymph nodes. It has been proposed that the staging system for esophageal cancer be modified to include the number of malignant lymph nodes. The aim of this study was to determine the influence of the number of malignant-appearing regional lymph nodes detected on endoscopic ultrasonography (EUS) on survival in patients with esophageal adenocarcinoma. METHODS: Historical case series involved patients with esophageal adenocarcinoma who underwent EUS staging at a single center between 1994 and 2004. Endoscopy reports were reviewed to determine the number of malignant-appearing periesophageal lymph nodes seen on EUS examination. Subjects were categorized as having 0, 1-2, or >2 periesophageal lymph nodes. A regional cancer registry prospectively obtained survival data. RESULTS: Among 85 patients with esophageal adenocarcinoma, the Kaplan-Meier curves showed distinct survival advantages in those with fewer malignant-appearing regional lymph nodes (P=.0008). The median survivals were 66 months, 14.5 months, and 6.5 months for 0, 1-2, and >2 malignant-appearing lymph nodes, respectively. Survival was also influenced by celiac lymph nodes and tumor length, both of which were associated with increased number of malignant nodes. CONCLUSIONS: The number of malignant-appearing periesophageal lymph nodes detected by EUS is associated with improved survival stratification in patients with esophageal adenocarcinoma and should be considered in the presurgical staging of esophageal cancer.

Use of orlistat (xenical) to treat chylous ascites.

Chylous ascites is uncommon and occurs in about 1 in 20,000 hospital admissions. Causes include disruption of the lymphatic system due to malignancy, cirrhosis, surgery, or radiation therapy. The mainstay of therapy has been low-fat diet supplemented with medium-chain triglyceride oil. However, dietary compliance can be difficult to achieve for adequate response. We report a 47-year-old man with hepatitis C and alcohol-related cirrhosis with new-onset chylous ascites and chylothorax. His ascites triglyceride was 585 mg/dL, and the pleural fluid triglyceride was 691 mg/dL. Ascitic and pleural fluid cytology and acid-fast bacilli stain were negative. The patient was treated with low-fat diet and medium-chain triglyceride oil. However, his ascites remained chylous after 1 week of treatment because of poor compliance with the dietary restrictions. Orlistat was then added to his treatment regimen. A half week later, the chylous component of his ascites resolved. Remaining high-volume clear ascites was treated with placement of a transjugular intrahepatic portosystemic shunt. To our knowledge, orlistat has never been used in the treatment of chylous ascites. This case suggests the potential value of adding orlistat to low-fat diet and medium-chain triglyceride oil in the treatment of chylous ascites, especially in patients who are unable to comply with the dietary restrictions.

Dysplasia and risk of further neoplastic progression in a regional Veterans Administration Barrett's cohort.

OBJECTIVES: No published data are available on the risk of further neoplastic progression in Barrett's patients stratified by baseline dysplasia status. Our aims were to estimate and compare the risk of progression to high-grade dysplasia or cancer in groups of Barrett's patients stratified by baseline dysplasia status. METHODS: Consecutive Barrett's cases from 1988-2002 were identified via pathology databases in a regional VA health-care system and medical record data were abstracted. The risk of progression to high-grade dysplasia or cancer was measured and compared in cases with versus without low-grade dysplasia within 1 yr of index endoscopy using survival analysis. RESULTS: A total of 575 Barrett's cases had 2,775 patient-years of follow-up. There were 13 incident cases of high-grade dysplasia and two of cancer. The crude rate of high-grade dysplasia or cancer was 1 of 78 patient-years for those with baseline dysplasia versus 1 of 278 patient-years for those without (p= 0.001). One case of high-grade dysplasia in each group underwent successful therapy. One incident cancer case underwent successful resection and the other was unresectable. Two cases with high-grade dysplasia later developed cancer, one died postoperatively, the other was unresectable. When these two cases were included (total of four cancers), the crude rate of cancer was 1 of 274 patient-years for those with baseline dysplasia versus 1 of 1,114 patient-years for those without. CONCLUSIONS: In a large cohort study of Barrett's, incident malignancy was uncommon. The rate of progression to high-grade dysplasia or cancer was significantly higher in those with baseline low-grade dysplasia. These data may warrant reevaluation of current Barrett's surveillance strategies.