Physicochemical Compatibility of Ceftolozane-Tazobactam with Parenteral Nutrition.

Ceftolozane-tazobactam (CT) is used for the treatment of complicated infections and for multidrug-resistant strains of Pseudomonas aeruginosa and extended-spectrum beta-lactamase-producing enterobacteria. In certain cases, simultaneous administration of CT and parenteral nutrition (PN) may be required, but compatibility of Y-site co-administration is unknown. The aim of this study was to analyse the physicochemical compatibility of CT Y-site administered with PN. We evaluated a protocolized PN approach for critical patients in our center. We studied both bolus infusion (2 g ceftolozane/1 g tazobactam in 1 h) and continuous infusion (CI) (6 g ceftolozane/3 g tazobactam) strategies. Samples were visually observed against light, microscopically inspected, and pH was analysed using a pH meter. The mean lipid droplet diameter (MDD) was determined via dynamic light scattering. CT concentration was quantified using HPLC-HRMS. No alterations were observed through visual or microscopic inspection. Changes in pH were ≤0.2, and changes in osmolarity were less than 5%. MDD remained below 500 nm (284.5 ± 2.1 for bolus CT and 286.8 ± 7.5 for CI CT). CT concentrations at t = 0 h and t = 24 h remained within prespecified parameters in both infusion strategies. CT is physiochemically compatible with PN during simulated Y-site administration at the tested concentration and infusion rates.

Multiple Kernel Synthesis of Head CT Using a Task-Based Loss Function.

In CT imaging of the head, multiple image series are routinely reconstructed with different kernels and slice thicknesses. Reviewing the redundant information is an inefficient process for radiologists. We address this issue with a convolutional neural network (CNN)-based technique, synthesiZed Improved Resolution and Concurrent nOise reductioN (ZIRCON), that creates a single, thin, low-noise series that combines the favorable features from smooth and sharp head kernels. ZIRCON uses a CNN model with an autoencoder U-Net architecture that accepts two input channels (smooth- and sharp-kernel CT images) and combines their salient features to produce a single CT image. Image quality requirements are built into a task-based loss function with a smooth and sharp loss terms specific to anatomical regions. The model is trained using supervised learning with paired routine-dose clinical non-contrast head CT images as training targets and simulated low-dose (25%) images as training inputs. One hundred unique de-identified clinical exams were used for training, ten for validation, and ten for testing. Visual comparisons and contrast measurements of ZIRCON revealed that thinner slices and the smooth-kernel loss function improved gray-white matter contrast. Combined with lower noise, this increased visibility of small soft-tissue features that would be otherwise impaired by partial volume averaging or noise. Line profile analysis showed that ZIRCON images largely retained sharpness compared to the sharp-kernel input images. ZIRCON combined desirable image quality properties of both smooth and sharp input kernels into a single, thin, low-noise series suitable for both brain and skull imaging.

Application of White-Wine-Pomace-Derived Ingredients in Extending Storage Stability of Fresh Pork Burgers.

White wine pomace, a by-product from winemaking, was stabilized after the application of thermal blanching (with the aim of deactivating the polyphenoloxidase enzyme), milling, and processing by hydrostatic high-pressure treatment (with the aim of reducing initial microbial loads while preserving phenolic compounds content). The valorized pomace (VP) ingredient was added at different proportions to pork burgers (0.5%, 1%, and 3% w/w) to improve their preservation, and the effect was compared to those produced by sulfites and with a control (without sulfites or VP). Burgers were vacuum-packed and refrigerated for 7 days. Microbiological, color, oxidation, and sensory parameters were analyzed. Neither sulfites nor VP reduced the microbial development of most microorganism groups evaluated (p > 0.05); however, both prevented coliform growth during storage (p < 0.01). The use of sulfites prevented the discoloration of burgers during storage, while VP had no effect (p < 0.001). On the contrary, VP limited lipid and protein oxidation development during storage (p > 0.05), while sulfites had no effect. Therefore, the use of VP from white wine production could have an antioxidant effect but a limited antimicrobial or color-protective effect for the preservation of pork burgers.

Adaptation of a channelized Hotelling observer model to accommodate anthropomorphic backgrounds and moving test objects in X-ray angiography.

BACKGROUND: Prior implementations of the channelized Hotelling observer (CHO) model have succeeded in assessing the performance of X-ray angiography systems under a variety of imaging conditions. However, often times these conditions do not resemble those present in routine clinical imaging scenarios, such as having complex anthropomorphic backgrounds in conjunction with moving test objects. PURPOSE: This work builds up on prior established CHO methods and introduces a new approach to switch from the already established "multiple-sample" CHO implementation to a "single-sample" technique. The proposed implementation enables the inclusion of moving test objects upon nonuniform backgrounds by allowing only a single sample to represent the test object present condition that is to be used within the statistical test to estimate the detectability index. METHODS: To assess the proposed method, two image data sets were acquired with a clinical X-ray angiography system. The first set consisted of a uniform background in combination with static test objects while the second consisted of an anthropomorphic chest phantom in conjunction with moving test objects. The first set was used to validate the proposed approach against the multiple-sample method while the second was used to assess the feasibility of the proposed method under a variety of imaging conditions, including seven object sizes and seven detector target dose (DTD) levels. RESULTS: For the uniform background data set, considering all detectability indices greater or equal than 1, the ratio between the detectability indices of the proposed single-sample approach versus the multiple-sample method was 0.997 ± 0.056 (range 0.884-1.159). The average single-direction width of the 95% confidence intervals (CIs) of the detectability index estimates for the multiple-sample method was 0.38 ± 0.43 (range 0.03-2.20). For the single-sample approach, the average width was 2.52 ± 0.63 (range 1.11-5.44). For the anthropomorphic background image set, the results were consistent with classical quantum-limited signal-to-noise ratio (SNR) theory. The magnitude of the detectability indices varied predictably with changes in both object size and DTD, with the highest value associated with the highest dose and the largest object size. Additionally, the proposed method was able to capture differences in the imaging performance for a given test object across the field of view, which was associated with the attenuation levels provided by different features of the anthropomorphic background. CONCLUSIONS: A new single-sample variant of the CHO model to assess the performance of X-ray angiography imaging systems is proposed. The new approach is consistent with quantum-limited image quality theory and with a standard implementation of the CHO model. The proposed method enables the assessment of moving test objects in combination with complex, nonuniform image backgrounds, thereby opening the possibility to assess imaging conditions which more closely resemble those used in clinical care.

Forcing vine regrowth under different irrigation strategies: effect on polyphenolic composition and chromatic characteristics of cv. Tempranillo wines grown in a semiarid climate.

One of the effects of climate change in warm areas is the asynchrony between the dates of the technological and the phenolic maturity of grapes. This is important because the quality and color stability of red wines are directly related to the content and distribution of phenolic compounds. A novel alternative that has been proposed to delay grape ripening and make it coincide with a seasonal period more favorable for the formation of phenolic compounds is crop forcing. This consists of severe green pruning after flowering, when the buds of the following year have already differentiated. In this way, the buds formed during the same season are forced to sprout, initiating a new delayed cycle. The aim of the present work is to study the effect on the phenolic composition and color of wines elaborated from vines fully irrigated (C), grown using conventional non-forcing (NF) and forcing (F) techniques (C-NF and C-F), and wines from vines subjected to regulated irrigation (RI), grown using NF and F techniques (RI-NF and RI-F). The trial was carried out in an experimental vineyard of the Tempranillo variety located in a semi-arid area (Badajoz, Spain) in the 2017-2019 seasons. The wines (four by treatment) were elaborated and stabilized according to the classic methodologies for red wine. All wines had the same alcohol content, and malolactic fermentation was not carried out in any of them. Anthocyanin profiles were analyzed by HPLC, and total polyphenolic content, anthocyanin content, catechin content, the contribution to color due to co-pigmented anthocyanins, and various chromatic parameters were also determined. Although a significant effect of year was found for almost all the parameters analyzed, a general increasing trend in F wines was found for most of them. The anthocyanin profile of F wines was found to differ from that of C wines, especially in delphinidin, cyanidin, petunidin, and peonidin content. These results indicate that by using the forcing technique it was possible to increase the polyphenolic content by ensuring that the synthesis and accumulation of these substances occurred at more suitable temperatures.

Corrección endoscópica del reflujo vesicoureteral. Revisión narrativa / Endoscopic correction of vesicoureteral reflux. Narrative review

En esta revisión narrativa se plantea como objetivo realizar una descripción amplia y específica acerca de los agentes abultantes utilizados para la corrección endoscópica del reflujo vesicoureteral disponibles en el mercado hasta la actualidad, sus tasas de éxito y de complicaciones. Este texto se realizó a partir de una búsqueda sistemática con las palabras clave enunciadas a continuación como términos MESH. Se describen los distintos tipos de sustancias y se exponen los resultados de los artículos revisados. Finalmente se plantean las conclusiones.

The objective of this narrative review is to describe in a broad and specific way all the bulking agents used in the endoscopic correction of vesicoureteral reflux currently available, their success and complication rates. This text was done by a systematic search with the keywords seen below in MESH terms. The different types of substances are described, and the results of the reviewed articles are presented. Finally, conclusions are made.

Factores predictores de mortalidad en pacientes con enfermedad coronaria y compromiso del tronco principal izquierdo / Predictors of mortality in patients with coronary artery disease and involvement of the left main artery

Resumen: Introducción: el compromiso del tronco principal izquierdo no protegido (TPInp) en pacientes con enfermedad arterial coronaria (EAC) conlleva alto riesgo de eventos cardiovasculares. La cirugía de revascularización coronaria (CABG) ha sido el estándar de tratamiento; sin embargo, estudios recientes proponen la intervención coronaria percutánea (PCI) como alternativa. Objetivo: evaluar los desenlaces intrahospitalarios y durante el seguimiento del tratamiento de pacientes con compromiso del TPInp. Método: estudio observacional multicéntrico de cohorte retrospectivo, se evaluaron pacientes con EAC y afección del TPI. Muerte de cualquier causa, infarto de miocardio no fatal, accidente cerebrovascular, reintervención y/o readmisión hospitalaria fueron valorados como un desenlace compuesto e individualmente durante la hospitalizacioì n y el tiempo de seguimiento. Resultados: se incluyeron 82 pacientes, con edad promedio 71 ± 9.9 años; 35 recibieron PCI, 31 CABG y 16 manejo meìdico (MM). La mortalidad intrahospitalaria fue del 16%. En el seguimiento medio de 12.3 meses la tasa de mortalidad fue del 20%, la de reinfarto del 6% y la de readmisioìn hospitalaria del 4%. La tasa de incidencia de muerte para MM fue 5.19 por 10.000 personas/diìa, para PCI de 2.3 por 10.000 personas/diìa y para CABG de 1.06 por 10.000 personas/diìa; en el seguimiento la mortalidad fue mayor en el grupo de PCI (HR: 3.6; IC 95% 1.13-11.9; p = 0.02). La frecuencia cardiaca elevada al ingreso se asocioì con mayor mortalidad (0.05). Conclusión: el compromiso del TPI se asocia con alto riesgo de muerte y se presenta con anatomiìa coronaria compleja.

Abstract: Introduction: involvement of the unprotected left main coronary artery (TPInp) in patients with coronary artery disease (CAD) leads to a high risk of cardiovascular events. Coronary artery bypass grafting (CABG) has been the standard of management; however, recent studies propose percutaneous coronary intervention (PCI) as an alternative treatment. Objective: to evaluate the in-hospital and follow-up outcomes of patients with compromised TPInp. Method: retrospective multicenter observational cohort study, we evaluated patients with CAD and TPI involvement. Death from any cause, nonfatal myocardial infarction, stroke, reoperation, and/or hospital readmission were assessed as a composite endpoint and individually during hospitaliza- tion and follow-up time. Results: 82 patients were included, mean age 71 ± 9.9 years; 35 received PCI, 31 CABG, and 16 medical management (MM). In-hospital mortality was 16%. In the mean follow-up of 12.3 months, mortality was 20%, rein- farction 6% and hospital readmission 4%. The incidence rate of death was 5.19 per 10,000 people/day for MM, 2.3 per 10,000 people/day for PCI, and 1.06 per 10,000 people/day for CABG; at follow-up, mortality was higher in the PCI group (HR 3.6; 95%CI 1.13-11.9; p = 0.02). Elevated heart rate on admission was associated with higher mortality (p < 0.05). Conclusion: TPInp involvement is associated with a high risk of death and presents with complex coronary anatomy.

MRI Radiomics for Assessment of Molecular Subtype, Pathological Complete Response, and Residual Cancer Burden in Breast Cancer Patients Treated With Neoadjuvant Chemotherapy.

RATIONALE AND OBJECTIVES: There are limited data on pretreatment imaging features that can predict response to neoadjuvant chemotherapy (NAC). To extract volumetric pretreatment MRI radiomics features and assess corresponding associations with breast cancer molecular subtypes, pathological complete response (pCR), and residual cancer burden (RCB) in patients treated with NAC. MATERIALS AND METHODS: In this IRB-approved study, clinical and pretreatment MRI data from patients with biopsy-proven breast cancer who received NAC between September 2009 and July 2016 were retrospectively analyzed. Tumors were manually identified and semi-automatically segmented on first postcontrast images. Morphological and three-dimensional textural features were computed, including unfiltered and filtered image data, with spatial scaling factors (SSF) of 2, 4, and 6 mm. Wilcoxon rank-sum tests and area under the receiver operating characteristic curve were used for statistical analysis. RESULTS: Two hundred and fifty nine patients with unilateral breast cancer, including 73 (28.2%) HER2+, 112 (43.2%) luminal, and 74 (28.6%) triple negative breast cancers (TNBC), were included. There was a significant difference in the median volume (p = 0.008), median longest axial tumor diameter (p = 0.009), and median longest volumetric diameter (p = 0.01) among tumor subtypes. There was also a significant difference in minimum signal intensity and entropy among the tumor subtypes with SSF = 4 mm (p = 0.009 and p = 0.02 respectively) and SSF = 6 mm (p = 0.007 and p < 0.001 respectively). Additionally, sphericity (p = 0.04) in HER2+ tumors and entropy with SSF = 2, 4, 6 mm (p = 0.004, 0.02, 0.047 respectively) in luminal tumors were significantly associated with pCR. Multiple features demonstrated significant association (p < 0.05) with pCR in TNBC and with RCB in luminal tumors and TNBC, with standard deviation of intensity with SSF = 6 mm achieving the highest AUC (AUC = 0.734) for pCR in TNBC. CONCLUSION: MRI radiomics features are associated with different molecular subtypes of breast cancer, pCR, and RCB. These features may be noninvasive imaging biomarkers to identify cancer subtype and predict response to NAC.

Non-Anthocyanin Compounds in Minority Red Grapevine Varieties Traditionally Cultivated in Galicia (Northwest Iberian Peninsula), Analysis of Flavanols, Flavonols, and Phenolic Acids.

Non-anthocyanin compounds (NAN) such as flavonol, flavanol, and phenolic acids should be considered in the characterization of minority red grapevine varieties because these compounds are involved in copigmentation reactions and are potent antioxidants. Sixteen NAN were extracted, identified, and quantified by High Performance Liquid Chromatography (HPLC) from grapes of 28 red genotypes of Vitis vinifera L. grown in Galicia (Northwest of Spain) in 2018 and 2019 vintages. The percentage of total NAN with respect to the total polyphenol content (TPC) values was calculated for each sample and established into three categories: high percentage NAN varieties (NANV), those varieties showing low percentages of NAN (ANV), and finally those varieties showing medium percentages of NAN (NANAV). 'Xafardán' and 'Zamarrica', classified as NANAV, had high values of TPC and showed good percentages of flavonol and flavanol compounds. Principal component analyses (PCA) were performed with flavonol, flavanol, and phenolic acid profiles. The flavonol and flavanol profiles allowed a good discrimination of samples by variety and year, respectively. The flavonol profile should therefore be considered as a potential varietal marker. The results could help in the selection of varieties to be disseminated and in the identification of the most appropriate agronomic and oenological techniques that should be performed on them.

Task-specific efficient channel selection and bias management for Gabor function channelized Hotelling observer model for the assessment of x-ray angiography system performance.

PURPOSE: Channelized Hotelling observer (CHO) models have been implemented to assess imaging performance in x-ray angiography systems. While current methods are appropriate for assessing unprocessed images of moving test objects upon uniform-exposure backgrounds, they are inadequate for assessing conditions which more appropriately mimic clinical imaging conditions including the combination of moving test objects, complex anthropomorphic backgrounds, and image processing. In support of this broad goal, the purpose of this work was to develop theory and methods to automatically select a subset of task-specific efficient Gabor channels from a task-generic Gabor channel base set. Also, previously described theory and methods to manage detectability index (d') bias due to nonrandom temporal variations in image electronic noise will be revisited herein. METHODS: Starting with a base set of 96 Gabor channels, backward elimination of channels was used to automatically identify an "efficient" channel subset which reduced the number of channels retained in the subset while maintaining the magnitude of the d' estimate. The concept of a pixelwise Hotelling observer (PHO) model was introduced and similarly implemented to assess the performance of the efficient-channel CHO model. Bias in d' estimates arising from temporally variable nonstationary noise was modeled as a bivariate probability density function for normal distributions, where one variable corresponds to the signal from the test object and the other variable corresponds to the signal from temporally variable nonstationary noise. Theory and methods were tested on uniform-exposure unprocessed angiography images with detector target dose (DTD) of 6, 18, and 120 nGy containing static disk-shaped test objects with diameter in the range of 0.5 to 4 mm. RESULTS: Considering all DTD levels and test object sizes, the proposed method reduced the number of Gabor channels in the final subset by 63-82% compared to the original 96 Gabor channel base set, while maintaining a mean relative performance ( ( d CHO ' / d PHO ' ) × 100 % ) of 95%  ±  4% with respect to the reference PHO model. Experimental results demonstrated that the bivariate approach to account for bias due to temporally variable nonstationary noise resulted in improved correlation between the CHO and PHO models as compared to a previously proposed univariate approach. CONCLUSIONS: Computationally efficient backward elimination can be used to select an efficient subset of Gabor channels from an initial channel base set without substantially compromising the magnitude of the d' estimate. Bias due to temporally variable nonstationary noise can be modeled through a bivariate approach leading to an improved unbiased estimate of d'.