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Summary Background Watch and wait is a novel management strategy in patients with rectal cancer who have a clinical complete response after neoadjuvant chemoradiotherapy. Surveillance of these patients is generally intensive, because local regrowth (with the potential for salvage) occurs in 25% of patients, and distant metastases occur in 10% of patients. It is unclear for how long these patients should be followed up. To address this issue, we did conditional survival modelling using the International Watch & Wait Database (IWWD), which is a large-scale registry of patients with a clinical complete response after neoadjuvant chemotherapy who have been managed by a watch-and-wait strategy. Methods We did a retrospective, multicentre registry study using a dataset from the IWWD, which includes data from 47 clinics across 15 countries. We selected patients (aged ≥18 years) with rectal cancer who had a clinical complete response after neoadjuvant chemotherapy, and who were subsequently managed by a watch-and-wait strategy between Nov 25, 1991, and Dec 31, 2015. Patients who had not achieved a clinical complete response or who had undergone any surgical procedure were excluded. The criteria used for defining a clinical complete response and the specific surveillance strategies were at the discretion of each participating centre. We used conditional survival modelling to estimate the probability of patients remaining free of local regrowth or distant metastasis for an additional 2 years after sustaining a clinical complete response or being distant metastasis-free for 1, 3, and 5 years from the date of the decision to commence watch and wait. The primary outcomes were conditional local regrowth-free survival at 3 years, and conditional distant metastasis-free survival at 5 years. Findings We identified 793 patients in the IWWD with clinical complete response who had been managed by a watch-and-wait strategy. Median follow-up was 55·2 months (IQR 36·0–75·6). The probability of remaining free from local regrowth for an additional 2 years if a patient had a sustained clinical complete response for 1 year was 88·1% (95% CI 85·8–90·9), for 3 years was 97·3% (95·2–98·6), and for 5 years was 98·6% (97·6–100·0). The probably of remaining free from distant metastasis for a further 2 years in patients who had a clinical complete response without distant metastasis for 1 year was 93·8% (92·3–95·9), for 3 years was 97·8% (96·6–99·3), and for 5 years was 96·6% (94·0–98·9). Interpretation These results suggest that the intensity of active surveillance in patients with rectal cancer managed by a watch-and-wait approach could be reduced if they achieve and maintain a clinical complete response within the first 3 years of starting this approach. Funding European Registration of Cancer Care, financed by the European Society of Surgical Oncology, the Champalimaud Foundation Lisbon, the Bas Mulder Award, granted by the Alpe d’HuZes Foundation and the Dutch Cancer Society, the European Research Council Advanced Grant, and the National Institute of Health and Research Manchester Biomedical Research Centre.

PurposeThis paper examines the role of co-inventor collaboration with China and/or the USA on a country's increase in centrality in global knowledge networks. It also explores the role of specific institutional factors – corruption and intellectual property rights (IPR) protection – on this relationship.Design/methodology/approachIn the study, co-inventor data from the United States Patent and Trademark Office (USPTO) applications have been used to construct networks of technological knowledge collaboration at the country level over the years 2002–2015. Using eigenvector centrality as the dependent variable, the study uses fixed effect regression analyses on a panel of 171 countries, contributing to recent debates on knowledge networks and international cooperation.FindingsBuilding on research in economic development, innovation and social network theory, this research finds that co-patenting with Chinese inventors is positively related to a country's centrality in global knowledge networks and that this relationship is negatively moderated by collaboration with the current most central knowledge network – namely that of the USA – suggesting a substitution effect. It also finds a partial substitution between institutional factors, IPRs protection and transparency, and collaboration with China on a country's knowledge centrality.Practical implicationsRegarding policymakers, the findings can be used to encourage international collaboration for increased access to new sources of knowledge that fosters innovation while keeping a close eye on local institutions, especially emerging economies that want to increase their international knowledge network centrality.Originality/valueThis study creates a unique panel data set and extends the social networks approach in international business literature, focusing on institutional characteristics related to participation in knowledge networks.

Organizations use multiple strategies to increase the number and impact of eco-innovations as a path to achieve competitive advantage. In this article, we study the role of open innovation activities, specifically related to market sources, as a driver of eco-innovation performance. While studies have looked at the relationship between these two emergent innovation phenomena from a broad perspective, we explore whether specific market knowledge sources—clients, suppliers, competitors, and consultants—and their combined use—affect eco-innovation performance. We rely on insights from theories of open innovation and sustainable and environmental innovation to build a theoretical framework about the determinants of eco-innovation performance from a market-driven open innovation perspective. Our sample consists of 3047 firm-year observations obtained from three consecutive panels of the Chilean Innovation Survey (2009–2014). We found that clients, suppliers, competitors, and consultants as knowledge sources positively influence eco-innovation performance in firms. In addition, our results suggest that a combination of client sourcing with supplier and consultant sources of knowledge positively affect eco-innovation performance. We discuss the implications of our findings for open innovation activities on eco-innovation and suggest ideas for future research.

This work explores the improvements that can be made in the process of parametrization of discrete-event simulation models. A manufacturing process is modeled through queuing systems and alternative decisions to perform production, transport, and merchandise handling tasks. The use of recursive artificial intelligence is suggested to improve the quality of the parameters used in the simulation model. Specifically, a vector support machine is used for statistical learning. A relevant characteristic of the proposed model is the integration of different information technology platforms so that the simulation can be recursive.

Background Antibodies to the aquaporin-4 (AQP4) water channel in neuromyelitis optica spectrum disorder (NMOSD) are reported to trigger the complement cascade, which is implicated in astrocyte damage and subsequent neuronal injury. The PREVENT study demonstrated that the terminal complement inhibitor eculizumab reduces adjudicated relapse risk in patients with anti-AQP4 immunoglobulin G-positive (AQP4+) NMOSD. The objective of this analysis was to evaluate the efficacy of eculizumab in reducing relapse risk and its safety in AQP4+ NMOSD across clinically relevant subgroups in PREVENT. Methods In the randomized, double-blind, time-to-event, phase 3 PREVENT trial, 143 adults received eculizumab (maintenance dose, 1200 mg/2 weeks) or placebo (2:1), with stable-dose concomitant immunosuppressive therapy (IST) permitted (except rituximab and mitoxantrone). Post hoc analyses of relapses and adverse events were performed for prespecified and post hoc subgroups based on concomitant IST and prior rituximab use, demographic and disease characteristics, and autoimmune comorbidity. Results The significant reduction in relapse risk observed for eculizumab versus placebo in the overall PREVENT population was consistently maintained across subgroups based on concomitant IST and previous rituximab use, age, sex, region, race, time since clinical onset of NMOSD, historical annualized relapse rate, baseline Expanded Disability Status Scale score, and history of another autoimmune disorder. The serious infection rate was lower with eculizumab than placebo regardless of rituximab use in the previous year, concomitant IST use, or history of another autoimmune disorder. Conclusion Across a wide range of clinically relevant AQP4+ NMOSD patient subgroups in PREVENT, eculizumab therapy was consistently effective versus placebo in reducing relapse risk, with no apparent increase in serious infection rate. Trial registration NCT01892345 (ClinicalTrials.gov).

BACKGROUND: The strategy of watch and wait (W&W) in patients with rectal cancer who achieve a complete clinical response (cCR) after neoadjuvant therapy is new and offers an opportunity for patients to avoid major resection surgery. However, evidence is based on small-to-moderate sized series from specialist centres. The International Watch & Wait Database (IWWD) aims to describe the outcome of the W&W strategy in a large-scale registry of pooled individual patient data. We report the results of a descriptive analysis after inclusion of more than 1000 patients in the registry.METHODS: Participating centres entered data in the registry through an online, highly secured, and encrypted research data server. Data included baseline characteristics, neoadjuvant therapy, imaging protocols, incidence of local regrowth and distant metastasis, and survival status. All patients with rectal cancer in whom the standard of care (total mesorectal excision surgery) was omitted after neoadjuvant therapy were eligible to be included in the IWWD. For the present analysis, we only selected patients with no signs of residual tumour at reassessment (a cCR). We analysed the proportion of patients with local regrowth, proportion of patients with distant metastases, 5-year overall survival, and 5-year disease-specific survival.FINDINGS: Between April 14, 2015, and June 30, 2017, we identified 1009 patients who received neoadjuvant treatment and were managed by W&W in the database from 47 participating institutes (15 countries). We included 880 (87%) patients with a cCR. Median follow-up time was 3·3 years (95% CI 3·1-3·6). The 2-year cumulative incidence of local regrowth was 25·2% (95% CI 22·2-28·5%), 88% of all local regrowth was diagnosed in the first 2 years, and 97% of local regrowth was located in the bowel wall. Distant metastasis were diagnosed in 71 (8%) of 880 patients. 5-year overall survival was 85% (95% CI 80·9-87·7%), and 5-year disease-specific survival was 94% (91-96%).INTERPRETATION: This dataset has the largest series of patients with rectal cancer treated with a W&W approach, consisting of approximately 50% data from previous cohort series and 50% unpublished data. Local regrowth occurs mostly in the first 2 years and in the bowel wall, emphasising the importance of endoscopic surveillance to ensure the option of deferred curative surgery. Local unsalvageable disease after W&W was rare.FUNDING: European Registration of Cancer Care financed by European Society of Surgical Oncology, Champalimaud Foundation Lisbon, Bas Mulder Award granted by the Alpe d'Huzes Foundation and Dutch Cancer Society, and European Research Council Advanced Grant.

Research on knowledge sources and innovation has focused mainly on external knowledge sources and the generation of technological innovations. This study contributes by examining the dual role of internal and external sources of knowledge and information on the adoption of managerial innovations, a type of non‐technological innovation deemed essential for organizational effectiveness but not examined sufficiently. It also contributes to the innovation adoption literature by analysing adoption as a process, rather than a dichotomous choice. We investigate how the involvement of stakeholders for the selection of a new programme, and organizational actions for the implementation of that programme, affect its adoption. Regression analyses of privatization of 64 services in 1,512 public organizations provide empirical evidence in support of the influence of internal and external involvement, and internal, but not external, implementation actions. We also find that while the relative influence of internal and external stakeholders’ involvement on innovation adoption does not differ, internal implementation actions have a stronger effect than external implementation actions. We discuss the implications of our findings for the adoption of innovations in organizations and offer research ideas for understanding non‐technological innovations and their effects on organizational conduct and outcomes.

Aim: To determine the impact of KRAS mutation status on survival in patients undergoing surgery for colorectal liver metastases (CLM). Patients & methods: Patients with resected CLM and KRAS mutations. Survival was compared between mt-KRAS and wt-KRAS. Results: Of 662 patients, 174 (26.3%) were mt-KRAS and 488 (73.7%) wt-KRAS. mt-KRAS patients had significantly lower recurrence-free survival (HR: 1.42; 95% CI: 1.10–1.84). There were no differences between the groups for sidedness. Poorer survival was associated with mt-KRAS with positive lymph nodes, >1 metastases, tumors >5 cm, synchronous tumors and R1–R2. Conclusion: KRAS mutation status can help predict recurrence-free survival. Primary tumor location was not a prognostic factor after resection. KRAS mutation status can help design a multidisciplinary approach after curative resection of CLM.

Background Kawasaki Disease (KD) is the second most common vasculitis in the pediatric population and the leading cause for pediatric acquired heart disease in developed countries. It is commonly diagnosed in the Mexican pediatric population, epidemiology in this country is not established, since cases are not usually reported to the healthcare system. The clinical features are quite variable, but diagnosis and prompt treatment will decrease morbidity and mortality. Coronary artery aneurysms are the most common complication, which represent the leading cause of acute coronary syndrome before 40 years of age. Recurrence of KD is estimated to be around 3% in Japanese patients and 1% in the United States, nevertheless, this data in Latin-American children is unknown. It usually affects patients before reaching 3 years old and within 2 years of the initial attack, presenting with an abrupt onset and higher complication rates, requiring aggressive workup, treatment and follow-up. Objectives To review an atypical presentation of KD and early recurrence in a 7-month-old female. Methods We present a 7-month-old female diagnosed with KD at 48 days old. She presented to the emergency unit with irritability, high and persistent fever and acholia. During workup, she was found with cholestasis and gallbladder hydrops. Negative CSF, blood and urine cultures were documented during hospitalization, and fulfilled the KD criteria. The cardiac ultrasound revealed coronary abnormalities: a RCA of 2.8mm (Z-Score +4.79), LCA of 3.3mm (Z-Score +5.69) and LAD of 2.4mm (Z-SCORE +4.25), which fit into classification 3 and 4, as small and medium aneurysms, according to AHA 2017. Immunoglobulin (2g/kg) and aspirin (80mg/kg) were administered and she was discharged 36 hours after the IVIg infusion, afebrile and with ambulatory follow-up, 30 days later the coronary abnormalities showed RCA of 2.0mm (Z-Score +2.3), LCA of 3.0mm (Z-Score +6), LAD 2.3mm (Z-Score +2.9). Six months later, she presented fever for 6 days, irritability and polymorphous rash. On physical exam BCGitis, non-suppurative conjunctivitis and pallor in hands and feet, elevated CRP and ESR, leukocytosis, thrombocytosis and sterile leukocyturia. Echocardiography reported RCA od 2.4mm (Z-Score +4.8), LCA of 3.1 (Z-Score +4.2) and LAD of 2.3mm (Z-Score +3.2), diagnosing KD recurrence, admitting the patient for IVIg and aspirin administration. Results The patient was treated with IVIg and aspirin. Follow-up by Cardiology determined improvement of Z-Scores. Recurrence occurred with worsening of the cardiac abnormalities. Cardiac prognosis is importantly affected due to the atypical age, vascular abnormalities and repeated vasculitic process. Rheumatologic consult should be considered since disease like Takayasu Arteritis, Polyarteritis Nosa and ADA2 deficiency need to be ruled out. Conclusion KD needs prompt diagnosis and treatment due to the potential consequences when delayed. Clinical suspicion is important due to the possible atypical presentation. As with this patient, age, gender and presentation are not exclusive. Despite adequate treatment, recurrence and worsening of the cardiac abnormalities occurred. Both KD events before 1 year old and with atypical presentations. Rheumatologic and cardiac follow-up need to be stringent through lifetime, to determine pharmacologic treatment, as ell as physical activity and reproductive counseling. References [1] McCrindle BW, Rowley AH, Newburger JW, Burns JC, Bolger AF, Gewitz M, et al. Diagnosis, Treatment and Long-term Management of Kawasaki Disease: A scientific Statement for Health Professionals From the American Heart Association. Circulation2017;135(17):e927-e99. Disclosure of Interests None declared

Traditional knowledge about fire and its effects held by indigenous people, who are connected to specific landscapes, holds promise for informing contemporary fire and fuels management strategies and augmenting knowledge and information derived from western science. In practice, however, inadequate means to organize and communicate this traditional knowledge with scientists and managers can limit its consideration in decisions, requiring novel approaches to interdisciplinary and cross-cultural communication and collaboration. We propose that Participatory Geographic Information Systems (PGIS) is one platform for the assemblage and communication of traditional knowledge vital to fire and fuels management, while preserving linkages to broader cultural contexts. We provide summaries of four preliminary case studies in the Intermountain West of North America to illustrate different potential applications of a PGIS tool in this context and describe some remaining challenges. Management and Policy Implications: Participatory Geographic Information Systems (PGIS) can offer a powerful approach for enhancing current decisionmaking by allowing for the integration of traditional and scientific knowledge systems with spatial environmental data in an interactive participatory process. Integrated data sets can allow traditional and scientific knowledge experts to share, explore, manage, analyze, and interpret multidimensional data in a common spatial context to develop more informed management decisions. Such combined data sets could provide a more comprehensive assessment of fire-related ecological change than is currently used in decisionmaking and enhance inclusion of effects on local resource utility values and areas of cultural significance. The use of a PGIS interface creates opportunities for traditional knowledge holders to share information and potential prescriptions while maintaining confidentiality. Knowledge integration efforts using PGIS as an organizational tool would help to bridge the communication gap that commonly exists between scientists, managers, and traditional knowledge holders as ecosystems continue to be altered through processes of land management and climate change.

Background The non-surgical management in a selected group of rectal cancer patients has shown promising results with adequate follow up. Aims describing the results of the non-surgical management in patients with complete clinical response, with a close follow up. Methods Between 2006 and 2015, patients with rectal cancer, stages I-III, without metastasis, treated with neoadjuvant CRT/CT, who had clinical complete response were included. CCR was defined through digital palpation, endoscopy-based criteria and MRI. Follow up was set according to institutional guidelines. Results 68 patients were included. Initial stage was assessed with MRI in 55/68 pts and EUS 11/68. Considering the recurrence risk factors 57.6% (29/68) were T2-3ab N0, 3.3% (2/68) were T4N0, 29% (20/68) were T3-4 N1-2, with 39.7% with positive MRC. Mean distance to the anal margin was 3 cm. Chemoradiation included radiotherapy at 50.4 cGy, and concurrent capecitabine. In 22% a fluoropirimidine and oxaliplatin-based schema was used as induction therapy. Median follow up was 37.5 months and response assessment time 9 weeks (5–19). Eleven patients recurred, 6 endoluminally, 3 developed mesorectal recurrence, and two distant failure. Five years DFS and OS were 76.3% and 93.8%. Conclusions conservative management was feasible with close follow up in leading cancer centres. In this series, DFS and OS were comparable to the data already reported in the literature.

BACKGROUND Treatment of children with medulloblastoma (MB) can lead survivors to lidiate with long term sequelae and affect their quality of life (QoL). This study evaluates QoL in long term MB survivors. DESIGN/ METHODS Clinical files of MB survivors from 1997 to 2016 were retrospectively analyzed. QoL was defined by Schipper Criteria in a five dimensional evaluation: clinical data, physic effects of treatment, academic develop, functional state and self welfare report. RESULTS Clinical data: Twenty eight survivors were identified, mean age at review was 18 years, median follow up was 106 months. Functional state: Last visit Karfnosky/lansky were 90 to 80% in 25% of patients. Physic effects of treatment: Cerebellar Mutism or ataxia were present in 25% of cases. Two patients required external dispositives. Audiometry detected an auditive tonal decrease in 25% of cases. An endocrine disfunction was present in 46% of cases, 32% required hormone replacement and 28% having short size. Renal damage without dialysis was detected in 7% and 10% had a transient tubulopaty. One case had bilateral amaurosis and 14% uses glasses. Three patients had a life partner. One female has offspring and two males had azoospermia. Academic development: While 90% attends to school, 35.7% complained of learning difficulties and 18% needed special education. Self welfare report: Difficulties in social environment were described in 21% and 14% still feeling sick during years. CONCLUSIONS Survivors of MB had adverse physical effects, followed by academic development, functional state and self welfare report and all this has a negative impact in their QoL.

BACKGROUND Rubinstein–Taybi syndrome (RTS) is characterized by multiple congenital anomalies and associated with mutations in CREBBP (70%) and EP300 (5–10%). Previous reports have suggested an increased incidence of benign and possibly also malignant tumors, but the correlation remains unclear. Here we present a case of a patient with RTS and medulloblastoma. CLINICAL CASE: A 5-year-old male presented with increased intracranial pressure. An MRI revealed a 4.2 x 4.7 cm mass in the midline of cerebellum arising from the floor of 4th ventricle. The patient underwent a complete resection and pathology revealed medulloblastoma, classic histology. Staging established no disseminated disease. At diagnosis, a peculiar phenotype consisting in mild mental retardation, microcephaly, down-slanting palpebral fissures, broad nasal bridge, highly arched palate, mild micrognathia, screwdriver incisors and wide thumbs and toes was noted. Clinical genetics evaluation was consistent with RTS. Karyotype was performed and normal. Further genetics testing was not done. Treatment consisted in 8 cycles of chemotherapy and craniospinal radiation (2300 cGy to spine, 5500 cGy Total). At the end of treatment, there was no evidence of disease. He was under surveillance for 33 months free of disease, but relapsed with a supratentorial meningeal disease that ultimately resulted in death. CONCLUSION This report highlights the fact that pediatric medulloblastoma can be associated to RTS, in this case associated to classical histology and recurrent disease.

BACKGROUND Brain tumors are the most common solid tumors in childhood, 35% of them being low-grade gliomas (LGGs). Few data is available regard LGGs in low-and-middle-income countries. This study evaluates LGGs in a tertiary center in Mexico. DESIGN: A retrospective review of clinical files of 105 children diagnosed with LGG other than optic nerve glioma from 2007 to 2019 was done. RESULTS Median age at diagnosis was 7.2 years (from 5 months to 18 years). Male to female ratio was 0.75:1. WHO Grade I represented 68% of the cases. Anatomic sites were: posterior fossa (41%), supratentorial (43.5 %), spinal (8.5%), subependymal (6 %) and pineal (1%). Ten percent of patients had a diagnosed phacomatosis. Treatment was observation without surgery in 3.8%, surgery followed by observation in 49.5%, only chemotherapy in 2.8%, only radiotherapy in 6.7%, and surgery combined with chemotherapy or radiotherapy in 37.2% of cases. Among patients who had surgical intervention, 40% achieved gross total resection, 44% subtotal resection and 16% only biopsy. One or more recurrences were found in 20 % of patients. The 5 and 10-year overall survival (OS) was 83% and 73% respectively. The 5 and 10-year progression-free survival (PFS) was 66 % and 44 % respectively. CONCLUSIONS In this series the OS were lower compared with countries with high income, reflecting the need to improve surgery, since only 40% achieved complete resection that is a determining factor for the prognosis. We observed a decrease in OS until 10-year follow and the PFS was even lower due to recurrence/progression.

BACKGROUND Ependymomas occur in the brain or spinal cord and rarely as an extraspinal variety at the sacrococcygeal region, separated from the spinal cord. This rare presentation is thought to originate from a group of heterotopic ependymal cells called the coccygeal medullary vestige. There are few reports of this occurrence in children. CLINICAL CASE: A 7-year-old male presented with a history of a soft mass arising in the sacrococcygeal area 3 years earlier, diagnosed as pilonidal cyst at primary level and treated with surgery twice, as this mass recurred the boy was sent to our hospital, a 3rd surgery was performed, all tumoral tissue was removed, no attachment with dural space was founded, pathology revealed myxopapilar ependymoma with positivity for PS100, EMA and Vimentin. After surgery a Follow up MRI of cranium and spine showed absence of disease, no radiotherapy neither chemotherapy was implemented. He has been on surveillance from 3 years now without recurrence. CONCLUSION This report highlights the fact that pediatric ependymoma can have an extradural presentation and can be confounded with pilonidal cyst, total resection is needed to control the disease. Potential for recurrence or metastatic disease can continue 20 years from the time of primary tumor, so prolonged surveillance is important.

Research on open innovation has mainly focused on the management of flows of knowledge sources across organizational boundaries and its effect on technological (product and process) innovations. Th...

Tennis is a sport with a very complex technique. Amateur tennis players have trainers and/or coaches, but are not usually accompanied by them to championships. Curiously, in this sport, the result of many matches can be changed by a small hint like `hit the ball a little higher when serving&rsquo, However, the biomechanical of a tennis stroke is only clear to an expert. We, therefore, developed a prototype of a rule-based expert system (RBES) aimed at an amateur competition player that is not accompanied by his/her coach to a championship and is not serving as usual (the RBES is so far restricted to serving). The player has to answer a set of questions about how he/she is serving that day and his/her usual serving technique and the RBES obtains a diagnosis using logic inference about the possible reasons (according of the logic rules that have been previously given to the RBES). A certain knowledge of the tennis terminology and technique is required from the player, but that is something known at this level. The underlying logic is Boolean and the inference engine is algebraic (it uses Groebner bases).

The gingival injures have a multifactorial etiology as hormonal influences, trauma, bacterial plaque, and rests derived from odontogenic epithelium that can cause different developmental or odontogenic anomalies. Objective: To show an unusual case with presence of ectopic glandular tissue in gingiva. Medical description: A 72-year-old woman with a medical history of mastectomy 6 years ago, presents with a swelling above the alveolar ridge at the level of the right lower premolar, translucent, fluctuating, asymptomatic, of 2 months’ duration. Radiography description: Root tip with endodontic treatment; diffuse radiolucent cervical area extending 3 mm on each side. Histopathology description: Cuts of 5 µm, from excisional biopsy, stained with hematoxylin and eosin (H & E) observed in magnitude 10 x and 40 x; a bilayer epithelium, eosinophilic cuboidal cells with a sometimes-ciliated glandular appearance, band of fibrous tissue and chronic inflammatory infiltrate. Other histochemical stains: The Alcian blue–stained epithelial structures with mucinous content, and the periodic acid-Schiff (PAS) was not observed. Conclusion: Ectopic glandular tissue in the gingiva is rare and might be related to glandular odontogenic cyst (found more often intraosseous, this case is in the alveolar ridge) or gingival salivary gland choristoma, a mature tissue in ectopic location. Therefore, pluripotential embryonic epithelial cells can develop into glandular tissue. Collaboration: Pathology Institute Mejia Jimenez (Cali, Colombia).

We communicate the first reported application of video-assisted thoracic surgery for early repair of a postintubation tracheal laceration. The patient was a 60-year-old man. After an initial unsuccessful approach with conservative measures, surgical repair was indicated. The patient underwent 2-port video-assisted thoracic surgery for direct tracheal repair using a 3-0 resorbable monofilament running suture and two reinforcing X-stitches. Bronchoscopic control after 2 and 4 weeks showed complete restoration of the airway, with no complication.

The student of architecture with the basic knowledge of the disciplines of structural engineering can easily understand structural processes more technologically developed. The use of optimization starts from the understanding of how the structure behaves statically and aims to generate physical models that address structural criteria, such as supports and loads, and functional criteria, such as the type of material used, openings and solid areas. By knowing the variables required for optimization, the geometric shape of the structural element tends to change to an organic architecture configuration. Even with optimization processes presenting a lot of mathematical complexity, this paper approaches the essential stages for teaching the structural topological optimization in undergraduate architecture. Also, through examples, propose practical and simplified models that can be easily implemented in the classroom and in the professional life of the architect, conferring excellent results in terms of functionality and structurally efficient. To achieve these results, three software were used in free and educational versions, such as ForcePad, Topostruct and MIDAS NFX . The studies were applied in the structural design of a vertical building, a footbridge, a hammerhead bridge pier and a cantilevered building.

Background: In this paper, we report our experience in the resection and immediate reconstruction of chest wall tumors, using oncoplastic surgery criteria. Methods: This is a prospective study including 27 patients with malignant tumors of the chest wall (primary and metastatic) who underwent oncoplastic surgery with curative intent. Results: In 15 cases, it was a sternal defect and in 12, the ribs were involved. Immediate closure, in collaboration with teams of plastic surgeons, was conducted with different prostheses to provide wall stability and then be able to cover the defect with musculocutaneous flaps at different levels, depending on the need. Conclusions: Extended resection of the chest wall is the best treatment for most tumors affecting this region. Reconstruction with mesh and musculocutaneous flap is an effective technique for repairing such defects, although not without morbidity. J Curr Surg. 2015;5(1):133-136 doi: http://dx.doi.org/10.14740/jcs262w

Device-to-Device (D2D) communications have been already playing a relevant role in 3GPP for several releases of the LTE standard. This paper first shortly introduces how D2D was brought into 3GPP standards and how it evolved, starting from direct discovery and communication between devices being specified in Release 12, through UE-to-Network relaying feature introduction in Release 13, up to vehicle-to-vehicle (V2V) communications support in Release 14. Currently, the versatility of D2D communications has led to consideration of its inherent advantages also in the context of IoT and wearable devices, where the priority is to provide low power connectivity via short-range communications. In this context, there are use cases that can take advantage of UE-relayed communication that capitalizes on the LTE QoS framework. After highlighting the limitations of the currently standardized UE-to-Network relay feature and introducing the enhanced relay architecture being developed in Release 15, the paper discusses the challenges related to end-to-end QoS support in UE-relayed communications, and presents an enhancement to the current standard for dynamic split and allocation of packet delay budget in each hop of the relayed connection. Afterwards, the focus moves to QoS support in mobility scenarios, where path switch between relayed and non-relayed communication might be required while ensuring service continuity, which proves to be a challenging task. Several solutions that trade-off signaling overhead, buffer size requirements and suitability to high-mobility scenarios are presented and explained in detail.

Vascular injuries in the oral cavity cause anesthetic and functional problems, and a high risk of severe hemorrhages in simple surgical treatments; therapy with copper wires and corticosteroids generates local coagulation and fibrosis and are effective for an uncomplicated resection. Through a series of cases, clinical and anatomopathologic characteristics of the combined sclerotherapy effects are described, as an alternative for the treatment of vascular malformations performed on 7 patients, using intralesional corticoid (0.2 mL/cm2) for 2 or 3 weeks, followed by a cerclage with copper wires, for 1 week, until color change from red or purple to lighter color and a fibrous consistency was observed. Continued resection of the lesion occurred in the absence of bleeding. Histologic studies were performed, which revealed neoformation of fibrous tissue, hyalinization of blood vessels, and loss of endothelial continuity. The result was favorable in 100% of the cases.

Neuroendocrine tumors (NET) include a spectrum of malignancies arising from neuroendocrine cells throughout the body. The objective of this clinical investigation of retrospectively and prospectively collected data was to describe the prevalence, demographic data, clinical symptoms and methods of diagnosis of NET and the treatment and long-term follow-up of patients with NET. Data were provided by the participating centers and assessed for consistency by internal reviewers. All the cases were centrally evaluated (when necessary) by the pathologists in our group. The tissue samples were reviewed by hematoxylin and eosin and immunohistochemical staining techniques to confirm the diagnosis of NET. In total, 532 cases were documented: 461 gastroenteropancreatic-NET (GEP-NET) and 71 bronchial NET (BNET). All the tumors were immunohistochemically defined according to the World Health Organization (WHO) and European Neuroendocrine Tumor Society criteria. The most common initial symptoms in GEP-NET were abdominal pain, diarrhea, bowel obstruction, flushing, gastrointestinal bleeding and weight loss. The most common tumor types were carcinoid (58.0%), non-functional pancreatic tumor (23.0%), metastatic NET of unknown primary (16.0%) and functional pancreatic tumor (3.0%). Of the BNET, 89.0% were typical and 11.0% atypical carcinoids. Of the patients with GEP-NET, 59.2% had distant metastasis at diagnosis. The locations of the primary tumors in GEP-NET were the small bowel (26.9%), pancreas (25.2%), colon-rectum (12.4%), appendix (7.6%), stomach (6.9%), esophagus (2.8%), duodenum (2.0%) and unknown primary (16.3%). The histological subtypes based on the WHO classification were well-differentiated NET (20.1%), well-differentiated neuroendocrine carcinomas (66.5%) and poorly differentiated neuroendocrine carcinomas (10.3%). Overall, 67.3% of the patients underwent surgery, 41.2% with curative intent and 26.1% for palliative purposes. The 5-year survival rates were 65.1% (95% confidence interval, 58.0-71.4%) in GEP-NET and 100.0% in typical carcinoid of the lung. This observational, non-interventional, longitudinal study aimed to accumulate relevant information regarding the epidemiology, clinical presentation and current practices in the treatment of NET patients in Argentina, providing insight into regional differences and patterns of care in this heterogeneous disease.

This paper presents the development of capacitance measurement with RF signal (RFCV) for MOSFET. Such technic is fundamental to measure and extract capacitances from nanometric range oxide thickness, which are very leaky in low frequency range measurements. This method uses the control and synchronization of a vector network analyzer (VNA) with a Source Measure Unit (SMU) from a parameter analyzer (PA). The control is established by a remote graphical interface developed in Python. It includes the use of standards like IEEE 488.2, SCPI and Ethernet link protocol. For the RFCV measurements, the SMU provides the DC voltage whereas the VNA the RF signal.

The exponential increase in capacity and data rate demands, along with the diversification of use cases and verticals that are planning to use cellular radio access networks (RANs) to provide connectivity, has prompted the development of the fifth generation (5G) of radio access technology. Traffic steering, which aims at optimum mapping of the data flows to the appropriate RAN access points (APs), is considered to be one of the key enablers for supporting diverse set of requirements ranging from 1000 times higher capacity than 2010 figures to 99.999 % reliability. Furthermore, to constrain power consumption due to the ultra-densification of the network in 5G, enhanced mechanisms are required that can exploit multi-connectivity. In this paper, we build upon the envisioned connectivity provided through multiple radio links and provide schemes to enable dynamic traffic steering and energy-efficient RAN moderation in 5G. First, we present the various protocol options for tight integration of long-term evolution (LTE) and 5G networks. We then investigate how faster traffic steering over the multiple radio links can be enabled, which can both reduce the packet delivery time by increasing the capacity and reliability, and also reduce the power consumption of the network through efficient operation. Detailed performance evaluations done on the various presented mechanisms indicate the technology potential of the proposed enhancements.

Spamming botnets present a critical challenge in the control of spam messages because of the sheer volume and wide spread of the botnet members. In this paper, we advocate the approach for recipient mail servers to filter messages directly delivered from remote end-user EU machines, given that the majority of spamming bots are EU machines. We develop a support vector machine SVM-based classifier to separate EU machines from legitimate mail server LMS machines, using a set of machine features that cannot be easily manipulated by spammers. We investigate the efficacy and performance of the SVM-based classifier using a number of real-world data sets. Our performance studies show that the SVM-based classifier is indeed a feasible and effective approach in distinguishing EU machines from LMS machines. For example, training and testing on an aggregated data set containing both EU machines and LMS machines, on average, we found that the SVM-based classifier can achieve a 99.25% detection accuracy, with very small false positive rate 0.35% and false negative rate 1.27%, significantly outperforming eight Domain Name System-based blacklists widely used today. Copyright © 2012 John Wiley & Sons, Ltd.

Compromised machines are one of the key security threats on the Internet; they are often used to launch various security attacks such as spamming and spreading malware, DDoS, and identity theft. Given that spamming provides a key economic incentive for attackers to recruit the large number of compromised machines, we focus on the detection of the compromised machines in a network that are involved in the spamming activities, commonly known as spam zombies. We develop an effective spam zombie detection system named SPOT by monitoring outgoing messages of a network. SPOT is designed based on a powerful statistical tool called Sequential Probability Ratio Test, which has bounded false positive and false negative error rates. In addition, we also evaluate the performance of the developed SPOT system using a two-month e-mail trace collected in a large US campus network. Our evaluation studies show that SPOT is an effective and efficient system in automatically detecting compromised machines in a network. For example, among the 440 internal IP addresses observed in the e-mail trace, SPOT identifies 132 of them as being associated with compromised machines. Out of the 132 IP addresses identified by SPOT, 126 can be either independently confirmed (110) or highly likely (16) to be compromised. Moreover, only seven internal IP addresses associated with compromised machines in the trace are missed by SPOT. In addition, we also compare the performance of SPOT with two other spam zombie detection algorithms based on the number and percentage of spam messages originated or forwarded by internal machines, respectively, and show that SPOT outperforms these two detection algorithms.

The impact of apathy on health-related quality of life (HRQOL) in recently diagnosed Parkinson's disease (PD) has not been systematically investigated. The objective of this cross-sectional survey (ANIMO study) was to examine the contribution of apathy to HRQOL in a Spanish sample of recently diagnosed PD patients. PD patients, diagnosed within 2 years of inclusion, were recruited at 102 outpatient clinics in 82 communities throughout Spain. Apathy was quantified using the Lille Apathy Rating Scale and HRQOL with the EuroQol-5D questionnaire. A mean EuroQol-5D index score of 0.89 obtained from population references in Spain was used as the cutoff for this study. The relationship between apathy and the dichotomized EuroQol-5D index score (

Vehicles traveling on wet pavements produce splash and spray that reduce driver comfort and safety. The amount of water thrown up by a vehicle's tires depends on many factors such as the type of vehicle and the speed at which it is traveling, the weather conditions, and the pavement surface. Drainage wearing courses and rough macrotexture pavements reduce or completely suppress splash and spray. Nonetheless, the effect of pavement type on splash and spray has yet to be fully elucidated, and there is a need for simple systems that can provide rapid measurements of this phenomenon on real roads. Tests are described with a prototype for a new system consisting of a laser unit and a high-resolution camera that measures splash and shows the effect of pavement surface on the amount of splash produced. Unlike existing systems, which evaluate a single, often nonrepresentative stretch of pavement, the system described can provide continuous measurements over stretches of road. Moreover, the measurement process is sensitive to both water flow and tire speed, and the results analyzed confirm the repeatability of the system and its sensitivity to pavement texture.

e15533Background: In pts. with advanced CRC, KRAS mutations predicts response to treatment with EGFR inhibitor. The Liver metastases selection criteria include anatomic and biological variables. Re...

This paper illustrates and compares the results of the application of two different approaches—non-parametric and artificial neural network techniques—for the rapid cost estimation of turbine components. This technique is a simple and automatic way for the estimation of the cost of a piece with no expert intervention. Three methods of estimation are compared: the projection pursuit method (PPR), the local polynomial approach (LOESS) and adaptive neural networks (ANNs). This comparative analysis serves to enhance current work that seeks to choose the optimum predictor model. The results confirm the validity of the neural network theory in this field of application, but not a clear superiority as compared with the non-parametric approach. The present research provides a new tool to avoid inadequate piece budgeting strategies. The use of these methods contributes to the minimisation of errors in the budgeting of new items.

We calculated ranges for the cost per disability adjusted life year (DALY) averted for cutaneous leishmaniasis (CL) treatment during an ongoing epidemic of CL in Chaparral, Colombia. Using operational clinical and cost data, we calculated that the cost of treating leishmaniasis patients with standard pentavalent antimony was US$345 (95% CI 277-488) per patient treated and cured. The cost per DALY averted per patient cured with antimony was estimated to be approximately US$15 000 (95% CI 12 226-21 532).

Given the large volume of content on the Internet, scalability is one of the critical challenges in the design and development of information-centric network (ICN) architectures. In this paper we develop a scalable name-based inter-domain routing (NIDR) system that can meet the demanding requirement of supporting the large volume of content on the Internet in ICNs. NIDR adopts two critical techniques to improve its scalability. First, NIDR assumes a URL-like hierarchical content naming structure, and routes content-request packets based on only the domain name of content instead of the complete content name. Second, given the large number of domain names on the Internet, only a small subset of Internet domain names are announced at the inter-domain level. Domain names unknown to the NIDR system are first mapped (and routed) to their corresponding attachment point (AP) networks that are in the NIDR system, which is supported by a name resolution service. In addition to presenting the design of the NIDR system, we also evaluate the performance of NIDR and compare it with both BGP and EPIC, an enhancement over BGP. Our simulation studies based on the simBGP simulator show that NIDR can perform comparably with EPIC.

BACKGROUND: Air traffic controllers (ATC) work shifts and their work schedules vary according to the characteristics of each airport. The human body adapts to shiftwork differently. These adjustments affect the health-disease process, predisposing ATC to risk conditions associated with sleep deprivation and lack of night sleep, which can lead to conditions such as cardiovascular diseases, mood disorders, anxiety, and obesity. This study investigated the characteristics of health, sleep, and quality of life of ATC exposed to 8-h alternate work shifts and 6-h rotational work shifts. METHODS: The study was cross-sectional with convenience samples consisting of 84 ATC from two international airports in Brazil. We applied questionnaires to collect data about socioeconomic conditions, quality of life, sleep, and physical activity levels. We also collected health data regarding nutritional status, body composition, and blood pressure. We analyzed the differences between ATC from the two airports considering the variables of sleep, quality of life, and health. RESULTS: Differences were found between the groups in terms of body fat percentage (30.7% and 27.8%), scores of overall quality of life (56.2 and 68), concentration (3.37 and 3.96), energy (3.12 and 3.62), and sleep time on working days (5:20 h and 6:15 h). CONCLUSION: ATC under 8-h alternate shifts showed lower scores for quality of life, higher body fat, and less sleep time on working days, which characterizes inadequate shiftwork for this population. Sonati J, De Martino M, Vilarta R, Maciel E, Moreira E, Sanchez F, De Martino G, Sonati R. Quality of life, health, and sleep of air traffic controllers with different shift systems. Aerosp Med Hum Perform. 2015; 86(10):895-900. Language: en

Introduction: In a Spanish cohort of uncontrolled patients(pts) who initiated omalizumab(OMA) in the clinical practice, symptoms and exacerbations were significantly improved. Here, we describe the concomitant change in asthma-related healthcare resource utilization(HRU) and on absences from work or school. Methods: Analysis of HRU by the Spanish pts of a prospective, 2-years, international registry of subjects with uncontrolled severe allergic asthma who started OMA in the previous 15 weeks. Results: Among 96 subjects with a mean age (SD, range) of 45 (15;16-75) years, 69% females, the percentages of pts without clinically significant exacerbations and no severe exacerbations increased from 9% (mean 3.7/pt) and 45%, respectively, in the pre-OMA year, up to 65% (mean 1.0/pt) and 84% during the 1st year with OMA (p

Network-facilitated device to device (D2D) communication is expected to play a central role in 5th generation cellular systems, as this allows to substantially reduce the end-to-end latency in mission-critical communication use cases, but also to obtain network and spectral efficiency improvements through the exploitation of proximity gains, hop gains and reuse gains in mobile broadband scenarios. The likely complement of evolved legacy standards with non-backward compatible radio interfaces in the 5G context will allow to design radio technology that natively and efficiently supports D2D from the very beginning. However, there are various fundamental design questions to be answered, focusing in this work on the question of how mode selection between D2D and device-infrastructure-device communication should ideally be conducted, as this will have a major impact on protocol stack design. We compare a fast, instantaneous SINR based mode selection (likely implemented on MAC level) against a typically assumed path-loss based slow mode selection (PDCP or RRC level). Through extensive simulation studies, it is shown that fast mode selection does allow to improve D2D performance without impairing cellular performance, but likely requires highly coordinated RRM, and it is thus needed to carefully consider whether the depicted gains would justify the likely more complicated and overhead-prone implementation of mode selection on MAC level.

This paper presents a new delivery model for IP communication services based on using lightweight Customer Premises Equipment (CPE) that is remotely controlled by virtualized software images running on a provider cloud.