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Background Sarcopenia is defined as either low pre-operative muscle mass or low muscle density on abdominal CT imaging. It has been associated with worse short-term outcomes after surgery for colorectal liver metastases. This study aimed to evaluate whether sarcopenia also impacts long-term survival outcomes in these patients. Methods A random-effects meta-analysis was conducted following the PRISMA guidelines. Overall survival (OS) and disease-free survival (DFS) outcomes were evaluated. Results Eleven studies were included, ten reporting on the impact of low muscle mass and four on low muscle density. Sample sizes ranged between 47 and 539 (2124 patients in total). Altogether, 897 (42%) patients were considered sarcopenic, although definitions varied between studies. Median follow-up was 21–74 months. Low muscle mass (hazard ration (HR) 1.35, 95%CI 1.08–1.68) and low muscle density (HR 1.97, 95%CI 1.07–3.62) were associated with impaired OS. Low muscle mass (pooled HR 1.17, 95%CI 0.94–1.46) and low muscle density (pooled HR 1.13, 95%CI 0.85–1.50) were not associated with impaired RFS. Discussion Sarcopenia is associated with poorer OS, but not RFS, in patients with CRLM. Additional studies with standardized sarcopenia definitions are needed to better assess the impact of sarcopenia in patients with CRLM.

Modern communication networks can be flexibly shaped and controlled using Software Defined Networking (SDN) paradigm. However, besides unprecedented functional benefits, this solution exploits an architectural single point of failure. Securing the communication among SDN functional element is therefore a critical requirement for improving the network reliability. A novel approach to secure communications is provided by Quantum Key Distribution (QKD) that is a physical layer technology capable to securely deliver symmetric encryption keys leveraging on quantum physic properties. Our research demonstrates how to provide unconditionally secure communication at SDN level dramatically improving the reliability of the communication network itself.

Breast cancer screening has been shown to reduce breast cancer-associated mortality. However, screening is limited to the targeted age group of 45 to 69 years in New Zealand despite the recognized increased risk with age. This study aims to compare the outcomes of women aged over 70 years with screen-detected and clinically detected cancers.A retrospective review was performed of prospectively collected data from June 2000 to May 2013 by the Auckland Breast Cancer Register. Demographic and tumor characteristics of women with invasive cancer and ductal carcinoma in situ diagnosis aged 70 years and over were compared between those screened and clinically detected. Five-year disease-free and overall survival outcomes were reviewed.A total of 2128 women aged 70 years and over were diagnosed with breast cancer (median, 77 years; interquartile range [IQR], 74-84 years). Of these, 416 (19.5%) were diagnosed through mammography screening, with a median age of 74 years (IQR, 71-77 years) compared with 79 years (IQR, 74-85 years) for those with clinical detected cancer diagnosis. Screen-detected cancers accounted for a significantly higher proportion of diagnoses in those aged 70 to 74 years compared with older patients (P .001). Screen-detected cancers were of lower T and N stages. Disease-specific survival was significantly longer in screen-detected cancers versus other cancers (5-year survival, 93.7% vs. 81.9%; P .001), as was overall survival (5-year survival, 84.7% vs. 57.4%; P .001).Screening in those aged 70 years and over continues to identify breast cancer at early stages and with improved survival. Although aware of the potential for lead-time bias and the healthy volunteer effect, there should still be consideration to extend breast cancer screening to patients aged to up 74 years after appropriate assessment of comorbidities and functional status.

Pain is a symptom of many disorders associated with actual or potential tissue damage in human body. Managing pain is not only a duty but also highly cost prone. The most primitive state of pain management is the assessment of pain. Traditionally it was accomplished by self-report or visual inspection by experts. However, automatic pain assessment systems from facial videos are also rapidly evolving due to the need of managing pain in a robust and cost effective way. Among different challenges of automatic pain assessment from facial video data two issues are increasingly prevalent: first, exploiting both spatial and temporal information of the face to assess pain level, and second, incorporating multiple visual modalities to capture complementary face information related to pain. Most works in the literature focus on merely exploiting spatial information on chromatic (RGB) video data on shallow learning scenarios. However, employing deep learning techniques for spatio-temporal analysis considering Depth (D) and Thermal (T) along with RGB has high potential in this area. In this paper, we present the first state-of-the-art publicly available database, 'Multimodal Intensity Pain (MIntPAIN)' database, for RGBDT pain level recognition in sequences. We provide a first baseline results including 5 pain levels recognition by analyzing independent visual modalities and their fusion with CNN and LSTM models. From the experimental evaluation we observe that fusion of modalities helps to enhance recognition performance of pain levels in comparison to isolated ones. In particular, the combination of RGB, D, and T in an early fusion fashion achieved the best recognition rate.

Although calcium (Ca) precipitation may play a pathogenic role in atherosclerosis, information on temporal patterns of microcalcifications in human coronary arteries, their relation to expression of calcification-regulating proteins, and colocalization with iron (Fe) and zinc (Zn) is scarce. Human coronary arteries were analyzed post mortem with a proton microprobe for element concentrations and stained (immuno)histochemically for morphological and calcification-regulating proteins. Microcalcifications were occasionally observed in preatheroma type I atherosclerotic intimal lesions. Their abundance increased in type II, III, and IV lesions. Moreover, their appearance preceded increased expression of calcification-regulating proteins, such as osteocalcin and bone morphogenetic protein-2. In contrast, their presence coincided with increased expression of uncarboxylated matrix Gla protein (MGP), whereas the content of carboxylated MGP was increased in type DI and IV lesions, indicating delayed posttranslational conversion of biologically inactive into active MGP. Ca/phosphorus ratios of the microcalcifications varied from 1.6 to 3.0, including amorphous Ca phosphates. Approximately 75% of microcalcifications colocalized with the accumulation of Fe and Zn. We conclude that Ca microprecipitation occurs in the early stages of atherosclerosis, inferring a pathogenic role in the sequel of events, resulting in overt atherosclerotic lesions. Microcalcifications may be caused by local events triggering the precipitation of Ca rather than by increased expression of calcification-regulating proteins. The high degree of colocalization with Fe and Zn suggests a mutual relationship between these trace elements and early deposition of Ca salts. (Ant J Pathol 2011, 178:2879-2887; DOI: 10.1016/j.ajpath.2011.02.004)

BackgroundVascular calcification is associated with poor cardiovascular outcome. Histochemical analysis of calcification and the expression of proteins involved in mineralization are usually based on whole section analysis, thereby often ignoring regional differences in atherosclerotic lesions. At present, limited information is available about factors involved in the initiation and progression of atherosclerosis.Aim of This StudyThis study investigates the intra-section association of micro-calcifications with markers for atherosclerosis in randomly chosen section areas of human coronary arteries. Moreover, the possible causal relationship between calcifying vascular smooth muscle cells and inflammation was explored in vitro.Technical ApproachTo gain insights into the pathogenesis of atherosclerosis, we performed analysis of the distribution of micro-calcifications using a 3-MeV proton microbeam. Additionally, we performed systematic analyses of 30 to 40 regions of 12 coronary sections obtained from 6 patients including histology and immuno-histochemistry. Section areas were classified according to CD68 positivity. In vitro experiments using human vascular smooth muscle cells (hVSMCs) were performed to evaluate causal relationships between calcification and inflammation.ResultsFrom each section multiple areas were randomly chosen and subsequently analyzed. Depositions of calcium crystals at the micrometer scale were already observed in areas with early pre-atheroma type I lesions. Micro-calcifications were initiated at the elastica interna concomitantly with upregulation of the uncarboxylated form of matrix Gla-protein (ucMGP). Both the amount of calcium crystals and ucMGP staining increased from type I to IV atherosclerotic lesions. Osteochondrogenic markers BMP-2 and osteocalcin were only significantly increased in type IV atheroma lesions, and at this stage correlated with the degree of calcification. From atheroma area type III onwards a considerable number of CD68 positive cells were observed in combination with calcification, suggesting a pro-inflammatory effect of micro-calcifications. In vitro, invasion assays revealed chemoattractant properties of cell-culture medium of calcifying vascular smooth muscle cells towards THP-1 cells, which implies pro-inflammatory effect of calcium deposits. Additionally, calcifying hVSMCs revealed a pro-inflammatory profile as compared to non-calcifying hVSMCs.ConclusionOur data indicate that calcification of VSMCs is one of the earliest events in the genesis of atherosclerosis, which strongly correlates with ucMGP staining. Our findings suggest that loss of calcification inhibitors and/or failure of inhibitory capacity is causative for the early precipitation of calcium, with concomitant increased inflammation followed by osteochondrogenic transdifferentiation of VSMCs.

Nonuniform seismic motion affects the seismic behavior of long-span bridges. Three main reasons for this nonuniformity have been identified. They are local soil conditions, wave passage, and incoherency effects. Other effects, such as extended source and attenuation, are relatively small. The importance of nonuniform seismic motions, especially for sensitive and important structures, has led to the development of several methods of analysis. These methods can be subdivided into two general categories, deterministic and stochastic. Because of the inherent uncertainty of the nonuniform seismic motions, deterministic methods, mainly time integration methods, can be computationally inefficient. Stochastic methods have been based mainly on modal analysis methods. The input/output are described in terms of either power spectral density or response spectra. This paper presents a direct frequency-domain method that is based on formulating the whole soil-structure problem. The use of this direct frequency-domain m...

Sensors based on organic electronic devices are emerging in a wide range of application areas. Here we present a sensor platform using organic light emitting diodes (OLED) and organic photodiodes (OPD) as active components. By means of lamination and interconnection technology the functional foils with OLED and OPD arrays form an in-plane optical sensor platform (IPOS). This platform can be extended with a wireless data and signal processing unit yielding a sensor node. The focus of our research is to engage the node in a healthcare application, in which a bandage is able to monitor the vital signs of a person, a so-called Smart Bandage. One of the principles that is described here is based on measuring the absorption modulation of blood volume induced by the pulse (photoplethysmography). The information from such a bandage could be used to monitor wound healing by measuring the perfusion in the skin. The OLED and OPD devices are manufactured on separate foils and glass substrates by means of printing and coating technologies. Furthermore, the modular approach allows for the application of the optical sensing unit in a variety of other fields including chemical sensing. This, ultimately enables the measurement of a large variety of physiological parameters using the same bandage and the same basic sensor architecture. Here we discuss the build-up of our device in general terms. Specific characteristics of the used OLEDs and OPDs are shown and finally we demonstrate the functionality by simultaneously recorded photoplethysmograms of our device and a clinical pulseoximeter.

The current paradigm reads that calcifications characterize the advanced and complex lesions in the atherosclerotic process. To explore the possibility that coronary artery wall calcifications already commence at an early stage of atherosclerosis, a combination of proton beam techniques with a (sub-) micrometer resolution, i.e., micro-proton induced X-ray emission, backward and forward scattering spectroscopy, was applied on human coronary arteries with lesions preceding overt atheromas. The detection limits of phosphorus and calcium in each separate pixel, 0.88*0.88 microm2 in size, were approximately 150 and 80 microg/g dry weight, respectively. Calcium distributions of entire coronary artery cross section were obtained, and calcifications were demonstrated at a preatheroma stage of the atherosclerotic process. The size of the microcalcifications varied between 1 and 10 microm. The composition of the microcalcifications was deduced from the calcium-to-phosphorus ratio. In order to quantify this ratio, the thickness of the specific X-ray absorber used for PIXE had to be accurately determined. Also, thick target PIXE calculations were performed and the method was validated. The calcium-to-phosphorus ratios of the microcalcifications were assessed with good accuracy and varied from 1.62 to 2.79, which corresponds with amorphous calcium phosphate.

Monitoring of personal wellbeing and optimizing human performance are areas where sensors have only begun to be used. One of the reasons for this is the specific demands that these application areas put on the underlying technology and system properties. In many cases these sensors will be integrated in clothing, be worn on the skin, or may even be placed inside the body. This implies that flexibility and wearability of the systems is essential for their success. Devices based on polymer semiconductors allow for these demands since they can be fabricated with thin film technology. The use of thin film device technology allows for the fabrication of very thin sensors (e.g. integrated in food product packaging), flexible or bendable sensors in wearables, large area/distributed sensors, and intrinsically low-cost applications in disposable products. With thin film device technology a high level of integration can be achieved with parts that analyze signals, process and store data, and interact over a network. Integration of all these functions will inherently lead to better cost/performance ratios, especially if printing and other standard polymer technology such as high precision moulding is applied for the fabrication. In this paper we present an optical transmission sensor array based on polymer semiconductor devices made by thin film technology. The organic devices, light emitting diodes, photodiodes and selective medium chip, are integrated with classic electronic components. Together they form a versatile sensor platform that allows for the quantitative measurement of 100 channels and communicates wireless with a computer. The emphasis is given to the sensor principle, the design, fabrication technology and integration of the thin film devices.

The introduction in the market of ubiquitous sensing applications relies heavily on the availability of affordable sensors. Key in the cost of a sensor is its modus of manufacture. In this paper a sensing scheme is presented, in which the signal transduction is based on an induced change in the optical path between an organic light emitting diode (OLED) and an organic photovoltaic (OPV) array. Using this platform, several aspects of cost efficient manufacturing technology are investigated. These aspects include the intrinsic printability of the active (OLED, responsive coating and OPV) components, which allows control of the local sensor functionality and sensitivity. It offers a large amount of freedom in sensor layout, while using relatively few process steps. Also investigated is the ability to realize the active devices on foil, which enables high throughput processing (e.g. in a reel-to-reel scheme). Moreover, the presented generic sensing scheme is of a modular design. It allows easy switching of the sensor functionality mostly by simply changing the transduction module. Since this does not affect the production parameters of the other components, these may be standardized, thus invoking favorable economies of scale.

Introduction To assess an optimized 3D imaging protocol for intracranial nitinol stents in 3D C-arm flat detector imaging. For this purpose, an image quality simulation and an in vitro study was carried out. Methods Nitinol stents of various brands were placed inside an anthropomorphic head phantom, using iodine contrast. Experiments with objects were preceded by image quality and dose simulations. We varied X-ray imaging parameters in a commercially interventional X-ray system to set 3D image quality in the contrast–noise–sharpness space. Beam quality was varied to evaluate contrast of the stents while keeping absorbed dose below recommended values. Two detector formats were used, paired with an appropriate pixel size and X-ray focus size. Zoomed reconstructions were carried out and snapshot images acquired. High contrast spatial resolution was assessed with a CT phantom. Results We found an optimal protocol for imaging intracranial nitinol stents. Contrast resolution was optimized for nickel–titanium-containing stents. A high spatial resolution larger than 2.1 lp/mm allows struts to be visualized. We obtained images of stents of various brands and a representative set of images is shown. Independent of the make, struts can be imaged with virtually continuous strokes. Measured absorbed doses are shown to be lower than 50 mGy Computed Tomography Dose Index (CTDI). Conclusion By balancing the modulation transfer of the imaging components and tuning the high-contrast imaging capabilities, we have shown that thin nitinol stent wires can be reconstructed with high contrast-to-noise ratio and good detail, while keeping radiation doses within recommended values. Experimental results compare well with imaging simulations.