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PURPOSE: To describe a case of light adjustable lens implantation after radial keratotomy. METHODS: A patient with a 30-year history of radial keratotomy subsequently underwent phacoemulsification with implantation of intraocular light adjustable lenses. Serial refractions were performed at varying hours of the day postoperatively and were repeated for 3 months. The light adjustable lenses were adjusted twice, and the refractive power of the implant was eventually locked. RESULTS: The patient was able to achieve uncorrected distance visual acuity of 20/25 in both eyes, improving from 20/125 in the right eye and 20/80 in the left eye, with no surgical complications. CONCLUSIONS: The authors report the first case of light adjustable lens implantation after radial keratotomy, which has yielded promising results for mitigating intraocular lens miscalculations after radial keratotomy. [ J Refract Surg . 2020;36(12):852–854.]

Background: Adjuvant therapy with AI improve survival and is recommended to all postmenopausal women with hormone receptor-positive BC. A typical duration of the therapy is from 5 to 10 years. Despite clinically proven efficacy early discontinuation rate approaching 10% per year. The purpose of this study was to determine the adherence level through the Morisky Medication Adherence Scale (MMAS-8) among women with breast cancer treated at Texas Tech University Health Sciences Center El Paso (TTUHSC EP). Methods: Institutional review board approval was obtained prior to initiating this prospective study. 133 postmenopausal women were consented and participated in this study. Patients seen at the TTUHSC EP who was diagnosed with stage I-III breast cancer and who were on adjuvant AIs, were given the MMAS-8 questionnaire, and a demographics questionnaire. In order to identify reasons for non-adherence to AIs, all patients were also asked to identify the reason why they did not take their medication if applicable.Results: One hundred thirty-three patients were enrolled, median age 64 (range 41 - 89), 110 (90.2%) identified themselves as Hispanic/Latino. 58.2% have an income of 15K or less. 39% completed eighth grade or less, 34.5% completed high school, and 12% obtained a technical degree. Mean duration of AI therapy was 6.5 years. The majority of patients have high or intermediate levels of adherence 88%. Only 12 % had a low level of adherence. 7 (5.6%) patients scored two or below in the intentional adherence scale, and 18 (13.5%) scored two or below in the unintentional adherence scale (maximum scale is four). Conclusions: Our results indicate that the majority of patients treated at TTUHSC EP have a high or intermediate level of adherence to AI therapy. The main reason listed for non-adherence were mostly unintentional: forgetfulness and missing getting refills on time. Citation Format: Alexander Philipovskiy, Aleli Campbell, Brenda Castillo, Rosalinda Heydarian, Sumit Gaur, Alok Dwivedi, Zeina Nahleh. Prospective evaluation of adherence to adjuvant aromatase inhibitor (AI) therapy among Hispanic/Latino women with breast cancer (BC) living in the border city of El Paso, Texas [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-12-12.

Introduction Pronator syndrome has classically required open surgery that leaves a large scar; initial endoscopic techniques required approaches of an average 4 cm without achieving release of all structures. The purpose of this study was to describe a new endoscopic approach that allows the median nerve to be safely and completely decompressed, leaving a smaller and less visible scar. Methods Description of a new approach for decompression of the median nerve in the proximal third of the forearm with minimal incision and endoscopic technique in cryopreserved cadaveric specimens, describing incision, endoscopic anatomy, safe corridors and decompression sites. Results In 20 elbows of cadavers, an endoscopic approach of the median nerve in the proximal forearm with a 4 mm endoscope and 0° of angulation was performed. The advantages and limitations of the technique and surgical details are presented for release in the most common compression points of the nerve in the forearm. We performed this technique in 3 patients with good results without complications. Discussion Release of the median nerve and section of potential aponeurotic compression structures by endoscopy is possible. The ulnar head of the pronator and the aponeurotic arch of the flexor digitorum superficialis are frequently implicated in the syndrome. The scar is aesthetically good. It is a relatively new technique, with lower morbidity that allows faster recovery of patients. Conclusions It is possible to perform a complete decompression of the median nerve in the forearm using an endoscopic approach, safely with lower comorbidity for the patient.

Background: Estimates of the burden of cardio-metabolic risk factors in Latin America and the Caribbean (LAC) rely on relative risks (RRs) from non-LAC countries. Whether these RRs apply to LAC remains unknown. Methods: We pooled LAC cohorts. We estimated RRs per unit of exposure to body mass index (BMI), systolic blood pressure (SBP), fasting plasma glucose (FPG), total cholesterol (TC) and non-HDL cholesterol on fatal (31 cohorts, n=168,287) and non-fatal (13 cohorts, n=27,554) cardiovascular diseases, adjusting for regression dilution bias. We used these RRs and national data on mean risk factor levels to estimate the number of cardiovascular deaths attributable to non-optimal levels of each risk factor. Results: Our RRs for SBP, FPG and TC were like those observed in cohorts conducted in high-income countries; however, for BMI, our RRs were consistently smaller in people below 75 years of age. Across risk factors, we observed smaller RRs among older ages. Non-optimal SBP was responsible for the largest number of attributable cardiovascular deaths ranging from 38 per 100,000 women and 54 men in Peru, to 261 (Dominica, women) and 282 (Guyana, men). For non-HDL cholesterol, the lowest attributable rate was for women in Peru (21) and men in Guatemala (25), and the largest in men (158) and women (142) from Guyana. Interpretation: RRs for BMI from studies conducted in high-income countries may overestimate disease burden metrics in LAC; conversely, RRs for SBP, FPG and TC from LAC cohorts are similar to those estimated from cohorts in high-income countries. Funding: Wellcome Trust (214185/Z/18/Z)

As the south-westernmost region of Europe, the Iberian Peninsula stands as a key area for understanding the process of modern human dispersal into Eurasia. However, the precise timing, ecological setting and cultural context of this process remains controversial concerning its spatiotemporal distribution within the different regions of the peninsula. While traditional models assumed that the whole Iberian hinterland was avoided by modern humans due to ecological factors until the retreat of the Last Glacial Maximum, recent research has demonstrated that hunter-gatherers entered the Iberian interior at least during Solutrean times. We provide a multi-proxy geoarchaeological, chronometric and paleoecological study on human–environment interactions based on the key site of Peña Capón (Guadalajara, Spain). Results show (1) that this site hosts the oldest modern human presence recorded to date in central Iberia, associated to pre-Solutrean cultural traditions around 26,000 years ago, and (2) that this presence occurred during Heinrich Stadial 2 within harsh environmental conditions. These findings demonstrate that this area of the Iberian hinterland was recurrently occupied regardless of climate and environmental variability, thus challenging the widely accepted hypothesis that ecological risk hampered the human settlement of the Iberian interior highlands since the first arrival of modern humans to Southwest Europe., This research was carried out in the context of the ERC MULTIPALEOIBERIA project, funded by the European Research Council (ERC-2018-STG-805478), and the PALEOINTERIOR project, funded by the Spanish Ministry of Science and Innovation (HAR2017-82483-C3-3-P). The sedimentological, micromorphological and part of the radiocarbon analyses were funded by subproject C1 of the CRC 806 “Our way to Europe” (DFG, German Research Foundation) and the Marie Curie Intra European Fellowship project ‘Hiatus LPleis Iberia’ (FP7-2013-IEF-628179). We gratefully acknowledge contributions made by the wide excavation and laboratory team. Fieldworks at Peña Capón were authorized by the Dirección General de Cultura de la Junta de Comunidades de Castilla–La Mancha (Spain) (Exp. 14.0955-P4 and Exp.: 19.248) with permission from the Confederación Hidrográfica del Tajo

This chapter presents a teaching experience in which a virtual immersive conference was created to hold participative meetings between senior researchers and young scientists on soil sciences. Our aim was to provide PhD students with the opportunity to attend and present their work to experts at an international conference such as the European Geosciences Union Assembly, whose main purpose is to transfer this scientific and educative experience to other fields. An overview of the experiences along the last three editions of the conference (2015–2017) is provided. The main points of concern were technical. In particular, it was essential that the server at the conference site have the capacity to provide a reliable Internet connection for the number of participants attending. Regarding the strengths, the young scientists greatly appreciated the sense of immersion and the fun atmosphere, which encouraged them to interact, voice their opinions freely and use a foreign language. Unlike conventional presentations, the more informal format of these innovative meetings clearly increased interaction among participants, which was well valued by the young scientists.

This is the case of a 58 year-old man with a painful tumour in his right ankle, resulting from a long development. An osteolytic injury was found in an X-ray, formed by bone or osteoid trabeculae surrounded by epithelioid osteoblasts and amongst these cells there were osteoclast-type multinucleated cells. The histogenesis of the tumour, the differential diagnosis and the treatment modalities are reported. Resumen: Se presenta el caso de un hombre de 58 años de edad con un tumor doloroso en el tobillo derecho, de larga evolución. Radiológicamente se encontró una lesión osteolítica, con un anillo de esclerosis en el astrágalo. Histológicamente el tumor, está formado por trabéculas de hueso u osteoide rodeadas de osteoblastos epitelioides y entre estas células hay células multinucleadas tipo osteoclasto. Se comenta la histogénesis del tumor, el diagnóstico diferencial y las modalidades de tratamiento. Keywords: Osteoblastoma, Aggressive osteoblastoma, Epithelioid osteoblastoma, Palabras clave: Osteoblastoma, Osteoblastoma agresivo, Osteoblastoma epitelioides

Background: The SARS CoV 2 coronavirus pandemic has rocked health care systems to the core. Concurrent circulation of COVID 19 has led to service disruptions and delays in the standard procedures related to lung cancer (LC) diagnose and may negatively impact in the management, care and therapeutic patient intervention. We aimed to determine COVID 19 impact in the molecular diagnosis of LC at our institution. Methods: A total of 203 patients (pts) diagnosed with advanced NSCLC with molecular testing requested in the period of 2019–2020 were included. Clinical characteristics and testing patient results evaluated in 2019 and 2020 were compared. The SOC at our institution includes evaluation of DNA and RNA from tissue(t) and/or blood(b) with NGS or nCounter. Single-gene testing by PCR, IHC and/or FISH is used as complementary assays to NGS when tissue is limited or in case of genomic platform service interruptions. Results: A total of 106 and 97 pts were required for molecular testing during 2019 and 2020 respectively. Clinical patient characteristics in both cohorts were very similar and there were no significant differences in the number of DNA-based or RNA-based analyses required between both period times (DNAt p = 0.25;DNAb p = 0.59;RNAt p =.08). The 2019 cohort identified 66 pts (65%) with driver genes: being KRAS the most commonly detected (34%), followed by EGFR 15%, BRAF 4%, ALK 4% and METΔ14 4%. During 2020, driver alterations were found in 56 pts (60%) in a quite similar proportion except for KRAS mutations, 21%. The total number of non evaluable (NE) samples was significantly increased in 2020 compared to 2019 (p =.029). During 2019, 80% of the NE samples could be evaluated by any multiplex technique. On the contrary, during 2020 only 54% of NE were tested by any NGS-based method. Conclusions: Our results show that molecular diagnosis of LC could be preserved during the COVID 19 outbreak. However genomic service disruptions during critical months of the pandemic clearly impacted in the number of pts with a NE result and might explain the differences in the incidence of KRAS mutations observed. While this global crisis rightly demands the world's attention, a continuous and accurate molecular diagnostic testing must be ensured to guarantee quality-care for LC pts. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: C. Teixido: Honoraria (self), Personal fees: Pfizer;Honoraria (self), Personal fees: Novartis;Honoraria (self), Personal fees: Takeda;Honoraria (self), Personal fees: MSD;Honoraria (self), Personal fees: Roche;Honoraria (self), Personal fees: Diaceutics;Honoraria (self), Personal fees: AstraZeneca;Research grant/Funding (self), Research funding: Pfizer;Research grant/Funding (self), Research funding: Novartis. R. Reyes: Honoraria (self), Speaker Honoraria: Roche;Honoraria (self), Speaker Honoraria: MSD. L. Mezquita: Honoraria (self), Speaker Honoraria: Bristol-Myers Squibb;Honoraria (self), Speaker Honoraria: Tecnofarma;Honoraria (self), Speaker Honoraria: Roche;Honoraria (self), Speaker Honoraria: Takeda;Advisory/Consultancy: Roche Diagnostics;Advisory/Consultancy: Takeda;Advisory/Consultancy: Roche;Travel/Accommodation/Expenses: Bristol-Myers Squibb;Travel/Accommodation/Expenses: Roche;Research grant/Funding (self): Amgen;Research grant/Funding (self): Bristol-Myers Squibb;Research grant/Funding (self): Boehringer Ingelheim;Speaker Bureau/Expert testimony, Mentorship program with key opinion leaders: AstraZeneca. N. Reguart: Honoraria (self), Speaker Honoraria: MSD;Honoraria (self), Speaker Honoraria: BMS;Honoraria (self), Speaker Honoraria: Roche;Honoraria (self), Speaker Honoraria: Boehringer Ingelheim;Honoraria (self), Speaker Honoraria: Guardant Health;Honoraria (self), Speaker Honoraria: Pfizer;Honoraria (self), Speaker Honoraria: AbbVie;Honoraria (self), Speaker Honoraria: Ipsen;Honoraria (self), Speaker Honoraria: Novartis;Honoraria (self), Speaker Honoraria: AstraZeneca;Honoraria (self), Speaker onoraria: Lilly;Honoraria (self), Speaker Honoraria: Takeda;Honoraria (self), Speaker Honoraria: Amgen;Honoraria (self), Organization of educational events: Amgen;Honoraria (self), Organization of educational events: Roche;Advisory/Consultancy: MSD;Advisory/Consultancy: BMS;Advisory/Consultancy: Roche;Advisory/Consultancy: Boehringer Ingelheim;Advisory/Consultancy: Guardant Health;Advisory/Consultancy: Pfizer;Advisory/Consultancy: AbbVie;Advisory/Consultancy: Ipsen;Advisory/Consultancy: Novartis;Advisory/Consultancy: AstraZeneca;Advisory/Consultancy: Lilly;Advisory/Consultancy: Takeda;Advisory/Consultancy: Amgen;Travel/Accommodation/Expenses: Boehringer Ingelheim;Travel/Accommodation/Expenses: MSD;Travel/Accommodation/Expenses: Roche;Research grant/Funding (self): Novartis;Research grant/Funding (self): Pfizer. All other authors have declared no conflicts of interest.

This study sets out to increase the overall efficiency of equipment in the automotive battery assembly line by reducing the number of non-compliant products. To this end, the root cause analysis was performed, and it determined that disconformities are caused by the lack of standardization of processes, paucity of working methods, and inadequate maintenance plans. The proposal of this study involves the use of total productive maintenance (TPM) tools as the modal analysis of failures and effects, self-maintenance, and planned maintenance based on reliability-centric maintenance (RCM). The joint use of these tools leads to an increase in the quality of automotive batteries. The application of TPM and RCM is subject to internal and external factors affecting a company. The proposed methodology can be applied to small and medium-sized manufacturing industries with different production lines. As a result of its application, the number of non-compliant batteries was reduced by 30%, machine efficiency increased by 3.00%, and the mean time between failures was reduced by 19.96%.

This study investigated adaptive decision making styles (DMSs; Rational and Intuitive) among working and non-working students. These cognitive styles involve approaching tasks objectively, analytically, thoroughly and unemotionally. Workers performing tasks in organizations are expected to use intuition and make rational business decisions compared to non-workers. Work personality, which is influenced by both home and school environments, has been identified to influence critical adult work behaviors such as task completion as well as how we engage with others in work settings. Increasingly, college aged students are working full or part-time and have to combine their studies with work demands in addition to other responsibilities at home. Prior studies have found no significant differences between working and non-working students on outcomes such as academics and social experiences. However, working students seem to transfer and optimize their decision making competencies to be successful on the job and in college compared to non-working students. We predicted that task oriented working students would use more adaptive decision making styles than non-workers after controlling for gender and age. A total of 130 respondents participated in this study and the results partially supported our assertion. Task oriented working students were significantly different than non-working students in the use of the rational decision making style than any other DMS. Our results were consistent with previous studies on adaptive decision making styles.

In the early decades of the twentieth century a metrical romance on the life of Juan Tamad, recounting the Westernized narrative of the adventures of the Tagalog numskull hero, Juan Tamad, was printed in Manila. This article links the text’s literary history to the discursive regimes of the Spanish and American colonial orders, and treats it as a heteroglossic text that carries the impulses of both clerical and secular didacticism and of radical anticolonial politics. Juan Tamad has since been the embodiment of the Filipino critical imagination in cultural permutations across Philippine history, such as the cinema of Manuel Conde (1947–1963). Keywords: colonialism • metrical romance • indolence • trickster hero • heteroglossia

Advancements in technology have allowed for more efficient methods of testing and assessment. In particular, remotely delivered assessments can be taken on mobile or nonmobile devices in addition to traditional pencil and paper tests. This has led to an increased interest in the comparability of mobile and nonmobile devices on performance outcomes. A variable to consider in performance outcomes on a mobile or nonmobile device is proctoring. There is evidence for both proctored and unproctored conditions leading to better performance outcomes. The present study compared performance on a remotely delivered assessment across mobile and nonmobile devices in proctored and unproctored conditions. Participants were randomly assigned to take a remotely delivered cognitive ability test on either a mobile or nonmobile device in a proctored or unproctored condition. Results indicated that participants tended to perform similarly regardless of the device type or proctoring. Implications are that organizations should consider testing job applicants via mobile devices because performance on a high stakes assessment tends to be similar to testing on a traditional desktop or laptop. Further validation of these results could allow companies to reduce hiring costs by remotely delivering assessments to applicants’ own devices.

Silvopasture is a type of agroforestry that could deliver ecosystem services and support local livelihoods by integrating trees into pasture-based livestock systems. This study modeled the financial returns from silvopastures, planted forests, and conventional cattle-pasture systems in Amazonas, Peru using capital budgeting techniques. Forests had a lower land expectation value (USD 845 per hectare) than conventional cattle systems (USD 1275 per hectare) at a 4% discount rate. &ldquo, Typical&rdquo, model silvopastures, based on prior landowner surveys in the Amazonas region, were most competitive at low discount rates. The four actual silvopastoral systems we visited and examined had higher returns (4%: USD 1588 to USD 9524 per hectare) than either alternative pure crop or tree system, more than likely through strategies for generating value-added such as on-site retail stands. Silvopasture also offers animal health and environmental benefits, and could receive governmental or market payments to encourage these practices.

Why was the cohort set up? Latin America and the Caribbean (LAC) are characterized by much diversity in terms of socio-economic status, ecology, environment, access to health care,1,2 as well as the frequency of risk factors for and prevalence or incidence of non-communicable diseases;3–7 importantly, these differences are observed both between and within countries in LAC.8,9 LAC countries share a large burden of non-communicable (e.g. diabetes and hypertension) and cardiovascular (e.g. ischaemic heart disease) diseases, with these conditions standing as the leading causes of morbidity, disability and mortality in most of LAC.10–12 These epidemiological estimates—e.g. morbidity—cannot inform about risk factors or risk prediction, which are relevant to identify prevention avenues. Cohort studies, on the other hand, could provide this evidence. Pooled analysis, using data from multiple cohort studies, have additional strengths such as increased statistical power and decreased statistical uncertainty.13 LAC cohort studies have been under-represented,14 or not included at all,15–17 in international efforts aimed at pooling data from multiple cohort studies. We therefore set out to pool data from LAC cohorts to address research questions that individual cohort studies would not be able to answer. Drawing from previous successful regional enterprises (e.g. Asia Pacific Cohort Studies Collaboration),18,19 we established the Cohorts Consortium of Latin America and the Caribbean (CC-LAC). The main aim of the CC-LAC is to start a collaborative cohort data pooling in LAC to examine the association between cardio-metabolic risk factors (e.g. blood pressure, glucose and lipids) and non-fatal and fatal cardiovascular outcomes (e.g. stroke or myocardial infarction). In so doing, we aim to provide regional risk estimates to inform disease burden metrics, as well as other ambitious projects including a cardiovascular risk score to strengthen cardiovascular prevention in LAC. Initial funding has been provided by a fellowship from the Wellcome Trust Centre for Global Health Research at Imperial College London (Strategic Award, Wellcome Trust–Imperial College Centre for Global Health Research, 100693/Z/12/Z). Additional funding is being provided by an International Training Fellowship from the Wellcome Trust (214185/Z/18/Z). At the time of writing, the daily operations and pooled database are hosted at Imperial College London, though a mid-term goal is to transfer this expertise and operations to LAC. The collaboration relies fundamentally on a strong regional network of health researchers and practitioners

Background: Radiation (RT) activates a type 1 interferon (IFN-1) response and, in preclinical studies, this is critical to the effect of RT in priming a response to immune checkpoint blockade. Recent studies report the impact of external beam radiotherapy (EBRT) dose and fractionation on IFN-1 response, however little is known about the time course of this effect. Clinical interest in utilizing systemically administered targeted radionuclide therapy agents (TRT) is growing. It is unclear how IFN-1 activation induced by continuous delivery of RT during exponential decay of a TRT source will compare to that induced following instantaneous EBRT. Here we report the time course of IFN-1 response following RT in vitro and in vivo. Methods: For in vitro studies, we utilized murine models of melanoma (B16, B16 STING knockout, B78), and head and neck cancer (MOC2). EBRT was prescribed to 12 Gy, 20 Gy, or 3 fractions of 8 Gy. For in vivo studies, syngeneic C57BL/6 mice were engrafted with either B78 or MOC2 cells on the flank and RT was delivered when mean tumor size was ~ 150 mm3. EBRT was prescribed to 2 Gy or 12 Gy. For TRT, we used 90Y conjugated to NM600, an alkylphosphocholine analog that exhibits selective uptake and retention in tumor cells of nearly any type, including B78 and MOC2. Tumor-specific dosimetry for 90Y-NM600 was determined using sequential 86Y-NM600PET/CT imaging (3h, 24h, 72h) and a Monte Carlo based dose calculation platform. TRT was prescribed to a dose of 2 Gy or 12 Gy. Following delivery of RT in vitro or in vivo, cells or tumors were harvested at 24h, 7d, and 14 d post RT and RNA was isolated. Gene expression of Ifn-β and IFN response elements (Oas2, Oas3, and Mx1) was quantified by qPCR and normalized to untreated controls. Results: In agreement with prior studies, we observed significant IFN-1 activation 24 hours following 8 Gy x 3 in our B16, B78, and MOC2 tumor cell lines. At 12 Gy and 20 Gy, we continued to detect significant IFN-1 activation. Peak activation was 7d following EBRT for all doses, raising the potential for a lead-time bias when comparing fractionated to single dose treatments. For all doses, select IFN response genes remained upregulated at 14d. In vivo delivery of EBRT and TRT to B78 and MOC2 tumors resulted in a comparable time course of IFN-1 activation peaking 7d after RT and persisting to 14d. Using a STING knockout variant of B16 melanoma, we confirmed that activation of IFN-1 response by RT was STING dependent at all time points evaluated. Conclusions: We report the time course for activation of a STING-dependent IFN-1 response following RT in multiple murine tumor models. We observe maximal activation 7d following both EBRT and TRT. We show the potential of TRT to generate EBRT comparable IFN-1 activation. Further studies evaluating the time course and magnitude of IFN-1 response following TRT may be critical in metastatic settings to integrating this modality with immunotherapy. Citation Format: Justin C. Jagodinsky, Ian S. Arthur, Juliana S. Castillo, Ishan Chakravarty, Luke M. Zangl, Ryan J. Brown, Ravi B. Patel, Wonjon J. Jin, Peter M. Carlson, Reinier Hernandez, Joseph J. Grudzinski, Ian R. Marsh, Jamey P. Weichert, Bryan P. Bednarz, Zachary S. Morris. Comparing type 1 interferon activation in tumor cells following external beam radiotherapy versus targeted radionuclide therapy [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 477.

Purpose: Surgical resection or stereotactic ablative radiation therapy (SBRT) in early stage non-small cell lung cancer (NSCLC) have local control rates of 90% or higher. Current treatment paradigms effectively control primary tumor sites, but distant relapse remains a challenge with metastatic failure in more than 30% of patients with primary tumors larger than 5 cm. We hypothesized that adjuvant immune checkpoint blockade with anti-CTLA4 (C4) and /or bempegaldesleukin (NKTR-214), a CD122-preferential pegylated-interleukin-2 (IL2) pathway agonist,in combination with primary tumor ablative radiation or surgical resection would reduce metastases in a spontaneously metastatic syngeneic Lewis Lung Carcinoma (LLC) model. Methods: LLC flank tumors were established in C57BL/6 mice (n=6 per replicate, 12 total). When tumors were ~100 mm3 they were randomized to receive: vehicle only (VO); NKTR-214 (16 μg on Days 6, 15, 24) + C4 (200 μg IP on Days 4, 7, 10); RT (8Gy x 3 on Days 1, 2, 3); RT + C4, RT + NKTR-214; RT + C4 + NKTR-214; Primary surgery (Day 16), or Surgery + NKTR-214 + C4. Primary tumor size, survival, and a binary assessment of metastatic disease was made for each mouse. Flow cytometry studies examined tumor immune cell infiltrates on Day 21 in mice treated with VO, RT, RT + C4, C4 + NKTR-214, or RT + C4 + NKTR-214. Results: NKTR + C4 prevented development of spontaneous metastasis (p < 0.01) but did not control primary disease compared to VO treatment. RT alone significantly reduced primary tumor size compared to VO control (p < 0.01), but these mice all developed metastases. Adjuvant NKTR-214 + C4 after RT reduced development of spontaneous metastasis in mice treated by this regimen by 91% and 73% compared to RT alone and RT + C4 respectively. RT + C4 + NKTR-214 also significantly improved survival compared to both RT + C4 and RT + NKTR-214 (p = 0.02, p = 0.003). 58% of mice treated with RT + C4 + NKTR-214 cleared their primary tumors compared to 16% with RT + C4 and 0% in RT + NKTR-214 at day 30 (p = 0.03, p < 0.01). All mice clearing primary tumors rejected LCC rechallenge. Flow cytometric immuneprofiling of the primary tumors demonstrated increased CD8+T cells, NK cells (NK1.1+CD3−), and NKT cells (NK1.1+CD3+) with NKTR-214 + C4 w/wo RT treatment compared to VO controls. NKTR-214 + C4 prior to surgical resection also reduced the development of spontaneous lung metastases compared to surgery alone (p < 0.01). Conclusions: Addition of systemic NKTR-214 + C4 treatment to RT or primary surgical resection reduces development of distant metastatic disease in a preclinical NSCLC model. Moreover, treatment with NKTR-214 + C4 increases infiltration of innate and adaptive immune effector cells in the primary tumor. This treatment strategy has important translational potential to prevent distant relapse in patients undergoing definitive local therapies for early stage NSCLC. Citation Format: Ryan J. Brown, Luke Zangl, Ian Arthur, Alex Pieper, Peter M. Carlson, Juliana Castillo, Paul M. Sondel, Alexander Rakhmilevich, Zach S. Morris, Ravi B. Patel. Combination of bempegaldesleukin and anti-CTLA-4 prevents metastatic dissemination after primary surgery or radiation therapy in a preclinical model of non-small cell lung cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 4455.

We report a patient with diffuse large B-cell lymphoma of skin, nongerminal center type double hit double expressor, with an initial presentation as a left forearm mass. The patient underwent chemotherapy after initial diagnosis. After chemotherapy regimen, she developed a second mass, followed by CNS involvement with neurological defects. At this time, a three line of chemotherapy was used with minimal effects. The patient was deemed terminal and was recommended hospice care. The patient decided to continue with skin and crainospinal radiotherapy and intrathecal chemotherapy; she achieved complete remission. After achieving complete remission, the patient underwent an autologous stem cell transplant with minimal transplant-related toxicity.

Propósito: Analizar los resultados obtenidos del trasplante de membrana amniótica con fines oftalmológicos en la provincia de Granada entre los años 2013-2017 para identificar posibles variables que influyan en mayor o menor medida en un buen pronóstico postquirúrgico. Materiales y métodos: Estudio retrospectivo de serie de casos. Se estudiaron 44 pacientes con lesiones en la superficie ocular, los cuales recibieron trasplante de membrana amniótica entre 2013-2017 en la provincia de Granada (España) con un seguimiento mínimo de 8 meses. Los pacientes presentaron: abrasiones corneales, descematoceles, perforaciones, pterigium recidivantes, queratopatías en banda, queratitis numular, simbléfaron y úlceras recidivantes. Las variables recogidas en cada caso fueron las siguientes: sexo, edad, fecha del trasplante, técnica empleada, número de membrana amniótica implantadas en cada paciente, número de capas de membrana amniótica implantadas, tipo de membrana amniótica, motivo del trasplante, ¿hubo complicaciones?, ¿cuándo?, ¿se puso una segunda membrana amniótica?, ¿se realizó otra intervención?, ¿infecciones postquirúrgicas?,¿mejoría agudeza visual?,¿transparencia corneal ? y ¿éxito o fracaso global de la intervención?. Para el análisis estadístico, se compararon los resultados del grupo de éxito frente a los del grupo de fracaso mediante la prueba de Mann-Whitney, aplicándose el test de Kendall para identificar correlación entre grupos. Resultados: Respecto al éxito o fracaso del tratamiento, se encontraron diferencias estadísticamente significativas entre el grupo de éxito y el de fracaso para las siguientes variables: motivo de implante por perforación corneal (la mayoría fracasaban), existencia de complicaciones y la transparencia corneal, las cuales se correlacionaron de forma positiva o negativa con el éxito del trasplante. Con respecto a estos últimos dos parámetros (la ausencia de complicaciones y una buena trasparencia corneal) se relacionaron con el éxito postquirúrgico. Conclusión: El presente estudio preliminar sugiere que el trasplante de membrana amniótica podría ser útil en oftalmología, existiendo una clara asociación entre el éxito de esta técnica y ciertos factores relacionados con la evolución del paciente. Asimismo, la membrana amniótica no debería utilizarse de forma aislada en pacientes con perforación ocular, debido al elevado riesgo de fracaso de la técnica, siendo necesaria su realización junto a tratamientos coadyuvantes y recomendándose el estudio de tratamientos más definitivos, Purpose: To analyze the results obtained from the amniotic membrane transplant for ophthalmological purposes in the province of Granada between the years 2013-2017 to identify possible variables that influence, to a greater or lesser extent, a good postoperative prognosis. Materials and methods: Retrospective study of case series. Forty-four patients with lesions on the ocular surface were studied, who received an amniotic membrane transplant between 2013-2017 in the province of Granada (Spain) with a minimum follow-up of 8 months. The patients presented: corneal abrasions, descemetoceles, perforations, recurrent pterygium, band keratopathies, nummular keratitis, symblepharon and recurrent ulcers. The variables collected in each case were: sex, age, date of transplant, technique used, number of amniotic membrane implanted in each patient, number of implanted amniotic membrane layers, type of amniotic membrane, reason for the transplant, were there complications?, when?, did you put a second amniotic membrane?, did you perform another intervention?, were there postoperative infections?, improvement in acuity visual, corneal transparency? and global success or failure of the intervention ?. For the statistical analysis, the results of the success group were compared with those of the failure group using the Mann-Whitney test, applying the Kendall test to identify correlation between groups. Results: Regarding the success or failure of the treatment, statistically significant differences were found between the success group and the failure group for the following variables: implant motive due to corneal perforation (most failed), existence of complications and corneal transparency, which correlated positively or negatively with the success of the transplant. With regard to these last two parameters (the absence of complications and a good corneal transparency) were related to postoperative success. Conclusion: This preliminary study suggests that amniotic membrane transplantation could be useful in ophthalmology, there being a clear association between the success of this technique and certain factors related to the evolution of the patient. Likewise, the amniotic membrane should not be used in isolation in patients with ocular perforation, due to the high risk of failure of the technique, being necessary to perform along with adjuvant treatments and recommended the study of more definitive treatments.

Introduction The attributable population risk of work-related asthma is between 10% and 20% of total cases of asthma. In Chile, the prevalence of common asthma is 10.2% but the proportion of occupational asthma (OA) is hidden and invisible. The study objective was to determine the prevalence of OA among asthmatic patients in regular control in the Primary Health Care (PHC) adult respiratory diseases program in Santiago, Chile. Methods A descriptive, cross-sectional multicenter study of patients aged 20 to 64 years with diagnosis of asthma, according to medical records and functional respiratory tests; who were working or had worked and were in control in PHC in a healthcare district of Santiago. An Occupational Asthma Screening Questionnaire (OAS) was developed and validated in four PHC centres to identify occupational asthma in the population in control for bronchial asthma. The screening instrument included six questions with a scale from 6 to 16 points. The instrument was prepared with a panel of experts with validation of feasibility, reliability, logic, content, construct and criteria, using confirmatory diagnostic tests and blind medical evaluation by two specialists in respiratory diseases and occupational medicine as the gold standard. Patients were classified into three categories: OA, work-exacerbated asthma WEA or common asthma (CA), according to OAS and the medical evaluation. Result Two hundred and two patient completed the OAS and were evaluated by specialists. A cut-off of >10.5, points in the OAS yielded sensitivity of 0.79; specificity of 0.78; VP (+) 0.22 and VP (-) 0.98. The detected prevalence of OA was 8.2% and asthma exacerbated by work was 14.2%, for a total prevalence of work-related asthma of 22%. Discussion The findings support implementation of an occupational asthma surveillance program in the PHC network in Santiago, Chile to benefit workers and to improve the results of PHC respiratory health programs.

Background.On 8 November 2013, supertyphoon Haiyan made landfall in the Philippines, severely disrupting health service delivery. Reestablishment of essential services for birthing mothers and their newborns became high priority.Methodology.Following a baseline assessment, an Essential Intrapartum and Newborn Care (EINC) training package was implemented and posttraining assessments (1 and 3 months after training) were undertaken.Results.Baseline assessments (n=56facilities) revealed gaps in provider’s skill and shortage of life-saving commodities. Facilities lacked newborn bags/masks (9%), towels (6%), and magnesium sulfate (39%). Service providers lacked skills in partograph use (54%), antenatal steroid (44%) use, and breastfeeding initiation (50%). At 3 months after training (n=51facilities), dramatic increases in correct partograph use (to 92%), antenatal steroid use (to 98%), breastfeeding initiation (to 86%), kangaroo mother care (to 94%), availability of magnesium sulfate (to 94%), and bag/masks (to 88%) were documented. Gaps persisted for skills in assisted vaginal delivery and removal of placental fragments.Conclusion.Health services were severely disrupted after supertyphoon Haiyan. Our study demonstrates that essential birthing services and quality improvements to strengthen local health systems can be restored in a timely manner even in immediate postdisaster settings.

Clinical Image: A 66-year-old female presents with a past medical history of hypertension, chronic back pain from injury following spinal fusion, and a family history positive for paternal grandfather with leukemia. Patient was diagnosed with Acute Myeloid Leukemia (AML) that originated from a background of myelodysplastic features. She initially presented with worsening fatigue and back pain, and was found to have pancytopenia around March 2017. Bone marrow biopsy showed AML 30% blasts with complex cytogenetic abnormalities, including monosomy 7 and p53 mutations. Cerebrospinal Fluid (CSF) studies were negative. She was not considered as an allogeneic stem cell transplant candidate, and instead started on palliative chemotherapy. Patient tolerated well the combination of hypomethylating agents and Venetoclax. She had multiple admissions for neutropenic fever treated empirically with antibiotics. Upon clinic visit on January 2018, she presented with a low-grade fever, and was FLU positive. She was treated with Tamiflu, and completed the therapy by January 9, 2018. She presented again to the clinic on January 15, 2018 complaining of black, painless lesions on the surface of her tongue that were noted upon waking up (Figure 1). Complete Blood Count (CBC) showed White Blood Cell (WBC) 0.5, Hemoglobin (Hgb) 9.2, and Platelet count of 2. Dermatology was consulted, and it was planned to biopsy the lesions after the platelet transfusion were performed, given severe thrombocytopenia due to her chemotherapy regimen. Patient received the platelet transfusions and by the end of the day, upon completion of the transfusion, the lesions on her tongue completely resolved (Figure 2). It is possible, that the lesions were small hemorrhages. Most reported cases of oral hemorrhages have not presented in this manner, as they usually involve a wider area, and are confined to one spot rather than presenting at multiple sites, like in this case. This case is reported due to the rarity of the presentation of these lesions, and their complete, instantaneous resolution upon platelet transfusion. The aim of this article is to increase awareness among our fellow dermatologists and other physicians.

Neochloris oleoabundans (=Ettlia oleoabundans) is a green microalga that has great potential for the production of biodiesel. To achieve economically viable processes for the production of biodiesel from microalgae, the use of wastewater is highly recommended. However, there are no reports on the cultivation of N. oleoabundans utilizing anaerobic digestates of vinasse or stillage, which is a highly polluting wastewater from the alcohol industry. A first group of experiments was conducted, aiming to establish the optimal culture conditions of N. oleoabundans (UTEX 1185) using anaerobic effluents of vinasse (AEV) in bubble columns incubated under controlled conditions. The highest culture density was obtained in a medium containing 6 % of such effluents with a daily addition of sodium bicarbonate (1 g L−1). The total lipid content varied from 17.7 to 38.5 % for a range of 2 to 8 % of AEV with added sodium bicarbonate. A second group of experiments using 6 % AEV + sodium bicarbonate and flat plate photobioreactor-incubated outdoors was performed. An increase of 62 % in cell density compared to the value registered in Bold’s basal medium (BBM) was observed. Furthermore, a high ammonium–nitrogen removal (85.2 %) and a high flocculation efficiency (42 % after 30 min) indicate that dual-purpose systems aimed at producing high densities of lipid-enriched biomass of this green microalga are feasible. The uses of supplemental bicarbonate and organic waste as a source of nutrients are very important factors that contribute to reducing the cost of production.

Objective: the purpose of the present study was to analyze the concurrent validity and reliability of a force platform clinical COBS Feedback® for the estimation of the height of vertical jumps. Design: a cross-sectional correlational and comparative study. Setting: University Human Movement and Physiotherapy Laboratory. Participants: healthy university students (14 female and 13 male) aged between 18 and 25 years old (mean = 20.074 ±1.542). Main Outcome Measures: vertical jump heights, technical error and grade of agreement between methods of measurement. Results: after the 27 subjects performed a total of 135 vertical jumps on COBS Feedback®platform while simultaneously being recorded with a high-speed camera-based method, the intraclass correlation coefficient showed an almost perfect concordance between the two methods (ICC = 0.916, CI95%= 0.882 to 0.940, p

440 Background: Globally, gastric cancer (GC) is the fourth most prevalent cancer, and the second leading cause of cancer related deaths. Epstein-Barr virus is implicated in the pathogenesis of 5-10% of gastric cancers. Based upon the results obtained from of the cancer genome atlas, EBV related GC is characterized by promoter hypermethylation, PIK3CA mutations (80%) and increased expression of PD-1 and PD-L1, making it an attractive target for molecularly targeted therapy and immunotherapeutic options. As such, a case can be made for routine testing for EBV in all GC patients. University medical center, El Paso is a tax payer funded safety net health system in El Paso country, TX. We conducted a pilot study to characterize the prevalence of EBV associated gastric cancer seen at this facility. Methods: After obtaining institutional review board (IRB) approval, we identified cases of GC that were diagnosed between January 1, 2008- and December 31-2017. A total of 104 cases were identified of which 17 samples were randomly selected. Pathology specimens were reviewed to identify grade, subtype (intestinal vs diffuse), degree of lymphocytic infiltration and presence/absence of H. pylori. Representative sections from archived tumors were used to perform in-situ hybridization to look for the presence of Epstein-Barr virus. Samples were analyzed using the Rembrandt In situ Hybridization and Detection Universal RISH& HRP Detection Kit for Epstein-Barr early RNA. Results: The median age of the 17 patients is 63 years with 59% being males. 95% self identified as Hispanic. 41% were smokers, 18% used alcohol. The mean BMI was 27.3. Forty one percent of gastric cancer cases were found in the body, 29% in the antrum, 12% in the cardia, and 6% in the fundus. Forty one percent of cases were Stage IV, 24% stage II, 17% Stage III and 17% Stage I. 95% of cases were high grade, 53% of them had signet ring features. 18% of samples were H. pylori positive. None of the seventeen samples tested positive for EBV. Conclusions: EBV does not seem to contribute significantly to the pathogenesis of gastric cancer in our local population. As such routine testing for EBV in all gastric cancer patients may not be a cost effective utilization of resources at our hospital.

Purpose: Previous research has shown that physical activity during dialysis can improve adherence to exercise, improve physical performance, resulting in healthier outcomes. This case report aims to determine

Clinical decision support systems have the potential to improve patient care in a multitude of ways. Clinical decision support systems can aid in the reduction of medical errors and reduction in adverse drug events, ensure comprehensive treatment of patient illnesses and conditions, encourage the adherence to guidelines, shorten patient length of stay, and decrease expenses over time. A clinical decision support system is one of the key components for reaching compliance for Meaningful Use. In this article, the advantages, potential drawbacks, and clinical decision support system adoption barriers are discussed, followed by an in-depth review of the characteristics that make a clinical decision support system successful. The legal and ethical issues that come with the implementation of a clinical decision support system within an organization and the future expectations of clinical decision support system are reviewed.

El estudio a escala genomica de las enfermedades cardiovasculares permite entenderlas mejor para optimizar y dirigir terapias personalizadas. En el desarrollo de la muerte subita cardiaca destacan dos grandes grupos de enfermedades de gran heterogeneidad genetica y fenotipica: las enfermedades estructurales o miocardiopatias y las arritmogenicas o canalopatias. El principal problema de ambos tipos de enfermedad es que a menudo causan la muerte subita en individuos previamente asintomaticos en los que la muerte subita cardiaca es la primera manifestacion de cardiopatia en un alto numero de casos. Por consiguiente, y dado que se trata de enfermedades hereditarias, hay un elevado riesgo para los familiares que, pese permanecer asintomaticos, podrian ser portadores de variantes geneticas de riesgo. Se han descrito alrededor de 100 genes implicados en las enfermedades asociadas a muerte subita cardiaca. La capacidad de la secuenciacion convencional de genes Sanger es limitada con respecto a las nuevas opciones tecnologicas en constante desarrollo, tales como los arrays de resecuenciacion y especialmente la secuenciacion masiva en paralelo, next generation sequencing. Gracias a la mejora de las diferentes quimicas en las distintas opciones tecnologicas, los proveedores centran sus esfuerzos en el aumento de la capacidad de generacion de datos de estos equipos, asi como en la rebaja de los costes de los reactivos necesarios para estos analisis, con objeto de facilitar a la comunidad cientifica el acceso a estas tecnologias. Dadas la gran cantidad y la complejidad de los datos geneticos derivados de la ultrasecuenciacion, que requieren un analisis minucioso de sus implicaciones medicas en todas las ramas de la medicina, es necesaria la creacion de centros especializados en el estudio de enfermedades concretas, en el manejo de datos geneticos a gran escala y en prestar asesoramiento genetico a las familias.

An estimated one in four transgender women (trans women) in the U.S. are infected with HIV. Rates of HIV testing are not commensurate with their risk, necessitating alternative strategies for early detection and care. We explored the feasibility and acceptability of HIV self-testing (HIVST) with 50 HIV-negative adult trans women in San Francisco. Participants received three self-test kits to perform once a month. Acceptability and behavioral surveys were collected as were 11 in-depthinterviews (IDIs). Among 50 participants, 44 reported utilizing HIVST at least once; 94% reported the test easy to use; 93% said results were easy to read; and 91% would recommend it to others. Most participants (68%) preferred HIVST to clinic-based testing, although price was a key barrier to uptake. IDIs revealed a tension between desires for privacy versus support found at testing sites. HIVST for trans women was acceptable and feasible and requires careful consideration of linkage to support services.

The United States (US) Department of Defense (DoD) offers a great opportunity to implement solar energy solutions across its US bases. It is the single largest energy consumer in the federal govern...

We present a standalone software tool which makes reports for analysis and evaluation of GRBs. Recently, analysis and evaluation of GRBs were done without help of semiautomated tools or routines; so the time elapsed from the detection until getting all the information produced (DSS-2 data: Digitized Sky Surveys, elevation diagrams in each observatory, etc.) could be 30 minutes. The software presented allows to reduce the time elapsed to 30 seconds, getting an email, web, and sms reports. Copyright © 2010 S. Castillo-Carrión and A. J. Castro-Tirado.

To determine the effect of the type of mutation in low-density lipoprotein receptor gene and the risk factors associated with the development of premature cardiovascular disease (PCVD) in a large cohort of heterozygous familial hypercholesterolemia (hFH) subjects with genetic diagnosis in Spain.A cross-sectional study was conducted on 811 non-related FH patients (mean age 47.1+/-14 years, 383 males and 428 females) with a molecular defect in the low-density lipoprotein receptor (LDLR) gene from the Spanish National FH Register. Prevalence of PCVD was 21.9% (30.2% in males and 14.5% in women, P0.001). Mean age of onset of cardiovascular event was 42.1 years in males and 50.8 years in females. Of those patients with PCVD, 59.5% of males and 27% of females suffered a second cardiovascular (CV) event. In multivariate analysis male gender, age, tobacco consumption (ever), and total cholesterol/HDL-cholesterol (TC/HDL-C) ratio were significantly associated with PCVD. Two hundred and twenty different mutations were found with a large heterogeneity. Patients carrying null-mutations had significantly higher frequency of PCVD and recurrence of CV events. No relationship with Lp(a) levels and genotype of Apo E were found.This study confirms the importance of identifying some classic risk factors such as smoking and TC/HDL-C ratio, and also the type of mutation in LDLR gene in order to implement early detection and intensive treatment for the prevention of cardiovascular disease in FH patients.

Background B-Acute lymphoblastic leukemia (B-ALL) represents a hematologic malignancy with poor clinical outcome and low survival rates in adult patients. Remission rates in Hispanic population are almost 30 % lower and Overall Survival (OS) nearly two years inferior than those reported in other ethnic groups. Only 61 % of Colombian adult patients with ALL achieve complete remission (CR), median overall survival is 11.3 months and event-free survival (EFS) is 7.34 months. Identification of prognostic factors is crucial for the application of proper treatment strategies and subsequently for successful outcome. Our goal was to identify a gene expression signature that might correlate with response to therapy and evaluate the utility of these as prognostic tool in hispanic patients. Methods We included 43 adult patients newly diagnosed with B-ALL. We used microarray analysis in order to identify genes that distinguish poor from good response to treatment using differential gene expression analysis. The expression profile was validated by real-time PCR (RT-PCT). Results We identified 442 differentially expressed genes between responders and non-responders to induction treatment. Hierarchical analysis according to the expression of a 7-gene signature revealed 2 subsets of patients that differed in their clinical characteristics and outcome. Conclusions Our study suggests that response to induction treatment and clinical outcome of Hispanic patients can be predicted from the onset of the disease and that gene expression profiles can be used to stratify patient risk adequately and accurately. The present study represents the first that shows the gene expression profiling of B-ALL Colombian adults and its relevance for stratification in the early course of disease. Electronic supplementary material The online version of this article (doi:10.1186/s13046-016-0333-z) contains supplementary material, which is available to authorized users.

Uterine arteriovenous malformation (AVM) is a rare but potentially life-threatening source of bleeding. A high index of suspicion and accurate diagnosis of the condition in a timely manor are essential because instrumentation that is often used for other sources of uterine bleeding can lead to massive hemorrhage. Although angiography remains the gold standard for diagnosis, ultrasound (US) and magnetic resonance imaging (MRI) are the modalities of choice for the evaluation of a suspected AVM. US and MRI cannot only accurately define a uterine AVM, but they also have the ability to assess the extent of pelvic involvement noninvasively. The definitive treatment of uterine AVM is hysterectomy. However, most women diagnosed with the condition are of childbearing age. Transcatheter uterine artery embolization offers a safe and effective alternative to surgery, with the major advantage of retaining childbearing capacity.