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Introduction: The Spanish National Health System has defined complexity as a set of factors of increased difficulty that require the intervention of a palliative care team . Palliative care aims to improve the quality of life of patients with chronic terminal illnesses. This study aims to describe the degree of complexity of cancer patients in palliative care, to determine which elements of complexity are most prevalent and to determine which other hospital clinical factors are associated with the level of complexity., Methods: This study is a descriptive, observational, and cross-sectional analysis that included patients diagnosed with advanced oncological pathology undergoing palliative treatment who were admitted to the Medical Oncology ward of the Miguel Servet University Hospital between March and April 2023., Result: A total of 100 patients were selected for the study. According to the IDC-Pal, 68% of patients were classified as highly complex, 26% of patients were complex and only 6% of patients were classified as non-complex. The presence of pain ( P < .001), nausea and vomiting ( P = .027), depression ( P = .033) and functional status ( P = .011) were statistically independent predictors of high complexity., Discussion: This study has shown that a high proportion of hospitalized palliative care cancer patients have high complexity, suggesting a good matching of healthcare resources to patient complexity. Four factors related to complexity have been identified, namely pain, nausea and vomiting, depression and a bedridden functional state. The presence of any of the 4 factors could help healthcare professionals to identify patients for early specialized palliative care., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Mixed affective states in bipolar disorder (BD) is a common psychiatric condition that occurs when symptoms of the two opposite poles coexist during an episode of mania or depression. A four-dimensional model by Goldbeter (Progr Biophys Mol Biol 105:119-127, 2011; Pharmacopsychiatry 46:S44-S52, 2013) rests upon the notion that manic and depressive symptoms are produced by two competing and auto-inhibited neural networks. Some of the rich dynamics that this model can produce, include complex rhythms formed by both small-amplitude (subthreshold) and large-amplitude (suprathreshold) oscillations and could correspond to mixed bipolar states. These rhythms are commonly referred to as mixed mode oscillations (MMOs) and they have already been studied in many different contexts by Bertram (Mathematical analysis of complex cellular activity, Springer, Cham, 2015), (Petrov et al. in J Chem Phys 97:6191-6198, 1992). In order to accurately explain these dynamics one has to apply a mathematical apparatus that makes full use of the timescale separation between variables. Here we apply the framework of multiple-timescale dynamics to the model of BD in order to understand the mathematical mechanisms underpinning the observed dynamics of changing mood. We show that the observed complex oscillations can be understood as MMOs due to a so-called folded-node singularity . Moreover, we explore the bifurcation structure of the system and we provide possible biological interpretations of our findings. Finally, we show the robustness of the MMOs regime to stochastic noise and we propose a minimal three-dimensional model which, with the addition of noise, exhibits similar yet purely noise-driven dynamics. The broader significance of this work is to introduce mathematical tools that could be used to analyse and potentially control future, more biologically grounded models of BD., Competing Interests: Conflict of interestThe authors have no relevant financial or non-financial interests to disclose., (© The Author(s), under exclusive licence to Springer Nature B.V. 2022. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Introduction: Malignant paragangliomas (M-PGL) are a group of neuroendocrine tumors that originate from chromaffin cells. The most common location for PGL is the head and neck, which comprise 65-70% of all PGL, and the M-PGL accounts for 0.6% of all head and neck cancers. It is a rare tumor, with an incidence of 2-8 per million. Diagnosing PGL can be challenging, and treatment for metastatic disease is usually not curative., Case Presentation: A 66-year-old woman was diagnosed with left cervical pain and laterocervical mass in March 2015. Octreotide scintigraphy showed intense uptake in the cervical mass, two pulmonary micronodules of 4-5 mm, and another lesion in the lumbar region (L3-L4). The final diagnosis was malignant nonsecretory PGL with adjacent tissue involvement and distant metastases. After three different treatments with minimal symptomatic improvement, 177Lu-DOTATATE was requested off-label. With a dose of 7,400 MBq until January 2018, the patient showed remarkable symptomatic pain improvement and a decrease in tumor size., Conclusion: We believe that our case report provides relevant information that can be considered in similar cases. First, the patient tripled the expected survival in such a clinical setting, and this benefit seems to rely on 177Lu-DOTATATE treatment. Second, we documented an early symptomatic response to this treatment but a long-term delayed volumetric radiographic response., Competing Interests: The authors have no conflicts of interest to declare., (© 2024 The Author(s). Published by S. Karger AG, Basel.)

Background: The role of children in household transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains unclear. We describe the epidemiological and clinical characteristics of children with coronavirus disease 2019 (COVID-19) in Catalonia, Spain, and investigate the household transmission dynamics., Methods: A prospective, observational, multicenter study was performed during summer and school periods (1 July 2020-31 October 2020) to analyze epidemiological and clinical features and viral household transmission dynamics in COVID-19 patients aged <16 years. A pediatric index case was established when a child was the first individual infected. Secondary cases were defined when another household member tested positive for SARS-CoV-2 before the child. The secondary attack rate (SAR) was calculated, and logistic regression was used to assess associations between transmission risk factors and SARS-CoV-2 infection., Results: The study included 1040 COVID-19 patients. Almost half (47.2%) were asymptomatic, 10.8% had comorbidities, and 2.6% required hospitalization. No deaths were reported. Viral transmission was common among household members (62.3%). More than 70% (756/1040) of pediatric cases were secondary to an adult, whereas 7.7% (80/1040) were index cases. The SAR was significantly lower in households with COVID-19 pediatric index cases during the school period relative to summer (P = .02) and compared to adults (P = .006). No individual or environmental risk factors associated with the SAR., Conclusions: Children are unlikely to cause household COVID-19 clusters or be major drivers of the pandemic, even if attending school. Interventions aimed at children are expected to have a small impact on reducing SARS-CoV-2 transmission., (© The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)

Competing Interests: Competing interests: None declared.

The conductance-based refractory density (CBRD) approach is a parsimonious mathematical-computational framework for modelling interacting populations of regular spiking neurons, which, however, has not been yet extended for a population of bursting neurons. The canonical CBRD method allows to describe the firing activity of a statistical ensemble of uncoupled Hodgkin-Huxley-like neurons (differentiated by noise) and has demonstrated its validity against experimental data. The present manuscript generalises the CBRD for a population of bursting neurons; however, in this pilot computational study, we consider the simplest setting in which each individual neuron is governed by a piecewise linear bursting dynamics. The resulting population model makes use of slow-fast analysis, which leads to a novel methodology that combines CBRD with the theory of multiple timescale dynamics. The main prospect is that it opens novel avenues for mathematical explorations, as well as, the derivation of more sophisticated population activity from Hodgkin-Huxley-like bursting neurons, which will allow to capture the activity of synchronised bursting activity in hyper-excitable brain states (e.g. onset of epilepsy).

We propose a numerical approach to study the invasion fitness of a mutant and to determine evolutionary singular strategies in evolutionary structured models in which the competitive exclusion principle holds. Our approach is based on a dual representation, which consists of the modeling of the small size mutant population by a stochastic model and the computation of its corresponding deterministic model. The use of the deterministic model greatly facilitates the numerical determination of the feasibility of invasion as well as the convergence-stability of the evolutionary singular strategy. Our approach combines standard adaptive dynamics with the link between the mutant survival criterion in the stochastic model and the sign of the eigenvalue in the corresponding deterministic model. We present our method in the context of a mass-structured individual-based chemostat model. We exploit a previously derived mathematical relationship between stochastic and deterministic representations of the mutant population in the chemostat model to derive a general numerical method for analyzing the invasion fitness in the stochastic models. Our method can be applied to the broad class of evolutionary models for which a link between the stochastic and deterministic invasion fitnesses can be established., (Copyright © 2017 Elsevier Inc. All rights reserved.)

We present two approaches to study invasion in growth-fragmentation-death models. The first one is based on a stochastic individual based model, which is a piecewise deterministic branching process with a continuum of types, and the second one is based on an integro-differential model. The invasion of the population is described by the survival probability for the former model and by an eigenproblem for the latter one. We study these two notions of invasion fitness, giving different characterizations of the growth of the population, and we make links between these two complementary points of view. In particular we prove that the two approaches lead to the same criterion of possible invasion. Based on Krein-Rutman theory, we also give a proof of the existence of a solution to the eigenproblem, which satisfies the conditions needed for our study of the stochastic model, hence providing a set of assumptions under which both approaches can be carried out. Finally, we motivate our work in the context of adaptive dynamics in a chemostat model.

The management of foreign bodies in the gastrointestinal tract is not standardized. Foreign body ingestions in prisoners are always intentional and inmates can be manipulative, which makes medical decision even more difficult. Our objective is to propose a decisional algorithm for management of foreign body ingestion in prisoners. We reviewed the records of 198 admissions for foreign body ingestion for a 10-year period. Type and number of ingested foreign bodies, radiographic findings, outcome as well as the management method including conservative, endoscopic removal, or surgical treatment were analyzed. Most cases were managed conservatively (87.6%). Endoscopy of the upper gastrointestinal tract was performed in 37 cases with a success rate of 46 per cent. In 9.3 per cent of cases, the final treatment was endoscopic. Only five patients required surgical treatment, being emergent just in one case. We advocate conservative treatment for asymptomatic patients with foreign body ingestion. Endoscopic removal is proposed for pointed objects or objects bigger than 2.5 cm located in the stomach. Objects longer than 6 to 8 cm located in the stomach should be removed by endoscopy or laparoscopy. Patients with objects in the small bowel or colon should be treated conservatively unless there are complications or they fail to progress.