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The ability to accurately predict pain generators for chronic neck and back pain remains elusive.We evaluated whether injections targeted at foci with uptake on single-photon emission computerized tomography-computed tomography (SPECT-CT) were associated with improved outcomes in patients with chronic neck and back pain.A retrospective review was completed on patients undergoing SPECT-CT for chronic neck and back pain between 2016 and 2020 at a tertiary academic center. Patients' records were reviewed for demographic, clinical, imaging, and outcomes data. Only those patients who had facet injections after SPECT-CT were included in this evaluation. Patients undergoing injections targeted at foci of abnormal radiotracer uptake were compared with patients without uptake concerning immediate positive response, visual analog scale, and the need for additional injection or surgery at the target level.A total of 2849 patients were evaluated with a SPECT-CT for chronic neck and back pain. Of those, 340 (11.9%) patients received facet joint injections after SPECT-CT. A propensity score regression analysis adjusted for age, gender, body mass index, hypertension, multiple target injections, and injection location showed uptake targeted injections not being associated with an improved immediate positive response (odds ratio: 0.64; 95% confidence interval: 0.34-1.21; P = 0.172). In patients with a failed facet injection preceding SPECT-CT, adding SPECT-CT to guide facet injections was associated with a decrease in visual analog scale pain scores 2 weeks after injection (P = 0.018), particularly when changes were made to the facets being targeted (P = 0.010).This study suggests that there is benefit with SPECT-CT specially to guide facet injections after failed prior facet injections.

Contribution: This paper offers a general framework of technology development which allows for (a) a systematic approach to analyze technologies’ main components, strengths, limitations and forward paths; (b) a better understanding by en- gineers of their practices and their projects; and (c) a clearer way to convey the engineering enterprise to students, non-engineering stakeholders in projects and the general public. Background: Technology has been an immense force of material, economical and societal change in the last centuries. Several authors, such as Marshall McLuhan and Kevin Kelly, developed important ideas related to technology and the engineering process, but there seem to remain gaps between these theories to be explored, bridged and extrapolated. Research questions: (1) What are engineers’ aims in developing technologies? (2) What are technology’s main components, and its relationships? (3) What differentiates the engineering enterprise from others? Methodology: Integrate previous theories of technology, apply more technical concepts that were not addressed by writers who did not come from an engineering background, and derive consequences from the proposed methods. Findings: A proper theory of technology can better guide engineers from several branches to understand their practices and the fruits of their labor. It also aids in explaining these points to stakeholders, students and the general public.

Prospective nonrandomized studies have found less postoperative fatigue and improved quality of life in patients undergoing awake spine surgery under spinal anesthesia compared with general anesthesia. Randomized trials are needed to validate these findings.To prospectively investigate patients' willingness to enroll in randomized trials of lumbar spine surgery under spinal versus general anesthesia and identify any potential barriers.We recruited patients undergoing lumbar spine surgery for degenerative disease. We described a randomized trial of spine surgery under spinal versus general anesthesia and assessed patients' willingness to participate in such trial. We elicited preferences for treatment along with demographics. The association between these factors and willingness to participate in the trial was examined.Fifty patients completed interviews; 58% were female, mean age of 60.9 ± 12.5 years. A total of 52% patients stated that they were definitely willing to participate in the hypothetical randomized trial, and 8% probably willing. Only 16% of patients were aware of spinal anesthesia as an option for low back surgery, and 60% indicated no strong preference for the anesthesia techniques. Patients without strong preferences stated a greater willingness to participate than those with strong preferences (80% vs. 10% definitely willing, P0.0001). Age, sex, education, work status, and race were not significantly associated with willingness to participate.Sixty percent of patients stated that they were either definitely or probably willing to participate in the randomized trial. Subjects lacking strong preferences for the anesthesia technique stated a greater willingness to enroll than those with strong preference.

Management of degenerative disease of the spine has evolved to favor minimally invasive techniques, including nonrobotic-assisted and robotic-assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Value-based spending is being increasingly implemented to control rising costs in the US healthcare system. With an aging population, it is fundamental to understand which procedure(s) may be most cost-effective.To compare robotic and nonrobotic MIS-TLIF through a cost-utility analysis.We considered direct medical costs related to surgical intervention and to the hospital stay, as well as 1-yr utilities. We estimated costs by assessing all cases involving adults undergoing robotic surgery at a single institution and an equal number of patients undergoing nonrobotic surgery, matched by demographic and clinical characteristics. We adopted a willingness to pay of $50 000/quality-adjusted life year (QALY). Uncertainty was addressed by deterministic and probabilistic sensitivity analyses.Costs were estimated based on a total of 76 patients, including 38 undergoing robot-assisted and 38 matched patients undergoing nonrobot MIS-TLIF. Using point estimates, robotic surgery was projected to cost $21 546.80 and to be associated with 0.68 QALY, and nonrobotic surgery was projected to cost $22 398.98 and to be associated with 0.67 QALY. Robotic surgery was found to be more cost-effective strategy, with cost-effectiveness being sensitive operating room/materials and room costs. Probabilistic sensitivity analysis identified robotic surgery as cost-effective in 63% of simulations.Our results suggest that at a willingness to pay of $50 000/QALY, robotic-assisted MIS-TLIF was cost-effective in 63% of simulations. Cost-effectiveness depends on operating room and room (admission) costs, with potentially different results under distinct neurosurgical practices.

Conditional gene regulation inDrosophilathrough binary expression systems like theLexA-LexAopsystem provides a superb tool for investigating gene and tissue function. To increase the availability of defined LexA enhancer trap insertions, we present molecular, genetic and tissue expression studies of 301 novel Stan-X LexA enhancer traps derived from mobilization of the index SX4 line. This includes insertions into distinct loci on the X, II and III chromosomes that were not previously associated with enhancer traps or targeted LexA constructs, an insertion intoptc, and eleven insertions into natural transposons. A subset of enhancer traps was expressed in CNS neurons known to produce and secrete insulin, an essential regulator of growth, development and metabolism. Fly lines described here were generated and characterized through studies by students and teachers in an international network of genetics classes at public, independent high schools, and universities serving a diversity of students, including those underrepresented in science. Thus, a unique partnership between secondary schools and university-based programs has produced and characterized novel resources inDrosophila, establishing instructional paradigms devoted to unscripted experimental science.

General anesthesia (GA) and spinal anesthesia (SA) have been adopted for lumbar spine surgery (LSS), but GA is used far more widely. We conducted a survey of spine surgeons to explore their attitudes and preferences regarding awake spine surgery under SA.A survey was emailed to 150 spine surgeons. Exposure and attitudes towards spine surgery under SA were elicited. A five-point Likert scale of agreement examined perceptions of SA, while attitudes towards SA were recorded by categorizing free text into themes.Seventy-five surgeons completed the survey, 50 % response rate. Only 27 % said they perform LSS under SA. Most surgeons, 83 %, would recommend GA to a healthy patient undergoing lumbar laminectomy. Only 41 % believes SA to be as safe as GA, and only 30 % believes SA is associated with better postoperative pain control. The most common reasons why SA is not favored was lack of proven benefits over GA (65 %). When asked if a randomized trial finds SA to lead to less postoperative fatigue, 50 % said they would be more likely to offer SA, a significant increase from the baseline response of 27 % (p = 0.002).Our survey indicates that the low adoption of SA for LSS is due to lack of surgeons' belief in the benefits of SA over GA, and that a randomized patient-centered trial has the potential of changing surgeons' perspective and increasing adoption of SA for LSS.

Immune checkpoint inhibitors (ICI) have drastically changed the landscape of metastatic melanoma management, thus significantly improving survival. Clinically, assessing treatment response may be challenging in a portion of cases due to a massive influx of immune cells into the tumor microenvironment, causing a transient increase in the target lesion size. This phenomenon, coined pseudoprogression, can occur in 5–10% of metastatic patients, and it is commonly followed by a tumor regression. Its incidence, however, may be underestimated, given its ephemeral nature and often being documented in visceral metastatic lesions, which are only assessed by imaging scans every 2–3 months. More recently, ICI has been studied in the neoadjuvant setting, yielding durable pathological responses in patients with cutaneous melanoma. Here, we report a case of a large retroauricular melanoma mass with regional lymph node involvement treated with ipilimumab and nivolumab combination therapy that developed pseudoprogression. Initially documented as an increase in size along with inflammatory features, followed by a dramatic clinical improvement. A complete regression was pathologically documented after 3 months and the patient remains disease-free for 14 months after treatment initiation. In conclusion, we document a pseudoprogression case during neoadjuvant ICI treatment and raise the question of whether the incidence of this phenomenon is higher when observed in superficial lesions, which can be assessed by routine physical exam.

Chordoma is a rare but devastating tumor that arises in the cranial skull base or spine. There are currently no US Food and Drug Administration-approved targeted therapies for chordoma, and little understanding of whether using more than one therapy has benefit over monotherapy. The objective of this study was to systematically review the current status of clinical trials completed for patients with chordoma to determine if multimodal therapy offers a benefit in progression-free survival over monomodal therapy. We performed a systematic review of the literature according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to review the available clinical trials of targeted therapy for chordoma. We compiled the clinical data to determine if there is a benefit of multimodal therapy over monotherapy. Our search resulted in 11 clinical trials including 270 patients with advanced chordoma who were treated with targeted therapies. The most commonly employed targeted therapies acted within the following pathways: platelet-derived growth factor receptor (187 patients), vascular endothelial growth factor (66 patients), and mammalian target of rapamycin (43 patients). Reported progression-free survival for included studies ranged from 2.5 to 58 months, with the longest progression-free survival in a trial that included a platelet-derived growth factor receptor inhibitor, nilotinib, and concurrent radiotherapy (58.2 months). There was a higher range of progression-free survival for trials treating patients with multimodal therapy (10.2–14 months vs 2.5–9.2 months, except for a monotherapy trial published in 2020 with a progression-free survival of 18 months), and those published in 2018 or later (14–58.2 months vs 2.5–10.2 months). Only 23% of patients with chordoma in published clinical trials have been treated with multimodal therapy. Progression-free survival may be enhanced by the use of targeted therapy with concurrent radiotherapy, use of multimodal therapy, and use of newer targeted therapy. Future clinical trials should consider use of concurrent radiotherapy and multimodal therapy for patients with advanced chordoma.

Dogs are the most common domestic reservoir of Leishmania infantum, making canine visceral leishmaniasis (CVL) a serious public health issue. Identifying new methodologies that can mimic lymphoid and myeloid competence in naturally infected dogs could lower costs and save time in preliminary screenings of potential immunotherapeutic agents and vaccines against CVL. For that, we established a cell-to-cell communication approach between lymphocytes and myeloid cells from healthy, asymptomatic (infected, without apparent clinical signs) and symptomatic (infected with apparent clinical signs) dogs. Peripheral blood mononuclear cells (PBMC) from these dogs were used as source of CD4

Submitted by Diogo Garcia Nunes (diogo.nunes@unesp.br) on 2022-06-29T19:47:55Z No. of bitstreams: 1 DISSERTACAO_DIOGO_GARCIA_NUNES.pdf: 1579070 bytes, checksum: 16d2b90ce94a5ab6aa2c25625cb2bacb (MD5) Approved for entry into archive by Luciana Máximo (luciana.maximo@unesp.br) on 2022-06-30T13:54:57Z (GMT) No. of bitstreams: 1 nunes_dg_me_guara.pdf: 1579070 bytes, checksum: 16d2b90ce94a5ab6aa2c25625cb2bacb (MD5) Made available in DSpace on 2022-06-30T13:54:57Z (GMT). No. of bitstreams: 1 nunes_dg_me_guara.pdf: 1579070 bytes, checksum: 16d2b90ce94a5ab6aa2c25625cb2bacb (MD5) Previous issue date: 2022-03-04 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) O glicerol tem diversas aplicações nas indústrias química, de alimentos e rações, farmacêutica entre outras; no entanto, conforme a produção do biodiesel tem aumentado, o estoque do glicerol também aumentou significativamente. Para os grandes produtores de biodiesel, não é economicamente viável a purificação do glicerol, com isso ele acaba tornando-se um grande passivo ambiental. Como o mundo tem vivido um aumento gradual da demanda energética e nas emissões dos GEE, novas tecnologias para aproveitamento energético têm sido estimuladas, como por exemplo a implementação de biocombustíveis. Dentre eles os mais utilizados no Brasil e no mundo, o biodiesel, que é utilizado em grande maioria através de sua combustão. Entre as diversas formas de aproveitamento do glicerol temos a oxi-combustão, que por sua vez pode ser considerada um passo adiante da combustão, onde visa obter um gás de exaustão rico em CO2, para que assim, possa ser utilizado como insumo para a própria oxi-combustão, e subsequentemente ter sua captura. Este trabalho tem como objetivo avaliar o comportamento térmico e cinético da combustão e oxi-combustão do glicerol bruto, determinando a melhor condição de queima em atmosfera de oxi-combustão. Foram estudadas atmosferas inertes com N2 e CO2, além de uma atmosfera de combustão com ar sintético 21% de O2 e 79% de N2 e 3 diferentes composições para atmosfera de oxi-combustão sendo 20/80, 30/70 e 40/60 em % de O2/CO2. A análise térmica considerou apenas a taxa de aquecimento de 10 °C/min para a determinação de índices, tais como, o índice de combustão através das curvas de TGA/DTG além das análises de DTA. A análise cinética usou o método Free Kinetics para determinar a energia de ativação em cada atmosfera de queima, onde foram utilizadas 3 razões de aquecimento sendo 10, 20 e 30 °C/min, utilizando uma termobalança. Os resultados da análise térmica e cinética indicam que a melhor condição de oxi-combustão estudada seria 30/70, levando em consideração como principais resultados o índice de combustão e a energia de ativação média 79,9 kJ/mol. Apesar dos índices e da energia de ativação, no geral demonstrarem melhor desempenho para a oxi-combustão 40/60, um fator que impactou muito nos resultados foi o índice de combustão e a utilização de menos O2, visando obter no final uma maior concentração de CO2 no gás de exaustão. Glycerol has several applications in the chemical, food and feed, pharmaceutical, among others, however, as the production of biodiesel has increasing, the stock of glycerol has also increased significantly. For large biodiesel producers, it is not economically viable to purify glycerol, so glycerol ends up becoming a major environmental liability. As the world has experiencing a gradual increase in energy demand and GHG emissions, new technologies for energy use have been stimulated, such as the implementation of biofuels. Among the most used biofuels in Brazil and in the world, we have biodiesel, which is used in great majority through its combustion. Among the different ways of using glycerol, we have oxy-combustion, which in turn can be considered a step ahead of combustion, where it aims to obtain an exhaust gas rich in 〖CO〗_2 so that it can be used as an input for oxy-combustion itself, and may subsequently have its capture. This work aims to evaluate the thermal and kinetic behavior of combustion and oxy-combustion of crude glycerol, determining the best burning condition in an oxy-combustion atmosphere. Inert atmospheres with N_2 and 〖CO〗_2 were studied, in addition to a combustion atmosphere with synthetic air 21% of O_2 and 79% of N_2 and 3 different compositions for oxy-combustion atmosphere, being 20/80, 30/70 and 40/60 in % of 〖O_2/CO〗_2. The thermal analysis considered only the heating of 10 °C/min for the determination of indexes such as the combustion index through the TGA/DTG curves in addition to the DTA analysis. The kinetic analysis used the Free Kinetics method to determine the activation energy in each burning atmosphere, where 3 heating rates were used, being 10, 20 and 30 °C/min, using a thermobalance. The results of the thermal and kinetic analysis indicate that the best oxy-combustion condition studied would be 30/70, taking into account the combustion index and the average activation energy of 79.9 kJ/mol as main results. Although the indices and the activation energy in general demonstrate better performance for the 40/60 oxy-combustion, a factor that greatly impacted the results was the combustion index and the use of less O_2, aiming to obtain in the end a greater concentration of 〖CO〗_2 in the exhaust gas. CAPES 433463/2019-01

Background During awake craniotomy, securing the patient's airway might be necessary electively or emergently. The objective of this study was to compare the feasibility of airway management using a laryngeal mask airway (LMA) and 4 alternative airway management techniques in an awake craniotomy simulation. Methods After completing a questionnaire, 9 anesthesia providers attempted airway management in a cadaver positioned to simulate awake craniotomy conditions. Following the simulation, participants rated and ranked the devices in their order of preference. Results Only 3 approaches resulted in the successful securement of an airway device for 100% of participants: LMA (median; interquartile range time to secure the airway 6 s, 5 to 10 s), fiberoptic bronchoscopy through an LMA (41 s; 23 to 51 s), and video laryngoscopy (49 s; 43 to 127 s). In contrast, the oral and nasal fiberoptic approaches demonstrated only 44.4% (154.5 s; 134.25 to 182 s) and 55.6% (75 s; 50 to 117 s) success rates, respectively. The LMA was the fastest and most reliable primary method to secure the airway (P=0.001). After the simulation, 100% of participants reported that an LMA would be their first choice for emergency airway management, followed by fiberoptic intubation through the LMA (7 of 9 participants) if the LMA failed to properly seat. Conclusions We demonstrated that an LMA was the fastest and most reliable primary method to secure an airway in a laterally positioned cadaver with 3-pin skull fixation. Fiberoptic and video laryngoscope airway equipment should be readily available during awake craniotomy procedures, and an attempt to visualize the vocal cords through the LMA should be attempted before removing it for alternative techniques.

Overcoming immunosurveillance is a major step in the progression of many types of tumors. Several immune escape strategies have been identified, including immunoediting and the establishment of an immune suppressive microenvironment. The aim of the present study was to determine whether the hereditary or sporadic context has any influence in the relationship between immune surveillance and tumor development, using sporadic and familial adenomatous polyposis related colorectal adenomas as a model.The immune tumor-infiltrating cells of a total of 58 low-grade and 18 high-grade colorectal adenomas were examined and compared, using immunostaining for CD3, CD4, CD8, CD57, CD68 and FoxP3.FoxP3 and CD68 counts were significantly higher in sporadic low-grade dysplasia (p = 0.0003 and p = 0.0103, respectively),and FoxP3 and CD4 counts were found to be significantly higher in high-grade sporadic dysplasia (p = 0.0008 and p = 0.0018, respectively)when compared with corresponding lesions in patients with familial adenomatous polyposis.This study suggests that the immune microenvironment of sporadic and hereditary lesions is different. Sporadic lesions contain a higher number of immune suppressive Treg cells, which suggests a stronger immune selective pressure. In contrast, hereditarylesions seem to benefit from a more tolerant immune microenvironment, allowing for the development of lesions with lower immune cell infiltration.This study shows that sporadic lesions harbor higher tumor-infiltrating immune cell counts, which might reflect a higher immune tolerance towards hereditary lesions.Introdução: A capacidade de contornar a imunovigilância é fundamental na progressão de muitos tumores. Já foram identificadas várias estratégias de escape imunológico, incluindo immunoediting e o estabelecimento de um microambiente imunológico supressivo. O objetivo do presente estudo passa por determinar se o contexto hereditário ou esporádico influencia a relação entre a imunovigilância e o desenvolvimento do tumor, usando adenomas coloretais esporádicos e hereditários, no contexto de polipose adenomatosa familiar, como modelos. Material e Métodos: Os infiltrados imunológicos tumorais de um total de 58 adenomas coloretais de baixo grau e de 18 de alto grau foram avaliados e comparados, usando imunohistoquímica com marcação para CD3, CD4, CD8, CD57, CD68 e FoxP3. Resultados: As contagens celulares com imunorreatividade para FoxP3 e CD68 foram significativamente mais elevadas na displasia esporádica de baixo grau (p = 0,0003 e p = 0,0103, respetivamente), enquanto que as contagens para FoxP3 e CD4 foram significativamente mais elevadas na displasia esporádica de alto grau (p = 0,0008 e p = 0,0018, respetivamente) quando comparadas com lesões correspondentes em doentes com polipose adenomatosa familiar. Discussão: O presente estudo sugere que o microambiente imunológico de lesões esporádicas e hereditárias é diferente. As lesões esporádicas contam com um número superior de células T reguladoras, supressoras da função imunológica, sugerindo-se uma pressão imune seletiva mais forte. Por seu turno, as lesões hereditárias parecem beneficiar de um microambiente imunológico mais tolerante, permitindo o desenvolvimento de lesões com menor infiltrado celular imune. Conclusão: Este estudo demonstra que as lesões esporádicas contam com contagens de infiltrados imunológicos tumorais superiores, o que poderá refletir uma maior tolerância imunológica face a lesões hereditárias.

We present a method to super-resolve voxelized point clouds down-sampled by a fractional factor, using look-up-tables (LUT) constructed from self-similarities from its own down-sampled neighborhoods. Given a down-sampled point cloud geometry Vd, and its corresponding fractional down-sampling factor s, the proposed method determines the set of positions that may have generated Vd, and estimates which of these positions were indeed occupied (super-resolution). Assuming that the geometry of a point cloud is approximately self-similar at different scales, LUTs relating down-sampled neighborhood configurations with children occupancy configurations can be estimated by further down-sampling the input point cloud to Vd2 , and by taking into account the irregular children distribution derived from fractional down-sampling. For completeness, we also interpolate texture by averaging colors from adjacent neighbors. We present extensive test results over different point clouds, showing the effectiveness of the proposed method against baseline methods.

Geometry-based point cloud compression (G-PCC) has been rapidly evolving in the context of international standards. Despite the inherent scalability of octree-based geometry description, current G-PCC attribute compression techniques prevent full scalability for compressed point clouds. In this paper, we present a solution to add scalability to attributes compressed using the region-adaptive hierarchical transform (RAHT), enabling the reconstruction of the point cloud using only a portion of the original bitstream. Without the full geometry information, one cannot compute the weights in which the RAHT relies on to calculate its coefficients for further levels of detail. In order to overcome this problem, we propose a linear relationship approximation relating the downsampled point cloud to the truncated inverse RAHT coefficients at that same level. The linear relationship parameters are sent as side information. After truncating the bitstream at a point corresponding to a given octree level, we can, then, recreate the attributes at that level. Tests were carried out and results attest the good approximation quality of the proposed technique.

O objetivo do artigo é descrever a utilização do método Failure Mode end Effect Analysis (FMEA) no gerenciamento do processo de movimentação de contêineres vazios em uma empresa do ramo da logística, que atua, entre outras atividades logísticas, como Terminal de Contêineres Vazios. Desta forma, buscou-se identificar e classificar os modos de falha potenciais que podem ocorrer durante o processo. O estudo de caso consistiu na aplicação de um questionário semiestruturado, o qual foi direcionado à equipe multidisciplinar composta por oito funcionários da empresa em estudo. Com o auxílio de profissionais da área, identificou-se vinte modos de falha potenciais, que adaptados à realidade da empresa estudada, foram classificados quanto à gravidade, ocorrência e detectabilidade. A partir dos cinco modos de falha potenciais com maior Número de Prioridade de Risco (RPN), foram identificados as causas e os efeitos. Assim, elencou-se sugestões de medidas corretivas que podem ser adotadas pela empresa para minimizar os efeitos das falhas, melhorar a produtividade da empresa e diminuir o lead time do processo. Sugere-se, para trabalhos futuros, a aplicação das medidas corretivas elencadas nesta pesquisa e a comparação dos cenários para verificação de melhorias no processo, na produtividade e na qualidade do serviço prestado.

An accurate diagnosis of visceral leishmaniasis is an essential tool for control of the disease. While serologic methods are very useful, these conventional methodologies still present limitations in terms of sensitivity and specificity. The use of flow cytometry is a worldwide trend in the development of high-performance diagnostic methods. Herein, we describe a new flow cytometry serology test, characterized by the employment of the Cytometric Bead Array microspheres A4 and E4 coated with the recombinant antigens rLci1A and rLci2B respectively, to improve the serodiagnosis of canine visceral leishmaniasis. The tests were conducted in a wide variety of sera groups (n = 140), where the diagnostics development would be optimized accounting not just the ability to identify infected dogs with different clinical status, but also to exclude cross-reaction and differentiate vaccinated dogs from dogs infected. Serological testing of the antigenic system A4-rLci1A showed a sensitivity of 90.0% and specificity of 75%, while the E4-rLci2B testing demonstrated a sensitivity of 95.0% and specificity of 82.5%. The use of a multiplex assay of A4-rLci1A and E4-rLci2B, resulted in a diagnostic improvement, with a sensitivity of 95.0% and specificity of 91.2%. Our results show that this novel flow cytometry serology test is a viable tool for sensitive and specific serodiagnosis. Notably, the combination of distinct antigenic systems allows us to test for antibodies to multiple recombinant antigens from a single serum sample. This benefit emphasizes the importance of this methodology as an alternative in the serological diagnosis.

Objective Robotic surgical systems have been developed to improve spine surgery accuracy. Studies have found significant reductions in screw revision rates and radiation exposure with robotic assistance compared with open surgery. The aim of the present study was to compare the perioperative outcomes between robot-assisted (RA) and fluoroscopically guided (FG) minimally invasive (MI) transforaminal lumbar interbody fusion (TLIF) performed by a single surgeon. Methods The present retrospective cohort study analyzed all patients with lumbar degenerative disease who had undergone MI-TLIF by a single surgeon from July 2017 to March 2020. One group had undergone FG MI-TLIF and one group had undergone RA MI-TLIF. Results Of the 101 patients included in the present study, 52 had undergone RA MI-TLIF and 49, FG MI-TLIF. We found no statistically significant differences in the operative time (RA, 241 ± 69.3 minutes; FG, 246.2 ± 56.3 minutes; P = 0.681). The mean radiation time for the RA group was 32.8 ± 28.8 seconds, and the mean fluoroscopy dose was 31.5 ± 30 mGy. The RA radiation exposure data were compared with similar data for the FG MI-TLIF group in a previous study (59.5 ± 60.4 mGy), with our patients' radiation exposure significantly lower (P = 0.035). The postoperative complications and rates of surgical revision were comparable. Conclusions Our results have demonstrated that RA MI-TLIF provides perioperative outcomes comparable to those with FG MI-TLIF. A reduced radiation dose to the patient was observed with RA compared with FG MI-TLIF. No differences were noted between the RA and FG cohorts in operative times, complication rates, revision rates, or length of stay.

Hypothalamic hamartomas are rare congenital gray matter heterotopias associated with a triad of gelastic seizures, precocious puberty, and developmental delay. Gelastic seizures typically have a childhood onset and are drug-resistant, with scalp electroencephalogram (EEG) having limited utility to identify abnormalities. On neuroimaging with brain MRI, the hamartomas are usually nonenhancing, are nearly isointense relative to the adjacent gray matter on all sequences, and are not associated with abnormal restricted diffusion.

The objective of the work is to carry out research and evidence of national and international publications on the subject of port leasing management models. It is an applied study, with quantitative character, whose delineation follows the guidelines of a descriptive research, with the use of bibliometric analysis as an analysis tool. The research was carried out in IEEE, Science Direct, Scopus and Web of Science databases. As a limitation of the study, the non-use of keywords used by the authors in the portfolio articles was obtained, as well as the increase of the databases. It is suggested for future works the expansion of the key words, in order to complement the understanding of the gaps identified in the present study and the accomplishment of other analyses to the research subject, such as the meta analysis and the metasynthesis., El objetivo de lo trabajo es llevar a cabo investigaciones y pruebas de publicaciones nacionales e internacionales sobre el tema de los modelos de gestión de arrendamiento de puertos. Se trata de un estudio aplicado, de carácter cuantitativo, cuya delimitación sigue las pautas de una investigación descriptiva, con el uso del análisis bibliométrico como herramienta de análisis. La investigación se llevó a cabo en las bases de datos del IEEE, Science Direct, Scopus y Web of Science. Como limitación del estudio, se obtuvo la no utilización de palabras clave utilizadas por los autores en los artículos de la cartera, así como el aumento de las bases de datos. Se sugiere para futuros trabajos la ampliación de las palabras clave, a fin de complementar la comprensión de las lagunas identificadas en el presente estudio y la realización de otros análisis al tema de investigación, como el meta análisis y la metasíntesis., O objetivo do trabalho é realizar investigação e evidenciação das publicações nacionais e internacionais, acerca da temática de modelos de gestão de arrendamento portuário. Trata-se de um estudo aplicado, com caráter quantitativo, cujo delineamento segue as diretrizes de uma pesquisa descritiva, com o emprego da análise bibliométrica como ferramenta de análise. A pesquisa foi procedida nas bases de dados IEEE, Science Direct, Scopus e Web of Science. Como limitação do estudo, obteve-se o não emprego de palavras-chave utilizadas pelos autores nos artigos do portfólio, bem como, o aumento das bases de dados. Sugere-se para trabalhos futuros a ampliação das palavras-chave, a fim de complementar o entendimento das lacunas identificadas no presente estudo e a realização de outras análises ao tema de pesquisa, como a meta análise e a metassíntese.

The objective of the work is to carry out research and evidence of national and international publications on the subject of port leasing management models. It is an applied study, with quantitative character, whose delineation follows the guidelines of a descriptive research, with the use of bibliometric analysis as an analysis tool. The research was carried out in IEEE, Science Direct, Scopus and Web of Science databases. As a limitation of the study, the non-use of keywords used by the authors in the portfolio articles was obtained, as well as the increase of the databases. It is suggested for future works the expansion of the key words, in order to complement the understanding of the gaps identified in the present study and the accomplishment of other analyses to the research subject, such as the meta analysis and the metasynthesis. El objetivo de lo trabajo es llevar a cabo investigaciones y pruebas de publicaciones nacionales e internacionales sobre el tema de los modelos de gestión de arrendamiento de puertos. Se trata de un estudio aplicado, de carácter cuantitativo, cuya delimitación sigue las pautas de una investigación descriptiva, con el uso del análisis bibliométrico como herramienta de análisis. La investigación se llevó a cabo en las bases de datos del IEEE, Science Direct, Scopus y Web of Science. Como limitación del estudio, se obtuvo la no utilización de palabras clave utilizadas por los autores en los artículos de la cartera, así como el aumento de las bases de datos. Se sugiere para futuros trabajos la ampliación de las palabras clave, a fin de complementar la comprensión de las lagunas identificadas en el presente estudio y la realización de otros análisis al tema de investigación, como el meta análisis y la metasíntesis. O objetivo do trabalho é realizar investigação e evidenciação das publicações nacionais e internacionais, acerca da temática de modelos de gestão de arrendamento portuário. Trata-se de um estudo aplicado, com caráter quantitativo, cujo delineamento segue as diretrizes de uma pesquisa descritiva, com o emprego da análise bibliométrica como ferramenta de análise. A pesquisa foi procedida nas bases de dados IEEE, Science Direct, Scopus e Web of Science. Como limitação do estudo, obteve-se o não emprego de palavras-chave utilizadas pelos autores nos artigos do portfólio, bem como, o aumento das bases de dados. Sugere-se para trabalhos futuros a ampliação das palavras-chave, a fim de complementar o entendimento das lacunas identificadas no presente estudo e a realização de outras análises ao tema de pesquisa, como a meta análise e a metassíntese.

BACKGROUND Intraoperative detection of residual tumor and isocitrate dehydrogenase (IDH) mutations can assist in maximizing surgical resection beyond contrast enhancing margins and guide intraoperative surgical decision making for glioma patients. We aimed to evaluate the use of desorption electrospray ionization-mass spectrometry (DESI-MS) for intraoperative assessment of IDH mutations and estimation of tumor cell percentage (TCP). METHODS This is a prospective study using intraoperative DESI-MS analysis of freshly obtained tissue samples to evaluate IDH mutations via 2-hydroxyglutarate (2-HG) intensity and TCP via measurement of N-acetylaspartic acid (NAA) intensity and characteristic lipid profiles. These IDH mutation and TCP estimates were subsequently validated by a senior neuropathologist. RESULTS A total of 247 biopsies from a 49-patient study were previously collected and analyzed at Indiana University. Assessment of TCP in 203 margin and core biopsies based on NAA intensity yielded sensitivity, specificity, and accuracy values of 91, 76, and 83%, whereas TCP assessment based on characteristic lipid profiles yielded 76, 85, and 81%, respectively. Assessment of IDH mutation status of 71 core biopsies yielded sensitivity, specificity, and accuracy values of 89, 100, and 94%. Further validation of the methodology is being performed in an ongoing collaboration with Mayo Clinic-Jacksonville, where we have collected 178 biopsies from 24 patients. Preliminary results of IDH mutation assessments indicate 100% sensitivity, specificity, and accuracy. DISCUSSION/CONCLUSION We present a novel system to allow intraoperative evaluation of IDH status and to guide surgical resection by TCP measurement from tissue biopsies. Prospectively, we propose to modify our DESI-MS system by placing a surgical material (e.g. cottonoid) along the surgical margin and transferring material from the blot to a microscope slide prior to DESI-MS analysis. This will allow the retention of the spatial distribution of diagnostic molecules while analyzing a wall of the surgical cavity without the need for biopsy.

Background. The tumor immune microenvironment exerts a pivotal influence in tumor initiation and progression. The aim of this study was to analyze the immune context of sporadic and familial adenomatous polyposis (FAP) lesions along the colorectal adenoma–carcinoma sequence (ACS). Methods. We analyzed immune cell counts (CD3+, CD4+, CD8+, Foxp3+, and CD57+), tumor mutation burden (TMB), MHC-I expression and PD-L1 expression of 59 FAP and 74 sporadic colorectal lesions, encompassing adenomas with low-grade dysplasia (LGD) (30 FAP, 30 sporadic), adenomas with high-grade dysplasia (22 FAP, 30 sporadic), and invasive adenocarcinomas (7 FAP, 14 sporadic). Results. The sporadic colorectal ACS was characterized by (1) a stepwise decrease in immune cell counts, (2) an increase in TMB and MHC-I expression, and (3) a lower PD-L1 expression. In FAP lesions, we observed the same patterns, except for an increase in TMB along the ACS. FAP LGD lesions harbored lower Foxp3+ T cell counts than sporadic LGD lesions. A decrease in PD-L1 expression occurred earlier in FAP lesions compared to sporadic ones. Conclusions. The colorectal ACS is characterized by a progressive loss of adaptive immune infiltrate and by the establishment of a progressively immune cold microenvironment. These changes do not appear to be related with the loss of immunogenicity of tumor cells, or to the onset of an immunosuppressive tumor microenvironment.