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Introduction. Surgery of the primary tumor following extended course of chemoimmunotherapy has only recently been recognized as a feasible and safe option for selected groups of patients with initially unresectable non-small cell lung cancer. Case outline. Here we report a case of a 49-year-old female patient, who never smoked, that was diagnosed with metastatic non-small cell lung cancer. Lesions were evident in both lungs and the brain. She underwent stereotactic radiosurgery for brain metastases and combination therapy of chemotherapy, atezolizumab and bevacizumab. Response to therapy was both remarkable and durable. Ten cycles into treatment, magnetic resonance imaging of the brain revealed no metastatic lesions. Positron emission tomography / computed tomography revealed a single lesion in the right upper lobe 22 × 23 mm in diameter. The patient underwent a right upper lobectomy. Pathohistological evaluation of the specimen revealed complete pathologic response. The patient recovered from surgery and continued chemoimmunotherapy. Four months post-surgery she is disease free and of excellent performance status. Conclusion. Primary tumor surgery following extensive chemoimmunotherapy regiment is feasible and could be considered as a treatment option. Further research is warranted to define a patient population that stands to benefit the most from this modality.

Introduction. Primary malignant tumors of the sternum are rare, with chondrosarcoma being the most common primary malignant tumor of the chest. The gold standard in treatment is surgical treatment with wide resection margins, where the rigidity of the chest wall must be ensured, with protection of internal organs with satisfactory lung function. Case outline. We present a 67-year-old patient in whom previous computed tomography and magnetic resonance imaging examinations confirmed a tumor mass involving the sternum with the associated ribs, with involvement of the soft tissues above. First, sternum resection was performed with partial resection of the associated ribs and soft tissues. Reconstruction and stabilization of the chest wall were achieved with two layers of polypropylene mesh and methyl methacrylate bone cement with antibiotics. We reconstructed the primary soft tissue defect with a combination of a large local fasciocutaneous flap raised from the abdomen and a smaller sliding flap from the chest. The secondary defect was reconstructed by wide undermining of the skin in the area of the anterior abdominal wall and a small Thiersch-type free skin graft. In the postoperative period, the flaps were vital, but there was necrosis of the free skin graft. That defect was closed secondary thanks to bandaging. Respiratory function was preserved. Conclusion. Surgical treatment is the main treatment for sternal chondrosarcoma. With an adequate preoperative and intraoperative approach, it is necessary to enable good postoperative oncological outcomes with the achievement of chest rigidity and satisfactory respiratory status.

Nosocomnial (hospital) pneumonias (hospital-acquired pneumonia - HAP) are defined as pneumonias in hospitalized patients that occur within 48 hours after admission to the hospital or later. These types of lung parenchymal infections are caused by pathogens that are present in the hospital environment. The incubation period is no longer than two days. Nosocomial pneumonias are the second most common of all hospital infections and the highest prevalence is recorded in intensive care units (ICU) (internal medicine and surgery). They represent a great burden on the health system everywhere in the world, because it is estimated that as many as 25% of infections in the ICU are hospital-acquired, and that 50% of all antibiotics are used precisely for their treatment. Recognizing the causative agent can be challenging, primarily due to the difficulty of adequate sputum sampling, but also due to the lack of understanding of the epidemiological situation in a particular health facility.

BackgroundAssessing the relationship between lung cancer and metabolic conditions is challenging because of the confounding effect of tobacco. Mendelian randomization (MR), or the use of genetic instrumental variables to assess causality, may help to identify the metabolic drivers of lung cancer.Methods and findingsWe identified genetic instruments for potential metabolic risk factors and evaluated these in relation to risk using 29,266 lung cancer cases (including 11,273 adenocarcinomas, 7,426 squamous cell and 2,664 small cell cases) and 56,450 controls. The MR risk analysis suggested a causal effect of body mass index (BMI) on lung cancer risk for two of the three major histological subtypes, with evidence of a risk increase for squamous cell carcinoma (odds ratio (OR) [95% confidence interval (CI)] = 1.20 [1.01-1.43] and for small cell lung cancer (OR [95%CI] = 1.52 [1.15-2.00]) for each standard deviation (SD) increase in BMI [4.6 kg/m2]), but not for adenocarcinoma (OR [95%CI] = 0.93 [0.79-1.08]) (Pheterogeneity = 4.3x10-3). Additional analysis using a genetic instrument for BMI showed that each SD increase in BMI increased cigarette consumption by 1.27 cigarettes per day (P = 2.1x10-3), providing novel evidence that a genetic susceptibility to obesity influences smoking patterns. There was also evidence that low-density lipoprotein cholesterol was inversely associated with lung cancer overall risk (OR [95%CI] = 0.90 [0.84-0.97] per SD of 38 mg/dl), while fasting insulin was positively associated (OR [95%CI] = 1.63 [1.25-2.13] per SD of 44.4 pmol/l). Sensitivity analyses including a weighted-median approach and MR-Egger test did not detect other pleiotropic effects biasing the main results.ConclusionsOur results are consistent with a causal role of fasting insulin and low-density lipoprotein cholesterol in lung cancer etiology, as well as for BMI in squamous cell and small cell carcinoma. The latter relation may be mediated by a previously unrecognized effect of obesity on smoking behavior.

Background/Aim. Pectus excavatum (PE) is the most common deformity of the frontal aspect of the chest wall in children. A particular dilemma arises about the degree of deformity that should be subjected to surgical treatment. The aim of this study was to compare several morphological methods of evaluating the degree of deformity and determine the matching among them, a s w ell a s t o determine the connection between the functional and morphological abnormalities of echocardiography. Methods. The study included 35 patients with PE, aged between 7 and 15 years. A noninvasive evaluation of chest deformity was carried out in all patients by photographic method (surrogate of clinical examination), native X-ray imaging, and computed tomography (CT), as well as by echocardiographic examination. Results. In our group of patients, males were more common (67.5%), as well as children with the Haller index (HI) > 3.5 [represented in most children (86.7%)]. A significant correlation of the index of the affected sternum segment (ASt) and the total length of the sternum (ASt/LSt) determined by the photographic method with that determined by the CT scan of the chest was established (p = 0.001). In addition, the correlation between HI, determined by the X-ray method and CT images was presented (p = 0.012). In contrast, despite the high frequency of echocardiographic abnormalities (69%), those were not mutually correlated with the degree of pronounced morphological deformities of the chest wall. Conclusion. A detailed clinical examination and photographic evaluation method, combined with the X-ray method, can determine the severity of deformity with a high degree of agreement with the CT chest findings. In this way, it is possible for children with PE, who are not candidates for surgical treatment, to be s pared f rom r epeated C T scans t hat a re c arried o ut i n order to monitor the development of chest deformities with growth. Echocardiographic evaluation remains an integral part of the assessment of children with PE.

In this paper, the analysis of Shannon capacity for selection combining (SC) and maximal ratio combining (MRC) diversity systems in the generalized α - κ - μ fading channel is presented. Closed-form expressions for probability density function (PDF) at the output of SC and MRC diversity systems are given. Also, closed-form expressions for Shannon capacity for cases of SC diversity with independent and identically distributed branches, MRC diversity with independent and identically distributed branches and for case of no diversity are derived. The obtained results are numerically calculated and graphically presented for different combinations of fading parameters α, κ and μ.

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Background: To assess the subjective experience of patients and their parents or relatives about the existing pectus excavatum deformity and to contribute to the definition of indications for surgical treatment of this deformity. Methods: The initial sample of psychosocial characteristics consisted of self‐assessments and observations of patients (and parents) regarding their health, self‐image, health care, possible environmental response to their physical appearance, expectations regarding treatment. A modified version of the original Nuss questionnaire on quality of life was used in the psychological part of the examination. Results: The study included a sample of 58 patients aged 10 to 30 years, and a sample of 58 family members of the patient (parents, relatives). The experience of poor emotional status, withdrawals, and bad self‐image in patients older than 15 years than younger were significant. The tendency for female patients to have a worse experience is pronounced and significant. The largest percentage of parents have an 'indecisive' or 'weakly expressed' attitude towards surgery. Parents at a significantly higher rate show greater concern for female children. Conclusion: A systematic evaluation of the psychosocial perception of patients and their relatives (who will consent for the operation) may be a useful diagnostic assessment before correcting an anterior chest wall malformation. [ABSTRACT FROM AUTHOR]

In this paper, HK statistical model is considered. The application of HK distribution in modeling atmospheric turbulence channel under the influence of strong and weak turbulences and all irradiance fluctuations are discussed. Expression for atmospherics turbulence channel model, pointing error models and path loss are given. Probability density functions (PDF) for both pointing error models (zero boresight and nonzero boresight) are calculated and graphically represented. Also, average bit-error-rate (BER) for zero boresight pointing error and nonzero boresight pointing error are calculated and graphically represented. Closed form expression for PDF and BER are given. Impact of zero boresight pointing error and nonzero boresight pointing error on transmission over atmospheric turbulence channel in FSO system is explained.

Introduction. Retroperitoneal hematoma may occur as a result of trauma, but also from rupture of arterial aneurysms (aortic or iliac), surgical complications, tumors or anticoagulation therapy. Case report. We presented a patient on permanent anticoagulation therapy. On the day of admission to our institution, the patient had the value of his INR 5.57 which required immediate suspension of the therapy. The main symptom in this patient was pain in the right inguinal canal with propagation along the right leg, which was indicated in clinical picture of spontaneous retroperitoneal haematoma. After three days the fall of hemoglobin occurred, so the additonal diagnostics was done. A computed tomography of the abdomen was performed showing well limited, large retroperitoneal hematoma (213 x 79 x 91 mm). Transfusion of concentrated red blood cells was performed twice with satisfactory correction of hemoglobin level, and four units of fresh frozen plasma. The patient was hemodynamically stabilized and discharged after a two-month long intensive care unit treatment, with the advice to use low-molecular weight heparin 2 x 0.4 mg subcutaneusly, due to persistent arrhythmia. Conclusion. In patients on anti-coagulation therapy regular monitoring of the anticoagulant status is extremely important, because of the possibility of fatal complications development, such as retroperitoneal hematoma.

The most common causative agents of dermatomycoses are fungi belonging to genders Trichophyton, Microsporum and Epidermophyton. Media mainly used for isolation of dermatophytes are mycobiotic agar, dermatophyte test medium Sabouraud agar (original formula or modification by Emmons) with or without antibiotics and cycloheximide. Peptones are the most important components of the media, which enable adequate reproductivity in identification of dermatophytes. Standard medium for isolation of dermatophytes is not produced in our country. The aim of the study was to create an optimal easily accessible and economic medium which enables isolation and identification of dermatophytes according to criteria for morphological diagnosis provided by identification guides. We examined 57 strains of Trichophyton, 24 of Microsporum and 5 of Epidermophyton floccosum (E. floccosum). Each strain was seeded on Sabouraud dextrose agar (Torlak Serbia and Montenegro), Sabouraud maltose agar (Torlak), two experimental modified Sabouraud dextrose agar media marked as SA-2 and SA-3 (Torlak) Sabouraud-Chloramp- henicole agar (Biomerieux, France) Sabouraud-Chloramphenicole agar (Himedia, India), Glucose-peptone agar (Himedia, India) and Sabouraud Emmons dextrose Agar with Chloramphenicole and Cycloheximide (Biolife, Italy). Colony morphology of Trichophyton mentagrophytes (T. mentagrophytes) was uni- form on all the media, while morphology of Trichophyton rubrum (T. rubrum) and Microsporum canis (M. canis) depended more on the media type. Colonies of E. floccosum were typical and uniform on all the media, as were the control species of Trichophyton schoenleinii (T. schoenleinii) and Trichophyton soudanense (T. soudanense). Experimental modified Sabouraud dextrose agar (Torlak) marked as SA-3 demonstrated the best results in identification of dermatophytes in this study.

As a part of wider project sigma-delta modulator was designed. It represents an A/D part of a power meter IC. Requirements imposed were: SNDR and dynamic range > 50 dB for maximum input swing of 250 mV differential at 50 Hz. Over sampling ratio is 128 with clock frequency of 524288 Hz which gives bandwidth of 2048 Hz. Circuit is designed in 3.3 V supply standard CMOS 0.35 µm technology.

The main issue when dealing with the non-adaptive scalar quantizers is their sensitivity to variance-mismatch, the effect that occurs when the data variance differs from the one used for the quantizer design. In this paper, we consider the influence of that effect in low-rate (2-bit) uniform scalar quantization (USQ) of Laplacian source and also we propose adequate measure to suppress it. Particularly, the approach we propose represents the upgraded version of the previous approaches used to improve performance of the single quantizer. It is based on dual-mode quantization that combines two 2-bit USQs (with adequately chosen parameters) to process input data, selected by applying the special rule. Analysis conducted in theoretical domain has shown that the proposed approach is less sensitive to variance-mismatch, making the dual-mode USQ more efficient in terms of robustness than the single USQ. Also, a gain is achieved compared to other 2-bit quantizer solutions. Experimental results are also provided for quantization of weights of the multi-layer perceptron (MLP) neural network, where good matching with the theoretical results is observed. Due to these achievements, we believe that the solution we propose can be a good choice for compression of non-stationary data modeled by Laplacian distribution, such as neural network parameters. [ABSTRACT FROM AUTHOR]

Quantization and compression of neural network parameters using the uniform scalar quantization is carried out in this paper. The attractiveness of the uniform scalar quantizer is reflected in a low complexity and relatively good performance, making it the most popular quantization model. We present a design approach for the memoryless Laplacian source with zero-mean and unit variance, which is based on iterative rule and uses the minimal mean-squared error distortion as a performance criterion. In addition, we derive closed-form expressions for SQNR (Signal to Quantization Noise Ratio) in a wide dynamic range of variance of input data. To show effectiveness on real data, the proposed quantizer is used to compress the weights of neural networks using bit rates from 9 to 16 bps (bits/sample) instead of standardly used 32 bps full precision bit rate. The impact of weights compression on the NN (neural network) performance is analyzed, indicating good matching with the theoretical results and showing negligible decreasing of the prediction accuracy of the NN even in the case of high variance-mismatch between the variance of NN weights and the variance used for the design of quantizer, if the value of the bit-rate is properly chosen according to the rule proposed in the paper. The proposed method could be possibly applied in some of the edge-computing frameworks, as simple uniform quantization models contribute to faster inference and data transmission. [ABSTRACT FROM AUTHOR]

BSIM4 model is not suitable for distortion analysis of circuits with bias point , such as passive mixers and RF switches, due to discontinuities in higher order derivatives. Surface potential based PSP model has continuous derivatives to at least third-order, and is therefore suitable for intermodulation products simulation. This paper presents the case study of BSIM4 to PSP model conversion flow and comparison of active and passive mixers and SPDT RF switch simulation results. Simulation results show good agreement of original BSIM4 and converted PSP models' CV, IV, compression point, conversion loss and noise figure, which validates the conversion flow. The converted model has a correct third-order intermodulation products (IM3) slope of three, allowing the simulation of intermodulation products, which was not possible with the original BSIM4 model. [ABSTRACT FROM AUTHOR]

The paper presents some aspects of overhead transmission lines (OHL) modeling for lightning overvoltages estimation in engineering practice. Different models of elements are compared, and sensitivity analysis is performed with the aim to investigate their influence to the OHL insulation stress due to lightning discharges. Elements are modeled according to international technical documents covering this field. Great influence of applied model of air flashover to the lightning current, sufficient to cause back flashover, is noticed. Calculation results obtained with different combinations of element models have been compared and large deviations are noticed. The models of elements for lightning overvoltages estimation should be carefully chosen to achieve reliable estimations. Constant resistance model of tower grounding and voltage-time curve model of air breakdown must be avoided in calculations, despite the fact that they are suggested in many technical documents dealing with lightning overvoltages at OHL. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]