•39,848 cancer patients were registered between Feb-May 2020 in 66 ROD in Spain.•For COVID-19, incidence was 0.8%. Mortality was 22%. 64,3% required hospitalization.•Compared to the general ...population, higher severity and mortality of COVID-19 was observed.•Patient and treatment selection is crucial. Hypofractionation should be considered.
The main contribution of this paper is to show a new AC/DC converter based on the rearrangement of the flyback converter. The proposed circuit only manages part of the energy and the rest is ...delivered directly from the source to the load. Therefore, with the new topology, the efficiency is increased, and the stress of the components is reduced. The rearrangement consist of the secondary of the flyback is placed in parallel with the load, and this arrangement is connected in series with the primary side and the rectified voltage source. The re-arranged flyback is only a reductive topology and with no magnetic isolation. It was studied as a power supply for LEDs. A low frequency averaged analysis (LFAA) was used to determine the behavior of the proposed circuit and an equivalent circuit much easier to analyze was obtained. To validate the theoretical analysis, a design methodology was developed for the re-arranged flyback converter. The designed circuit was implemented in a 10 W prototype. Experimental results showed that the converter has a THDi = 21.7% and a PF = 0.9686.
There are few trials published on treatment in elderly women with low-risk breast cancer. Although the clinical behavior is like younger patients, there is a tendency to undertreat them, which may ...lead to an increase in the risk of local relapses and decrease their survival. The local recurrences omitting adjuvant treatment (tamoxifen or radiotherapy) after breast conserving surgery (BCS) even in low-risk patients is high, reaching up 20%, which is unacceptable. Although tamoxifen and radiotherapy seem to have a similar effect in reducing local recurrence with equal overall survival, the combination of both achieves the maximum benefit with local relapses of less than 2%. In recent years two studies have been published and were designed specifically for elderly patients. The CALGB 9343 and the PRIME II trials recommend omitting radiotherapy in patients with low-risk tumors treated with BCS and tamoxifen based on a similar survival, but with an increase in local relapses when radiotherapy is omitted, 10% at 10 years
2%. There is no basis to ensure that a treatment with tamoxifen has less toxicity in this group of patients who are usually poly-treated, and it seems that treatment compliance is much lower than expected. The decrease in the number of sessions in external radiotherapy with hypofractionation and accelerate partial breast irradiation, especially intraoperative radiotherapy (IORT) with a single session, makes this recommendation very controversial. Elderly patients may benefit from radiation therapy after BCS.
•Classification and prediction of bulk densities of states and chemical attributes with machine learning techniques.•Clusterization algorithm based on information obtained from the DOS.•Four groups ...clearly differentiated, whose more representative elements are scandium, iron, gold and mercury.•Possibility to univocally classify materials and predict in a fast and accurate manner different physical and chemical properties.
The electronic structure encapsulated in the density of states (DOS) is key to explain several physical properties of any material, i.e. from the knowledge of the DOS and its dependence on certain parameters it is possible to obtain a lot of information on the type of material and its behaviour. We outline in this article a series of methods that can be employed to classify and predict bulk DOS in an easy and efficient manner. These methods are based on machine learning techniques that are used to classify the elements and extract information from the DOS curves. We focus in particular in the bulk DOS of d-elements with different crystal lattices. We use a clusterization algorithm based on information obtained from the DOS, which is able to properly classify the elements in groups that are electronically similar. We find four groups clearly differentiated, whose more representative elements are scandium, iron, gold and mercury, and which tend to crystallize in similar lattice structures in their ground state. We further reduce the dimensionality of the data and find a new basis of DOS that, along with chemical properties of each type of element and basic information encapsulated in the DOS, is able to predict with a high degree of accuracy most of the original curves. We apply such basis and information to predict with reasonably accuracy the DOS curve of different elements. We also use that data to predict the chemical properties and the correlations between them. In particular, we apply the algoritm to calculate the Pauling electronegativity and find a rather good agreement between the predicted and real values. Finally, from intrinsic parameters, the DOS of other elements and additional information that is needed to properly describe the electronic structure, we predict the particular DOS of a particular element with a good degree of accuracy, including the width and general shape of the central part associated to the d states. These calculations prove that, by using pure electronic information encapsulated in the bulk DOS, it is possible to univocally classify materials and predict in a fast and accurate manner different physical and chemical properties.
This paper focuses on the main reasons of low efficiency in a current-fed DC-DC resonant converter applied to photovoltaic (PV) isolated systems, comparing the effects derived by the overlapping time ...in the gate-signals (gate-source voltage) combining silicon (Si), silicon carbide (SiC), and gallium nitride (GaN)-based power devices. The results show that unidirectional switches (metal–oxide–semiconductor field-effect transistors (MOSFETs) plus diode) present hard switching as a result of the diode preventing the MOSFET capacitance of being discharged. The effectiveness of the converter was verified with a 200-W prototype with an input voltage range of 0–30.3 V, an output voltage of 200 V, and a switching frequency of 200 kHz. The reduction losses by applying GaN versus Si and SiC technologies are 66.49% and 53.57%, respectively. Alternatively, by applying SiC versus Si devices the reduction loss is 27.84%. Finally, according to the results, 60% of losses were caused by the diodes on both switches.
The aim of this study was evaluate the rate of sustained viral response (SVR) and the influence of different factors on the SVR in patients with chronic hepatitis C virus (HCV) infection treated with ...pegylated interferon alfa 2a and ribavirin.
We retrospectively analysed 272 naïve patients with chronic hepatitis C who had been treated for 24 weeks or 48 weeks and had been followed for an additional 6 months thereafter.
Out of 272 patients, 243 completed the entire treatment. The overall SVR rate in intent-to-treat analysis was 66.5% and in treated patients was 74.5%. In an univariate analysis, the SVR was associated with age <40 years (84.4%),pre-treatment viral load <500.000 IU/ml (86.9%), non-1 genotype HCV (86.4%), non cirrhosis or pre-cirrhosis (76.5%), rapid virologic response (RVR) (91.4%) and early virologic response (EVR) (83.8%). In the multivariate logistic regression analysis, the presence of an infection caused by a non-1 genotype and to achieve ERV were independent predictors of SVR. The RVR and histological stage of liver disease were not included in the multivariate analysis because these data were not available in most of the patients. The PPV and NVP of RVR were 91.5% and 48.7% respectively, of EVR were 83.8% and 95.8% respectively and of complete EVR were 91.3% and 78.7%, respectively.
The SVR was higher than in other studies. The genotype and EVR were independent factors to predict the effect of antiviral therapy. The EVR had a high NPV and the complete EVR a high PPV.
Infection with SARS-CoV-2 variant Omicron is considered to be less severe than infection with variant Delta, with rarer occurrence of severe disease requiring intensive care. Little information is ...available on comorbid factors, clinical conditions and specific viral mutational patterns associated with the severity of variant Omicron infection. In this multicenter prospective cohort study, patients consecutively admitted for severe COVID-19 in 20 intensive care units in France between December 7th 2021 and May 1st 2022 were included. Among 259 patients, we show that the clinical phenotype of patients infected with variant Omicron (n = 148) is different from that in those infected with variant Delta (n = 111). We observe no significant relationship between Delta and Omicron variant lineages/sublineages and 28-day mortality (adjusted odds ratio 95% confidence interval = 0.68 0.35-1.32; p = 0.253). Among Omicron-infected patients, 43.2% are immunocompromised, most of whom have received two doses of vaccine or more (85.9%) but display a poor humoral response to vaccination. The mortality rate of immunocompromised patients infected with variant Omicron is significantly higher than that of non-immunocompromised patients (46.9% vs 26.2%; p = 0.009). In patients infected with variant Omicron, there is no association between specific sublineages (BA.1/BA.1.1 (n = 109) and BA.2 (n = 21)) or any viral genome polymorphisms/mutational profile and 28-day mortality.
Background
Despite current broad natural and vaccine-induced protection, a substantial number of patients infected with emerging SARS-CoV-2 variants (e.g., BF.7 and BQ.1.1) still experience severe ...COVID-19. Real-life studies investigating the impact of these variants on clinical outcomes of severe cases are currently not available. We performed a prospective multicenter observational cohort study. Adult patients with acute respiratory failure admitted between December 7, 2021 and December 15, 2022, in one of the 20 participating intensive care units (17 from the Greater Paris area and 3 from the North of France) were eligible for inclusion if they had SARS-CoV-2 infection confirmed by a positive reverse transcriptase-polymerase chain reaction (RT-PCR). Full-length SARS-CoV-2 genomes from all included patients were sequenced by means of next-generation sequencing. The primary endpoint of the study was day-28 mortality.
Results
The study included 158 patients infected with three groups of Omicron sublineages, including (i) BA.2 variants and their early sublineages referred as “BA.2” (n = 50), (ii) early BA.4 and BA.5 sublineages (including BA.5.1 and BA.5.2, n = 61) referred as “BA.4/BA.5”, and (iii) recent emerging BA.5 sublineages (including BQ.1, BQ.1.1, BF.7, BE.1 and CE.1, n = 47) referred as “BQ.1.1”. The clinical phenotype of BQ1.1-infected patients compared to earlier BA.2 and BA.4/BA.5 sublineages, showed more frequent obesity and less frequent immunosuppression. There was no significant difference between Omicron sublineage groups regarding the severity of the disease at ICU admission, need for organ failure support during ICU stay, nor day 28 mortality (21.7%, n = 10/47 in BQ.1.1 group vs 26.7%, n = 16/61 in BA.4/BA.5 vs 22.0%, n = 11/50 in BA.2, p = 0.791). No significant relationship was found between any SARS-CoV-2 substitution and/or deletion on the one hand and survival on the other hand over hospital follow-up.
Conclusions
Critically-ill patients with Omicron BQ.1.1 infection showed a different clinical phenotype than other patients infected with earlier Omicron sublineage but no day-28 mortality difference.
Fístula de alto gasto Almeida Varela, Ricardo; Suárez Echeverría, Oscar; Pérez Gutiérrez, Oscar ...
Revista cubana de cirugía,
06/2012, Letnik:
51, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Se presenta a un paciente de 37 años de edad que acude a nuestro Cuerpo de Guardia politraumatizado, con lesiones torácicas y abdominales, con síntomas y signos sugestivos de fracturas costales ...múltiples, con hemotórax derecho y hemoperitoneo, corroborado imaginológicamente y en la punción abdominal. Se realiza pleurostomía mínima intermedia y laparotomía exploratoria. Se le encuentran lesiones hepáticas de los segmentos VI, V, VIII y IV, con una profundidad mayor de 3 cm, además, deserosamientos en las asas delgadas intestinales y colon. Se realiza hepatorrafia y empaquetamiento hepático. Posteriormente van apareciendo complicaciones, por lo que tiene que ser reintervenido en más de 60 ocasiones. Entre ellas, la aparición de una fístula de alto gasto, que lo llevó a la desnutrición y a la permanencia con el abdomen expuesto durante 7 meses hasta el egreso. Se revisa la literatura correspondiente a estas entidades.
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