A Conditional Simple Temporal Network with Uncertainty (CSTNU) is a formalism able to model temporal plans subject to both conditional constraints and uncertain durations. The combination of these ...two characteristics represents the uncontrollable part of the network. That is, before the network starts executing, we do not know completely which time points and constraints will be taken into consideration nor how long the uncertain durations will last. Dynamic Controllability (DC) implies the existence of a strategy scheduling the time points of the network in real time depending on how the uncontrollable part behaves. Despite all this, CSTNUs fail to model temporal plans in which a few conditional constraints are under control and may therefore influence (or be influenced by) the uncontrollable part. To bridge this gap, this paper proposes Conditional Simple Temporal Networks with Uncertainty and Decisions (CSTNUDs) which introduce decision time points into the specification in order to operate on this conditional part under control. We model the dynamic controllability checking (DC-checking) of a CSTNUD as a two-player game in which each player makes his moves in his turn at a specific time instant. We give an encoding into timed game automata for a sound and complete DC-checking. We also synthesize memoryless execution strategies for CSTNUDs proved to be DC and carry out an experimental evaluation with ▪, a tool that we have designed for CSTNUDs to make the approach fully automated.
This scientific commentary refers to ‘Intraoperative functional remapping unveils evolving patterns of cortical plasticity’ by Ng et al. (https://doi.org/10.1093/brain/awad116).
We investigated the clinical significance of a vascular growth pattern of hepatocellular carcinoma (HCC), the vessels that encapsulate tumor clusters (VETC), previously linked to HCC metastatic ...dissemination. VETC was assessed in a large multi‐institutional cohort of 541 resected HCCs from Italy, Korea and Japan, and matched against a full spectrum of clinical and pathological variables. The VETC phenotype (defined as ≥ 55% tumor area by CD34 immunostaining) was easily reproducible and reliably detectable in whole sections and small‐sized tissues of tissue microarray. VETC HCCs represented 18.9% of the whole series, the lowest proportion occurring in the cohort with smallest tumors (8.7%, Japanese series). VETC was significantly associated with several clinical and pathological features such as high alfa‐fetoprotein (AFP) level, tumor size greater than 5 cm, poor differentiation, macrotrabecular pattern, less compact pattern, less inflammatory infiltrates, and frequent microvascular invasion. VETC was associated with early recurrence (hazard ratio HR: 1.52 1.06‐2.19, P = 0.023), disease‐free survival (HR: 1.66 1.21‐2.27, P = 0.002), and overall survival (HR: 2.26 1.37‐3.72, P = 0.001) at multivariable analysis. VETC affected the survival in HCC patients stratified for etiology (hepatitis C virus/hepatitis B virus), vascular invasion, and specific molecular phenotypes (β‐catenin/GS+). This distinct vascular pattern was enriched in the recently reported macrotrabecular massive HCC subtype, which was seen in 7.8% (42 of 541) of patients and associated with high AFP levels and poor differentiation. Conclusion: The VETC pattern was found to be easily detectable in a consistent fraction of HCC and a powerful pathological finding affecting survival. This study suggests that the heterogeneous pattern of angiogenesis is involved in HCC behavior.
Abstract The timeless nature of fairy tales can help uncover the timeless nature of many cybersecurity notions. Using 16 classical tales as illustration, in this article, the author shows that fairy ...tales are full of cybersecurity motifs and examples, and can thus be used extensively and effectively to explain cybersecurity notions. Obviously not cybersecurity as we know it today, but rather the fundamental and archetypal concepts that are at its heart. Fairy tales can thus be employed to mediate in conversations with less-knowledgeable, misinformed, or even skeptical laypersons about cybersecurity, increase their understanding and awareness, and thereby strengthen the overall cybersecurity of systems and applications.
Background
R0 resection is the standard for colorectal liver metastases (CLMs). Adequacy of R1 resections is debated. Detachment of CLMs from vessels has been proposed to prioritize parenchyma ...sparing and increase resectability, but outcomes are still to be elucidated. The present study aimed to clarify the outcomes of R1 surgery (margin <1 mm) in patients with CLMs, distinguishing standard R1 resection (parenchymal margin, R1Par) and R1 resection with detachment of CLMs from major intrahepatic vessels (R1Vasc).
Methods
All patients undergoing first resection between 2004 and June 2013 were prospectively considered. R0, R1Par, and R1Vasc were compared in per-patient and per-resection area analyses.
Results
The study included 627 resection areas in 226 consecutive patients. Fifty-one (8.1 %) resections in 46 (20.4 %) patients were R1Vasc, and 177 (28.2 %) resections in 107 (47.3 %) patients were R1Par. Thirty-two (5.1 %) surgical margin recurrences occurred in 28 (12.4 %) patients. Local recurrence risk was similar between the R0 and R1Vasc groups (per-patient analysis 5.3 vs. 4.3 %; per-resection area analysis 1.5 vs. 3.9 %,
p
= n.s.) but increased in the R1Par group (19.6 and 13.6 %,
p
< 0.05 for both). The R1Par group had a higher rate of hepatic-only recurrences (49.5 vs. 36.1 %,
p
= 0.042). On multivariate analysis, R1Par was an independent negative prognostic factor of overall survival (
p
= 0.034, median follow-up 33 months); conversely R1Vasc versus R0 had no significant differences.
Conclusions
R1Par resection is not adequate for CLMs. R1Vasc surgery achieves outcomes equivalent to R0 resection. CLM detachment from intrahepatic vessels can be pursued to increase patient resectability and resection safety (parenchymal sparing).
To analyze the impact of COVID-19 emergency on elective oncological surgical activity in Italy.
COVID-19 emergency shocked national health systems, subtracting resources from treatment of other ...diseases. Its impact on surgical oncology is still to elucidate.
A 56-question survey regarding the oncological surgical activity in Italy during the COVID-19 emergency was sent to referral centers for hepato-bilio-pancreatic, colorectal, esophago-gastric, and sarcoma/soft-tissue tumors. The survey portrays the situation 5 weeks after the first case of secondary transmission in Italy.
In total, 54 surgical Units in 36 Hospitals completed the survey (95%). After COVID-19 emergency, 70% of Units had reduction of hospital beds (median -50%) and 76% of surgical activity (median -50%). The number of surgical procedures decreased: 3.8 (interquartile range 2.7-5.4) per week before the emergency versus 2.6 (22-4.4) after (P = 0.036). In Lombardy, the most involved district, the number decreased from 3.9 to 2 procedures per week. The time interval between multidisciplinary discussion and surgery more than doubled: 7 (6-10) versus 3 (3-4) weeks (P < 0.001). Two-third (n = 34) of departments had repeated multidisciplinary discussion of patients. The commonest criteria to prioritize surgery were tumor biology (80%), time interval from neoadjuvant therapy (61%), risk of becoming unresectable (57%), and tumor-related symptoms (52%). Oncological hub-and-spoke program was planned in 29 departments, but was active only in 10 (19%).
This survey showed how surgical oncology suffered remarkable reduction of the activity resulting in doubled waiting-list. The oncological hub-and-spoke program did not work adequately. The reassessment of healthcare systems to better protect the oncological path seems a priority.
There is an increasing number of cyber-systems (e.g., systems for payment, transportation, voting, critical infrastructures) whose security depends intrinsically on human users. In this paper, we ...introduce a novel approach for the formal and automated analysis of security ceremonies. A security ceremony expands a security protocol to include human nodes alongside computer nodes, with communication links that comprise user interfaces, human-to-human communication and transfers of physical objects that carry data, and thus a ceremony’s security analysis should include, in particular, the mistakes that human users might make when participating actively in the ceremony. Our approach defines mutation rules that model possible behaviors of a human user, automatically generates mutations in the behavior of the other agents of the ceremony to match the human-induced mutations, and automatically propagates these mutations through the whole ceremony. This allows for the analysis of the original ceremony specification and its possible mutations, which may include the way in which the ceremony has actually been implemented or could be implemented. To automate our approach, we have developed the tool X-Men, which is a prototype that builds on top of Tamarin, one of the most common tools for the automatic unbounded verification of security protocols. As a proof of concept, we have applied our approach to three real-life case studies, uncovering a number of concrete vulnerabilities. Some of these vulnerabilities were so far unknown, whereas others had so far been discovered only by empirical observation of the actual ceremony execution or by directly formalizing alternative models of the ceremony by hand, but X-Men instead allowed us to find them automatically.
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