Search

Different discretization and trust-region methods are compared for the low-thrust fuel-optimal trajectory optimization problem using successive convex programming. In particular, the differential and integral formulations of the adaptive pseudospectral Legendre–Gauss–Radau method, an arbitrary-order Legendre–Gauss–Lobatto technique based on Hermite interpolation, and a first-order-hold discretization are considered. The number of discretization points and segments is varied. Moreover, two hard-trust-region methods and a soft-trust-region strategy are compared. It is briefly discussed whether these methods, if implemented on relevant hardware, would fulfill the general requirements for onboard guidance. A perturbed cubic interpolation and the propagation of the nonlinear dynamics are used to generate initial guesses of varying quality. Interplanetary transfers to a near-Earth asteroid, Venus, and asteroid Dionysus are chosen to assess the overall performance.

Adverse reactions, toxicity, and poor compliance from patients still represent major challenges for conventional chemotherapy treatments. Localized drug delivery would ideally improve therapeutic efficacy, minimizing the side effects. An MSU-type mesoporous silica-based nanodevice (FOL-MSN-BTZ), able to selectively deliver the antineoplastic drug bortezomib (BTZ) to folate receptor over-expressing multiple myeloma (FR+ MM) cells is described. The receptor-specific ligand, folic acid, grafted on the external surface of the nanosystem, allows tumor recognition and cell internalization, while BTZ, mainly linked to the pore internal surface through a covalent pH-sensitive bond, is released in an acidic tumor environment. A detailed investigation showed that only the fine balancing of different functionalities of the nanodevice around the external and internal surfaces of MSN particles shows the absence of toxicity towards healthy cells in vitro and negligible BTZ-release at physiological pH, which are suitable features for applicative purposes in the engineering of therapies. After complete characterization in vitro, an accurate suspendability assessment, which considered the sedimentation process that reduces the particle amount and, consequently, drug content in the suspensions, allowed the development of an injectable formulation of FOL-MSN-BTZ that showed higher antitumor efficacy and an overall tendency to lower toxicity in a MM mice model compared to the conventional bortezomib chemotherapy.

Background Primary mediastinal B–cell lymphoma (PMBCL) is an aggressive B–cell lymphoma that represents 2–3% of non –Hodgkin lymphoma cases and typically affects young adult Caucasian women. Diagnosis can be difficult and often need a multidisciplinary approach. Case a 75 year old female, with history of hypertension, came to ER for severe dyspnea. She complains also neck and left arm oedema. Blue swelling of face and trunk were described. Heart PoCUS was inconclusive, describing only a hypoechoic dilation of right atrium while the other three heart chambers were reduced in dimensions. Chest TC revealed a huge mediastinal mass next to a thrombosis of superior cava vein and right atrium (7 cm diameter) and a diffuse subsegmental pulmonary embolism. Arm and neck Lymphnodes were also enlarged . Low molecular weight heparin was given twice a day. Due the respiratory failure a high–flow nasal cannula oxygen treatment was performed. PET revealed FDG uptake in antero–superior mediastinum, but there was the same uptake in heart right atrium without a connection with the previous described. Therefore, this was no more considered as thrombus but as mass. The micro–bubble test revealed right to left shunt. She refused heart MRI. The patient was not suitable for an open–surgery biopsy, thus she was scheduled for a TC guided one, in order to obtain a pathological diagnosis for a suspected right atrium sarcoma. Due to the high risk we choose to perform the less invasive as possible way to have a histological sample. Thus, and intravascular biopsy of atrial mass by femoral vein was performed. The patient did not present any sequelae after procedure and she continued anticoagulation. The subsequent histological analysis revealed a PMBCL with a primary localization in Right atrium. Unfortunately, a sepsis by multiple resistant pseudomonas Aeruginosa and Aspergillus spp. arose and the patient died three weeks after biopsy. Conclusion A PMBCL is a rare and aggressive disease. Like in our patient, mediastinal syndrome is often associated to the disease. However, intracardiac localization are even rarer events. In large case series, less than 1% of intracardiac masses were lymphomas. In our patient, open–surgery was not suitable for multiple comorbidities. However, intravascular approach was less aggressive but effective to obtain enough tissue for diagnosis. Unfortunately, the immune suppression related to PMBCL and opportunistic infections drive a mortal sepsis.

Given the amount of untreated sewage released into the environment and possible consequences, new methodologies are required for the detection and quantification of potential pollutants found in se...

Background & Aims: Liver transplantation (LT) has been proposed as an effective salvage therapy even for the sickest patients with acute-on-chronic liver failure (ACLF). This large collaborative study was designed to assess the current clinical practice and outcomes of patients with ACLF who are wait-listed for LT in Europe. Methods: This was a retrospective study including 308 consecutive patients with ACLF, listed in 20 centres across 8 European countries, from January 2018 to June 2019. Results: A total of 2,677 patients received a LT: 1,216 (45.4%) for decompensated cirrhosis. Of these, 234 (19.2%) had ACLF at LT: 58 (4.8%) had ACLF-1, 78 (6.4%) had ACLF-2, and 98 (8.1%) had ACLF-3. Wide variations were observed amongst countries: France and Germany had high rates of ACLF-2/3 (27-41%); Italy, Switzerland, Poland and the Netherlands had medium rates (9-15%); and the United Kingdom and Spain had low rates (3-5%) (p 4 mmol/L (hazard ratio [HR] 3.14; 95% CI 1.37-7.19), recent infection from multidrug resistant organisms (HR 3.67; 95% CI 1.63-8.28), and renal replacement therapy (HR 2.74; 95% CI 1.37-5.51) were independent predictors of post-LT mortality. During the same period, 74 patients with ACLF died on the waiting list. In an intention-to-treat analysis, 1-year survival of patients with ACLF on the LT waiting list was 73% for ACLF-1 or-2 and 50% for ACLF-3. Conclusion: The results reveal wide variations in the listing of patients with ACLF in Europe despite favourable post-LT survival. Risk factors for mortality were identified, enabling a more pre-cise prognostic assessment of patients with ACLF. Lay summary: Acute-on-chronic liver failure (ACLF) is a severe clinical condition for which liver transplantation is an effective therapeutic option. This study has demonstrated that in Europe, referral and access to liver transplantation (LT) for patients with ACLF needs to be harmonised to avoid inequities. Post-LT survival for patients with ACLF was >80% after 1 year and some factors have been identified to help select patients with favourable outcomes. (C) 2021 European Association for the Study of the Liver. Published by Elsevier B.V. All reserved.

Let $\mathcal{E}$ be the set of endomorphisms of the $n$-torus. We exhibit an example of a map such that is robustly transitive if $\mathcal{E}$ is endowed with the $C^2$ topology but is not robustly transitive if $\mathcal{E}$ is endowed with the $C^1$ topology.

BACKGROUND AND AIMS: Despite concerns that liver transplant (LT) recipients may be at increased risk of unfavorable outcomes from COVID-19 due the high prevalence of co-morbidities, immunosuppression and ageing, a detailed analysis of their effects in large studies is lacking. METHODS: Data from adult LT recipients with laboratory confirmed SARS-CoV2 infection were collected across Europe. All consecutive patients with symptoms were included in the analysis. RESULTS: Between March 1 and June 27, 2020, data from 243 adult symptomatic cases from 36 centers and 9 countries were collected. Thirty-nine (16%) were managed as outpatients while 204 (84%) required hospitalization including admission to the ICU (39 of 204, 19.1%). Forty-nine (20.2%) patients died after a median of 13.5 (10-23) days, respiratory failure was the major cause. After multivariable Cox regression analysis, age >70 (HR, 4.16; 95% CI, 1.78-9.73) had a negative effect and tacrolimus (TAC) use (HR, 0.55; 95% CI, 0.31-0.99) had a positive independent effect on survival. The role of co-morbidities was strongly influenced by the dominant effect of age where comorbidities increased with the increasing age of the recipients. In a second model excluding age, both diabetes (HR, 1.95; 95% CI, 1.06-3.58) and chronic kidney disease (HR, 1.97; 95% CI, 1.05-3.67) emerged as associated with death CONCLUSIONS: Twenty-five percent of patients requiring hospitalization for COVID-19 died, the risk being higher in patients older than 70 and with medical co-morbidities, such as impaired renal function and diabetes. Conversely, the use of TAC was associated with a better survival thus encouraging clinicians to keep TAC at the usual dose. ispartof: GASTROENTEROLOGY vol:160 issue:4 pages:1151-+ ispartof: location:United States status: published

For the last decade, there has been growing concern regarding the rising rates of youth engagement in self-injury and suicide. The worldwide outbreak of the coronavirus disease 2019 (COVID-19) has elevated these concerns due to increased risk factors pertaining to social, family, economic, and health stressors, in addition to changes to typical routines and support systems. Unfortunately, there are many barriers to at-risk youth being able to access evidence-based mental health services including cost, lack of trained providers, transportation issues, and physical distancing due to the pandemic. Providing school-based prevention and intervention programs that promote social, emotional, and behavioral well-being helps to address many of these barriers. This article highlights important considerations to providing these services in a school-based telehealth modality. Symptom clusters that put youth at risk of harm to self are described. Best practice therapeutic modalities that can be disseminated in a school-based telehealth modality, such as cognitive behavior therapy, dialectical behavior therapy, and mindfulness-based approaches, are reviewed. Although there is growing empirical literature for these school-based prevention and intervention approaches, additional research is needed to determine how to best support at-risk youth remotely.

Background: The impact of COVID-19 on patients on the waiting list for liver transplantation (LT) and on their post-LT course is presently unknown. Methods: Data from consecutive adult LT candidates with COVID-19 were collected across Europe in a dedicated registry and analyzed. Findings: From February 21st to November 20th, 2020, 136 adult cases with laboratory confirmed SARS-CoV-2 infection from 33 centers in 11 European countries were collected, with 113 having COVID-19. Thirty-seven (37/113, 32·7%) patients died after a median of 18 (10-30) days, respiratory failure being the major cause (33/37, 89·2%). The 60-day mortality risk did not significantly change between first (35·3%, 95% CI 23·9-50·0) and second wave (26·0%, 95% CI 16·2-40·2). Multivariable Cox regression analysis showed lab-MELD score ≥15 (MELD 15-19 HR 6·09, 95% CI 2·01-18·45; MELD ≥20 HR 5·21, 95% CI 1·76-15·45) and dyspnea on presentation (HR 4·10, 95% CI 2·09-8·06) being the two negative independent factors for mortality. The mortality risk reached 49·2% (31/63) in patients with decompensated cirrhosis and lab-MELD score ≥15. Twenty-six patient received a LT after a median time of 78.5 (IQR 44-102) days and 25 (96%) are alive after median follow-up of 118 days (IQR 31-170). Interpretation: Increased mortality in LT candidates with COVID-19 (32·7%), reaching 49·2% in those with decompensated cirrhosis and lab-MELD score ≥15, with no significant difference between first and second wave of the pandemic. Respiratory failure was the major cause of death. The dismal prognosis of patients with decompensated cirrhosis supports the adoption of strict preventative measures and the urgent testing of vaccination efficacy in this population. Prior SARS-CoV-2 symptomatic infection did not affect early post-transplant survival (96%). Funding: No funding source. Declaration of Interests: None to declare. Ethics Approval Statement: Data was collected in accordance with General Data Protection Regulation (GDPR), the European Union legislation and the ELTR privacy policy. Reg. HCB/2020/0479 released by CLINICAL RESEARCH ETHICS COMMITTEE from Hospital Clinic Barcelona

Consider the set $E$ of endomorphisms of the n-torus endowed with the $C^1$ topology. A point in $E$ that is persistently singular and robustly transitive is exhibited., A series of typos was corrected. The proof of what was Theorem 3.1 was split into a series of Lemmas which provide transparecy to the arguments

This study reports a novel and environmentally friendly method based on bar adsorptive microextraction (BAμE) with cork pellet as extraction phase for the determination of methylparaben, ethylparaben, propylparaben and butylparaben in river water samples. This natural approach consists of a cork pellet recycled from wine stoppers used as biosorbent material to replace the traditional BAμE device. The analytical determinations were performed using a high-performance liquid chromatography-diode array detector (HPLC-DAD). Parameters such as type of desorption solvent, desorption and extraction time, sample pH and ionic strength were carefully optimized through univariate and multivariate approaches. Cork pellets of 15 mm length were inserted into vials containing 15 mL of water sample adjusted at pH 3 and 25% (w/v) of NaCl. The extraction step was carried out under agitation for 45 min followed by liquid desorption with 120 μL of methanol:acetonitrile (1:1 v/v) for 30 min. Satisfactory analytical performance was obtained with coefficients of determination ranging from 0.9921 for methylparaben to 0.9994 for propylparaben; intraday precision ranged from 6.7 to 18.3%, and interday precision varied from 7.2 to 20.0%. Accuracy was assessed through relative recovery assays and varied from 53 to 124%.

The development and application of alternative green solvents in analytical techniques consist of trends in sample preparation, since this subject represents an important step toward sustainability in experimental procedures. This review is focused on the main theoretical aspects related to deep eutectic solvents (DES), switchable hydrophilicity solvents (SHS) and supramolecular solvents (SUPRAS). Recent applications are highlighted, particularly for the extraction of different analytes from environmental, biological and food matrices. Moreover, novel configurations are emphasized, aiming for efficient, automated and high-throughput procedures. This review also provides some critical points regarding the use of these solvents and their green aspects.

Objectives We have conducted this study to assess medical students’ empathy and to examine empathy differences by students’ socio-demographic characteristics, including gender, and specialty preference. Methods We have conducted a cross-sectional and descriptive research. Among 595 medical students registered at the Federal University of Santa Catarina (Brazil) in 2012, we have selected a sample of 320 enrolled in the first, third, fifth, seventh, ninth, eleventh, and in the last semester of the course. The response rate obtained was 70.6% (n=226). Data was collected by using a self-report questionnaire, and the variables analyzed included course semester, socio-demographic characteristics (such as age, gender, household monthly income and parents level of education), students’ specialty preference, and empathy assessed by the Jefferson Scale of Empathy. We have used descriptive statistics, 95% Confidence Interval for percentages, Student's t-test, and Analysis of Variance to analyze the data. Results Mean empathy among students was (M=119.7, SD=9.9), with no difference by according to semester (F(6,219)=1.5, p=.2). Empathy means were higher among females (M=118.3, SD=10.6) than among males (M=121.0, SD=9.3, t(222)=-2.1, p=.032). Students who preferred a people-oriented specialty obtained significantly higher mean scores (M=121.5, SD=8.1) in comparison to students who preferred technology-oriented specialties (M=118.0, SD=11.3, t(135)=2.4, p=.02). Conclusions Our study has found consistently high scores of empathy among medical students enrolled in all levels of training at the Federal University of Santa Catarina, and higher empathy among women and students who intend to pursue a people-oriented specialty. Conclusions on higher empathy among medical students require further study.

This study reports the use ofa natural deep eutectic solvent (NADES) with hollow fiber-microporous membrane liquid-liquid microextraction (HF-MMLLE) for the multiclass determination of 11 compounds classified as emerging contaminantsin water. Different deep eutectic solvents were synthetized and Thymol: Camphor (1:1 molar fraction) wasused as extraction solvent. The Thymol:Camphor was impregnated into the polypropylene membrane porous for 10 min, replacing commonly used solvents (ex. hexane and octanol). The optimized parameters were obtained by multi and univariate models. Extractions were carried out for 50 min using 1.5 mL of water sample at pH 6 and without addition of salt while desorption was made in a mixture of acetone: methanol (3:1, v/v) for 15 min. Separation/quantification was conducted by HPLC with a diode array detection (DAD)and calibration curves were obtained for each analyte. Determination coefficients higher than 0.9906 and limits of detection ranged from 0.3 to 6.1 µg L−1. Intraday precision (n = 3) ranged from 1.6 to 18.4% and inter day from 5.0 to 21.3%. Relative recoveries were performed in tap and stream water and ranged from 64 to 123%.

Introduction Breast cancer is the most common cancer in women worldwide. Early breast cancer diagnosis and improvement of therapeutic procedures have reduced the impact of treatment on function and increased the proportion of possibly employed survivors. The growth in female labour participation and the extension of working life have increased the number of women with breast cancer that work or have to face the issue of returning to work. The aim of the study was to identify predictors of reduced work ability at return to work among women treated for breast cancer. Methods A questionnaire was sent to all 18–65 years old women resident and treated for breast cancer in Bologna Local Health Authority area in the period 2010–2012 to collect data about personal characteristics, medical history, breast cancer treatment work history and return to work. A multivariate logistic regression analysis was performed to identify predictors of reduced work ability among workingwomen. Results A total of 1578 women were invited to fill in the questionnaire. The response rate was 53,3%. Data of 503 workingwomen returned to work at the time of the study were analysed. Reduced work ability at return to work was reported by 43.5% women compared to the pre-diagnosis period. Reduced work ability was significantly more common in non-cohabiting than in cohabiting/married women, in labourers than in Office clerks/sales assistants and managers and more frequent after mastectomy than after breast-conserving interventions. Adjustments of work activities, occupational physician visits, less support from employer and colleagues and discrimination were significantly more frequently reported by women with a reduced work ability. Conclusion Perceived reduced work ability is common in women who return to work after the treatment for breast cancer. Occupational physicians and GPs should be aware of a wide asset of factors to facilitate a successful return to work.