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Background Metastatic pancreatic cancer has a median overall survival of less than 12 months, even if treated with chemotherapy. Selected patients with oligometastatic disease could benefit from multimodal treatments connecting chemotherapy and surgical treatment or radiofrequency ablation (RFA) of metastases. Case presentation We present a patient with oligometastatic pancreatic cancer recurrence who was successfully treated with a multimodal therapeutic approach. A 57-year-old male initially presenting with resectable pancreatic cancer underwent pancreatoduodenectomy. The histopathological diagnosis revealed ductal pancreatic adenocarcinoma with positive surgical resection margins and negative lymph nodes. He completed six cycles of adjuvant therapy with gemcitabine (1000 mg/mq 1,8,15q 28), followed by external radiotherapy (54 Gy in 25 fractions) associated with gemcitabine 50 mg/mq twice weekly. Three years later, the patient developed multiple liver metastases, and he started FOLFIRINOX (oxaliplatin 85 mg/mq, irinotecan 180 mg/mq, leucovorin 400 mg/mq and fluorouracil 400 mg/mq given as a bolus followed by 2400 mg/mq as a 46 h continuous infusion,1q 14) as a first-line treatment. The CT scan showed a partial response after 6 cycles. After multidisciplinary discussion, the patient underwent a laparotomic metastasectomy of the three hepatic lesions. After additional postsurgical chemotherapy with 4 cycles of the FOLFIRINOX schedule, the patient remained free of recurrence for 12 months. A CT scan showed a new single liver metastasis, which was treated with radiofrequency ablation (RFA). A second radiofrequency ablation was performed when the patient developed another single liver lesion 12 months after the first RFA; currently, the patient is free from recurrence with an overall survival of 6 years from the diagnosis. Conclusions Our case has benefited from successful multimodal treatment, including surgical and local ablative techniques and systemic chemotherapy. A multimodal approach may be warranted in selected patients with oligometastatic pancreatic cancer and could improve overall survival. Further research is needed to investigate this approach.

Since children with chronic diseases represent a primary target for immunization strategies, it is important that their immunization coverage and timeliness of vaccines is optimal. We performed a study to measure immunization coverage and timeliness of vaccines in children with type 1 diabetes, HIV infection, Down syndrome, cystic fibrosis, and neurological diseases. A total of 275 children aged 6 months–18 years were included in the study. Coverage for diphtheria–tetanus–pertussis (DTP), polio (Pol), and hepatitis B (HBV) vaccines approximated 85% at 24 months, while measles–mumps–rubella (MMR) coverage was 62%. Immunization coverage for seasonal influenza was 59%. The analysis of timeliness revealed that there was heterogeneity among children with different chronic diseases. A proportional hazard model showed that children with HIV infection had the longest time to complete three doses of DTP, Pol, and HBV, and those with neurological diseases received the first dose of MMR later than the other categories. Causes of missing or delayed vaccination mostly included a concurrent acute disease. Children with chronic diseases should be strictly monitored for routine and recommended vaccinations, and health care providers and families should be properly informed to avoid false contraindications.

IntroductionTo achieve adequate nasal proportions, nostril surgery can be a complementary technique useful in facial surgery. To help surgeons with the decision to realize nostril surgery, we conducted a systematic review to summarize reported cases on surgical procedures with a specific interest on indications, surgical procedures and postoperative outcomes. A therapeutic algorithm is also proposed.MethodWe carried out this review in accordance with the PRISMA criteria. Twenty-two eligible studies were identified using Medical databases, including 1599 patients. A qualitative and quantitative analysis was carried out.DiscussionExcision techniques were realized on 728 patients (45.5%), followed by cinching sutures on 642 patients (40%) and combined techniques: excision techniques with flap advancement techniques in 189 cases (12%), excision techniques with flap advancement techniques and cinching suture in 40 patients (2.5%). When excessive alar flaring was present, alar wedge resection was preferred in the 92% of followed by alar and sill resection. Cinching sutures were realized when excessive alar flaring was associated with a vertical alar axis, in cases of wide alar base, of associated orthognathic surgery. When excessive alar flaring was associated with wide alar bases, indications changed basing on the associated deformities. In 795 patients, nostril surgery was conducted simultaneously with rhinoplasty.ConclusionNostril surgery through excision techniques, cinching sutures or flaps advancement techniques, reveals good outcomes and can be complementary to rhinoplasty or orthognathic surgery. Through this systematic review, we tried to orient surgeons to find the best treatment for nostril base surgery.Level of Evidence IIIThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Background. Despite a decreasing incidence of listeriosis in the United States, molecular subtyping has increased the number of recognized outbreaks. In September 2000, the New York City Department of Health identified a cluster of infections caused by Listeria monocytogenes isolates with identical molecular subtypes by pulsed-field gel electrophoresis (PFGE) and ribotyping. Methods. To determine the magnitude of the outbreak and identify risk factors for infection, we notified state health departments and conducted a case-control study. A case was defined as a patient or mother-infant pair infected with Listeria monocytogenes whose isolate yielded the outbreak PFGE pattern. Controls were patients infected with Listeria monocytogenes whose isolate yielded a different PFGE pattern. Patients were asked about food and drink consumed during the 30 days before the onset of illness. Results. Between May and December 2000, there were 30 clinical isolates of Listeria monocytogenes with identical PFGE patterns identified in 11 US states. Cases of infection caused by these isolates were associated with 4 deaths and 3 miscarriages. A case-control study implicated sliced processed turkey from a delicatessen (Mantel-Haenszel odds ratio, 8.0; 95% confidence interval, 1.2–43.3). A traceback investigation identified a single processing plant as the likely source of the outbreak, and the company voluntarily recalled 16 million pounds of processed meat. The same plant had been identified in a Listeria contamination event that had occurred more than a decade previously. Conclusions. Prevention of persistent L. monocytogenes contamination in food processing plants presents a critical challenge to food safety professionals.

Hepatocellular carcinoma (HCC) is the fourth most frequent cause of cancer-related death worldwide. HCC frequently presents as advanced disease at diagnosis, and disease relapse following radical surgery is frequent. In recent years, immune checkpoint inhibitors (ICIs) have revolutionized the treatment of advanced HCC, particularly with the introduction of atezolizumab/bevacizumab as the new standard of care for first-line treatment. Recently, dual immune checkpoint blockade with durvalumab plus tremelimumab has also emerged as an effective first-line treatment for advanced HCC and most of the research is currently focused on developing combination treatments based mainly on ICIs. In this review, we will discuss the rationale and ongoing clinical trials of immune-based combination therapies for the treatment of advanced HCC, also focusing on new immunotherapy strategies such as chimeric antigen receptor T cells (CAR-T) and anti-cancer vaccines.

Blind source separation is one of the major analysis tool to extract relevant information from multichannel data. While being central, joint deconvolution and blind source separation (DBSS) methods are scarce. To that purpose, a DBSS algorithm coined SDecGMCA is proposed. It is designed to process data sampled on the sphere, allowing large-field data analysis in radio-astronomy.

In this paper, we present the design, simulation and experimental validation of a control architecture for a flying hand, i.e., a system made of an unmanned aerial vehicle, a robotic manipulator and a gripper, which is grasping an object fixed on a vertical wall. The goal of this work is to show that the overall control allows the flying hand to approach the wall, to dock on the object by means of the gripper, take the object and fly away. The control strategy has been implemented and validated in the simulated model and in experiments on the complete flying hand system.

Two research questions are posed: (1) How have ecosystem conditions changed through time in southwestern Oregon? (2) How have culture-driven and climate-driven processes contributed to ecosystem change in southwestern Oregon? A brief introduction to the Little River study area is followed by a cultural and ecological history of the watershed. Historical, ecological and archaeological data are used to describe shifts in landscape structure, stand structure and fire behavior. Changes in corridor/patch/matrix relationships, increases in stand densities, and changes in stand age and species structure are documented, and changes in fire dynamics from frequent to infrequent, and small to large are corroborated with descriptive statistics from the nearby 2002 Umpqua Fires. Hypotheses are then proposed to test the relative influence of humans vs. climate on landscape change during Aboriginal (<1820) vs. Euro-agrarian (1850-1950) cultural phases. While precipitation shows no correlation with fire frequency or tree recruitment before 1820, significant associations are observed from 1850 to 1950. Moreover, a significant correlation exists between fire frequency and subsequent tree recruitment after 1850, but is not observed during aboriginal times. This suggests that indigenous management fires may have obscured precipitation influences that become apparent only after 1850. In order to test spatial hypotheses concerning the associations between indigenous humans and the landscape, archaeological sites were digitized into a GIS, and ergonomic pathways were modeled between them. These maps are then compared to historically fire-maintained upland meadows interpreted from 1946 aerial photos. A significant spatial correlation was found between archaeological sites and historic meadows, and a highly significant spatial correlation was found between modeled travel networks and historic meadows. The close spatial association between cultural features and fire-maintained habitats again suggests active landscape management by local Indians. These associations are corroborated with historical records. After summarizing the shifts in ecological conditions and describing current conditions, I argue that while restoring the landscape to aboriginal conditions is no longer possible, emulating those conditions within the framework of the Little River Adaptive Management Area Plan can improve the resilience and productivity of the Little River watershed.

We propose a new experiment to measure the running of the electromagnetic coupling constant in the space-like region by scattering high-energy muons on atomic electrons of a low- Z target through the elastic process μ e → μ e . The differential cross section of this process, measured as a function of the squared momentum transfer t = q 2 < 0 , provides direct sensitivity to the leading-order hadronic contribution to the muon anomaly a μ HLO . By using a muon beam of 150 GeV, with an average rate of ∼ 1.3 × 10 7 muon/s, currently available at the CERN North Area, a statistical uncertainty of ∼ 0.3% can be achieved on a μ HLO after two years of data taking. The direct measurement of a μ HLO via μ e scattering will provide an independent determination, competitive with the time-like dispersive approach, and consolidate the theoretical prediction for the muon g -2 in the Standard Model. It will allow therefore a firmer interpretation of the measurements of the future muon g -2 experiments at Fermilab and J-PARC.

Nature-based solutions inherently require a multifaceted perspective that encompasses diverse fields. The aim of this project is to develop more effective nature-based solutions, climate action and environmental awareness by breaking down boundaries between disciplines and fostering a co-creative process. Concepts of ecology and urban forestry were combined with the research on political ecology, environmental humanities, land art, regenerative art, performing art, participatory art, and more-than-human art. This process resulted in the creation of Aula Verde Aniene. It is located in an urban park in Rome and consists of a stand of trees arranged in circles with a specific design to give the perception of being in an outdoor vegetated room. The project activities involved community participation through art performances and citizen science initiatives. Regulating and cultural ecosystem services of Aula Verde were assessed using i-Tree Eco software and citizens’ surveys. Beyond numerical descriptions of ecosystem services, the manuscript introduces shinrin-yoku as a practice to raise awareness of nature. The distinctive approach here described contributed to convey a sense of belonging to the ecosystem to citizens. The project framework and study findings have been developed to formulate policy recommendations and disseminate a format that can be adapted to diverse locations.