Letteratura scientifica selezionata sul tema "302.23/45/082"

Purpose:To determine the effects of creatine supplementation on blood lactate during incremental cycling exercise.Methods:Thirteen male subjects (M ± SD 23 ± 2 yr, 178.0 ± 8.1 cm, 86.3 ± 16.0 kg, 24% ± 9% body fat) performed a maximal, incremental cycling test to exhaustion before (Pre) and after (Post) 6 d of creatine supplementation (4 doses/d of 5 g creatine + 15 g glucose). Blood lactate was measured at the end of each exercise stage during the protocol, and the lactate threshold was determined as the stage before achieving 4 mmol/L. Lactate concentrations during the incremental test were analyzed using a 2 (condition) × 6 (exercise stage) repeated-measures ANOVA. Differences in power at lactate threshold, power at exhaustion, and total exercise time were determined by paired t tests and are presented as M ± SD.Results:Lactate concentrations were reduced during exercise after supplementation, demonstrating a significant condition effect (p = .041). There was a tendency for increased power at the lactate threshold (Pre 128 ± 45 W, Post 143 ± 26 W; p = .11). Total time to fatigue approached significant increases (Pre 22.6 ± 3.2 min, Post 23.3 ± 3.3 min; p = .056), as did maximal power output (Pre 212.5 ± 32.5 W, Post 220 ± 34.6 W; p = .082).Conclusions:Our findings demonstrate that creatine supplementation decreases lactate during incremental cycling exercise and tends to raise lactate threshold. Therefore, creatine supplementation could potentially benefit endurance athletes.

IntroductionPatients with locally advanced prostate cancer are at high risk of recurrence after definitive treatment. There are emerging data that radical prostatectomy can delay the progression of castration resistance and potentially prolong survival. Neoadjuvant radiation therapy improves local control and has shown survival benefit with favourable toxicity profiles in several other malignancies. We have designed this trial to investigate whether this combination, which theoretically maximises local control, is a safe and feasible approach for treating locally advanced prostate cancer.Methods and analysisThis study is a phase I, open-label study to investigate the safety and feasibility of neoadjuvant hormone and radiation therapy followed by robot-assisted radical prostatectomy by a traditional 3+3 dose-escalation design with four planned radiation dose levels (39.6 Gy/22F, 45 Gy/25F, 50.4 Gy/28F and 54 Gy/30F). Locally advanced prostate cancer patients with positive pelvic and/or retroperitoneal lymph nodes will be recruited. The primary objective is to determine the adverse events and maximal tolerable dose (MTD) of neoadjuvant radiotherapy. Toxicity will be assessed using the National Cancer Institute Common Toxicity Criteria V.5.0.Ethics and disseminationThis protocol was approved by the Institutional Review Board of Shanghai Changhai Hospital (ref. CHEC2019-070 and CHEC2019-082). The study will be performed in compliance with applicable local legislation and in accordance with the ethical principles developed by the World Medical Association in the Declaration of Helsinki 2013. Study results will be disseminated through conferences and peer-reviewed scientific journals.Trial registration numbersChiCTR1900022716; ChiCTR1900022754.

ObjectivesThis study aimed to assess whether the combined use of proton pump inhibitors (PPIs) with non-steroidal anti-inflammatory drugs (NSAIDs) or antibiotics (penicillins, macrolides, cephalosporins or fluoroquinolones) was associated with an increased risk of acute kidney injury (AKI).DesignA nested case–control study.SettingA health insurance claims database constructed by the Japan Medical Data Center.ParticipantsPatients were eligible if they were prescribed a PPI, NSAID and antibiotic at least once between January 2005 and June 2017. The patients who were new PPI users and did not have any history of renal diseases before cohort entry were included (n=219 082). The mean age was 45 and 44% were women.InterventionsCurrent use of PPIs, NSAIDs, or antibiotics.Primary outcome measuresAcute kidney injury.ResultsDuring a mean follow-up of 2.4 (SD, 1.7) years, 317 cases of AKI were identified (incidence rate of 6.1/10 000 person-years). The current use of PPIs was associated with a higher risk of AKI compared with past PPI use (unadjusted OR, 4.09; 95% CI, 3.09 to 5.44). The unadjusted ORs of AKI for the current use of PPIs with NSAIDs, cephalosporins and fluoroquinolones, compared with the current use of PPIs alone, were 3.92 (95% CI, 2.40 to 6.52), 2.57 (1.43 to 4.62) and 3.08 (1.50 to 6.38), respectively. The effects of concurrent use of PPIs with NSAIDs, cephalosporins or fluoroquinolones remain significant in the adjusted model. The analyses on absolute risk of AKI confirmed the results from the nested case–control study.ConclusionsConcomitant use of NSAIDs with PPIs significantly increased the risk for AKI. Moreover, the results suggested that concomitant use of cephalosporins or fluoroquinolones with PPIs was associated with increased risk of incident AKI.

Tuberculosis (TB) remains a significant cause of morbidity and mortality in Myanmar. The fourth National TB Prevalence Survey was conducted in 2017–2018 to determine the actual burden of TB not only at the national level but also for three subnational strata (the states, regions other than Yangon, and the Yangon region) and develop a more efficacious country strategy on TB care and control. One hundred and thirty eight clusters were selected by population proportionate sampling. Adult (≥15 years of age) residents having lived for 2 weeks or more in the households of the selected clusters were invited to participate in the survey. The survey participants were screened for TB by a questionnaire and digital chest X-ray (CXR) after providing written informed consent. Individuals with a positive symptom screen and/or chest X-ray suggestive of TB were asked to provide sputum samples to test for Mycobacterium tuberculosis (Mtb) by Ziehl-Neelsen direct light microscopy, Xpert MTB/RIF Ultra (Xpert), and culture (Ogawa media). Bacteriologically confirmed TB cases were defined by an expert panel. Of 75 676 eligible residents, 66 480 (88%) participated, and 10 082 (15%) screened positive for TB. Among these, 322 participants were defined as bacteriologically confirmed TB cases. Cough lasting for two weeks or longer, one of the criteria used for screening for symptoms, could detect only 14% (45/322) of the study cases. The estimated prevalence of bacteriologically confirmed adult pulmonary TB was 468 (95% CI: 391–546) per 100,000. The prevalence was much higher among males, the older age group, urban Yangon and remote villages. In-depth interview with the participants on TB treatment showed that none of them was diagnosed in a TB health centre (primary care facilities). The prevalence of TB in Myanmar is still high due to challenges such as uncontrolled urbanization, an ageing population, migration, and poor access to health facilities in remote areas. New screening and diagnostic tools might help to detect more TB patients. There is a need to lay greater emphasis on multisectoral approaches, decentralization and the integration of basic TB services into primary care facilities.

Abstract Abstract 1554 Poster Board I-577 Introduction The International Prognostic Factor Project Score (IPS) is the most widely utilized risk stratification index for Hodgkin lymphoma (HL) (Hasenclever, N Engl J Med, 1998). Based on patients treated before 1992, it incorporates 7 adverse risk features (male gender, age ≥45 y, stage IV, hemoglobin <105 g/L, WBC ≥15 × 109/L, lymphocyte count <0.6 × 109/L or <8% of differential, albumin <40 g/L) and predicts for a 5-year freedom-from progression (FFP) ranging from 42-84%.The IPS has not been validated in a more recently treated population, where more accurate pathologic diagnosis, routine use of growth factors and enhanced supportive care may have improved outcomes compared with historic results. Methods This retrospective population-based analysis used the British Columbia Cancer Agency Lymphoid Cancer Database to identify all patients ages 15-65 y diagnosed from January 1st,1990 to June 30th, 2008 with advanced stage HL (stage III/IV, or stage I/II with B symptoms or bulky disease ≥10 cm), who were treated with curative intent with ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) or an ABVD-equivalent regimen and had complete information including all IPS variables. Primary endpoint was FFP, defined as the interval from diagnosis to first progression or relapse or death due to treatment toxicity; deaths from unrelated causes were censored. Results 579 patients were identified. Median age was 29 y (range 15-65); 11 (2%) stage I, 239 (41%) stage II, 202 (35%) stage III and 127 (22%) stage IV; 245 (42.3%) had bulky disease; and 359 (62%) had B symptoms. Histologies included: 455 (79%) nodular sclerosing, 35 (6%) mixed cellularity, 7 (1%) lymphocyte-rich, 11 (2%) lymphocyte depleted, 13 (2%) nodular lymphocyte predominant, 58 (10%) HL NOS. 161 (28%) patients received IFRT with primary treatment. Adverse prognostic factors were present as follows: 119 (21%) age≥45, 375 (65%) albumin <40 g/L, 88 (15%) WBC ≥15 × 109/L, 116 (20%) hemoglobin <105 g/L, 57 (10%) lymphocyte count <0.6 × 109/L or <8%, 302 (52%) male, 127(22%) stage IV. Only 37 (6.4%) patients had a prognostic score ≥5. With a median follow-up of 73 months (range, 1-222), 512 (88.4%) patients were alive and 67 (11.6%) had died (39 with HL, 7 due to toxicity and 21 from unrelated causes). Five year FFP and overall survival (OS) were 79% and 91%, respectively. The IPS was prognostic for both FFP (p=.0035) and OS (p<.0001), with 5-y FFP ranging from 66% to 86% and 5-y OS ranging from 74% to 98% (Table 1). In univariate analysis only stage IV (p=.003) and hemoglobin (P=.001) were prognostic for FFP. Albumin (p=.054), age (p=.082) and WBC (p=.094) were borderline significant, but gender (p=.329) and lymphocyte count (P=.496) appeared to have a weaker prognostic value for FFP. Only stage IV (HR=1.63, CI 1.10-2.40, p=.014) and hemoglobin (HR=1.73, CI 1.17-2.57, p=.006) were prognostic for FFP in a multivariate Cox regression. Conclusion The IPS remains prognostic for patients with advanced stage HL treated in a more modern era. However, it does not identify risk groups with sufficiently good or poor outcome to justify deviation from standard therapy. Identification of truly low or high risk populations will require supplementation with molecular markers and/or the use of early PET scanning. Caution should be used when comparing results from current clinical trials to historic controls, since more recent outcomes with standard therapy are clearly superior to those previously reported. Disclosures No relevant conflicts of interest to declare.

Histórico: Devido à sua microflora ocular, a espécie equina está predisposta a desenvolver úlceras micóticas que, quando não tratadas adequadamente, podem levar à formação de um abscesso estromal. O abscesso estromal ocorre pela introdução de microrganismos no estroma da córnea. Durante a reepitelização, o corpo estranho é encapsulado, criando assim uma barreira que protege as bactérias ou os fungos do tratamento com medicação antimicrobiana. Esse quadro pode acabar resultando em cegueira devido à iridociclite crônica, colocando em risco a visão do animal. O presente trabalho tem como objetivo relatar um caso de cirurgia corretiva de abscesso estromal em uma égua com a administração de fluconazol intraestromal no intraoperatório, a fim de corroborar a eficácia da técnica. Caso: Foi avaliada uma égua de 9 anos de idade, com a queixa de que seu olho direito estava fechado e "amarelado" e que já havia sido tratada com anti-inflamatório injetável intramuscular à base de flunexina meglumina (Banamine® - 50 mg) por 15 dias, referindo-se a uma possível úlcera no olho direito. A triagem oftalmológica resultou em um reflexo direto negativo e nenhuma resposta de ameaça no olho direito. O exame da conjuntiva mostrou congestão e quemose. O exame da córnea do olho direito foi negativo para os testes de Fluoresceína e Lissamina Verde, e foram observadas opacidade e neovascularização corneana. O diagnóstico final foi de um abscesso corneano de provável origem fúngica secundário a uma ceratomicose. Após a consulta, foram realizados exames complementares de sangue e bioquímicos, que apresentaram resultados normais para a espécie em questão, e o tratamento foi iniciado com colírio à base de atropina 1% (Fagra® - 20 mL), colírio antimicrobiano de ciprofloxacina (Ciprovet Colirio® - 5 mL) e colírio antifúngico à base de cetoconazol 1% (manipulado), além de anti-inflamatório injetável intramuscular à base de flunexina meglumina (Banamine® - 50 mg - 1. 1 mg/kg SID) e um analgésico injetável intramuscular à base de dipirona sódica (Febrax® - 0,5 g - 15 mL/animal SID) até o dia da cirurgia, que foi marcada para 3 dias depois. A intervenção cirúrgica foi então instituída pela técnica de ceratectomia lamelar anterior, seguida de hidratação intraestromal com fluconazol e formação de retalho bipediculado, com o objetivo de remover o tecido necrótico e os fatores de estimulação antigênica, enquanto o retalho conjuntival visava melhorar a irrigação sanguínea e proteger a área lesionada, favorecendo a cicatrização local. Para melhor qualidade do pós-operatório do animal, foi prescrita a continuação do mesmo tratamento anterior à cirurgia por um período de 15 dias. O retorno do animal para a retirada do retalho estava previsto para 45 dias após a cirurgia, porém, devido à pandemia da COVID-19, houve um atraso de 135 dias. Quando o animal retornou, o retalho ainda estava estável. Foi instituída uma segunda cirurgia para a retirada do retalho, durante a qual foi possível afirmar que a córnea havia recuperado a integridade total e a transparência parcial com apenas um leucoma no local anterior do abscesso. Discussão: A técnica de ceratectomia lamelar anterior juntamente com o uso de um retalho de conjuntiva para o tratamento de abscesso estromal em equinos é uma técnica conhecida e utilizada rotineiramente, embora alguns casos relatem a formação de uma segunda infecção no mesmo espaço. No entanto, há poucos relatos sobre o uso de hidratação intraestromal com medicação antifúngica adjuvante à técnica cirúrgica, o que, conforme demonstrado neste relato, mostrou-se eficaz, pois mesmo com a questão do atraso na remoção do retalho conjuntival, o olho permaneceu íntegro e não houve uma segunda infecção. Portanto, o uso dessa técnica pode ser indicado para o tratamento de abscesso estromal em equinos, dada a segurança que a aplicação do antifúngico intratromal proporciona.

Due to specific mission goals, many satellites are subject to cone constraints on the thrust direction. For example, James Webb Space Telescope, launched on December 25, 2021 toward a Halo orbit around the Sun-Earth L2 libration point, has a thermal shield that must prevent the telescope and other instruments from overheating [1]. Therefore, it is constrained to always keep its attitude such that the angle between the normal to the shield and the Sun direction is smaller than 53 deg. It results in conical constraints for the propulsion directions. Using chemical propulsion to perform small impulsive corrections of the trajectory or a low-thrust satellite with very specific constraints on the control does not always allow to do any desirable maneuver, as we showed in [2], where the controllability of non-ideal solar sails in orbit about a planet was investigated. In [2], we considered elliptic Keplerian orbits, and we formulated a convex optimization problem aimed at assessing whether some functions of the integrals of motion could not be decreased after one orbital period. Existence of such functions implies that there is a half-space of the neighborhood orbit's coordinates (orbital elements) where motion is locally forbidden [3]. In that paper, we strongly relied on the super-integrability of the Kepler problem. Here, we extend the methodology to infer local controllability of station-keeping satellites for any periodic orbit, regardless the dynamical system at hand. Given the projection of the nominal orbit on a surface of section, the methodology aims at verifying if a half space of such projection exists where the motion is forbidden after one orbital period. Variation of parameters is used to achieve a convex optimization problem that investigates the existence of obstructions to variations of local integrals of motion. Conical constraints are enforced by leveraging on the formalism of positive polynomials postulated by Nesterov [4], so that a finite-dimensional formulation of the convex program is achieved. Halo orbit in the CRTBP is eventually considered in the case study, but we emphasize again that the methodology is developed for a generic locally-integrable system. We compare the aforedescribed methodology with the results achieved in [5], where the authors looked at the controllability and the impact of limitations of the thrust direction on the station-keeping from a dynamical point of view. They use the Floquet Mode reference frame to describe the motion of the satellite in a close proximity to the orbit, and study the cost of station-keeping by projecting the thrust direction on the saddle plane. The minimum requirement that we propose can be used for a design of space missions around any periodic orbit for satellites that have specific constraints on the thrust directions. It can be applied to a low-thrust satellite or even those with chemical propulsion under condition of using small impulses, so that the linearization of the dynamics holds. [1] J. Petersen, “L2 Station Keeping Maneuver Strategy For The James Webb Space Telescope,” AIAA/AAS Astrodynamics Specialist Conference, American Institute of Aeronautics and Astronautics, 2019. [2] A. Herasimenka, L. Dell’Elce, J.-B. Caillau, and J.-B. Pomet, “Controllability Properties of Solar Sails,” Journal of Guidance, Control, and Dynamics, 2022. in press. [3] J.-B. Caillau, L. Dell’Elce, A. Herasimenka, and J.-B. Pomet, “On the Controllability of Nonlinear Systems with a Periodic Drift,” 2022. HAL preprint no. 03779482. [4] Y. Nesterov, “Squared Functional Systems and Optimization Problems,” High Performance Optimization (P. M. Pardalos, D. Hearn, H. Frenk, K. Roos, T. Terlaky, and S. Zhang, eds.), Vol. 33, pp. 405–440, Boston, MA: Springer US, 2000. Series Title: Applied Optimization, 10.1007/978-1-4757-3216-0 17. [5] A. Farres, C. Gao, J. J. Masdemont, G. Gomez, D. C. Folta, and C. Webster, “Geometrical Analysis of Station-Keeping Strategies About Libration Point Orbits,” Journal of Guidance, Control, and Dynamics, Vol. 45, June 2022, https://arc.aiaa.org/doi/10.2514/1.G006014.