Gotowa bibliografia na temat „305.5/6”

Purpose: To report a modified surgical technique called the “donor tissue holding technique for Descemet’s membrane endothelial keratoplasty (DMEK)” using a newly developed 25-gauge graft manipulator. Methods: Six consecutive patients exhibiting endothelial dysfunction were enrolled and treated by DMEK. In brief, after insertion of a DMEK donor into the anterior chamber, the edge of the roll was grasped using a graft manipulator and this grasp was maintained throughout the centering and opening of the roll (holding technique). The following parameters were evaluated in comparison to the previous 10 consecutive DMEK cases in which the no touch technique was used: time of graft unfolding, incidence of intra-/postoperative complications, and best spectacle-corrected visual acuity (BCVA) and endothelial cell density (ECD) 6 months after the procedure. Results: In both technique groups, neither intra- nor postoperative complications were noted in any case. No differences were observed between the two groups in postoperative BCVA (p = 0.88). Also, no differences were observed between the two groups in postoperative ECD (holding technique group: 2,108.3 cells/mm2, no touch technique group: 1,491.7 cells/mm2) (p = 0.08) Most notably, the time of graft unfolding prior to filling with air was significantly reduced in the holding technique group (305.5 s) compared to that of the no touch technique group (1,310.0 s; p = 0.01). Conclusions: This donor tissue holding technique enabled rapid and safe DMEK in a reproducible manner, even in Asian eyes with shallow anterior chambers with high vitreous pressure.

Endoscopic biliary drainage is the main treatment for unresectable malignant hilar biliary obstruction (MHBO). Recurrent biliary obstruction (RBO) often occurs after unilateral metal stent deployment. Endoscopic reintervention can be complex for this problem, especially for drainage of the contralateral bile duct. The stent-in-stent (SIS) method is a possible solution to this problem. Our objective was to evaluate the safety and feasibility of the SIS method for endoscopic reintervention in patients with RBO due to MHBO after unilateral metal stent deployment. Eleven patients with MHBO received endoscopic reintervention using the SIS method to manage RBO after unilateral metal stent deployment. Clinical data, including technical and clinical success, procedure time, adverse events and complications, stent patency, RBO of the revisionary stent, and survival time were recorded. Nine patients (82%) achieved technical success, and all 9 of them also achieved clinical success. The 2 unsuccessful cases received percutaneous transhepatic cholangial drainage. The median procedure time was 73 minutes. The 3 adverse events were post-endoscopic retrograde cholangiopancreatography pancreatitis, cholangitis, and liver abscess. 6 patients (67%) experienced RBO of the revisionary stent, the median time to RBO of the revisionary stent was 95.5 days, the median survival time after reintervention was 111 days, and the median overall survival time was 305.5 days. Endoscopic reintervention after previous unilateral metal stent deployment using the SIS method appears to be safe and technically feasible for MHBO patients who experience RBO.

A retrospective study was conducted on a population of 24 patients who had undergone coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). This population is divisible into two groups that differ in prime constituents. Group A used 500cc of 6% Hydroxyethyl starch (Hespan) as the colloid, and Group B used 150cc of 25% albumin. No statistically significant differences were found in the preoperative demographics. All of these cases were done using the same perfusion technique and equipment. Intraoperative values displayed levels of significant difference (p <.05) between the two groups with respect to 1) bypass platelet count; and 2) greater usage of protamine in Group A. Group A Hespan = Platelet count x 1000/ml was 99.90+/-32.4, Blood loss (cc's) was 1033.3+/-305.5, Protamine:Heparin ratio was 1.41:1.0 +/- .37 Group B Albumin = Platelet count x 1000/ml was 153.84 +/- 34.17; Blood loss was 929.6+/- 105.4; Protamine:Heparin ratio was 1.01:1.0 +/- .43 In the postoperative phase which ended when the chest tube was removed, levels of significant difference were as follows: Group A Hespan = Platelet Ct.#2 x 1000/ml was 124.87 +/- 30.62, Blood loss (cc's) was 1390.25 +/- 405.78, PPF Admin. ratio was 1417 +/- 506.32. Group B Albumin= Platelet count x 1000 ml was 159.71 +/- 41.22; Blood loss= 1087.0 +/- 385.72, PPF Admin. ratio was 875 +/- 291.94. From this study it seems as though there are two factors contributing to the increased blood loss seen in Group A that may result from Hespan usage - the intraoperative and postoperative decreased platelet count and the increased amount of protamine used. Furthermore, Group A patients required substantially more PPF postoperatively.

The high mortality risk in severe SARS-CoV-2 infections is tightly correlated to the extreme elevation of inflammatory markers. This acute accumulation of inflammatory proteins can be cleared using plasma exchange (TPE), commonly known as plasmapheresis, although the available data on performing TPE in COVID-19 patients is limited regarding the optimal treatment protocol. The purpose for this study was to examine the efficacy and outcomes of TPE based on different treatment methods. A thorough database search was performed to identify patients from the Intensive Care Unit (ICU) of the Clinical Hospital of Infectious Diseases and Pneumology between March 2020 and March 2022 with severe COVID-19 that underwent at least one session of TPE. A total of 65 patients satisfied the inclusion criteria and were eligible for TPE as a last resort therapy. Of these, 41 patients received 1 TPE session, 13 received 2 TPE sessions, and the remaining 11 received more than 2 TPE sessions. It was observed that IL-6, CRP, and ESR decreased significantly after all sessions were performed in all three groups, with the highest decrease of IL-6 in those who received >2 TPE sessions (from 305.5 pg/mL to 156.0 pg/mL). Interestingly, there was a significant increase in leucocyte levels after TPE, but there was no significant difference in MAP changes, SOFA score, APACHE 2 score, or the PaO2/FiO2 ratio. The ROX index was significantly higher among the patients who underwent more than two TPE sessions, with an average of 11.4, compared to 6.5 in group 1 and 7.4 in group 2, which increased significantly after TPE. Nevertheless, the mortality rate was very high (72.3%), and the Kaplan–Meier analysis identified no significant difference in survival according to the number of TPE sessions. TPE can be used as last resort salvage therapy that can be regarded as an alternative treatment method when the standard management of these patients fails. It significantly decreases the inflammatory status measured via IL-6, CRP, and WBC, as well as demonstrating an improvement of the clinical status measured via PaO2/FiO2, and duration of hospitalization. However, the survival rate does not seem to change with the number of TPE sessions. Based on the survival analysis, one session of TPE as last resort treatment in patients with severe COVID-19 proved to have the same effect as repeated TPE sessions of 2 or more.

Reflection cracks are one of the most common problems in semi-rigid base pavement. Setting a stress absorption layer can effectively delay the occurrence of reflection cracks, but further improvement is still needed in its interlayer bonding performance and anti-reflection crack performance. Considering the excellent crack resistance of basalt fibers and the good elastic recovery ability of rubber asphalt, it is considered worthwhile to incorporate them into traditional stress absorption layers to improve performance. To simulate the actual pavement layer effect, composite specimens consisting of a cement-stabilized macadam base + basalt fiber rubber asphalt stress-absorbing layer + AC-20 asphalt mixture surface layer were prepared to evaluate their performance through interlayer direct shear tests, interlayer tensile tests, three-point bending tests, and overlay tests (OTs). To determine the optimal fiber blending combination, four fiber lengths (3 cm, 6 cm, 9 cm, 12 cm) and four fiber proportions (120 g/m2, 140 g/m2, 160 g/m2, 180 g/m2) were selected respectively. The specific effects of basalt fibers with different lengths and dosages were analyzed. The results show that compared with the absence of fibers, the improvement of interlayer bonding performance of rubber asphalt with basalt fibers is not significant, and it has certain limitations; however, the improvement of anti-reflective crack performance is significant, with an increase of up to 305.5%. This indicates that the network structure formed by basalt fibers and rubber asphalt stress absorption layer can effectively absorb and disperse external loads, causing an excellent crack resistance effect. Meanwhile, the results indicate that the main factor affecting its interlayer bonding strength and anti-reflective crack performance is the fiber content. Based on the comprehensive analysis of the performance and economy of the stress absorption layer of basalt fiber rubber asphalt, the optimal fiber parameter combination recommended is as fiber length 9 cm and fiber content 160 g/m2.These results can provide a reference for the design and performance evaluation of basalt fiber rubber asphalt stress absorption layer, and have certain application value.

PURPOSE We report a multicenter controlled trial comparing renal recovery and tolerance profile of doublet versus triplet bortezomib-based regimens in patients with initial myeloma cast nephropathy (CN) and acute kidney injury (AKI) without need for dialysis. METHODS After symptomatic measures and high-dose dexamethasone, patients were randomly assigned to receive bortezomib plus dexamethasone (BD), or BD plus cyclophosphamide (C-BD). In patients with < 50% reduction of serum free light chains (sFLCs) after 3 cycles, chemotherapy was reinforced with either cyclophosphamide (BD group) or thalidomide (C-BD group). RESULTS Ninety-two patients were enrolled in each group. At random assignment, characteristics of the 2 groups were similar, including median age (68 years) and serum creatinine level (305.5 and 273.5 µmol/L in BD and C-BD group, respectively). At 3 months, renal response rate (primary end point) was not different (41 v 47 responders in the BD and C-BD groups, respectively; relative risk [RR], 0.87; P = .46). Very good partial response (free light chain reduction ≥ 90%) or more was achieved in 36 and 47 patients, respectively (RR, 0.76; P = .10). After 1 cycle of chemotherapy, 69 in the BD group and 67 patients in the C-BD group had achieved sFLC level ≤ 500 mg/L. Serious adverse events were recorded in 30 and 40 patients, respectively. At 12 months, 19 patients had died (9 in the BD group v 10 in the C-BD group), including 10 (6 in the BD group and 4 in the C-BD group) from myeloma progression and 3 (0 in the BD group and 3 in the C-BD group) from infection. Within median follow-up of 27 months, 43 and 42 patients switched to new therapy, respectively. Overall, 50 patients (24 in the BD group and 26 in the C-BD group) had died. CONCLUSION This randomized study did not show any benefit of C-BD compared with BD on renal recovery of patients with initial CN not requiring dialysis. Adding cyclophosphamide did not sufficiently improve the efficacy-toxicity balance. Patients with myeloma with AKI are fragile, and indication for doublet or triplet regimen should be adapted to frailty.

This study investigates the negative impact of temperature on spodumene flotation from the perspective of the gas–liquid interface of sodium oleate (NaOL) solutions. Micro-flotation tests revealed a significant decrease in the flotation recovery of spodumene when NaOL was employed as a collector, dropping from 55.3% at 305.4 K to 5.1% at 277.3 K as the temperature decreased. A strong linear correlation between the surface tension of the NaOL solution and temperature was established. As the temperature decreased, the surface tension of 6 × 10−5 mol/L NaOL increased from 37.88 mN/m at 294.9 K to 40.71 mN/m at 281.9 K, while its critical micelle concentration decreased from 9.49 × 10−4 mol/L at 305.0 K to 6.85 × 10−4 mol/L at 288.0 K. Additionally, molecular dynamics (MD) simulations indicated that a decrease in temperature resulted in an enhancement of intermolecular action forces, a more compacted interfacial structure, and weakened molecular thermal motion at the gas–liquid interface of the NaOL solution. These variations were found to be the main reason for the rise in the surface tension of the NaOL solution as the temperature decreased, which in turn lowered its efficiency, resulting in a decrease in the flotation efficiency of spodumene.

Abstract Feeding low protein (LP) diets to nursery pigs has been reported to improve intestinal health, reduce incidence of post-weaning diarrhea (PWD) and nitrogen excretion. However, these benefits are often undermined by significant reduction in growth performance. This study evaluated the effects of low protein diets supplemented with dietary nucleotides on growth performance, post weaning diarrhea and nitrogen utilization. A total of 210 piglets (Duroc × Landrace × Yorkshire) were weaned at 21 d of age and allowed a 3-d adaptation to a common solid post weaning diet. At 24 d old, pigs were reweighed (6.02 ± 0.05 kg) and allocated to 5 dietary treatments in a completely randomized block design to give 7 replicates per treatment (n = 6 piglets per replicate). The 5 dietary treatments included i) a high protein positive control diet (PC) with 24% crude protein (CP); ii) a low protein negative control (NC) with 16% CP; iii) NC with 0.1% dietary nucleotide inclusion (NC01); iv) NC with 0.3% dietary nucleotide inclusion (NC03); and v) NC with 0.9% dietary nucleotide inclusion (NC09). All diets were corn-soybean meal based, supplemented with lysine, methionine, tryptophan, and threonine, with all low protein diets (LP) additionally fortified with crystalline isoleucine, and valine to meet the ideal amino acid requirements. Diets were provided ad libitum for 35 d and weekly feed intake (FI) and body weight (BW) were measured. On d 35, blood and fecal samples were collected to determine serum metabolites and nutrient digestibility respectively. Data were analyzed by PROC GLM and orthogonal polynomial contrast of SAS. Comparison between positive and negative control diets and nucleotide levels were performed with orthogonal contrast analysis. Relative to PC, NC diet had decreased overall average daily gain (343.5 vs. 305.5 g/d), incidence of PWD (2.5 vs. 1.2 fecal consistency score), blood urea nitrogen (BUN; 11.3 vs. 3.4 mg/dL) and total tract digestibility of energy (81.3 vs. 80.1 %; P &lt; 0.05, P &lt; 0.05, P &lt; 0.0001 and P &lt; 0.1, respectively). Relative to PC, the NC01, NC03 and NC09 treatments had comparable average daily gain (P &gt; 0.05) while maintaining reduced (P &lt; 0.05) BUN and incidence of PWD. Total tract digestibility of dry matter (83.1 vs. 82.1%) and energy (81.3 vs. 80.1%) were similar between PC and NC09 treatments (P &gt; 0.05). Crude protein reduction decreased serum glutathione (P &lt; 0.05), but without an effect of nucleotide supplementation. Serum glucose and insulin concentrations were not different across treatments (P &gt; 0.05). Results suggest that feeding LP diets supplemented with dietary nucleotide after weaning can increase protein utilization efficiency, reduce incidence of PWD while partially ameliorating the negative effects of LP diets on growth performance.

BackgroundInterstitial lung disease in systemic sclerosis(SSc-ILD) is heterogeneous with limited therapeutic options. Mycophenolate mofetil (MMF) is the most commonly used first line agent for SSc-ILD. Tacrolimus has shown promising efficacy in few small case series, and large cohorts of patients with non-SSC-ILD[1], but has never been evaluated in the setting of a clinical trial.ObjectivesTo compare the safety and efficacy of Tacrolimus with MMF in patients with progressive SSc-ILD.MethodsIn this single center open labelled, prospective, two-arm parallel group, randomized controlled pilot study (INSIST) conducted between November 2021 to December 2022, patients with progressive ILD (FVC decline >10%) due to SSc, aged between 18-65 years, disease duration <10 years, without concomitant inflammatory myositis, with an FVC of 40-85%, and not having received active immunosuppression other than prednisolone <10mg/day in the last 6 months were randomized to receive either MMF (target dose 2gm/day) or tacrolimus (Max dose-0.075 mg/kg/day; target trough levels- 4-10ng/ml) for 24 weeks. The primary endpoint was the difference in change in FVC% at 24 weeks; secondary outcomes included absolute change in FVC, skin scores, 6-minute walk distance, Mahler’s transitional dyspnea index, ACR-CRISS and revised CRISS responses and adverse outcomes. (Trial Reg: CTRI/2021/11/037864)Results25 out of 26 patients (13 in each group) completed 24 weeks follow up. Majority had Anti-Scl 70 positivity (73%) and limited skin disease. At 24 weeks, the mean change in FVC was 4.4% (10.6) and 6.92%(8.4) in the MMF and tacrolimus groups respectively (difference 2.52%, 95% CI (-10.3 to 5.18); p-0.500). All patients on tacrolimus and 85% of patients on MMF had stabilization (ΔFVC% -5% TO 5%) or improvement (ΔFVC%>10%) in lung function. Secondary outcomes were similar between two groups. Subgroup analyses stratified by ILD type, skin involvement at baseline, and early vs late SSc yielded similar results. The mean tacrolimus levels were 4.9 ng/ml(1.47) and the median dose needed to achieve these levels was 4mg/d. No serious adverse events were noted in either group; use of tacrolimus did not result in renal dysfunction or renal crises.ConclusionTacrolimus resulted in comparable improvement to MMF across primary and secondary outcome measures at 24 weeks with a favorable safety profile in patients with SSc ILD. Larger studies with longer follow up are needed to investigate the role of calcineurin inhibitors in SSc.Reference[1]Ge Y, Zhou H et al. The efficacy of tacrolimus in patients with refractory dermatomyositis/polymyositis: a systematic review. Clin Rheumatol.2015 Dec 1;34(12):2097–103.Table 1.Primary and Secondary outcomes at 24 weeksMMF (n=13)Tacrolimus (n=13)P valueChange in FVC (% predicted), mean (SD)+ 4.4 (10.6)+ 6.92 (8.4)Difference 2.52%, 95% CI (-10.3 to 5.18); p-0.500Absolute change in FVC (ml), mean (SD)+ 176.8 (305.5)+130.7 (164.6)0.636Change in mRSS, median (IQR)-1 (-3 to -0.5)-1 (-1 to -0.5)0.209Change in 6MWD (metres), mean (SD)63.15 (56.72)32.67 (27.53)0.094Change in SGRQ score, mean (SD)-14.83 (12.40)-12.97 (11.78)0.698Focal Score TDI, median (IQR)3 (2-4)3 (2-4)0.979Change in SF-36 PCS, mean (SD)5.59 (4.89)4.72 (12.91)0.823Change in SF-36 MCS, mean (SD)3.46 (7.86)5.58 (5.54)0.446Change in PGA, median (IQR)-2.0 (-2.5 to -1.5)-2.0 (-2 to -1)0.364Change in HAQ-DI, median (IQR)-0.23 (-0.25 to -0.19)-0.125 (-0.25 to -0.125)0.393ACR-CRISS Improvement, n (%)5 (38.5)3 (23.1)0.395Revised ACR-CRISS responders; n (%)10 (76.9)7 (53.9)0.416FVC: Forced Vital Capacity; 6MWD- 6 minute walk distance; mRSS- Modified Rodnan Skin Score; SGRQ- St. George Respiratory Questionnaire; HAQ-DI- Health Assessment Questionnaire-Disability Index; TDI- Transitional Dyspnea Index; SF-36- Short Form 36; PCS- Physical component summary; MCS- Mental Component Summary; CRISS - Composite Response Index in Systemic SclerosisFigure 1.Changes in FVC% stratified by magnitude of changeAcknowledgements:NIL.Disclosure of InterestsNone Declared.

Objectives: To evaluate predictive ability of asymptomatic screening MRI’s of Major League Baseball (MLB) pitchers and compare associated findings with future DL placement, pitching statistics, and elbow surgery. Methods: A total of 40 consecutive asymptomatic elbow MRI’s in MLB pitchers at a single organization were analyzed from 2005 - 2017. Asymptomatic MRI was defined as a screening MRI at time of contract signing having been performed at least 6 months prior to DL placement for any elbow-related injury. Publicly available DL data, career innings pitched, career games started, career pitch count, and career max velocity of pitch were obtained. A blinded investigator examined each MRI for pathological signals. Data was analyzed on players that were eventually placed on the DL compared to those with no DL placement. Results: 40 consecutive elbow MRIs of MLB players were reviewed. The average age of the injured cohort was 28.3 ± 3.2 years (16 players) and 28.8 ± 5.5 years (24 players) for the non-injured cohort. There was no statistical difference in age, handedness, height, weight, or pitching stats between the injured and non-injured cohorts. Abnormal radiographic signal intensity in the UCL (p<0.001) and humeral elevation of the UCL (p=0.01) were significantly associated with future DL placement. Those injured spent an average of 200.7 days and 191.7 days in the DL with signal in the UCL and those with humeral elevation of the UCL, respectively. Ulnar elevation/signal of the UCL (p=0.06), and posteromedial impingement (p=0.08) were approaching statistical significance. Of those injured 68.8% (11/16) underwent elbow surgery. Findings of ligament signal intensity (p<0.001), ulnar-sided UCL elevation (p=0.018), humeral-sided UCL elevation (p=0.002), and posteromedial impingement (p=0.042) were all significantly associated with future surgery. There was no significant correlation between injury and radiocapitellar or ulnohumeral chondral lesion, bone edema, loose bodies, or flexor-pronator mass muscle defect. The presence of a flexor-pronator mass muscle defect was associated with a significantly reduced number of innings pitched (53.7 ± 74.3 vs. 304.4 ± 305.5 innings, p=0.0317), games started (5 ± 7.1 vs. 40.1 ± 49.0 games, p=0.004), and pitch count (680.5 ± 919.9 vs. 40.1 ± 49.0 pitches, p=0.022). The presence of ligament signal (26.2 ± 37.1 vs. 51.7 ± 56.5 games, p=0.036) and ulnar elevation (6.3 ± 9.3 vs. 41.2 ± 9.3 games, p=0.003) was associated with significantly fewer games started. The presence of bone edema was associated with significantly decreased pitch count (1451.2 ± 1746.8 vs. 4128.0 ± 4718.0 pitches, p=0.023). There was no association between humeral UCL elevation, flexor-pronator mass tendon, or posteromedial impingement with innings pitched, games started, or pitch count. Conclusion: The heavy demand placed on the elbow joint in professional pitching produces degenerative changes visible on MRI prior to any symptoms, as demonstrated in previous studies. Specific degenerative changes in the UCL Ligament, particularly humeral sided elevation of the UCL, are significantly associated with future injury. [Table: see text]