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Biopolymeric Anticorrosion Surface finishes coming from Cellulose Nanofibrils along with Colloidal Lignin Allergens.
Conclusions The predictive equations with best performance to assess muscle mass in both NDD-CKD patients and KTR was SMM-BIA by Janssen and ASM-BIA by Kyle. The reproducibility to diagnose low muscle mass, comparing BIA with DXA, was high using ASM/BMI in females and ASM/height2 in males in both groups.Objective The objective of the study was to describe the implementation of Neurally Adjusted Ventilatory Assist (NAVA) by characteristics of patients receiving NAVA and by staff-experienced opportunities and barriers. Methods Design. A retrospective review of hospital records of mechanically ventilated patients over two time periods after implementation, as well as a questionnaire survey and interviews with staff. Setting A secondary Danish ICU. Participants ICU patients, nurses, and intensivists. Intervention Implementation of NAVA, which included theoretical education, bedside training, and frequent updates. Main outcome measure Evaluation of NAVA implementation measured by characteristics of patients receiving NAVA and staff experiences with NAVA. Results A total of 311 patients were included. Hereof 43 (27%) and 68 (44%) patients, respectively, had recieved NAVA. The patients receiving NAVA had higher severity scores and more hours on ventilators. A total of 35 nurses (76%) and 16 physicians (64%) completed the questionnaire. Most clinicians found, to a high (43%) or very high (41%) degree, that NAVA was an effective therapy option. Furthermore, 77% did not experience any barriers regarding NAVA therapy. The main advantages experienced with NAVA were increased patient comfort, respiratory synchrony with the ventilator, and improved opportunities for monitoring patient respiratory performance. The main disadvantage was the need for additional theoretical and practical knowledge. Conclusion Despite staff experience of NAVA as a beneficial treatment option, more than half of the patients did not receive NAVA treatment two years after the start of its implementation. Implementation of a therapy which is substantially different to earlier practices is complicated.E proteins, a subset of basic helix-loop-helix (bHLH) proteins, are transcription activators and their functions are inhibited by DNA-binding inhibitor (Id) 1-4. Studies have shown that Treg levels are decreased in Id3 knockout mice. Mice over-expressing Id1 in CD4 T cells possessed a greater number of regulatory T cells (Treg) and exhibited attenuated experimental autoimmune encephalomyelitis (EAE). The significance of Id proteins in human systemic lupus erythematosus (SLE) remains unclear. In this study, we systematically analyzed Id transcription in naïve, memory CD4 cells and regulatory T cells in peripheral blood mononuclear cells (PBMCs) in patients with active or inactive SLE. In parallel, Treg subsets in PBMCs were analyzed using different strategies. Id expression levels were correlated with Treg numbers as well as clinical indicators. We found that Id genes expressed in human peripheral CD4 cells were mainly Id2 and Id3. Id3 levels were significantly elevated in CD4+CD25hi T cells of patients with active SLE. Likewise, Id3 levels were positively correlated with increased CD4+FoxP3+ and CD4+Helios+FoxP3+ Treg cells in these patients. Id3 levels were found to be positively correlated with erythrocyte sedimentation rate (ESR), lupus anticoagulant (LAC), ribosomal antibody and SLE Disease Activity Index (SLEDAI) in patients with active SLE. Mice overexpressing Id1 in CD4+ T cells possessed significantly higher Treg levels in spleen and lower autoantibody concentrations in serum. Our results suggest that during the pathogenesis of SLE, up-regulation of Id3 can promote Treg differentiation to play an inhibitory effect on autoimmune responses.Background Simulation-based education and objective evaluation of surgical skill have been incorporated into many surgical training programs. We describe the development and implementation of a timed, multitask, station-based Surgical Games to evaluate orthopedic resident surgical skills. Methods Participants in the study were postgraduate-year 2 to 5 orthopedic surgery residents from a single institution. Residents completed 4-timed simulated tasks cadaveric carpal tunnel release (CTR), Sawbones model of total knee arthroplasty (TKA), Sawbones model of ankle fracture open reduction internal fixation (ORIF), and knee arthroscopy simulator (KAS) of removal of loose body. Evaluations were performed using standardized score sheets by attending surgeons. Resident performance was analyzed by postgraduate-year and number of weeks of prior task-related residency training. Results A total of 32 residents were assessed at the 4 stations. Total scores were significantly different for CTR (p = 0.006), TKA (p = 0.05), and the KAS (p = 0.004) by year of training, but not for the ankle ORIF task. Residents with more task-specific experience performed significantly better on the KAS (p less then 0.001), TKA (p = 0.002), and CTR (p = 0.02) tasks but not on the ankle ORIF task (p = 0.1). Overall, residents rated the exercise valuable to their education with mean scores of 3.9 ± 0.54 on a 5-point Likert Scale. check details Conclusions This Surgical Games exercise provided an objective evaluation of surgical skill that correlated with year-in-training and prior experience in skill-specific rotations for the KAS, TKA, and CTR tasks. This surgical skills assessment provided an opportunity for effective structured feedback and identification of areas for improvement.Objective In recent years, there has been an explosion of interest in global surgery (GS) among students, residents, and surgeons. However, little information regarding the landscape of GS in general surgery residencies exists. This study was therefore designed to explore the opportunities and the framework for global surgery in Canadian general surgery training programs. Design The Program Director (PD) at each Canadian general surgery residency program was invited to complete an online survey. Results All 17 PDs participated. Only 3 institutions have a formal curriculum in GS, while 9 have an Office of GS. Seven residencies mention GS on their department website. Ten of 17 residencies have had trainees participate in GS experiences in the last academic year. Funding or pre-experience training is available at less than half of all institutions. Only one residency ranked GS exposure as being "very important" to their program. Across all programs, the average ranking of GS experiences was 2.3 out of 5, which translates descriptively to being of "little importance". Despite this, 10 PDs identified GS as attractive to applicants, and 5 stated their plans to expand GS opportunities at their institution. Conclusions This is the first study to look at the GS landscape in general surgery residencies across Canada. These results may inform graduating medical students and residents about the current status of GS in Canadian residencies. This study may also assist other residencies in the development and tailoring of GS programs.Objective The aim of this study was to prospectively determine the incidence of medication-related osteonecrosis of the jaw (MRONJ) and define risk factors in patients with metastatic breast cancer treated with zoledronic acid and/or denosumab. Study design In a prospective cohort study performed in Region Skåne, Sweden, from January 1, 2012, until December 31, 2015, all patients with breast cancer who had radiographic evidence of bone metastases and were treated with zoledronic acid or denosumab were included and followed up until May 31, 2018. Results Of the 242 patients, MRONJ developed in 16 (6.6%) during the 77 months of study. The incidence of MRONJ in patients treated with zoledronic acid was 4.1%, and in patients treated with denosumab, it was 13.6%. The risk of MRONJ was higher in patients on denosumab than in those treated with zoledronic acid (P = .011). Corticosteroid use was associated with a decreased risk of MRONJ (P = .008), and diabetes was associated with an increased risk of MRONJ (P = .02). Conclusions The incidence of MRONJ is 6.6% (>3 times higher) in denosumab-treated patients with breast cancer compared with that in patients treated with zoledronic acid. Corticosteroid use decreased the risk of MRONJ.Background Available therapies for castrate-resistant prostate cancer (CRPC) confer minimal survival advantage; thus, there is interest in metastasis-directed therapy (MDT) for oligometastatic or oligoprogressive disease to improve outcomes. Here, we describe outcomes of oligoprogressive CRPC treated with stereotactic ablative radiotherapy (SABR). Objective To report outcomes of oligoprogressive CRPC treated with MDT using SABR. Design, setting, and participants Patients with oligoprogressive CRPC were retrospectively evaluated, and outcomes following MDT were reported. Outcomes were additionally compared with oligoprogressive CRPC treated with change in systemic therapy alone. Intervention SABR to oligoprogressive lesions. Outcome measurements and statistical analysis Outcomes of interest were time to prostate-specific antigen (PSA) failure, time to next intervention (TTNI), distant metastasis-free survival (DMFS), and overall survival. Survival analysis was performed using the Kaplan-Meier method, and univae. Future prospective trials are needed to confirm these findings. Patient summary In this report, we retrospectively analyzed outcomes of patients with oligoprogressive castrate-resistant prostate cancer treated with radiation therapy to progressing lesions. Our results suggest that treatment of these lesions with radiation therapy can result in sustained periods of disease-free survival and might add benefit in addition to systemic therapy at the time of progression. These results need to be verified in a prospective trial to identify the optimal integration of radiation therapy into metastatic castrate-resistant prostate cancer.Background The recent introduction of magnetic resonance-guided radiation therapy (MRgRT) has allowed improved treatment planning and delivery of stereotactic body radiotherapy (SBRT) in prostate cancer (PC). The health-related quality of life (HRQoL) outcomes using this novel approach are important in shared decision making for patients. Objective To report HRQoL using both patient- and clinician-reported outcomes at 1 yr following stereotactic MRgRT for patients with localized PC. Design, setting, and participants A prospective phase 2 trial included 101 patients with localized PC. Intervention All patients received 36.25Gy in five fractions of MRgRT delivered within 2 wk. Outcome measurements and statistical analysis HRQoL was prospectively assessed at baseline, at the last fraction, at 6 wk, and at 3, 6, 9, and 12 mo after treatment, by patient-reported outcome measures using European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-PR25 questionnaires, and International Prostate Symptom y at 1 yr. Patient summary All patients completed magnetic resonance-guided radiation therapy, which was well tolerated with only transient early urinary and bowel symptoms, which resolved 1 yr after treatment, as confirmed by patient-reported outcome measures.
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