Bulletin of Computer Science and Electrical Engineering (BCSEE)
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Outcomes of primary surgical treatment of medically recalcitrant post-keratoplasty glaucoma with transscleral cyclophotocoagulation
No full textPurpose To report the outcomes of slow-coagulation continuous-wave transscleral cyclophotocoagulation (CW-TSCPC) in post-keratoplasty glaucoma refractory to medical therapy. Methods Medical records of 47 patients (mean age of 70.7 +/- 15.7 years and follow-up of 13.9 +/- 7.1 months) were retrospectively enrolled. All patients had the diagnosis of secondary glaucoma after penetrating keratoplasty (PKP; n = 28) or Descemet's stripping automated endothelial keratoplasty (DSAEK; n = 19) with no previous history of incisional glaucoma or TSCPC surgeries. Study participants underwent slow-coagulation CW-TSCPC (1250-milliwatt power and 4-second duration). Results A statically significant reduction of IOP from 31.8 +/- 8.0 mmHg preoperatively to 16.9 +/- 9.0 mmHg postoperatively was noted (p < 0.001). Similarly, the number of glaucoma medications decreased from 4.0 +/- 1.0 to 2.7 +/- 1.4 (p < 0.001). The overall success rates at 12 and 24 months were 68.1% and 66.0%, respectively, with no difference in success rates between post-PKP and post-DSAEK subgroups (p = 0.836). No significant changes in VA or central corneal thickness (CCT) were observed (p = 0.345 and 0.311, respectively). One (3.3%) patient had a graft rejection. The majority of the complications noted during this study were mild and transient. Conclusions Our study suggests that slow-coagulation TSCPC may be a safe and efficient surgical glaucoma treatment modality in patients with medically uncontrolled post-keratoplasty glaucoma
A multi-targeted investigation of Deepwater Horizon crude oil exposure impacts on the marine teleost stress axis
No full textThe toxicity of the polycyclic aromatic hydrocarbons (PAHs) in Deepwater Horizon (DWH) oil is well-established, but a knowledge gap exists regarding how this combination of PAHs affects the vertebrate stress axis. We hypothesized that (1) marine vertebrates exposed to DWH PAHs experience stress axis impairment, and co-exposure to an additional chronic stressor may exacerbate these effects, (2) serotonin (5-hydroxytryptamine; 5-HT) may act as a secondary cortisol secretagogue in DWH PAH-exposed fish to compensate for impairment, and (3) the mechanism of stress axis impairment may involve downregulation of cyclic adenosine monophosphate (cAMP; as proxy for melanocortin 2 receptor (MC2R) functionality), total cholesterol, and/or mRNA expression of CYP1A and steroidogenic proteins StAR, P450scc, and 11β-h at the level of the kidney. We found that in vivo plasma cortisol and plasma adrenocorticotropic hormone (ACTH) concentrations in Gulf toadfish exposed to an environmentally relevant DWH PAH concentration (ΣPAH= 4.6 ± 1.6 μg/L) for 7 days were not significantly different from controls, whether fish were chronically stressed or not. However, the rate of cortisol secretion by isolated kidneys after acute stimulation with ACTH was significantly lower in PAH-exposed toadfish compared to clean seawater (SW) controls. 5-HT does not appear to be acting as a secondary cortisol secretagogue, rather, PAH-exposed + stressed toadfish exhibited significantly lower plasma 5-HT concentrations than clean SW + stressed fish as well as a reduced sensitivity to 5-HT at the level of the kidney. There was a tendency for kidney cAMP concentrations to be lower in PAH-exposed fish (p = 0.069); however, mRNA expression of steroidogenic proteins between control and PAH-exposed toadfish were not significantly different and a significant elevation in total cholesterol concentration in PAH-exposed toadfish compared to controls was measured. Future work is needed to establish whether the slower cortisol secretion rate by isolated kidneys of PAH-exposed fish is detrimental, to determine the potential role of other secretagogues in compensating for the impaired kidney interrenal cell function, and to determine whether there is a reduction in MC2R mRNA expression or an impairment in the function of steroidogenic proteins
Catecholamine-Induced Inflammasome Signaling in Post-Stroke Cardiac Injury
No full textCerebrovascular stroke patients, with no prior cardiac conditions, show an increased incidence of cardiac arrhythmias compared to age-matched controls. The mechanisms of post-traumatic cardiac dysfunction are multifactorial and include the surge of catecholamine release and an increased systemic inflammatory response. However, whether the innate immune response mediated by the inflammasome contributes to cardiac dysfunction remains largely unexplored. In this study, we used a mouse model of photothrombotic stroke (PTS) to investigate the role of inflammasome activation in post-stroke cardiac damage. At 24 hours after PTS, immunoblotting of atria and ventricles showed significant activation of the AIM2 inflammasome, consistent with increased oligomerization of apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC). Moreover, administration of IC100, a humanized antibody against ASC after PTS significantly reduced the levels of interleukin (IL)-1b in the ventricles compared to the saline-treated group. Next, we tested whether a surge of catecholamines released after stroke induced inflammatory cell death in the heart by injecting naïve mice with epinephrine (0.5mg/kg) intravenously. Accordingly, significant increase in the levels of IL-1b was present in the atria and ventricles, whereas increased levels of AIM2 were present in the atria. Lastly, human aorta cardiac cells treated with 3 mM epinephrine showed significant elevation in caspase-1 activity that was blocked by treatment with IC100. Taken together, these findings indicate that stroke initiates a surge of catecholamines that serves as a danger-associated molecular pattern (DAMP) that induces inflammasome activation and pyroptosis in the heart, hence, providing a framework for the development of therapeutics for stroke-related cardiovascular injury. </p
A multicenter report of the use of plasma rich in growth factors (PRGF) for the treatment of patients with ocular surface diseases in North America
No full textTo investigate the efficacy and safety of plasma rich in growth factors (PRGF) eyedrops in the management of patients with ocular surface diseases in North America.
Multicenter interventional case series of patients using PRGF eyedrops for the first time. A cohort of patients was analyzed for corneal staining score at initial visit and at 3 months of therapy with PRGF. Another cohort responded to a 10-item questionnaire that evaluated patients' satisfaction and safety, which included the symptom assessment questionnaire in dry eye (SANDE) score, after 6 months of PRGF treatment.
A total of 153 patients were analyzed. Of these, 102 were reviewed for corneal epitheliopathy and 99 patients responded to the questionnaire. The mean (±SD) age of the population was 63.7 ± 17 years and 72.5% were female. The clinical indications for PRGF usage were dry eye (60%), neurotrophic keratopathy (15%), dormant corneal ulcers (12%), limbal stem cell deficiency (10%), and cicatrizing conjunctivitis (4%). At the final visit, 74.3% of patients showed an improvement of their corneal staining. Those who had punctate epithelial erosions or epithelial defects were reduced from 76.5% to 47% and 23.5% to 7.8% respectively (p < 0.0001). Symptoms, measured via SANDE score, significantly decreased from a median of 90 to 34.6 out of 100 points on follow-up (p < 0.0001). Only one patient (0.98%) complained of ocular burning sensation as a side effect.
This multicentric study demonstrates the safety and efficacy of the use of PRGF for treating signs and symptoms in patients with significant ocular surface diseases.
•Multicentric longitudinal study of patients with different ocular surface disorders treated with autologous PRGF for the first time.•Improvement on initial corneal epitheliopathy was statistically significant and observed in 74.3% of patients.•Likewise, a statistically significant reduction was observed in patient symptoms via the SANDE score.•Positive outcomes were similar between the different clinical indications and the severity of the initial epitheliopathy.•Patients received a questionnaire about their PRGF treatment experience and responded positively with regards to satisfaction and safety
Simulation and Analysis of Distributed Generation Installation on a 20 kV Distribution System Using ETAP 19.0
No full textConventional power plants are generally designed on a large scale, centralized, and built far from the load center so that they require transmission and distribution networks to distribute electric power. The condition of the distribution channel's length, the high load supplied, and the increasing number of requests for electrical energy each year affect the quality of distribution of electrical energy. From the above problems, simulation and analysis of the installation of distributed generation are carried out. In installing Distributed Generation, three scenarios are used based on the most significant voltage drop point. The installation of Distributed Generation scenario 1 has an average voltage value of 95.16% or 19.81 kV and an average voltage drop of 9.82% or 1.965 kV, and power losses of 946.69 Kw, where losses power loss was reduced by 17.8% or 733.7 kW. The installation of Distributed Generation scenario 2 has an average voltage value of 95.84% or 19.17 kV and an average voltage drop of 4.16% or 0.833 kV, and power losses of 1062.4 Kw, where losses power loss was reduced by 15.8% or 618 kW. The installation of Distributed Generation scenario three does not experience a voltage drop, the average voltage value is 102.4% or 20.38 kV, and power losses are 1062.4 KW, where power losses are reduced by 29.7% or 1114, 6 kW
Surgical rib fixation in traumatic rib fractures: is it warranted?
No full textTraumatic chest wall injuries and rib fractures remain a prevalent injury. Despite many advances, these injuries result in high morbidity and mortality. Surgical stabilization of rib fractures (SSRF) is increasing in utilization with expanding indications. Recent studies have demonstrated that many patients may benefit from surgical intervention.
Over the past 20 years the indications and timing of SSRF has evolved. Once reserved mainly for the most extreme of injuries, expanding indications demonstrate that even minimally injured patients may benefit from intervention regarding pain control, respiratory complications, and overall mortality.
SSRF has become more prevalent with improving outcomes for patients. Understanding the indications will help expand utilization and improve patient outcomes
Long-Term Survival With Tafamidis in Patients With Transthyretin Amyloid Cardiomyopathy
No full textBackground:
Tafamidis is approved in many countries for the treatment of transthyretin amyloid cardiomyopathy. This study reports data on the long-term efficacy of tafamidis from an ongoing long-term extension (LTE) to the pivotal ATTR-ACT (Tafamidis in Transthyretin Cardiomyopathy Clinical Trial).
Methods:
Patients with transthyretin amyloid cardiomyopathy who completed ATTR-ACT could enroll in an LTE, continuing with the same tafamidis dose or, if previously treated with placebo, randomized (2:1) to tafamidis meglumine 80 or 20 mg. All patients in the LTE transitioned to tafamidis free acid 61 mg (bioequivalent to tafamidis meglumine 80 mg) following a protocol amendment. In this interim analysis, all-cause mortality was assessed in patients treated with tafamidis meglumine 80 mg in ATTR-ACT continuing in the LTE, compared with those receiving placebo in ATTR-ACT transitioning to tafamidis in the LTE.
Results:
Median follow-up was 58.5 months in the continuous tafamidis group (n=176) and 57.1 months in the placebo to tafamidis group (n=177). There were 79 (44.9%) deaths with continuous tafamidis and 111 (62.7%) with placebo to tafamidis (hazard ratio, 0.59 [95% CI, 0.44–0.79];
P
<0.001). Mortality was also reduced in the continuous tafamidis (versus placebo to tafamidis) subgroups of: variant transthyretin amyloidosis (0.57 [0.33–0.99];
P
=0.05) and wild-type transthyretin amyloidosis (0.61 [0.43–0.87];
P
=0.006); and baseline New York Heart Association class I and II (0.56 [0.38–0.82];
P
=0.003) and class III (0.65 [0.41–1.01];
P
=0.06).
Conclusions:
In the LTE, patients initially treated with tafamidis in ATTR-ACT had substantially better survival than those first treated with placebo, highlighting the importance of early diagnosis and treatment in transthyretin amyloid cardiomyopathy.
Registration:
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT01994889 and NCT02791230
MP38-15 LEPTIN INDUCED LEYDIG CELL DIFFERENTIATION AND TESTOSTERONE PRODUCTION IS INFLUENCED DIFFERENTIALLY WITH RESPECT TO BMI
No full textOutcomes of Allogeneic Hematopoietic Cell Transplantation in T Cell Prolymphocytic Leukemia: A Contemporary Analysis from the Center for International Blood and Marrow Transplant Research
No full text•Allogeneic hematopoietic cell transplantation is effective in yielding durable remissions in patients with T cell prolymphocytic leukemia.•Myeloablative conditioning, age >60 years, and Karnofsky Performance Status <90 were associated with reduced overall survival (OS).•Reduced-intensity conditioning and avoidance of in vivo T cell depletion correlated with better disease-free survival (DFS) and lower treatment-related mortality (TRM).•Total body irradiation was found to have no significant effect on OS, DFS. or TRM.
T cell prolymphocytic leukemia (T-PLL) is a rare, aggressive malignancy with limited treatment options and poor long-term survival. Previous studies of allogeneic hematopoietic cell transplantation (alloHCT) for T-PLL are limited by small numbers, and descriptions of patient and transplantation characteristics and outcomes after alloHCT are sparse. In this study, we evaluated outcomes of alloHCT in patients with T-PLL and attempted to identify predictors of post-transplantation relapse and survival. We conducted an analysis of data using the Center for International Blood and Marrow Transplant Research database on 266 patients with T-PLL who underwent alloHCT between 2008 and 2018. The 4-year rates of overall survival (OS), disease-free survival (DFS), relapse, and treatment-related mortality (TRM) were 30.0% (95% confidence interval [CI], 23.8% to 36.5%), 25.7% (95% CI, 20% to 32%), 41.9% (95% CI, 35.5% to 48.4%), and 32.4% (95% CI, 26.4% to 38.6%), respectively. In multivariable analyses, 3 variables were associated with inferior OS: receipt of a myeloablative conditioning (MAC) regimen (hazard ratio [HR], 2.18; P 60 years (HR, 1.61; P = .0053), and suboptimal performance status, defined by Karnofsky Performance Status (KPS) 90 or chemosensitive disease