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Essential principles for blood centrifugation.
No full textCurrently, autologous platelet concentrates (APCs) are frequently used for soft- and hard-tissue regeneration, not only within the oral cavity, but also extra-orally including chronic wounds, burns, joints, dermatological conditions, among others. The benefits of APCs are largely influenced by the treatment strategy but also their preparation. This paper therefore discusses in detail: the physical properties of blood cells, the basic principles of blood centrifugation, the impact of the centrifugation protocol (rotations/revolutions per minute, g-force, variation between centrifuges), the importance of timing during the preparation of APCs, the impact of the inner surface of the blood tubes, the use/nonuse of anticoagulants within APC tubes, the impact of the patient's hematocrit, age, and gender, as well as the important requirements for an optimal centrifugation protocol. All these variables indeed have a significant impact on the clinical outcome of APCs
La contrarreforma en escena: teatro escolar y teatro musical en el Sacro imperio Romano Germánico
No full textMortality in acute ischemic stroke patients with new cancer diagnosed during the index hospitalization versus after discharge.
No full textBACKGROUND
Early diagnosis of previously unknown cancer (i.e., occult cancer) after an acute ischemic stroke (AIS) could result in faster initiation of cancer therapy and potentially improve clinical outcomes. Our study aimed to compare mortality rates between AIS patients with occult cancer diagnosed during the index stroke hospitalization versus those diagnosed after hospital discharge.
METHODS
Among consecutive AIS patients treated at our stroke center from 2015 through 2020, we identified new cancer diagnoses made within the year after the AIS. We used multivariable Cox regression analyses to evaluate the association between the timing of occult cancer diagnosis (during the AIS hospitalization versus after discharge) and long-term survival.
RESULTS
Of 3894 AIS patients with available long-term follow-up data, 59 (1.5%) were diagnosed with a new cancer within one year after index stroke. Of these, 27 (46%) were diagnosed during the index hospitalization and 32 (54%) were diagnosed after discharge. During a median follow-up of 406 days (interquartile range, 89-1073), 70% (n=19) of patients whose cancer was diagnosed during hospitalization had died, compared to 63% (n=20) of patients whose cancer was diagnosed after discharge (p=0.58). In our main multivariable model, there was no difference in long-term mortality between patient groups (adjusted hazard ratio, 1.16; 95% confidence interval, 0.53-2.52; p=0.71).
CONCLUSIONS
In this analysis, timing of a new cancer diagnosis after AIS did not seem to influence patients' long-term survival. Given the fairly small number of included patients with previously occult cancer, larger multicenter studies are needed to confirm our results
Retrograde Ureteral Stents versus Percutaneous Nephrostomy in the Management of Malignant Ureteral Obstruction: A Systematic Review and Meta-Analysis.
No full textOBJECTIVE
To evaluate outcomes in cancer patients with ureteral obstruction by comparison of retrograde stenting and percutaneous nephrostomy techniques.
METHODS
Systematic review of all studies up to October 2023. Studies were identified from all major databases including MEDLINE, Cochrane, and EMBASE. All comparative studies between retrograde stenting and percutaneous nephrostomy were searched; studies with paediatric populations were excluded. Primary outcomes were procedure and intervention failure rates; secondary outcomes were infection, blockage, displacement and unplanned exchange rates along with procedure time and length of stay.
RESULTS
Eighteen studies with 1228 patients contributed to the summative outcome. Percutaneous nephrostomy was statistically superior to retrograde stenting for procedure failure rate (p<0.00001) and intervention failure rate (p=0.0004). Retrograde stenting was statistically superior to percutaneous nephrostomy for displacement rates (p=0.003), procedure time (p<0.00001) and length of stay (p<0.00001). Retrograde stenting showed no difference to percutaneous nephrostomy for infection rates (p=0.94), blockage rates (p=0.93), unplanned exchange rates (p=0.48), CONCLUSION: There is no absolute superiority for retrograde stenting or percutaneous nephrostomy for malignant ureteral obstruction. Both techniques have their advantages and disadvantages, with some comparable outcomes; patients are key when selecting the best technique. Larger studies are required to assess the outcomes of both techniques
Exploring the role of emotions and conversation content in interpersonal synchrony: A case study of a couple therapy session.
Get PDFOBJECTIVE
This exploratory study investigated the association between interpersonal movement and physiological synchronies, emotional processing, and the conversational structure of a couple therapy session using a multimodal, mixed-method approach.
METHOD
The video recordings of a couple therapy session, in which the participants' electrodermal activity was recorded, were analyzed. The session was divided into topical episodes, a qualitative analysis was conducted on each topical episode's emotional aspects, conversational structure and content. In addition, movement and physiological synchrony were calculated in each topical episode. Regression models were used to discover the associations between qualitative variables and synchronies.
RESULTS
Physiological synchrony was associated with the emotional aspects of the session and to episodes in which the spouses' relationship was addressed, while movement synchrony was only related to emotional valence. No association between synchrony and conversational structure was found.
CONCLUSION
The findings suggest that physiological and movement synchrony play distinct roles in psychotherapy. The exploratory study sheds light on the association between momentary synchrony, emotions, and conversational structure in a couple therapy session
Depression and anxiety symptoms are underestimated risk factors for postoperative prognosis in patients with Type 2 diabetes and peripheral artery disease undergoing partial foot amputation: Results from a prospective cohort study.
No full textOBJECTIVE
The aim of this study was to evaluate the prevalence and impact of depression and anxiety symptoms on post-operative prognosis and 1-year all-cause mortality in a large unique cohort of patients with Type 2 diabetes (T2D) and peripheral artery disease (PAD) after partial foot amputation (PFA).
METHODS
Prospective cohort study with 1-year follow-up of 785 consecutive patients (mean age 60.9 ± 9.1 years; 64.1% males) with T2D and PAD after PFA. Depressive symptoms were assessed by Patient Health Questionnaire-9 (PHQ-9) and anxiety symptoms by Hamilton Anxiety Rating Scale (HARS). We used multivariable Cox proportional hazard models to examine the association of depression and anxiety with all-cause mortality.
RESULTS
One-year all-cause mortality was 16.9% (n = 133). 331 (42.1%) patients had PHQ-9 score ≥ 10 indicating major depressive disorder. After adjusting for confounders, PHQ-9 score ≥ 10 was associated with an increased risk of 1-year all-cause mortality (HR = 1.68 (95%CI[1.16-2.44], p = 0.006). Depression dimensions of negative self-feeling and suicidal ideations were independently associated with 1-year mortality (HR = 1.26 (95%CI[1.24-1.55], p = 0.029 and HR = 2.37 (95%CI[1.89-2.96], p 30) were associated with increased 1-year mortality (HR = 2.25(95%CI [1.26-4.05], p = 0.006).
CONCLUSION
Depressive symptoms and severe anxiety have shown independently increased risk of 1-year all-cause mortality in patients with T2D and PAD requiring PFA. Our results indicate that screening for anxiety and depression should be considered under these circumstances to identify patients at increased risk to allow appropriate intervention
Overcoming Challenges in O-Nitration: Selective Alcohol Nitration Deploying N,6-Dinitrosaccharin and Lewis Acid Catalysis.
No full textNitrate esters hold pivotal roles in pharmaceuticals, energetic materials, and atmospheric processes, motivating the development of efficient synthesis routes. Here, we present a novel catalytic method for the synthesis of nitrates via the direct O-nitration of alcohols, addressing limitations of current traditional methods. Leveraging bench-stable and recoverable N,6-dinitrosaccharin reagent, our catalytic strategy employs magnesium triflate to achieve mild and selective O-nitration of alcohols, offering broad substrate scope and unprecedented large functional group tolerance (e.g. alkenes, alkynes, carbonyls). DFT mechanistic studies reveal a dual role of the magnesium catalyst in the activation of both the nitrating reagent and the alcohol substrate. They also unveil a barrierless proton transfer upon formation of a widely-accepted - yet elusive in solution - nitrooxonium ion intermediate. Overall, our work contributes to the development of mild, selective, and sustainable approaches to nitrates synthesis, with potential applications in drug discovery, materials science, and environmental chemistry
Human‐initiated autocyclic delta failures
Get PDFRiver regulations have resulted in changes in the hydrology and particle bud- gets of fluvial systems. Since the 19th century, many rivers have been signifi- cantly modified to control flood hazards, to gain land from swamp areas for agricultural purposes, and to stabilize river-levels and lake-levels to facilitate navigation. These dramatic changes of the river courses have impacted the sediment budgets and grain-size dissemination along them as well as the sedi- ment distribution at the delta mouths in the downstream lakes, which could lead to slope instabilities. Deposits of such catastrophic lacustrine mass move- ments caused by delta collapses have been, for instance, observed in Lake Bri- enz (Switzerland), where relatively thick (0.5 to 1.3 m) and voluminous (>1 million m3) megaturbidites are stacked in the deep basin witnessing these pro- cesses. This study uses sediment cores and seismic data to reconstruct the megaturbidites’ history in Lake Brienz. Data reveal that mass-movement deposits, originating from the Aare Delta, one of the two main inflows, have mean ages of 1853, 1905, 1942 and 1996 CE and that they were unprecedented in, at least, half a millennium. The fact that the numbers of floods and earth- quakes have not changed radically over this time period implies that human impact is the most likely explanation for these failure events. Therefore, the recurrent delta collapses are attributed to the focused sediment accumulation at the front of the channelized inflow in the proximal delta region, caused by the modification of the Aare River through its straightening and channeliza- tion during the late 19th century. These findings indicate that river regulation can affect delta sedimentation, leading to autocyclic delta collapses. Those collapses, in turn, can potentially generate tsunami waves, representing an additional natural hazard for shoreline communities
Omission of Radiotherapy in Primary Mediastinal B-Cell Lymphoma: IELSG37 Trial Results.
No full textBACKGROUND
The role of consolidation radiotherapy in primary mediastinal B-cell lymphoma (PMBCL) patients is controversial.
METHODS
The IELSG37 trial, a randomized non-inferiority study, aimed to assess whether irradiation can be omitted in PMBCL patients with complete metabolic response (CMR) after induction immunochemotherapy. Primary endpoint was progression-free survival (PFS) at 30 months post-randomization. Patients with CMR were randomly assigned to observation or consolidation radiotherapy (30 Gy). With a non-inferiority margin of 10% (assuming a 30-month PFS of 85% in both arms), a sample size of 540 patients was planned with 376 expected to be randomized.
RESULTS
The observed events were considerably lower than expected, therefore, primary endpoint analysis was conducted when ≥95% of patients were followed for ≥30 months. Of 545 patients enrolled, 268 were in CMR after induction and were randomized to observation (n=132) or radiotherapy (n=136). The 30-month PFS was 96.2% in the observation arm and 98.5% in the radiotherapy arm, with a stratified hazard ratio of 1.47 (95%CI, 0.34 to 6.28) and absolute risk difference of 0.68% (95%CI, -0.97% to 7.46%). The 5-year overall survival was 99% in both arms.Non-randomized patients were managed according to local policies. Radiotherapy was the only treatment in 86% of those with Deauville score (DS) 4 and in 57% of those with DS 5. The 5-year PFS and OS of patients with DS 4 (95.8% and 97.5%, respectively) were not significantly different from those of randomized patients. Patients with DS5 had significantly poorer 5-year PFS and OS (60.3% and 74.6%, respectively).
CONCLUSIONS
This study, the largest randomized trial of radiotherapy in PMBCL, demonstrated favorable outcomes in patients achieving CMR with no survival impairment for those omitting irradiation
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