A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Calculation of metal buildings with structural elements of corrugated trunks

100 σ.Στα πλαίσια της παρούσας διπλωματικής εργασίας μελετάται η κατασκευή ενός απλού μονώροφου κτιρίου από χάλυβα S235, με χρήση δοκών με αυλακωτούς κορμούς. Συνήθως για πλαίσια με μεγάλα ανοίγματα, γίνεται χρήση δικτυωτής δοκού, όπου μέσω μεταβολής του εμβαδού των ράβδων και του στατικού ύψους, επιτυγχάνεται η βελτιστοποίηση του βάρους. Όμως, η μείωση του κόστους συνδέεται με πρόσθετα μέτρα όσον αφορά την οργάνωση, την παραγωγή και την ανέγερση του έργου. Η χρήση δικτυωμάτων για τα συνήθη ανοίγματα και στατικά ύψη συνίσταται αντιοικονομική λόγω κόστους των συνδέσεων των ράβδων. Έτσι, αποφασίστηκε χρήση δοκών με αυλακωτούς κορμούς για τις δοκούς και τα υποστυλώματα του υπό μελέτη κτιρίου. Οι δοκοί με αυλακωτούς κορμούς είναι συγκολλητές διατομές, η παραγωγή των οποίων γίνεται τελείως αυτόματα. Η κάμψη των ελασμάτων των κορμών, η σύνδεσή τους και η συγκόλληση τους με τα πέλματα γίνεται σε μια φάση εργασίας. Αρχικά, γίνεται υπολογισμός των δράσεων του φέροντος οργανισμού του κτιρίου, που προέρχονται από μόνιμα (ίδιον βάρος κατασκευής, φορτία αναρτήσεων, φορτία επικαλύψεων), κινητά (χιόνι, άνεμος) και σεισμικά φορτία. Στην συνέχεια γίνεται διαστασιολόγηση της δοκού και του υποστυλώματος για τους επιμέρους ελέγχους που απαιτούνται, όσον αφορά τη χρήση δοκών με αυλακωτούς κορμούς, όπως έλεγχος έναντι διατμητικού λυγισμού (κύρτωση) της ορθότροπης πλάκας, αντοχή έναντι τέμνουσας, έναντι συγκεντρωμένου φορτίου και συνδυαστική αντοχή έναντι αξονικών δυνάμεων και ροπών. Αναλυτικά, ξετάστηκαν δύο περιπτώσεις πλαισίων, ένα με δοκούς με κυματοειδής κορμούς και ένα με δοκούς με τραπεζοειδείς κορμούς. Στη συνέχεια, προχωρήσαμε στη σύνδεση δοκού και υποστυλώματος μέσω μια κοχλίωσης. Αρχικά τοποθετήθηκε μια μετωπικά πλάκα, πάνω στην οποία συγκολλήθηκε η δοκός και στη συνέχεια με χρήση κοχλιώσεων έγινε η σύνδεση δοκού και υποστυλώματος. Ο χάλυβας που χρησιμοποιήθηκε είναι S235, ενώ οι κοχλίες είναι Μ24 και ποιότητας 10.9. Η πραγμάτωση των παραπάνω ελέγχων για τον φέροντα οργανισμό και την κοχλίωση έγινε με χρήση του προγράμματος Microsoft Excel, ενώ η σχεδίαση της λεπτομέρειας της κοχλίωσης έγινε με Autocad.Ιn the present of this diploma thesis , we deal with the construction of a simple storey metal building, using beams with corrugated trunks. For frames with large openings, use is made of lattice ginder, wherein by varying the area of the bars and the static height, we can achieve weight optimization. However, the cost savings are associated with additional measures regarding the organization, production and construction of the project. Τhe use of a netting for standard openings and static heights is uneconomical due to cost of connections of rods. Thus, it was decided using beams with corrugated trunks for beams and columns of the studied building. The beams with corrugated trunks are welded sections, the production of which is fully automatic. The bending of plates of logs, connecting a bonding with soles are made in a working phase. First, we start with a calculation of the actions of the metal structure of the building from permanent (self-weight construction, suspension loads, loads of coatings), mobile (snow, wind) and seismic loads. Then becomes dimensioning of the beam and the columns for the individual controls required in the use of beams with corrugated trunks, as control versus shear buckling of orthotropic plate, shear resistance and concentrated load versus combined resistance to axial forces and torques. Analytically, we examined two cases of frames, one with undulatory beams and a corrugated web beams with trapezoidal trunks. Then we proceeded to connect beams and columns via a screw. Initially, we placed frontally a plate, on which the beam was annealed, and then by using bolting we ade the connection of the beam and the column. The steel used is S235 , while the screws are M24 and 10.9 quality. The making of these checks for load bearing and bolting was performed by using the program Microsoft Excel, while the design detail of the screw was performed by using Autocad.Δημήτριος Σ. Χονδρόπουλο

Balanced control of both hyper and hypo-inflammatory phases as a new treatment paradigm in sepsis

The immune response of the host against invading pathogens is clinically manifested as sepsis. Sepsis is a complicated process characterized by distinct phases that usually occur in a sequential manner. The initial hyper-inflammation helps in elimination of the pathogen, but potentially may lead to excessive tissue injury. Hypo-inflammation helps in restoring immune homeostasis, but may lead to significant immune suppression and death from secondary infections if not appropriately controlled. Immune-modulating intervention in sepsis should be based on a balanced control of both the hyper and the hypo-inflammatory phase. © 2016. Journal of Thoracic Disease

Extramedullary leukemia relapse after allogeneic stem cell transplantation: A novel mechanism of immune escape?

Background: Relapse is a significant cause of treatment failure after allogeneic stem cell transplantation. In many cases relapse occurs when leukemic cells escape from immune surveillance. Methods &results: In the setting of haploidentical transplantation, immune escape is usually the result of the loss of the mismatched haplotype from leukemic cells, while downregulation of HLA-expression has been postulated as a significant cause of immune escape after transplantation with the use of HLA-matched donors. We observed that patients with acute leukemia who relapse at the time of active graft-versus-host-disease, usually develop extramedullary leukemia while they remain free of leukemia in peripheral blood and bone marrow. Conclusion: Our observation points toward a novel mechanism of immune escape which is microenvironment-specific. © 2020 Future Medicine Ltd

Evidence of sperm storage in schreiber’s fringe-fingered lizard, acanthodactylus schreiberi schreiberi, from cyprus: (Reptilia: Lacertidae)

Four females of Schreiber’s Fringe-fingered Lizard, Acanthodactylus schreiberi schreiberi Boettger, 1878, from the Troodos Mountains in Cyprus were captured after mating in the field and moved into isolated terraria in the laboratory. Three of them laid two clutches and the fourth one laid four clutches without any further mating with males. The last oviposition was observed 90 days after capture in the field. This indicates that females of this species are capable of storing functional sperms for at least a period of three months. This ability may have played an important role in the distribution of the lizard into the inner island and the Troodos Mountains where it can be found in sparse populations. © 2012 Taylor & Francis Group, LLC

Neogene climatic oscillations shape the biogeography and evolutionary history of the Eurasian blindsnake

Typhlops vermicularis is the only extant scolecophidian representative occurring in Europe. Its main distribution area, the eastern Mediterranean, has a complicated geological and climatic history that has left an imprint on the phylogenies and biogeography of many taxa, especially amphibians and reptiles. Since reptiles are sensitive indicators of palaeogeographical and palaeoclimatic events, we investigated the intraspecific genealogy of T. vermicularis in a phylogeographical framework. A total of 130 specimens were analyzed, while the use of formalin and ethanol as preservatives called for a special treatment of the samples. Partial sequences of two mitochondrial (12S and ND2) and one nuclear (PRLR) marker were targeted and the results of the phylogenetic analyses (NJ, ML and BI) and the parsimony-network revealed the existence of 10 evolutionary significant units within this species. In combination with the results of the dispersal-vicariance analysis, we may conclude that the Eurasian blindsnake has encountered a sequence of extinction events, followed by secondary expansion from refugia. Estimation of divergence times showed that severe climatic changes between significantly wetter and drier conditions in the Late Neogene have played a key role on the evolutionary and biogeographical history of T. vermicularis. Additionally, both markers (mtDNA and nDNA) distinguished a largely-differentiated evolutionary lineage (Jordan and south Syria), which could even be reckoned as a full species. Our study reveals the existence of cryptic evolutionary lineages within T. vermicularis, which calls for further attention both on the protection of intraspecific varieties and the respective geographic areas that hold them. (C) 2011 Elsevier Inc. All rights reserved

Direct evidence for normalization of platelet function resulting from platelet count reduction in essential thrombocythemia

Essential thrombocythemia is characterized by persistent elevation and functional disturbances of platelets. Both the platelet function analyzer-100 (PFA-100) collagen-epinephrine (CEPI) cartridge and aggregometry with epinephrine are considered sensitive and valid methods in detecting abnormal platelet function in essential thrombocythemia. We attempted to confirm that restoration of abnormal platelet function results from platelet count reduction in essential thrombocythemia, by using these two methods. Thirty-nine essential thrombocythemia patients were divided into two groups on the basis of their platelet count. Group A participants (n = 20) exhibited platelet counts greater than 500 × 10 9/l, whereas group B participants (n = 19) had platelet counts below this limit. Hematological parameters, plasma von Willebrand factor (vWF) antigen and activity levels were assessed. Platelet function was analyzed by the PFA-100 and light transmission aggregometry with epinephrine, collagen, and ADP. The point mutation JAK2 V617F was identified and its effect on platelet function tests was also investigated. By using logistic regression analysis, white blood cell count, vWF activity level, and the measurements of aggregation in response to epinephrine were significantly different between the two groups. Epinephrine-induced aggregation retained the statistical significance in the multivariable procedure (P: 0.002). PFA-100 CEPI closure times were lower-but not statistically significant-in group B. Neither the JAK2 V617F positivity nor different cytoreductive treatments had any influence on ex-vivo platelet function tests. Our findings demonstrate normalization of platelet function resulting from platelet count reduction in essential thrombocythemia and reinforce the concept of lowering platelet counts in these patients. © 2011 Wolters Kluwer Health | Lippincott Williams &Wilkins

Management of cutaneous T-Cell lymphoma patients with extracorporeal photopheresis. The hellenic experience

Extracorporeal photopheresis (ECP) is an established therapy for cutaneous T-cell lymphoma (CTCL). The objective of this study was to further explore the clinical efficacy of ECP combined with immunomodulatory agents.Eighteen patients with histologically proven CTCL were followed-up after therapy with ECP, mainly combined with interferon-α or bexarotene.A total of 61% of patients responded to therapy (n=11; CR: 5, PR: 6). Median survival was 51. months, progression free survival was 28. months and response duration was 29±23.9. months.ECP combined therapy was highly effective or had a palliative effect in CTCL resistant to previous treatments. © 2011

Repetitively administered low-dose donor lymphocyte infusion for prevention of relapse after allogeneic stem cell transplantation in patients with high-risk acute leukemia

Background: Patients with high-risk acute leukemia have a high risk of relapse after allo-geneic stem cell transplantation (allo-SCT). In an effort to reduce the relapse rate, various therapeutic methods have been implemented into clinical practice. Among them, prophylactic donor lymphocyte infusion (pro-DLI) has shown significant efficacy. However, the widespread application of pro-DLI has been restricted mostly due to concerns regarding the development of graft versus host disease (GVHD). In the present study, we tested the safety and efficacy of a novel method of prophylactic-DLI based by repetitive administration of low lymphocyte doses. Methods: DLI was administered to patients with high-risk acute leukemia at a dose of 2 × 106 /kg CD3-positive cells. DLI at the same dose was repeated every two months for at least 36 months post-allo-SCT, or until relapse or any clinical or laboratory feature suggested GVHD, whichever occurred first. Forty-four patients with a median age of 53 years (range 20–67) who underwent allo-SCT between 2011 and 2020 were included in our study. Thirty-three patients with high-risk acute myeloid leukemia (AML) and 11 with high-risk acute lymphoblastic leukemia (ALL) after allo-SCT from a matched sibling (MSD, no = 38 pts) or a matched-unrelated donor (MUD, no = 6 pts) received pro-DLI. Twenty-three patients were in CR1, all with unfavorable genetic features; 12 patients were in CR2 or beyond; and 9 patients had refractory disease at the time of transplant. Ten out of 23 patients in CR1 had detectable minimal residual disease (MRD) at the time of allo-SCT. Disease risk index (DRI) was high and intermediate in 21 and 23 patients, respectively. Conditioning was myeloablative (MAC) in 36 and reduced intensity (RIC) in 8 patients, while GVHD prophylaxis consisted of cyclosporine-A in combination with low-dose alemtuzumab in 39 patients or with low-dose MTX in 5 patients, respectively. Results: Thirty-five patients completed the scheduled treatment and received a median of 8 DLI doses (range 1–35). Fifteen out of 35 patients received all planned doses, while DLI was discontinued in 20 patients. Reasons for discontinuation included GVHD development in nine, donor unavailability in seven, disease relapse in three, and secondary malignancy in one patient, respectively. Nine patients were still on treatment with DLI, and they received a median of four (range 2–12) doses. Fourteen percent of patients developed transient grade-II acute GVHD while 12% developed chronic GVHD post-DLI administration. Acute GVHD was managed successfully with short course steroids, and four out of five patients with cGVHD were disease-free and off immunosuppression. With a median follow-up of 44 months (range 8–120), relapse-free (RFS) and overall survival (OS) were 74%, (95% CI, 54–87%) and 78%, (95% CI, 58–89%) respectively, while the cumulative incidence of non-relapse mortality (NRM) was 13% (95% CI, 4–28%). The cumulative incidence of relapse in patients with intermediate and high DRI is 7% and 15%, respectively. Conclusion: Prolonged—up to three years—low-dose pro-DLI administered every two months is safe and effective in reducing relapse rate in patients with high-risk acute leukemia. The low-dose repetitive administration DLI strategy reduced the risk of DLI-mediated GVHD, while the prolonged repeated administration helped in preventing relapse, possibly by inducing a sustained and prolonged immunological pressure on residual leukemic cells. This novel strategy deserves testing in larger cohort of patients with high-risk acute leukemia. © 2021 by the authors. Licensee MDPI, Basel, Switzerland