Effect of intraperitoneal chemotherapy concentration on morbidity and survival

Contains fulltext : 218098.pdf (publisher's version ) (Open Access)BACKGROUND: Selected patients with colorectal peritoneal metastases are treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The concentration of intraperitoneal chemotherapy reflects the administered dose and perfusate volume. The aim of this study was to calculate intraperitoneal chemotherapy concentration during HIPEC and see whether this was related to clinical outcomes. METHODS: An observational multicentre study included consecutive patients with colorectal peritoneal metastases who were treated with CRS-HIPEC between 2010 and 2018 at three Dutch centres. Data were retrieved from prospectively developed databases. Chemotherapy dose and total circulating volumes of carrier solution were used to calculate chemotherapy concentrations. Postoperative complications, disease-free and overall survival were correlated with intraoperative chemotherapy concentrations. Univariable and multivariable logistic regression, Cox regression and survival analyses were performed. RESULTS: Of 320 patients, 220 received intraperitoneal mitomycin C (MMC) and 100 received oxaliplatin. Median perfusate volume for HIPEC was 5.0 (range 0.7-10.0) litres. Median intraperitoneal chemotherapy concentration was 13.3 (range 7.0-76.0) mg/l for MMC and 156.0 (91.9-377.6) mg/l in patients treated with oxaliplatin. Grade III or higher complications occurred in 75 patients (23.4 per cent). Median overall survival was 36.9 (i.q.r. 19.5-62.9) months. Intraperitoneal chemotherapy concentrations were not associated with postoperative complications or survival. CONCLUSION: CRS-HIPEC was performed with a wide variation in intraperitoneal chemotherapy concentrations that were not associated with complications or survival

Effects of composition and phase relations on mechanical properties and crystallisation of silicate glasses

Crystallization, mechanical properties and workability are all important for commercialization and optimization of silicate glass compositions. However, the inter-relations of these properties as a function of glass composition have received little investigation. Soda-lime-silica glasses with Na2O-MgO-CaO-Al2O3-SiO2 compositions relevant to commercial glass manufacture were experimentally studied and multiple liquidus temperature and viscosity models were used to complement the experimental results. Liquidus temperatures of the fabricated glasses were measured by the temperature gradient technique, and Rietveld refinements were applied to X-Ray powder diffraction (XRD) data for devitrified glasses, enabling quantitative determination of the crystalline and amorphous fractions and the nature of the crystals. Structural properties were investigated by Raman spectroscopy. Acoustic echography, micro-Vicker’s indentation and single-edge notched bend testing methods were used to measure Young’s moduli, hardness and fracture toughness, respectively. It is shown that it is possible to design lower-melting soda-lime-silica glass compositions without compromising their mechanical and crystallization properties. Unlike Young’s modulus, brittleness is highly responsive to the composition in soda-lime-silica glasses, and notably low brittleness values can be obtained in glasses with compositions in the wollastonite primary phase field: an effect that is more pronounced in the silica primary phase field. The measured bulk crystal fractions of the glasses subjected to devitrification at the lowest possible industrial conditioning temperatures, indicate that soda-lime-silica glass melts can be conditioned close to their liquidus temperatures within the compositional ranges of the primary phase fields of cristobalite, wollastonite or their combinations

Derivation of a general three-dimensional crack-propagation law: A generalization of the principle of local symmetry

We derive a general crack propagation law for slow brittle cracking, in two and three dimensions, using symmetry, gauge invariance, and gradient expansions. Our derivation provides explicit justification for the ``principle of local symmetry,'' which has been used extensively to describe two dimensional crack growth, but goes beyond that principle to describe three dimensional crack phenomena as well. We also find that there are new materials properties needed to describe the growth of general cracks in three dimensions, besides the fracture toughness and elastic constants previously used to describe cracking.Comment: 31 pages, including several figure

Influence of particle size and particle size distribution on toughening mechanisms in rubber-modified epoxies

The principal toughening mechanism of a substantially toughened, rubber-modified epoxy has again been shown to involve internal cavitation of the rubber particles and the subsequent formation of shear bands. Additional evidence supporting this sequence of events which provides a significant amount of toughness enhancement, is presented. However, in addition to this well-known mechanism, more subtle toughening mechanisms have been found in this work. Evidence for such mechanisms as crack deflection and particle bridging is shown under certain circumstances in rubber-modified epoxies. The occurrence of these toughening mechanisms appears to have a particle size dependence. Relatively large particles provide only a modest increase in fracture toughness by a particle bridging/crack deflection mechanism. In contrast, smaller particles provide a significant increase in toughness by cavitation-induced shear banding. A critical, minimum diameter for particles which act as bridging particles exists and this critical diameter appears to scale with the properties of the neat epoxy. Bimodal mixtures of epoxies containing small and large particles are also examined and no synergistic effects are observed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44701/1/10853_2005_Article_BF01184979.pd

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Bevlogenheid en burn-out in relatie tot persoonlijkheid en context bij aiossen psychiatrie: Een verkennend onderzoek

Contains fulltext : 166655.pdf (publisher's version ) (Open Access)Achtergrond: Er wordt in internationale studies de laatste jaren een toename van burn-out en depressieve klachten bij artsen in opleiding tot specialist (aiossen) gemeld. Bevlogenheid als positieve tegenhanger van burn-out wordt in toenemende mate betrokken in dit onderzoeksveld. Doel: Achterhalen hoe een groep Nederlandse aiossen psychiatrie zich in het werkveld voelt, nagaan in welke mate er sprake is van burn-out en bevlogenheid bij deze groep, en verhelderen welke factoren hiermee samenhangen. Methode: Bij 59 aiossen psychiatrie van vier verschillende opleidingsinstituten werden vragenlijsten afgenomen gericht op burn-outklachten (UBOS-C), bevlogenheid (UBES-15) en persoonlijkheid (BFI-NL). Daarnaast werden ervaringen en omstandigheden in de opleidings- en werkcontext uitgevraagd. Resultaten: Bij de UBOS-C scoorden 4 aiossen (6,7%) boven het 75ste percentiel en voldeden daarmee aan de kenmerken van een burn-out. Bij de bfi-nl scoorden de aiossen gemiddeld significant lager op neuroticisme en significant hoger op altruïsme dan een vergelijkbare normgroep. 'Trots zijn op je werk' liet een sterke samenhang zien met ervaren bevlogenheid en meer in het bijzonder met de factor toewijding. Conclusie Het percentage aiossen met burn-outklachten is in onderhavige studie beduidend lager dan tot op heden beschreven is in de literatuur. De resultaten laten eerder zien dat aiossen zichzelf als relatief emotioneel stabiel, vriendelijk en toegewijd omschrijven.7 p

Improvement of Symptoms after Lymphaticovenous Anastomosis in Patients with Abdominal Wall Lymphedema

At our institution, we performed a lymphaticovenous anastomosis in patients with primary or secondary abdominal lymphedema. Patients report good outcomes and feel relieved of their complaints. To obtain good results, it is important to have decent knowledge on the anatomical state of the lymphatic system. In general, the lymphatic system of the lower abdomen can be compared with the system of the upper legs. According to our current case results, the abdominal area might be susceptible to lymphaticovenous anastomosis procedure. Further research should be performed to confirm the effect of the intervention and the imaging techniques to monitor the improvements

Improvement of Symptoms after Lymphaticovenous Anastomosis in Patients with Abdominal Wall Lymphedema

Summary:. At our institution, we performed a lymphaticovenous anastomosis in patients with primary or secondary abdominal lymphedema. Patients report good outcomes and feel relieved of their complaints. To obtain good results, it is important to have decent knowledge on the anatomical state of the lymphatic system. In general, the lymphatic system of the lower abdomen can be compared with the system of the upper legs. According to our current case results, the abdominal area might be susceptible to lymphaticovenous anastomosis procedure. Further research should be performed to confirm the effect of the intervention and the imaging techniques to monitor the improvements