Massive pulmonary embolism in patients with extreme bleeding risk: a case series on the successful use of ultrasound-assisted, catheter directed thrombolysis in a district general hospital

This is the final version. Available from the publisher via the DOI in this record.Massive pulmonary embolism (PE), characterised by profound arterial hypotension, is a life-threatening emergency with a 90-day mortality of over 50%. Systemic thrombolysis can signifcantly reduce the risk of death or cardiovascular collapse in these patients, by around 50%, but these benefts are ofset by a fvefold increased risk of intracranial haemorrhage and major bleeding, which may limit its use in patients at high risk of catastrophic haemorrhage. We describe a case series of 3 patients presenting with massive PE, each with extreme risk of bleeding and contra-indication to systemic thrombolysis, treated successfully with ultrasound-assisted, catheter directed thrombolysis (U-ACDT). Our experience of this novel technique using the EkoSonic Endovascular System (Ekos, BTG, London, UK) on carefully selected patients has demonstrated the potential to improve clinical status in shocked patients, with minimal bleed risk. There have been several clinical studies evaluating the Ekos system. Both the ULTIMA and SEATTLE II studies have shown signifcant reductions in RV/LV ratio by CT scanning when compared to standard anticoagulation in patients with intermediate-risk PE, with minimal bleeding complications. However, there is a pressing need for a randomised trial demonstrating improvement in robust clinical outcomes when comparing U-ACDT to simple anticoagulation. We believe that this case series adds new insight and highlights the potential of catheter directed thrombolysis in this high-risk patient cohort and consideration should be made to its use in cases where systemic thrombolysis is felt to be too high ris

Activities across Africa to improve antimicrobial utilisation and reduce AMR

There are concerns with current prescribing and dispensing of antimicrobials in Africa. Point prevalence studies in hospitals shown variable rates with high rates HIV in some. Variable ASPs, extended prophylaxis and high rates self purchasing in some

Nanomechanical probing and strain tuning of the Curie temperature in suspended Cr2Ge2Te6-based heterostructures

Two-dimensional magnetic materials with strong magnetostriction are attractive systems for realizing strain-tuning of the magnetization in spintronic and nanomagnetic devices. This requires an understanding of the magneto-mechanical coupling in these materials. In this work, we suspend thin Cr2Ge2Te6 layers and their heterostructures, creating ferromagnetic nanomechanical membrane resonators. We probe their mechanical and magnetic properties as a function of temperature and strain by observing magneto-elastic signatures in the temperature-dependent resonance frequency near the Curie temperature, TC. We compensate for the negative thermal expansion coefficient of Cr2Ge2Te6 by fabricating heterostructures with thin layers of WSe2 and antiferromagnetic FePS3, which have positive thermal expansion coefficients. Thus we demonstrate the possibility of probing multiple magnetic phase transitions in a single heterostructure. Finally, we demonstrate a strain-induced enhancement of TC in a suspended Cr2Ge2Te6-based heterostructure by 2.5 ± 0.6 K by applying a strain of 0.026% via electrostatic force

Use of record linkage to evaluate treatment outcomes and trial eligibility in a 1 real-world metastatic prostate cancer population in Scotland

Purpose: New treatments are introduced into standard care based on clinical trial results. However, it is not clear if these benefits are reflected in the broader population. This study analysed the clinical outcomes of patients with metastatic castration-resistant prostate cancer, treated with abiraterone and enzalutamide, within the Scottish National Health Service. Methods: Retrospective cohort study using record linkage of routinely collected healthcare data (study period: February 2012 to February 2017). Overall survival (OS) was analysed using Kaplan-Meier methods and Cox Proportional Hazard models; a subgroup analysis comprised potentially trial-eligible patients. Results: Overall, 271 patients were included and 73.8% died during the study period. Median OS was poorer than in the pivotal trials, regardless of medication and indication: 10.8 months (95% confidence interval [CI] 8.6-15.1) and 20.9 months (95% CI 14.9-29.0) for abiraterone, and 12.6 months (95% CI 10.5-18.2) and 16.0 months (95% CI 9.8—not reached) for enzalutamide, post and pre chemotherapy, respectively. Only 46% of patients were potentially “trial eligible” and in this subgroup OS improved. Factors influencing survival included baseline performance status, and baseline prostate-specific antigen, alkaline phosphatase, and albumin levels. Conclusions: Poorer prognostic features of non-trial eligible patients impact real-world outcomes of cancer medicines. Electronic record linkage of routinely collected healthcare data offers an opportunity to report outcomes on cancer medicines at scale and describe population demographics. The availability of such observational data to supplement clinical trial results enables patients and clinicians to make more informed treatment decisions, and policymakers to contextualise trial findings

Single-shot temporal characterization of XUV pulses with duration from ~10 fs to ~350 fs at FLASH

Ultra-short extreme ultraviolet pulses from the free-electron laser FLASH are characterized using terahertz-field driven streaking. Measurements at different ultra-short extreme ultraviolet wavelengths and pulse durations as well as numerical simulations were performed to explore the application range and accuracy of the method. For the simulation of streaking, a standard classical approach is used which is compared to quantum mechanical theory, based on strong field approximation. Various factors limiting the temporal resolution of the presented terahertz streaking setup are investigated and discussed. Special attention is paid to the cases of very short (similar to 10 fs) and long (up to similar to 350 fs) pulses.We want to acknowledge the work of the scientific and technical team at FLASH. NMK acknowledges the hospitality and financial support from DESY and from the theory group in cooperation with the SQS research group of the European XFEL (Hamburg). KW and MD acknowledge support by the SFB925-A1. UF and AD acknowledge support by the excellence cluster `The Hamburg Center for Ultrafast Imaging-Structure, Dynamics and Control of Matter at the Atomic Scale' (DFG)-EXC 1074 project ID 194651731. SW acknowledges support by the DFG Forschergruppe FOR 1789. Editoria

Tresca stress study of CoCrMo-on-CoCrMo bearings based on body mass index using 2D computational model

Many investigations for developing total hip arthroplasty performance presented in previous literature show focusing on implant users' external factors. Although this is important, assessing loading based on implant user’s weight also needs to be examined as it contributes to overall performance of this prosthesis. Our study attempted to evaluate Tresca stress in CoCrMo-on-CoCrMo hip implant based on body mass index from patient. 2D computational model in this paper has been establishing to reach this objective. Loading variation is also considered with different body mass index categories from underweight, normal, overweight, obese class I, obese class II, and obese class III under normal walking condition. We found that Tresca stress rises with higher body mass index category

Minimizing Risk of Failure from Ceramic-on-Ceramic Total Hip Prosthesis by Selecting Ceramic Materials Based on Tresca Stress

The choice of ceramic-on-ceramic coupling in total hip prosthesis has advantages over couplings with other combinations of materials that use polyethylene and metal materials in terms of high hardness, scratch resistance, low wear rate, and increased lubrication performance. To reduce the risk of primary postoperative failure, the selection of ceramic materials for ceramicon-ceramic coupling is a strategic step that needs to be taken. The current study aims to analyze ceramic-on-ceramic coupling with commonly used ceramic materials, namely zirconium dioxide (ZrO2), silicon nitride (Si3N4), and aluminium oxide (Al2O3), according to Tressa failure criterion for the investigation of the stress distribution. A two-dimensional axisymmetric finite element-based computational model has been used to evaluate the Tresca stress on ceramic-on-ceramic coupling under gait cycle. The results show that the use of ZrO2-on-ZrO2 couplings can reduce Tresca stress by about 17.34% and 27.23% for Si3N4-on-Si3N4 and Al2O3-on-Al2O3 couplings, respectively