Symptomatic lymphocele after kidney transplantation: a single-center experience.

INTRODUCTION: In a retrospective study, we evaluated the frequency, clinical presentation, and management of lymphocele in kidney transplant recipients operated on in a single center. MATERIALS AND METHODS: Between September 1984 and June 2005, we had 2147 kidney transplantations from living donors. During the follow-up period, ultrasonography was performed in symptomatic patients and those with elevated serum creatinine level postoperatively. Other radiological procedures were done in complicated cases. Patients with lymphocele were treated by percutaneous drainage with or without injection of sclerotizing agent (povidone iodine). If recurrence occurred, surgical intraperitoneal drainage was performed. In cases with multiloculated collection or inappropriate access for percutaneous drainage, the primary approach was surgical intraperitoneal drainage. RESULTS: Symptomatic lymphocele collection was seen in 17 kidney recipients of our series (0.8; 95 confidence interval, 0.4 to 1.2). It presented with elevation of serum creatinine concentrations (47.1), pain and abdominopelvic swelling (29.4), and lower extremity edema (23.5). Percutaneous drainage was used for the treatment of lymphocele in 11 patients, but recurrence occurred in 7 (63.6). These cases were treated with open surgical drainage. In 6 patients, the primary approach was surgical intraperitoneal drainage, because of multiloculated collection or inappropriate access for percutaneous drainage. All of the patients were treated successfully and no graft loss occurred during the follow-up period. CONCLUSION: Symptomatic lymphocele is an uncommon complication after kidney transplantation. Surgical intraperitoneal drainage is the most effective approach for the management of symptomatic lymphocele

Neratinib plus trastuzumab is superior to pertuzumab plus trastuzumab in HER2-positive breast cancer xenograft models

Lapatinib (L) plus trastuzumab (T), with endocrine therapy for estrogen receptor (ER)+ tumors, but without chemotherapy, yielded meaningful response in HER2+ breast cancer (BC) neoadjuvant trials. The irreversible/pan-HER inhibitor neratinib (N) has proven more potent than L. However, the efficacy of N+T in comparison to pertuzumab (P) + T or L + T (without chemotherapy) remains less studied. To address this, mice bearing HER2+ BT474-AZ (ER+) cell and BCM-3963 patient-derived BC xenografts were randomized to vehicle, N, T, P, N+T, or P+T, with simultaneous estrogen deprivation for BT474-AZ. Time to tumor regression/progression and incidence/time to complete response (CR) were determined. Changes in key HER pathway and proliferative markers were assessed by immunohistochemistry and western blot of short-term-treated tumors. In the BT474-AZ model, while all N, P, T, N + T, and P + T treated tumors regressed, N + T-treated tumors regressed faster than P, T, and P + T. Further, N + T was superior to N and T alone in accelerating CR. In the BCM-3963 model, which was refractory to T, P, and P + T, while N and N + T yielded 100% CR, N + T accelerated the CR compared to N. Ki67, phosphorylated (p) AKT, pS6, and pERK levels were largely inhibited by N and N + T, but not by T, P, or P + T. Phosphorylated HER receptor levels were also markedly inhibited by N and N + T, but not by P + T or L + T. Our findings establish the efficacy of combining N with T and support clinical testing to investigate the efficacy of N + T with or without chemotherapy in the neoadjuvant setting for HER2+ BC

Global mortality and readmission rates following COPD exacerbation-related hospitalisation: a meta-analysis of 65 945 individual patients

\ua9 2024, European Respiratory Society. All rights reserved.Background Exacerbations of COPD (ECOPD) have a major impact on patients and healthcare systems across the world. Precise estimates of the global burden of ECOPD on mortality and hospital readmission are needed to inform policy makers and aid preventive strategies to mitigate this burden. The aims of the present study were to explore global in-hospital mortality, post-discharge mortality and hospital readmission rates after ECOPD-related hospitalisation using an individual patient data meta-analysis (IPDMA) design. Methods A systematic review was performed identifying studies that reported in-hospital mortality, postdischarge mortality and hospital readmission rates following ECOPD-related hospitalisation. Data analyses were conducted using a one-stage random-effects meta-analysis model. This study was conducted and reported in accordance with the PRISMA-IPD statement. Results Data of 65 945 individual patients with COPD were analysed. The pooled in-hospital mortality rate was 6.2%, pooled 30-, 90- and 365-day post-discharge mortality rates were 1.8%, 5.5% and 10.9%, respectively, and pooled 30-, 90- and 365-day hospital readmission rates were 7.1%, 12.6% and 32.1%, respectively, with noticeable variability between studies and countries. Strongest predictors of mortality and hospital readmission included noninvasive mechanical ventilation and a history of two or more ECOPD-related hospitalisation

Distribution of angle kappa measurements with Orbscan II in a population-based survey

PURPOSE: To determine the mean angle kappa and its determinants in the population of Tehran, Iran. METHODS: In a cross-sectional survey with random cluster sampling, a total of 442 participants aged >14 years were selected from 4 municipality districts of Tehran for Orbscan acquisitions. Exclusion criteria were history of eye surgery for refractive errors, cataract or glaucoma, and use of topical medication or any type of contact lens at the time of the study. Mean angle kappa in different age and gender groups and its association with other factors was assessed. Considering the high correlation between the right and left eyes, only results of the right eyes are presented. RESULTS: After applying exclusion criteria, 800 eyes (399 right eyes and 401 left eyes) were examined. Mean participant age was 40.6±16.8 years (range: 14 to 81 years), and 38.8 of eyes were from men. Mean angle kappa was 5.46±1.33° in total; 5.41±1.32° in men and 5.49±1.34° in women (P=.558). It decreased significantly with age; 0.015°/year (P<.001). In individuals with myopia, emmetropia, and hypermetropia, the mean value was 5.13±1.50°, 5.72±1.10°, and 5.52±1.19°, respectively (P=.025); the post-hoc test indicated this was due to the difference between emmetropes and myopes. CONCLUSIONS: According to our results, angle kappa reduces with age, and the inter-gender difference is not significant. Largest angle kappas were seen among individuals with emmetropia. Angle kappas were larger in the hypermetropic population compared to the myopic population. Copyright © SLACK Incorporated

Distribution of cataract surgical rate and its economic inequality in Iran

Purpose. To determine the distribution of the cataract surgical number per million population per year (CSR), the CSR in the population older than 50 years (CSR 50+) in the provinces of Iran, and their economic inequality in 2010. Methods. As part of the cross-sectional 2011 CSR survey, the provincial CSR and CSR 50+ were calculated as the total number of surgeries in major and minor centers divided by the total population and the population older than 50 years in each province. Economic inequality was determined using the average province income, the average urban and rural household incomes, and the percentage of urban and rural population in each province. Results. Tehran and Ilam provinces had the highest and lowest CSR (12,465 vs. 359), respectively. Fars and Ilam provinces had the highest and lowest CSR 50+ (71,381 vs. 2481), respectively. Low CSR (5000) was observed in 14 provinces (45.2) where rates were 0.6 to 59.9 higher than the global target. Cataract surgical rate increased at higher economic quintiles. Differences between the first, second, and fifth (poorest) quintiles were statistically significant. The CSR concentration index was 0.1964 (95 confidence interval, 0.0964 to 0.2964). Conclusions. In line with the goals of the Vision 2020 initiative to eliminate cataract blindness, more than 70 of geographic areas in Iran have achieved the minimum CSR of 3000 or more. However, a large gap still exists in less than 30 of areas, mainly attributed to the economic status. Copyright © 2015 American Academy of Optometry

Hydrogen production via methane pyrolysis in a liquid metal bubble column reactor with a packed bed

Methane pyrolysis experiments using a quartz glass-steel bubble column reactor filled with liquid tin and cylindrical quartz glass rings serving as a packed bed were conducted at various liquid metal temperature levels in the range of 930–1175 °C. Besides the liquid metal temperature, special attention was paid to the influence of the feed gas volume flow rate in the range of 50–200 mln/min and the inlet feed gas dilution with nitrogen. Increasing liquid metal temperatures resulted in increasing hydrogen yields, leading to a maximum hydrogen yield of 78% at 1175 °C and 50 mln/min methane volume flow rate. Within all experimental runs, less than 1.5 mol-% intermediate products were detected in the product gas. The produced carbon appeared as a powder consisting of flake shaped agglomerations in the size range of 15–20 μm, wherein the particle size varied from 40 nm to 100 nm. During the experiments, the produced carbon was completely separated and accumulated at the top surface of the liquid metal. Only minor quantities were transported with the off gas stream. Within the liquid metal inventory, a thin carbon layer of about 10 μm, probably partly showing the formation of nanotubes, in the hot reaction zone, had been deposited on the quartz glass reactor wall