Patients with an Open Abdomen in Asian, American and European Continents: A Comparative Analysis from the International Register of Open Abdomen (IROA)

Background: International register of open abdomen (IROA) enrolls patients from several centers in American, European, and Asiatic continent. The aim of our study is to compare the characteristics, management and clinical outcome of adult patients treated with OA in the three continents. Material and methods: A prospective analysis of adult patients enrolled in the international register of open abdomen (IROA). Trial registration: NCT02382770. Results: 1183 patients were enrolled from American, European and Asiatic Continent. Median age was 63 years (IQR 49–74) and was higher in the European continent (65 years, p < 0.001); 57% were male. The main indication for OA was peritonitis (50.6%) followed by trauma (15.4%) and vascular emergency (13.5%) with differences among the continents (p < 0.001). Commercial NPWT was preferred in America and Europe (77.4% and 52.3% of cases) while Barker vacuum pack (48.2%) was the preferred temporary abdominal closure technique in Asia (p < 0.001). Definitive abdominal closure was achieved in 82.3% of cases in America (fascial closure in 90.2% of cases) and in 56.4% of cases in Asia (p < 0.001). Prosthesis were mostly used in Europe (17.3%, p < 0.001). The overall entero-atmospheric fistula rate 2.5%. Median open abdomen duration was 4 days (IQR 2–7). The overall intensive care unit and hospital length-of-stay were, respectively, 8 and 11 days (no differences between continents). The overall morbidity and mortality rates for America, Europe, and Asia were, respectively, 75.8%, 75.3%, 91.8% (p = 0.001) and 31.9%, 51.6%, 56.9% (p < 0.001). Conclusion: There is no uniformity in OA management in the different continents. Heterogeneous adherence to international guidelines application is evident. Different temporary abdominal closure techniques in relation to indications led to different outcomes across the continents. Adherence to guidelines, combined with more consistent data, will ultimately allow to improving knowledge and outcome

Mode-locking characteristics and relative intensity noise reduction in hybrid soliton pulse source

The noise and mode-locking phenomena of a hybrid soliton pulse source (HSPS) utilizing different fiber Bragg gratings (FBG) with or without linear chirp are described. The HSPS is modeled by a time-domain solution of the coupled-mode equations including spontaneous emission noise, and relative intensity noise (RIN) is calculated using numerical solutions of these equations. It is found that transform-limited pulses over a wide tuning range around the fundamental mode-locking frequency are generated from mode-locked HSPS with linearly chirped uniform and Gaussian apodized FBGs. Mode-locked pulses that are not transform-limited are generated over a wide tuning range from HSPS with Gaussian apodized and uniform FBGs. These gratings can give transform-limited pulses only over a limited tuning range around the fundamental mode-locking frequency. It is also found that RIN reduction is possible for the mode-locked HSPS by selecting a suitable apodization function such as Gaussian and linear chirp rate

Lipid Matrix Nanoparticles: Pharmacokinetics and Biopharmaceutics

WOS: 000271386300019Lipid matrix nanoparticles, such as solid lipid nanoparticles (SLN) and nanostructured lipid carriers (NLC), have been sought as a useful alternative for formulating poorly soluble drugs intended for several administration routes, e. g. oral, parenteral and topical. These systems are surfaced by a film of surfactant in an aqueous phase, being therefore physicochemically and thermodynamically stable having a mean particle size below 1 m. The matrix of SLN is solely composed of a pure solid lipid ( melting point above 40 degrees C) whereas NLC is composed of a blend of solid and liquid lipids, which must also be solid at both body and room temperatures. The achievements of SLN and NLC as drug carrier systems are due to several advantages, e. g. incorporation of hydrophobic and hydrophilic drug molecules ( including peptides and proteins), controlled release, protection of chemically labile drugs, fulfil several prerequisites for an optimum colloidal drug carrier. The present review aims to emphasize the special features of lipid matrix nanoparticles, in particular for controlled release purposes. An overview on pharmacokinetic and biopharmaceutic results achieved by different research groups is given and their parameters are analyzed

W/O/W multiple emulsions containing nitroimidazole derivates for vaginal delivery

WOS: 000245983300003PubMed ID: 17454033The aim of our study was to formulate a stable multiple emulsions containing two nitromidazole derivates, metronidazole (MT) and ornidazole (OR), for vaginal therapy. MT and OR were located internal and external phases of multiple emulsion, respectively, and the in vitro release studies were realized in phosphate (pH 7) and lactate buffer (pH 4.5) solutions to investigate better the effect of pH and location of active substance on the release. The imaging studies were realized in rabbits following labeling NIT and OR with Technethium-99m (Tc-99m) to evaluate the in vivo absorption characteristics. The percentage of MT and OR released from the multiple emulsions in alkaline media were 3.2- and 2.8-fold greater than that observed in acidic media, respectively, when they were introduced in the internal phase of the multiple emulsions. The absorption rate of NIT from vaginal epithelium was faster than OR. We observed that especially in alkaline medium a high release was found that was convenient for the vaginal infections seen in the alkaline pH. We concluded that W/O/W multiple emulsions were locally effective in vagina and they could be introduced as a new drug carrier system. for vaginal delivery

A rare urea cycle disorder in a neonate: N-acetylglutamate synthetase deficiency

Urea cycle disorders (UCD), are genetically inherited diseases that may have a poor outcome due to to profound hyperammonemia. We report the case of a baby girl diagnosed as N-acetylglutamate synthase (NAGS) deficiency. The patient was evaluated due to diminished sucking and hypotonicity. Physical examination showed hepatomegaly. Complete blood count, biochemical values and blood gas analyses were normal, acute phase reactants were negative. Further laboratory analyses showed no ketones in blood and highly elevated ammonia. Metabolic tests were inconclusive. Emergency treatment was initiated immediately and she was discharged on the 15th day of admission. NAGS deficiency was confirmed by DNA-analysis. She is now without any dietary restriction or other medication, except N-carbamylglutamate (NCG). NAGS deficiency is the only UCD which can be specifically and effectively treated by NCG. Early recognition of disease will lead to early treatment that may prohibit devastating effects of hyperammonemia