Surgical Management of Cervical Spondyloarthropathy in Hemodialysis Patients

Dialysis-related spondyloarthropathy is a rare cause of spinal deformity and cervical myelopathy. Optimal management of cervical spine spondyloarthropathy often requires circumferential reconstructive surgery, because affected patients typically have both the anterior column and the facet joints compromised. The occasional presence of noncontiguous or "skip lesions" adds an additional level of complexity to surgical management, because decompression and fusion in an isolated segment of neural compression can worsen spine deformity by applying increased stress to adjacent cervical spine segments. We report two cases of hemodialysis patients who presented with cervical myelopathy and initially had anterior cervical discectomy or corpectomy. Because symptoms recurred due to hardware failure, both patients required posterior spine fusion as well. In retrospect, because of the hardware failure, both of these patients might have benefited from a circumferential (combined anterior and posterior) cervical spine reconstruction as their initial treatment

Exploring the views of infection consultants in England on a novel delinked funding model for antimicrobials: the SMASH study

OBJECTIVES: A novel 'subscription-type' funding model was launched in England in July 2022 for ceftazidime/avibactam and cefiderocol. We explored the views of infection consultants on important aspects of the delinked antimicrobial funding model. METHODS: An online survey was sent to all infection consultants in NHS acute hospitals in England. RESULTS: The response rate was 31.2% (235/753). Most consultants agreed the model is a welcome development (69.8%, 164/235), will improve treatment of drug-resistant infections (68.5%, 161/235) and will stimulate research and development of new antimicrobials (57.9%, 136/235). Consultants disagreed that the model would lead to reduced carbapenem use and reported increased use of cefiderocol post-implementation. The presence of an antimicrobial pharmacy team, requirement for preauthorization by infection specialists, antimicrobial stewardship ward rounds and education of infection specialists were considered the most effective antimicrobial stewardship interventions. Under the new model, 42.1% (99/235) of consultants would use these antimicrobials empirically, if risk factors for antimicrobial resistance were present (previous infection, colonization, treatment failure with carbapenems, ward outbreak, recent admission to a high-prevalence setting).Significantly higher insurance and diversity values were given to model antimicrobials compared with established treatments for carbapenem-resistant infections, while meropenem recorded the highest enablement value. Use of both 'subscription-type' model drugs for a wide range of infection sites was reported. Respondents prioritized ceftazidime/avibactam for infections by bacteria producing OXA-48 and KPC and cefiderocol for those producing MBLs and infections with Stenotrophomonas maltophilia, Acinetobacter spp. and Burkholderia cepacia. CONCLUSIONS: The 'subscription-type' model was viewed favourably by infection consultants in England

Exploring the views of infection consultants in England on a novel delinked funding model for antimicrobials: the SMASH study

OBJECTIVES: A novel ‘subscription-type’ funding model was launched in England in July 2022 for ceftazidime/avibactam and cefiderocol. We explored the views of infection consultants on important aspects of the delinked antimicrobial funding model. METHODS: An online survey was sent to all infection consultants in NHS acute hospitals in England. RESULTS: The response rate was 31.2% (235/753). Most consultants agreed the model is a welcome development (69.8%, 164/235), will improve treatment of drug-resistant infections (68.5%, 161/235) and will stimulate research and development of new antimicrobials (57.9%, 136/235). Consultants disagreed that the model would lead to reduced carbapenem use and reported increased use of cefiderocol post-implementation. The presence of an antimicrobial pharmacy team, requirement for preauthorization by infection specialists, antimicrobial stewardship ward rounds and education of infection specialists were considered the most effective antimicrobial stewardship interventions. Under the new model, 42.1% (99/235) of consultants would use these antimicrobials empirically, if risk factors for antimicrobial resistance were present (previous infection, colonization, treatment failure with carbapenems, ward outbreak, recent admission to a high-prevalence setting). Significantly higher insurance and diversity values were given to model antimicrobials compared with established treatments for carbapenem-resistant infections, while meropenem recorded the highest enablement value. Use of both ‘subscription-type’ model drugs for a wide range of infection sites was reported. Respondents prioritized ceftazidime/avibactam for infections by bacteria producing OXA-48 and KPC and cefiderocol for those producing MBLs and infections with Stenotrophomonas maltophilia, Acinetobacter spp. and Burkholderia cepacia. CONCLUSIONS: The ‘subscription-type’ model was viewed favourably by infection consultants in England

Implementation of a Computerized System for monitoring the reliability and improving the performance of Thermal Power Plants

139 σ.Ο σκοπός της εργασίας είναι η ανάπτυξη μηχανογραφικής εφαρμογής για την παρακολούθηση της ικανότητας των Μονάδων Ηλεκτροπαραγωγής της Δημόσιας Επιχείρησης Ηλεκτρισμού (ΔΕΗ) να προσφέρουν επαρκή ενέργεια για συγκεκριμένα χρονικά διαστήματα (Διαθεσιμότητα) καθώς και η ανάλυση των αιτίων που προκαλούν αστοχίες όποτε αυτό δεν καθίσταται εφικτό. Συγκεκριμένα, αναπτύχθηκε κατ’ αρχήν μία σειρά δεικτών μέσα από τους οποίους γίνεται η παρακολούθηση της αποτελεσματικής λειτουργίας των Μονάδων, κωδικοποιούνται και καταγράφονται τα συμβάντα που προκαλούν μείωση της ονομαστικής ικανότητας παραγωγής και συνεπώς καθιερώνονται ως συμβάντα μείωσης διαθεσιμότητας. Όλα τα δεδομένα και οι δείκτες, συσχετίζονται με την ικανότητα πρόβλεψης των Μονάδων να προσφέρουν συγκεκριμένες ποσότητες ενέργειας σε καθορισμένες τιμές, γεγονός που εξασφαλίζει και το επιχειρησιακό τους κέρδος, παρακολουθείται η απόδοση και η ικανότητά τους στην πράξη και προκύπτουν χρήσιμα συμπεράσματα που εκδίδονται και αξιολογούνται μέσα από μια σειρά σύνθετων και αναλυτικών αναφορών. Το σύστημα εφαρμόζεται ήδη με επιτυχία στην πράξη εδώ και περίπου 20 χρόνια με μια προγενέστερη μορφή, η οποία μέσα από την παρούσα εργασία, βελτιώθηκε σημαντικά, υπεισήλθαν σε αυτό νέες παράμετροι, αναλυτικές αναφορές και η απόκρισή του έγινε γρηγορότερη και αποτελεσματικότερη. Προς το παρόν, η μηχανογραφική εφαρμογή που αναπτύχθηκε στα πλαίσια της παρούσας εργασίας, καλύπτει όλο το φάσμα των θερμικών ηλεκτροπαραγωγών μονάδων του διασυνδεδεμένου συστήματος της Ελληνικής επικράτειας και των δύο μεγάλων νησιών της Κρήτης και της Ρόδου. Υπάρχει όμως δυνατότητα επέκτασής της και ολοκλήρωσής της ώστε να ενταχθούν σε αυτήν και οι θερμικές μηχανές (κυρίως ντίζελ, εσωτερικής καύσης) που είναι εγκατεστημένες στα περισσότερα λοιπά μικρότερα νησιά της χώρας (ως τοπικοί αυτόνομοι σταθμοί) καθώς και των υδροηλεκτρικών μονάδων του διασυνδεδεμένου συστήματος, εργασία που βρίσκεται ήδη σε εξέλιξη και αναμένεται να έχει ολοκληρωθεί μέχρι το τέλος του τρέχοντος έτους.The scope of this thesis was the development of a computerized application for the monitoring of the performance of the thermal power units of the Public Power Corporation of Greece (PPC) and their ability to deliver to the National Distribution System (Mainland and the Islands) specific amounts of energy in a predefined time span (Availability). There is also an analysis of all events which cause power loss from the nominal ability of each Unit. Specifically, there was developed a series of Reliability Indicators regarding the operation and performance analysis of the thermal power units, and a classification of all reasons of non- availability. All data and indicators are correlated to the ability of the units to deliver certain amounts of energy to the Distribution System, having in mind that good predictions results high enterprise profits in the Daily Bidding System of the Electric Gross Market. A similar, older application was in effect in PPC for the last 20 years with satisfactory results. This thesis, improves the existing application, establishing new performance indicators, developing a new more interactive and user friendly interface, and shortening the required computational time. The reporting system is also enriched with a number of more detailed reports which gives the opportunity to the decision makers to choose the best solutions to improve the effectiveness of the Units equipment. At present, the computerized application covers the cases of thermal units which operate in the Mainland Distribution System as well as in the Islands of Crete and Rhodos. There is the option and the perspective to include to the system the Diesel Engines which operate to the autonomous stations of the rest smaller Islands as well as the hydroelectric units of the Mainland Distribution System. This work is in progress and it is estimated to be completed by the end of this year.Μιχαήλ Α. Δ. Σπίνο

Treatment strategies for inverted papillomas with intracranial or intraorbital involvement

Objective Sinonasal inverted papillomas are challenging benign tumours of the nasal cavity because of their high recurrence rates and the lifetime malignant transformation risk of 10 per cent as well as their locally aggressive behaviour. This study aimed to describe treatment strategies for inverted papillomas with intracranial or intraorbital involvement. Method This was a prospective case series study of 18 patients with inverted papilloma with intracranial or intraorbital involvement. Patient demographic data, imaging, pathology, surgical technique and recurrences were recorded prospectively over a period of seven years. Results A total of 83 per cent of the patients in this study had been previously operated on, consisting of 8 cases with intracranial involvement, 1 case with intraorbital involvement and 9 with both. During follow up with a medium of 37 months (range, 13-115 months) there were two recurrences. Conclusion It was postulated that intracranial or intraorbital involvement observed in this series was the result of multiple revisions. However, using accurate imaging protocols and the pedicle-oriented approach for tumour excision, complete tumour removal was achieved in most cases with minimal post-operative complications

Prognostic Factors and Survival of Gliomatosis Cerebri: A Systematic Review and Meta-Analysis

Background: Gliomatosis cerebri (GC) is a fatal diffusely infiltrating glioma. Because of its rarity, only scarce evidence is available regarding outcome predictors and the proper management of GC. Methods: Reported studies of patients with histologically confirmed GC were systematically reviewed and individual patient-level data (n = 523) extracted. Multivariable Cox proportional hazard models were fit for overall survival (OS) and progression-free survival (PFS). Results: The median OS and PFS were 13 and 10 months, with 5-year rates of 18% and 13%, respectively. Age ≥65 years at diagnosis (hazard ratio for OS [HROS], 2.32; 95% confidence interval [CI], 1.62–3.31), high-grade tumor (HRPFS for grade III, 1.57; 95% CI, 1.02–2.40; HRPFS for grade IV, 1.74; 95% CI, [0.98–3.10), GC type II (HROS, 1.49; 95% CI, 1.12–1.98; HRPFS, 1.56; 95% CI, 1.04–2.34), more central nervous system (CNS) regions involved (HROS, 1.09; 95% CI, 1.01–1.18), focal neurological deficits (HROS, 1.41; 95% CI, 1.07–1.86), cerebellar symptoms (HRPFS, 2.20; 95% CI, 1.42–3.39), more symptoms at presentation (HROS, 1.21; 95% CI, 1.05–1.40), Karnofsky performance scale score <70 (HROS, 3.58; 95% CI, 1.73–7.39; HRPFS, 4.48; 95% CI, 1.39–14.4), magnetic resonance imaging contrast enhancement (HROS, 1.48; 95% CI, 1.12–1.96; HRPFS, 1.74; 95% CI, 1.18–2.55), symmetric bilateral CNS invasion (HROS, 1.42; 95% CI, 1.03–1.96), and high proliferation index (Ki-67 >5%; HROS, 2.32; 95% CI, 1.11–4.86) were independent predictors of poor outcomes. In contrast, seizure occurrence (HROS, 0.77; 95% CI, 0.60–1.00; HRPFS, 0.68; 95% CI, 0.47–0.95), isocitrate dehydrogenase 1 mutation (HROS, 0.16; 95% CI, 0.05–0.49), and O6-methylguanine-DNA-methyltransferase promoter methylation (HROS, 0.23; 95% CI, 0.09–0.59) were associated with prolonged survival. Chemotherapy and surgical resection were associated with improved outcomes, but radiotherapy, whether monotherapy or combined with chemotherapy, was not superior to chemotherapy alone. Conclusions: In the largest study to date on GC, we have identified clinical, imaging, and molecular outcome predictors that are similar to other gliomas and highlight the beneficial effect of chemotherapy and surgical resection, when feasible, on outcomes. © 2018 Elsevier Inc

A rare presentation of medullary thyroid cancer metastasis to the prostate in a patient with multiple endocrine neoplasia 2B syndrome treated with laparoscopic radical prostatectomy

Multiple endocrine neoplasia (MEN) syndromes are rare and potentially malignant hereditary entities. Clinical manifestations of MEN 2B include medullary thyroid cancer, pheochromocytoma, gastrointestinal ganglioneuromatosis, and musculoskeletal and ophthalmologic lesions. Metastases to the prostate from the cancers of other organs are extremely rare. There are only a few cases of metastases to the prostate gland, originating from medullary thyroid cancer, found in literature, especially associated with MEN 2B syndrome. In this case report, we present the extremely rare case of a 28-year-old patient, diagnosed with MEN 2B syndrome, with medullary thyroid cancer metastasis to the prostate. Although a few reports of medullary thyroid cancer metastasis into the prostate gland can be found in the literature, to our knowledge, this is the first case of a laparoscopic radical prostatectomy procedure performed as a metastasectomy to treat the prostatic metastasis. Laparoscopic radical prostatectomy, performed as a metastasectomy, for the treatment of metastatic cancer, is an extremely rare surgical indication with distinctive requirements and difficulties. The extraperitoneal access enables the realization of the laparoscopic radical prostatectomy procedure even in the cases of patients with a history of multiple intra-abdominal operations. © 2023 Wolters Kluwer Medknow Publications. All rights reserved

Defining the optimal dietary approach for safe, effective and sustainable weight loss in overweight and obese adults

Various dietary approaches with different caloric content and macronutrient composition have been recommended to treat obesity in adults. Although their safety and efficacy profile has been assessed in numerous randomized clinical trials, reviews and meta-analyses, the characteristics of the optimal dietary weight loss strategy remain controversial. This mini-review will provide general principles and practical recommendations for the dietary management of obesity and will further explore the components of the optimal dietary intervention. To this end, various dietary plans are critically discussed, including low-fat diets, low-carbohydrate diets, high-protein diets, very low-calorie diets with meal replacements, Mediterranean diet, and diets with intermittent energy restriction. As a general principle, the optimal diet to treat obesity should be safe, efficacious, healthy and nutritionally adequate, culturally acceptable and economically affordable, and should ensure long-term compliance and maintenance of weight loss. Setting realistic goals for weight loss and pursuing a balanced dietary plan tailored to individual needs, preferences, and medical conditions, are the key principles to facilitate weight loss in obese patients and most importantly reduce their overall cardiometabolic risk and other obesity-related comorbidities. © 2018 by the authors. Licensee MDPI, Basel, Switzerland