Complications associated with the treatment of chronic limb-threatening ischemia

The aim of the work is to review current national and foreign specialized literature on various complications associated with the treatment of chronic limb-threatening ischemia. Atherosclerotic lesion of the lower limb arteries is the most common cause of tissue perfusion deficiency of the lower limbs and can lead to their loss. A radical method of treatment for chronic limb-threatening ischemia (CLTI) remains revascularization. Despite the modern possibilities of surgical treatment and many years of experience in such treatment, the percentage of surgical complications is still substantial. The level of providing qualitative care to patients with CLTI consists in the successful correction of the mentioned complications. That is why the analysis of this problem is an urgent issue of modern angiosurgery. Conclusions. Most complications after surgical treatment of atherosclerotic lower limb lesions could cause both a limb loss and a severe systemic disorder development in general. The presented data of the professional literature review of clinical and experimental studies justify the need for an early management of complications associated with surgical treatment of chronic limb-threatening ischemia. It would contribute not only to the limb preservation, but also prevent the occurrence of severe general somatic complications

Probiotics for Preterm Infants: a strain specific systematic review and network meta-analysis

Several randomised controlled trials (RCTs) on the use of probiotics to reduce morbidity and mortality in preterm infants have provided inconsistent results. Whilst meta-analyses that group all of the used strains together, suggest efficacy, it is not possible to determine the most effective strain which is more relevant to the clinician. We therefore used a network meta-analysis (NMA) approach in order to identify strains with greatest efficacy

Клінічний випадок лікування інфікованої рани стегна з ураженням синтетичного судинного протеза

The aim of the study: to learn the clinical case of complicated infected postoperative wound of patient’s thigh after the reconstruction of the distal anastomosis of bifurcation alloprosthesis and analyze the results of treatment with V.A.C. therapy.The article presents the clinical case of infected wound of patient’s thigh after reconstruction of distal anastomotic pseudoaneurysm three years after the aorto- bifemoral graft placement. Approach to treatment of complicated postoperative wound combined systemic antibiotic therapy with local vacuum-assisted wound therapy. The pathogens and selected targeted antibiotic therapy was verified on the basis of wound culture results for pathogenic microflora with sensitivity to antibiotics. Local clinical effect of vacuum-assisted therapy was detected in adequate drainage of content of complicated infected wound. The use of such combination therapy for the given patient enabled to achieve positive dynamics of surgical site infection with complete elimination of the nidus of infection in seven weeks. The abovementioned combination therapy is an effective comprehensive approach to healing postoperative wounds. Long-term follow-up of the patient for six months confirmed the absence of wound infection and signs of pseudoaneurysm.Цель работы: исследование клинического случая осложненной инфицированной послеоперационной раны бедра у больного после реконструкции дистального анастомоза бифуркационного аллопротеза и анализ результатов ее лечения с применением ВАК-терапии.В статье представлен клинический случай инфицированной раны бедра у больного после реконструкции псевдоаневризмы дистального анастомоза через три года после бифуркационного аорто-бедренного протезирования. Стратегия лечения осложненной послеоперационной раны заключалась в сочетании системной антибиотикотерапии с локальной вакуум-ассистированной терапией раны. На основании результатов посева содержимого раны на патогенную микрофлору с определением чувствительности к антибиотикам были верифицированы возбудители и подобрана целевая антибактериальная терапия. Локальный клинический эффект вакуум-ассистованой терапии оказывался в адекватном дренировании содержания осложненной инфицированной раны. Применение данного лечебного комплекса в описанного пациента позволило достичь положительной динамики инфекции области хирургического вмешательства с окончательной ликвидацией инфекционного очага через семь недель. Вышеупомянутое комбинированное лечение является эффективным комплексным способом заживления послеоперационной раны. Отдаленное наблюдение пациента в течение шести месяцев подтвердило отсутствие инфекции раны и признаков псевдоаневризмы.Мета роботи: було дослідження клінічного випадку ускладненої інфікованої післяопераційної рани стегна у хворого після реконструкції дистального анастомозу біфуркаційного алопротеза та аналіз результатів її лікування із застосуванням ВАК-терапії.У статті представлено клінічний випадок інфікованої рани стегна у хворого після реконструкції псевдоаневризми дистального анастомозу через три роки після біфуркаційного аорто-стегнового протезування. Стратегія лікування ускладненої післяопераційної рани полягала у поєднанні системної антибіотикотерапії із локальною вакуум-асистованою терапією рани. На підставі результатів посіву вмісту рани на патогенну мікрофлору із визначенням чутливості до антибіотиків було верифіковано збудники та підібрану цільову антибактеріальну терапію. Локальний клінічний ефект вакуум-асистованої терапії виявлявся в адекватному дренуванні вмісту ускладненої інфікованої рани. Застосування даного лікувального комплексу в описаного пацієнта дозволило досягти позитивної динаміки інфекції ділянки хірургічного втручання із остаточною ліквідацією інфекційного осередку через сім тижнів. Вищезгадане комбіноване лікування є ефективним комплексним способом загоєння післяопераційної рани. Віддалене спостереження пацієнта протягом шести місяців підтвердило відсутність інфекції рани та ознак псевдоаневризми

Probiotics and Preterm Infants: A Position Paper by the ESPGHAN Committee on Nutrition and the ESPGHAN Working Group for Probiotics and Prebiotics

More than 10,000 preterm infants have participated in randomised controlled trials on probiotics worldwide, suggesting that probiotics in general could reduce rates of necrotising enterocolitis (NEC), sepsis, and mortality. However, answers to relevant clinical questions as to which strain to use, at what dosage, and how long to supplement, are not available. On the other hand, an increasing number of commercial products containing probiotics are available from sometimes suboptimal quality. Also, a large number of units around the world are routinely offering probiotic supplementation as the standard of care despite lacking solid evidence. Our recent network meta-analysis identified probiotic strains with greatest efficacy regarding relevant clinical outcomes for preterm neonates. Efficacy in reducing mortality and morbidity was found for only a minority of the studied strains or combinations. In the present position paper, we aim to provide advice which specific strains might potentially be used and which strains should not be used. Besides, we aim to address safety issues of probiotic supplementation to preterm infants, who have reduced immunological capacities and occasional indwelling catheters. For example, quality reassurance of the probiotic product is essential, probiotic strains should be devoid of transferable antibiotic resistance genes, and local microbiologists should be able to routinely detect probiotic sepsis. Provided all safety issues are met, there is currently a conditional recommendation (with low certainty of evidence) to provide either L. rhamnosus GG ATCC53103 or the combination of B. infantis Bb-02, B. lactis Bb-12, and Str. thermophilus TH-4 in order to reduce NEC rates

Probiotics for the management of pediatric gastrointestinal disorders: position paper of the ESPGHAN Special Interest Group on Gut Microbiota and Modifications

Probiotics, defined as live microorganisms that, when administered in adequate amounts, confer a health benefit on the host, are widely used despite uncertainty regarding their efficacy and discordant recommendations about their use. The ESPGHAN Special Interest Group on Gut Microbiota and Modifications provides updated recommendations for the use of probiotics for the management of selected pediatric gastrointestinal disorders

Cancer screening and preventative care among long-term cancer survivors in the United Kingdom

BACKGROUND: Long-term cancer survivors in the United Kingdom are mostly followed up in a primary care setting by their general practitioner; however, there is little research on the use of services. This study examines whether cancer survivors receive adequate screening and preventative care in UK primary care. PATIENTS AND METHODS: We identified a cohort of long-term survivors of breast, colorectal and prostate cancer with at least a 5-year survival using the General Practice Research Database, with controls matched for age, gender and practice. We compared adherence with cancer screening and the use of preventative care between cancer survivors and controls. RESULTS: The cancer survivors' cohort consisted of 18 612 breast, 5764 colorectal and 4868 prostate cancer survivors. Most cancer survivors receive cancer screening at the same levels as controls, except for breast cancer survivors who were less likely to receive a mammogram than controls (OR=0.78, 95% CI: 0.66-0.92). Long-term cancer survivors received comparable levels of influenza vaccinations and cholesterol tests, but breast (OR 0.81, 95% CI: 0.74-0.87) and prostate cancer survivors (OR=0.70, 95% CI: 0.57-0.87) were less likely to receive a blood pressure test. All survivors were more likely to receive bone densitometry. CONCLUSION: The provision and uptake of preventive care in a primary care setting in the United Kingdom is comparable between the survivors of three common cancers and those who have not had cancer. However, long-term breast cancer survivors in this cohort were less likely to receive a mammogra

Prototypes for Content-Based Image Retrieval in Clinical Practice

Content-based image retrieval (CBIR) has been proposed as key technology for computer-aided diagnostics (CAD). This paper reviews the state of the art and future challenges in CBIR for CAD applied to clinical practice

New polymorph of InVO4: A high-pressure structure with six-coordinated vanadium

This document is the unedited Author’s version of a Submitted Work that was subsequently accepted for publication in Inorganic Chemestry, copyright © American Chemical Society after peer review. To access the final edited and published work see http://pubs.acs.org/doi/abs/10.1021/ic402043xA new wolframite-type polymorph of InVO4 is identified under compression near 7 GPa by in situ high-pressure (HP) X-ray diffraction (XRD) and Raman spectroscopic investigations on the stable orthorhombic InVO4. The structural transition is accompanied by a large volume collapse (Delta V/V = -14%) and a drastic increase in bulk modulus (from 69 to 168 GPa). Both techniques also show the existence of a third phase coexisting with the low- and high-pressure phases in a limited pressure range close to the transition pressure. XRD studies revealed a highly anisotropic compression in orthorhombic InVO4. In addition, the compressibility becomes nonlinear in the HP polymorph. The volume collapse in the lattice is related to an increase of the polyhedral coordination around the vanadium atoms. The transformation is not fully reversible. The drastic change in the polyhedral arrangement observed at the transition is indicative of a reconstructive phase transformation. The HP phase here found is the only modification of InVO4 reported to date with 6-fold coordinated vanadium atoms. Finally, Raman frequencies and pressure coefficients in the low- and high-pressure phases of InVO4 are reported.This research supported by the Spanish government MINECO under Grant Nos. MAT2010-21270-C04-01/04 and CSD2007-00045. O.G. acknowledges support from Vicerrectorado de Investigacion y Desarrollo of UPV (Grant No. UPV2011-0914 PAID-05-11 and UPV2011-0966 PAID-06-11). S.N.A. acknowledges support provided by Universitat de Valencia during his visit to it. B.G.-D. acknowledges the financial support from MINECO through the FPI program.Errandonea, D.; Gomis Hilario, O.; García-Domene, B.; Pellicer Porres, J.; Katari, V.; Achary, SN.; Tyagi, AK.... (2013). New polymorph of InVO4: A high-pressure structure with six-coordinated vanadium. Inorganic Chemistry. 52(21):12790-12798. https://doi.org/10.1021/ic402043xS1279012798522

Prospective screening study of 0.5 Tesla dedicated magnetic resonance imaging for the detection of breast cancer in young, high-risk women

BACKGROUND: Evidence-based screening guidelines are needed for women under 40 with a family history of breast cancer, a BRCA1 or BRCA2 mutation, or other risk factors. An accurate assessment of breast cancer risk is required to balance the benefits and risks of surveillance, yet published studies have used narrow risk assessment schemata for enrollment. Breast density limits the sensitivity of film-screen mammography but is not thought to pose a limitation to MRI, however the utility of MRI surveillance has not been specifically examined before in women with dense breasts. Also, all MRI surveillance studies yet reported have used high strength magnets that may not be practical for dedicated imaging in many breast centers. Medium strength 0.5 Tesla MRI may provide an alternative economic option for surveillance. METHODS: We conducted a prospective, nonrandomized pilot study of 30 women age 25–49 years with dense breasts evaluating the addition of 0.5 Tesla MRI to conventional screening. All participants had a high quantitative breast cancer risk, defined as ≥ 3.5% over the next 5 years per the Gail or BRCAPRO models, and/or a known BRCA1 or BRCA2 germline mutation. RESULTS: The average age at enrollment was 41.4 years and the average 5-year risk was 4.8%. Twenty-two subjects had BIRADS category 1 or 2 breast MRIs (negative or probably benign), whereas no category 4 or 5 MRIs (possibly or probably malignant) were observed. Eight subjects had BIRADS 3 results, identifying lesions that were "probably benign", yet prompting further evaluation. One of these subjects was diagnosed with a stage T1aN0M0 invasive ductal carcinoma, and later determined to be a BRCA1 mutation carrier. CONCLUSION: Using medium-strength MRI we were able to detect 1 early breast tumor that was mammographically undetectable among 30 young high-risk women with dense breasts. These results support the concept that breast MRI can enhance surveillance for young high-risk women with dense breasts, and further suggest that a medium-strength instrument is sufficient for this application. For the first time, we demonstrate the use of quantitative breast cancer risk assessment via a combination of the Gail and BRCAPRO models for enrollment in a screening trial