Sugammadex for reversal of neuromuscular blockade: A retrospective analysis of clinical outcomes and cost-effectiveness in a single center

OBJECTIVE: The aim of the study is to evaluate the clinical and economic impact of introducing a rocuronium-neostigmine-sugammadex strategy into a cisatracurium-neostigmine regimen for neuromuscular block (NMB) management. METHODS: We conducted a retrospective analysis of clinical outcomes and cost-effectiveness in five operating rooms at University Hospital of Padova. A clinical outcome evaluation after sugammadex administration as first-choice reversal drug in selected patients (rocuronium-sugammadex) and as rescue therapy after neostigmine reversal (rocuronium-neostigmine-sugammadex) compared to control was performed. A cost-analysis of NMB management accompanying the introduction of a rocuronium-neostigmine-sugammadex strategy into a cisatracurium-neostigmine regimen was carried out. To such purpose, two periods were compared: 2011-2012, without sugammadex available; 2013-2014, with sugammadex available. A subsequent analysis was performed to evaluate if sugammadex replacing neostigmine as first choice reversal drug is cost-effective. RESULTS: The introduction of a rocuronium-neostigmine-sugammadex strategy into a cisatracurium-neostigmine regimen reduced the average cost of NMB management by 36%, from €20.8/case to €13.3/case. Patients receiving sugammadex as a first-choice reversal drug (3%) exhibited significantly better train-of-four ratios at extubation (P<0.001) and were discharged to the surgical ward (P<0.001) more rapidly than controls. The cost-saving of sugammadex as first-choice reversal drug has been estimated to be €2.9/case. Patients receiving sugammadex as rescue therapy after neostigmine reversal (3.2%) showed no difference in time to discharge to the surgical ward (P=0.44) compared to controls. No unplanned intensive care unit (ICU) admissions with rocuronium-neostigmine-sugammadex strategy were observed. The potential economic benefit in avoiding postoperative residual curarization (PORC)-related ICU admission in the 2013-2014 period was estimated at an average value of €13,548 (€9,316-€23,845). CONCLUSION: Sugammadex eliminated PORC and associated morbidities. In our center, sugammadex reduced the costs of NMB management and promoted rapid turnover of patients in operating rooms, with total cost-effectiveness that counteracts the disadvantages of its high cost

New Synthetic Endocannabinoid as Anti-Inflammaging Cosmetic Active: an In Vitro Study on a Reconstructed Skin Model

Endocannabinoids have been recently appointed as interesting cosmetic actives in regulating inflammaging, a state of chronic low-grade inflammation, known for being involved in many senescence\u2019s manifestations, included skin aging. The aim of this study was to assess the anti-inflammaging activity of a new synthetic endocannabinoid, Isopalmide\uae, on a reconstructed skin model, on which inflammaging has been reproduced through UVA radiation and light mechanical stress. We tested Isopalmide\uae both as a single active and conveyed in a cosmetic product, in comparison with Anandamide, a well-known natural endocannabinoid with anti-inflammatory action. The anti-inflammaging activity of topically applied products has been assessed, after 6 hours of treatment post-irradiation, through the transcriptional modification of genes involved in the NF-\u3baB pathway and the epigenetic pathway targeting miRs as potential biomarkers of inflammaging: miR-21, miR-126 and miR-146a. The results confirmed the anti-inflammatory action of Anandamide which inhibits NF-\u3baB, while Isopalmide\uae showed its anti-inflammaging activity through the establishment of an inflammatory/anti-inflammatory balance by maintaining NF-\u3baB inactive in the cytoplasm and active in the nucleus. The anti-inflammaging activity was shown also by the cosmetic product containing Isopalmide

Formulating O/W Emulsions with Plant-Based Actives: A Stability Challenge for an Effective Product

Quality, safety, and efficacy concerns added to instability, poor absorption, and the dispersion of actives are common problems while formulating plant-based cosmetics. Furthermore, a correct balance between the stability of the emulsion, the sensory profile, and the high efficacy has to be considered to formulate an effective product. In this paper, we demonstrate that rheology is a methodological tool that can be used while designing a new product. In particular, we developed an O/W emulsion which is easy to spread on irritated skin, and that can soothe the redness and discomfort caused by the exposure to both physical and chemical irritating agents. The green active mixture consists of three natural raw materials: Bosexil\uae, Zanthalene\uae, and Xilogel\uae. Each ingredient has a well-demonstrated efficacy in terms of soothing, anti-itching, and moisturizing properties respectively. Starting from the selection of a new green emulsifying system, through the analysis of the rheological properties, we obtained a stable and easy-to-apply o/w emulsion. The efficacy of the optimized product was assessed in vitro on intact and injured skin using the SkinEthic\u2122 Reconstituted Human Epidermis (RHE) as a biological model

De la idea al negocio

Durante estos últimos años me he dado cuenta que existe un problema entre los estudiantes y nunca se ha hecho nada al respecto para tratar de solucionarlo. Este problema hace referencia al servicio que ofrecen las bibliotecas en épocas de exámenes y cómo la gente se comporta en estos establecimientos. Por tratar con algunos ejemplos, podemos considerar a los estudiantes que reservan el sitio a sus amigos colocando apuntes en la mesa, gente que hace descansos de 2 horas dejando el sitio ocupado, y muchas otras cosas. Al final, el hecho de salir de casa sin saber de antemano si vas a tener sitio o no para estudiar, dificulta mucho la vida a los estudiantes ya que pueden estar perdiendo una hora por las mañanas para encontrar sitio en varias bibliotecas, o incluso deciden no ir porque piensan que será imposible encontrar uno. La cuestión es, ¿cómo es posible que en la época tecnológica en la que vivimos aún no seamos capaces de solucionar todo estos problemas?. Es por ello que decidí llevar un proyecto a cabo durante todo este año que he estado en Francia cursando mis estudios, llamado BE2SIT, en el que he diseñado una aplicación móvil que pasaría a solucionar todo tipo de problemas en las bibliotecas tanto para los estudiantes como para los trabajadores, permitiendo comprobar el número de sitios disponibles en tiempo real e incluso la posibilidad de reservar un sitio por tiempo limitado a través de la App.Por lo tanto he elaborado este trabajo de fin de grado siguiendo las pautas y explicando todos los procesos en los que he estado trabajando en Francia.<br /

CyberLiveApp: a secure sharing and migration approach for live virtual desktop applications in a cloud environment

In recent years we have witnessed the rapid advent of cloud computing, in which the remote software is delivered as a service and accessed by users using a thin client over the Internet. In particular, the traditional desktop application can execute in the remote virtual machines without re-architecture providing a personal desktop experience to users through remote display technologies. However, existing cloud desktop applications mainly achieve isolation environments using virtual machines (VMs), which cannot adequately support application-oriented collaborations between multiple users and VMs. In this paper, we propose a flexible collaboration approach, named CyberLiveApp, to enable live virtual desktop applications sharing based on a cloud and virtualization infrastructure. The CyberLiveApp supports secure application sharing and on-demand migration among multiple users or equipment. To support VM desktop sharing among multiple users, a secure access mechanism is developed to distinguish view privileges allowing window operation events to be tracked to compute hidden window areas in real time. A proxy-based window filtering mechanism is also proposed to deliver desktops to different users. To support application sharing and migration between VMs, we use the presentation streaming redirection mechanism and VM cloning service. These approaches have been preliminary evaluated on an extended MetaVNC. Results of evaluations have verified that these approaches are effective and useful

Green Polymers in Personal Care Products: Rheological Properties of Tamarind Seed Polysaccharide

Tamarind seed polysaccharide (TSP) is a xyloglucan of vegetable origin, recently proposed for the cosmetic and pharmaceutical market as a "green" alternative to hyaluronic acid. In this study, TSP water dispersions, at different concentrations, were characterized by means of rheological measurements, both in continuous and oscillatory flow conditions. The results were compared with those of hyaluronic acid of two different molecular weights. The results pointed out the close rheological behaviors between TSP and hyaluronic acid with comparable molecular weight. Afterwards, the structural features of binary and ternary polysaccharide associations prepared with TSP, hyaluronic acid (very high MW) and dehydropolysaccharide gum, a modified xanthan gum, with high stabilizing properties, were investigated. The rheological properties were significantly affected by the polysaccharide ratios in the mixture, suggesting that the combination of TSP with other polymers can lead to a modulation of the texture and functional properties of cosmetics

THINC: A Remote Display Architecture for Thin-Client Computing

Rapid improvements in network bandwidth, cost, and ubiquity combined with the security hazards and high total cost of ownership of personal computers have created a growing market for thin-client computing. We introduce THINC, a remote display system architecture for high-performance thin-client computing in both LAN and WAN environments. THINC transparently maps high-level application display calls to a few simple low-level commands which can be implemented easily and efficiently. THINC introduces a number of novel latency-sensitive optimization techniques, including offscreen drawing awareness, command buffering and scheduling, non-blocking display operation, native video support, and server-side screen scaling. We have implemented THINC in an XFree86/Linux environment and compared its performance with other popular approaches, including Citrix MetaFrame, Microsoft Terminal Services, SunRay, VNC, and X. Our experimental results on web and video applications demonstrate that THINC can be as much as five times faster than traditional thin-client systems in high latency network environments and is capable of playing full-screen video at full frame rate

Evaluation of screencasts settings applied to CAD online teaching

Screencasts are video recording techniques that capture dynamic images of the computer screen. Besides that, the screen recordings are combined with audio or subtitles instructions. Originally, screencasts were developed to produce videos that aim to teach instructional content. The most frequent applications of screencasts are in videos about software tutorials. Due to these features, screencasts present potential to be employed in online classes of technical drawing, especially ones that apply Computer-Aided Design (CAD) software. However, it is fundamental to optimize the screencast settings that adjust to the teaching-learning process. This article aims to evaluate different screencasts settings, directed to technical drawing online teaching with AutoCAD. Three participants evaluated four different screencasts settings to find which settings are adequated for capturing the attention and the student video comprehension. As a result, the participants exposed their preference for screencasts with audio instructions due to the facility of assimilating the audio with the images simultaneously. Additionally, there were inconclusive aspects related to the instructor’s webcam application in screencasts. Thus, it is recommended deep investigation in the future.The authors are glad to Prorectorate for Outreach and Extension (PROEX) of Universidade Federal de Santa Catarina (UFSC), Brazil, which become available financial resources to the Group of Innovative Communication Technologies for Education in Technical Drawing for Engineering Courses (NTICEGEng). NTICEGEng organized the course Introduction to AutoCAD Screencasts to train professors in online teaching for CAD. Juliane Silva de Almeida is a Junior Lecturer of the Graphic Communication Department at UFSC, Brazil, since 2015 and the head of the NTICEGEng. She lectures technical drawing with CAD and descriptive geometry for engineering undergrads. NTICEGEng activities are focused on promoting outreach training courses about online teaching tools and techniques. Nicole Santini Baratto is a student of Civil Engineering undergrad at UFSC, Brazil, since 2018 and a junior researcher at NTICEGEng. 64

Larix decidua Bark as a Source of Phytoconstituents: An LC-MS Study

Larix decidua bark is a waste of the timber industry and is widely diffused in Northern Italy. This material can be considered a good source of antioxidants and phytoconstituents with possible use in cosmetic or nutraceutical products. In this study, simple extraction of larch bark was performed using mixtures of ethanol/water. Furthermore, the phytochemical composition of larch bark extract was studied using LC-MS(n) methods and the main constituents were identified as flavonoids, spiro-polyphenols, and procyanidins. To confirm the identification by LC-MS semi-preparative HPLC was performed in order to isolate the main constituents and verify the structures by \ub9H-NMR. Antioxidant properties were studied using an in vitro approach combining DPPH assay and LC-MS in order to establish different roles of the various classes of phytochemicasl of the extract. DPPH activity of some of the isolated compounds was also assessed. The overall results indicate this waste material as a good source of antioxidant compounds, mainly procyanidins, whichresulted the most active constituents in the DPPH assay

Análisis exergético de un sistema de refrigeración por absorción de doble efecto con eyecto-compresión

El presente trabajo muestra un estudio de análisis paramétrico de diferentes sistemas de refrigeración por absorción, como lo son los de simple efecto con y sin eyecto-compresión y los de doble efecto con y sin eyecto-compresión. De esta manera se presenta una revisión bibliográfica de los sistemas de refrigeración por absorción convencionales, al igual que también se presentan los estudios relacionados con los sistemas de refrigeración por absorción con eyecto-compresión. Para el análisis de estos sistemas de refrigeración por absorción, se utilizaron la Primera y Segunda Ley como conceptos termodinámicos, con el fin de determinar el coeficiente de operación (COP) y efectuar el análisis exergético para dichos sistemas. Este trabajo estuvo enfocado en la sustancia LiBr/H2O como fluido de trabajo en los sistemas de refrigeración por absorción, ya que, el cálculo de las propiedades exergéticas, así como también, el porcentaje de concentración para esta sustancia, están establecidas por los diferentes autores de la literatura suministrada en este trabajo. El cálculo de las propiedades termodinámicas y exergéticas de la sustancia LiBr/H2O, se realizó con el software EES®. El planteamiento del sistema de doble efecto con eyecto-compresión, fue tomado a partir de estudios preliminares basados en un sistema de simple efecto utilizando eyectores, con el fin de llevar a cabo esta idea al sistema de absorción de doble efecto. De esta manera se analizan, entre otros, tres sistemas diferentes de doble efecto con eyecto-compresión, buscando que estos sistemas sean técnicamente viables, comparados con los sistemas de absorción convencionales. Los resultados obtenidos en este trabajo, parten de la simulación de cada ciclo para dichos sistemas utilizando el software EES®. Estos resultados se presentan a partir de tablas y gráficas en forma comparativa para los diferentes sistemas de refrigeración por absorción, donde se muestra el comportamiento tanto del coeficiente de operación (COP), como el comportamiento de la eficiencia exergética, y la exergía destruida debido a la implementación del sistema de eyecto-compresión En los anexos se presenta el cálculo de las diferentes propiedades de la sustancia LiBr/H2O y las condiciones bajos las cuales se obtuvieron las propiedades para dicha solución a través del EES®. También se presentan las ecuaciones que modelan los diferentes sistemas de refrigeración por absorción y por último, se presentan las tablas de resultados con los diferentes valores de las propiedades termodinámicas para los sistemas de absorción analizados