Thoracolumbar fascia deformation during deadlifting and trunk extension in individuals with and without back pain

BackgroundAlterations in posture, lumbopelvic kinematics, and movement patterns are commonly seen in patients with low back pain. Therefore, strengthening the posterior muscle chain has been shown to result in significant improvement in pain and disability status. Recent studies suggest that thoracolumbar fascia (TLF) has a major impact on the maintenance of spinal stability and paraspinal muscle activity, and thus is likely to have an equal impact on deadlift performance.ObjectiveAim of the study was to evaluate the role of thoracolumbar fascia deformation (TFLD) during spinal movement in track and field athletes (TF) as well as individuals with and without acute low back pain (aLBP).MethodsA case–control study was performed with n = 16 aLBP patients (cases) and two control groups: untrained healthy individuals (UH, n = 16) and TF (n = 16). Participants performed a trunk extension task (TET) and a deadlift, being assessed for erector spinae muscle thickness (EST) and TLFD using high-resolution ultrasound imaging. Mean deadlift velocity (VEL) and deviation of barbell path (DEV) were measured by means of a three-axis gyroscope. Group differences for TLFD during the TET were examined using ANOVA. Partial Spearman rank correlations were calculated between TLFD and VEL adjusting for baseline covariates, EST, and DEV. TLFD during deadlifting was compared between groups using ANCOVA adjusting for EST, DEV, and VEL.ResultsTLFD during the TET differed significantly between groups. TF had the largest TLFD (−37.6%), followed by UH (−26.4%), while aLBP patients had almost no TLFD (−2.7%). There was a strong negative correlation between TLFD and deadlift VEL in all groups (r = −0.65 to −0.89) which was highest for TF (r = −0.89). TLFD during deadlift, corrected for VEL, also differed significantly between groups. TF exhibited the smallest TLFD (−11.9%), followed by aLBP patients (−21.4%), and UH (−31.9%).ConclusionTFLD maybe a suitable parameter to distinguish LBP patients and healthy individuals during lifting tasks. The cause-effect triangle between spinal movement, TFLD and movement velocity needs to be further clarified.Clinical trial registrationhttps://drks.de/register/de/trial/DRKS00027074/, German Clinical Trials Register DRKS00027074

Optimizing the anti-tumor efficacy of protein-drug conjugates by engineering the molecular size and half-life

Despite some approvals of antibody-drug conjugates for cancer therapy, their clinical success rate is unsatisfactory because of very small therapeutic windows, influenced by on-target and off-target toxicities of conjugate and liberated toxin. Additional formats with systematically investigated molecular parameters must therefore be explored to increase their therapeutic window. Here we focused on the effective molecular weight. To generate conjugates with exactly defined drug loads and tunable pharmacokinetics, we used Designed Ankyrin Repeat Proteins (DARPins), fused to unstructured polypeptides of different lengths, to produce proteins with any desired half-life, to identify those with the best efficacy. We generated an EpCAM-targeting DARPin-MMAF conjugate, fused to PAS or XTEN of different lengths, and a matched series of controls of a non-binding DARPin to account for the enhanced permeability and retention (EPR) effect, covering half-lives of minutes to 20.6 h in mice. All conjugates were produced at high purity, and demonstrated high specificity and cytotoxicity in human tumor cell cultures, with IC50 values in the low nM range, independent of the polypeptide type and length. Due to their more facile purification, the PASylated conjugates were tested in nude mice bearing HT29 tumor xenografts. Independent of their size, all PASylated conjugates were very well tolerated after repeated systemic administration of 300 nmol/kg. We found that the conjugates with intermediate size and half-life showed the strongest anti-tumor effects, and deduced that this effect is a compromise of serum half-life and diffusion within the tumor, as on-rates and affinities are essentially identical, with extravasation playing only a very minor role

Inguinal Lymph Node Metastasis of a Primary Serous Papillary Carcinoma of the Peritoneum One Year after CRS and HIPEC

Background: Primary peritoneal serous papillary carcinoma is a rare malignant epithelial tumor which was first described in 1959. Peritoneal serous papillary carcinoma arises from the peritoneal epithelium and originates from a single or multicentric focus of the peritoneum involving the peritoneum of the abdomen and pelvis. The involvement of retroperitoneal lymph nodes occurs in 64% of the patients diagnosed with this malignancy. So far, there is no report about inguinal lymph node metastasis in this disease. Case Report: We present a rare case of a 63-year-old female patient who developed singular inguinal lymph node metastasis 1 year after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy due to peritoneal serous papillary carcinoma. The lymph node metastasis was found by computed tomography (CT) scan and was resected and histologically confirmed. The postoperative course was uneventful, and the patient was discharged on postoperative day 1. The last CT scan 24 months after initial cytoreduction and 12 months after lymph node resection showed no further tumor recurrence. Conclusion: This case report should raise the awareness of potentially unexpected presentation of extraperitoneal metastasis and highlights the importance of patient follow-up including clinical examination and CT scans of thorax/abdomen/pelvis following a systematic schedule

High Reliability Pistons for Reciprocating Compressors with Validated Performance Modelling

LecturePiston ring leakage on reciprocating compressors is predictable due to defined leakage paths at the end gaps of piston rings. A new engineering approach quantifies the slippage and determines the dynamic pressure difference on each ring. With this approach the expected discharge gas temperature increase, expected capacity losses and the risks of rider bands activation due to piston ring slippage can be quantified. The piston design and ring styles can be iterated to find an optimized piston layout for a given application. 30% of the reciprocating compressors in the process gas industry show high sensitivity to piston ring leakage and subsequent performance related issues. This paper suggests quantifying piston performance as a standard when evaluating compressor reliability and efficiency. The industry managed to reduce compressor valve related problems due to more sophisticated modelling tools and smart design changes on valves. It is time to go that next step on pistons

BEARING LOAD ANALYSIS OF RECIPROCATING PISTON COMPRESSORS

Case StudiesMany problems in today’s industrial environment require smart modeling assumptions in order to make them numerically accessible with an acceptable amount of effort. This case study shows how a field problem (main bearing failures) is turned into a numerical model: we present a bearing force analysis of a 5-throw reciprocating compressor with severe problems on its third main bearing. Inertial and gas-dependent forces are calculated. The crankshaft is modeled as a uniform beam; its load-dependent deformation and the resulting bearing loads are estimated based on Clapeyron’s three-moment equation with the assumption of zero bearing clearances. The resulting calculation time is < 1s for a 360-degree load cycle, allowing detailed studies that yield conclusive results: polar load diagrams clearly confirm that the problematic bearing is exposed to the highest loads in operation. The short calculation time allows for parametric studies investigating the effect of lower reciprocating masses, partial load conditions, counterweights, different crankshaft designs, or combinations of the above

Lack of Oncological Benefit from Bursectomy in Radical Gastrectomy: A Systematic Review

Background: Resection of the omental bursa has been suggested to reduce peritoneal recurrence and facilitate a complete oncological resection during a gastrectomy. The addition of this procedure increases technical complexity and prolongs the procedure. Published data regarding the oncological benefit of this procedure are conflicting. We hypothesized that a bursectomy during a radical gastrectomy does not improve overall survival. Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline, a comprehensive literature search of 3 electronic databases (PubMed, Scopus, and Embase) was conducted to identify the clinical studies that compared bursectomy with no-bursectomy in radical gastrectomy for gastric adenocarcinoma. Qualitative and quantitative data synthesis was performed using RevMan software. A random-/fixed-effect modeling was used depending upon the heterogeneity. Bias and quality assessment tools were applied. The study was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42019116556). Results: Of 8 studies assessing the role of bursectomy in gastric adenocarcinoma, 6 (75%) were included – of which 2 (33%) are randomized controlled trials. Of 2,904 patients, 1,273 (%) underwent a bursectomy. There was no statistically significant difference in either overall survival (hazard ratio [HR] = 0.89, 95% CI 0.75–1.06, I2 = 14%) or disease recurrence (HR = 1.01, 95% CI 0.84–1.20, I2 = 22%) in the bursectomy group compared to the no-bursectomy group. Conclusion: There is no additional oncological benefit of adding bursectomy to radical gastrectomy in all patients with gastric adenocarcinoma

Possibilities and Limitations of Spatially Explicit Site Index Modelling for Spruce Based on National Forest Inventory Data and Digital Maps of Soil and Climate in Bavaria (SE Germany)

Combining national forest inventory (NFI) data with digital site maps of high resolution enables spatially explicit predictions of site productivity. The aim of this study is to explore the possibilities and limitations of this database to analyze the environmental dependency of height-growth of Norway spruce and to predict site index (SI) on a scale that is relevant for local forest management. The study region is the German federal state of Bavaria. The exploratory methods comprise significance tests and hypervolume-analysis. SI is modeled with a Generalized Additive Model (GAM). In a second step the residuals are modeled using Boosted Regression Trees (BRT). The interaction between temperature regime and water supply strongly determined height growth. At sites with very similar temperature regime and water supply, greater heights were reached if the depth gradient of base saturation was favorable. Statistical model criteria (Double Penalty Selection, AIC) preferred composite variables for water supply and the supply of basic cations. The ability to predict SI on a local scale was limited due to the difficulty to integrate soil variables into the model

Perioperative Pleural Drainage in Liver Transplantation: A Retrospective Analysis from a High-Volume Liver Transplant Center

BACKGROUND Pleural effusions represent a common complication after liver transplantation (LT) and chest drain (CD) placement is frequently necessary. MATERIAL AND METHODS In this retrospective cohort study, adult LT recipients between 2009 and 2016 were analyzed for pleural effusion formation and its treatment within the first 10 postoperative days. The aim of the study was to compare different settings of CD placement with regard to intervention-related complications. RESULTS Overall, 597 patients met the inclusion criteria, of which 361 patients (60.5%) received at least 1 CD within the study period. Patients with a MELD >25 were more frequently affected (75.7% versus 56.0%, P<0.001). Typically, CDs were placed in the intensive care unit (ICU) (66.8%) or in the operating room (14.1% during LT, 11.5% in the context of reoperations). In total, 97.0% of the patients received a right-sided CD, presumably caused by local irritations. Approximately one-third (35.4%) of ICU-patients required pre-interventional optimization of coagulation. Of the 361 patients receiving a CD, 15 patients (4.2%) suffered a post-interventional hemorrhage and 6 patients (1.4%) had a pneumothorax requiring further treatment. Less complications were observed when the CD was performed in the operating room compared to the ICU: 1 out 127 patients (0.8%) versus 20 out of 332 patients (6.0%); P=0.016. CONCLUSIONS CD placement occurring in the operating room was associated with fewer complications in contrast to placement occurring in the ICU. Planned CD placement in the course of surgery might be favorable in high-risk patients