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OBJECTIVES: The consumption of dietary supplements might prevent the deficiency of necessary nutrients. On the other hand, in cases of overconsumption, adverse effects might occur. In Lithuania, the COVID-19 pandemic provoked an increase in the consumption of dietary supplements. The aim of this study was to reveal the post-pandemic trend of the consumption of dietary supplements among the working-age residents of Lithuania with respect to social and demographic factors and food selection criteria. METHODS: A cross-sectional observational study was performed. In total, using the same methods, 3,200 residents were surveyed: 1,600 in 2021 and 1,600 in 2022. Both samples were representative for Lithuania and included residents of Lithuania aged from 18 to 64 years. According to socio-demographic factors (sex, age, level of education, type of place of residence, marital status, number of family members, presence of children under 18 years old in the household, employment status, level of income), COVID-19 experience (presence of COVID-19 cases among friends or relatives, severeness of COVID-19) and food selection criteria (health strengthening, other) the prevalence of the consumption of dietary supplements was compared between the samples. RESULTS: The consumption of dietary supplements accounted for 78.1% and 71.6% of the respondents in 2021 and 2022, respectively (p < 0.001). After the COVID-19 pandemic, the prevalence of the consumption of dietary supplements decreased in the majority of social and demographic groups analysed in this article (p < 0.05). The consumption of dietary supplements remained unchanged among those who selected foods for health strengthening (p = 0.098). CONCLUSIONS: The prevalence of the consumption of dietary supplements decreased after the COVID-19 pandemic in most social and demographic groups except those who selected foods for health strengthening.
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COVID-19 , Suplementos Dietéticos , SARS-CoV-2 , Humanos , Suplementos Dietéticos/estadística & datos numéricos , Lituania/epidemiología , COVID-19/epidemiología , COVID-19/prevención & control , Estudios Transversales , Adulto , Femenino , Masculino , Persona de Mediana Edad , Adolescente , Adulto Joven , Pandemias , Factores Sociodemográficos , Factores SocioeconómicosRESUMEN
Living donor liver transplantation (LDLT) is a treatment option for select patients with unresectable colorectal liver metastasis (uCRLM). We describe our center's experience of patient selection, insurance approval, and outcomes after LDLT after first referral in March 2019. Of the 206 evaluated patients, twenty-three underwent LDLT. We found that patients who were referred earlier in their oncologic course were more likely to be eligible for transplantation. After completion of the Rochester Protocol for LDLT eligibility, recipients had a median delay of care of 10 days (IQR 0-36) related to insurance appeal, with six patients (30%) having a delay longer than 30 days. LDLT recipients had an overall survival proportion of 100% and 91% at 1, and 3 years; and a recurrence-free survival proportion of 100% and 40%, at 1 and 3 years, respectively. All donors underwent right hepatectomy, of which only one donor had a Clavien-Dindo IIIa complication and readmission. There was no donor mortality. We assert that multidisciplinary care and strict patient selection through the Rochester Protocol were paramount to our center's success. In the appropriately selected patient, LDLT for uCRLM may be justified, and patients should be referred to transplant oncology centers for evaluation.
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OBJECTIVES: Recent front-line clinical trials used the International Prognostic Index (IPI) to identify trial-eligible patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL). However, many IPI-like variants with improved accuracy have been developed over the years for rituximab-treated patients. METHODS: We assessed the impact of International Prognostic Indices on patient enrolment in clinical trials, aiming to exclude low-risk IPI patients based on POLARIX/EPCORE DLBCL-2 trial criteria. RESULTS: We identified 2877 patients in the Danish Lymphoma Registry who would have been eligible for the POLARIX trial if patients with IPI 0-1 scores were included. IPI and NCCN-IPI assigned 33.3% and 11.9% of patients to the low-risk group, respectively. Shorter 5-year overall survival (91.4% vs. 97.5%), higher relapse rate (9.9% vs. 4.4%), and more deaths (16.1% vs. 4.4%) occurred in the low-risk IPI group compared with low-risk NCCN-IPI group. Analyzed models failed to identify true high-risk patients with poor prognosis. Similar results were found in the confirmatory cohort developed based on EPCORE DLBCL-2 trial eligibility criteria. CONCLUSION: True low-risk patients are more optimal identified by NCCN-IPI and should be excluded from front-line clinical trials due to their excellent prognosis. However, additional high-risk factors besides clinical prognostic models need to be considered when selecting trial-eligible patients.
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BACKGROUND: An important difference between explanatory and pragmatic clinical trials concerns eligibility criteria. Eligibility criteria are restrictive in explanatory trials, while pragmatic trials are more inclusive or even all-inclusive. METHODS: To better understand the diverging views regarding eligibility criteria, we examine the contrast between theoretical and clinical medicine, and 3 different research contexts: laboratory research, population studies and clinical trials. In each context we review the purpose for selecting study subjects or research material, as well as the type of inductive inference or generalization that is sought by such selection. RESULTS: In each context, selection concerns different things and serves different purposes: In the laboratory, selection concerns the homogenous research material that will help isolate a causal signal. In the epidemiological context selection concerns the (random) sampling method, designed to produce a representative sample of the population. In the clinical trial setting, selection concerns patients in need of care. Restrictive eligibility criteria become inappropriate in the care setting because the aim of the trial is not to represent a population nor to isolate a causal signal, but to find out which patients benefit from treatment. CONCLUSION: The idea of selecting patients comes from methods that belong to theoretical medicine. In the care setting, most clinical trials should be pragmatic and as inclusive as possible.
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BACKGROUND: Despite multiple calls for more inclusive studies, most clinical trial eligibility criteria remain too restrictive. Thrombectomy trials have been no exception. METHODS: We review the landmark trials that have shown the benefits of thrombectomy, their eligibility criteria, and consequences on clinical practice. We discuss the rationale behind various reasons for exclusions. We also examine the logical problem involved in using eligibility criteria as indications for treatment. RESULTS: Most thrombectomy trials have been too restrictive. This has been shown by a plethora of follow-up studies that have refuted most of the previously recommended trial eligibility restrictions. Meanwhile, the effect of clinical recommendations based on restrictive eligibility criteria is that treatment has been denied to the majority of patients who could have benefitted. Trial eligibility criteria cannot be used to make clinical decisions or recommendations unless, like any other medical diagnosis, they have been shown capable of reliably differentiating patients into those that will, and those that will not benefit from treatment. This goal can only be achieved with all-inclusive pragmatic trials. CONCLUSION: Restrictive eligibility criteria render clinical trials incapable of guiding medical decisions or recommendations.
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Living donor liver transplantation (LDLT) was first performed in the US in 1989, primarily benefiting pediatric patients. Its adoption for adults faced setbacks after a donor death in 2001, causing widespread risk aversion. Despite ethical justification and demonstrated safety, LDLT remains underutilized, with fewer than 10% of liver transplants being LDLT. Recent trends indicate improved access to deceased donor liver transplantation (DDLT) due to increased organ donation and technological advances like Normothermic Regional Perfusion (NRP). However, LDLT remains critical, especially for pediatric patients and specific adult populations who benefit significantly from it. Barriers to LDLT include public and clinician apprehensions about donor risks, despite studies showing low-complication rates. Non-directed donations and broader social media engagement have increased donor pools, though the volume of LDLT in the US remains lower than in Asia due to limited training and experience. The A2ALL consortium has been pivotal in studying LDLT safety and outcomes. Currently, around 40 US centers perform LDLT, with high-volume centers leading by example. Training paradigms for LDLT are evolving, with initiatives like the ASTS LDLT master class aiming to enhance surgical expertise. While LDLT is embedded in US liver-transplant practices, its expansion is hampered by risk aversion and the availability of DDLT. Nonetheless, LDLT is essential for addressing the supply-demand mismatch in liver transplantation.
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PURPOSE: International Medical Graduates (IMGs) face challenges in securing orthopaedic surgery residencies in the U.S. This study examines residency matching trends and geographic distribution for U.S. and non-U.S. citizen IMGs. METHODS: The National Resident Matching Program (NRMP) data from 2008 to 2022 were analyzed for USMLE scores, publication counts, and match rates, using linear regression. The proportion of non-US IMGs in orthopaedic surgery residency was compared with the foreign-born population of each region based on the 2021 American Community Survey. RESULTS: The overall IMG fill rate decreased significantly from 2.04% in 2008 to 1.26% in 2022 (P = 0.002). The number of publications for matched US IMGs was at least three times that of matched MD seniors and about two times that of unmatched US IMGs. Matched non-US IMGs had approximately five and three times the number of publications as matched MD seniors and unmatched non-US IMGs, respectively. Mississippi had the highest IMG-to-all-filled-position ratio (6.7%) and New York matched the most IMGs (36 residents). Although the foreign-born population comprises approximately 13.72% of the US population, non-US IMGs accounted for less than 1% of total matched residents. When compared to the foreign-born population, non-US IMGs were underrepresented in the US. This underrepresentation was observed in all nine geographic divisions, particularly in the West South Central and Pacific regions. CONCLUSIONS: While IMGs constitute a low percentage of matched MDs in orthopaedic surgery, they show three to five times more publications than MD seniors. IMGs should recognize the importance of higher publication numbers in the matching process as well as states with higher IMG matching rates.
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Médicos Graduados Extranjeros , Internado y Residencia , Ortopedia , Internado y Residencia/estadística & datos numéricos , Internado y Residencia/tendencias , Médicos Graduados Extranjeros/estadística & datos numéricos , Médicos Graduados Extranjeros/tendencias , Humanos , Estados Unidos , Ortopedia/educación , Ortopedia/tendenciasRESUMEN
Logistics is critical in every company's supply chain (SC), and outsourcing helps businesses concentrate on their core competencies. Third-party logistics (3 PL) or logistics service providers (LSPs) assist businesses in cutting costs while improving performance, sustainability, and revenue. Logistics evaluation and LSPs choice are complicated and critical components of value delivery. This study aims to review logistics outsourcing literature to understand the trends, prospects, factors, and strategies used in logistics companies' outsourcing choices. This work examines the literature on LSPs selection published between 2010 and 2023. This paper uses VOSviewer (version 1.6.19) to visualize the relationships. Pricing, timely shipment, service quality, reliability, agility, technology, and consumer feedback are the most commonly utilized, whereas societal and environmental factors are seldom used. The study comprises journal publications, the year, selection criteria, and assessment methodologies. Numerous scholars have discovered and employed many critical selection criteria. Many investigators have also embraced multi-criteria decision-making (MCDM) methodologies, and their fuzzy form is widely used. In conclusion, recommendations for theorists and managers, limits, and future directions for research are offered.
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Abiotic stress tolerance breeding programs present a spectrum of perspectives, yet definitive solutions remain elusive, with each approach carrying its own set of advantages and disadvantages. This study systematically evaluates extant methodologies, comparing plant performance across varied genotypes and selection traits under optimal and stress conditions. The objective is to elucidate prevailing ambiguities. Ten homozygous lines (F8 generation) were assessed using a randomized block design alongside five control varieties, with four replicates cultivated under well-watered and deficit water conditions. It is noteworthy that six of the ten homozygous lines were cultivated exclusively under well-watered conditions (F3 to F7), while four lines experienced deficit water conditions (F3 to F7). All five control varieties underwent cultivation under both conditions. These findings underscore the necessity for tailored breeding programs attuned to specific environmental exigencies, recognizing that individual traits manifest divergent responses to varying conditions. It is evident that certain traits exhibit marked disparities under well-watered conditions, while others evince heightened differentiation under water deficit conditions. Significantly, our analysis reveals a pronounced interaction between irrigation regimes and selection traits, which serves to underscore the nuanced interplay between genotype and environmental stress.
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Sequías , Gossypium , Fitomejoramiento , Estrés Fisiológico , Gossypium/genética , Fitomejoramiento/métodos , Estrés Fisiológico/genética , Genotipo , Selección Genética , FenotipoRESUMEN
Choosing a romantic partner for a long-term relationship is one of the most significant decisions one makes during our lifetime. We have inherited an evolved framework from our ancestors that contains traits, as well as preferences for these traits, to solve this task. We use this framework consciously or unconsciously to choose prospective romantic partners. Following this reasoning, sexual strategy theory (SST) has been proposed for predicting which traits women and men prefer in a romantic partner for a long-term relationship. These predictions were empirically tested in the current work based on a sample of 1193 Norwegian adolescents who responded to an online questionnaire. We implemented the study hypotheses, derived from SST, in three statistical models, which were tested using structural equation modeling. In brief, our results revealed that women only valued resources more than men when we controlled for materialistic traits. This finding contrasts with SST's prediction that women would value resources more than men, independently of other variables. As for the second prediction that men value physical attractiveness more than women, this pattern existed universally and was independent of, for instance, how egalitarian they were. We thus conclude that SST was only partially supported and that variables that may reflect societal circumstances (e.g., wealth, gender, equality) should be considered when examining the mate choice behavior of women and men. The theoretical and practical implications of the study are also discussed.
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Introdução: A aprovação na Assembleia da República, em dezembro de 2021, da lei aplicável à Gestação de Substituição, suscita a reflexão acerca dos aspetos práticos em que o regime se concretizará e das orientações necessárias para os profissionais de saúde envolvidos. Por esse motivo, foram definidos como objetivos: analisar um conjunto de recomendações para a prática clínica no âmbito da Gestação de Substituição em países com experiência no procedimento e promover uma discussão com peritos na área da Procriação Medicamente Assistida. Material e Métodos: Foi realizada uma análise documental das publicações e documentos oficiais sobre o tema que serviu de base para o estudo de desenho qualitativo baseado em grupos focais com diferentes profissionais -médicos e psicólogos- com experiência em Procriação Medicamente Assistida. A discussão foi concretizada através de sessões via Zoom®, realizadas separadamente com os dois grupos focais. Resultados: Na discussão os peritos fizeram as suas apreciações e propostas de melhoria em relação à versão inicial do documento resultante da análise documental. Conclusão: Obteve-se uma versão consolidada do conjunto de orientações para os profissionais de saúde com as dimensões a avaliar e acompanhar junto da gestante e parte beneficiária na Gestação de Substituição.
Introducción : La aprobación por el Parlamento portugués, en diciembre de 2021, de la ley aplicable a la Gestación Subrogada, plantea la reflexión sobre los aspectos prácticos en los que se implementará el esquema y las directrices necesarias para los profesionales de la salud involucrados. Por este motivo, se definieron los siguientes objetivos: analizar un conjunto de recomendaciones para la práctica clínica en el ámbito de la gestación subrogada en países con experiencia en el procedimiento y promover un debate con expertos en el campo de la Reproducción Médicamente Asistida. Material y Métodos : Se realizó un análisis documental de publicaciones y documentos oficiales sobre el tema, que sirvió de base para el estudio de diseño cualitativo basado en focus group con diferentes profesionales -médicos y psicólogos- con experiencia en Reproducción Médicamente Asistida. La discusión se realizó a través de sesiones via Zoom®, celebradas por separado con los dos focus group. Resultados : En la discusión, los expertos realizaron sus apreciaciones y propuestas de mejora respecto a la versión inicial del documento resultante del análisis documental. Conclusión : Se obtuvo una versión consolidada del conjunto de directrices para los profesionales de la salud con las dimensiones para evaluar y dar seguimiento a la madre sustituta y a los beneficiarios en la Gestación Subrogada.
Introduction: The approval by the Portuguese Parliament, in December 2021, of the law applicable to Surrogate Pregnancy, raises reflection on the practical aspects in which the scheme will be implemented and the necessary guidelines for health professionals involved. For this reason, the following objectives were defined: to analyze a set of recommendations for clinical practice in surrogacy in countries with experience in the procedure and to promote a discussion with experts in Medically Assisted Reproduction. Material and Methods: A documental analysis of publications and official documents on the theme was conducted. This served as a basis for the qualitative design study based on focus groups with different professionals -physicians, and psychologists- with experience in Medically Assisted Reproduction. The discussion was realized through sessions via Zoom®, held separately with the two focus groups. Results : In the debate, the experts made their appreciation and proposals for improvement concerning the initial version of the document resulting from the document analysis. Conclusion : A consolidated version of the set of guidelines for health professionals was obtained with the dimensions to evaluate and follow up with the surrogate and beneficiaries in Surrogacy.
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The gelatinisation temperature and bimodal granule size distribution of barley starch are important characteristics regarding resource efficiency and product quality in the brewing industry. In this work, the diversity in starch amylose content and granule proportions in a set of modern barley varieties (N = 23) was investigated and correlated with their starch gelatinisation behaviour. Milled barley samples had peak starch gelatinisation temperatures ranging from 60.1 to 66.5 °C. Upon separating the barley starch from the non-starch compounds, sample-dependent decreases in starch gelatinisation temperatures were observed, indicating the importance of differences in barley composition. The peak gelatinisation temperatures of milled barley and isolated barley starches were strongly correlated (r = 0.96), indicating that the behaviour of the starch population is strongly reflected in the measurements performed on milled barley. Therefore, we investigated whether amylose content or starch granule size distribution could predict the gelatinisation behaviour of the starches. Broad ranges in the small starch granule volumes (13.9-32.0 v/v%) and amylose contents (18.2-30.7 w/w%) of the barley starches were observed. For the barley samples collected in the north of the USA (N = 8), the small starch granule volumes correlated positively with the peak gelatinisation temperatures of barley starches (r = 0.90, p < 0.01). The considerable variation in starch properties described in this work highlights that, besides starch content, starch gelatinisation temperature or granule size distribution might provide brewers with useful information to optimise resource efficiency.
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Anterior cruciate ligament (ACL) injuries continue to be a prevalent concern among athletes and individuals with an active lifestyle. Traditionally, the standard of care for ACL tears has involved surgical reconstruction using autograft or allograft. This article aims to provide an overview of the evolving landscape of primary ACL repair, examining the current evidence, surgical techniques, patient selection criteria, outcomes, and potential future directions in this field.
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Lesiones del Ligamento Cruzado Anterior , Reconstrucción del Ligamento Cruzado Anterior , Humanos , Reconstrucción del Ligamento Cruzado Anterior/métodos , Lesiones del Ligamento Cruzado Anterior/cirugía , Traumatismos en Atletas/cirugía , Selección de PacienteRESUMEN
This observational study aimed to explore the association of farmer-driven selective dry cow therapy (DCT), milking routine and dry cow management practices with SCC in early-lactation cows from 21 commercial dairy herds. Milking routine practices evaluated referred to cow preparation for milking, in-lactation mastitis management, and recording. Dry cow management practices related to dry cow environment and cleaning, dry-off procedure, milk cessation strategy and calving environment. Data from 2,016 multiparous cows in 21 commercial spring-calving grazing dairy herds were available for the study. Herd owners self-reported DCT (the assignment and administration of DCT was at the discretion of the herd owners with no involvement from the research team), management practices during milking and the dry period. Cow-level last test-day SCC records in 2020 (range = 105-285 DIM) and first test-day records in 2021 (range = 5-60 DIM) were obtained from milk recording databases. Quarter-level milk sampling was carried out on all cows in late lactation of 2020 (range = 240-261 DIM) for bacterial culturing. Bacteriological results were used to define cows with IMI when ≥1 quarter sample resulted in bacterial growth and there were no contaminated samples from that cow. Mixed model analyses were used to evaluate the association of selective DCT, milking routine, and dry cow management practices with cows' first test-day log 10 SCC (logSCC) in 2021. At dry-off in 2020, 47.6% of the cows were administered an internal teat sealant alone (ITS), while 52.4% were administered an antibiotic plus an internal teat sealant (AB+ITS). The mean herd-level percentage of cows with IMI was 19.7% (range = 9.8%-39.5%); Staphylococcus aureus accounted for the majority of cow-level IMI (89.9%, 357/397). Between herds, the proportion of cows administered ITS ranged from 17.7% (14/79; in a herd with an IMI prevalence of 10.1%) to 86.8% (66/76; in a herd with an IMI prevalence of 27.6%). In total, 11.8% (105/889) and 29.8% (292/980) of cows that were administered ITS or AB+ITS had an IMI in late lactation 2020, respectively. The mean untransformed SCC at the last test day in 2020 of cows administered ITS and AB+ITS was 55,000 and 197,200 cells/mL, respectively. The statistical analysis showed a significant interaction between selective DCT and milk yield at last test-day in 2020; cows with a milk yield of 15 kg and administered ITS had a 0.1 higher (untransformed SCC of 19,000 cells/mL higher) first test-day logSCC compared with cows administered AB+ITS. Additionally, greater parity, IMI in late lactation, higher logSCC at the last test-day in 2020 and longer dry periods were associated with higher logSCC at the first test-day in 2021. The current study identified cow- and herd-level management practices that could aid dairy farmers in improving the outcome of selective DCT and decrease early lactation SCC.
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Industria Lechera , Lactancia , Mastitis Bovina , Leche , Animales , Bovinos , Femenino , Industria Lechera/métodos , Mastitis Bovina/prevención & control , Leche/citología , Recuento de Células/veterinariaRESUMEN
Hepatocellular carcinoma (HCC) poses a significant global health challenge, and liver transplantation (LT) remains the best curative option. Living donor liver transplantation (LDLT) emerged as a potential solution to organ scarcity, reducing waitlist times. This comprehensive review explores LDLT practices, focusing on patient selection criteria and oncologic outcomes. A systematic review following PRISMA guidelines included 50 studies (2004-2023) with 8062 patients. Data encompassed baseline characteristics, HCC features, and oncologic outcomes. Further analysis categorized results by geography and publication year. Heterogeneity in patient demographics, tumor burden, and transplant characteristics was observed. Recent LDLT series demonstrated a shift towards refined selection criteria, increased neoadjuvant treatment, and improved oncologic outcomes. Geographic disparities revealed unique challenges in Eastern and Western practices. LDLT proves effective for HCC, addressing donor shortages. Evolving practices highlight the importance of refining inclusion criteria and optimizing tumor management. While geographic differences exist, LDLT, when judiciously applied, offers promising outcomes.
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Oral suspension is the most preferred dosage form for the paediatric population because of the difficulties related to solid medications, such as the swallowing limitations, bitter taste, and poor oral bioavailability, which can cause serious impairment to attain a successful treatment. Given the importance of successful therapies, there is a need for safe and effective commercially-available paediatric oral suspension and their characterization. For the latter, it is important to identify safe excipients and preservatives. The paediatric group is a diverse category which includes infants and teenagers, with major pharmacokinetics and pharmacodynamics differences, mainly because of physiological and behavioral variations. Therefore, finding a single formulation for paediatric population remains a challenge, as well asthe formulation of stable-in-time suspension. In addition, drug's dissolving characteristic and permeation, are the main determinants for oral absorption, which are closely related to drug release kinetics from the pharmaceutical form. In this context, drug release profile is an important and limiting step in oral bioavailability, particularly for BCS class II drugs; thus, it is possible to increase bioavailability and minimize adverse effects by changing the release rate of such drugs. This review covers all the aspects for paediatric oral suspension development, and analyses the considerations for excipients selection as a crucial task for effectively choosing a safe and effective pharmaceutical form and correctly dosing paediatric patients.
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Disponibilidad Biológica , Excipientes , Suspensiones , Humanos , Administración Oral , Niño , Excipientes/química , Composición de Medicamentos/métodos , Adolescente , Liberación de Fármacos , Química Farmacéutica/métodos , Lactante , Preparaciones Farmacéuticas/administración & dosificación , Preparaciones Farmacéuticas/químicaRESUMEN
OBJECTIVE: Our study aimed to compare the outcomes of COVID-19 patients who met a low-risk inclusion criteria for veno-venous extra corporeal membrane oxygenation (VV ECMO) with those who did not meet criteria due to higher risk but were subsequently cannulated. METHODS: This was a retrospective observational cohort study that included adult patients who were placed on VV ECMO for COVID-19 related acute respiratory distress syndrome (ARDS) at a tertiary care academic medical center. The primary outcome was the association between the low-risk criteria and mortality. The patients met the criteria if they met EOLIA severe ARDS criteria, no absolute contraindications (age > 60 years, BMI > 55 kg/m2, mechanical ventilation (MV) duration >7 days, irreversible neurologic damage, chronic lung disease, active malignancy, or advanced multiorgan dysfunction), and had three or less relative contraindications (age > 50 years, BMI > 45 kg/m2, comorbidities, MV duration > 4 days, acute kidney injury, receiving vasopressors, hospital LOS > 14 days, or COVID-19 diagnosis > 4 weeks). RESULTS: Sixty-five patients were included from March 2020 through March 2022. Patients were stratified into low-risk or high-risk categories. The median Sequential Organ Failure Assessment score was 7 and the median PaO2/FiO2 ratio was 44 at the time of ECMO cannulation. The in-hospital mortality was 47.8% in the low-risk group and 69.0% in the high-risk group (p = 0.096). CONCLUSION: There was not a statistically significant difference in survival between low-risk patients and high-risk patients; however, there was a trend toward higher survival in the lower-risk group.
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COVID-19 , Oxigenación por Membrana Extracorpórea , Humanos , COVID-19/mortalidad , COVID-19/terapia , COVID-19/complicaciones , Oxigenación por Membrana Extracorpórea/mortalidad , Oxigenación por Membrana Extracorpórea/métodos , Masculino , Persona de Mediana Edad , Femenino , Estudios Retrospectivos , Anciano , Síndrome de Dificultad Respiratoria/terapia , Síndrome de Dificultad Respiratoria/mortalidad , SARS-CoV-2 , Adulto , Factores de Riesgo , Respiración Artificial , Mortalidad Hospitalaria , Medición de Riesgo , Puntuaciones en la Disfunción de ÓrganosRESUMEN
Proton radiotherapy may be a compelling technical option for the treatment of breast cancer due to its unique physical property known as the "Bragg peak." This feature offers distinct advantages, promising superior dose conformity within the tumor area and reduced radiation exposure to surrounding healthy tissues, enhancing the potential for better treatment outcomes. However, proton therapy is accompanied by inherent challenges, primarily higher costs and limited accessibility when compared to well-developed photon irradiation. Thus, in clinical practice, it is important for radiation oncologists to carefully select patients before recommendation of proton therapy to ensure the transformation of dosimetric benefits into tangible clinical benefits. Yet, the optimal indications for proton therapy in breast cancer patients remain uncertain. While there is no widely recognized methodology for patient selection, numerous attempts have been made in this direction. In this review, we intended to present an inspiring summarization and discussion about the current practices and exploration on the approaches of this treatment decision-making process in terms of treatment-related side-effects, tumor control, and cost-efficiency, including the normal tissue complication probability (NTCP) model, the tumor control probability (TCP) model, genomic biomarkers, cost-effectiveness analyses (CEAs), and so on. Additionally, we conducted an evaluation of the eligibility criteria in ongoing randomized controlled trials and analyzed their reference value in patient selection. We evaluated the pros and cons of various potential patient selection approaches and proposed possible directions for further optimization and exploration. In summary, while proton therapy holds significant promise in breast cancer treatment, its integration into clinical practice calls for a thoughtful, evidence-driven strategy. By continuously refining the patient selection criteria, we can harness the full potential of proton radiotherapy while ensuring maximum benefit for breast cancer patients.
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Neoplasias de la Mama , Terapia de Protones , Femenino , Humanos , Neoplasias de la Mama/patología , Neoplasias de la Mama/radioterapia , Órganos en Riesgo/efectos de la radiación , Selección de Paciente , Terapia de Protones/efectos adversos , Terapia de Protones/métodos , Protones , Planificación de la Radioterapia Asistida por Computador/métodosRESUMEN
Urea, as one of the most sustainable organic solutes, denies the high salt consumption in commercial electrolytes with its peculiar solubility in water. The bi-mixture of urea-H2O shows the eutectic feature for increased attention in aqueous Zn-ion electrochemical energy storage (AZEES) technologies. While the state-of-the-art aqueous electrolyte recipes are still pursuing the high-concentrated salt dosage with limited urea adoption and single-anion selection category. Here, a dual-anion urea-based (DAU) electrolyte composed of dual-Zn salts and urea-H2O-induced solutions is reported, contributing to a stable electric double-layer construction and in situ organic/inorganic SEI formation. The optimized ZT2S0.5-20U electrolytes show a high initial Coulombic efficiency of 93.2% and durable Zn-ion storage ≈4000 h regarding Zn//Cu and Zn//Zn stripping/plating procedures. The assembled Zn//activated carbon full cells maintain ≈100% capacitance over 50 000 cycles at 4 A g-1 in coin cell and ≈98% capacitance over 20 000 cycles at 1 A g-1 in pouch cell setups. A 12 × 12 cm2 pouch cell assembly illustrates the practicality of AZEES devices by designing the cheap, antifreezing, and nonflammable DAU electrolyte system coupling proton donor-acceptor molecule and multi-anion selection criteria, exterminating the critical technical barriers in commercialization.