Multifractal Conductance Fluctuations of Helical Edge States.

Two-dimensional topological insulators are characterized by the bulk gap and one-dimensional helical states running along the edges. The theory predicts the topological protection of the helical transport from coherent backscattering. However, the unexpected deviations of the conductance from the quantized value and localization of the helical modes are generally observed in long samples. Moreover, at millikelvin temperatures significant mesoscopic fluctuations are developed as a function of the electron energy. Here we report the results of an experimental study of the transport in a HgTe quantum well with an inverted energy spectrum that reveal a multifractality of the conductance fluctuations in the helical edge state dominated transport regime. We attribute observed multifractality to mesoscopic fluctuations of the electron wave function or local density of states at the spin quantum Hall transition. We have shown that the mesoscopic two-dimensional topological insulator provides a highly tunable experimental system in which to explore the physics of the Anderson transition between topological states.

Assessment of experimental OpenCV tracking algorithms for ultrasound videos.

This study aims to compare the tracking algorithms provided by the OpenCV library to use on ultrasound video. Despite the widespread application of this computer vision library, few works describe the attempts to use it to track the movement of liver tumors on ultrasound video. Movements of the neoplasms caused by the patient`s breath interfere with the positioning of the instruments during the process of biopsy and radio-frequency ablation. The main hypothesis of the experiment was that tracking neoplasms and correcting the position of the manipulator in case of using robotic-assisted surgery will allow positioning the instruments more precisely. Another goal of the experiment was to check if it is possible to ensure real-time tracking with at least 25 processed frames per second for standard definition video. OpenCV version 4.5.0 was used with 7 tracking algorithms from the extra modules package. They are: Boosting, CSRT, KCF, MedianFlow, MIL, MOSSE, TLD. More than 5600 frames of standard definition were processed during the experiment. Analysis of the results shows that two algorithms-CSRT and KCF-could solve the problem of tumor tracking. They lead the test with 70% and more of Intersection over Union and more than 85% successful searches. They could also be used in real-time processing with an average processing speed of up to frames per second in CSRT and 100 + frames per second for KCF. Tracking results reach the average deviation between centers of neoplasms to 2 mm and maximum deviation less than 5 mm. This experiment also shows that no frames made CSRT and KCF algorithms fail simultaneously. So, the hypothesis for future work is combining these algorithms to work together, with one of them-CSRT-as support for the KCF tracker on the rarely failed frames.

Healthcare-associated infections: a threat to the survival of patients with COVID-19 in intensive care units.

BACKGROUND: Wide variation in mortality rates among critically ill patients with coronavirus disease 2019 (COVID-19) has been reported. This study evaluated whether healthcare-associated infections (HAI) are a risk factor for death among patients with severe COVID-19 in the intensive care unit (ICU). METHODS: This retrospective cohort study included patients with severe COVID-19 hospitalized in the ICU of four hospitals in the city of Curitiba, Brazil. Patients with COVID-19 who died during ICU hospitalization were compared with those who were discharged. A second analysis compared patients who developed HAI in the ICU with those who did not. Multiple logistic regression models were used to control for confounders. RESULTS: In total, 400 patients were included, and 123 (31%) patients developed HAI. The most common HAI was lower respiratory tract infection (67%). Independent risk factors for death were: age [odds ratio (OR) 1.75, 95% confidence interval (CI) 1.43-2.15; P<0.0001]; clinical severity score (OR 2.21, 95% CI 1.70-2.87; P<0.0001); renal replacement therapy (OR 12.8, 95% CI 5.78-28.6; P<0.0001); and HAI (OR 5.9, 95% CI 3.31-10.5; P<0.0001). A longer interval between symptom onset and hospital admission was protective against death (OR 0.93, 95% CI 0.88-0.98; P=0.017). The only independent factors associated with HAI were high C-reactive protein and low PaO2/FiO2 ratio. CONCLUSIONS: No factors that could point to a high-risk group for HAI acquisition were identified. However, age, dialysis and HAI increased the risk of death in ICU patients with severe COVID-19; of these, HAI is the only preventable risk factor.

Nationwide surveillance system to evaluate hospital-acquired COVID-19 in Brazilian hospitals.

BACKGROUND: Although the risk of SARS-CoV-2 transmission within hospitals has been well recognized, there is a paucity of data on its occurrence. Our aim was to report the incidence of hospital-acquired (HA) COVID-19 at Brazilian hospitals. METHODS: We investigated the incidence of HA COVID-19 in Brazilian hospitals using data from a national surveillance system, from August 2020 through September 2021. Definitions of HA COVID-19 were: (1) symptom onset >14 days after hospital admission plus a positive SARS-CoV-2 RNA or antigen test; (2) symptom onset on days 8-14 after admission, plus a positive SARS-CoV-2 RNA or antigen test positive, plus documented high-risk exposure. We performed descriptive analyses and reported HA COVID-19 rates using pooled mean and percentile distribution. RESULTS: A total of 48,634 cases of HA COVID-19 were reported from 1428 hospitals. Incidence ranged from 0.16/1000 patient-days at neonatal intensive care units (ICUs) to 5.8/1000 patient-days at adult ICUs. The highest incidence of HA COVID-19 was during the months March to July 2021, similar to that which was observed for community-acquired COVID-19. CONCLUSIONS: This report provides a national view of the burden of HA COVID-19. The highest incidence of HA COVID-19 similar that which was observed for community-acquired COVID-19. We believe that this reflects the difficulty of implementing preventive measures. Further studies evaluating risk factors for the hospital transmission of SARS-Cov-2 should clarify strategies to minimize the risk of HA COVID-19 and may be applicable to other respiratory diseases. Furthermore, the implementation of a national system to evaluate HA COVID-19 has the potential to shine a light on this problem and lead to interventions in each hospital.

Acute Kidney Injury and Renal Replacement Therapy in COVID-19 Versus Other Respiratory Viruses: A Systematic Review and Meta-Analysis.

BACKGROUND: Acute kidney injury (AKI) is a potentially fatal complication of Coronavirus Disease-2019 (COVID-19). Binding of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the virus responsible for COVID-19, to its viral receptor, angiotensin converting enzyme 2 (ACE2), results in viral entry and may cause AKI. OBJECTIVES: We performed a systematic review and meta-analysis of the frequencies of AKI and renal replacement therapy (RRT) in critically ill COVID-19 patients and compared those frequencies with patients who were infected by respiratory viruses that bind or downregulate ACE2 (ACE2-associated viruses) and viruses that do not bind nor downregulate ACE2 (non-ACE2-associated viruses). DESIGN: Systematic review and meta-analysis. SETTING: Observational studies on COVID-19 and other respiratory viral infections reporting AKI and RRT were included. The exclusion criteria were non-English articles, non-peer-reviewed articles, review articles, studies that included patients under the age of 18, studies including fewer than 10 patients, and studies not reporting AKI and RRT rates. PATIENTS: Adult COVID-19, Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), and influenza patients. MEASUREMENTS: We extracted the following data from the included studies: author, year, study location, age, sex, race, diabetes mellitus, hypertension, chronic kidney disease, shock, vasopressor use, mortality, intensive care unit (ICU) admission, ICU mortality, AKI, and RRT. METHODS: We systematically searched PubMed and EMBASE for articles reporting AKI or RRT. AKI was defined by authors of included studies. Critical illness was defined by ICU admission. We performed a random effects meta-analysis to calculate pooled estimates for the AKI and RRT rate within each virus group using a random intercept logistic regression model. RESULTS: Of 23 655 hospitalized, critically ill COVID-19 patients, AKI frequencies were not significantly different between COVID-19 patients (51%, 95% confidence interval [CI]: 44%-57%) and critically ill patients infected with ACE2-associated (56%, 95% CI: 37%-74%, P = .610) or non-ACE2-associated viruses (63%, 95% CI: 43%-79%, P = .255). Pooled RRT rates were also not significantly different between critically ill, hospitalized patients with COVID-19 (20%, 95% CI: 16%-24%) and ACE2-associated viruses (18%, 95% CI: 8%-33%, P = .747). RRT rates for both COVID-19 and ACE2-associated viruses were significantly different (P < .001 for both) from non-ACE2-associated viruses (49%, 95% CI: 44%-54%). After adjusting for shock or vasopressor use, AKI and RRT rates were not significantly different between groups. LIMITATIONS: Limitations of this study include the heterogeneity of definitions of AKI that were used across different virus studies. We could not match severity of infection or do propensity matching across studies. Most of the included studies were conducted in retrospective fashion. Last, we did not include non-English publications. CONCLUSIONS: Our findings suggest that viral ACE2 association does not significantly alter the rates of AKI and RRT among critically ill patients admitted to the ICU. However, the rate of RRT is lower in patients with COVID-19 or ACE2-associated viruses when compared with patients infected with non-ACE2-binding viruses, which might partly be due to the lower frequencies of shock and use of vasopressors in these two virus groups. Prospective studies are necessary to demonstrate whether modulation of the ACE2 axis with Renin-Angiotensin System inhibitors impacts the rates of AKI and whether they are beneficial or harmful in COVID-19 patients.

MISE EN CONTEXTE: L'insuffisance rénale aiguë (IRA) est une complication potentiellement mortelle de la maladie à coronavirus-2019 (COVID-19). Obligatoire du Coronavirus 2 du Syndrome Respiratoire Aigu Sévère (SARS-CoV-2), le virus responsable du COVID-19, à son récepteur, l'enzyme de conversion de l'angiotensine 2 (ACE2), entraîne une entrée virale et peut provoquer une IRA. OBJECTIFS DE L'ÉTUDE: Nous avons effectué une revue systématique et une méta-analyse des fréquences de l'IRA et de la thérapie de remplacement renal (RRT) chez les patients COVID-19 gravement malades et a comparé ces fréquences avec les patients qui ont été infectés par des voies respiratoires virus qui lient ou régulent négativement l'ACE2 (virus associés à l'ACE2) et les virus qui ne régulent pas négativement ni ne lient l'ACE2 (virus non associés à l'ACE2). CADRE ET TYPE D'ÉTUDE: Revue systématique et méta-analyse. Des études d'observation sur le COVID-19 et d'autres infections virales respiratoires signalant une AKI et une RRT ont été incluses. Les critères d'exclusion étaient des articles non anglophones, des articles non évalués par des pairs, des articles de revue, des études incluant des patients moins de 18 ans, les études incluant moins de 10 patients et les études ne rapportant pas les taux d'IRA et de RRT. PATIENTS: Adultes COVID-19, syndrome respiratoire aigu sévère (SRAS), syndrome respiratoire du Moyen-Orient (MERS) et malades de la grippe. MESURES: Nous avons extrait les données suivantes des études incluses : auteur, année, lieu de l'étude, âge, sexe, race, diabète sucré, hypertension, maladie rénale chronique, état de choc, utilisation de vasopresseurs, mortalité, admission en unité de soins intensifs (USI), Mortalité en soins intensifs, AKI et RRT. MÉTHODOLOGIE: Nous avons systématiquement recherché dans PubMed et EMBASE les articles rapportant AKI ou RRT. AKI a été défini par les auteurs des études incluses. La maladie grave a été définie par l'admission aux soins intensifs. Nous avons effectué une méta-analyse à effets aléatoires pour calculer estimations regroupées pour le taux d'IRA et de RRT au sein de chaque groupe de virus à l'aide d'un modèle de régression logistique d'interception aléatoire. RÉSULTATS: Sur 23 655 patients hospitalisés et gravement malades COVID-19, les fréquences AKI n'étaient pas significativement différentes entre patients COVID-19 (51 %, intervalle de confiance à 95 % [IC] : 44 %-57 %) et patients gravement malades infectés par l'ACE2 associé (56 %, IC à 95 % : 37 % à 74 %, P = 0,610) ou des virus non associés à l'ACE2 (63 %, IC à 95 % : 43 % à 79 %, P = 0,255). Tarifs RRT groupés n'étaient pas non plus significativement différents entre les patients hospitalisés gravement malades atteints de COVID-19 (20 %, IC à 95 % : 16 % à 24 %) et virus associés à l'ACE2 (18 %, IC à 95 % : 8 % à 33 %, P = 0,747). Taux de RRT pour les virus associés au COVID-19 et à l'ACE2 étaient significativement différents (P < 0,001 pour les deux) des virus non associés à l'ACE2 (49 %, IC à 95 % : 44 % à 54 %). Après ajustement pour le choc ou l'utilisation de vasopresseurs, les taux d'IRA et de RRT n'étaient pas significativement différents entre les groupes. LIMITES DE L'ÉTUDE: Les limites de cette étude incluent l'hétérogénéité des définitions de l'IRA qui ont été utilisées pour différents virus études. Nous n'avons pas pu faire correspondre la gravité de l'infection ou faire une correspondance de propension entre les études. La plupart des études incluses ont été menées de manière rétrospective. Enfin, nous n'avons pas inclus les publications non anglophones. CONCLUSIONS: Nos résultats suggèrent que l'association virale ACE2 ne modifie pas de manière significative les taux d'IRA et de RRT parmi les patients gravement malades admis aux soins intensifs. Cependant, le taux de RRT est plus faible chez les patients atteints de COVID-19 ou associés à l'ACE2 virus par rapport aux patients infectés par des virus ne se liant pas à l'ACE2, ce qui pourrait être dû en partie à la plus faible fréquences de choc et utilisation de vasopresseurs dans ces deux groupes de virus. Des études prospectives sont nécessaires pour démontrer si la modulation de l'axe ACE2 avec les inhibiteurs du système rénine-angiotensine a un impact sur les taux d'IRA et si ells sont bénéfiques ou nocifs chez les patients COVID-19.

The BC ADPKD Network: A Comprehensive Provincial Approach to Support Specialized and Locally Delivered Multidisciplinary ADPKD Care.

PURPOSE: With evolving evidence around the progression, assessment, and management of autosomal dominant polycystic kidney disease (ADPKD), care of the disease has become increasingly complex. Needs assessments in British Columbia (BC) described variability in knowledge and comfort with incorporating these new aspects of ADPKD care into clinical practice. Undercapture of early-stage ADPKD patients in existing renal databases was also identified as an unmet need. SOURCES OF INFORMATION: A multidisciplinary group of clinicians and patient partners with interest and expertise in ADPKD and/or multidisciplinary kidney care informed the project work. An existing provincial renal database was used to support the provincial ADPKD registry. METHODS: A formalized, comprehensive provincial ADPKD Network was created within the existing infrastructure of multidisciplinary kidney clinics (MDCs) in BC. The Network is coordinated provincially and implemented locally. It incorporates robust data collection, education, creation, and dissemination of dedicated clinical tools; collaboration between clinics and clinicians across the province; and ongoing evaluation and continuous quality improvement. KEY FINDINGS: Over the 5 years since its inception, the BC ADPKD Network has enabled increased and earlier identification of British Columbians living with ADPKD and a shift in practice toward increased and earlier enrollment of ADPKD patients into MDCs. A host of tailored ADPKD clinical tools have been created and implemented in all MDCs across the province to support existing MDC staff in the delivery of more standardized and specialized ADPKD care. A collaborative provincial clinician network founded on Local Clinical Champions has been established to support ongoing experience sharing between clinics. An evaluation framework has been established to evaluate outcomes and enable ongoing refinement of the Network. LIMITATIONS: The provincial ADPKD registry is undergoing enhancements to enable more comprehensive capture of APDKD-specific information such as total kidney volume and genetic results, but at present, this remains a limitation. It remains to be seen whether the activities of the ADPKD Network will improve long-term clinical outcomes and care experiences of patients living with ADPKD, and a long-term sustainability assessment of this model of care will be required. IMPLICATIONS: The structure, tools, and coordinated and collaborative clinician network established through this comprehensive provincial ADPKD Network may be valuable in addressing the variability and gaps in existing ADPKD care while allowing patients and families across BC to receive enhanced care locally, in their usual kidney care environments.

JUSTIFICATION: L'évolution des données entourant la progression, l'évaluation et la prise en charge de la polykystose autosomique dominante (ADPKD) complexifie de plus en plus son traitement. En Colombie-Britannique (C.-B.), une évaluation des besoins a décrit la variabilité des connaissances et le niveau de confort quant à l'intégration de ces nouveaux aspects des soins pour l'ADPKD dans la pratique clinique. La capture des patients atteints d'ADPKD à un stade précoce dans les bases de données rénales existantes a également été reconnue comme un besoin non satisfait. SOURCES: Les travaux ont été orientés par un groupe multidisciplinaire de cliniciens et de patients partenaires possédant une expertise dans le domaine de l'ADPKD ou dans les soins rénaux multidisciplinaires. Une base de données provinciale existante sur les maladies rénales a été utilisée en appui au registre provincial de l'ADPKD. MÉTHODOLOGIE: Un réseau provincial complet et structuré pour l'ADPKD a été créé au sein de l'infrastructure existante des cliniques rénales multidisciplinaires (CRM) de la Colombie-Britannique. Le réseau est coordonné à l'échelle provinciale et mis en œuvre localement. Le réseau englobe une collecte rigoureuse des données, de l'éducation, la création et la diffusion d'outils cliniques dédiés, la collaboration entre les cliniques et les cliniciens de toute la province, de même que l'évaluation et l'amélioration continues de la qualité. PRINCIPAUX RÉSULTATS: Au cours des cinq années qui ont suivi sa création, le réseau ADPKD de la C.-B. a permis d'identifier en plus grand nombre et plus précocement les Britanno-Colombiens vivant avec l'ADPKD. On a également pu observer un virage dans la pratique vers une plus vaste et une plus précoce inclusion des patients atteints d'ADPKD dans les CRM. De plus, une foule d'outils cliniques sur mesure ont été créés et mis en œuvre dans tous les CRM de la province afin d'appuyer le personnel des CRM existantes dans la prestation de soins normalisés et plus spécialisés pour l'ADPKD. Un réseau coopératif provincial de cliniciens, fondé sur les champions cliniques locaux, a été créé pour favoriser le partage continu de l'expérience entre les cliniques. Enfin, un cadre d'évaluation a été établi pour examiner les résultats et permettre l'amélioration continue du réseau. LIMITES: Le registre provincial de l'ADPKD fait présentement l'objet d'améliorations qui permettront une saisie plus complète de l'information spécifique à l'APDKD, notamment le volume rénal total et les résultats génétiques, mais à l'heure actuelle, ceci demeure une limite. Reste à voir si les activités du réseau ADPKD permettront d'améliorer les résultats cliniques à long terme et les expériences de soins des patients vivant avec l'ADPKD. Une évaluation à long terme de la durabilité de ce modèle de soins sera nécessaire. CONCLUSION: La structure, les outils et le réseau coordonné et collaboratif de cliniciens mis en place par le biais de ce réseau provincial sur l'APDKD peuvent être utiles pour rendre compte de la variabilité et combler les lacunes des soins existantes, tout en permettant aux patients et aux familles de la Colombie-Britannique de recevoir localement de meilleurs soins, soit dans leur milieu de soins rénaux habituel.

Treatment Preferences for Cardiac Procedures of Patients With Chronic Kidney Disease in Acute Coronary Syndrome: Design and Pilot Testing of a Discrete Choice Experiment.

BACKGROUND: Chronic kidney disease is associated with a high incidence of acute coronary syndrome and related morbidity and mortality. Treatment choices for patients with chronic kidney disease involve trade-offs in the potential benefits and harms of invasive management options. OBJECTIVE: The objective was to quantify preferences of patients with chronic kidney disease toward invasive heart procedures. DESIGN: Design and pilot a discrete choice experiment. SETTING: We piloted the discrete choice experiment in 2 multidisciplinary chronic kidney disease clinics in Calgary, Alberta, using an 8-question survey. PATIENTS: Eligible patients included those aged 18 years and older, an estimated glomerular filtration rate < 45 mL/min/1.73 m2, not currently receiving dialysis, and able to communicate in English. MEASUREMENTS: Quantification of the average importances of key attributes of invasive heart procedures. METHODS: We identified attributes most important to patients and physicians concerning invasive versus conservative management for acute coronary syndrome, using semi-structured qualitative interviews. Levels for each attribute were derived from analysis of early invasive versus conservative acute coronary syndrome management clinical trials and cohort studies, where subgroups of patients with chronic kidney disease were reported. We designed the pilot study with patient partners with relevant lived experience and considered statistical efficiency to estimate main effects and interactions, as well as response efficiency. Hierarchical Bayesian estimation was used to quantify average importances of attributes. RESULTS: We recruited 43 patients with chronic kidney disease, mean (SD) age 67 (14) years, 67% male, and 35% with a history of cardiovascular disease, of whom 39 completed the survey within 2 weeks of enrollment. The results of the pilot revealed acute kidney injury requiring dialysis and permanent kidney replacement therapy, as well as death within 1 year were the most important attributes. Measures of internal validity for the pilot discrete choice experiment were comparable to those for other published discrete choice experiments. LIMITATIONS: Discrete choice experiments are complex instruments and often cognitively demanding for patients. This survey included multiple risk attributes which may have been challenging for some patients to understand. CONCLUSIONS: This pilot study demonstrates the feasibility of a discrete choice experiment to quantify preferences of patients with chronic kidney disease toward the benefits and trade-offs related to invasive versus conservative management for acute coronary syndrome. These preliminary findings suggest that patients with chronic kidney disease may be on average similarly risk averse toward kidney replacement therapy and death. This pilot information will be used to inform a larger discrete choice experiment that will refine these estimates of patient preferences and characterize subgroups with distinct treatment preferences, which should provide new knowledge that can facilitate shared decision-making between patients with chronic kidney disease and their care providers in the setting of acute coronary syndrome.

CONTEXTE: L'insuffisance rénale chronique (IRC) est associée à une forte incidence du syndrome coronarien aigu, de même qu'à la morbidité et à la mortalité qui y sont liées. Les options de traitement pour les patients atteints d'IRC impliquent de faire des compromis sur les avantages et inconvénients des options invasives. OBJECTIF: Quantifier les préférences des patients atteints d'IRC quant aux procédures cardiaques invasives. CONCEPTION: Concevoir et piloter une expérience avec choix discrets. CADRE: Nous avons mené cette expérience avec choix discrets dans deux cliniques multidisciplinaires de néphropathie chronique de Calgary (Alberta) à l'aide d'un sondage en huit questions. SUJETS: Les patients admissibles étaient des adultes avec un débit de filtration glomérulaire estimé (DFGe) inférieur à 45 mL/min/1,73 m 2 et ne suivant pas de traitements de dialyse. Les patients inclus devaient être capables de communiquer en anglais. MESURES: Quantification de l'importance moyenne des principaux attributs des procédures cardiaques effractives. MÉTHODOLOGIE: Les attributs les plus importants pour les patients et les médecins concernant une gestion invasive par rapport à une gestion conservatrice du syndrome coronarien aigu ont été déterminés à l'aide d'interviews qualitatives semi-structurées. L'analyse d'essais cliniques et d'études de cohorte ayant inclus des sous-groupes de patients atteints d'IRC et portant sur la gestion invasive précoce du syndrome coronarien aigu par opposition à une gestion conservatrice a permis de dériver les le degré d'importance pour chaque attribut. Nous avons conçu l'étude pilote en compagnie de patients partenaires ayant une expérience vécue pertinente et nous avons tenu compte de l'efficacité statistique pour estimer les principaux effets et interactions, de même que l'efficacité de la réponse. Une estimation hiérarchique bayésienne a été employée pour quantifier l'importance moyenne des attributs. RÉSULTATS: Nous avons recruté 43 patients atteints d'IRC dont l'âge moyen (É-T) était de 67 ans (14). La cohorte était constituée à 67 % d'hommes et 35 % des sujets avaient des antécédents de maladies cardiovasculaires. L'étude porte sur les 39 patients ayant rempli le questionnaire dans les deux semaines suivant le recrutement. Les résultats de l'étude pilote ont révélé que la mortalité dans la première année et l'insuffisance rénale aiguë (IRA) nécessitant la dialyse et une thérapie de remplacement rénal permanente étaient les attributs les plus importants. Les mesures des intervalles de validité de cette expérience pilote avec choix discrets étaient similaires à ceux des autres expériences publiées du même type. LIMITES: Les expériences avec choix discrets sont des outils complexes et souvent exigeants pour les patients sur le plan cognitif. Ce questionnaire comportait plusieurs attributs de risque qui ont peut-être été difficiles à comprendre pour certains patients. CONCLUSION: Cette étude pilote démontre la faisabilité d'une expérience avec choix discrets pour qualifier les préférences des patients atteints d'IRC en ce qui concerne les avantages et les compromis liés à une gestion invasive ou conservatrice du syndrome coronarien aigu. Ces résultats préliminaires semblent indiquer que les patients atteints d'IRC seraient en moyenne tout aussi réticents envers le risque de thérapie de remplacement rénal qu'envers le risque de décès. Les informations tirées de ce pilote serviront à orienter une plus vaste expérience avec choix discrets qui raffinera ces estimations des préférences des patients et caractérisera les sous-groupes ayant des préférences de traitements distinctes. Ceci fournira de nouvelles connaissances susceptibles de faciliter la prise de décision partagée entre les patients atteints d'IRC et leurs fournisseurs de soins dans le contexte du syndrome coronarien aigu.

[Therapeutic approaches to the Rational Use of trip-le combination therapy with a fixed combination of amlodipine, indapamide and perindopril arginine (TRIPLE COMBINATION) in patients with hypertension who do not control blood pressure on conventional treatment. (Description and main results of the TRIO program)].

Aim To study tactics of outpatient physicians in choosing the treatment when the previous double antihypertensive therapy (AHT) fails and to analyze the effectivity of an amlodipine/indapamide/perindopril arginine triple combination (TC).Material and methods The program included 1252 patients with arterial hypertension (AH); the TC group consisted of 992 (79.23 %) patients (38.3 % males; age, 61.6 [55.0; 67.9]); the control group included 260 (20.77 %) patients (37.7 % males; age, 60.6 [53.3; 67.4]). The main inclusion criteria were essential AH, age 18-79 years, insufficient response to previous AHT (clinical systolic blood pressure (SBP) >140-179 mm Hg). The study duration was three months. The following parameters were evaluated: dynamics of clinical and ambulatory BP (BP self-monitoring (BPSM); frequency of achieving the first goal of <140 / 90 mm Hg and the goal of <130 / 80 mm Hg); and changes in glomerular filtration rate (GFR) and quality of life (QoL). Responses to TC were analyzed in groups with different ranges of increased baseline SBP in patients with AH and diabetes mellitus (DM)/impaired glucose tolerance (IGT), overweight or obesity, and chronic kidney disease (CKD, reduced estimated GFR (eGFR <60 ml/min/1.73 m2). Safety was evaluated based on records of adverse events (AEs).Results The TC group had a more severe condition at baseline by clinical parameters and history and had higher baseline BP, which made difficult the intergroup comparison. Nevertheless at three months, the decrease in clinical SBP was more pronounced in the TC group (from 162.1  to 126.8 mm Hg, Δ=35.7  mm Hg) than in the control group (from 157.8 to 128.4  mm Hg, Δ=29.4  mm Hg). 87.8% of patients in the TC group and 81.9 % (р=0.012) in the control group achieved the first BP goal of <140 / 90 mm Hg; 34.3% and 28.2% of patients, respectively, achieved the BP goal of <130 / 80 mm Hg (р=0.055). The more effective SBP control in the TC group was associated with a pronounced BP decrease with higher BP values at baseline, which was also confirmed by an analysis in subgroups with SBP 140-160, 160-180, and >180 mm Hg. The TC treatment was associated with a pronounced antihypertensive effect with respect of BPSM values, improved QoL, and renal function. Significant decreases in BP and achievement of BP goals by a vast majority of patients receiving TC were also observed in subgroups with DM or IGT, overweight and/or obesity, and CKD. AEs were observed during the treatment only in 8 patients (0.64 %), which confirmed good tolerability and high safety of the therapy.Conclusion The study results demonstrated a therapeutic effect of the amlodipine/indapamide/perindopril arginine fixed-dose combination (Triplixam®). This effect was evident as control of clinical BP with any baseline BP level, including different ranges of increased SBP, in AH combined with DM, IGT, obesity, and CKD, which offers advantages over a subjective choice of AHT. TC improved BPSM values, QoL indexes, provided nephroprotection, and was well tolerated.

Stokes flow around an obstacle in viscous two-dimensional electron liquid.

The electronic analog of the Poiseuille flow is the transport in a narrow channel with disordered edges that scatter electrons in a diffuse way. In the hydrodynamic regime, the resistivity decreases with temperature, referred to as the Gurzhi effect, distinct from conventional Ohmic behaviour. We studied experimentally an electronic analog of the Stokes flow around a disc immersed in a two-dimensional viscous liquid. The circle obstacle results in an additive contribution to resistivity. If specular boundary conditions apply, it is no longer possible to detect Poiseuille type flow and the Gurzhi effect. However, in flow through a channel with a circular obstacle, the resistivity decreases with temperature. By tuning the temperature, we observed the transport signatures of the ballistic and hydrodynamic regimes on the length scale of disc size. Our experimental results confirm theoretical predictions.

The comparison of the process of manual and robotic positioning of the electrode performing radiofrequency ablation under the control of a surgical navigation system.

This study is aimed at the comparison of the process of manual and robotic positioning of the electrode performing radiofrequency ablation under the control of a surgical navigation system. The main hypothesis of this experiment was that the use of a collaborative manipulator (KUKA iiwa) will allow to position the active part of the electrode relative to the center of the tumor more accurately and from the first attempt. We also monitor the stability of the electrode's velocity during insertion and consider some advantages in ergonomics using the robotic manipulator. We use three more criteria to compare the surgeon's and robotic performance, unlike other studies, where only the target point's accuracy criterion is observed. The main idea is to examine the movement parameters of the electrode that can lead to potential patient trauma. Sphere-shaped tumor phantoms measuring 8 mm in diameter were filled with contrast and inserted in bovine livers. 10 livers were used for the robotic experiment and an equal quantity for manual surgery. The livers were encased in silicone phantoms designed to imitate the liver position in a real patient's abdominal cavity. Analysis of CT data gave the opportunity to find the entry and the target point for each tumor phantom. This data was loaded into a surgical navigation system that was used to track and record the position of the RF-electrode during the operation for further analysis. The standard deviation of points from the programmed linear trajectory totaled in the average 0.3 mm for the robotic experiment and 2.33 mm for the manual operation with a maximum deviation of 0.55 mm and 7.99 mm respectively. Standard deviation from the target point was 2.69 mm for the collaborative method and 2.49 mm for the manual method. The average velocity was 2.97 mm/s for the manipulator and 3.12 mm/s for the manual method, but the standard deviation of the velocity relative to the value of the average velocity was 0.66 mm/s and 3.05 mm/s respectively. Thus, in two criteria out of three, the manipulator is superior to the surgeon, and equality is established in one. Surgeons also noticed advantages in ergonomics performing the procedure using the manipulator. This experiment was produced as part of the work on the developing of a robotic multifunctional surgical complex. We can confirm the potential advantages of using collaborative robotic manipulators for minimally invasive surgery in case of practice for cancer treatment.

Dynamic light scattering biosensing based on analyte-induced inhibition of nanoparticle aggregation.

A new approach to direct quantitative detection of small molecules (haptens) by dynamic light scattering biosensing is presented. The proposed technique implements a homogeneous competitive immunoassay and is based on optical detection of specific inhibition of nanoparticle aggregation induced by the analyte in a sample. The technique performance was tested both in buffer and milk for detection of chloramphenicol - antibiotic relevant to food safety diagnostics. Good specificity, sensitivity (LOD in milk is 2.4 ng/ml), precision (4.0 ± 1.2%), ruggedness (8.3%), and 96% recovery in conjunction with a record wide dynamic range (3 orders of magnitude) of the nanosensing technique were demonstrated. Such characteristics complemented by the assay simplicity (no washing step) and a short assay time make the approach attractive for application as an analytical platform for point-of-care and field-oriented diagnostics. Graphical abstract.

[Combined application of physiotherapy and acupuncture in patients with knee osteoarthrosis]. / Sochetannoe primenenie fizioterapii i igloukalyvaniia v lechenii patsientov s osteoartrozom kolennykh sustavov.

RATIONALE: Osteoarthrosis (OA) is one of the most common heterogeneous diseases. OA treatment is stopping the pain syndrome with the help of medical methods. Currently, there are no comprehensive programs, including a combination of physiotherapy and acupuncture, in the treatment of OA. AIM: The scientific justification and development of a comprehensive treatment for patients with OA of the knee joints (OAKJ) using transdermal electropharmstimulation (TEFS) and acupuncture in microacupuncture zones of the hand and foot. MATERIAL AND METHODS: We examined 210 patients with OAKJ who underwent outpatient treatment at LLC 'Sanatorium 'Zelenaya Roscha'', Republic of Bashkortostan (Ufa) in 2014-2017. Patients were divided into 3 groups at random. The groups were comparable by medical and demographic characteristics (gender, age), average duration and stage of the disease, and body mass index. The 1st group (comparison group) included 70 patients who were prescribed TEFS with a non-steroidal anti-inflammatory drug, combined with traditional drug treatment. In the 2nd group (main group) - 70 patients who underwent TEFS with a non-steroidal anti-inflammatory drug in combination with acupuncture in the microacupuncture zones of the hand and foot, as well as traditional drug therapy. In the 3rd group (control group) - 70 patients who received only drug therapy with a non-steroidal anti-inflammatory drug of 15 mg/day. Therapeutic efficacy was evaluated on the 4th, 7th, 11th, 11th and 12-15th days of treatment based on the timing of the relief of the pain syndrome, the dynamics of the clinical presentation of the disease, the visual analogue scale (VAS) for pain, the McGill pain questionnaire, tensoalgometry, electromyography of the thigh muscles, as well as changes in blood microcirculation in the knee joints on the 1st - 5th day of treatment. RESULTS: It was found that the combined use of TEFS and acupuncture in the microacupuncture zones of the hand and foot in patients with OAKJ relieves pain earlier than in the patients of the control group and the comparison group, and also leads to an increase in tensoalgometry, a decrease in VAS pain, and a decrease in the number of words-descriptors and sums of ranks, normalization of the amplitude of electric potentials and the frequency of muscle contractions of the thigh muscles, improvement of microcirculation of blood of the knee joints faster. CONCLUSION: The obtained results indicate the high efficiency of the combined use of TEFS and acupuncture in the microacupuncture zones of the hand and foot in the treatment of patients with OAKJ.

The role of the GABAA receptor Alpha 1 subunit in the ventral hippocampus in stress resilience.

Pre-pubertal stress increases post-traumatic stress disorder (PTSD) susceptibility. We have previously demonstrated that enriched environment (EE) intervention immediately after pre-pubertal stress protects from the effects of trauma in adulthood. Here, we examined whether exposure to EE would also be beneficial if applied after exposure to trauma in adulthood. We have recently shown that exposure to juvenile stress and under-water trauma (UWT) is associated with increased expression of GABAA receptor subunit α1 in the ventral hippocampus. However, differentiating between affected and unaffected individuals, this increased expression was confined to stress-exposed, behaviorally unaffected individuals, suggesting upregulation of α1 expression as a potential mechanism of resilience. We now examined whether EE-induced resilience renders increased expression of α1 in the ventral hippocampus redundant when facing a trauma later in life. Adult rats were exposed to UWT, with pre-exposure to juvenile stress, and tested in the open field and elevated plus maze paradigms four weeks later. EE exposure during juvenility prevented pre-pubertal stress-induced vulnerability, but not if performed following UWT in adulthood. Furthermore, juvenile EE exposure prevented the trauma-associated increase in α1 expression levels. Our findings emphasize the importance of early interventions in order to reduce the likelihood of developing psychopathologies in adulthood.

Paradoxical response to carbonic anhydrase inhibitors in patients with intraretinal cystoid spaces.

Background: Intraretinal cystoid spaces (IRCS) are fluid-filled spaces seen in some retinal dystrophies and often treated with carbonic anhydrase inhibitors. The purpose of this study is to report an unexpected bilateral improvement in the IRCS after discontinuation of therapy. Material and Methods: We identified from our records 23 patients with retinal dystrophy and IRCS who had been treated with topical and/or oral carbonic anhydrase inhibitors. All subjects had regular follow-up with OCT and previous genetic testing. Results: We identified four (17%) patients who experienced a bilateral and symmetrical paradoxical improvement in IRCS size and visual acuity after discontinuation of carbonic anhydrase inhibitors. Two were mutations in RS1, one in CLN3 and another in NR2E3. All patients were followed for at least three years (range 39-63 months). None had systemic abnormalities. Conclusions: Patients with IRCS may exhibit a paradoxical response after discontinuation of carbonic anhydrase inhibitors. Although the pathophysiology of these phenomena is unclear, stopping treatment may be an option in patients who cease to improve or get worse on treatment.

Electronic thermal conductivity in 2D topological insulator in a HgTe quantum well.

We have measured the differential resistance in a two-dimensional topological insulator (2DTI) in a HgTe quantum well, as a function of the applied dc current. The transport near the charge neutrality point is characterized by a pair of counter propagating gapless edge modes. In the presence of an electric field, the energy is transported by counter propagating channels in the opposite direction. We test a hot carrier effect model and demonstrate that the energy transfer complies with the Wiedemann Franz law near the charge neutrality point in the edge transport regime.

What we know and do not know about women and kidney diseases; Questions unanswered and answers unquestioned: Reflection on World Kidney Day and International Woman's Day.

Chronic kidney disease affects approximately 10% of the world's adult population: it is within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. World Kidney Day and International Women's Day in 2018 coincide, thus offering an opportunity to reflect on the importance of women's health and specifically women's kidney health on the community and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply those learnings more broadly. Girls and women, who make up approximately 50% of the world's population, are important contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care, and participation in clinical studies. Pregnancy is a unique state for women, offering an opportunity for diagnosis of kidney disease, but also a state in which acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. Various autoimmune and other conditions are more likely to impact women, with profound consequences for child bearing and the fetus. Women have different complications on dialysis than men, and are more likely to be donors than recipients of kidney transplants. In this editorial, we focus on what we know and do not know about women, kidney health, and kidney disease, and what we might learn in the future to improve outcomes worldwide.

Implementation of tailored interventions in a statewide programme to reduce central line-associated bloodstream infections.

BACKGROUND: There have been few studies exploring implementation strategies to central line-associated bloodstream infections (CLABSIs) in low- or middle-income countries. AIM: To implement tailored interventions to reduce CLABSI rates in adult intensive care units. METHODS: The implementation strategy of the State Health Department was performed in São Paulo State, Brazil, over two cycles. Cycle 1 (56 hospitals) was exploratory and cycle 2 (77 hospitals) was designed to confirm the hypothesis generated by the first cycle, with three phases each (pre-intervention, intervention, post-intervention). Cycles included: evaluation of healthcare workers' knowledge, observation of practices, and CLABSI rates monthly report. In cycle 1, a log-normal mixed model was used to select variables significantly associated with the reduction of CLABSI. In cycle 2, CLABSI rates were evaluated. FINDINGS: Healthcare workers' practices improved after intervention. In cycle 1, reduction of CLABSI rates was more pronounced in hospitals with initial CLABSI rates >7.4 per 1000 catheter-days (P < 0.001) and those that introduced the use of peripherally inserted central catheters (P = 0.01). For hospitals with high CLABSI initial rates, simulation demonstrated that the rates were expected to decrease by 36% (95% CI: 9-63), no matter the type of intervention. In cycle 2, there was an overall decrease in CLABSI rates during the intervention period; whereas the mean rate fell further post-intervention, rates at the 90th percentile increased. CONCLUSION: The implementation strategy may have had an effect on infection rates independently of the specific interventions implemented; however, the sustainability of reduction in the post-intervention period remains a challenge.

What we do and do not know about women and kidney diseases; Questions unanswered and answers unquestioned: Reflection on World Kidney Day and International Woman's Day.

Chronic kidney disease (CKD) affects approximately 10% of the world's adult population; it is within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. World Kidney Day and International Women's Day in 2018 coincide, thus offering an opportunity to reflect on the importance of women's health and specifically their kidney health, on the community, and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply those learnings more broadly. Girls and women, who make up approximately 50% of the world's population, are important contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care, and participation in clinical studies. Pregnancy is a unique state for women, which not only offers an opportunity for diagnosis of kidney disease, but also states where acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. There are various autoimmune and other conditions that are more likely to impact women with profound consequences for childbearing, and on the fetus. Women have different complications on dialysis than men and are more likely to be donors than recipients of kidney transplants. In this editorial, we focus on what we do and do not know about women, kidney health, and kidney disease and what we might learn in the future to improve outcomes worldwide.

Chronic kidney damage in the adult Fontan population.

OBJECTIVES: 1) To determine the accuracy of estimated GFR (eGFR) as compared to directly measured GFR (mGFR) in the adult Fontan population; 2) to determine the true prevalence of chronic kidney damage (CKD) as determined by uACR AND eGFR. METHODS: Prospective study of 81 patients Fontan patients (≥18years) followed at St. Paul's Hospital, University of British Columbia. CKD-EPI and MDRD equations used to calculate eGFR, mGFR determined by 99mTc-DTPA renal dynamic imaging and urine albumin to creatinine ratios were calculated. RESULTS: The mGFR was 93±27ml/min/1.73m2: 28 (53%) had an mGFR<90ml/min/1.73m2 and 1 (2%) had an mGFR <60ml/min/1.73m2. There was a modest correlation between mGFR and eGFR (EPI/MDRD) (r=0.50, p<0.0001 and r=0.54, p<0.0001 respectively). Both eGFR (EPI) (bias 27.0; 95% CI 18.0-27.7ml/min/m2, p<0.0001) and eGFR (MDRD) (bias 15.5; 95% CI 7.6-17.4ml/min/m2, p<0.0001) overestimated GFR as compared to mGFR. Among patients with an eGFR (EPI)/(MDRD) >90ml/min/1.73m2, 50% and 46% respectively had an mGFR <90ml/min/1.73m2. Significant albuminuria (>3mg/mmol) was present in 33% and upwards of 32% of patients with a normal eGFR (MDRD/EPI) had evidence of CKD with uACR >3mg/mmol. Using combined criteria of eGFR <90ml/min/1.73m2 and/or uACR >3mg/mmol, 46% of patients had evidence of CKD. CONCLUSIONS: This study draws attention to the need for stringent CKD screening as an important proportion of CKD is currently not being detected. Mild undetected CKD, an early marker of end organ damage, may also be an early sign of Fontan failure that requires warrants further research.