Late Course Research Articles

Dilated cardiomyopathy revealing Refsum disease: a case report

BackgroundRefsum disease is a rare autosomal recessive hereditary disorder of lipid metabolism that results in the accumulation of phytanic acid. This syndrome is characterized with a range of classic symptoms including ataxia, peripheral neuropathy, amyotrophy, retinopathy, ichthyosis, and hearing loss. Later in life, individuals with Refsum disease may present cardiac manifestations, such as arrhythmias or conduction defects (first-degree atrioventricular block and bundle branch block) and hypertrophic or dilated cardiomyopathy, leading to heart failure and sudden death. To the best of our knowledge, this is the first case revealed by cardiac manifestations described in literature.Case presentation: We report the case of 38-year-old white Moroccan male who was admitted in our department for an acute decompensated heart failure episode. Transthoracic echocardiography found a dilated cardiomyopathy with a reduced ejection fraction at 15%. Further evaluation showed different features of Refsum disease. High plasma level of phytanic acid confirmed the diagnosis. Cardiac manifestations are frequent in the late course of the adult Refsum disease and include, cardiomyopathy, electrical abnormalities, and sudden cardiac death. Moreover, arrhythmias remain one of the main causes of death in these patients.ConclusionRefsum’s disease is an autosomal recessive disorder. It presents as retinitis pigmentosa with anosmia, deafness ataxia, and cardiac defects. Current interventions for individuals with Refsum disease consist of dietary phytanic acid restriction and lipid apheresis to control symptoms and enhance quality of life.

Outcomes in Pregnancies Complicated with Preterm Hypertensive Disorders with and without Late Antenatal Corticosteroids.

This study aimed to determine whether administration of a late preterm (34-36 weeks) course of antenatal corticosteroids (ACS) is associated with improved short-term neonatal outcomes among pregnancies complicated with hypertensive disorders of pregnancy (HDP) who delivered in the late preterm period. A single tertiary center retrospective cohort study, including pregnant individuals with singleton fetuses who delivered between 34.0 and 36.6 weeks following an HDP diagnosis. Exclusion criteria were major fetal anomalies and treatment with ACS before 34 weeks. Cases were divided into two groups: exposed group, consisting of individuals treated with a late ACS course, and nonexposed group, receiving no ACS. The primary outcome was a composite adverse neonatal outcome, including intensive care unit admission, oxygen treatment, noninvasive positive pressure ventilation, mechanical ventilation, respiratory distress syndrome, transient tachypnea, or apnea of prematurity. Secondary neonatal outcomes included birth weight, Apgar score, intraventricular hemorrhage, necrotizing enterocolitis, bronchopulmonary dysplasia, surfactant use, hypoglycemia, hyperbilirubinemia, sepsis, and neonatal death. Multivariable regression models were used to determine adjusted odds ratio (aOR)and 95% confidence intervals (CIs). Of 7,624 preterm singleton deliveries during the study period, 438 (5.7%) were diagnosed with HDP and delivered between 34.0 and 36.6 weeks. Infants who received ACS were diagnosed more commonly with fetal growth restriction (16.0 vs. 5.6%, p < 0.01) and were delivered at an earlier gestational age (GA) (mean GA: 35.6 vs. 36.3 weeks, p < 0.01). The composite neonatal morbidity did not differ between the groups after adjustments (aOR: 0.97, 95% CI: 0.47, 1.98). Neonatal hypoglycemia and hyperbilirubinemia were more common in the exposed group than in the nonexposed group (46.9 vs. 27.4%; aOR: 2.27; 95% CI: 1.26, 4.08 and 64.2 vs. 46.5%; aOR: 2.08; 95% CI: 1.16, 3.72 respectively). In people with HDP, a course of ACS given in the late preterm period did not improve neonatal morbidity. · In people with HDP, a late preterm ACS course did not improve neonatal morbidity.. · Respiratory morbidity rate was similar between infants who received late ACS and those who did not.. · Neonatal hypoglycemia and hyperbilirubinemia were more common in infants who received late ACS..

Ácido acetilsalicílico versus inibidores dos receptores P2Y12 para prevenção secundária em pacientes tratados por meio de intervenção coronária percutânea

Currently, percutaneous coronary intervention with a drug-eluting stent implantation is the main method of myocardial revascularization in tertiary care hospitals, regardless of the clinical presentation of coronary artery disease. It is well known that to be effective, it requires the use of a dual antiplatelet therapy, which is a combination of acetylsalicylic acid and a P2Y12 platelet receptor inhibitor, which plays a key role in preventing thromboses after endoprosthesis implantation and is also indicated to prevent atherothrombotic events in the late clinical course, regardless of the stent model used. After a variable period of time, depending on some factors, such as the clinical presentation of coronary artery disease and the type of stent implanted, this therapy is discontinued, and the main current guidelines recommend interrupting the P2Y12 receptor inhibitor and maintaining acetylsalicylic acid in the long term, as one of the main pharmacological measures for secondary prevention of atherosclerosis. However, recently, due to their greater antiplatelet potency and probable lower potential for significant bleeding, especially in the digestive tract, P2Y12 inhibitors have been considered a valid and attractive option as an antiplatelet agent for long-term use; but this alternative has not been endorsed by guidelines yet. This review discusses the details related to this important decision that must be made by cardiologists when discontinuing the different antithrombotic therapies initially used after percutaneous coronary intervention. In principle, the scarcity of conclusive and normative clinical studies, especially in the population treated by percutaneous intervention, means that acetylsalicylic acid is the only antiplatelet agent with class I indication for secondary prevention of atherosclerosis.

Neurological Outcome and Respiratory Insufficiency in Intramedullary Tumors of the Upper Cervical Spine.

Background and Objectives: Intramedullary spinal cord tumors (IMSCT) are rare entities. A location in the upper cervical spine as a highly eloquent region carries the risk of postoperative neurological deficits, such as tetraparesis or respiratory dysfunction. Evidence for respiratory dysfunction is scarce. This study aimed to describe these highly eloquent tumors' early and late postoperative clinical course. Materials and Methods: This is a single-center retrospective cohort study. We included 35 patients with IMSCT at levels of the craniocervical junction to C4 who underwent surgical treatment between 2008 and 2022. The authors analyzed the patients' preoperative status, tumor- and surgery-specific characteristics, and follow-up functional status. Results: The study cohort included twenty-two patients with grade II ependymoma (62.9%), two low-grade astrocytomas (5.7%), two glioblastomas (5.7%), six hemangioblastomas (17.1%), two metastases (5.7%), and one patient with partially intramedullary schwannoma (2.9%). Gross total resection was achieved in 76% of patients. Early dorsal column-related symptoms (gait ataxia and sensory loss) and motor deterioration occurred in 64% and 44% of patients. At a follow-up of 3.27 ± 3.83 years, 43% and 33% of patients still exhibited postoperative sensory and motor deterioration, respectively. The median McCormick Scale grade was 2 in the preoperative and late postoperative periods, respectively. Only three patients (8.6%) developed respiratory dysfunction, of whom, two patients, both with malignant IMSCT, required prolonged invasive ventilation. Conclusions: More than 60% of the patients with IMSCT in the upper cervical cord developed new neurological deficits in the immediate postoperative period, and more than 40% are permanent. However, these deficits are not disabling in most cases since most patients maintain functional independence as observed by unchanged low McCormick scores. The rate of respiratory insufficiency is relatively low and seems to be influenced by the rapid neurological deterioration in high-grade tumors.

Sustainable navigation approach: Efficacy assessment of the constant radius turn technique in calculating wheel over point using a ship simulator

Changing a ship’s course while manoeuvring on a planned track is challenging as the ship may deviate from its intended course line, particularly when a late course alteration is made. Therefore, a wheel over point must be precisely established as an indicator to initiate course alteration. The study examines the Constant Radius Turn technique’s accuracy, where it is frequently used to calculate and determine the wheel over point. Even though mariners on board the ship have been widely using the technique, there is a lack of evidence in the scholarly literature to verify its effectiveness. In this study, simulations were carried out using a ship simulator to obtain the cross-track distance data for a ship’s manoeuvrability in various navigation regions consist of harbour and confined water, coastal navigation, and open water navigation. The results were then compared to the cross-track limits for each region, which led to the discovery that constant radius turn is an excellent method for identifying wheel over points in coastal and open water navigation, but it is not suitable for use in harbours and confined water areas.

Experience in surgical treatment of enteroatmospheric fistulas in the late period of postoperative peritonitis

Background. Enteroatmospheric fistulas (EAF) that occur during the use of the “open abdomen” surgical tactics are a complex surgical pathology with a high mortality rate.The aim. To assess the effectiveness of treatment of various forms of enteroatmospheric fistulas in patients with postoperative peritonitis using vacuum aspiration technology.Methods. We assessed the results of the surgical treatment of 46 patients with EAF in the late course of postoperative peritonitis (PP). Three clinical and morphological groups were distinguished: group 1 (n = 24) – EAF in small wounds of the anterior abdominal wall; group 2 (n = 15) – EAF opening into limited cavities; group 3 (n = 7) – EAF opening into laparostoma wounds. In group 1, a fistula was formed using continuous aspiration devices or VAC systems. In group 2, we used continuous aspiration of intestinal contents from the cavity. In group 3, laparostoma was treated using vacuum devices with isolation of the intestinal fistula and simulation of a floating enterostoma.Results. Group 3 of patients with EAF was characterized by a high flow rate (1224.2 ± 210.3 ml), duration of treatment (87.3 ± 12.5 day), extensive laparostoma (335.4 ± 14.3 сm2), high mortality rate (57.1 %). The best results of treatment were obtained in groups 1 and 2. The flow rate was 675.8 ± 154.3 and 541.3 ± 114.1 ml, the duration of treatment was 2 or 3 times less (37.7 ± 6.1 and 26.4 ± 5.2 days), the mortality rate was 8.3 % and 6.7 % respectively.Conclusion. EAF that occur when using the “open abdomen” surgical tactics due to the impossibility of their isolation in extensive wounds of the anterior abdominal wall are complicated clinical and morphological forms. For their treatment, it is advisable to use VAC systems, aimed at the treatment of both the anterior abdominal wall wound itself and the intestinal fistula opening into it for its gradual extraterritorialization by modeling a floating enterostoma in a vacuum device.

COVID-19 associated infections in the ICU setting: A retrospective analysis in a tertiary-care hospital

IntroductionOur work describes the frequency of superinfections in COVID-19 ICU patients and identifies risk factors for its appearance. Second, we evaluated ICU length of stay, in-hospital mortality and analyzed a subgroup of multidrug-resistant microorganisms (MDROs) infections. MethodsRetrospective study conducted between March and June 2020. Superinfections were defined as appeared ≥48h. Bacterial and fungal infections were included, and sources were ventilator-associated lower respiratory tract infection (VA-LRTI), primary bloodstream infection (BSI), secondary BSI, and urinary tract infection (UTI). We performed a univariate analysis and a multivariate analysis of the risk factors. ResultsTwo-hundred thirteen patients were included. We documented 174 episodes in 95 (44.6%) patients: 78 VA-LRTI, 66 primary BSI, 9 secondary BSI and 21 UTI. MDROs caused 29.3% of the episodes. The median time from admission to the first episode was 18 days and was longer in MDROs than in non-MDROs (28 vs. 16 days, p<0.01). In multivariate analysis use of corticosteroids (OR 4.9, 95% CI 1.4–16.9, p 0.01), tocilizumab (OR 2.4, 95% CI 1.1–5.9, p 0.03) and broad-spectrum antibiotics within first 7 days of admission (OR 2.5, 95% CI 1.2–5.1, p<0.01) were associated with superinfections. Patients with superinfections presented respect to controls prolonged ICU stay (35 vs. 12 days, p<0.01) but not higher in-hospital mortality (45.3% vs. 39.7%, p 0.13). ConclusionsSuperinfections in ICU patients are frequent in late course of admission. Corticosteroids, tocilizumab, and previous broad-spectrum antibiotics are identified as risk factors for its development.

Letter to the Editor: Delayed Fibrosis and Late Course Magnetic Resonance Imaging Findings in Clozapine-Induced Myocarditis in an Adolescent.

Journal of Child and Adolescent PsychopharmacologyAhead of Print Letter to the Editor: Delayed Fibrosis and Late Course Magnetic Resonance Imaging Findings in Clozapine-Induced Myocarditis in an AdolescentConnor J. Byeman, Rabia S. Khan, and Carissa GundersonConnor J. ByemanAddress correspondence to: Connor J. Byeman, BS, University of Iowa Carver College of Medicine, University of Iowa Hospitals and Clinics, 375 Newton Road, Iowa City, IA 52242, USA E-mail Address: connor-byeman@uiowa.eduhttps://orcid.org/0000-0003-4273-2210University of Iowa Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.Search for more papers by this author, Rabia S. KhanDivision of Pediatric Cardiology, Department of Pediatrics, Stead Family Children's Hospital, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.Search for more papers by this author, and Carissa GundersonDivision of Child Psychiatry, Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.Search for more papers by this authorPublished Online:6 Apr 2023https://doi.org/10.1089/cap.2022.0075AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Letter to the Editor: Delayed Fibrosis and Late Course Magnetic Resonance Imaging Findings in Clozapine-Induced Myocarditis in an Adolescent." Journal of Child and Adolescent Psychopharmacology, , pp. –FiguresReferencesRelatedDetails Volume 0Issue 0 InformationCopyright 2023, Mary Ann Liebert, Inc., publishersTo cite this article:Connor J. Byeman, Rabia S. Khan, and Carissa Gunderson.Letter to the Editor: Delayed Fibrosis and Late Course Magnetic Resonance Imaging Findings in Clozapine-Induced Myocarditis in an Adolescent.Journal of Child and Adolescent Psychopharmacology.ahead of printhttp://doi.org/10.1089/cap.2022.0075Online Ahead of Print:April 6, 2023PDF download

Investigating the Moral Sensitivity of Medical Students in the Preclinical and Late Clinical Courses.

Paying attention to moral issues is one of the essential requirements of medical practice, and moral aspects must be considered in making decisions to achieve the desired results and ensure the patient's satisfaction. Moral sensitivity is one of the components that enable physicians to act ethically in their decisions. Since medical students must acquire the necessary skills to deal with patients properly in clinical courses, the current paper examines the moral sensitivity of medical students in both preclinical and late clinical courses. This is a cross-sectional study performed on 180 medical students in the preclinical and late clinical course. The study tool is an adapted version of the Kim-Lutzen ethical sensitivity questionnaire with 25 items and Likert scoring 0-4. The obtained score can be between 0-100. Data was analyzed using SPSS25. Statistical t-test or its non-parametric equivalent (Mann-Whitney) was used for quantitative variables and Chi-square or Fisher exact tests were used for qualitative variables. Pearson's correlation coefficient was used to measure the correlation of the variables. The mean age of stagers and interns was 22.7 + 0.85, and 26.5 + 1.11. 41 (51.2%) of stagers and 51 (63.7%) of interns had a history of participating in workshops related to medical ethics, and 4 (5%) of the former and 3 (3.8%) of the latter had previously conducted research in the field of medical ethics. there was a significant relationship between the stagers' history of conducting research in the field of ethics and their moral sensitivity. Concerning moral sensitivity components, the highest scores belonged to "altruism and trustworthiness", "the use of moral concepts in moral decisions", and "respect for the patient's autonomy" in both groups., 95% of stagers and 98.8% of interns had medium level (51-75) of moral sensitivity. Medical students' moral sensitivity did not increase significantly during the clinical course. It is necessary to review and reconsider medical ethics educational methods, the time allocated to relevant courses, and the practical need for clinical education in addition to theory. Directing research projects and student dissertations toward topics related to medical ethics can also contribute significantly to enhancing moral sensitivity.

Functional enhancement strategies to potentiate the therapeutic properties of mesenchymal stromal cells for respiratory diseases.

Respiratory diseases remain a major health concern worldwide because they subject patients to considerable financial and psychosocial burdens and result in a high rate of morbidity and mortality. Although significant progress has been made in understanding the underlying pathologic mechanisms of severe respiratory diseases, most therapies are supportive, aiming to mitigate symptoms and slow down their progressive course but cannot improve lung function or reverse tissue remodeling. Mesenchymal stromal cells (MSCs) are at the forefront of the regenerative medicine field due to their unique biomedical potential in promoting immunomodulation, anti-inflammatory, anti-apoptotic and antimicrobial activities, and tissue repair in various experimental models. However, despite several years of preclinical research on MSCs, therapeutic outcomes have fallen far short in early-stage clinical trials for respiratory diseases. This limited efficacy has been associated with several factors, such as reduced MSC homing, survival, and infusion in the late course of lung disease. Accordingly, genetic engineering and preconditioning methods have emerged as functional enhancement strategies to potentiate the therapeutic actions of MSCs and thus achieve better clinical outcomes. This narrative review describes various strategies that have been investigated in the experimental setting to functionally potentiate the therapeutic properties of MSCs for respiratory diseases. These include changes in culture conditions, exposure of MSCs to inflammatory environments, pharmacological agents or other substances, and genetic manipulation for enhanced and sustained expression of genes of interest. Future directions and challenges in efficiently translating MSC research into clinical practice are discussed.

Should Paxlovid be prescribed for patients with severe COVID‐19 in the late course of infection? A case report

AbstractThe infection of the coronavirus disease 2019 (COVID‐19) is often accompanied by pneumonia with both high incidence and mortality. Paxlovid is commonly prescribed in patients with mild and normal pneumonia within 5 days from the symptom onset. Herein, we report a practically effective use of Paxlovid compensatively in patients with COVID‐19 and severe pneumonia after 5 days of infection in a typical case in China. In this case, a 75‐year‐old man was diagnosed with severe COVID‐19 complicated with a pulmonary bacterial infection. After treatment with oxygen inhalation, Cefoperazone‐sulbactam and ambroxol, fever and upper respiratory symptoms were alleviated, except for the Oxygenation index (OI) remaining worse, Coronavirus was detected as positive, and levels of interleukin‐6 remained high. Paxlovid was prescribed for 5 days subsequently though it was 14 days since symptom onset. Thereafter, the nucleic acid of the patient turned negative in 7 days and the symptoms resolved. This case showed that Paxlovid can be considered in patients with COVID‐19 and severe pneumonia even in the later course of infection in clinical practice in China.

Systematic review with meta-analysis: Efficacy and safety of biological treatment on salivary gland function in primary Sjögren's syndrome.

Objective: The study aimed to assess the efficacy and safety of clinical trials of biologics in improving the salivary gland (SG) function in primary Sjögren's syndrome (pSS), which has not been analyzed critically and systematically. Methods: PubMed, Web of Science, ClinicalTrials.gov, the EU Clinical Trials Register, and the Cochrane Library were searched for clinical trials that reported effects of biological treatment on the SG function and safety in pSS patients. Inclusion criteria were defined following participants, interventions, comparisons, outcome, and study design (PICOS) recommendations. The objective index (the change of unstimulated whole saliva (UWS) flow) and the serious adverse event (SAE) were assessed as main outcome measures. A meta-analysis of the efficacy and safety of the treatment was conducted. Quality assessment, sensitivity analysis, and publication bias were assessed. The effect size together with a 95% confidence interval was used to estimate the efficacy and safety of biological treatment and was plotted as a forest plot. Results: The literature search yielded 6,678 studies, nine of which fulfilled the inclusion criteria, with seven randomized controlled trials (RCTs) and two non-RCT clinical studies. Generally, biologics do not significantly increase UWS from the baseline of pSS patients compared to the control group at a matched time point (p = 0.55; standard mean difference, SMD = 0.05; 95% confidence interval, CI: -0.11 and 0.21). However, pSS patients with shorter disease duration (≤3years; SMD = 0.46; 95% CI: 0.06 and 0.85) were prone to have a better response to biological treatment by showing higher increased UWS than patients with longer disease duration (> 3years; SMD = -0.03; 95% CI: -0.21 and 0.15) (p = 0.03). For the meta-analysis of the safety of biological treatment, the SAEs in the biologics group were significantly higher than those of the control group (p = 0.0021; log odds ratio, OR = 1.03; 95% CI: 0.37 and 1.69). Conclusion: Biological intervention during the early course of the disease may benefit pSS patients better than that during the late course. Significantly, more SAEs in the biologics group indicate that the safety of biologics needs to be addressed for future biological clinical trials and treatment.

Choledochal Cyst Excision in Infants-A Retrospective Study.

A choledochal cyst is a rare malformation primarily diagnosed in children. The only effective therapy remains surgical cyst resection followed by Roux-en-Y hepaticojejunostomy. Treating asymptomatic neonates remains a point of discussion. Between 1984 and 2021, we performed choledochal cyst (CC) excision in 256 children at our center. Out of this group, we retrospectively reviewed the medical records of 59 patients who were operated on under one year of age. Follow-up ranged from 0.3 to 18 years (median 3.9 years). The preoperative course was asymptomatic in 22 (38%), while 37 patients (62%) had symptoms before surgery. The late postoperative course was uneventful in 45 patients (76%). In symptomatic patients, 16% had late complications, while in asymptomatic patients, only 4%. Late complications were observed in the laparotomy group in seven patients (17%). We did not observe late complications in the laparoscopy group. Early surgical intervention is not followed by a high risk of complications and may prevent the onset of preoperative complications, giving excellent early and long-term results, especially after minimally invasive laparoscopic surgery.

PET-based radiomics visualizes tumor-infiltrating CD8 T cell exhaustion to optimize radiotherapy/immunotherapy combination in mouse models of lung cancer

BackgroundCumulative preclinical and clinical evidences showed radiotherapy might augment systemic antitumoral responses to immunotherapy for metastatic non-small cell lung cancer, but the optimal timing of combination is still unclear. The overall infiltration and exhausted subpopulations of tumor-infiltrating CD8+ T cells might be a potential biomarker indicating the response to immune checkpoint inhibitors (ICI), the alteration of which is previously uncharacterized during peri-irradiation period, while dynamic monitoring is unavailable via repeated biopsies in clinical practice.MethodsBasing on tumor-bearing mice model, we investigated the dynamics of overall infiltration and exhausted subpopulations of CD8+ T cells after ablative irradiation. With the understanding of distinct metabolic characteristics accompanied with T cell exhaustion, we developed a PET radiomics approach to identify and visualize T cell exhaustion status.ResultsCD8+ T cell infiltration increased from 3 to 14 days after ablative irradiation while terminally exhausted populations significantly predominated CD8+ T cells during late course of this infiltrating period, indicating that 3–7 days post-irradiation might be a potential appropriate window for delivering ICI treatment. A PET radiomics approach was established to differentiate T cell exhaustion status, which fitted well in both ICI and irradiation settings. We also visualized the underlying association of more heterogeneous texture on PET images with progressed T cell exhaustion.ConclusionsWe proposed a non-invasive imaging predictor which accurately assessed heterogeneous T cell exhaustion status relevant to ICI treatment and irradiation, and might serve as a promising solution to timely estimate immune-responsiveness of tumor microenvironment and the optimal timing of combined therapy.

Alfa-mannosidosis: Frequent Symptoms in Rare Patient

Background. Alfa-mannosidosis is ultra-rare autosomal recessive lysosomal storage disease caused by the mutation in the MAN2B1 gene. Pathogenic nucleotide variants and structural changes in this gene lead to acid alpha-mannosidase deficiency, this enzyme is involved in oligosaccharides degradation. This disease is characterized by multisystem involvement and chronic progressive course.Clinical case description. The clinical case attracted our attention due to the late disease diagnosis in a boy living in a metropolis. The child has classic clinical manifestations of the disease: typical phenotype, spinal deformity, developmental speech and motor delays, hearing loss, hepatomegaly, splenomegaly, umbilical and inguinal hernias. Despite developmental speech delay and frequent recurrent otitis, the patient has not been referred to surdologist examination until the age of 4.5 years. Intriguing fact is the presence of congenital cataract that was the reason for surgery twice.Conclusion. Congenital cataract is one of the early manifestation of this disease. 3 out of 8 patients with alfa-mannosidosis observed in our centre had congenital cataract. We assume that such patients should be referred to genetics for the early exclusion of alpha-mannosidosis. Late diagnosis and progressive course of the disease led to early disability of the patient. Nowadays, as enzyme replacement therapy is available, it is crucial to identify these patients timely in order to improve their quality of life and increase survivability.

ЭФФЕКТИВНОСТЬ ПРИМЕНЕНИЯ ИСКУССТВЕННОГО ПНЕВМОПЕРИТОНЕУМА ДО И ПОСЛЕ ПНЕВМОНЭКТОМИИ У БОЛЬНЫХ РАСПРОСТРАНЕННЫМ ДЕСТРУКТИВНЫМ ТУБЕРКУЛЕЗОМ ЛЕГКИХ

Aim: to evaluate the effectiveness of artificial pneumoperitoneum (APP) in the pre-operative and post-operative period in patients, who underwent pneumonectomy due to advanced destructive pulmonary TB. Materials and methods. We studied 104 patients, who underwent pneumonectomy with anterior mediastinal plasty (AMP) due to advanceddestructive pulmonary TB. The patients were divided into two groups. The main group consisted of 34 patients enrolled prospectively, who underwent APP before and after pneumonectomy with AMP. The comparison group consisted of 70 patients enrolled retrospectively, who did not undergo APP before and after pneumonectomy with AMP. Treatment effectiveness was estimated based on the parameters of the early course and late course (after 2 months) of post-operative period and dynamic chest X-ray signs. We also performed morphological and bacteriological studies of resection samples to estimate TB activity and bacterioexcretion massivity. Results. The effectiveness of APP for prevention of mediastinal lung hernias (MLH) was 93.3%. The studies of resection samples from the main group patients revealed decreased incidence of lymphohematogenic or bronchogenic dissemination, as well as more pronounced organization of granulomas and small foci as compared to resection samples from the controls. The comparison of key spirometry parameters in the groups did not reveal significant differences. Conclusion. The use of APP before and after pneumonectomy with AMP is a safe and highly effective method for prevention of MLH. It also contributes to stabilization of TB process in the remaining lung.

Development of DCS SCADA Teaching Module on A Pid-Based Water Level Control Case Using Labview and Factory I/O

The DCS SCADA course is one of the latest courses for the 2022 curriculum at Politeknik ATI Makassar. This course has case study-based learning from the industrial world and involves very expensive instrumentation devices for Real Plant, so a Teaching Module with factory i/o was created. This research aims to develop a DCS SCADA Teaching Module based on the Water Level Control case using Labview and Factory I/O. The virtual plant uses a water tank with instruments consisting of two control valves, namely the fill valve and the discharge valve, and two transducers, namely the level meter and the flow meter. To connect the factory I/O to NI Labview, the open protocol Modbus Ethernet is used. Based on the testing results, the calibration for the level measurement has an accuracy of 99.59% and a precision of 0.69% with the interpolation y = 0.301x -0.536 for a 100% correlation. For the system response with SP = 150 without disturbance, the PID parameters should be set to Kp = 25, Ti = 0.1, and Td = 0 with a system response consisting of Rise Time = 396 seconds, no Overshoot, Settling Time = 430 seconds, and Steady state error = 0.566 cm. For the system response with SP = 150 with a DV = 50% disturbance, the PID parameters should be set to Kp = 25, Ti = 0.1, and Td = 0 with a system response consisting of Rise Time = 382 seconds, no Overshoot, Settling Time = 462 seconds, and Steady state error = 1.469 cm.

Prehabilitation of overweight and obese patients with dysglycemia awaiting bariatric surgery: Predicting the success of obesity treatment.

Bariatric surgery offers the best health results in overweight and obese patients but is not a risk and/or complication-free treatment. In cases with additional hyperglycemia, the burden of surgery can be even higher and alter both short-term and long-term outcomes. Although bariatric surgery offers glycemic improvements and in the case of early onset diabetes disease remission, weight loss results are lower than for obese patients without diabetes. Different multimodal programs, usually including interventions related to patients' performance, nutritional and psychological status as well as currently available pharmacotherapy before the surgery itself might considerably improve the immediate and late postoperative course. However, there are still no clear guidelines addressing the prehabilitation of obese patients with dysglycemia undergoing bariatric surgery and therefore no unique protocols to improve patients' health. In this minireview, we summarize the current knowledge on prehabilitation before bariatric surgery procedures in patients with obesity and dysglycemia.

Educational Process Mining for Discovering Students' Problem-Solving Ability in Computer Programming Education

Educational process mining is now a promising method to provide decision-support information for the teaching–learning process via finding useful educational guidance from the event logs recorded in the learning management system. Existing studies mainly focus on mining students' problem-solving skills or behavior patterns and intervening in students' learning processes according to this information in the late course. However, educators often expect to improve the learning outcome in a proactive manner through dynamically designing instructional strategies prior to a course that are more appropriate to students' average ability. Therefore, in this article, we propose a two-stage problem-solving ability modeling approach to obtain students' ability in different learning stages, including the pre-problem-solving ability model and the post-problem-solving ability model. The models are trained with Gradient Boosting Decision Tree (GBDT) on the historical event logs of the prerequisite course and the target course, respectively. With the premodel, we establish the students' pre-problem-solving ability profiles that reflect their average knowledge level before starting a course. Then, the instructional design is dynamically chosen according to the profiles. After a course completes, the post-problem-solving ability profiles are generated by the postmodel to analyze the learning outcome and prompt the learning feedback, in order to complete the closed-loop teaching process. We study the modeling of coding ability in computer programming education to show our teaching strategy. The experimental results show that the generalizable problem-solving ability models yield high classification precision, while most students' abilities have been significantly improved by the proposed approach at the end of the course.

Study on the Safety and Efficacy of Biological Target Radiotherapy Based on 11C-MET PET/CT in Patients with Newly Diagnosed Glioblastoma

<h3>Purpose/Objective(s)</h3> The purpose of this study was to evaluate the safety and efficacy of biological target area (BTV) defined by ¹¹C-methionine positron emission tomography / computed tomography (¹¹C-MET PET/CT) in postoperative radiotherapy for glioblastoma. <h3>Materials/Methods</h3> This study is a single-arm, open, single-center exploratory clinical study. Patients with newly diagnosed glioblastoma confirmed by pathology in our center were enrolled. The initial biological target area (BTV) was delineated on the basis of the area of high metabolism of ¹¹C-MET PET/CT. Finally, the BTV included the highly increased area of ¹¹C-MET PET/CT metabolism and comprehensively considered the abnormal signal areas on multimodal magnetic resonance imaging. BTV dose escalation with a simultaneous or increased in late course. Oral chemotherapy of temozolomide was given concurrently, and temozolomide adjuvant chemotherapy was given for 6 cycles after simultaneous radiotherapy and chemotherapy. The primary clinical study endpoints were safety, progression-free survival (PFS), and the secondary study endpoints were overall survival (OS) and 1 year survival (OS-1). The Common Terminology Criteria for Adverse Events (CTCAE) version 5. 0 was used to evaluate the adverse reactions. Folstein Mini-Mental Status Exam (MMSE) was used to evaluate the cognitive function of the patients. <h3>Results</h3> A total of 18 patients with assessable glioblastoma were enrolled from November 22, 2018 to June 2, 2021. The median follow-up period was 14.4 months (7.9months-37.2months). The median BTV dose was 74 Gy (64 Gy-75 Gy), and the median CTV dose was 60 Gy (50.1 Gy-60 Gy). The median dose of CTV1 was 46 Gy (30 Gy-50.1 Gy), and the median dose of CTV2 was 14 Gy (8 Gy-23.4 Gy). The median PFS was 10.1 months (95%CI:7.25-12.95). The main acute adverse events were hematological adverse events. Grade 1 leukopenia occurred in 5 patients (27.8%), and no grade 2 leukopenia was observed.4 patients (22.2%) developed grade 2 gastrointestinal reactions (nausea, vomiting, anorexia). One patient (5.6%) had advanced cognitive decline (MMSE score ≤ 26). No other hematological adverse events and non-hematological adverse events such as radiation brain necrosis were observed. OS-1 is 85.6%. The median OS was not reached. <h3>Conclusion</h3> BTV based on ¹¹C-MET PET/CT images guided dose-escalated radiotherapy has a good short-term effect in the treatment of newly diagnosed glioblastoma patients, and the incidence of adverse reactions is low, safe and tolerable. The long-term effect still needs longer follow-up and a large sample of clinical studies.