Preemptive Approach Research Articles

Time series forecasting methods and their applications to particle accelerators

Particle accelerators are complex facilities that produce large amounts of structured data and have clear optimization goals as well as precisely defined control requirements. As such they are naturally amenable to data-driven research methodologies. The data from sensors and monitors inside the accelerator form multivariate time series. With fast preemptive approaches being highly preferred in accelerator control and diagnostics, the application of data-driven time series forecasting methods is particularly promising. This review formulates the time series forecasting problem and summarizes existing models with applications in various scientific areas. Several current and future attempts in the field of particle accelerators are introduced. The application of time series forecasting to particle accelerators has shown encouraging results and promise for broader use, and existing problems such as data consistency and compatibility have started to be addressed.

Sustainable Multi-Objective Production Planning for the Refrigerating and Air Conditioning Industry in Saudi Arabia: A Preemptive Goal Programming Approach

This research presents a preemptive goal-programming model for sustainable multi-objective production planning for the refrigeration and air conditioning industry in Saudi Arabia. The model was solved using LINGO software, taking into account market demand, production revenue, production time, and production cost data to optimize production planning. The findings showed that the objectives of minimizing production cost, maximizing sales revenue, and maximizing machine utilization were achieved, with no negative or positive deviational variables. The study suggests that by using sensitivity analysis, the company can increase costs by 2.14% to minimize production costs in the following year, but this could result in a 4.37% reduction in revenues. Overall, the goal-programming model demonstrates the potential for the refrigeration and air conditioning industry in Saudi Arabia to achieve its goals for cost optimization, sales revenue maximization, and resource utilization.

Update on the management of cytomegalovirus infection in transplant recipients

Cytomegalovirus (CMV) infection remains a significant infectious complication after transplantation. In this article, we summarize the recent advances in the management of CMV infection in solid-organ and hematopoietic stem-cell transplant recipients. Firstly, recent trials have better delineated the indications for the preventive strategies available, namely antiviral prophylaxis and the preemptive approach. Secondly, the antiviral armamentarium has been expanded with the advent of less toxic oral drugs that are available for antiviral prophylaxis and for therapy of refractory/resistant CMV infection. Finally, increasing evidence suggests that cell-mediated immune assays can be used in routine care for individualizing the prevention strategies against CMV.

The Effect of COVID-19 Pandemic and the Development of Technology and Robots on Jobs

Background: The prevalence of COVID-19 has had a devastating economic impact on countries, leading to reduction of many jobs. Earlier, the advent of technology and robotics had been the source of much concern and analysis about the future of jobs. The present study aims to investigate the effects of the COVID-19 pandemic and the emergence and development of technology and robots on jobs and compare them with each other.
 Methods: The present study was conducted qualitatively. Data collection was done by holding two expert panels. The experts were purposefully selected from different universities in Iran. Findings from the expert panel were analyzed using the content analysis technique. Erlingsson's approach was used for content analysis.
 Results: The effects of the advent of technology and robots and the effects of the COVID-19 outbreak on jobs were examined from seven aspects, including economic, social, political, the impact on developed and developing countries, health, education, and workforce skills. The effects of the advent of technology and robots on jobs can vary depending on the two scenarios of interaction or substitution. The effects of the COVID-19 outbreak on jobs can also be in line with different scenarios with the emergence of technology and robots in some respects.
 Conclusion: The possible conformity of economic and social systems in gradual changes faces fewer challenges, while conditions like pandemics have few opportunities to adapt to new situations. Increasing flexibility with a preemptive approach and not just based on the existing scenarios are necessary to deal with these situations.

Innovations at the Nexus of Sustainability and Industry 4.0: Data-Driven Approach for Preemptive Equipment Management in Smart Factories

The convergence of Industry 4.0 and sustainability has brought forth a new era of manufacturing, where data-driven approaches play a pivotal role in achieving operational efficiency while minimizing environmental impact. This paper presents an innovative framework for sustainable smart manufacturing through data-driven predictive maintenance planning. By integrating advanced analytics and machine learning, we propose a preemptive equipment management approach that not only optimizes production processes but also fosters environmental responsibility. Our methodology combines the power of Long Short-Term Memory (LSTM) networks for pattern modeling and the Sea Lion Optimization Algorithm for feature selection. We demonstrate the effectiveness of our approach through a comprehensive empirical analysis conducted on a real case study, where the results indicate significant improvements over baseline studies, as evidenced by reduced Root Mean Square Error (RMSE) and Mean Absolute Percentage Error (MAPE), along with higher R-squared (R2) values. Our findings emphasize the synergy between technological innovation and sustainability imperatives, positioning our approach as a catalyst for reshaping modern manufacturing practices.

Satellite Imaging Techniques for Ground Movement Monitoring of a Deep Pipeline Trench Backfilled with Recycled Materials

The damage to pipeline infrastructures caused by reactive soils has been a critical challenge for asset owners. Sustainable backfilling materials have recently gained interest to stabilize highly reactive zones as a pre-emptive approach towards sustainability. In this study, two adjacent sections of a sewer pipeline trench in Melbourne, Australia were backfilled with two blends of 100% recycled aggregates. The sites were monitored for ground deformations during October 2020–February 2022 (17 months) using surveying techniques. Interferometric synthetic aperture radar (InSAR) techniques and algorithms were also employed to estimate the ground movements of the sites and surrounding regions. The cross-validation of deformation results achieved from both techniques enabled an in-depth analysis of the effectiveness of the recycled aggregates to address reactive soil issues in urban developments. Observational deformation data and their spatiotemporal variation in the field were satisfactorily captured by the InSAR techniques: differential InSAR (DInSAR), persistent scatterer interferometry (PSI), and small baseline subset (SBAS). The SBAS estimations were found to be the closest to field measurements, primarily due to the analysis of zones without well-defined geometries. This study’s contribution to existing knowledge defines the spatiotemporal influence of sustainable backfill in areas with reactive soil through field data and satellite imaging. The relationship between InSAR techniques and actual field behavior of sustainable backfill can be a baseline for the growing construction that may be challenging to perform field monitoring due to resource constraints.

National survey of prevention and management of CMV infection in pediatric kidney transplantation in comparison to clinical practice guidelines.

Cytomegalovirus (CMV) is one of the most frequent opportunistic infections in kidney transplant (KT) recipients and is a risk factor for patient and graft survival after KT. Center-to-center variation, optimal prevention and treatment strategies in pediatric KT are currently unknown. This survey aimed to assess current CMV prevention and treatment strategies used among French pediatric KT centers. A web-based survey was sent to all 13 French pediatric kidney transplantation centers. Twelve (92%) centers responded to the survey. All centers used prophylaxis for the donor-positive/recipient-negative (D+/R-) group. For R + patients, 54% used prophylaxis, 37% used a pre-emptive strategy. In the low-risk group, D-/R-, 50% used a pre-emptive approach and 50% had no specific prevention strategy. The antiviral used by all centers for prophylaxis was valganciclovir (VGCV). The duration of prophylaxis varied from 3 to 7 months and the duration of viral load monitoring varied from 6 months to indefinitely. No center used a hybrid/sequential approach. For the treatment of CMV DNAemia, VGCV or intravenous GCV were used. Therapeutic drug monitoring of VGCV was performed in 5 centers (42%). Five centers reported drug resistance. Eight centers (67%) administered VGCV during the treatment of acute graft rejection. There is uniformity in CMV management in some areas among pediatric KT centers in France but not in others which remain diverse and are not up to date with current guidelines, suggesting unnecessary variation which could be reduced with better evidence to inform practice.

A Non-Archimedean Interior Point Method and Its Application to the Lexicographic Multi-Objective Quadratic Programming

This work presents a generalized implementation of the infeasible primal-dual interior point method (IPM) achieved by the use of non-Archimedean values, i.e., infinite and infinitesimal numbers. The extended version, called here the non-Archimedean IPM (NA-IPM), is proved to converge in polynomial time to a global optimum and to be able to manage infeasibility and unboundedness transparently, i.e., without considering them as corner cases: by means of a mild embedding (addition of two variables and one constraint), the NA-IPM implicitly and transparently manages their possible presence. Moreover, the new algorithm is able to solve a wider variety of linear and quadratic optimization problems than its standard counterpart. Among them, the lexicographic multi-objective one deserves particular attention, since the NA-IPM overcomes the issues that standard techniques (such as scalarization or preemptive approach) have. To support the theoretical properties of the NA-IPM, the manuscript also shows four linear and quadratic non-Archimedean programming test cases where the effectiveness of the algorithm is verified. This also stresses that the NA-IPM is not just a mere symbolic or theoretical algorithm but actually a concrete numerical tool, paving the way for its use in real-world problems in the near future.

A goal programming approach for agile-based software development resource allocation

In the current proposal, three objectives have defined which need to be considered while solving the resource allocation problem in ASD. This multi objective has then been solved using Goal Programming approach. The three approaches to solving a Goal Programming Problem i.e. the Weighted Approach (or the Archimedean Goal Programming), the Preemptive Approach (or the Lexicographic Approach) and the Chebyshev Approach (or the Min–Max Goal Programming) have been discussed to cater to the problem thoroughly. Furthermore, the three objectives have been handled singularly as well, i.e. as a single objective problem. The proposed optimization models have been validated on an agile-based software development dataset. Sensitivity analysis has been performed to gauge the impact of the variables involved.

Prevalence of pre-operative anemia and its implication for patient blood management in a Nigerian Hospital

Objectives: Pre-operative anemia is common in Sub-Saharan Africa including Nigeria. Anemia is a known risk factor for blood transfusion. In our hospital, like many others, patients are usually admitted a day before elective surgeries and the default treatment for anemia by most surgeons and anesthetists is allogenic blood transfusion. Anemia and blood transfusion are independently and synergistically associated with complications and undesirable outcomes. Patient blood management (PBM) is gaining popularity and has been advocated by the World Health Organization (WHO) for member countries to adopt as a means of improving patient outcomes. There is currently no research from the University of Calabar Teaching Hospital highlighting the prevalence of pre-operative anemia. This research was aimed at filling this gap and also presenting a baseline for comparison as the hospital strives to implement the three pillars of PBM strategies: Manage anemia, minimize blood loss and harness tolerance to anemia to improve patient outcomes. Material and Methods: All surgical patients who consented to the study were recruited prospectively. Patients who had no pre-operative hemoglobin (Hgb) or packed cell volume (PCV) recorded were excluded from the study. Demographic data, type of surgery, and pre-operative PCV levels were documented. Anemia was defined using the WHO standard as PCV <39% (Hgb 13.0 g/dL) in men and <36% (Hgb 12.0 g/dL) in women. Data were obtained about transfusion at the end of surgery. Surgeries were categorized into general, orthopedic, obstetric, gynecological, urologic, pediatric, ear, nose, throat/maxillofacial, burns and plastic unit (BPU), neurological, and thoracic. The information was entered into SPSS version 20. Data were cleaned and analyzed. The statistical significance was placed at P < 0.05. Results are presented as tables, chats, and histograms. Results: A total of 237 patients were recruited with a mean age of 37.30 ± 19.05. More of them were females (54.0%) and a higher proportion of them (64.6%) had elective surgery. The categories of surgeries were predominantly general surgical (24.9%) and gynecological (21.9%) followed by orthopedic (17.7%), ENT/maxillofacial (9.3%), urologic (8.0%), and obstetric (7.2%) cases. The rest were neurosurgical (3.4%) and pediatric surgical (2.1%) cases. The overall prevalence of anemia was found to be 54.9%. The mean pre-operative PCV was 34.90 ± 7.37%. The highest proportion of pre-operative anemia was found among the pediatric surgical cases (80.0%) followed by the urologic (68.4%) and neurosurgical cases (62.5%). The prevalence of pre-operative anemia among the different surgical patients was gynecological (46.2%), general surgical (45.8%), obstetric (41.2%), ENT/maxillofacial (40.9%), and orthopedic (38.1%) cases. The lowest proportion of pre-operative anemic patients was found among the thoracic (25.0%) and Burns and Plastics (11.1%) cases. Most of the patients (86.5%) were not transfused intraoperatively. Whereas 20% of the anemic patients were transfused; only 5.6% of the non-anemic ones needed a blood transfusion. Conclusion: Pre-operative anemia remains prevalent in our environment and anemia is a risk factor for a blood transfusion which carries both risk and cost implications. PBM has as its first pillar the management of anemia. This pre-emptive approach to allogeneic blood transfusion avoidance is aimed at improving patient outcomes. Prevention and treatment of pre-operative anemia will be beneficial not just to the patients but to all healthcare stakeholders.

A new interactive fuzzy programming with priority control for multi-objective decision-making problems

Fuzzy multiple objective linear programming (FMOLP) approaches have been used to be solved many applications of multi-objective decision-making (MODM) problems. Several methods have been proposed including max-min approaches, preemptive approaches, and weighted approaches. However, they have some limitations in use; some may not be able to obtain efficient solutions or can give only a few solutions. Some methods need to be solved in two steps or specify the target level, which may be difficult for decision-makers (DMs). In this research, a new single-phase interactive fuzzy programming approach with priority control that can find several efficient solutions is proposed. It is not necessary to specify the target value for each objective and it can solve with only one step for each solution. The DM can easily select the appropriate solutions from a set of efficient solutions. This method is different from existing single-phase approaches by controlling the satisfaction level of the last priority instead of using weight additive. Simple examples and a practical example of a perishable product supply chain network were tested to show the effectiveness of the proposed model. The performance of the proposed method was also compared with existing methods to verify and validate the model.

A multi‐queue priority‐based task scheduling algorithm in fog computing environment

AbstractFog computing is a novel, decentralized and heterogeneous computing environment that extends the traditional cloud computing systems by facilitating task processing near end‐users on computing resources called fog nodes. These diverse and resource‐constrained fog devices process a large volume of tasks generated by various fog applications. These tasks are generated by various applications, some of which may be latency‐sensitive, while others may tolerate some degree of delay in their normal functions. Task scheduling determines when a task should be allocated to a computing resource and how long that task can occupy the assigned resource. The majority of task scheduling algorithms focus on prioritizing the latency‐sensitive tasks only, which results in the long waiting time for the other type of tasks. Hence, these priority‐based schedulers cause task starvation for less important tasks while achieving delay‐optimal results for latency‐sensitive tasks. As a result, in this paper, we propose MQP, a multi‐queue priority‐based preemptive task scheduling approach that achieves a balanced task allocation for those applications that can tolerate a certain amount of processing delay and the latency‐sensitive fog applications. At run‐time, the MQP algorithm categorizes tasks as short and long based on their burst time. MQP algorithm maintains a separate task queue for each task category and dynamically updates the time slot value for preemption. The proposed technique's major purpose is to reduce response time for those data‐intensive applications in the fog computing environment, which include both latency‐sensitive tasks and tasks which are less latency‐sensitive, thereby addressing the starvation problem for less latency‐sensitive tasks. A smart traffic management case study is created to model a scenario with both latency‐sensitive short and less latency‐sensitive long tasks. We implement the MQP algorithm using iFogSim and confirm that it reduces the service latencies for long tasks. Simulation results show that the MQP algorithm allocates tasks to a fog device more efficiently and reduces the service latencies for long tasks. The average value of percentage reduction in the latency across all experimental configurations achieved is 22.68% and 38.45% in comparison to First Come‐First Serve and shortest job first algorithms.

TYROSINE KINASE INHIBITORS MANAGEMENT AFTER ALLOGENEIC STEM CELL TRANSPLANTATION FOR PH+ ALL: LESSONS FROM A PEDIATRIC CHALLENGING CASE

Philadelphia chromosome is found in less than 5% of pediatric but in more than 20% of adults patients with acute lymphoblastic leukemia (ALL). The advent of tyrosine kinase inhibitors (TKIs) lead to a dramatic improvement in the prognosis of these patients, who now have the same stem cell transplantation (SCT) indications as other ALL patients. Recommendations regarding the choice between prophylactic or preemptive strategy, duration of use and the best type of TKI post-SCT need to be better defined. Here we aimed to report a Ph+ ALL pediatric case and to discuss TKI management after SCT. An 9-year-old boy, diagnosed with hyperleukocytic Ph+ B-ALL,mutated IKZF1 and negative CNS was treated according to EsPhALL 2010 protocol. He was poor steroid responder on D8, started imatinib on D14, had 30% of blasts on D15 and 0,4% on D33, persistent positive MRD 0.14% by flow cytometry on week 12. Thus, he was classified as high risk, with allogeneic SCT indication in first remission. He received a 10/10 HLA-matched unrelated SCT from an ABO compatible, male, cytomegalovirus positive donor, with cyclophosphamide, total body irradiation and thymoglobulin for conditioning and cyclosporine plus methotrexatefor graft-versus-host disease prophylaxis. Prophylatic imatinib (100 mg/day) started on D+63 post-SCT. Nevertheless, molecular relapse occurred on D+170. Imatinib was replaced by dasatinib (60 mg/day) and he received three donor lymphocytes infusions (DLI), achieving molecular remission. Due to the occurrence of hematochezia and cytopenias a short suspension and subsequent dose reduction of dasatinib was necessary, after that, he tolerated well 20 mg/day for seven months. After three negative MRD, dasatinib was suspended. Ten months after dasatinib withdrawal, he had an isolated hematological relapse (51% of blasts), at two years post-SCT. He received dexamethasone and dasatinib for cytoreduction followed by IntReALL protocol with hematological remission, but MRD remained positive. Dasatinib was maintained without complications. He received two cycles of blinatumomab, achieving molecular remission. He underwent a second SCT with haploidentical donor in third complete remission. However, he developed severe hepatic venoocclusive disease (VOD) and died on D+48. Several issues related to the TKI usage post-SCT for Ph+ ALL has to be elucidate. The EBMT recommendation of prophylactic imatinib use after SCT,was based on lower relapse rate and better survival reported by a retrospective study in adults patients with imatinib. More recently, a systematic review showed that both prophylactic and preemptive TKIs approaches post-SCT improved survival of patients in CR1 before transplant. Thus, the choice ofpreemptiveuse of TKIs seems to be reasonable, since is less toxic and less immunosuppressive; however, it require a more frequent MRD monitoring by flow cytometry or IgH/TCR PCR and TKIs maintenance until at least one year after MRD negativity. : Our case illustrates the efficacy of dasatinib preemptive associated with DLI in inducing molecular remission. However, it points out that, in addition to the extension of the marrow MRD monitoring period, the duration of TKI use to guarantee the persistence of molecular remission can be long, for more than one year since MRD negativity.

TPMT and NUDT15 testing for thiopurine therapy: A major tertiary hospital experience and lessons learned.

Variants in thiopurine methyltransferase (TPMT) and nudix hydrolase 15 (NUDT15) are associated with an accumulation of cytotoxic metabolites leading to increased risk of drug-related toxicity with standard doses of thiopurine drugs. We established TPMT and NUDT15 genetic testing for clinical use and evaluated the utilization, service outcomes and potential value of multi-gene PGx testing for 210 patients that underwent pharmacogenetics (PGx) testing for thiopurine therapy with the aim to optimize service delivery for future prescribing. The test was most commonly ordered for Gastroenterology (40.0%) and Neurology (31.4%), with an average turnaround time of 2 days. Following testing, 24.3% patients were identified as intermediate or poor metabolizers, resulting in 51 recommendations for a drug or dose change in thiopurine therapy, which were implemented in 28 (54.9%) patients. In the remaining patients, 14 were not adjusted and 9 had no data available. Focusing on drug gene interactions available for testing in our laboratory, multi-gene PGx results would present opportunities for treatment optimization for at least 33.8% of these patients who were on 2 or more concurrent medications with actionable PGx guidance. However, the use of PGx panel testing in clinical practice will require the development of guidelines and education as revealed by a survey with the test providers. The evaluation demonstrated successful implementation of single gene PGx testing and this experience guides the transition to a pre-emptive multi-gene testing approach that provides the opportunity to improve clinical care.

Navigating preemptive and therapeutic donor lymphocyte infusions in advanced myeloid malignancies by high-sensitivity chimerism analysis.

Preemptive and therapeutic donor lymphocyte infusions (preDLI and tDLI) are widely used in relapsing and relapsed hematopoietic malignancies after allogeneic stem cell transplantation (alloSCT) to enhance the graft-versus-malignancy effect. However, in advanced myeloid malignancies, long-term survival after preDLI and tDLI remains low, reflecting our inability to master the double-edged sword of alloreactivity, balancing anti-neoplastic activity versus graft-versus-host disease (GvHD). We previously evaluated a quantitative PCR-based high-sensitivity chimerism (hs-chimerism) based on insertion/deletion polymorphisms instead of short tandem repeats, where increasing host chimerism in peripheral blood predicts relapse more than a month before clinical diagnosis, and declining host chimerism signals anti-host alloreactivity. Here we report 32 consecutive patients with advanced myeloid malignancies receiving preDLI or tDLI “navigated” by hs-chimerism (“navigated DLI”). We compared them to a historical cohort of 110 consecutive preDLI or tDLI recipients, prior to implementation of hs-chimerism at our institution (“controls”). Both groups were comparable regarding age, gender, conditioning, donor type, and time to DLI. With longer median follow-up of the navigated DLI group (8.5 versus 5 months), their landmark overall (64%) and disease-free survival (62%) at 2 years from first DLI compared favorably with controls (23% and 21%, respectively). Improved survival of navigated DLI was due to both reduced relapse incidence (38% versus 60%) and non-relapse mortality (17% versus 44%) at 2 years. Early relapse prediction by hs-chimerism allowed a preemptive approach in 28% of navigated DLI versus 7% in controls. Our results confirm hs-chimerism as a highly valuable tool for monitoring and steering immune interventions after alloSCT.

In-vitro evaluation of indigenous probiotic lactobacilli for lead bio-adsorption potential, its tolerance and complex stability

Probiotic lactic acid bacteria exhibit metal ion binding properties, which can be employed as metal bio-adsorbents in the human system. Lead is a prevalent dietary contaminant that causes lead toxicity in humans, especially children. In the present investigation, we evaluated the indigenous lactobacilli for their lead bioadsorption potential that can offer a pre-emptive approach for bioremediating lead toxicity. After standardizing the lead bioadsorption assay, ten probiotic lactobacilli showing lead retention of >80% in the pellet were selected. Statistical correlation analysis on lead bioadsorption assay, factors affecting lead and lead resistance profiling revealed L. plantarum HD 51 as the most potent lead adsorber. Scanning electron microscopy of L. plantarum HD 51 demonstrated that the binding occurred on the bacterial cell wall. Hence L. plantarum HD-51 could be used as a biotherapeutic agent to reduce the body’s burden on lead by sequestering it out of the human body.

Product allocation and network configuration in global production networks

Driven by an increasing demand for individualized products and shorter product life-cycles, companies continuously extend their product portfolio. Simultaneously, companies expand into new markets to reach customers and to exploit varying location factors to reduce costs. Global production networks (GPNs) have to be adapted constantly to react to new circumstances and changes in the demand of products. To remain competitive, product allocation and production network configuration are essential. At the same time, companies face an increasing complexity while handling these tasks. This poses a challenge particularly for small and medium sized companies, which have limited planning capacities and management resources. Current literature describes optimization-based approaches for the integrated product allocation and network configuration of production networks. Yet, multi-objective models lack transparency of results and user friendliness. Therefore, this paper presents a multi-objective optimization model that incorporates flexibility and reconfiguration aspects to determine an optimal product allocation and network configuration of a GPN over a given planning horizon. The preemptive goal programming approach is used to identify Pareto-optimal solutions and to increase user friendliness. The subsequent verification, validation and post-optimality analysis combined in a structured process enables a wide range of companies to apply the approach. The model is successfully applied in the GPN of a special machine manufacturer, which produces high precision metrology machines. Due to its transparent approach for complex planning problems, the developed method provides a solid base for well-founded, objective decisions. Hence, the risk of costly errors in the planning phase is reduced.

Myths and Misconceptions of Airway Pressure Release Ventilation: Getting Past the Noise and on to the Signal.

In the pursuit of science, competitive ideas and debate are necessary means to attain knowledge and expose our ignorance. To quote Murray Gell-Mann (1969 Nobel Prize laureate in Physics): “Scientific orthodoxy kills truth”. In mechanical ventilation, the goal is to provide the best approach to support patients with respiratory failure until the underlying disease resolves, while minimizing iatrogenic damage. This compromise characterizes the philosophy behind the concept of “lung protective” ventilation. Unfortunately, inadequacies of the current conceptual model–that focuses exclusively on a nominal value of low tidal volume and promotes shrinking of the “baby lung” - is reflected in the high mortality rate of patients with moderate and severe acute respiratory distress syndrome. These data call for exploration and investigation of competitive models evaluated thoroughly through a scientific process. Airway Pressure Release Ventilation (APRV) is one of the most studied yet controversial modes of mechanical ventilation that shows promise in experimental and clinical data. Over the last 3 decades APRV has evolved from a rescue strategy to a preemptive lung injury prevention approach with potential to stabilize the lung and restore alveolar homogeneity. However, several obstacles have so far impeded the evaluation of APRV’s clinical efficacy in large, randomized trials. For instance, there is no universally accepted standardized method of setting APRV and thus, it is not established whether its effects on clinical outcomes are due to the ventilator mode per se or the method applied. In addition, one distinctive issue that hinders proper scientific evaluation of APRV is the ubiquitous presence of myths and misconceptions repeatedly presented in the literature. In this review we discuss some of these misleading notions and present data to advance scientific discourse around the uses and misuses of APRV in the current literature.

Cytomegalovirus infection and disease in pediatric liver transplantation: Burden of disease under a preemptive therapy approach.

CMV remains a frequent complication after liver transplantation. Few studies exist in children reporting the epidemiology and outcomes of CMV after LT with current prevention strategies. Our goal is to report the incidence of CMV infection and disease in pediatric LT recipients under preemptive therapy, identify risk factors, complications, and adverse reactions to treatment. All pediatric LT recipients from a single center (1998-2018) were included. Antigenemia pp65 (1998-2003) and QNAT or both were used to inform preemptive therapy. Cutoff value for starting treatment was Agpp65 > 10 + cells/200 000 or QNAT >1500 copies/ml or any value in high-risk recipients (D+/R-). One hundred eighteen LT were analyzed. CMV infection was detected in 67% of patients, only 44 (37%) required treatment, and 5 (4%) developed CMV disease. All patients responded well to treatment, and no graft or patients were lost to CMV effects. There were no differences in mortality, CMV indirect effects, or other complications between those who required treatment and those who did not. Thirty-two percent of the patients who received antivirals developed an adverse hematological reaction. Risk factors associated with CMV infection requiring treatment were D+/R- (OR 13.9, p=.01) and fulminant hepatitis (OR 4.8, p=.02). Preemptive therapy for CMV in children is safe and effective, yields low CMV infection rates that require treatment, and minimal rates of CMV disease, without increasing CMV-related complications. Using this strategy, 63% of our patients did not receive treatment. Therefore, drug exposure, adverse reactions, and resistance risk were minimized.

Cytomegalovirus Infection Is Associated with Development of Chronic Lung Allograft Dysfunction

BackgroundCytomegalovirus (CMV) is the major and most common opportunistic infection complicating lung transplant (LTX). The aim of this study was to analyse the epidemiological aspects of CMV infection in lung transplant patients subject to a pre-emptive anti-CMV approach and to study the impact of this infection on lung transplant outcome, in terms of onset of chronic lung allograft dysfunction (CLAD).MethodsThis single-centre retrospective study enrolled 87 LTX patients (median age 55.81 years; 41 females, 23 single LTX, 64 bilateral LTX). All patients were managed with a pre-emptive anti-CMV approach. The incidences of the first episode of CMV infection, 1, 3, 6 and 12 months after LTX, were 12.64%, 44.26%, 50.77% and 56.14%. A median interval of 41 days elapsed between LTX and the first episode of CMV infection. The median blood load of CMV-DNA at diagnosis was 20,385 cp/ml; in 67.64% of cases, it was also the peak value. Patients who had at least one episode had shorter CLAD-free survival. Patients who had three or more episodes of CMV infection had the worst outcome.ResultsCMV infection was confirmed to be a common event in lung transplant patients, particularly in the first three months after transplant. It had a negative impact on transplant outcome, being a major risk factor for CLAD. The hypothesis that lower viral replication thresholds may increase the risk of CLAD is interesting and deserves further investigation.