Group Protocol Research Articles

Nephron sparing surgery and surgical management of intravascular extension of Wilms tumor.

Although general treatment approaches for Wilms tumor differ between Children's Oncology Group and Société Internationale d'Oncologie Pédiatrique-Renal Tumors Study Group protocols, complex tumors that may be candidates for nephron sparing surgery (NSS) and those with intravascular tumor extension represent a management challenge. In both of these scenarios, anatomic considerations are important in guiding management, making these areas of significant similarities in management between the international groups. This paper aims to explore the current approaches to NSS and intravascular tumor extension by both international groups, with attention to the evidence supporting these approaches and current knowledge gaps.

The Current State of High-Flow Nasal Cannula Protocols at Children's Hospitals.

To describe the current state of non-ICU high flow nasal cannula (HFNC) protocols at children's hospitals and explore associations between HFNC protocol type and utilization outcomes. We performed a cross-sectional study of the Pediatric Health Information Systems (PHIS) database. First, we designed a survey with the purpose of classifying HFNC protocols used at hospitals currently contributing data to PHIS. Next, we categorized hospitals based on their current HFNC protocol (ICU only, age-based non-ICU, or weight-based non-ICU). Finally, using the PHIS database, we compared hospital characteristics and patient-level bronchiolitis outcomes by HFNC protocol group. We received survey responses from 36 of 44 (82%) hospitals contributing data to PHIS in 2021. During the time period studied, there was a steady increase in adoption of non-ICU HFNC protocols, with 71% of responding children's hospitals reporting non-ICU HFNC protocols in 2021 compared with 11% before 2010. No differences in hospital characteristics were observed between ICU-only hospitals, age-based hospitals, or weight-based hospitals. Age-based hospitals had the highest proportion of bronchiolitis patients treated in the ICU (36.1%), whereas weight-based hospitals had the lowest proportion of patients treated in the ICU (21.0%, P < .001). Length of stay was longer at age-based hospitals (2.9 days) as compared with weight-based and ICU-only hospitals (1.9 days, P < .001). Most children's hospitals have adopted non-ICU HFNC protocols for patients with bronchiolitis, the majority of which are now utilizing weight-based maximum flow rates. Weight-based HFNC protocols were associated with decreased ICU utilization compared with age-based HFNC protocols.

Personalized dosing protocol for extended-release tacrolimus in kidney transplant recipients in the early postoperative period

Objective: to develop a personalized algorithm for extended-release tacrolimus in kidney recipients and to analyze its early outcomes in comparison with a retrospective control group.Materials and methods. The first (I) control group «Standard Protocol» included 228 patients operated on at Botkin City Clinical Hospital from June 2018 to November 2021; tacrolimus was administered postoperatively in a starting standard dosage of 0.2 mg/kg. The second group (II) consisted of 75 patients operated from December 2021 to November 2022, whose postoperative treatment involved a personalized extended-release tacrolimus dosing protocol. Induction immunosuppression was similar in both groups. The target tacrolimus level in the early postoperative period was considered to be 10-12 ng/ml for all patients. The comparison criteria included incidence of Over-immunosuppression (tacrolimus C0 &gt;15 ng/ml), incidence of acute rejection and infectious complications in the first month after surgery, incidence and duration of delayed graft function (DGF), and length of stay at the hospital.Results. Over-immunosuppression was statistically significantly lower in the personalized protocol group, with 36.7% in group I and 87.5% in group II (p &lt; 0.001). There was also a lower incidence of early infectious complications in group II: 5.4% vs. 13.2%, however, without reaching a level of statistical significance (p = 0.088). DGF incidence in group I and group II were 25.4% (58/228) and 22.7% (17/75), respectively. The length of stay at the hospital in group II was also statistically significantly lower: 13 versus 19 bed days (p = 0.033). In both subgroups, no patient developed acute rejection in the first month after surgery (p = 1).Conclusion. The personalized dosing protocol that was developed for extended-release tacrolimus in kidney recipients achieves the target levels of the drug recommended for the early postoperative period with low risk of under-immunosuppression and associated acute graft rejection, with a significantly lower incidence of over-immunosuppression.

Dematerialized participation challenges: Methods and practices for online focus groups.

This study explores the limitations and benefits of different approaches to conducting online focus groups and illustrates an online focus group protocol used within the Value for Schools project in Italy. According to the project evaluation design, 13 online focus groups were organized, with the participation of 101 teachers and 37 school principals. The protocol setup, incorporation, and reorganization of the indications have been discussed in the literature, addressing the methodological and practical issues, such as the selection of participants and preliminary communication with them; the web conference platform (Zoom Business); timing, as well as access times and mode; the roles of the researchers involved (moderator, co-host technical assistant, co-host-observer, co-host-animator) and their integration spaces; technological support; and animation tools. The recording and transcription tools and subsequent analysis of the textual corpus are presented. Finally, the authors discuss the validation and reliability of online focus group protocols.

Close the GAPS: A Standardized Perioperative Protocol Reduces Breast Reconstruction Implant Infections.

Implant-based breast reconstruction (IBBR) is a complex process with significant practice variability. Infections after IBBR are associated with higher rates of readmission, reoperation, and reconstructive failure. To reduce process variability and postoperative infections, the authors implemented an evidence-based, standardized protocol for IBBR. The protocol was applied to all patients undergoing IBBR at a single institution from December of 2019 to February of 2021. Intraoperative protocol adherence was recorded, and infection events were considered minor (managed with outpatient antibiotics) or major (managed with readmission or reoperation). A historic control group was retrospectively analyzed for comparison. Sixty-nine patients (120 breasts) in the protocol group were compared with 159 patients (269 breasts) in the retrospective group. No differences were found in demographic characteristics, comorbidities, or type of reconstruction (expander versus implant). Intraoperative protocol adherence was 80.5% (SD, 13.9%). Overall infection rate was significantly lower in the protocol group versus controls (8.7% versus 17.0%; P < 0.05). When dichotomized, protocol patients had a lower rate of both minor (2.9% versus 5.7%; P = 0.99) and major (5.8% versus 11.3%; P = 0.09) infections, although this was not statistically significant. Rate of reconstructive failure secondary to infection was significantly lower in the protocol group (4.4% versus 8.8%; P < 0.05). Among protocol patients, those without infection had higher protocol adherence (81.5% versus 72.2%; P < 0.06), which neared statistical significance. A standardized perioperative protocol for IBBR reduces process variability and significantly decreases rate of overall infections and reconstructive failure secondary to infection. Therapeutic, III.

Impact of neoadjuvant FLOT treatment of advanced gastric and gastroesophageal junction cancer following surgical therapy.

Therapeutic treatment for advanced-stage (T2-T4) gastroesophageal junction (GEJ) and gastric cancer involves neoadjuvant chemotherapy with subsequent surgical intervention. Neoadjuvant oncological treatment for GEJ and gastric cancer previously consisted of the intravenous administration of epirubicin, cisplatin and fluorouracil (ECF) or epirubicin, cisplatin and capecitabine (ECX) combination (Group 1). The new protocol (FLOT, F: 5-FU, L: leucovorin, O: oxaliplatin, T: docetaxel), included patients with resectable GEJ and gastric cancer who had a clinical stage cT2 or higher nodal positive cN+ disease (Group 2). Between 31 December 2008 and 31 October 2022, the effect of different oncological protocols in terms of surgical outcomes in cases of T2-T4 tumours were retrospectively evaluated. Results of randomly assigned patients from the earlier ECF/ECX protocol (n = 36) (Group 1) and the new FLOT protocol (n = 52) (Group 2) were compared. Effect of different neoadjuvant therapies on tumour regression, types of possible side effects, type of surgery, and oncological radicality of surgical procedures were analysed. When comparing the two groups, we found that in case of the FLOT neoadjuvant chemotherapy (Group 2, n = 52), complete regression was achieved in 13.95% of patients, whereas in the case of ECF/ECX (Group 1, n = 36), complete regression occurred in only 9.10% of patients. Furthermore, in the FLOT group, the mean number of lymph nodes removed was slightly higher (24.69 vs. 20.13 in the ECF/ECX group). In terms of the safety resection margin (proximal), no significant difference was found between the two treatment groups. Nausea and vomiting were the most common side effects. The occurrence of diarrhea was significantly higher in the FLOT group (p = 0.006). Leukopenia and nausea occurred more commonly with the old protocol (Group 1). The rate of neutropenia was lower following FLOT treatment (p = 0.294), with the lack of grade II and III cases. Anaemia occured at a significantly higher rate (p = 0.036) after the ECF/ECX protocol. As a result of the FLOT neoadjuvant oncological protocol for advanced gastro-esophageal junction and gastric cancer, the rate of complete tumour regression increased significantly. The rate of side effects was also appreciably lower following the FLOT protocol. These results strongly suggest a significant advantage of the FLOT neoadjuvant treatment used before surgery.

Changes in Physical Components after Gastrectomy for Adenocarcinoma of Stomach and Esophagogastric Junction

Objective: Enhanced Recovery After Surgery (ERAS) is a multidisciplinary approach that aims to optimize perioperative management, promote postoperative recovery, reduce postoperative complications, and improve long-term survival. The current study aimed to evaluate and compare the postoperative physical activity after gastrectomy between patients who underwent upper gastrointestinal surgery according to ERAS and those who underwent surgery based on the conventional care (CC) protocol. Materials and Methods: This prospective and retrospective review enrolled 60 patients (n = 31, ERAS group; n = 29, CC protocol group) diagnosed with adenocarcinoma of the stomach and esophagogastric junction who underwent curative surgical resection. Physical outcomes, including body weight, body mass index, body fat percentage, basal metabolic rate, muscle mass, gait speed, and handgrip strength at the preoperative and immediate postoperative periods and at 1, 3, and 6 months postoperatively, were comparedbetween the ERAS and CC protocol groups. Results: One month after surgery, the ERAS group had a lower percentage of body weight loss than the CC protocol group. There was no significant difference in terms of muscle mass loss between the two groups. The hand grip strength of the ERAS group increased after surgery. Further, at 1 month postoperatively, the gait speed of patients who underwent total gastrectomy in the ERAS group was significantly higher than that of patients in the CC protocol group. Conclusion: ERAS for gastrectomy was associated with a lower percentage of weight loss and a trend toward physical activity enhancement in the early postoperative period.

A Parathyroid Hormone–Guided Calcium and Calcitriol Supplementation Protocol Reduces Hypocalcemia-Related Readmissions Following Total Thyroidectomy

ObjectiveTo determine the effect of a 4-hour postoperative serum parathyroid hormone (PTH)–guided calcium (Ca) and calcitriol supplementation protocol on the incidence of hypocalcemia and hospital readmissions in patients undergoing total thyroidectomy. MethodsThis was a single-institution, retrospective chart review of patients who underwent total thyroidectomy; 148 and 389 of the patients underwent surgery prior to and after the protocol implementation, respectively. The risk of hypocalcemia was stratified as low (PTH level of >30 pg/mL), medium (15-30 pg/mL), and high (<15 pg/mL), using serum PTH values obtained 4 hours postoperatively. Hypocalcemia was defined as a total serum Ca level of <8 mg/dL. Baseline demographic and operative characteristics and postoperative outcome were recorded for both groups. The Fisher exact test and Wilcoxon rank sum test were used to compare the characteristics of the 2 groups. A multivariate logistic regression model was applied to account for potentially confounding variables. ResultsPostoperative hypocalcemia occurred significantly less frequently in the protocol group compared with that in the preprotocol group (10.3% vs 20.9%, P = .002). The reduction in hypocalcemia in the protocol group was observed in both patients with (16.3% vs 25.6%) and without (8.4% vs 19.3%) cervical lymph node dissection. The protocol group had a significantly lower incidence of hospital readmission events than the preprotocol group (1.0% vs 4.7%, P = .013). ConclusionCompared with a historical cohort, a PTH-guided protocol for Ca and calcitriol supplementation significantly reduces the postoperative hypocalcemia and hospital readmission rates in patients undergoing total thyroidectomy.

Effects of misoprostol in reducing blood loss during abdominal myomectomy in Nigeria.

Despite using a tourniquet to reduce bleeding during abdominal myomectomy, the procedure is still complicated by significant intraoperative bleeding. To determine whether misoprostol and tourniquet compared with tourniquet alone would significantly reduce bleeding during abdominal myomectomy at two tertiary hospitals in Enugu. This study is an open-label randomized controlled trial. A total of 126 consenting participants were recruited from women booked for abdominal myomectomy at the study centers over 7 months. They were randomized into groups A (vaginal misoprostol 400 μg) and B (no misoprostol) one hour before surgery. Intraoperatively, all participants had a tourniquet application. Intraoperative and postoperative blood loss was compared between the two groups. Descriptive and inferential analyses were carried out using IBM SPSS Version 22.0. A P- value of < 0.05 was considered statistically significant. An intention-to-treat analysis was carried out. All 63 participants (100%) and 56 (90%) completed the study according to the protocol in groups A and B, respectively. Socio-demographic characteristics were not significantly different in both groups. The mean intraoperative blood loss in the "misoprostol group" (522.6 ± 127.91 ml) was significantly lower than in the "no-misoprostol group" (583.5 ± 186.20 ml), with P = 0.028. The difference in mean hemoglobin (g/dl) was lower in the "misoprostol group" than in the "no-misoprostol group" (1.3 ± 0.79 vs. 1.9 ± 0.89, P < 0.001). The mean 48 hours postoperative blood loss (ml) between the two groups was 323.8 ± 221.44 vs. 549.4 ± 519.72), with P = 0.001. Among women receiving tourniquet during myomectomy in Enugu, the additional use of vaginal misoprostol 400 μg significantly reduced intraoperative blood loss.

Exploring the Impact of Buprenorphine/naloxone (Suboxone) Use to Length of Sobriety After Opioid Detoxification

PurposeThe purpose of this descriptive correlational study with retrospective chart review was to explore the relationship between inpatient buprenorphine/naloxone (Suboxone) protocols and discharge prescription practices with LOS at an inpatient western Washington Recovery Center. An approval letter from the organization's Director and IRB approval was obtained. The opioid crisis remains a public health concern. Utilization and access to quality Medication Assisted Treatment (MAT) for detoxification can impact length of sobriety (LOS). Relapse rates remain significant for opioid use disorder (OUD). Providers must consider many factors when prescribing buprenorphine/naloxone (Suboxone) inpatient and at discharge. Protocol and prescription practices play a role in relation to LOS and readmission. The conceptual framework was the John Hopkin's evidence-based practice (EBP) model which promotes an inquiry-based approach using evidence-based practice. MethodsWhat is the relationship between inpatient buprenorphine/naloxone (Suboxone) protocols, discharge prescriptions, and LOS? A convenient medical record sample of 150 patient charts were utilized between January 1, 2020, to December 31, 2021, which included a total of 244 readmissions, resulting in a total of 394 admissions. The sample included male and female adult patients over age 18 years who readmitted within one year after completing prior opioid detoxification treatment. Discharge summary and admission intake forms were utilized. ResultsRisk of relapse within 115 days was significantly higher without buprenorphine/naloxone (Suboxone) at discharged, compared to with (RR 3, CI 1.97-5.17; RR 0.34, CI 0.22-0.58). Buprenorphine/naloxone (Suboxone) prescription increased LOS by 42 days (95% CI, p<.0008). Buprenorphine/naloxone (Suboxone) protocol BID increased LOS significantly compared to other protocol groups. Conclusions: Buprenorphine/naloxone (Suboxone) is a partial opioid agonist, and this study is significant for persons involved in pain management, OUD, and the prescription practices impact LOS. It is unclear if it improves quality of life for patients and decreases opioid cravings. Future research is warranted.

PD37-03 DOES NEOADJUVANT CHEMOTHERAPY REDUCE THE COMPLEXITY OF WILMS TUMOR? AN ANALYSIS USING THE NEPHROMETRY SCORE

You have accessJournal of UrologyCME1 Apr 2023PD37-03 DOES NEOADJUVANT CHEMOTHERAPY REDUCE THE COMPLEXITY OF WILMS TUMOR? AN ANALYSIS USING THE NEPHROMETRY SCORE Catherine Nguyen, Eric Bih, Kathleen Hosek, Michelle Dai, and Niccolo Passoni Catherine NguyenCatherine Nguyen More articles by this author , Eric BihEric Bih More articles by this author , Kathleen HosekKathleen Hosek More articles by this author , Michelle DaiMichelle Dai More articles by this author , and Niccolo PassoniNiccolo Passoni More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003335.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Per the Children’s Oncology Group (COG) protocols, partial nephrectomy (PN) for Wilms tumor (WT) is reserved for bilateral tumors or lesions in solitary kidneys. Furthermore, most WTs are large masses that would not be amenable to partial nephrectomy. Unlike COG, the Societe Internationale d’Oncologie Pediatrique (SIOP) offers neoadjuvant chemotherapy (NAC) prior to surgical resection, allowing for tumor shrinkage. The Nephrometry score (NS) is a tool that was developed to assess the complexity of renal cell carcinoma, and thus the feasibility of partial nephrectomy. It relies on morphological features of tumors seen on cross-sectional imaging. The NS was however developed for renal cell carcinoma. Only one study to date has assessed Wilms tumors using the NS, showing that most are highly complex lesions not amenable to (PN). The goal of our study is to assess if NAC decreases the complexity of Wilms tumor using the NS. METHODS: We retrospectively identified patients with WT at our institution who received NAC (according to COG protocols). Pre- and post- treatment tumor volumes and NS were calculated by a single radiologist. For bilateral or multifocal tumors, the score was calculated for the most complex mass. NS was broken down into low, intermediate and high complexity groups. Rates of PN were stratified by NS score and by pre-operative variables. Statistical differences were assessed using paired t-tests and chi square tests. RESULTS: 54 patients were identified. The median pre- and post-treatment tumor volumes were 499 and 90 cm3, respectively (p<0.0001). Before NAC, NS was considered low, intermediate and high in 3.7%, 13% and 83.3% of patients, respectively. After NAC, the NS score was low, intermediate and high in 11.1%, 25.9% and 63% of patients. Fourteen tumors (26%) had their complexity downgraded. Overall rates of PN were 35% (n=19). There were statistically significant higher rates of PN for tumors with a low NS (83%) vs intermediate (64.3%) and high (14.7%) scores (p<0.0001). Among pre-operative variables such as age, sex, race, ethnicity, syndromic Wilms and stage, only female sex was statistically associated with higher rates of downgrading after NAC (36% vs 9.5% of males, p=0.028). CONCLUSIONS: The majority of WT are complex masses. Our data shows that NAC can reduce tumor complexity in 26% of cases, with more than half the patients with low or intermediate complexity WT undergoing successful PN. Further studies are needed to identify which patients with unilateral non-syndromic WT could benefit from NAC with the goal of nephron-sparing surgery. Source of Funding: Department © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e987 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Catherine Nguyen More articles by this author Eric Bih More articles by this author Kathleen Hosek More articles by this author Michelle Dai More articles by this author Niccolo Passoni More articles by this author Expand All Advertisement PDF downloadLoading ...

Multicentre, randomised, double-blind, placebo-controlled phase II study of prophylactic olanzapine for patients with metastatic breast cancer receiving T-DXd treatment: protocol for the ERICA study (WJOG14320B)

IntroductionThe antibody-drug conjugate trastuzumab deruxtecan (T-DXd) has led to a change in the clinical management of breast cancer. Nausea and vomiting are the most common adverse events of T-DXd, which...

Feasibility of a point-of-care ultrasound protocol for cardiorespiratory evaluation of horses in different clinical settings.

A point-of-care ultrasound (POCUS) protocol for evaluation of the cardiac and respiratory systems in horses does not exist. (a) Describe the windows of a POCUS protocol for cardiorespiratory assessment of horses (CRASH); (b) Estimate the number of acoustic windows that can be acquired by a sonographer-in-training; (c) Estimate the time required to complete the protocol for specific groups of horses; (d) Describe the sonographic abnormalities detected in horses presented with cardiovascular, respiratory, or systemic disease. Twenty-seven healthy horses, 14 horses competing in athletic events, and 120 horses with clinical disease. A pocket-sized ultrasound device was used to acquire 7 sonographic cardiorespiratory windows in various clinical scenarios. The duration of the examination was timed, and images were evaluated for diagnostic quality. Abnormalities in horses with clinical disease were determined by an expert sonographer. The CRASH protocol could be performed in healthy and diseased horses in hospital, barn, and competition settings between 5.5 ± 0.9 (athletic horses) and 6.9 ± 1.9min (horses with clinical disease). Thoracic windows were obtained most consistently, followed by right parasternal long-axis echocardiographic windows. Frequently detected abnormalities were pleural fluid, lung consolidation, B-lines, and moderate-to-severe left-sided heart disease. The CRASH protocol was feasible using a pocket-sized ultrasound device in various groups of horses, could be completed rapidly in a variety of settings, and frequently identified sonographic abnormalities when evaluated by an expert sonographer. The diagnostic accuracy, observer agreement, and utility of the CRASH protocol merit further evaluation.

Enhanced recovery after spinal surgery protocol versus conventional care in non- insulin diabetic patients: A prospective randomized trial

ABSTRACT Background Enhanced Recovery After Surgery (ERAS) approach was proven in many surgical specialties. This prospective, randomized, single-blinded trial was designed to assess the effectiveness of ERAS on quality of recovery (QOR) after surgery in non-insulin-dependent diabetic patients. Patients and methods 72 patients undergoing elective lumbar decompressive surgery were randomly allocated to one of two equal groups receiving either ERAS protocol in group E or conventional care in group C. QOR after surgery using QOR-40 score, pain score, perioperative opioid consumption, time to early ambulation, serum markers of stress response, length of stay and possible perioperative complications were recorded. Results QOR-40 scores were significantly greater in group E at PACU, first postoperative day and second postoperative day (P = 0.015, 0.041 and 0.048, respectively). VAS was significantly lower in group E in the first eight hours postoperative. Time to first postoperative analgesic requirement was significantly longer in group E (P = 0.0001). Intraoperative fentanyl and postoperative nalbuphine requirements were significantly less in group E (P = 0.001, and 0.0001, respectively). Time to early ambulation was significantly less in group E (P = 0.006). Both CRP and interleukin-6 were significantly less at the second postoperative day in group E (P = 0.001, and 0.017, respectively). There was insignificant difference among groups in length of hospital stay and intraoperative insulin requirements (P = 0.251, and 0.347, respectively). Conclusion In non-insulin diabetic patients, enhanced recovery after spinal surgery improved quality of recovery, lowered pain scores, reduced perioperative opioid consumption, allowed early ambulation and decreased stress response but not length of hospital stay.

Germline genetic variants and pediatric rhabdomyosarcoma outcomes: a report from the Children's Oncology Group.

Relative to other pediatric cancers, survival for rhabdomyosarcoma (RMS) has not improved in recent decades, suggesting the need to enhance risk stratification. Therefore, we conducted a genome-wide association study for event-free survival (EFS) and overall survival (OS) to identify genetic variants associated with outcomes in individuals with RMS. The study included 920 individuals with newly diagnosed RMS who were enrolled in Children's Oncology Group protocols. To assess the association of each single nucleotide polymorphism (SNP) with EFS and OS, we estimated hazard ratios (HRs) and 95% confidence intervals (CIs) using multivariable Cox proportional hazards models, adjusted for clinical covariates. All statistical tests were two sided. We also performed stratified analyses by histological subtype (alveolar and embryonal RMS) and carried out sensitivity analyses of statistically significant SNPs by PAX3/7-FOXO1 fusion status and genetic ancestry group. We identified that rs17321084 was associated with worse EFS (HR = 2.01, 95% CI = 1.59 to 2.53, P = 5.39 × 10-9) and rs10094840 was associated with worse OS (HR = 1.84, 95% CI = 1.48 to 2.27, P = 2.13 × 10-8). Using publicly available data, we found that rs17321084 lies in a binding region for transcription factors GATA2 and GATA3, and rs10094840 is associated with SPAG1 and RNF19A expression. We also identified that CTNNA3 rs2135732 (HR = 3.75, 95% CI = 2.34 to 5.99, P = 3.54 × 10-8) and MED31 rs74504320 (HR = 3.21, 95% CI = 2.12 to 4.86, P = 3.60 × 10-8) were associated with worse OS among individuals with alveolar RMS. We demonstrated that common germline variants are associated with EFS and OS among individuals with RMS. Additional replication and investigation of these SNP effects may further support their consideration in risk stratification protocols.

Optimal vs rotation heuristics in the role of cluster-head for routing in IoT constrained devices

Wireless Sensor Networks (WSNs) are crucial for implementing the Internet of Things (IoT) vision. A WSN can include distributed devices that can be battery powered, have a small amount of memory, have limited CPU processing capabilities and limited transmission range. WSNs are categorised into two main types that are homogeneous and heterogeneous. Homogeneous WSNs are composed of nodes that are all equal while heterogeneous ones are composed of nodes that can have different transmission rate and different initial energy. Collecting data in an energy efficient manner is one of the main goals when building wireless sensor networks since devices are battery powered and battery replacement can be difficult or impossible to be performed. Clustering protocols are one of the main approaches that have been used in order to collect data in an energy efficient way. A clustering protocol groups nodes into a set of clusters. Each cluster has a representative node that is referred to as Cluster Head (CH). This collects data from its cluster members and forwards them to an external Base Station, possibly in a multi-hop way among cluster heads. A rotation strategy for electing the cluster head is often used together with clustering in order to prolong the network lifetime. Rotation eliminates the overhead traffic that is needed for leader election and cluster formation since the old cluster heads directly designate new ones. In this work, we describe an Optimum Rotation Scheduling (ORS) that uses Integer Linear Programming in order to find the optimum rotation strategy. ORS assumes the WSN clusters are already formed by using some clustering protocol. A novel integer linear programming formulation is then used in order to define a cluster head rotation that produces the optimum cluster lifetime. Comparisons with existing heuristics and the provided optimum are then shown and discussed by means of extended simulations involving both homogeneous and heterogeneous WSNs.

Effect of Age and Different Doses of GnRH and PGF2α Analogue on Oesturs Synchronization and Conception Rate of Crossbreed Heifers

Forty-eight crossbreed heifers were artificially inseminated within 10-20 hours after standing heat to evaluate the effects of different doses of hormones and age on reproductive performance synchronized with GnRH and PGF2α. On day 90 after artificial insemination, the conception rate was confirmed by rectal palpation. There were significant differences (<I>P</I><0.05) in oesturs response in maximum doses (1.5 ml GnRH used in group III) of the hormone-treated group. The conception rate was significantly higher (<I>P</I><0.05) in the highest treatment group (1.5 ml, 66.67%) than in low treatment groups (1 ml and 1.3 ml; 42.85% and 44.44%; respectively) in morning synchronization protocol (83.33%). The effect of different doses of the hormone on conception rates was statistical significance on the age of crossbreed heifers (<I>P</I><0.05), time of initiation of ovsynch (<I>P</I><0.05), time of insemination (<I>P</I><0.05), semen placement (<I>P</I><0.05), body condition score (<I>P</I><0.05), retrieve to natural oesturs and subsequent pregnancy rate (<I>P</I><0.05). On the other hand, there was no significant (<I>P</I>>0.05) effect on conception rate by the onset of oesturs and duration of oesturs. The highest oesturs rate and conception rate was observed at 75.00% and 66.67%; respectively by administration of maximum doses of the hormone of body condition score (3) 69.23% of crossbreed heifer. When 1.5 ml GnRH was used in group III, the conception rate was observed higher at 25-30 months of age (77.78%) which were inseminated in the site of the deep cervix (77.77%) with frozen-thaw semen by experience inseminator at 10-14 hours (75%) after the onset of oesturs and naturally retrieve of oesturs on conception rate (75%). It was concluded that the age of the heifers, doses of the hormone, Body Condition Score (BCS), time of initiation of synchronization protocol, time of AI, semen placement and retrieve to oesturs naturally were the most important factors to get maximum oesturs response and conception rate of crossbreed heifers. So, it may be suggested that to achieve the desired rate of oesturs and conception, the farmers should inseminate their crossbreed heifers (BCS, 3 out of 5) with maximum doses of hormone in the deep cervix by technically sound and skilled inseminator at 10-14 hours after onset of oesturs in morning synchronization protocol. GnRH and PGF2α analogs could successfully induce oesturs response and improve the fertility of a dairy herd. Therefore, ovsynch protocol for crossbreed heifers is needed for further work involving a large number of animals for a definite conclusion.

Effects of intravenous immunoglobulin on the negatively transformed subpopulations of neutrophilic granulocytes in newborns with congenital pneumonia and neonatal sepsis

Today, the diagnosis and treatment of severe infectious and inflammatory diseases in newborns, e.g., congenital pneumonia (CP) and neonatal sepsis (NS), present difficult problems. Searching sensitive and specific severity markers of bacterial inflammatory process as well as early and effective treatment are crucial for the outcome and prognosis of these life-threatening diseases. The aim of our study was to assess the effects of intravenous immunoglobulin (IVIG) injections on the negatively transformed subpopulations of neutrophilic granulocytes (NG) СD64-CD16+СD32+СD11b+, СD64+CD16+СD32+СD11b+ and evaluation of their functional activity in newborns with CP and NS. We have observed 38 full-term newborn patients. Group 1 included 19 infants with CP, including 11 children who received conventional therapy and IVIG (group 1.1), and 8 children treated at conventional protocols (group 1.2). Group 2 included 19 children with NS, including 12 children who underwent conventional therapy and IVIG treatment (group 2.1), and 7 children who were subject to conventional therapy (group 2.2). The comparison group consisted of 22 healthy full-term newborns. Testing of NG population included the following parameters: counting the numbers of NG subpopulations which simultaneously expressed CD11b CD64, CD32, CD16, as well as their phenotypic patterns, with regard of the receptor expression density (MFI) using flow cytometric techniques. Moreover, we determined phagocytic and microbicidal activity of the granulocytes. We have revealed negative transformation of СD64-CD16+СD32+СD11b+ and СD64+CD16+СD32+СD11b+ subpopulations of neutrophilic granulocytes in newborns with CP and NS, The diagnostic significance of increased СD64+CD16+СD32+СD11b+NG subpopulation was more pronounced with increasing severity of bacterial infection and inflammatory process, i.e., 18.7-fold in CP, 52.3-fold in NS, along with predominant decrease in expression of appropriate membrane receptors. These phenotypic changes were associated with impaired phagocytic and killing activity of NG. The effect of IVIG on the impaired mechanisms of antibacterial immunity is associated not only with alleviation of IgG deficiency, but also with positive remodeling of negatively transformed subpopulations of СD64-CD16+СD32+СD11b+NG and СD64+CD16+СD32+СD11b+NG, improved effector functions of NG, especially in cases of CP. Thus, following IVIG treatment, a reduced number of СD64-CD16+СD32+СD11b+NG subpopulations was fully recovered in CP, while it increased 1.5 times in NS, and the content of diagnostically significant СD64+CD16+СD32+СD11b+NG subpopulation showed a significantly decrease, both in CP (2-fold) and in NS (2.6-fold). However, this index remained higher than the content of this subpopulation in healthy newborns. At the same time, we have noted the restorative or modulatory effects by changing density of trigger molecules in NG subpopulations. Limitation of the negative NG transformation in their functionally significant subpopulations in newborns with CAP and NS was accompanied by positive clinical effects, i.e., optimization of antibiotic therapy, reduced duration of treatment, and improved mortality rates.

Application value of Early-Follicular Phase Long-Acting Gonadotropin-Releasing Hormone Agonist Long Protocol in patients with resistant ovary syndrome

BackgroundResistant ovarian syndrome(ROS) is a rare disease. It is difficult to diagnose and treat. Most of the literature reports on assisted pregnancy treatment for ROS patients are individual case reports. In this paper, the ovulation stimulation protocol and assisted pregnancy process of ROS infertile patients in our reproductive center were summarized and analyzed to provide information and support for the clinical treatment of ROS patients.MethodsFrom January 2017 to March 2022, assisted reproductive technology treatments and clinical characteristics parameters of six patients with ROS were retrospectively reviewed. Based on controlled ovarian stimulation protocols, these stimulation cycles were separated into four groups: Early-Follicular Phase Long-Acting Gonadotropin-Releasing Hormone Agonist Long Protocol (EFLL) group (n = 6), Progestin Primed Ovarian Stimulation(PPOS) protocol group (n = 5), mild-stimulation protocol group (n = 2), and Natural cycle protocol group (n = 3).ResultsA total of 16 cycles of ovulation stimulation were carried out in 6 patients with ROS. A total of 19 oocytes were retrieved, as well as 13 MII oocytes, 11 two pronuclear(2PN) fertilized embryos, and 8 excellent embryos. The oocytes acquisition rate was 50% and the fertilization rate of 2PN was 57.9%, and the excellent embryo rate was 72.7%. The EFLL protocol obtained 17 oocytes, 12 MII oocytes, 11 2PN fertilized embryos, and 8 excellent embryos; the mild-stimulation protocol obtained 1 oocyte; the Natural cycle protocol obtained 1 oocyte, and oocytes were not matured after in vitro maturation (IVM); the PPOS protocol obtained no oocytes. Compared with three other protocols, The fertilization rate of 2PN (64.7%) and excellent embryo rate (72.7%) in the EFLL protocol were higher than those of other protocols(0%). Two fresh cycle embryo transfers resulted in live births, while two frozen-thawed embryo transfer cycles resulted in one live birth and one clinical pregnancy using the EFLL protocol.ConclusionAlthough the current study is based on a small sample of participants, the findings suggest that the EFLL protocol can be employed for ovarian stimulation and may result in a live birth in ROS patients.

One-stop combined CT angiography of coronary and craniocervical arteries: recommended as the first examination for patients suspected of coronary or craniocervical artery disease.

To investigate the potential diagnostic value of one-stop combined CT angiography (CTA) as the first examination for patients suspected of coronary artery disease (CAD) or craniocervical artery disease (CCAD), and compare its clinical performance with two consecutive CTA scans. Patients with suspected but unconfirmed CAD or CCAD were prospectively enrolled and grouped randomly to undergo coronary and craniocervical CTA using the combined protocol (group 1) or the consecutive protocol (group 2). Diagnostic findings were evaluated for both the targeted and non-targeted regions. The objective image quality, overall scan time, radiation dose, and contrast medium dosage were compared between the two groups. Each group enrolled 65 patients. A substantial number of lesions were found in non-targeted regions, which was 44/65 (67.7%) by patients for group 1 and 41/65 (63.1%) for group 2, reiterating the necessity of extending the scan coverage. Specifically, lesions in non-targeted regions were detected more often for patients suspected of CCAD than for those suspected of CAD (71.4% vs 61.7%). With 21.5% (~51.1s) reduction of scan time and 21.8% (~20.8mL) less contrast medium as compared to the consecutive protocol, high-quality images were obtained by the combined protocol. One-stop combined CTA enables effective detection of lesions in non-targeted regions at a lower cost of scan time and contrast medium than two separate examinations and is thus worth taking as the first examination for patients suspected of CAD or CCAD. • Extending the scan range for coronary or craniocervical CTA has the potential to reveal lesions in non-targeted regions. • One-stop combined CTA as enabled on high-speed wide-detector CT delivers high-quality images at a lower cost of contrast medium and operational time than two consecutive CTA scans. • Patients with suspected but unconfirmed CAD or CCAD may benefit from the one-stop combined CTA in the first examination.