Infektionen in der Shuntchirurgie

xlomafota.13 shared this article with you from Inoreader Infektionen in der Shuntchirurgie Via Latest Results for Gefässchirurgie Zusammenfassung Infektionen im Bereich eines Hämodialysezugangs stellen die zweithäufigste Komplikation nach der Thrombose dar, bei Vorhofkathetern sind Infektionen gar die häufigste Komplikation. Diese Infekte bedrohen sowohl den Dialysezugang selbst als auch das Leben der Patienten, da Zugangsinfektionen die Mortalität des Patientenkollektivs dramatisch erhöhen. Neben der allgemeinen Infektdiagnostik kommt der Sonographie und der frühen Blutkulturentnahme eine besondere Bedeutung für die weitere Therapieplanung zu. Unkomplizierte Infektionen nativer Fisteln können oft ambulant mit peroraler Antibiotikagabe erfolgreich therapiert werden, Abszesse müssen chirurgisch drainiert werden. Bei perianastomotischen Infekten besteht das Hauptrisiko in einer septischen Arrosionsblutung, sodass hier eine dringliche Operationsindikation besteht. Prothetische Hämodialysezugänge können je nach Ausdehnung des Infekts als segmentale oder subtotale Graftexplantation, nach Möglichkeit mit prothetischem Ersatz über nicht vom Infekt tangierten Arealen (aseptischer Bypass) chirurgisch therapiert werden. Bei vollständigem Protheseninfekt muss das prothetische Material in toto entfernt werden. Vorhofkatheterinfekte sollten stadiengerecht behandelt werden, obligat sind hier zentrale und periphere Blutkulturentnahmen. Der unkomplizierte Infekt des Exits kann bei negativer Blutkultur rein antibiotisch therapiert werden. Abszessbildungen im subkutanen Tunnel erfordern einen Katheterwechsel nach kontralateral, sofern keine Bakteriämie besteht. Bakteriäme Formen des Vorhofkatheterinfekts erfordern die dringliche Explantation des Vorhofkatheters und eine Neuanlage nach negativen Blutkulturen. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Gefäßmedizin in der ägyptischen Antike

xlomafota.13 shared this article with you from Inoreader Gefäßmedizin in der ägyptischen Antike – Appendix Via Latest Results for Gefässchirurgie Zusammenfassung Ein kurzer Appendix schließt die Serie zur ägyptischen Epoche der Antike ab. In diesem wird das Kuriosum von Ansätzen einer leitliniengerechten Medizin vorgestellt. Des Weiteren wird über den berühmten Imhotep berichtet, der der Heilkunde nahe gestellt wird und angeblich schon zu Lebzeiten eine Vergöttlichung erfuhr. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

EUS is accurate in characterizing pancreatic cystic lesions

xlomafota.13 shared this article with you from Inoreader EUS is accurate in characterizing pancreatic cystic lesions; a prospective comparison with cross-sectional imaging in resected cases Via Latest Results for Surgical Endoscopy Abstract Background Imaging modalities for characterizing pancreatic cystic lesions (PCLs) is a known uncertainty. The aim of this prospective study was to compare the diagnostic performance of endoscopic ultrasound morphology, cytology and cyst fluid carcinoembryonic antigen (EUS-FNA-CEA) with cross-sectional imaging in resected PCLs. Methods The cross-sectional imaging and EUS-FNA-CEA results were collected in an academic tertiary referral centre using histology of the surgical specimen as the diagnostic standard. Results Of 289 patients undergoing evaluation for PCL with cross-sectional imaging and EUS-FNA between February 2007 and March 2017, 58 underwent surgical resection providing a final diagnosis of the PCLs: 45 mucinous, 5 serous, 1 pseudocyst, 2 endocrine, 2 solid pseudopapillary neoplasms and 3 other. EUS-FNA-CEA was more accurate than cross-sectional imaging in diagnosing mucinous PCLs (95% vs. 83%, p = 0.04). Ninety-two percent of the PCLs with high-grade dysplasia or adenocarcinoma were smaller than 3 cm in diameter. The sensitivity of EUS-FNA-CEA and cross-sectional imaging for detecting PCLs with high-grade dysplasia or adenocarcinoma were 33% and 5% (p = 0.03), respectively. However, there was no difference in accuracy between the modalities (62% vs. 66%, p = 0.79). The sensitivity for detecting pancreatic adenocarcinomas only was 64% for EUS-FNA-CEA and 9% for cross-sectional imaging (p = 0.03). Overall, E US-FNA-CEA provided a correct diagnosis in more patients with PCLs than cross-sectional imaging (72% vs. 50%, p = 0.01). Conclusions EUS-FNA-CEA is accurate and should be considered a complementary test in the diagnosis of PCLs. However, the detection of PCLs with high-grade dysplasia or adenocarcinoma needs to be improved. Cyst size does not seem to be a reliable predictor of high-grade dysplasia or adenocarcinoma. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Myocardial Perfusion Simulation for Coronary Artery Disease: A Coupled Patient-Specific Multiscale Model

xlomafota.13 shared this article with you from Inoreader Myocardial Perfusion Simulation for Coronary Artery Disease: A Coupled Patient-Specific Multiscale Model Via Latest Results for Annals of Biomedical Engineering Abstract Patient-specific models of blood flow are being used clinically to diagnose and plan treatment for coronary artery disease. A remaining challenge is bridging scales from flow in arteries to the micro-circulation supplying the myocardium. Previously proposed models are descriptive rather than predictive and have not been applied to human data. The goal here is to develop a multiscale patient-specific model enabling blood flow simulation from large coronary arteries to myocardial tissue. Patient vasculatures are segmented from coronary computed tomography angiography data and extended from the image-based model down to the arteriole level using a space-filling forest of synthetic trees. Blood flow is modeled by coupling a 1D model of the coronary arteries to a single-compartment Darcy myocardium model. Simulated results on five patients with non-obstructive coronary artery disease compare overall well to [ \(^{15}\) O] \(\text {H}_{{2}}\) O PET exam data for both resting and hyperemic conditions. Results on a patient with severe obstructive disease link coronary artery narrowing with impaired myocardial blood flow, demonstrating the model's ability to predict myocardial regions with perfusion deficit. This is the first report of a computational model for simulating blood flow from the epicardial coronary arteries to the left ventricle myocardium applied to and validated on human data. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Adalimumab Biosimilars in the Treatment of Rheumatoid Arthritis

xlomafota.13 shared this article with you from Inoreader Adalimumab Biosimilars in the Treatment of Rheumatoid Arthritis: A Systematic Review of the Evidence for Biosimilarity Via Latest Results for Rheumatology and Therapy Abstract Although treatment with biologic disease-modifying antirheumatic drugs (bDMARDs) has significantly improved clinical outcomes in patients with rheumatoid arthritis (RA), many patients do not have access to these treatments. As cost-effective alternatives to their reference products (RPs), biosimilars provide an opportunity to increase access to bDMARDs. The European Medicines Agency and the US Food and Drug Administration have detailed pathways for the approval of biosimilars based on establishing the similarity of the biosimilar to the RP in terms of structure and function, pharmacokinetics (PK), efficacy, safety, and immunogenicity. A number of biosimilars of adalimumab, infliximab, etanercept, and rituximab RPs have been approved in the United States and/or European Union. This article is focused on the seven adalimumab biosimilars. A review of the data for the biosimilars FKB327, ABP 501, BI 695501, GP2017, MSB11022, PF-06410293, and SB5 confirm that these pr oducts are highly similar to the adalimumab RP with regard to structure, physicochemical and biological properties, PK, safety, immunogenicity, and efficacy in the treatment of RA and other chronic immune-mediated, inflammatory conditions. Data from several switching studies showed no changes in efficacy, safety, trough serum drug concentration, or immunogenicity between the biosimilars and their RP. Trial registration: ClinicalTrials.gov identifiers: NCT02260791, NCT02405780, NCT01970475, NCT02137226, NCT02045979, NCT02744755, NCT02144714, NCT02167139, NCT03014947, NCT02114931, NCT02640612, NCT02640612, NCT02167139, NCT03052322, NCT02480153. EudraCT numbers: 2012-005140-23, 2012-000785-37, 2013-003722-84, 2015-000579-28, 2014-002879-29, 2014-000662-21, 2013-004654-13, 2015-002634-41, 2014-005229-11, 2016-002852-26, 2014-000352-29 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Autotransplanted teeth including an evaluation of a novel surgical technique

xlomafota.13 shared this article with you from Inoreader A retrospective analysis of autotransplanted teeth including an evaluation of a novel surgical technique Via Latest Results for Clinical Oral Investigations Abstract Objectives To assess survival rates and frequency of complications for immature and mature autotransplanted teeth after at least 1 year in function. Materials and methods All consecutive patients who had undergone tooth autotransplantation between 2000 and 2018 were invited to a clinical and radiographic follow-up examination. First, survival rates were calculated on the basis of a phone inquiry. A clinical follow-up examination allowed for the calculation of the success rate, i.e., absence of any potentially adverse clinical and radiographic findings of the autotransplanted teeth. Moreover, the effect of demographic, dental, and surgical variables on survival/success was analyzed statistically. Results Thirty-eight teeth in 35 patients were transplanted during the study period. Three teeth in 3 patients were excluded due to missing records. All other patients were successfully contacted and interviewed by phone. Out of these 35 transplants, 32 were still in function, and 3 had been extracted, yielding a 91.4% survival probability after a median follow-up of 3.4 years. Of the 32 teeth qualifying for the success analysis, 20 (62.5%) showed absence of potentially adverse findings, while 3 (9.4%) required root canal treatment (RCT). Out of the 9 mature, root-end resected transplants, 4 exhibited ongoing pulp canal obliteration, all with a single root canal. Postoperative and potentially adverse findings or failures were found more frequently in the group of mature transplants (55.6%) than immature transplants (30.4%) and for molars (72.7%) than premolars (17.6%) or canines (25%). None of the potential predictors had a statistically significant effect on survival or success. Conclusion Autotransplanted teeth yielded a satisfying midterm survival rate regardless of their stage of development. An additional, extraoral root-end resection of mature transplants may lead to rates of revascularization and postoperative pulp canal obliteration higher than the data reported on unmodified mature transplants. Clinical relevance Extraoral root-end resection of mature teeth shows promising outcomes for transplants especially with a single root canal and uncomplicated root morphology. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Characterization of the Sheep Round Window Membrane

xlomafota13 shared this article with you from Inoreader Characterization of the Sheep Round Window Membrane Via Journal of the Association for Research in Otolaryngology Abstract Intratympanic injection is a clinically used approach to locally deliver therapeutic molecules to the inner ear. Drug diffusion, at least in part, is presumed to occur through the round window membrane (RWM), one of the two openings to the inner ear. Previous studies in human temporal bones have identified a three-layered structure of the RWM with a thickness of 70–100 μm. This is considerably thicker than the RWM in rodents, which are mostly used to model RWM permeability and assess drug uptake. The sheep has been suggested as a large animal model for inner ear research given the similarities in structure and frequency range for hearing. Here, we report the structure of the sheep RWM. The RWM is anchored within the round window niche (average vertical diameter of 2.1 ± 0.3 mm and horizontal diameter of 2.3 ± 0.4 mm) and has a curvature that leans towards the scala tympani. The centre of the RWM is the thinnest (55–71 μm), with increasing thickness towards the edges (< 171 μm), where the RWM forms tight attachments to the surrounding bony niche. The layered RWM structure, including an outer epithelial layer, middle connective tissue and inner epithelial layer, was identified with cellular features such as wavy fibre bundles, melanocytes and blood vessels. An attached "meshwork structure" which extends over the cochlear aqueduct was seen, as in humans. The striking anatomical similarities between sheep and human RWM suggest that sheep may be evaluated as a more appropriate system to predict RWM permeability and drug delivery in humans than rodent models. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.