Prevention of blood-transfusion-induced impairment of anastomotic healing by leucocyte depletion in rats.

OBJECTIVE: To find out what effect whole blood and leucocyte-depleted blood transfusions had on the healing process of intestinal anastomoses in rats. DESIGN: Experimental study. SETTING: Teaching hospital, Greece. SUBJECTS: 100 Wistar rats in five groups of 20 each. INTERVENTIONS: Small and large bowel anastomoses were made and the five groups were given normal saline, homologous whole blood, heterologous whole blood obtained from PVG rats, homologous leucocyte-depleted blood or heterologous leucocytedepleted blood during the operation. MAIN OUTCOME MEASURES: Bursting pressures of anastomoses on the third and seventh postoperative days and infective complications. RESULTS: The groups given whole blood transfusions had significantly more anastomotic abscesses than controls (p = 0.003 compared with heterologous, p = 0.05 compared with homologous for the small bowel, and p = 0.007 for the large bowel). The pressure measurements indicated a significant reduction in anastomotic strength in the same groups compared with the control group (p = 0.0001/p = 0.001 on the third postoperative day, and p = 0.00001/p = 0.0004 on the seventh postoperative day for small and large bowel, respectively). There was no reduction in anastomotic strength in the leucocyte-depleted blood groups. CONCLUSIONS: Transfusion of leucocyte-depleted blood does not seem to impair intestinal anastomotic healing and carries an acceptable incidence of postoperative complications.     

The use of miniscrew implants for temporary skeletal anchorage in orthodontics: a comprehensive review.

Though not a novel therapeutic concept, the use of miniscrew implants to obtain absolute anchorage has recently become very popular in clinical orthodontic approaches. The mode of anchorage facilitated by these implant systems has a unique characteristic owing to their temporary use, which results in a transient, albeit absolute anchorage. The foregoing properties together with the recently achieved simple application of these screws have increased their popularity, establishing them as a necessary treatment option in complex cases that would have otherwise been impossible to treat. The aim of this comprehensive review is to present and discuss the development, clinical use, benefits, and drawbacks of the miniscrew implants used to obtain a temporary but absolute/skeletal anchorage for orthodontic applications. Topics to be discussed include classification, types and properties (e.g., biocompatibility, osseointegration, types of anchorage, screw head, and thread design), clinical applications, site and placement method selection, clinical procedures for implant insertion, and loading and removal processes. Lastly, the potential complications and the advantages and disadvantages accompanying their use are presented.     

Cost-Effectiveness of Posaconazole versus Fluconazole or Itraconazole in the Prevention of Invasive Fungal Infections among Neutropenic Patients in the United States

Objectives:  Clinical trial data indicate that posaconazole is superior to fluconazole (FLU) or itraconazole (ITRA) in preventing invasive fungal infections (IFIs) among neutropenic patients. Our objective was to assess the cost-effectiveness of posaconazole versus FLU or ITRA for prevention of IFIs among neutropenic patients.
Methods:  We used modeling techniques to assess the cost-effectiveness of posaconazole versus FLU or ITRA in the prevention of IFIs among patients with acute myelogenous leukemia (AML) or myelodysplastic syndromes (MDS) and chemotherapy-induced neutropenia. The probabilities of experiencing an IFI, IFI-related death, and death from other causes over 100 days of follow-up were estimated from clinical trial data. Long-term mortality, drug costs, and IFI treatment costs were obtained from secondary sources.
Results:  Posaconazole is associated with fewer IFIs per patient (0.05 vs. 0.11) relative to FLU or ITRA over 100 days of follow-up, and lower discounted costs ($3900 vs. $4500) and increased life-years (2.50 vs. 2.43 discounted) over a lifetime horizon. Results from a probabilistic sensitivity analysis indicate that there is a 73% probability that posaconazole is cost saving versus FLU or ITRA and a 96% probability that the incremental cost-effectiveness ratio for posaconazole is at or below $50,000 per life-year saved.
Conclusions:  We conclude that posaconazole is very likely to be a cost-effective alternative to FLU or ITRA in the prevention of IFIs among neutropenic patients with AML and MDS, and may result in cost savings.     

Antithrombotic efficacy of direct oral anticoagulants on patency rate following microsurgical anastomosis in crushed rat arteries

BackgroundDuring the last decade direct oral anticoagulants (DOAC) have been established in various fields of medicine.Their use in microsurgery has not been evaluated yet though. This study aims to evaluate their efficacy in microsurgery and additionally compare them with a well established antithrombotic agent.Materials and methodsThe right femoral artery of 101 rats divided into 4 groups, was crushed and anastomosed. Group A (20 rats) received placebo therapy (1 ml NaCl 0.9%, orally), while Group B (27 rats), Group C (27 rats) and Group D (27 rats) received rivaroxaban (3 mg/kg, orally), dabigatran (30 mg/kg, orally) and enoxaparin (30 mg/kg, subcutaneously) respectively. All drugs were administered 3 h preoperatively and once daily for the following postoperative days until the sacrifice of the animals. Patency was evaluated at 1st, 7th and 20th postoperative day. Following patency evaluation the rats were sacrificed and the vessels were harvested for histological examination.ResultsNone of the rats died postoperatively. Patency rates of rivaroxaban group (78%), dabigatran group (70%) and enoxaparin group (63%) were statistically similar, but significantly higher than the placebo-treated control group (p < 0.05). Cells with morphologic features of endothelial cells were evident 7 days after the injury.ConclusionThe results of this study demonstrate the following: (1) rivaroxaban and dabigatran through inhibition of thrombus formation significantly enhanced the patency rate compared to placebo treatment (2) the antithrombotic efficacy of rivaroxaban and dabigatran in compromised microvessels was similar to that of enoxaparin, the most widely used antithrombotic agent.     

How Do Physical Activity and Sedentary Behaviour Affect Motor Competence in Children with Autism Spectrum Disorder Compared to Typically Developing Children: A Pilot Study

Journal of Autism and Developmental Disorders - Older children with Autism Spectrum Disorder (ASD) have high levels of motor impairment, however we are unsure if similar patterns exist in young...     

Differential diagnosis of apical hypertrophic cardiomyopathy and apical displacement of the papillary muscles: a multimodality imaging point of view

Apical hypertrophic cardiomyopathy (ApHCM) and apical displacement of papillary muscles (ADPM) are two different pathologies with a number of similar imaging findings that may hamper adequate diagnosis. While ApHCM is associated with increased rate of mortality, ADPM commonly presents with a benign course and differential diagnosis is of great importance. Clinical assessment and 2D echocardiography cannot sufficiently differentiate these conditions, however, and advanced echocardiographic methods may facilitate diagnosis. Although echocardiography is the first‐line imaging method in the diagnostic algorithm, cardiac magnetic resonance imaging (CMRI) is the gold standard for evaluating patients due to good spatial resolution and myocardial tissue characterization abilities. When CMRI is contraindicated, cardiac computed tomography may be an alternative reliable method that can also give information about the coronary anatomy. Nuclear imaging may also provide supplementary data regarding hypertrophy and coronary arteries when there is a suspicion of ischemia.     

Prevention of post-operative recurrence of Crohn’s disease

Endoscopic and clinical recurrence of Crohn’s disease(CD)is a common occurrence after surgical resection.Smokers,those with perforating disease,and those with myenteric plexitis are all at higher risk of recurrence.A number of medical therapies have been shown to reduce this risk in clinical trials.Metronidazole,thiopurines and anti-tumour necrosis factors(TNFs)are all effective in reducing the risk of endoscopic or clinical recurrence of CD.Since these are preventative agents,the benefits of prophylaxis need to be weighed-against the risk of adverse events from,and costs of,therapy.Patients who are high risk for post-operative recurrence should be considered for early medical prophylaxis with an anti-TNF.Patients who have few to no risk factors are likely best served by a three-month course of antibiotics followed by tailored therapy based on endoscopy at one year.Clinical recurrence rates are variable,and methods to stratify patients into high and low risk populations combined with prophylaxis tailored to endoscopic recurrence would be an effective strategy in treating these patients.