Treatment Concept
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Metals ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 1612
Author(s):  
Markus Härtel ◽  
Alisa Wilke ◽  
Sebastian Dieck ◽  
Pierre Landgraf ◽  
Thomas Grund ◽  
...  

Over the last years heat treatment concept of “quenching and partitioning” (Q&P) has reached popularity for its ability to precisely adjust material properties to desired values. Mostly, Q&P process are applied on tailor-made materials with high purities or prototype alloys. The research in hand presents the whole routine of how to investigate the potential of a commercial 0.54C-1.45Si-0.71Mn spring steel in terms of Q&P heat treatment from lab scale in dilatometer measurements to widely used inductive heat treatment on larger scale. In order to obtain the small process window for this material we were focusing on the interplay of the formed microstructure and the resulting mechanical properties in hardness measurements, compression tests as well as tensile tests. After full austenitizing, three different Q&P processing routes were applied. Microstructural analyses by optical microscopy, Scanning Electron Microscopy (SEM) and Electron Backscatter Diffraction (EBSD) exhibit a condition with 6.4 % and 15 % volume fraction of fine distributed retained austenite. Interestingly, the 15 % of retained austenite developed during the partitioning heat treatment. Contradictory to our expectations, tensile and compression testing were showing that the 6.4 % condition achieved improved mechanical properties compared to the 15 % retained austenite condition. The remarkable conclusion is that not only volume fraction and fine distribution of retained austenite determines the potential of improving mechanical properties by Q&P in commercial alloys: also the process step when the retained austenite is developing as well as occurring parallel formation of carbides may strongly influence this potential.


Heart ◽  
2021 ◽  
pp. heartjnl-2021-320054
Author(s):  
Shichao Lv ◽  
Yunjiao Wang ◽  
Wanqin Zhang ◽  
Hongcai Shang

Heart failure (HF) is a clinical syndrome in the late stage of cardiovascular disease and is associated with high prevalence, mortality and rehospitalisation rate. The pathophysiological mechanisms of HF have experienced the initial ‘water-sodium retention’ mode to ‘abnormal hemodynamics’ mode, and subsequent to ‘abnormal activation of neuroendocrine’ mode, which has extensively promoted the reform of HF treatment and updated the treatment concept. Since the Human Microbiome Project commencement, the study on intestinal microecology has swiftly developed, providing a new direction to reveal the occurrence of diseases and the mechanisms behind drug effects. Intestinal microecology comprises the gastrointestinal lumen, epithelial secretion, food entering the intestine, intestinal flora and metabolites. Choline and L-carnitine in the diet are metabolised to trimethylamine (TMA) by the intestinal micro-organisms, with TMA being absorbed into the blood. TMA then enters the liver through the portal vein circulation and is oxidised to trimethylamine oxide (TMAO) by the hepatic flavin-containing mono-oxygenase (FMO) family, especially FMO3. The circulating TMAO levels are associated with adverse outcomes in HF (mortality and readmission), and lower TMAO levels indicate better prognosis. As HF progresses, the concentration of TMAO in patients gradually increases. Whether the circulating TMAO level can be decreased by intervening with the intestinal microflora or relevant enzymes, thereby affecting the prognosis of patients with HF, has become a research hotspot. Therefore, based on the HF intestinal hypothesis, exploring the treatment strategy for HF targeting the TMAO metabolite of the intestinal flora may update the treatment concept in HF and improve its therapeutic effect.


Homeopathy ◽  
2021 ◽  
Author(s):  
Yola Moride

Abstract Background  EPI3 is an observational study of a representative sample of general practitioners (GPs) and patients in France, demonstrating that patient characteristics differ according to the prescribing preferences of their GPs for homeopathy. For selected conditions (musculoskeletal disorders, sleep disorders, anxiety/depression, upper respiratory tract infections), progression of symptoms and adverse events over follow-up in the homeopathy preference group did not significantly differ from other practice preferences, but there was a two-fold to four-fold lower usage of conventional medicines. The EPI3 study's validity was challenged due to absence of head-to-head comparison of medicines to conclude on a causal association between homeopathy and outcomes. Methods A critical review of the nine EPI3 publications was conducted, focusing on generalizability, selection bias, outcome measurements and confounding. Results The conceptual framework of EPI3 rests on a systemic construct, i.e., the homeopathic treatment concept assessed using the type of GP prescribing preference, taking into account the clinical, human and social aspects. The enrollment process enhanced the generalizability of findings. Validated instruments for outcome measurements were used for three conditions, and control of confounding was rigorous. Conclusion EPI3 was conducted according to best practices. Homeopathy prescribing preference met specific patient needs with less use of conventional medicines and without an apparent loss in therapeutic opportunity.


2021 ◽  
pp. 1-6
Author(s):  
Tim Brandenburg ◽  
Philipp Muchalla ◽  
Sarah Theurer ◽  
Kurt Werner Schmid ◽  
Dagmar Führer

<b><i>Introduction:</i></b> Primary squamous cell carcinoma (PSCC) of the thyroid is an exceptionally rare malignancy accounting for &#x3c;1% of all primary thyroid cancers. Therapy is multimodal including surgery, radiotherapy, and chemotherapy but with no consensus for management and therapy. Here, we describe a case of a male patient who presented with a BRAF V600E-mutated PSCC of the thyroid gland showing response to combined dabrafenib and trametinib therapy over a period of &#x3e;12 months. <b><i>Case Presentation:</i></b> A 78-year-old male patient presented with a 3-week history of dysphonia and dyspnoea. Laryngoscopy revealed a mechanical obstruction by a right-sided, subglottical mass, which on cervical ultrasound was highly suggestive of anaplastic thyroid carcinoma. Additional workup including esophagogastroduodenoscopy showed compression of the oesophagus but no oesophageal infiltration by the tumour. Immunohistochemistry displayed CK19-positive cells indicating epithelial origin of the tumour. CK5/6 and P40 immunohistochemistry confirmed the morphological impression of squamous cell differentiation while staining with thyroid markers TTF-1 and TPO was negative and PAX8 showed a nuclear positive signal. Based on immunohistopathology, presence of TP53 and BRAF V600E mutations, and exclusion of metastatic squamous cell carcinoma of other origin, the diagnosis of a PSCC of the thyroid was established. As an individualized treatment concept, we decided to advocate combined BRAF V600E targeting by the multikinase inhibitors dabrafenib and trametinib. This led to drastic improvement in patient’s quality of life without severe side effects over a period of &#x3e;12 months. <b><i>Conclusion:</i></b> In this case, molecular diagnosis allowed a highly individualized treatment concept with combined dabrafenib and trametinib therapy.


2021 ◽  
Author(s):  
Thomas Kleemann ◽  
Eleni Lampropoulou ◽  
Kleopatra Kouraki ◽  
Margit Strauss ◽  
Andràs Fendt ◽  
...  

Antibiotics ◽  
2021 ◽  
Vol 10 (8) ◽  
pp. 998
Author(s):  
Johannes Spille ◽  
Juliane Schulz ◽  
Dorothee Cäcilia Spille ◽  
Hendrik Naujokat ◽  
Henning Wieker ◽  
...  

The objective of the current study is to retrospectively evaluate animal-bite injuries and to gain insight into the epidemiology, accident consequences and treatment concept of these accidents in oral and maxillofacial surgery. Data of patients, who were admitted January 2015 and April 2021, were retrospectively evaluated regarding the patients’ characteristics (age, gender), facial distribution of substance defects/partial amputations, duration of hospitalization, operation treatments and antibiotic treatments. Data of 75 patients were included. Patients were bitten by dogs (n = 69.92%), cats (n = 4) and horses (n = 2). Lower eyelid/cheek complex was the most affected region (n = 37, 32.74%). Most of the patients between 0 and 3 years had to be operated on under general anesthesia (p = 0.011), while most of the adults could be operated on under local anesthesia (p = 0.007). In the age group 0–12 years, 30 patients (68%) were operated on under general anesthesia. Ampicillin/Sulbactam (48%) was the antibiotic most used. Antibiotics were adjusted after wound swabs in case of wound infections or critical wound conditions. This means that resistant antibiotics were stopped, and sensitive antibiotics were used. Structured surgical and antibiotic management of animal-bite wounds in the maxillofacial region is the most important factor for medical care to avoid long-term aesthetic consequences. Public health actions and policies under the leadership of an interdisciplinary committee could improve primary wound management, healing outcome and information status in the general population.


Cells ◽  
2021 ◽  
Vol 10 (8) ◽  
pp. 2110
Author(s):  
Masashi Fujitani ◽  
Yoshinori Otani ◽  
Hisao Miyajima

The 20–60 μm axon initial segment (AIS) is proximally located at the interface between the axon and cell body. AIS has characteristic molecular and structural properties regulated by the crucial protein, ankyrin-G. The AIS contains a high density of Na+ channels relative to the cell body, which allows low thresholds for the initiation of action potential (AP). Molecular and physiological studies have shown that the AIS is also a key domain for the control of neuronal excitability by homeostatic mechanisms. The AIS has high plasticity in normal developmental processes and pathological activities, such as injury, neurodegeneration, and neurodevelopmental disorders (NDDs). In the first half of this review, we provide an overview of the molecular, structural, and ion-channel characteristics of AIS, AIS regulation through axo-axonic synapses, and axo−glial interactions. In the second half, to understand the relationship between NDDs and AIS, we discuss the activity-dependent plasticity of AIS, the human mutation of AIS regulatory genes, and the pathophysiological role of an abnormal AIS in NDD model animals and patients. We propose that the AIS may provide a potentially valuable structural biomarker in response to abnormal network activity in vivo as well as a new treatment concept at the neural circuit level.


Author(s):  
Masashi Fujitani ◽  
Yoshinori Otani ◽  
Hisao Miyajima

The 20&ndash;60-&mu;m axon initial segment (AIS) is proximally located at the interface between the axon and cell body. AIS has characteristic molecular and structural properties regulated by the crucial protein, ankyrin-G. The AIS contains a high density of Na+ channels relative to the cell body, which allows low thresholds for initiation of action potential (AP). Molecular and physiological studies have shown that the AIS is also a key domain for the control of neuronal excitability by homeostatic mechanisms. The AIS has high plasticity in normal developmental processes and pathological activities such as injury, neurodegeneration, and neurodevelopmental disorders (NDDs). In the first half of this review, we provide an overview of the molecular, structural, and ion-channel characteristics of AIS, AIS regulation through axo-axonic synapses, and axo-glial interactions. In the second half, to understand the relationship between NDDs and AIS, we discuss the activity-dependent plasticity of AIS, the human mutation of AIS regulatory genes, and the pathophysiological role of the abnormal AIS in the NDD model animals and patients. We propose that AIS may provide a potentially valuable structural biomarker in response to abnormal network activity in vivo as well as a new treatment concept at the neural circuit level.


Author(s):  
Hian Parize ◽  
Christian Coachman ◽  
Maurice Salama ◽  
Newton Sesma ◽  
Lauren Bohner

The esthetic rehabilitation of anterior ridge defects and the achievement of patient satisfaction has become major clinical challenges for dentists and technicians. Poor diagnosis and treatment planning are frequently associated with multiple surgical procedures which fail to meet patient expectations. The loss of hard and soft tissues in esthetic compromised zone is commonly associated with anterior ridges and affects the rehabilitation prognosis. The presence of interdental papilla and papillary configuration play a decisive role in patient satisfaction. A treatment planning considering esthetic parameters, prosthetic needs, and morphological defects must be conducted to improve treatment outcomes. Therefore, this study aims to propose a treatment concept for anterior ridge defects focusing on digital evaluation systems and guided by an ideal facially driven smile design project. In addition, the relevance of the papilla for the esthetic outcomes and the treatment alternatives for anterior ridge defects are also addressed.


Author(s):  
Angela Zedda ◽  
Yan Huo ◽  
Mads Kronborg ◽  
Stefan Ulbrich ◽  
Julia Mayer ◽  
...  

Background - Atrial fibrillation (AF) ablation in an end-stage left atrial (LA) fibrotic disease is more complex, has more recurrences and may compromise transport function and stroke risk. We explored whether a total left atrial isolation procedure (TLAI) followed by left atrial appendage occlusion (LAAO) is a feasible treatment concept for rhythm and stroke risk control. Methods - Symptomatic AF patients with extended LA fibrosis were enrolled consecutively for TLAI followed by LAAO. At enrollment all patients received a sinus rhythm LA voltage map. For TLAI, LA anterior and paraseptal ablation lines were placed, combined with right atrial and epicardial line completion and right pulmonary vein isolation - as needed. Rhythm follow-up was provided through continuous monitoring using implantable cardiac devices. Results - 92 patients (71±9y, 41% male, 84% persistent AF, CHA 2 DS 2 -VASc 4) underwent 104 ablation procedures. Follow-up duration measured 48±22 months. At 12-month follow-up 70 out of 92 (76%) patients were free from any atrial arrhythmia recurrence, off antiarrhythmic drugs. All intended LAAO procedures were successfully performed 6-8 weeks after TLAI. Combination of TLAI and LAAO attenuated the native 4% annual stroke risk to <1% over the entire course of the study. Patients' clinical AF and heart failure symptoms (EHRA and NYHA classification) significantly improved and remained stable during further follow-up. Invasive hemodynamic assessment as well as echocardiographic transport function analysis did not show evidence of detrimental hemodynamic effects of the treatment concept. Conclusions - This is the first report on a structured concept of interventional electrical LA isolation and LA appendage occlusion for rhythm and stroke risk control in AF patients at an end-stage left atrial fibrotic disease. We report feasibility, safety, and efficacy of such a treatment approach.


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