Nuestra experiencia con el uso de cierre asistido al vacío

La aplicación de niveles controlados de presión subatmosférica han demostrado acelerar el proceso de curación de las heridas, aplicando este concepto, mostramos nuestra experiencia de 10 años de uso de esta terapia (VAC. Vaccumm-assited closure system ) (Kinetic Concepts Inc., San Antonio TX).para tratamiento de diferentes tipos de heridas, a través de una revisión de casos interesantes. Se estudiaron 162 pacientes con heridas complejas agudas y/ o crónicas, que comprometían diferentes partes del cuerpo, en todos los pacientes se realizó desbridamiento radical antes de aplicar la terapia de cierre asistido al vacío, todos recibieron presión negativa de forma intermitente y controlada y los cambios de la curación se realizaron cada 4 a 5 días. El tratamiento duro como promedio 20 días, todos los pacientes que iniciaron la terapia con infección fueron curados al cabo de ella y no tuvimos complicaciones serias. En nuestra experiencia de 10 años en el país, (BOLIVIA) creemos que la terapia cierre asistido al vacío, es el tratamiento de elección para todas aquellas heridas complejas, infectadas y que requieran cobertura, ya que pudimos comprobar la efectividad del sistema en todos los pacientes tratados, pues es de conocimiento general y demostrado ampliamente en la litera- tura, que el sistema Cierre Asistido al Vacío (CAV), incrementa el flujo capilar, estimula la granulación disminuyendo el tiempo requerido para la curación.

Surgical Challenges of Chronic Empyema and Bronchopleural Fistula

Chronic empyema has always been a clinical challenge for physicians. There is no standard procedure or treatment to deal with the situation, and multi-modality approach is often necessary. Surgical intervention plays a very crucial role in the treatment of chronic empyema. Since bronchopleural fistula is often seen in chronic empyema patients, therefore it should also be mentioned. In this chapter, the focus will be on the different treatment options, various surgical approaches, and the rationale behind every single modality. Certain specific entity will be included as well, such as tuberculosis infection, post lung resection empyema, and intrathoracic vacuum assisted closure system application. Even with the advancement of technology and techniques, chronic empyema management is still evolving, and we look forward to less traumatic ways of approach with better outcome in the future.

Challenge of polymers for biosimilar products packaging

Presently Packaging plays a significant role for Biosimilar product. The process of selecting materials and the type of packaging also offers an opportunity for the Packaging scientist to look for new biological delivery choices. Most injectable protein products were supplied in some sort of glass vial, prefilled syringe, and cartridge. Those product having high Ph content there is a chance of “delamination “from inner surface of glass vial. With protein-based drugs, the biggest issue is the effect of packaging derivatives on the protein’s three-dimensional and surface structure. These are any effects that relate to denaturation or aggregation of the protein due to oxidation or interactions from contaminants or impurities in the preparation. The potential for these effects needs to be carefully considered in choosing the container and the container closure system to avoid putting patients in jeopardy.

Efficacy and Safety of Ultrasound-Guided Repeat Access and Repeat Closure With an ExoSeal Vascular Closure System in Patients With Peripheral Arterial Disease

Objective The purpose of this study was to evaluate the efficacy and safety of ultrasound-guided repeat access and repeat closure with an ExoSeal vascular closure system. Methods A total of 123 endovascular therapy (EVT) procedures were performed in 59 patients (65 limbs) with ultrasound-guided repeat access and repeat implantation of an ExoSeal vascular closure system between January 2019 and March 2021. The procedural details and postprocedural outcomes of EVT with repeat access and use of ExoSeal (RE group) were compared with those of EVT with initial use of ExoSeal (IE group) in the same patients. In a subgroup analysis, these outcomes were also compared in early repeat (within 3 months) and late repeat (over 3 months) cases. Results The technical success rate of ultrasound-guided access in the RE group was 100%. The procedural success rate of EVT and deployment success rate of ExoSeal in the RE group were 93% and 94%, respectively, which were not significantly different to those in the IE group. Access site complications in the RE group occurred in 2 cases (2%), again with no significant difference with the IE group. The median puncture, procedural, and hemostasis times in the RE group were 3 [2-5], 36.5 [29-54], and 7 [5-10] min, respectively, which were not significantly longer than those in the IE group. In the RE group, early and late repeat closure was performed in 66 (54%) and 57 (46%) cases, respectively, and there were no significant differences in the technical success of ultrasound-guided access, procedural success of EVT, deployment success of ExoSeal, and access site complication rates in these cases. Conclusions Ultrasound-guided access facilitated higher technical success of repeat access and fewer access site complications in EVT with repeat use of ExoSeal, regardless of the interval between procedures.

Closure System and Its Semantics

It is well known that topological spaces are axiomatically characterized by the topological closure operator satisfying the Kuratowski Closure Axioms. Equivalently, they can be axiomatized by other set operators encoding primitive semantics of topology, such as interior operator, exterior operator, boundary operator, or derived-set operator (or dually, co-derived-set operator). It is also known that a topological closure operator (and dually, a topological interior operator) can be weakened into generalized closure (interior) systems. What about boundary operator, exterior operator, and derived-set (and co-derived-set) operator in the weakened systems? Our paper completely answers this question by showing that the above six set operators can all be weakened (from their topological counterparts) in an appropriate way such that their inter-relationships remain essentially the same as in topological systems. Moreover, we show that the semantics of an interior point, an exterior point, a boundary point, an accumulation point, a co-accumulation point, an isolated point, a repelling point, etc. with respect to a given set, can be extended to an arbitrary subset system simply by treating the subset system as a base of a generalized interior system (and hence its dual, a generalized closure system). This allows us to extend topological semantics, namely the characterization of points with respect to an arbitrary set, in terms of both its spatial relations (interior, exterior, or boundary) and its dynamic convergence of any sequence (accumulation, co-accumulation, and isolation), to much weakened systems and hence with wider applicability. Examples from the theory of matroid and of Knowledge/Learning Spaces are used as an illustration.

An examination of best practices for mine site reclamation: an investigation of Ontario's recent environmental assessment cases where reclamation is expected

Mining can have significant public health and environmental consequences such as deforestation, waste rock deposition, and toxic mine effluents. Standards for reclamation of Ontario mine sites are not clear as there is no received model. A strong policy framework is essential to develop a mine closure system that protects the environment. An Environmental Assessment is the first stage for reclamation investigation. By setting standards for reclamation, projects that complete an Environmental Assessment will be better prepared to meet environmental protection objectives. Based on determined objectives, the best practice for mine site reclamations must include: restoration of soils, systematic revegetation, reclamation of water and wildlife restoration through habitat formation. Based on the results, Ontario is ahead of the provinces evaluated for environmental reclamation. None of the countries reviewed have a firm policy on reclamation. The results demonstrate a high number of reclamation components not being evaluated at the environmental assessment level.

An examination of best practices for mine site reclamation: an investigation of Ontario's recent environmental assessment cases where reclamation is expected

Mining can have significant public health and environmental consequences such as deforestation, waste rock deposition, and toxic mine effluents. Standards for reclamation of Ontario mine sites are not clear as there is no received model. A strong policy framework is essential to develop a mine closure system that protects the environment. An Environmental Assessment is the first stage for reclamation investigation. By setting standards for reclamation, projects that complete an Environmental Assessment will be better prepared to meet environmental protection objectives. Based on determined objectives, the best practice for mine site reclamations must include: restoration of soils, systematic revegetation, reclamation of water and wildlife restoration through habitat formation. Based on the results, Ontario is ahead of the provinces evaluated for environmental reclamation. None of the countries reviewed have a firm policy on reclamation. The results demonstrate a high number of reclamation components not being evaluated at the environmental assessment level.