Early endoscopic treatment of symptomatic pancreatic necrotic collections

EUS-guided transmural endoscopic drainage is commonly used in the treatment of WOPN in the late phase of ANP. The role of endoscopic intervention remains unclear in the early phase of ANP. This study aimed to prospectively evaluate early endoscopic treatment of ANCs compared with endoscopic drainage of WOPN. Overall, 71 patients with ANP who underwent transmural endoscopic drainage for necrotic collections were included. Endoscopic intervention was performed within the first four weeks of ANP in 25 (35.21%) patients with ANC (Group 1) and in 46 (64.79%) patients after four weeks since the onset of ANP with WOPN (Group 2). The overall mean age of patients was 49.9 (22–79) years and 59 of them were males. The mean time of active drainage and duration of total endoscopic treatment was 26.8 and 16.9 days (P = 0.0001) and 270.8 and 164.2 days (P = 0.0001) in Groups 1 and 2, respectively. The average total number of endoscopic interventions was 9.5 and 4.5 in Groups 1 and 2, respectively (P = 0.0001). The clinical success rate, frequency of complications of endoscopic interventions, long-term success rate, and recurrence rate were not significantly different between the groups (P > 0.05 for each). Transmural endoscopic drainage is effective method of treatment of early ANCs within the first four weeks of ANP. However, compared with endoscopic intervention in WOPN, more interventions and longer duration of drainage are required.

Microfluidic Bioreactor Made of Cyclo-Olefin Polymer for Observing On-Chip Platelet Production

We previously proposed a microfluidic bioreactor with glass–Si–glass layers to evaluate the effect of the fluid force on platelet (PLT) production and fabricated a three-dimensional (3D) microchannel by combining grayscale photolithography and deep reactive ion etching. However, a challenge remains in observing the detailed process of PLT production owing to the low visibility of the microfluidic bioreactor. In this paper, we present a transparent microfluidic bioreactor made of cyclo-olefin polymer (COP) with which to observe the process of platelet-like particle (PLP) production under a bright-field, which allows us to obtain image data at a high sampling rate. We succeeded in fabricating the COP microfluidic bioreactor with a 3D microchannel. We investigated the bonding strength of COP-COP layers and confirmed the effectiveness of the microfluidic bioreactor. Results of on-chip PLP production using immortalized megakaryocyte cell lines (imMKCLs) derived from human-induced pluripotent stem cells show that the average total number of produced PLPs per imMKCL was 17.6 PLPs/imMKCL, which is comparable to that of our previous glass–Si–glass microfluidic bioreactor (17.4 PLPs/imMKCL). We succeeded in observing PLP production under a bright-field using the presented microfluidic bioreactor and confirmed that PLP fragmented in a narrow area of proplatelet-like protrusions.

190 THE USEFULNESS OF A BILATERAL TRANS-CERVICAL PNEUMOMEDIASTINAL APPROACH FOR MEDIASTINOSCOPIC RADICAL ESOPHAGECTOMY

Several authors have reported on the left trans-cervical and transhiatal approaches under pneumomediastinum and right cervical open surgery for mediastinoscopic esophagectomy. However, with these approaches, sufficient dissection of the right upper mediastinal paraesophageal lymph nodes, right recurrent nerve lymph nodes and the subaortic arch to the left tracheobronchial lymph nodes is thought to be difficult. We herein report the usefulness of the ‘bilateral’ trans-cervical pneumomediastinal approach. Methods Ten patients with thoracic esophageal cancer were treated using this approach. Under pneumomediastinum via a right neck incision, the right cervical and upper mediastinal paraesophageal lymph nodes were dissected. The left recurrent nerve lymph nodes were dissected using a left trans-cervical pneumomediastinal approach. The subaortic arch to the left tracheobronchial lymph nodes was dissected with a combined right and left trans-cervical crossover approach. After this approach, thoracoscopic observation was then performed in the left decubitus position, and if the lymph nodes were not sufficiently dissected, the remnant lymph nodes were retrieved thoracoscopically. Results The average total number of dissected lymph nodes among the right cervical and upper mediastinal paraesophageal lymph nodes identified with a right cervical open/right trans-cervical mediastinoscopic/right thoracoscopic approach was 3.2/4.0/0.6, respectively. The average total number of dissected lymph nodes among the subaortic arch to the left tracheobronchial lymph nodes with a right trans-cervical mediastinoscopic/right thoracoscopic approach was 1.5/0.6, respectively. These findings indicate that, without the right trans-cervical pneumomediastinal approach, roughly four of the right cervical and upper mediastinal paraesophageal lymph nodes and one or two of the subaortic arch to the left tracheobronchial lymph nodes could not have been retrieved. Conclusion A bilateral trans-cervical pneumomediastinal approach is useful for achieving sufficient upper mediastinal lymph node dissection and esophagectomy.

Monoclonal antibodies for cancerous conditions in essential medicine list: An experience from a tertiary hospital in Bengaluru, India

Globally, cancer is emerging as a major public health problem. Monoclonal antibodies are extensively used for cancerous conditions at tertiary hospitals. Many of these are not easily available for patients seeking treatment from public sector. It is difficult for poor patients to afford these drugs on individual basis.The aim of our study is to calculate the prescribed daily dose of monoclonal antibody in cancerous conditions, to know the number of monoclonal antibody present in the essential drug list and to know the average total number of drugs prescribed in generic names. The average dose of the monoclonal antibody used is calculated and the common conditions for which it is used is tabulated and the drug usage is noted for both genders. The number monoclonal antibody present in the list of essential medicine of India and WHO is compared. The average total number of drugs prescribed in generic names is calculated.Average prescribed dose calculated was 382 mg for Trastuzumab, 455mg for rituximab. Only a few monoclonal antibodies were found in who essential drug. Only Trastuzumab and rituximab monoclonal antibody were found in the essential drug list of India. While, Trastuzumab is the most commonly (61%) prescribed drug in the generic form. The study concludes that Trastuzumab is the commonly used monoclonal antibody followed by Rituximab and Bevacizumab. Only Trastuzumab and rituximab were found in Indian essential drug list. Measures for Inclusion of other monoclonal anti bodies can be made by the policy decisions.

Shifts in antimalarial drug policy since 2006 have rapidly selected P. falciparum resistance alleles in Angola

ABSTRACTBACKGROUNDPlasmodium falciparum resistance to chloroquine (CQ), the most widely used antimalarial drug, has historically posed a major threat to malaria control in Angola and throughout the world. Although Angola replaced CQ with artemisinin combination therapy (ACT) as a frontline treatment in 2006, malaria cases and deaths have recently been rising. CQ-resistance mutations may still be a contributing factor, given that (1) some also modulate resistance to ACT partner drugs and (2) ACT is not yet consistently implemented across Angola. It is important to continue monitoring all known resistance alleles in P. falciparum, but no studies have done so in Angola since 2012.METHODSWe sampled P. falciparum DNA from the blood of 50 hospital patients in Cabinda, Angola in 2018. Each infection was genotyped for 13 alleles in the genes crt, mdr1, dhps, dhfr, and kelch13, which collectively confer resistance to six common drugs. To analyze frequency trajectories over time, we also collated P. falciparum genotype data published from across Angola in the last two decades.RESULTSThe two most important alleles for CQ resistance, crt 72-76CVIET and mdr1 86Y, have both declined in frequency from respective highs of 98% in 1999 and 73% in 2003. However, the former remains at 71% frequency in this sample while the latter has dropped to just 7%. Of seven possible alleles for sulfadoxine-pyrimethamine (SP) resistance in dhps and dhfr, the average total number per isolate increased from 2.9 in 2004 to 4.4 in 2018. Finally, we detected no non-synonymous polymorphisms in kelch13, which is involved in artemisinin resistance in Southeast Asia.CONCLUSIONSChanges in drug policy in Angola since 2006 appear to have exerted strong selection on P. falciparum drug resistance alleles. Resistance to CQ is declining, but due to functional tradeoffs and novel selection at mdr1 loci, resistance to ACT partner drugs appears to be rising. More haplotype-based studies at mdr1 will be needed to understand the changing efficacy of multiple drugs. Finally, SP resistance has jumped rapidly since 2014, consistent with widespread use of intermittent SP treatment during pregnancy. These data can be used to support effective drug policy decisions in Angola.

A Wound Treatment Strategy for “Super Long-Term Difficult-to-Heal Wounds”: A Single-Center Retrospective Study

Chronic wounds are a challenge for clinicians. Treating chronic wounds in elderly patients is difficult due to comorbidities and poor immunity, tissue renewal, and regeneration. This study shared the therapeutic experiences of 40 patients with super long-term difficult-to-heal wounds and to describe the effects of negative pressure wound therapy (NPWT)-assisted debridement and autologous scalp grafting. Elderly patients with chronic wounds for more than 60 years who underwent NPWT-assisted debridement and autologous scalp grafting between 2015 and 2017 were retrospectively analyzed. Forty patients were identified and analyzed. Among all patients, the average wound area was 56 (interquartile range 30-90) cm2. The wound infection rate was 82.1%, and that before the first autologous scalp grafting was 51.3%. The average total number of surgeries was 3, and the number of times the NPWT device was replaced was once. A total of 97.4% of patients had one autologous scalp grafting performed. The transplanted scalp survived completely in 97.4% of patients. One hundred percent of patients had no postoperative complications and healed. The average wound healing time was 34.5 ± 10.1 days. This study showed that NPWT-assisted debridement and autologous scalp grafting have the advantages of high survival rate of the skin and decreased wound recurrence and may be a suitable treatment for super long-term difficult-to-heal wounds in elderly patients.

What Can We Learn from Burkina Faso COVID-19 Data? Using Phenomenological Models to Characterize the Initial Growth Dynamic of the Outbreak and to Generate Short-Term Forecasts

On 9 March 2020, two cases of COVID-19 were reported in Burkina Faso. As of 10 April 2020, a total number of 484 cases (404 cases in the Kadiogo province) were reported nationwide. Real-time forecasts of COVID-19 are important to inform decision-making in the country. Here, we propose an approach that tests the performance of four models (Exponential Growth model, the Generalized Growth model (GGM), the Generalized Logistic Growth, and Richards Growth model) to select the model that best fit data and to generate short-term forecasting (5-, 10-, and 15-day forecasts from 11 to 25 April 2020) in Kadiogo, the epicenter of the outbreak. Using daily number of confirmed COVID-19 cases, the results suggests that GGM performed the best out of the 4 models. Overall, our GGM predictions suggested an average total number of cumulative cases of 514 (95% CI, 464–559), 629 (95% CI, 559–691), and 750 (95% CI, 661–840) between 11 to 15 April, 16 to 20 April, and 20 to 25 April 2020, respectively. COVID-19 in this province was best approximated by sub exponential growth rather than exponential or logistic growth. Current data suggest that COVID-19 cases would continue to increase over the next 15-days.

Evaluation of The Number of Rainy Days Observed for Long Years Due to Global Climate Change in Nevşehir /Turkey

In this research caried out Nevsehir province, Avanos and Ürgüp districts of Turkey's Central Anatolia Nevsehir. In the study, it is aimed to reveal the trends of years by changing the number of long year total rainy days by Mann Kendall and Sperman's Rho correlation tests. Within the scope of the study, 34 years long total monthly rainy days data between 1986-2019, which were obtained from automatic meteorology stations, were evaluated. According to the results of the trend analysis, the average total number of rainy days in Nevşehir province was 77 days minimum, the maximum number of rainy days was 142 days, and the average of the average number of rainy days was 109 days. In Avanos district, the average number of rainy days for a long time was 57 days, and the maximum number of rainy days was 129 days, while the average of the number of rainy days for long years was 89 days. In Ürgüp district, the average number of rainy days for a long time was 65 days, the maximum number of rainy days was 129 days, and the average of the number of rainy days for long years was 95 days. As a result, considering the number of long year rainy days, it is concluded that there is no significant trend in Nevşehir province, Avanos and Ürgüp district stations.

Quantifying disruption of workflow by phone calls to the neuroradiology reading room

IntroductionThe purpose of this study was to understand the source and the reason for the phone calls to our neuroradiology suit and to quantify the size of the problem in terms of duration of individual and aggregated calls.Materials and methodsObservation of the neuroradiology reading room for the entire duration of the working hours over three non-consecutive days was performed, and included telephone calls start time, end time and calls duration for incoming telephone calls. After each phone call the recipients were queried on the details of the phone call; the origin of the call, the reason for the call and the response.ResultsThe average total number of minutes (min) spent on the phone each day was 64 min per working day with a total of 39 phone calls per day and 4.4 per hour on average. The trainees answered 71% of the phone calls with additional intervention by attending in 13% of phone calls. The most common source of phone calls was from either the MRI/CT technicians (48%), followed by providers (20%) and returning pages (18%).ConclusionCumulative time spent on the phone by neuroradiologists in the reading room ended up in more than an hour per working day, while trainees were taking the majority of phone calls. Most phone calls originated from technicians, hence, requiring specific solutions to mitigate this kind of interruption.

ASSESSMENT OF THE STRUCTURAL RELIABILITY OF TELECOMMUNICATION NETWORKS OF UNCERTAIN TOPOLOGY BASED ON IMITATION MODELING

This article is devoted to the analysis of existing and the development of new approaches to assess the structural reliability of networks with an uncertain topology. Ensuring reliability in modern telecommunication networks is becoming an increasingly important issue in connection with the intensive development of these networks over the past decade. Existing structural methods for evaluating reliability are focused on applications for networks with a known structure. However, in cases where the network topology is constantly changing, these methods are of little use. Therefore, an approach is proposed for obtaining estimates of the structural reliability of telecommunication networks with an uncertain topology based on the use of basic structural characteristics alone. The developed method for assessing the reliability of telecommunication networks with an uncertain topology is presented, which provides the ability to determine: the total number of routes in the network with a certain number of nodes and branches; the number of routes per one connection, as well as the number of routes of rank no more than the allowable value that can be used for one connection. The upper limit of the structural reliability of individual connections are determined by the routes obtained for each connection), on the basis of which the structural reliability of a network with an uncertain topology is evaluated. A simulation computer model has been created for assessing the structural reliability of a telecommunication network with an uncertain topology, which consists of a computer model that empirically estimates the number of routes in various implementations of obtaining indicators of the structural reliability of communication between a pair of nodes and the entire network as a whole. A simulation experiment of computer modeling with given structural characteristics consists of a series of tests, in each of which a specific random implementation of a network graph is generated and all the routes existing in it are searched. The article presents the main functions and components of the developed software system, the figures show the modules and the basic algorithms of the model. Interfaces for inputting initial data and for outputting simulation results in the form of values ​​of the number of routes based on the results of simulation experiments and corresponding graphs are demonstrated. A separate important issue that is solved in the simulation is the determination of a sufficient number of tests in an experiment. The criterion for assessing this modeling parameter was the deviation dynamics of the average total number of routes of ranks 1 through 4 obtained in the tests.