No effect of albumin infusion on the prevention of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt

Hepatic encephalopathy (HE) is a major problem in patients submitted to TIPS. Previous studies identified low albumin as a factor associated to post-TIPS HE. In cirrhotics with diuretic-induced HE and hypovolemia, albumin infusion reduced plasma ammonia and improved HE. Our aim was to evaluate if the incidence of overt HE (grade II or more according to WH) and the modifications of venous blood ammonia and psychometric tests during the first month after TIPS can be prevented by albumin infusion. Twenty-three patients consecutively submitted to TIPS were enrolled and treated with 1 g/Kg BW of albumin for the first 2 days after TIPS followed by 0,5 g/Kg BW at day 4th and 7th and then once a week for 3 weeks. Forty-five patients included in a previous RCT (Riggio et al. 2010) followed with the same protocol and submitted to no pharmacological treatment for the prevention of HE, were used as historical controls. No differences in the incidence of overt HE were observed between the group of patients treated with albumin and historical controls during the first month (34 vs 31 %) or during the follow-up (39 vs 48 %). Two patients in the albumin group and three in historical controls needed the reduction of the stent diameter for persistent HE. Venous blood ammonia levels and psychometric tests were also similarly modified in the two groups. Survival was also similar. Albumin infusion has not a role in the prevention of post-TIPS HE

3D Printed Shape Matching Game

This is a project to help children learn their shapes and work on their memory. Based on the classic toy used by children, this is made with LED lights and mechanical movement to enhance the toy. Once the child correctly fits the shapes into each hole, the LEDs will start to blink colors to reinforce the child\u27s actions and to catch their eyes so they are motivated to continue to practice. Additionally, this toy features a mechanically operated drawer to provide easy access to the blocks once each is inserted into the hole. This is also a great method to avoid messes

The expression of inhibitor of bruton's tyrosine kinase gene is progressively up regulated in the clinical course of chronic lymphocytic leukaemia conferring resistance to apoptosis.

Chronic lymphocytic leukaemia (CLL) is the most common B-cell malignancy with a variable clinical outcome. Biomarkers of CLL progression are required for optimising prognosis and therapy. The Inhibitor of Bruton's tyrosine kinase-isoform α (IBTKα) gene encodes a substrate receptor of Cullin 3-dependent E3 ubiquitin ligase, and promotes cell survival in response to the reticulum stress. Searching for novel markers of CLL progression, we analysed the expression of IBTKα in the peripheral blood B-cells of CLL patients, before and after first line therapy causing remission. The expression of IBTKα was significantly increased in disease progression, and decreased in remission after chemotherapy. Consistently with a pro-survival action, RNA interference of IBTKα increased the spontaneous and Fludarabine-induced apoptosis of MEC-1 CLL cells, and impaired the cell cycle of DeFew B-lymphoma cells by promoting the arrest in G0/G1 phase and apoptosis. Consistently, RNA interference of IBTKα up regulated the expression of pro-apoptotic genes, including TNF, CRADD, CASP7, BNIP3 and BIRC3. Our results indicate that IBTKα is a novel marker of CLL progression promoting cell growth and resistance to apoptosis. In this view, IBTKα may represent an attractive cancer drug target for counteracting the therapy-resistance of tumour cells

Design of experiments and manufacturing design space for multi‐step processes

Most industrial processes are composed of multiple subsequent steps. In this article, we provide a statistical approach to design experiments and to define the manufacturing design space of multi-step processes by taking into account the complex system of interactions among steps. We consider each intermediate outcome as an additional input factor in the next step and we plan experiments following a particular sequential structure. To encompass the potential deviations from the target levels of such input factors, designs are selected according to the D-optimality in average criterion and, in order to assess their prediction capabilities, a suitable extension of the fraction of design space technique has been proposed. The manufacturing design space of the process is then defined by combining the interconnected manufacturing design spaces of the process steps and by deriving the linear combination of the process inputs that ensures the required quality standard for the final outcome. Appealing properties of this approach are also shown by the application to a three-steps biochemical process of expression and purification of a recombinant protein in which 10 input factors are included in the design

Second-generation long-acting injectable antipsychotics in schizophrenia: patient functioning and quality of life

Long-acting injectable antipsychotics (LAIs) were developed to make treatment easier, improve adherence, and/or signal the clinician when nonadherence occurs. Second-generation antipsychotic LAIs (SGA-LAIs) combine the advantages of SGA with a long-acting formulation. The purpose of this review is to evaluate the available literature concerning the impact of SGA-LAIs on patient functioning and quality of life (QOL). Although several studies regarding schizophrenia patients’ functioning and QOL have been performed, the quantity of available data still varies greatly depending on the SGA-LAI under investigation. After reviewing the literature, it seems that SGA-LAIs are effective in ameliorating patient functioning and/or QOL of patients with schizophrenia, as compared with placebo. However, while methodological design controversy exists regarding the superiority of risperidone LAI versus oral antipsychotics, the significant amount of evidence in recently published research demonstrates the beneficial influence of risperidone LAI on patient functioning and QOL in stable patients and no benefit over oral treatment in unstable patients. However, the status of the research on SGA-LAIs is lacking in several aspects that may help physicians in choosing the correct drug therapy. Meaningful differences have been observed between SGA-LAIs in the onset of their clinical efficacy and in the relationships between symptoms and functioning scores. Moreover, head-to-head studies comparing the effects of SGA-LAIs on classical measures of psychopathology and functioning are available mainly on risperidone LAI, while those comparing olanzapine LAI with other SGA-LAIs are still lacking. Lastly, some data on their use, especially in first-episode or recent-onset schizophrenia and in refractory or treatment-resistant schizophrenia, is available

Role of Mucosal Inflammation in Eosinophilic Esophagitis: Review of the Literature

Eosinophilic esophagitis (EE) is increasingly recognized in adults. It is an inflammatory disease of the esophageal mucosa, with variable presentation, unresponsive to acid suppression therapy. The diagnosis requires histological confirmation of intense eosinophilic infiltration on esophageal biopsy specimen, however exact criteria required to make a diagnosis of EE is still being debated and a clear differentiation from gastroesophageal reflux disease (GERD) is important. Allergen elimination or anti-inflammatory therapy may be effective in such patients. The imperfect diagnostic criteria for EE mandate an understanding of the immunology and the pathophysiology of the disease. It may facilitate the introduction of novel treatment modalities in an individual unresponsive to acid suppression therapy. This paper describes basic elements of the immune-mediated injury to the esophageal mucosa and management aspects to provide a better understanding of the condition

Accesibilidad aplicada a embarcaciones, caso de estudio Centro de Atención Ambulatoria Fluvial (CAAF)

Accessibility as a design concept is generally applied in land constructions; however, the medical character of the case study requires it to be considered in the design process as of its conceptual stage. The riverine ambulatory care center (RACC) is a mobile health unit to carry out medical missions in populations located on the riverbanks; given the RACC dimensions, these have limited medical services to primary care and health brigades. Physical barriers1 are the causes for an environment being inaccessible; to eliminate them, from the RACC, an analysis and redesign was performed of the conceptual proposal, based on standards for accessibility, medical spaces, and ships. Two basic moments were taken for intervention, access and interior circulation, yielding as a result the design of an integrated system of products that eliminate the physical barriers from the environment, permitting boarding and offering medical services under equal, comfortable, and safe conditions. Accessibility as modifier of the environment to improve the quality of life of users should not only be applied in medical ships, this study opens an opportunity for industry to optimize the physical environment of other types of ships by applying this concept.La accesibilidad como concepto de diseño se aplica generalmente en las construcciones en tierra, sin embargo, el carácter médico del caso de estudio requiere que sea considerado en el proceso de diseño desde su etapa conceptual. El Centro de Atención Ambulatoria Fluvial (CAAF) es una unidad sanitaria móvil para realizar misiones médicas en poblaciones ubicadas en la ribera de los ríos, por las dimensiones del CAAF han limitado los servicios médicos a atención primaria y brigadas de salud. Las barreras físicas1 son las causantes de que un entorno no sea accesible, para eliminarlas del CAAF, se realizó un análisis y rediseño de la propuesta conceptual, apoyado en la normativa para accesibilidad, espacios médicos y embarcaciones. Se tomaron dos momentos básicos a intervenir, el acceso y la circulación interior, dando como resultado el diseño de un sistema integrado de productos que eliminan las barreras físicas del entorno, permitiendo un abordaje y prestación de los servicios médicos en condiciones iguales, confortables y seguras. La accesibilidad como modificador del entorno para mejorar la calidad de vida de los usuarios no debe ser aplicado solamente en embarcaciones médicas, con este estudio se abre una oportunidad para la industria de optimizar el entorno físico de otros tipos de embarcaciones, por medio de la aplicación de este concepto

New insights into adaptive enrichment designs

The transition towards personalized medicine is happening and the new experimental framework is raising several challenges, from a clinical, ethical, logistical, regulatory, and statistical perspective. To face these challenges, innovative study designs with increasing complexity have been proposed. In particular, adaptive enrichment designs are becoming more attractive for their flexibility. However, these procedures rely on an increasing number of parameters that are unknown at the planning stage of the clinical trial, so the study design requires particular care. This review is dedicated to adaptive enrichment studies with a focus on design aspects. While many papers deal with methods for the analysis, the sample size determination and the optimal allocation problem have been overlooked. We discuss the multiple aspects involved in adaptive enrichment designs that contribute to their advantages and disadvantages. The decision-making process of whether or not it is worth enriching should be driven by clinical and ethical considerations as well as scientific and statistical concerns