BACKGROUND Tracheostomy is commonly used in intensive care unit(ICU)patients who are expected to be on long-term mechanical ventilation or suffer from emergency upper airway obstruction.However,some studies have confl...BACKGROUND Tracheostomy is commonly used in intensive care unit(ICU)patients who are expected to be on long-term mechanical ventilation or suffer from emergency upper airway obstruction.However,some studies have conflicting findings regarding the optimal technique and its timing and benefits.AIM To provide evidence of practice,characteristics,and outcome concerning tracheostomy in an ICU of a tertiary care hospital.METHODS This was a retrospective cohort study including adult critical care patients in a single ICU for two consecutive years.Patients’demographic characteristics,severity of illness(APACHE II score),level of consciousness[Glasgow Coma Scale(GCS)],comorbidities,timing and type of tracheostomy procedure performed and outcome were recorded.We defined late as tracheostomy placement after 8 days or no tracheotomy.RESULTS Data of 660 patients were analyzed(median age of 60 years),median APACHE II score of 19 and median GCS score of 12 at admission.Tracheostomy was performed in 115 patients,of whom 63 had early and 52 late procedures.Early tracheostomy was mainly executed in case of altered level of consciousness and severe critical illness polyneuromyopathy,however there were no significant statistical results(47.6%vs 36.5%,P=0.23)and(23.8%vs 19.2%,P=0.55)respectively.Regarding the method selected,early surgical tracheostomy(ST)was conducted in patients with maxillofacial injuries(50.0%vs 0.0%,P=0.033),whereas late surgical tracheostomy was selected for patients with goiter(44.4%vs 0.0%P=0.033).Patients with early tracheostomy spent significantly fewer days on mechanical ventilation(15.3±8.5 vs 22.8±9.6,P<0.001)and in ICU in general(18.8±9.1 vs 25.4±11.5,P<0.001).Percutaneous dilatation tracheostomy(PDT)vs ST was preferable in older critical care patients in the case of Central Nervous System underlying cause of admission(62.5%vs 26.3%,P=0.004).ST was the method of choice in compromised airway(31.6%,vs 7.3%P=0.008).A large proportion of patients(88/115)with tracheostomy managed to wean from mechanical ventilation and were transferred out of the ICU(100%vs 17.4%,P<0.001).CONCLUSION PDT was performed more frequently in our cohort.This technique did not affect mechanical ventilation days,ventilator-associated pneumonia(VAP),ICU length of stay,or survival.No complications were observed in the percutaneous or surgical tracheostomy groups.Patients undergoing early tracheostomy benefited in terms of mechanical ventilation days and ICU length of stay but not of discharge status,presence of VAP,or survival.展开更多
Primary gastric lymphomas(PGLs)are distinct lymphoproliferative neoplasms described as heterogeneous entities clinically and molecularly.Their main histological types are diffuse large B-cell lymphoma(DLBCL)or mucosaa...Primary gastric lymphomas(PGLs)are distinct lymphoproliferative neoplasms described as heterogeneous entities clinically and molecularly.Their main histological types are diffuse large B-cell lymphoma(DLBCL)or mucosaassociated lymphoma tissue.PGL has been one of the main fields of clinical research of our group in recent years.Although gastric DLBCLs are frequent,sufficient data to guide optimal care are scarce.Until today,a multidisciplinary approach has been applied,including chemotherapy,surgery,radiotherapy or a combination of these treatments.In this minireview article,we provide an overview of the clinical manifestations,diagnosis and staging of these diseases,along with their molecular pathogenesis and the most important related clinical published series.We then discuss the scientific gaps,perils and pitfalls that exist regarding the aforementioned studies,in parallel with the unmet need for future research and comment on the proper methodology for such retrospective studies.Aiming to fill this gap,we retrospectively evaluated the trends in clinical presentation,management and outcome among 165 patients with DLBCL PGL who were seen in our institutions in 1980-2014.The study cohort was divided into two subgroups,comparing the main 2 therapeutic options[cyclophosphamide doxorubicin vincristine prednisone(CHOP)vs rituximab-CHOP(R-CHOP)].A better outcome with immunochemotherapy(R-CHOP)was observed.In the next 2 mo,we will present the update of our study with the same basic conclusion.展开更多
BACKGROUND Anastomotic leak constitutes a major problem in abdominal surgery.Technical insufficiency,topical or systemic factors contribute to disrupted healing of the performed bowel anastomosis and result in anastom...BACKGROUND Anastomotic leak constitutes a major problem in abdominal surgery.Technical insufficiency,topical or systemic factors contribute to disrupted healing of the performed bowel anastomosis and result in anastomosis leakage,with detrimental effects on patient postoperative outcomes.Despite the investigation of several factors and the invention of protective materials,the ideal agent to prevent anastomotic leaks is yet to be determined.AIM To study the effect of platelet rich plasma(PRP)on the healing of bowel anastomoses.METHODS A systematic literature search was performed in PubMed,EMBASE,and Scopus databases to identify studies investigating the effect of PRP application on bowel anastomosis.RESULTS Eighteen studies were eligible with a total population of 712 animals including rats(14 studies),rabbits(2 studies)and pigs(2 studies).No postoperative complications were reported following PRP application.Fourteen out of 18 studies reported a statistically significant higher anastomosis bursting pressure in PRP groups compared to control either in healthy animals or animal models with underlying condition or intervention,such as intraperitoneal chemotherapy or peritonitis.Similar results were reported by ten studies in terms of tissue hydroxyproline levels.One study reported significant increase in collagen deposition in PRP groups.PRP application resulted in significantly decreased inflammatory cell infiltration in the presence of peritonitis or intraperitoneal chemotherapy(6 studies).CONCLUSION The application of PRP is associated with improved bowel anastomosis outcomes,especially in animal models having an underlying condition affecting the normal healing process.PRP application seems to augment the normal healing process under these circumstances.However,further studies are needed to investigate the potential role of PRP on bowel anastomosis healing,especially in clinical settings.展开更多
The scope of this study is to investigate flanking noise transmission through joints between prefabricated concrete elements in Hellenic school buildings;such joints apparently are non-existent in the wholesome struct...The scope of this study is to investigate flanking noise transmission through joints between prefabricated concrete elements in Hellenic school buildings;such joints apparently are non-existent in the wholesome structure of ordinary concrete buildings.Sound insulation measurements were carried out in two prefabricated concrete buildings of the cell type;the latter involves demountable/reusable concrete elements(the cells);in this case,apparently,flanking noise transmission at joints,may be even more pronounced.A sample of seventeen fa?ade and interior partitions of classrooms was tested.Sound insulation was also predicted based on classical theory.Analysis of the measured data confirms,by and large,the satisfactory sound insulation performance of the test partitions,with the exception of composite partitions which involve door and window openings.The latter were identified to be a major source of sound insulation deterioration.The importance of meticulous sealing of joints is demonstrated.展开更多
The ability to control the wavefront of light is fundamental to focusing and redistribution of light,enabling many applications from imaging to spectroscopy.Wave interaction on highly nonlinear photorefractive materia...The ability to control the wavefront of light is fundamental to focusing and redistribution of light,enabling many applications from imaging to spectroscopy.Wave interaction on highly nonlinear photorefractive materials is essentially the only established technology allowing the dynamic control of the wavefront of a light beam with another beam of light,but it is slow and requires large optical power.Here we report a proof-of-principle demonstration of a new technology for two-dimensional(2D)control of light with light based on the coherent interaction of optical beams on highly absorbing plasmonic metasurfaces.We illustrate this by performing 2D all-optical logical operations(AND,XOR and OR)and image processing.Our approach offers diffractionlimited resolution,potentially at arbitrarily-low intensity levels and with 100 THz bandwidth,thus promising new applications in space-division multiplexing,adaptive optics,image correction,processing and recognition,2D binary optical data processing and reconfigurable optical devices.展开更多
Vision,microscopy,imaging,optical data projection and storage all depend on focusing of light.Dynamic focusing is conventionally achieved with mechanically reconfigurable lenses,spatial light modulators or microfluidi...Vision,microscopy,imaging,optical data projection and storage all depend on focusing of light.Dynamic focusing is conventionally achieved with mechanically reconfigurable lenses,spatial light modulators or microfluidics.Here we demonstrate that dynamic control of focusing can be achieved through coherent interaction of optical waves on a thin beam splitter.We use a nanostructured plasmonic metasurface of subwavelength thickness as the beam splitter,allowing operation in the regimes of coherent absorption and coherent transparency.Focusing of light resulting from illumination of the plasmonic metasurface with a Fresnel zone pattern is controlled by another patterned beam projected on the same metasurface.By altering the control pattern,its phase,or its intensity,we switch the lens function on and off,and alter the focal spot’s depth,diameter and intensity.Switching occurs as fast as the control beam is modulated and therefore tens of gigahertz modulation bandwidth is possible with electro-optical modulators,which is orders of magnitude faster than conventional dynamic focusing technologies.展开更多
文摘BACKGROUND Tracheostomy is commonly used in intensive care unit(ICU)patients who are expected to be on long-term mechanical ventilation or suffer from emergency upper airway obstruction.However,some studies have conflicting findings regarding the optimal technique and its timing and benefits.AIM To provide evidence of practice,characteristics,and outcome concerning tracheostomy in an ICU of a tertiary care hospital.METHODS This was a retrospective cohort study including adult critical care patients in a single ICU for two consecutive years.Patients’demographic characteristics,severity of illness(APACHE II score),level of consciousness[Glasgow Coma Scale(GCS)],comorbidities,timing and type of tracheostomy procedure performed and outcome were recorded.We defined late as tracheostomy placement after 8 days or no tracheotomy.RESULTS Data of 660 patients were analyzed(median age of 60 years),median APACHE II score of 19 and median GCS score of 12 at admission.Tracheostomy was performed in 115 patients,of whom 63 had early and 52 late procedures.Early tracheostomy was mainly executed in case of altered level of consciousness and severe critical illness polyneuromyopathy,however there were no significant statistical results(47.6%vs 36.5%,P=0.23)and(23.8%vs 19.2%,P=0.55)respectively.Regarding the method selected,early surgical tracheostomy(ST)was conducted in patients with maxillofacial injuries(50.0%vs 0.0%,P=0.033),whereas late surgical tracheostomy was selected for patients with goiter(44.4%vs 0.0%P=0.033).Patients with early tracheostomy spent significantly fewer days on mechanical ventilation(15.3±8.5 vs 22.8±9.6,P<0.001)and in ICU in general(18.8±9.1 vs 25.4±11.5,P<0.001).Percutaneous dilatation tracheostomy(PDT)vs ST was preferable in older critical care patients in the case of Central Nervous System underlying cause of admission(62.5%vs 26.3%,P=0.004).ST was the method of choice in compromised airway(31.6%,vs 7.3%P=0.008).A large proportion of patients(88/115)with tracheostomy managed to wean from mechanical ventilation and were transferred out of the ICU(100%vs 17.4%,P<0.001).CONCLUSION PDT was performed more frequently in our cohort.This technique did not affect mechanical ventilation days,ventilator-associated pneumonia(VAP),ICU length of stay,or survival.No complications were observed in the percutaneous or surgical tracheostomy groups.Patients undergoing early tracheostomy benefited in terms of mechanical ventilation days and ICU length of stay but not of discharge status,presence of VAP,or survival.
文摘Primary gastric lymphomas(PGLs)are distinct lymphoproliferative neoplasms described as heterogeneous entities clinically and molecularly.Their main histological types are diffuse large B-cell lymphoma(DLBCL)or mucosaassociated lymphoma tissue.PGL has been one of the main fields of clinical research of our group in recent years.Although gastric DLBCLs are frequent,sufficient data to guide optimal care are scarce.Until today,a multidisciplinary approach has been applied,including chemotherapy,surgery,radiotherapy or a combination of these treatments.In this minireview article,we provide an overview of the clinical manifestations,diagnosis and staging of these diseases,along with their molecular pathogenesis and the most important related clinical published series.We then discuss the scientific gaps,perils and pitfalls that exist regarding the aforementioned studies,in parallel with the unmet need for future research and comment on the proper methodology for such retrospective studies.Aiming to fill this gap,we retrospectively evaluated the trends in clinical presentation,management and outcome among 165 patients with DLBCL PGL who were seen in our institutions in 1980-2014.The study cohort was divided into two subgroups,comparing the main 2 therapeutic options[cyclophosphamide doxorubicin vincristine prednisone(CHOP)vs rituximab-CHOP(R-CHOP)].A better outcome with immunochemotherapy(R-CHOP)was observed.In the next 2 mo,we will present the update of our study with the same basic conclusion.
文摘BACKGROUND Anastomotic leak constitutes a major problem in abdominal surgery.Technical insufficiency,topical or systemic factors contribute to disrupted healing of the performed bowel anastomosis and result in anastomosis leakage,with detrimental effects on patient postoperative outcomes.Despite the investigation of several factors and the invention of protective materials,the ideal agent to prevent anastomotic leaks is yet to be determined.AIM To study the effect of platelet rich plasma(PRP)on the healing of bowel anastomoses.METHODS A systematic literature search was performed in PubMed,EMBASE,and Scopus databases to identify studies investigating the effect of PRP application on bowel anastomosis.RESULTS Eighteen studies were eligible with a total population of 712 animals including rats(14 studies),rabbits(2 studies)and pigs(2 studies).No postoperative complications were reported following PRP application.Fourteen out of 18 studies reported a statistically significant higher anastomosis bursting pressure in PRP groups compared to control either in healthy animals or animal models with underlying condition or intervention,such as intraperitoneal chemotherapy or peritonitis.Similar results were reported by ten studies in terms of tissue hydroxyproline levels.One study reported significant increase in collagen deposition in PRP groups.PRP application resulted in significantly decreased inflammatory cell infiltration in the presence of peritonitis or intraperitoneal chemotherapy(6 studies).CONCLUSION The application of PRP is associated with improved bowel anastomosis outcomes,especially in animal models having an underlying condition affecting the normal healing process.PRP application seems to augment the normal healing process under these circumstances.However,further studies are needed to investigate the potential role of PRP on bowel anastomosis healing,especially in clinical settings.
文摘The scope of this study is to investigate flanking noise transmission through joints between prefabricated concrete elements in Hellenic school buildings;such joints apparently are non-existent in the wholesome structure of ordinary concrete buildings.Sound insulation measurements were carried out in two prefabricated concrete buildings of the cell type;the latter involves demountable/reusable concrete elements(the cells);in this case,apparently,flanking noise transmission at joints,may be even more pronounced.A sample of seventeen fa?ade and interior partitions of classrooms was tested.Sound insulation was also predicted based on classical theory.Analysis of the measured data confirms,by and large,the satisfactory sound insulation performance of the test partitions,with the exception of composite partitions which involve door and window openings.The latter were identified to be a major source of sound insulation deterioration.The importance of meticulous sealing of joints is demonstrated.
基金supported by the UK’s Defence Science and Technology Laboratory(Grant DSTLX1000064081)the MOE Singapore(Grant MOE2011-T3-1-005)+2 种基金the Leverhulme Trustthe University of Southampton Enterprise Fundthe UK’s Engineering and Physical Sciences Research Council(Grant EP/G060363/1)。
文摘The ability to control the wavefront of light is fundamental to focusing and redistribution of light,enabling many applications from imaging to spectroscopy.Wave interaction on highly nonlinear photorefractive materials is essentially the only established technology allowing the dynamic control of the wavefront of a light beam with another beam of light,but it is slow and requires large optical power.Here we report a proof-of-principle demonstration of a new technology for two-dimensional(2D)control of light with light based on the coherent interaction of optical beams on highly absorbing plasmonic metasurfaces.We illustrate this by performing 2D all-optical logical operations(AND,XOR and OR)and image processing.Our approach offers diffractionlimited resolution,potentially at arbitrarily-low intensity levels and with 100 THz bandwidth,thus promising new applications in space-division multiplexing,adaptive optics,image correction,processing and recognition,2D binary optical data processing and reconfigurable optical devices.
基金supported by the University of Southampton Enterprise Fund,the UK's Engineering and Physical Sciences Research Council(grant EP/M009122/1)the MOE Singapore(grant MOE2011-T3-1-005)。
文摘Vision,microscopy,imaging,optical data projection and storage all depend on focusing of light.Dynamic focusing is conventionally achieved with mechanically reconfigurable lenses,spatial light modulators or microfluidics.Here we demonstrate that dynamic control of focusing can be achieved through coherent interaction of optical waves on a thin beam splitter.We use a nanostructured plasmonic metasurface of subwavelength thickness as the beam splitter,allowing operation in the regimes of coherent absorption and coherent transparency.Focusing of light resulting from illumination of the plasmonic metasurface with a Fresnel zone pattern is controlled by another patterned beam projected on the same metasurface.By altering the control pattern,its phase,or its intensity,we switch the lens function on and off,and alter the focal spot’s depth,diameter and intensity.Switching occurs as fast as the control beam is modulated and therefore tens of gigahertz modulation bandwidth is possible with electro-optical modulators,which is orders of magnitude faster than conventional dynamic focusing technologies.