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Farhad, Arshad, Dae-Ho Kim, and Jae-Young Pyun. "Resource Allocation to Massive Internet of Things in LoRaWANs." Sensors 20, no. 9 (2020): 2645. http://dx.doi.org/10.3390/s20092645.
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A long-range wide area network (LoRaWAN) adapts the ALOHA network concept for channel access, resulting in packet collisions caused by intra- and inter-spreading factor (SF) interference. This leads to a high packet loss ratio. In LoRaWAN, each end device (ED) increments the SF after every two consecutive failed retransmissions, thus forcing the EDs to use a high SF. When numerous EDs switch to the highest SF, the network loses its advantage of orthogonality. Thus, the collision probability of the ED packets increases drastically. In this study, we propose two SF allocation schemes to enhance the packet success ratio by lowering the impact of interference. The first scheme, called the channel-adaptive SF recovery algorithm, increments or decrements the SF based on the retransmission of the ED packets, indicating the channel status in the network. The second approach allocates SF to EDs based on ED sensitivity during the initial deployment. These schemes are validated through extensive simulations by considering the channel interference in both confirmed and unconfirmed modes of LoRaWAN. Through simulation results, we show that the SFs have been adaptively applied to each ED, and the proposed schemes enhance the packet success delivery ratio as compared to the typical SF allocation schemes.
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Zheng, Jiaqi, Yuan Li, Liangliang Chen, et al. "Effects of Packet Loss on Neural Decoding Effectiveness in Wireless Transmission." Brain Sciences 15, no. 3 (2025): 221. https://doi.org/10.3390/brainsci15030221.
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Background: In brain–computer interfaces, neural decoding plays a central role in translating neural signals into meaningful physical actions. These signals are transmitted to processors for decoding via wired or wireless channels; however, they are often subject to data loss, commonly referred to as “packet loss”. Despite their importance, the effects of different types and degrees of packet loss on neural decoding have not yet been comprehensively studied. Understanding these effects is critical for advancing neural signal processing. Methods: This study addresses this gap by constructing four distinct packet loss models that simulate the congestion, distribution, and burst loss scenarios. Using macaque superior arm movement decoding experiments, we analyzed the effects of the aforementioned packet loss types on decoding performance across six parameters (position, velocity, and acceleration in the x and y dimensions). The performance was assessed using the R2 metric and statistical comparisons across different loss scenarios. Results: Our results indicate that sudden, consecutive packet loss significantly degraded decoding performance. For the same packet loss probability, burst loss led to the largest decrease in the R2 value. Notably, when the packet loss rate reached 10%, the decoding performance for acceleration dropped to 73% of the original R2 value. On the other hand, when the packet loss rate was within 2%, the neural signal decoding results across all packet loss models remained largely unaffected. However, as the packet loss rate increased, the impact became more pronounced. These findings highlight the varying degrees to which different packet loss models affect decoding outcomes. Conclusions: This study quantitatively evaluated the relationship between packet loss and neural decoding outcomes, highlighting the differential effects of loss patterns on decoding parameters, and it proposed some methods and devices to solve the problem of packet loss. These findings offer valuable insights for the development of resilient neural signal acquisition and processing systems capable of mitigating the impact of packet loss.
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Kim, Sung-Chan, and Moon-Seog Jun. "A Study of efficient Wireless TCP Transmission Using Consecutive Packet Loss and Zero Window Control." KIPS Transactions:PartA 13A, no. 7 (2006): 573–80. http://dx.doi.org/10.3745/kipsta.2006.13a.7.573.
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Scheuvens, Lucas, Tom Hößler, Philipp Schulz, Norman Franchi, André Barreto, and Gerhard Fettweis. "State-Aware Resource Allocation for Wireless Closed-Loop Control Systems." IEEE Transactions on Communications 69, no. 10 (2021): 6604–19. https://doi.org/10.1109/TCOMM.2021.3095953.
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Wireless closed-loop control is of major significance for future industrial manufacturing. However, control applications pose stringent quality of service requirements for reliable operation. Contrary to traditional ultra-reliable low-latency communications design goals such as low packet loss rates and low latency, research results in the domain of networked control systems (NCS) state that depending on the sampling period, control applications inherently tolerate a few consecutive packet losses. This translates into a better-suited metric to capture control application requirements and therefore a more conclusive design goal for wireless networks: ensuring a maximum age of information (AoI). With a Markov modeling approach, we propose to exploit the tolerance through a novel dynamic multi-connectivity scheme that we term state-aware resource allocation (SARA), which temporally negatively correlates packet losses, thus avoiding long packet loss sequences. Through statistical multiplexing, SARA enables a mean time to failure (MTTF) in the order of years while keeping the per-agent average channel usage close to one, also in a multi-agent setting with competition for resources. Compared with static dual-connectivity, the MTTF can be increased 100-fold whereas the number of required channels reduces by 40%. Our approach also statistically guarantees system-wide AoI distributions, which aid to ensure control performance.
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Chughtai, Omer, Nasreen Badruddin, Maaz Rehan, and Abid Khan. "Congestion Detection and Alleviation in Multihop Wireless Sensor Networks." Wireless Communications and Mobile Computing 2017 (2017): 1–13. http://dx.doi.org/10.1155/2017/9243019.
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Multiple traffic flows in a dense environment of a mono-sink wireless sensor network (WSN) experience congestion that leads to excessive energy consumption and severe packet loss. To address this problem, a Congestion Detection and Alleviation (CDA) mechanism has been proposed. CDA exploits the features and the characteristics of the sensor nodes and the wireless links between them to detect and alleviate node- and link-level congestion. Node-level congestion is detected by examining the buffer utilisation and the interval between the consecutive data packets. However, link-level congestion is detected through a novel procedure by determining link utilisation using back-off stage of Carrier Sense Multiple Access with Collision Avoidance (CSMA/CA). CDA alleviates congestion reactively by either rerouting the data traffic to a new less congested, more energy-efficient route or bypassing the affected node/link through ripple-based search. The simulation analysis performed in ns-2.35 evaluates CDA with Congestion Avoidance through Fairness (CAF) and with No Congestion Control (NOCC) protocols. The analysis shows that CDA improves packet delivery ratio by 33% as compared to CAF and 54% as compared to NOCC. CDA also shows an improvement in throughput by 16% as compared to CAF and 36% as compared to NOCC. Additionally, it reduces End-To-End delay by 17% as compared to CAF and 38% as compared to NOCC.
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Arya darma wijaya, Arya, Elvin Andrean Theranata, and Yustian Servanda, A.Md, S.Kom, M.Kom. "Analysis of Wi-Fi Network Usage with Cellular Data Packages on Video Call Service Quality." Journal of Artificial Intelligence and Engineering Applications (JAIEA) 4, no. 3 (2025): 2044–47. https://doi.org/10.59934/jaiea.v4i3.1088.
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Abstract Video calls have now become an important part of daily activities, from personal communication to work meetings and online learning. However, the quality of video calls is highly dependent on the internet network used. This study aims to analyze the comparison of the quality of video call services when using Wi-Fi networks and cellular data packet networks. Testing was carried out by utilizing several main parameters of network quality, such as data transfer speed (throughput), data packet loss, delay, and signal interference (jitter). In addition, signal quality was also analyzed using the SINPO (Signal, Interference, Noise, Propagation, Overall) parameters, and signal strength was measured using the GNetTrack application. Testing was carried out using the Telegram video call application at three different times—morning, afternoon, and evening—for three consecutive days. The results of the study showed that the quality of video call services with Wi-Fi networks tends to be more stable and consistent compared to cellular data packets, especially during times of heavy internet usage. However, in conditions of a strong cellular signal, the quality of video call services can match or even approach the quality of Wi-Fi. This study concludes that network type and usage time have a significant impact on video call quality, and it is important for users to choose a network that suits environmental conditions and communication needs. Keywords: Video call, Wi-Fi, Mobile data, Network quality, SINPO, QoS
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Bhar, Jamila. "A Mac Protocol Implementation for Wireless Sensor Network." Journal of Computer Networks and Communications 2015 (2015): 1–12. http://dx.doi.org/10.1155/2015/697153.
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IEEE 802.15.4 is an important standard for Low Rate Wireless Personal Area Network (LRWPAN). The IEEE 802.15.4 presents a flexible MAC protocol that provides good efficiency for data transmission by adapting its parameters according to characteristics of different applications. In this research work, some restrictions of this standard are explained and an improvement of traffic efficiency by optimizing MAC layer is proposed. Implementation details for several blocks of communication system are carefully modeled. The protocol implementation is done using VHDL language. The analysis gives a full understanding of the behavior of the MAC protocol with regard to backoff delay, data loss probability, congestion probability, slot effectiveness, and traffic distribution for terminals. Two ideas are proposed and tested to improve efficiency of CSMA/CA mechanism for IEEE 802.15.4 MAC Layer. Primarily, we dynamically adjust the backoff exponent (BE) according to queue level of each node. Secondly, we vary the number of consecutive clear channel assessment (CCA) for packet transmission. We demonstrate also that slot compensation provided by the enhanced MAC protocol can greatly avoid unused slots. The results show the significant improvements expected by our approach among the IEEE 802.15.4 MAC standards. Synthesis results show also hardware performances of our proposed architecture.
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Zeng, Zhixiong, Fanguo Zeng, Xiaoteng Han, Hamza Elkhouchlaa, Qiaodong Yu, and Enli Lü. "Real-Time Monitoring of Environmental Parameters in a Commercial Gestating Sow House Using a ZigBee-Based Wireless Sensor Network." Applied Sciences 11, no. 3 (2021): 972. http://dx.doi.org/10.3390/app11030972.
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Significant intensification in livestock farming has become prevalent to meet the increasing meat production demand, resulting in a higher density of pigs in relatively small areas in a commercial swine building. The subsequent challenges of maintaining the quality of both routine management and environmental comfort of pigs to minimize the loss of both pigs’ health and welfare can be attained by implementing autonomous monitoring and intelligent management decisions based on precision livestock farming (PLF). A three-layer wireless sensor network (WSN) based on ZigBee technology has been devised to monitor four environmental parameters in real-time, namely: temperature, relative humidity, concentrations of carbon dioxide and ammonia in a commercial gestating sow house. The overall packet loss rate of the WSN system which reported 16,371 records from its 41 indoor slave nodes in a 10-min interval for three consecutive days was 4%. The carbon dioxide sensors had an average outlier rate of 6.5% after a series of preprocessing procedures. The spatial and temporal characteristics showed that the carbon dioxide level exceeded the limit of 2700 mg/m3 twice during both 07:00–08:00 and 14:00–15:00. Besides, the overall NH3 concentration in the swine building was maintained in a relatively low-level range with a maximum of less than 8 mg/m3. In sum, the real-time monitoring and timely intervention of microclimate in this commercial gestating sow house can be achieved by deploying this WSN system, thereby making it possible to provide an intelligent decision on precise management of livestock automatically.
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Bagchi, Debasis, Bernard Downs, Samudra Banik, et al. "Effective body recomposition vs. misconceptions of the traditional weight loss strategies: TRCAP21 - a novel technological breakthrough in body recomposition." Functional Foods in Health and Disease 12, no. 4 (2022): 134. http://dx.doi.org/10.31989/ffhd.v12i4.905.
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Background: The prevalence of obesity has increased an astounding 30.5% to 42.2% over the last two decades despite numerous weight loss products and programs, thus qualifying it as an epidemic. Fat is the lightest of macromolecules, the highest energy reserve of the body, and the last reservoir of survival insurance to be expended. Water, muscle, and electrolytes are diminished prior to the expenditure of fat resources, the primary cause of rapid weight loss. Contrary to popular belief that only “weight gain” is the sole and correct parameter for evaluating healthy body recomposition, there are no less than 10 additional factors that contribute to a reduction in metabolic rate and an increase in fat storage. These are mostly ignored from considerations regarding the etiology of obesity. Our laboratory developed a novel formulation of D-ribose nicotinamide, alpha glycerol phosphorylcholine and four other evidence-based botanical constituents encapsulated in a Prodosomed stimulant- and sugar-free TRCAP21 (TrimRoxTM) formulation that effectively addresses those contributing factors. To investigate the feasibility of doing a 90-day randomized, double-blind placebo-controlled investigation, we conducted a 21-day concept validation pilot study on TRCAP21 in 9 subjects to assess changes in various body parts, including chest, upper arms, waist/belly, hips, and thighs, as well as body weight. Objective: This physician-supervised 21-day concept validation pilot study on TRCAP21 was conducted on 9 subjects to determine changes in anthropometric parameters including chest, upper arms, waist/belly, hips, and thighs, as well as body weight, and determine the effect of TRCAP21 on energy, mood, satiety, and sugar cravings.Materials and Methods: The study was conducted on nine male and female subjects (age: 47-70 years) to assess the efficacy of TrimRoxTM over a period of 21 consecutive days. Body weights and anthropometric measurements were conducted at the initiation and termination of the study. The effect of TRCAP21 was evaluated on energy level, mood elevation, satiety level, sugar cravings, overall health, and adverse events in the subjects.Results: The results demonstrated that all subjects experienced a reduction in size of one or more these body parts. In addition, it also led to significant improvements in mood elevation, satiety, reduced sugar cravings, elevated energy levels and overall mental and physical health. Intake of 1 packet twice a day (BID) before meals resulted in a significantly greater reduction of body measurements than consuming it once a day (OID). Surprisingly, body weight was reduced in all nine subjects from 2 lbs. to 11 lbs. The randomized double-blind placebo-controlled study is underway to confirm and further substantiate these findings. Conclusion: The TRCAP21 Prodosomed nutraceutical formulation combines the evidence-based efficacy of 6 key constituents, mostly of botanical origin, that act synergistically to restore aerobic cellular metabolism, boost energy level, mood elevation, improve satiety, reduce sugar cravings, reduce body fat in various body compartments as well as weight and improve overall health. Owing to the encapsulation of the components in unique concentric layers of liposome, their release takes place in a sustained and sequential manner. It will be worthwhile to explore its effect on the Gut-Brain Axis, especially the associated microbiome in order to obtain further insights to more accurately define the multiple mechanisms of action.Keywords: obesity, weight management, body recomposition, Aerobic body homeostasis, prodosome®, herbal nutraceuticals
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Ounjaijean, Sakaewan, Manas Kotepui, and Voravuth Somsak. "Antimalarial Activity of Tinospora baenzigeri against Plasmodium berghei-Infected Mice." Journal of Tropical Medicine 2019 (September 5, 2019): 1–6. http://dx.doi.org/10.1155/2019/5464519.
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Plant species of the genus Tinospora (Menispermaceae) possess several pharmacological properties, and T. crispa has been reported to have antimalarial activity. T. baenzigeri (Chingcha Chalee) is a rich source of terpenes and quinoline alkaloids; however, it still has not yet been investigated the antimalarial activity of this plant extract. Hence, this study was aimed to evaluate the antimalarial activity of T. baenzigeri stem extract against Plasmodium berghei-infected mice. The aqueous crude extract of T. baenzigeri stem was prepared using a microwave-assisted method and tested for acute toxicity in mice. For evaluating the antimalarial activity in vivo, the standard 4-day test was carried out using groups of ICR mice infected with P. berghei ANKA administered orally by gavage with the extract (100, 250, and 500 mg/kg) for 4 consecutive days. Parasitemia, body weight, packed cell volume, and mean survival time were then measured. It was found that the aqueous crude extract of T. baenzigeri stem did not exhibit any sign of toxicity up to the dose of 2,000 mg/kg. The extract significantly (P<0.01) inhibited parasitemia in a dose-dependent manner, with 22.02%, 50.81%, and 74.95% inhibition. Moreover, the marked prevention of body weight loss and packed cell volume reduction was observed at doses of 100, 250, and 500 mg/kg of extract-treated mice. Additionally, the extract prolonged the mean survival time of P. berghei-infected mice, compared to the untreated group. In conclusion, the aqueous crude extract of T. baenzigeri stem has demonstrated potent antimalarial activity against P. berghei-infected mice with prolonged mean survival time and prevention of body weight loss and packed cell volume reduction.
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Jones, Jeffrey, Carol Newman, Jon Krohmer, and Connie Mattice. "Accuracy of the Prehospital Index in Identifying Major Hemorrhage in Trauma Victims." Prehospital and Disaster Medicine 8, no. 3 (1993): 237–40. http://dx.doi.org/10.1017/s1049023x00040425.
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AbstractPurpose:To determine the sensitivity of the Prehospital Index (PHI) in identifying patients with severe blood loss, a one-year review was conducted at a regional trauma facility.Methods:The study population consisted of 217 consecutive trauma admissions (ages 3 to 88 years). Patients were managed using standard resuscitation techniques; blood transfusions were ordered at the discretion of attending physicians and did not follow any preplanned protocol. Medical records were examined to determine total blood requiremets for each patient during the first 12 hours of hospitalization, the emergency department (ED) disposition, and final outcome of treatment. The following clinical variables were analyzed (unpaired t-test) to determine their value as predictors of blood loss: age, gender, mechanism of injury, initial vital signs, revised trauma score, PHI, and injury severityscore.Results:Forty-two percent (92 patients) received transfusions during the first 12 hours of hospitalization. The best predictor of blood loss was the Prehospital Index. Of the total group, 45% had a PHI >3; 77% (75/98) of these patients required transfusion and received an average of 7.1 units of packed cells. Fifty-five percent (119/217) had a PHI ≤3; 86% (102/119) of these patients did not require transfusion.Conclusion:The data suggest that patients with PHI scores >3 require close hemodynamic monitoring to rule out significant blood loss and may warrant immediate cross-matching on arrival to the ED.
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Aboalqez, Ahmed, Philipp Deindl, Chinedu Ulrich Ebenebe, Dominique Singer, and Martin Ernst Blohm. "Iatrogenic Blood Loss in Very Low Birth Weight Infants and Transfusion of Packed Red Blood Cells in a Tertiary Care Neonatal Intensive Care Unit." Children 8, no. 10 (2021): 847. http://dx.doi.org/10.3390/children8100847.
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An adequate blood volume is important for neonatal adaptation. The study objective was to quantify the cumulative iatrogenic blood loss in very low birth weight (VLBW) infants by blood sampling and the necessity of packed red cell transfusions from birth to discharge from the hospital. In total, 132 consecutive VLBW infants were treated in 2019 and 2020 with a median birth weight of 1180 g (range 370–1495 g) and a median length of stay of 54 days (range 0–154 days) were included. During the initial four weeks of life, the median absolute amount of blood sampling was 16.5 mL (IQR 12.3–21.1 mL), sampling volume was different with 14.0 mL (IQR 12.1–16.2 mL) for non-transfused infants and 21.6 mL (IQR 17.5–29.4 mL) for transfused infants. During the entire length of stay, 31.8% of the patients had at least one transfusion. In a generalized logistic regression model, the cumulative amount of blood sampling (p < 0.01) and lower hematocrit at birth (p = 0.02) were independent predictors for the necessity of blood transfusion. Therefore, optimized patient blood management in VLBW neonates should include sparse blood sampling to avoid iatrogenic blood loss.
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Roeder, Timo, Kai Risthaus, Nathalie Monnerie, and Christian Sattler. "Non-Stoichiometric Redox Thermochemical Energy Storage Analysis for High Temperature Applications." Energies 15, no. 16 (2022): 5982. http://dx.doi.org/10.3390/en15165982.
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Concentrated solar power is capable of providing high-temperature process streams to different applications. One promising application is the high-temperature electrolysis process demanding steam and air above 800 °C. To overcome the intermittence of solar energy, energy storage is required. Currently, thermal energy at such temperatures can be stored predominately as sensible heat in packed beds. However, such storage suffers from a loss of usable storage capacity after several cycles. To improve such storage, a one-dimensional packed bed thermal energy storage model using air as a heat transfer medium is set up and used to investigate and quantify the benefit of the incorporation of different thermochemical materials from the class of perovskites. Perovskites undergo a non-stoichiometric reaction extension which offers the utilization of thermochemical heat over a larger temperature range. Three different perovskites were considered: SrFeO3, CaMnO3 and Ca0.8Sr0.2MnO3. In total, 15 vol% of sensible energy storage has been replaced by one perovskite and different positions of the reactive material are analyzed. The effect of reactive heat on storage performance and thermal degradation over 15 consecutive charging and discharging cycles is studied. Based on the selected variation and reactive material, storage capacity and useful energy capacity are increased. The partial replacement close to the cold inlet/outlet of the storage system can increase the overall storage capacity by 10.42%. To fully utilize the advantages of thermochemical material, suitable operation conditions and a fitting placement of the material are vital.
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Bellad, MB, D. Mekhala, Jyotsna Shravage, MS Ganachari, and HA Dhumale. "Ormeloxifene versus Medroxyprogesterone Acetate (MPA) in the Treatment of Dysfunctional Uterine Bleeding: A Double-Blind Randomized Controlled Trial." Journal of South Asian Federation of Obstetrics and Gynaecology 3, no. 1 (2011): 21–24. http://dx.doi.org/10.5005/jp-journals-10006-1116.
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ABSTRACT Objective To find the effectiveness of ormeloxifene vs medroxyprogesterone acetate (MPA) to reduce blood loss in dysfunctional uterine bleeding (DUB). Materials and methods: Design—A double blind randomized controlled trial. Data source—The women attending gynecology OPD in teaching hospital attached to Jawaharlal Nehru Medical College, Belgaum, India for menorrhagia, meeting the selection criteria were enrolled into the study. Randomization—Computer-generated randomization, with block size of two, was done into two groups. Intervention—One group (group A) received capsule ormeloxifene 60 mg to be taken two days a week at an interval of 3 days, and a placebo form of medroxyprogesterone acetate for 21 days starting from day 2 to 5 of the menstrual cycle for three consecutive cycles. Other group (group B) received medroxyprogesterone acetate (MPA) 10 mg for 21 days starting from day 2 to 5 of the menstrual cycle, and a placebo form of ormeloxifene for 2 days a week with an interval of 3 days for three consecutive cycles. The drug and its placebo were in similar capsular form. All the participants were ensured to use the similar type of sanitary napkins, and transvaginal ultrasonography was done to note the endometrial thickness (ET) before and after the drug therapy. Blinding—The department of clinical pharmacy prepared the drug packets and kept the randomization code till the data was analyzed, thus ensuring the double blinding. Outcome Participants were interviewed during subsequent cycle. Pictorial blood assessment chart (PBAC) score was used to calculate blood loss during menses at the first and subsequent three months. Data analysis The mean PBAC scores and endometrial thickness were compared in two groups. Results The mean pretreatment PBAC scores in group A and group B were 262.26 and 238.71 ml respectively. The mean PBAC scores at the end of the study period were 73 and 108 in group A and B respectively, reporting an overall reduction in mean blood loss by 85.7 and 54.76% (p = 0.0205) in group A and B respectively. Thus, there was a significant reduction in blood loss in the group receiving ormeloxifene. The reduction in the mean endometrial thickness was more in ormeloxifene group. However, this was not statistically significant (p = 0.0942). Conclusion Ormeloxifene is more effective as compared to MPA in reducing the blood loss in the treatment of DUB.
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Molnar, R., G. Emery, and P. F. M. Choong. "Anaesthesia for Hemipelvectomy—A Series of 49 Cases." Anaesthesia and Intensive Care 35, no. 4 (2007): 536–43. http://dx.doi.org/10.1177/0310057x0703500412.
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We undertook an audit of 49 consecutive hemipelvectomies performed for primary or secondary malignancy. Combined epidural and general anaesthesia was used in 41 patients. The operations were long(range 90 to 600 minutes). The median crystalloid requirement was 8500 ml (range 1000 to 42000 ml) and a median of seven units of packed red blood cells were transfused (range 0 to 44 units). All measures of coagulation were normalised by the first postoperative day using fresh frozen plasma, platelets and cryoprecipitate. Warmed blood was administered at high flow rates using a custom designed system consisting of a roller pump and high capacity fluid warmer. Thirty-five patients were managed postoperatively in the intensive care unit, of whom 31 remained intubated for postoperative ventilation. In 41 patients, postoperative pain management was by a continuous epidural infusion of local anaesthetic and opioid. The average duration of infusion was 4.25 days (range 3 to 6 days). One patient died during surgery from complications relating to massive blood loss, 14 had wound infections and one had an acute brain syndrome. There was significant utilisation of resources involving anaesthesia, surgery, intensive care and blood transfusion services. Anaesthesia for hemipelvectomy is challenging because of the extensive tissue trauma involved, the potential for massive blood loss and the potential for severe postoperative pain. The perioperative management necessitates care from a well coordinated, directed and focused healthcare team.
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Al'Ala, Fatah Mumtaz, Rinta Kridalukmana, and Eko Didik Widianto. "Perancangan Sistem Proxy Server Menggunakan Protokol WCCPv2 dengan Konfigurasi Multi Router." Jurnal Teknologi dan Sistem Komputer 4, no. 2 (2016): 242. http://dx.doi.org/10.14710/jtsiskom.4.2.2016.242-248.
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Numbers of internet users are increasing incredibly fast. Ideally, this increasing numbers of users are also supported by capacity uplift, in this case an increase in bandwidth to maintain the standard services that received by the users. However, increasing the bandwidth not always becomes the first option since it is quite expensive. Implementing proxy server as content/cache engine is the other option available. It will cache the content that user requested and keep it for a while for servicing the other users that will request the same content in the future. WCCP protocol is used to redirect user’s traffic to the proxy server. The standard proxy server configurations are using single router with one or more proxy servers. This thesis is aims to design and implement proxy server system with multi routers configuration. Multi routers configuration is used as a failover mechanism to provide network high availability. It will use HSRP protocol to provide the high availability services. Tests that conducted after implementation shows the increase in transaction and successful transaction by 296% and 284% also a decrease in response time as well as failed transaction by 18% and 99% consecutively. Failover test shows the percentage of packet loss amounted to 31,3% and 26,3% for clients in VLAN 10 and VLAN 20 consecutively. The average time required for clients to reconnect to the internet after router failure is 7 seconds for clients in VLAN 10 and 6 seconds for client in VLAN 20.
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Revathi, D., and S. Ramalingam. "A study on critical associations of media components on enhanced cellulase production from wild Trichoderma viride and cellulase immobilization on iron-oxide magnetic nanoparticles." Journal of Environmental Biology 44, no. 1 (2023): 27–33. http://dx.doi.org/10.22438/jeb/44/1/mrn-5048.
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Aim: The current study is a preliminary step towards enhancing the cellulase productivity in wild Trichoderma viride which will enable robust valorization of non-edible lignocellulosic biomass through co-generative enzymatic saccharification, specifically concentrating on influence of individual media components on biomass growth and cellulase productivity. Further, cellulase immobilization on iron-oxide magnetic nanoparticles was also achieved that can increase the shelf life of the enzyme. Methodology: The cellulase production in the wild Trichoderma viride was enhanced using media design and formulation. EDC {1-Ethyl-3-(3-dimethylaminopropyl) carbodiimide} functionalized iron-oxide nanoparticles were chosen to act as carriers for cellulase immobilization. The binding efficiency and relative activity were measured in addition to optimal pH and temperature for cellulase bound iron-oxide nanoparticles. Further, the hydrolysis efficiency of immobilized cellulases was also measured after which it was subjected to consecutive hydrolytic cycles to calculate the recycle rate. Results: A maximum growth rate of 60 PCV (Packed cell volume) and total cellulase activity of 7.4 U ml-1 was obtained on media design and formulation. 82.5% binding efficiency was achieved on EDC functionalized iron-oxide magnetic nanoparticles which showed good stability at 5pH and 500C. There was 44.4% activity loss after 5 consecutive hydrolytic cycles which showed steady decline with increased cycle number and finally at the end of the 10th hydrolytic cycle, 22.2% of total relative activity was retained. Interpretation: Unprecedented total cellulase activity from a wild strain was obtained through media design. The stability of cellulases was further enhanced using iron-oxide magnetic nanoparticle immobilization. Key words: Cellulases, Immobilization, Iron-oxide magnetic nanoparticles, Submerged fermentation, Trichoderma viride
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Salame, Khalil, Georges E. R. Ouaknine, Nissim Razon, and Semion Rochkind. "The use of carbon fiber cages in anterior cervical interbody fusion." Neurosurgical Focus 12, no. 1 (2002): 1–5. http://dx.doi.org/10.3171/foc.2002.12.1.2.
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Object Cage devices were introduced in spinal fusion to overcome the shortcomings of autograft, allograft, and biocompatible implants. The aim of this study was to assess the short-term results of anterior cervical discectomy and fusion (ACDF) in which an interbody carbon fiber cage (CFC) and local osteophyte–derived bone graft were implanted. Methods A retrospective review was conducted of 100 consecutive patients treated by ACDF in which a CFC was packed with bone fragments obtained from osteophytes at the surgical site. Plain radiographs with dynamic lateral views obtained 1 year postoperatively were used to assess bone fusion, alignment of the cervical spine, and stability. Dynamic radiographs were also obtained at last follow up to determine whether loss of cervical alignment or collapse at the fused disc had occurred. The mean follow-up period was 25 months. In all cases the cervical lordosis was maintained or corrected to different extents and disc height was restored. Solid fusion was achieved in 98% of the cases. There were no cage-related complications and no cases of cage failure. Conclusions The authors conclude that application of the CFC for ACDF is safe, effective, and technically feasible. Osteophytes resected during surgery may be a good alternative material for bone grafting in cage-assisted cervical interbody fusion.
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Yoo, Seon Woo, Seung Park, Jongmin Seo, Hyungun Lee, Taehoon Kim, and Jun Ho Lee. "Effect of epinephrine-mixed fascia iliaca compartment block on bleeding in total hip arthroplasty: A single-center retrospective study." Medicine 103, no. 31 (2024): e38656. http://dx.doi.org/10.1097/md.0000000000038656.
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Fascia iliaca compartment block (FICB) reduces opioid consumption and pain scores after total hip arthroplasty (THA), and has recently been widely applied. We investigated whether FICB could also reduce postoperative bleeding. One hundred and fifteen consecutive patients who underwent elective THA under general anesthesia over 5 months were retrospectively analyzed. They were divided into 2 groups: the FICB group received an epinephrine-mixed FICB procedure and the control group did not receive any block. Using the hematocrit measured at 4 different time points (preoperative and 1, 24, and 48 hours after surgery), the estimated blood loss (EBL) was calculated for 3 different time periods (0–1, 1–24, 24–48 hours after surgery). EBL at 1 to 24 hours (226 vs 398 mL, P = .008) was significantly lower in the FICB group than in the control group. Additionally, the number of packed red cell (PRC) units transfused per patient over 48 hours was 0.38 units in the FICB group, which was significantly lower than the 0.70 units used in the control group (P = .040). Epinephrine-mixed FICB in THA has the potential to reduce postoperative bleeding in the first 24 hours after surgery as well as reduce PRC transfusion requirements.
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Dadure, Christophe, Magali Sauter, Sophie Bringuier, et al. "Intraoperative Tranexamic Acid Reduces Blood Transfusion in Children Undergoing Craniosynostosis Surgery." Anesthesiology 114, no. 4 (2011): 856–61. http://dx.doi.org/10.1097/aln.0b013e318210f9e3.
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Background Surgical correction of craniosynostosis in children is associated with substantial intraoperative bleeding. Tranexamic acid (TXA) decreases intraoperative blood loss during cardiac or orthopedic surgery in children. We hypothesized that intraoperative TXA would reduce blood transfusion relative to placebo in patients pretreated with erythropoietin. Methods Forty consecutive children, American Society of Anesthesiologists status 1 or 2, scheduled to undergo surgical correction of craniosynostosis were randomly assigned to receive either intravenous TXA or saline, 0.9%, intraoperatively. All children received preoperative erythropoietin (600 U/kg once a week for 3 weeks before surgery). Perioperative blood loss, number and volume of transfusions, percentage of children who underwent transfusion, and side effects were noted after surgery and at the end of the study. Surgeon satisfaction and cost of treatment were also recorded. Results There was no significant difference between groups in demographic or surgical data. In the TXA group, the volume of packed erythrocytes transfused was significantly reduced by 85% (from 11 to 1.6 ml/kg) intraoperatively and by 57% (from 16.6 to 7.2 ml/kg) throughout the study period (P &lt; 0.05). Compared with the placebo group, the percentage of children requiring blood transfusion was lower in the TXA group during surgery (9 [45%] of 20 vs. 2 [11%] of 19 children; P &lt; 0.05) and during the whole study period (14 [70%] of 20 vs. 7 [37%] of 19; P &lt; 0.05). Preoperative and postoperative hematologic parameters were comparable in both groups. There were no adverse events. Conclusion In children undergoing surgical correction of craniosynostosis and pretreated with erythropoietin, intraoperative TXA reduces the transfusion requirement.
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Alozieuwa, Uchenna Blessing, Abdulahi Mann, Adamu Yusuf Kabiru, and Emmannuel Olofu Ogbadoyi. "In vivo antimalarial efficacy of Psidium guajava leaf crude extract and fractions in Plasmodium berghei infected mice." AROC in Natural Products Research 02, no. 01 (2022): 28–37. http://dx.doi.org/10.53858/arocnpr02012837.
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Background: Malaria is a life-threatening disease caused by the protozoan parasite, Plasmodium. The emergence of drug-resistant Plasmodium species to currently available antimalarials has necessitated the search for more effective drugs. This study evaluated the antimalarial potential of the crude extract and fractions of Psidium guajava leaf in Plasmodium berghei infected mice. Method: Mice infected with Plasmodium berghei (P. berghei) were administered orally with the crude extract and fractions at doses ranging from 100-500 and 50-200mg/kg/day respectively, for five consecutive days. Results: The crude extract significantly (p<0.05) inhibited parasite growth as well as prevented body weight loss and packed cell volume reduction dose-dependently. Among the fractions, aqueous fraction was the most active with 54.26% inhibition of parasite growth at 200mg/kg. Remarkable inhibition of parasite growth by the crude extract and aqueous fraction was evident in the prolongation of mice survival relative to the control (27.33±1.76, 24.67±0.67, 28.0±1.16 and 8.33±0.67 for crude extract (500mg/kg), aqueous fraction (200mg/kg), chloroquine and negative control groups respectively). Phytochemical screening of the crude extract revealed the presence of phenol, alkaloids, flavonoids, and terpenoids. Conclusion: The results indicate that crude extract and aqueous fraction of P. guajava leaf are potent antimalarial agent that can be employed in the development of antimalarial drugs.
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Christiansen, S., C. Schmid, A. Löher, and H. H. Scheld. "Impact of Malignant Hematological Disorders on Cardiac Surgery." Cardiovascular Surgery 8, no. 2 (2000): 149–52. http://dx.doi.org/10.1177/096721090000800211.
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Background: Patients suffering from malignant hematological disorders may be at increased risk, when undergoing cardiac surgery. We report on our experiences with ten cardiac procedures in nine patients (3 males, 6 females. 19–85 yr old, mean age 61 yr). Methods and Results: There were two patients with Hodgkin's lymphoma and one patient each with Waldenström's syndrome, multiple myeloma, polycythemia, myelodysplasia, chronic lymphocytic leukemia, non-Hodgkin's lymphoma and idiopathic aplastic anemia. Cardiac diseases included coronary artery disease in six, aortic stenosis in two, and mitral insufficiency in one patient. Consecutively, cardiac procedures were coronary artery bypass grafting in six, aortic valve replacement in two, and mitral valve replacement in one patient. No patient died. Postoperatively, one patient suffered from a pericardial tamponade requiring surgical removal and 5 months later from a prosthetic endocarditis necessitating change of the bioprosthesis. One patient developed a superficial wound infection, which was treated conservatively. Four patients received no blood products. Altogether, we transfused 32 packed red blood cells, seven units of fresh frozen plasma and 16 platelet concentrates. Total drainage loss was 883 ml (250–1510 ml). Conclusions: Cardiac surgery in patients suffering from malignant hematological disorders may be performed, but carries an increased morbidity. Therefore, indications for cardiac procedures must be carefully considered.
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Morzycki, Alexander, Peter O. Kwan, Edward E. Tredget, and Joshua N. Wong. "Novel Application of a Surgeon-Operated Clysis Delivery System in Burn Surgery." European Burn Journal 3, no. 1 (2022): 234–40. http://dx.doi.org/10.3390/ebj3010020.
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Insufflation of epinephrine-containing solutions (clysis) has shown to decrease blood loss in burn surgery. Current delivery methods are associated with significant cost and may predispose burn patients to hypothermia. This was a proof-of-concept study to evaluate a novel surgeon-operated clysis delivery system. Our initial experience with a novel fluid management system is presented. Temperature, pressure, and volume of clysis was recorded. Patient and burn factors were evaluated and complications collected. Finally, a cost-effectiveness analysis was conducted. Thirty-seven consecutive cases comprising 22 adult patients (15/22, 68% male), with a mean age of 49 years (+/−19) were reviewed. The mean % total body surface area of all patients was 39 (+/−21.7). The mean temperature, pressure, and volume of administered clysis was 32.2 degrees Celsius (+/−4.4), 265.04 mmHg (+/−56.17), and 5805.8 mL (+/−4844.4), respectively. The mean dose of epinephrine administered was 14.5 mg (+/−12.1). The mean temperature variability was 1.1 °C (+/−1.2). The total mean of packed red blood cells (PRBC) transfused was 507.6 mL (+/−624.4). There were no recorded complications. We identified a cost savings of CAD 20,766 over the cases examined, compared to our conventional clysis delivery technique. This novel technique provides rapid and safe infiltration of warmed clysis in burn surgery. We were able to maintain intra-operative euthermia. In addition, this technique may be transfusion-sparing. The introduction of this method of clysis administration was associated with significant cost-savings. Future randomized study is necessary.
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Ounjaijean, Sakaewan, and Voravuth Somsak. "Effect of Allicin and Artesunate Combination Treatment on Experimental Mice Infected with Plasmodium berghei." Veterinary Medicine International 2022 (April 18, 2022): 1–7. http://dx.doi.org/10.1155/2022/7626618.
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Malaria is still a significant health problem in endemic countries and increases Plasmodium resistance to the available antimalarial drugs. Hence, this study aimed to investigate the antimalarial activity of allicin and its combination with artesunate (ART) against rodent malaria Plasmodium berghei ANKA (PbANKA) infected mice. Allicin was prepared in 20% Tween-80. Balb/c mice were inoculated intraperitoneally with 1×107 PbANKA-infected erythrocytes and orally given by gavage with the chosen doses of 1, 10, 50, and 100 mg/kg of allicin and 1, 5, 10, and 20 mg/kg of ART once a day for 4 consecutive days. Effective dose 50 (ED50) of allicin and ART was subsequently investigated. Moreover, the combination (1 : 1) of allicin and ART at the doses of their respective ED50, ED50 1/2, ED50 1/4, and ED50 1/8 was also carried out. The untreated control was given 20% Tween-80. The results showed that allicin presented a dose-dependent antimalarial activity with significance ( p < 0.05 ). The ED50 values of allicin and ART were about 14 and 5 mg/kg, respectively. For combination, allicin and ART showed a synergistic effect at the combination doses of ED50, ED50 1/2, and ED50 1/4 with significantly ( p < 0.01 ) prevented reduction of packed cell volume, bodyweight loss, rapid dropping of rectal temperature, and markedly prolonged mean survival time, compared with the untreated control and single treatment. It can be concluded that allicin exerted potential antimalarial activity in single and its combination with ART.
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Casati, Valter, Giovanni Speziali, Cesare D'Alessandro, et al. "Intraoperative Low-volume Acute Normovolemic Hemodilution in Adult Open-heart Surgery." Anesthesiology 97, no. 2 (2002): 367–73. http://dx.doi.org/10.1097/00000542-200208000-00013.
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Background Recently, various studies have questioned the efficacy of intraoperative acute normovolemic hemodilution (ANH) in reducing bleeding and the need for allogeneic transfusions in cardiac surgery. The aim of the present study was to reevaluate the effects of a low-volume ANH in elective, adult open-heart surgery. Methods Two hundred four consecutive adult patients undergoing cardiac surgery were prospectively randomized in a nonblinded manner into two groups: ANH group (103 patients), where 5-8 ml/kg of blood was withdrawn before systemic heparinization and replaced with colloid solutions, and a control group, where no hemodilution was performed (101 patients). Procedures included single and multiple valve surgery, aortic root surgery, coronary surgery combined with valve surgery, or partial left ventriculectomy. The purpose of the study was to evaluate the efficacy of ANH in reducing the need for allogeneic blood components. Routine hematochemical evaluations, perioperative blood loss, major complications, and outcomes were also recorded. Results No differences were found between the groups regarding demographics, baseline hematochemical data, and operative characteristics. There was no difference in the amount of transfusions of packed red cells, fresh frozen plasma, platelet concentrates, total number of patients transfused (control group, 36% vs. ANH group, 34.3%; P = 0.88), and amount of postoperative bleeding (control group, 412 ml [313-552 ml] vs. ANH group, 374 ml [255-704 ml]) (median [25th-75th percentiles]); P = 0.94. Further, perioperative complications, postoperative hematochemical data, and outcomes were not different. Conclusions In patients undergoing elective open-heart surgery, low-volume ANH showed lack of efficacy in reducing the need for allogeneic transfusions and postoperative bleeding.
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Deppe, Antje Christin, Georg Schlachtenberger, Stephen Gerfer, et al. "Major Bleeding after Surgical Revascularization with Dual Antiplatelet Therapy." Thoracic and Cardiovascular Surgeon 68, no. 08 (2020): 714–22. http://dx.doi.org/10.1055/s-0040-1710508.
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Abstract Objective Patients with acute coronary syndrome are treated with dual antiplatelet therapy containing acetylsalicylic acid (ASA) and P2Y12 antagonists. In case of urgent coronary artery bypass grafting this might be associated with increasing risks of bleeding complications. Methods Data from 1200 consecutive urgent operations between 2010 and 2018 were obtained from our institutional patient database. For this study off-pump surgery was excluded. The primary composite end point major bleeding consisted of at least one end point: transfusion ≥ 5 packed red blood cells within 24 hours, rethoracotomy due to bleeding, chest tube output >2000 mL within 24 hours. Demographic data, peri-, and postoperative variables and outcomes were compared between patients treated with mono antiplatelet therapy, ASA + clopidogrel (ASA-C) +ticagrelor (ASA-T) or +prasugrel (ASA-P) < 72 hours before surgery. Furthermore, we compared patients with dual antiplatelet therapy with ASA monotherapy. Results From 1,086 patients, 475 (44%) received dual antiplatelet therapy. Three-hundred seventy-two received ASA-C (77.7%), 72 ASA-T (15%), and 31 ASA-P (6.5%). Major bleeding (44 vs. 23%, p < 0.0001) was more frequently in patients receiving dual therapy with higher rates of massive drainage loss within 24 hours (23 vs. 11%, p < 0.0001) of mass transfusion (34 vs. 16%, p < 0.0001) and rethoracotomy (10 vs. 5%, p = 0.002) when compared with ASA. In this analysis, ASA-T and ASA-P were not associated with higher bleeding complications compared with ASA-C. Conclusion Dual antiplatelet therapy is associated with higher rates of major bleeding. Further studies should examine the difference in the prevalence of major bleeding complications in the different dual antiplatelet therapy regimes in patients requiring urgent surgery.
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Ioffe, Yevgeniya J. M., Sigrid Burruss, Ruofan Yao, et al. "When the balloon goes up, blood transfusion goes down: a pilot study of REBOA in placenta accreta spectrum disorders." Trauma Surgery & Acute Care Open 6, no. 1 (2021): e000750. http://dx.doi.org/10.1136/tsaco-2021-000750.
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BackgroundPatients with placenta accreta spectrum (PAS) disorders often suffer massive hemorrhage during cesarean hysterectomies (CHyst). A novel strategy to decrease blood loss and minimize perioperative morbidity associated with PAS is utilization of ER-REBOA Catheter intraoperatively. In this study, we explore the use of ER-REBOA Catheter during CHyst with the goal of minimizing perioperative morbidity and packed red blood cell (PRBC) transfusions.MethodsWe conducted a retrospective case–control study at a regional referral center of consecutive patients with PAS undergoing CHyst. The primary outcomes were PRBC transfusions of ≥4 units. Secondary outcomes included surgical intensive care unit admissions, postoperative length of stay (LOS), postoperative ileus, and vascular complication rate. We also explored utilization of manual palpation and omission of precesarean fluoroscopy for resuscitative endovascular balloon occlusion of the aorta (REBOA) placement verification in distal aortic zone 3.Results90 patients were included in the study. REBOA and non-REBOA cases were similar in clinicodemographic characteristics. 17.7% of REBOA cases received ≥4 units of PRBC compared with 49.3% of non-REBOA cases (p=0.03). Zero REBOA patients developed postoperative ileus, whereas 18 (25%) non-REBOA patients did (p=0.02). LOS was reduced in the REBOA group. Postplacement fluoroscopy was omitted in all REBOA cases. Two postoperative arterial thrombotic events (2 of 19, 11% of REBOA patients) were identified in the REBOA group, one requiring a thrombectomy (1 of 19, 5%).DiscussionDecrease in blood transfusions of ≥4 units of PRBC is demonstrated when ER-REBOA Catheter is placed in distal aortic zone 3 during CHyst performed for severe PAS disorders. The incidence of postoperative ileus and LOS are reduced in the ER-REBOA Catheter group. Placement and utilization of ER-REBOA Catheter during CHyst may be feasible without fluoroscopy when manual placement verification is performed by an experienced operator. Protocol modifications focusing on reducing thrombotic rate are ongoing.Level of evidenceIV.
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Morzycki, Alexander, and Joshua N. Wong. "606 Novel application of a surgeon-operated clysis delivery system in burn surgery." Journal of Burn Care & Research 43, Supplement_1 (2022): S142—S143. http://dx.doi.org/10.1093/jbcr/irac012.234.
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Abstract Introduction Tangential excision of burns is associated with significant bleeding. Sub-eschar insufflation of epinephrine-containing clysis has shown to decrease blood loss and associated complications. Administration of adrenaline-containing infiltrates are also beneficial in the harvest of split thickness skin grafts. Clysis is typically delivered with the assistance of a perfusionist-operated system. This method, however, is associated with significant cost and dependent on personnel availability. This study evaluated the use of a novel surgeon-operated fluid management system in the delivery of clysis in burn surgery. Methods Our initial experience with a novel fluid management system is presented. Prospective collection of infiltration data, including average temperature, pressure, and volume of clysis was performed. Patient and burn factors were evaluated and complications collected. Finally, a cost-effectiveness analysis was conducted. Results Thirty-seven consecutive cases comprising 22 adult patients (15/22, 68% male), with a mean age of 49 years (+/- 19) were reviewed. The mean % total body surface area of all patients was 39 (+/- 21.7). The mean temperature, pressure and volume of administered clysis was 32.2 degrees Celsius (+/- 4.4), 265.04 mmHg (+/-56.17), and 5805.8 mL (+/- 4844.4), respectively. The mean dose of epinephrine administered was 14.5mg (+/- 12.1). The mean temperature variability was 1.1 °C (+/- 1.2). Total mean packed red blood cells (PRBC) transfused was 507.6 mL (+/- 624.4). There were no recorded complications. We identified a cost savings of $20,766 CAD over the cases examined. Conclusions We present the novel application of a fluid management system in burn surgery. This technique provides rapid and safe infiltration of warmed clysis. We are able to maintain intra-operative euthermia despite a large volume of administered clysis and significant intraoperative vulnerability to hypothermia. In addition, this technique may be transfusion-sparing. The introduction of this method of clysis administration was associated with significant cost-savings.
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Liu, Congcong, Li Lin, Weixing Wang, Guohua Lv, and Youwen Deng. "Long-term outcomes of vertebral column resection for kyphosis in patients with cured spinal tuberculosis: average 8-year follow-up." Journal of Neurosurgery: Spine 24, no. 5 (2016): 777–85. http://dx.doi.org/10.3171/2015.8.spine15534.
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OBJECTIVE The authors conducted a study to evaluate the long-term clinical and radiographic outcomes of vertebral column resection (VCR) for kyphosis in patients with cured spinal tuberculosis. METHODS This was a retrospective study. Between 2003 and 2009, 28 consecutive patients with cured spinal tuberculosis underwent VCR for kyphosis in which the target vertebra was removed completely. Autologous iliac crest bone graft or titanium mesh packed with autograft was placed into the osteotomy gap to reconstruct the spine for anterior column stability. Posterior pedicle screw fixation and fusion were typically performed. Radiographic parameters, including kyphosis angle and sagittal balance, were measured, and visual analog scale score, America Spinal Injury Association grade, Scoliosis Research Society outcome instrument (SRS-22) score, Oswestry Disability Index, patient satisfaction index, and long-term complications were evaluated. RESULTS This study included 12 males and 16 females, with an average age of 20.9 years at the time of surgery. The average follow-up was 96.9 months. No deaths occurred in this study. At the final follow-up, the kyphosis angle improved from the preoperative average of 70.7° to the final follow-up average of 30.2°, and the average kyphosis correction loss was 8.5°. The sagittal balance averaged 15.4 mm before surgery, 2.8 mm after surgery, and 5.4 mm at the final followup. Thirteen patients showed improvement of more than 1 America Spinal Injury Association grade. The visual analog scale, Oswestry Disability Index, and SRS-22 scores improved significantly, and the overall satisfaction rate was 92.9%. Adjacent-segment degeneration occurred in 3 patients. No severe instrumentation-related complications were observed. CONCLUSIONS The long-term safety and efficacy of the VCR technique for treating spinal tuberculosis-related kyphosis were favorable, and no severe late-stage complications appeared. Lumbar tubercular kyphosis showed a tendency for sagittal decompensation within the first 3 postoperative years. Cases of adjacent-segment degenerations were relatively few and mild without clinical symptoms.
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Harroud, Adil, Alexander G. Weil, Jean Turgeon, Claude Mercier, and Louis Crevier. "Association of postoperative furosemide use with a reduced blood transfusion rate in sagittal craniosynostosis surgery." Journal of Neurosurgery: Pediatrics 17, no. 1 (2016): 34–40. http://dx.doi.org/10.3171/2015.5.peds14666.
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OBJECT A major challenge in sagittal craniosynostosis surgery is the high transfusion rate (50%–100%) related to blood loss in small pediatric patients. Several approaches have been proposed to prevent packed red blood cell (PRBC) transfusion, including endoscopic surgery, erythropoietin ortranexamic acid administration, and preoperative hemodilution. The authors hypothesized that a significant proportion of postoperative anemia observed in pediatric patients is actually dilutional. Consequently, since 2005, at CHU Sainte-Justine, furosemide has been administered to correct the volemic status and prevent PRBC transfusion. The purpose of this study was to evaluate the impact of postoperative furosemide administration on PRBC transfusion rates. METHODS This was a retrospective study of 96 consecutive patients with sagittal synostosis who underwent surgery at CHU Sainte-Justine between January 2000 and May 2012. The mean age at surgery was 4.9 ± 1.5 months (range 2.8–8.7 months). Patients who had surgery before 2005 constituted the control group. Those who had surgery in 2005 or 2006 were considered part of an implementation phase because furosemide administration was not routine. Patients who had surgery after 2006 were part of the experimental (or furosemide) group. Transfusion rates among the 3 groups were compared. The impact of furosemide administration on transfusion requirement was also measured while accounting for other variables of interest in a multiple logistic regression model. RESULTS The total transfusion rate was significantly reduced in the furosemide group compared with the control group (31.3% vs 62.5%, respectively; p = 0.009), mirroring the decrease in the postoperative transfusion rate between the groups (18.3% vs 50.0%, respectively; p = 0.003). The postoperative transfusion threshold remained similar throughout the study (mean hemoglobin 56.0 g/dl vs 60.9 g/dl for control and furosemide groups, respectively; p = 0.085). The proportion of nontransfused patients with recorded hemoglobin below 70 g/dl did not differ between the control and furosemide groups (41.7% vs 28.6%, respectively; p = 0.489). Surgical procedure, preoperative hemoglobin level, estimated blood loss, and furosemide administration significantly affected the risk of receiving a postoperative PRBC transfusion. When these variables were analyzed in a multiple logistic regression model, furosemide administration remained strongly associated with a reduced risk of being exposed to a blood transfusion (OR 0.196, p = 0.005). There were no complications related to furosemide administration. CONCLUSIONS A significant part of the postoperative anemia observed in patients who underwent sagittal craniosynostosis surgery was due to hypervolemic hemodilution. Correction of the volemic status with furosemide administration significantly reduces postoperative PRBC transfusion requirements in these patients.
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Gbotosho, Oluwabukola, Maria G. Kapetanaki, Mark A. Ross, et al. "Nrf2 Null Mice Are Deficient in CD169+ Macrophages, Associated with Impaired Erythroid Response and Delayed Recovery from Acute Blood Loss." Blood 134, Supplement_1 (2019): 1038. http://dx.doi.org/10.1182/blood-2019-127295.
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Erythropoiesis occurs in specialized niches in the bone marrow consisting of a central macrophage, surrounded by differentiating erythroblasts. This central macrophage has been identified by several markers including, CD169 (Sialoadhesin or Siglec-1), F4/80, CD11b, VCAM-1, ER-HR3 and Ly-6G. These CD169+ macrophages support erythropoiesis both at steady state and during stress. Nuclear factor erythroid 2-related factor 2 (Nrf2) is the master regulator of the cellular oxidative defense system. It modulates hematopoietic stem cells but its loss produces no visible phenotype in steady state hematological parameters. However, the importance of Nrf2 and macrophage subsets has not been fully characterized during recovery from stress erythropoiesis. We examined specific subsets of CD169+ macrophage populations in Nrf2 knockout (Nrf2−/−) mice as well as the role of Nrf2 in recovery from stress erythropoiesis in vivo. We quantified the expression of CD169, F4/80 and CD11b, markers of central macrophages, in the BM and spleen of Nrf2+/+ and Nrf2-/- mice at steady state. Surprisingly, Nrf2-/- mice showed a phenotype characterized by lower percentages of cells expressing known macrophage markers. We observed a significant decrease of 47% (p≤0.01), 24% (p≤0.01) and 50% (p≤0.01) in BM macrophage subpopulations expressing F4/80hiCD169hi, F4/80hiCD11bhi and CD169hiCD11bhi respectively, in age-matched Nrf2-/- mice compared to Nrf2+/+ control mice (Fig. 1a). In the spleen, we also observed a similar significant deficiency in BM macrophages (p≤0.01). Further validating this phenotype, immunofluorescence staining of isolated spleen tissue showed that expression of CD169+ macrophages was dramatically lower in spleen sections of Nrf2-/- mice than in Nrf2+/+ control mice. We hypothesized that our macrophage-deficient mice would display a defect in recovery from blood loss. Five to seven days after acute blood loss, immature erythroid progenitors (CD71hiTer119hi) increased in marrow by about 5-fold in Nrf2+/+ mice (p≤0.001, Fig. 1b), and mature erythroid progenitors (CD71loTer119hi) increased in marrow by 12-fold (p≤0.05) but the erythroid marrow response was impaired significantly in the macrophage deficient Nrf2-/- mice. To extend our observations regarding macrophage deficiency and impaired erythroid response, we chose a more functional outcome of recovery from anemia after high-grade blood loss produced by daily phlebotomies over 3 consecutive days to induce stress erythropoiesis in Nrf2+/+ and Nrf2-/- mice. We found significantly lower packed cell volume values specifically on Days 2, 4 and 10, implying delayed erythroid recovery (p≤0.05, two-way ANOVA). The Nrf2-/- mice also showed a significant decline in total hemoglobin than the Nrf2+/+ mice (p≤0.05). Additionally, peripheral blood reticulocyte response to blood loss is delayed in Nrf2 deficient mice compared to age-matched controls (11.0 ± 0.6% vs. 14.8 ± 0.6%, p≤0.001). We analyzed expression of heme-oxygenase 1 (HO-1), a well-known Nrf2-regulated gene. HO-1 mRNA expression increased 3-fold and 23-fold in Nrf2+/+ mice animals subjected to phlebotomy and hemin treatment compared to 2-fold and 12-fold expression in Nrf2-deficient mice (p≤0.05). We demonstrate for the first time that Nrf2-deficient mice have a deficiency of macrophages that includes subsets considered erythroblastic island (EI) macrophages, and that this deficiency is associated with impaired erythroid response to induced stress. Secondly, our multiple phlebotomies data in aggregate demonstrate that Nrf2-/- mice deficient in BM macrophages have significant delay in functional erythroid response and recovery from experimentally-induced anemia. Thirdly, impaired inducibility of HO-1 is a known feature of Nrf2-/- mice, which we confirmed in our results, could be contributing to the impairment in erythroid response. However, it is not likely that restricted iron trafficking to erythroid progenitors occurs in Nrf2-/- mice, since there is no characteristic alteration of mean corpuscular volume and mean corpuscular hemoglobin in peripheral blood. This is an area worthy of additional investigation. We conclude that the Nrf2 gene plays a previously unappreciated role in erythroid biology that appears to be mediated through macrophage function. Disclosures Ofori-Acquah: Shire Human Genetic Therapies Inc: Other: Financial Relationship. Kato:Bayer: Research Funding; Novartis, Global Blood Therapeutics: Consultancy, Research Funding.
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Catena, Marco, Luca Aldrighetti, Renato Finazzi, et al. "Treatment of Non-Endemic Hepatolithiasis in a Western Country. The Role of Hepatic Resection." Annals of The Royal College of Surgeons of England 88, no. 4 (2006): 383–89. http://dx.doi.org/10.1308/003588406x98711.
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INTRODUCTION The aim of this study was to assess the safety and the efficacy of hepatic resective surgery in the treatment of single lobe hepatolithiasis. PATIENTS AND METHODS Retrospective analysis and comparison between hepatic resections in patients with hepatolithiasis (hepatolithiasis group [HG]) and liver masses (control group [CG]). Seventeen consecutive Caucasian patients with single lobe hepatolithiasis (HG) and 30 patients with liver masses without chronic liver disease and previous chemotherapy (CG), were operated during the 5-year period 2000–2005, inclusive. Major hepatic resections including 4 right hepatectomies, 10 left hepatectomies, and 3 left lateral sectionectomy in HG, and 12 right hepatectomies, 3 extended right hepatectomy, 5 left hepatectomies, 4 left lateral sectionectomy, 5 bisegmentectomy, and 1 mesohepatectomy in CG. The main outcome measures were: type and length of surgical procedures, intra- and postoperative blood losses and transfusions (packed red blood cells [PRBC] and fresh frozen plasma [FFP]), intra- and postoperative course and complications (within 30 days of the operation), length of hospitalisation, histopathology, and recurrence of hepatolithiasis. RESULTS Mean operation time was 6.21 ± 2.38 h in HG versus 7.10 ± 2.21 h in CG (P = 0.33). Mean intra-operative blood loss in CG was higher than in HG (1010 ± 550 ml versus 560 ± 459 ml; P = 0.035). The other variables considered in the two groups were not statistically different. Intra-operative transfusion were 0.50 ± 0.85 units in HG versus 1.35 ± 2.25 units of PRBC in CG (P = 0.06), and 0.66 ± 1.34 units in HG versus 0.68 ± 1.20 units of FFP in CG (P = 0.44), respectively. No cases of death were registered. Postoperative complications occurred in 12 patients (25.5%) – 5 cases (10.6%) in HG and 7 cases (14.8%) in CG (P = 0.18). Mean postoperative transfusions were 0.47 ± 1.24 units in HG versus 1.10 ± 1.18 units of PRBC in CG (P = 0.35), and 0.65 ± 1.40 units in HG versus 0.46 ± 0.82 units of FFP in CG (P = 0.25), respectively. Difference in median hospitalisation was not statistically significant (14 ± 10 days versus 12 ± 9 days; P = 0.28). Histopathology showed cholangiocarcinoma in 2 cases (11.7%). During the follow-up period (range, 5–127 months; mean, 50.4 ± 41.9 months), 1 patient had lithiasis recurrence and 1 patient died for the co-existing cholangiocarcinoma. CONCLUSIONS Hepatic resection is the treatment of choice in patients with single lobe hepatolithiasis. An early indication for surgery may reduce the mortality/morbidity rates of hepatic resection for hepatolithiasis.
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Guembe-Michel, Nerea, Adrián Durán, Rafael Sirera, and Gustavo González-Gaitano. "Solvent-Free Formation of Cyclodextrin-Based Pseudopolyrotaxanes of Polyethylene Glycol: Kinetic and Structural Aspects." International Journal of Molecular Sciences 23, no. 2 (2022): 685. http://dx.doi.org/10.3390/ijms23020685.
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Pseudopolyrotaxanes (PPRs) are supramolecular structures consisting of macrocycles able to thread on a linear polymer chain in a reversible, non-covalent way, often referred to in the literature as “molecular necklaces”. While the synthesis and reaction mechanisms of these structures in solution have been widely described, their solvent-free production has received little attention, despite the advantages that this route may offer. We propose in this work a kinetic mechanism that describes the PPR formation in the solid phase as a process occurring in two consecutive stages. This mechanism has been used to investigate the spontaneous formation of a PPR that occurs when grinding α-Cyclodextrin (α-CD) with polyethylene glycol (PEG). In the threading stage, the inclusion of the polymer and subsequent release of the water molecules lodged in the cavity of the macrocycle cause vibrational changes that are reflected in the time-dependence of the FTIR-ATR spectra, while the further assembly of PPRs to form crystals produces characteristic reflections in the XRD patterns, due to the channel-like arrangement of CDs, that can be used to track the formation of the adduct in crystalline form. The effects that working variables have on the kinetics of the reaction, such as temperature, feed ratio, molar mass of the polymer and the introduction of an amorphous block in the polymer structure, have been investigated. The rate constants of the threading step increase with the temperature and the activation energy of the process increases at lower proportions of CD to PEG. This is attributed to the lower degree of covering of the polymer chain with CDs that reduces the hydrogen-bonding driven stabilization between adjacent macrocycles. The formation of crystalline PPR, which takes place slowly at room temperature, is markedly promoted at higher temperatures, with lower proportions of CD favoring both the formation and the growth of the crystals. The molar mass of the polymer does not modify the typical channel-like arrangement of packed PPRs but the conversion into crystalline PPR diminishes when using PEG1000 instead of PEG400. At a microscopic level, the crystals arrange into lamellar structures, in the order of hundreds of nm, embedded in an amorphous-like matrix. The introduction of a polypropylene oxide block in the structure of the polymer (Pluronic L62) renders poorer yields and a considerable loss of crystallinity of the product of the reaction. The methodology here proposed can be applied to the general case of inclusion complexes of CDs with drugs in the solid phase, or to multicomponent systems that contain polymers as excipients in pharmaceutical formulations along with CDs.
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Wijaya, I. Gede Herry Ananta. "Myelodysplastic syndromes: Laporan Kasus." Intisari Sains Medis 13, no. 2 (2022): 613–17. http://dx.doi.org/10.15562/ism.v13i2.1383.
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Background: Myelodysplastic syndrome (MDS) is a group of bone marrow disorders characterized by ineffective hematopoiesis resulting in cytopenia and an increased risk of Acute Myeloid Leukemia (AML). MDS is a disease that is often found in elderly patients. The mean age at disease onset was 70 years. Case: A 72-year-old woman complained of feeling tired easily since 5 months throughout the day, not aggravated by activity and starting to gain weight in the last 1 week to interfere with the patient's activities. The patient also complained of intermittent dizziness since 2 months, was not affected by activity or change of position, and was not accompanied by nausea and vomiting. Complaints of fever, prolonged cough, bleeding, yellow body, red skin rash, progressive weight loss, bowel and bladder disorders were denied. Physical examination of the patient revealed vital signs within normal limits. The patient's conjunctiva was anemic, the patient's extremities also looked pale and there was no organ enlargement such as hepatomegaly and splenomegaly. Laboratory examinations at the time of presentation showed an increase in leukocytes, a decrease in erythrocytes, a decrease in hemoglobin, and a decrease in hematocrit. The patient's platelets were still in the normal range and there were no disturbances in kidney and liver function. The results of leukocytes, erythrocytes, and hemoglobin taken consecutively on 3 consecutive days still show an increase in leukocytes despite the downward trend in value. The results of bone marrow examination, namely trephine morphology, showed hypercellular marrow (approximately 80% cellularity) with an increase in blast cells of 10-15%, decreased maturation of myeloid series, erythroid cells and dyserythropoiesis, scattered plasma cells, increased megakaryocytes accompanied by dysmegakaryopoiesis. Patient diagnosed as Myelodysplastic Syndrome with Excess Blast. The therapy given to the patient during hospitalization aims to overcome the symptoms experienced by the patient. Transfusion of PRC (Packed Red Cell) 1 Kolf/day with Furosemide 20 mg by injection before transfusion and administration of Folic Acid 1 x 1 tablet per day provided an improvement in the patient's condition. This is evidenced by the increase in hemoglobin levels during treatment. The patient was referred to a referral hospital for further treatment. Conclusion: Myelodysplastic syndrome (MDS) is a group of bone marrow disorders characterized by ineffective hematopoiesis resulting in cytopenia and an increased risk of acute myeloid leukemia (AML). The patient was diagnosed with MDS with Excess Blast based on bone marrow biopsy. Other investigations, namely complete blood count, found an increase in leukocytes and hemoglobin, this also supports the diagnosis of MDS in this patient. The prognosis in this patient is classified as high risk based on IPSS-R, which means survival for 1-2 years is 13%. Latar Belakang: Myelodysplastic syndrome (MDS) adalah kelompok penyakit gangguan sumsum tulang ditandai dengan hematopoiesis yang tidak efektif mengakibatkan sitopenia dan peningkatan risiko terjadinya Leukemia Mieloid Akut (AML). MDS merupakan penyakit yang sering ditemukan pada pasien lanjut usia dengan rerata onset penyakit yaitu usia 70 tahun. Kasus: Perempuan berusia 72 tahun mengeluh mudah lelah sejak 5 bulan yang dirasakan sepanjang hari, tidak diperberat dengan aktivitas dan mulai bertambah berat 1 minggu terakhir hingga menganggu aktivitas pasien. Keluhan pusing yang hilang timbul sejak 2 bulan, tidak dipengaruhi oleh aktivitas atau perubahan posisi, dan tidak disertai dengan mual dan muntah. Keluhan demam, batuk lama, perdarahan, badan kuning, ruam merah dikulit, penurunan berat badan yang progresif, gangguan BAB dan BAK disangkal. Pasien didapatkan tanda vital dalam batas normal. Konjungtiva pasien anemis, ekstremitas pasien juga tampak pucat dan tidak didapatkan pembesaran organ seperti hepatomegaly dan splenomegaly. Hasil laboratorium diperoleh leukositosis, eritropenia, anemia, dan penurunan hematokrit. Platelet pasien masih berada pada rentang normal dan tidak terdapat gangguan pada fungsi ginjal dan hati. Hasil leukosit, eritrosit, dan hemoglobin yang diambil berturut-turut pada 3 hari berturut-turut tetap menunjukkan peningkatan leukosit meskipun tren nilai mengalami penurunan. Hasil pemeriksaan sumsum tulang yaitu gambaran morfologi trephine menunjukkan sumsum hiperseluler (kurang lebih 80% selularitas) dengan peningkatan sel blast 10 – 15 %, penurunan maturasi seri myeloid, sel eritroid dan diseritropoiesis, scattered sel plasma, peningkatan megakariosit disertai dismegakariopoiesis. Pasien diagnosa sebagai Myelodysplastic Syndrome with Excess Blast. Terapi yang diberikan pada pasien selama perawatan di rumah sakit bertujuan untuk mengatasi gejala yang dialami pasien. Transfusi PRC (Packed Red Cell) 1 Kolf/hari dengan pemberian Furosemide 20 mg secara injeksi sebelum transfusi dan pemberian Asam Folat 1 x 1 tablet per hari memberikan perbaikan kondisi pada pasien. Hal ini dibuktikan dengan peningkatan kadar hemoglobin selama perawatan. Pasien dirujuk ke rumah sakit rujukan untuk penanganan lebih lanjut. Simpulan: Myelodysplastic syndrome (MDS) adalah kelompok penyakit gangguan sumsum tulang ditandai dengan hematopoiesis yang tidak efektif mengakibatkan sitopenia dan peningkatan risiko terjadinya Leukemia Myeloid Akut (AML). Pasien didiagnosis mengalami MDS with Excess Blast berdasrakan pemeriksaan biopsis sumsum tulang. Prognosis pada pasien ini tergolong high risk berdasarkan IPSS-R yang artinya survival untuk 1 – 2 tahun yaitu 13%.
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Blatny, Jan, Prasad Mathew, John Puetz, Petra Ovesna, and Petr Brabec. "SeveN BleeP Registry – 5 Years Later: An Update." Blood 116, no. 21 (2010): 3651. http://dx.doi.org/10.1182/blood.v116.21.3651.3651.
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Abstract Abstract 3651 Introduction: SeveN Bleep (Seven A in Nonhemophilia Bleeding in Pediatrics) is a web-based registry for collecting data on the use of rFVIIa in the treatment of severe and/or life threatening bleeding in children without hemophilia. The registry was endorsed by the Paediatric/Perinatal SSC subcommittee of ISTH. Methods: The registry was established in 2005. During the five years of its existence, 191 cases were recorded, of which 164 (86%) records fulfilled the validation criteria and were eligible for further analyses. For the purpose of analysis, the patients were stratified into two groups: neonates and infants <1 year, and children >1 yr old. Statistical methods were used as appropriate. Results: Fifty nine (36%) valid records described the treatment with rFVIIa in neonates and infants, and 105 (64%) in older children. Of these, 27(16%) were for the prevention of severe bleeding. In the rest (84%) of cases, rFVIIa was used to treat severe bleeding. Those 137 cases (42 neonates+infants and 95 older children) were further analysed for the purpose of this report. The median weight in the <1 year old was 2.4 kg. The reasons for administration of rFVIIa included: bleeding during “non-trauma” surgery (17%), cardiac surgery (12%), trauma (12%) and intracranial haemorrhage (12%). Overall survival rate was 50%. Only one neonate experienced a thrombembolic event as a possible SAE from the treatment with rFVIIa. There were no deaths related to rFVIIa treatment. In those older than 1 year, the median age was 10 years and median weight 30 kg. The reasons for administration of rFVIIa included trauma (45%), “non-trauma” surgery (14%) and bleeding related to malignancy and/or its treatment (11%). Survival rate in this group was 72%. 17% of deaths were related to the underlying hemorrhage treated. There were no thrombotic event or death related to rFVIIa treatment recorded in this group. There was a trend towards using a higher total dose (median 160ug/kg) in patients that died compared to a lower dose (median 120 ug/kg) in those who survived (p=0.078). In addition, those who survived needed lesser number of doses as compared to the deceased patients (median number of doses 1 and 2, respectively; p=0.052). Use of rFVIIa led to a significant decrease in the consumption of blood products in the 24 hour period after rFVIIa administration compared to the 24 hours prior to the use of rFVIIa - packed red cells (280 ml vs. 560 ml; p=0.001), FFP (250 ml vs. 500 ml; p=0.003). There were also significant changes in certain laboratory parameters related to rFVIIa administration also. Estimated blood loss decreased from 30 ml/kg prior to rFVIIa administration to 3 ml/kg after the use of rFVIIa (p=0.002). Conclusion: SevNBleep registry has proven to be a useful international tool for collection of relevant clinical data on the use of rFVIIa. rFVIIa appears to be beneficial in the management of bleeding in the pediatric population. The prevalence of adverse events related to use of rFVIIa was very low, though not absent. To minimize the potential bias related to reporting of SAEs, all major contributing centers has been contacted for further information with regards to consecutive reporting of patients treated with rFVIIa. Disclosures: Off Label Use: rFVIIa use in life threatening bleeding in children.
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Mehta, Pallavi, Stalin Ramprakash, C. Raghuram, et al. "In-Vivo Adsorption of Iso-Haemagglutinin (IHA) Antibodies By Donor Type Red Cell Transfusion during Conditioning Is a Safe and Effective Method to Overcome Major ABO Incompatibility-Related Acute Hemolytic Reactions in Stem Cell Transplant Using Bone Marrow As Stem Cell Graft Source." Blood 134, Supplement_1 (2019): 4467. http://dx.doi.org/10.1182/blood-2019-131118.
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Introduction: ABO blood group incompatibility is not a barrier to performing allogeneic stem cell transplant, but may result in life-threatening acute hemolytic reactions as well as pure red cell aplasia. As stem cell product manipulation is cumbersome and may entail cell loss, attempts have been made in the past to reduce IHA titers in-vivo either by donor type red cell transfusion or using frozen plasma in peripheral blood stem cell (PBSC) transplants (Scholl et al. Transfusion 2005; Damodar et al. BMT 2005). The efficacy of such strategies have not been described in Bone marrow transplant (BMT) setting. We are reporting the effectiveness and safety of donor type red cell infusion during conditioning as a method of reducing acute hemolytic reaction during transplant while using unmanipulated marrow as stem cell source (BMT). Materials and Methods: We retrospectively analyzed 241 consecutive allogeneic BMTs for beta thalassemia major, between August 2015 and July 2019 out of which 82 were ABO mismatched transplants, either major (n=30) or minor (n=40), or bidirectional (n =12) mismatched. Infusion of donor type red blood cell during conditioning after the infusion of Anti-thymocyte globulin (ATG) and post-transplant complication of acute hemolysis were determined by retrospective review of individual medical records. When there is a major ABO incompatibility and IHA titers against the donor were > 1:64, a single unit of donor type Packed Red Blood cell (PRBC) was divided into 4 aliquots, irradiated and administered over 4 days at increasing incremental volumes once daily over 4 days if tolerated (Day 1 - 5 ml, Day 2 - 10ml, Day 3- 20-30 ml, Day 4 - 40-60 ml) (Fig.1). Patients were watched carefully for febrile reactions and hemoglobinuria and mild reactions were tolerated. If no clinical evidence of severe hemolytic reaction, bone marrow was infused without manipulation on the day of transplant. Results: Out of 30 patients with major ABO incompatibility, 13 patients had titers more than 1:64 (highest was 1:2048) and hence received donor type PRBC infusion in small incremental doses. Eight patients showed evidence of some hemolysis (4 during infusion of donor type PRBC aliquot and 4 showed increase in indirect bilirubin with marrow infusion) which was managed conservatively with hydration. None of the patients developed severe hemolytic or anaphylactic reaction at the time of marrow infusion. Post infusion of donor type blood, titers were checked in 7 patients. 6 patients had significant reduction in titers (all were less than 1:32) except for 1(titers increased to 1:4096), which was not considered clinically relevant as he tolerated 100mls of donor type PRBC. He also tolerated marrow infusion without any evidence of severe hemolytic reaction. Four more patients with bidirectional mismatch had IHA titers against the donor more than 1:64, hence the same procedure was followed. One of them had mild hemoglobinuria during donor type PRBC infusion and 3 patients had mild hemoglobinuria with rise in indirect bilirubin at the time of marrow infusion. All patients were managed conservatively with hydration. Conclusion: Our experience demonstrated that donor-type PRBC infusion as a method of in-vivo adsorption of IHA antibodies against donor is safe and effective in preventing acute hemolysis in major ABO-mismatched stem cell transplants even in the context where bone marrow is used as graft source. This simple method in addition to avoiding the problems related to product manipulation can also be safely and easily performed in resource limited settings. Disclosures No relevant conflicts of interest to declare.
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Efficace, Fabio, Valeria Santini, Giorgio La Nasa, et al. "Health-Related Quality Of Life In Transfusion-Dependent Patients With Myelodysplastic Syndromes Treated With Deferasirox. A Multicenter Prospective Study." Blood 122, no. 21 (2013): 2980. http://dx.doi.org/10.1182/blood.v122.21.2980.2980.
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Abstract Background Anemia is a common symptom in patients with Myelodysplastic Syndromes (MDS) and although erythropoietic agents are often active, it is frequently treated with red blood cell (RBC) transfusions. A substantial proportion of patients might also eventually become transfusion-dependent and, Iron-chelating therapies might be important to minimize complications of iron overload. Objectives To investigate the impact of deferasirox therapy on health-related quality of life (HRQOL) of lower risk transfusion-dependent MDS patients over a one year period. Secondary objectives were to investigate relationships between HRQOL and ferritin levels and to explore the prognostic value of baseline HRQOL on the probability of achieving transfusion independence. Patients and Methods This was a prospective study whose clinical findings (i.e., primary endpoint was safety and tolerability) were previously reported. HRQOL was a secondary endpoint of the study and we herein report, for the first time, HRQOL prospective findings. Eligible patients included: MDS patients 18 years or older, International Prognostic Scoring System (IPSS) low or intermediate-1 risk and diagnosed with transfusional siderosis following a minimum of 20 blood transfusions. Patients received daily oral deferasirox at a dose between 10 and 30 mg/kg of body weight for a period of 1 year. HRQOL was assessed with the EORTC QLQ-C30. HRQOL at baseline and at 3, 6, 9 and 12 months after treatment start. The EORTC QLQ-C30 consists of 30 items and includes five functional scales (physical, role, emotional, social, and cognitive), three symptom (fatigue, nausea and vomiting and pain) and a global health status/QOL scale and six single items (dyspnea, insomnia, appetite loss, constipation, diarrhea and financial difficulties). The mean trend of HRQOL over time was estimated via a linear mixed model with a one-step autoregressive covariance structure. Such covariance structure provided the best model fit among those investigated. Results Overall, 159 patients were screened at 37 centers. The median duration of disease at enrollment was 32 months and median number of units of packed RBC received was 37. Seven patients did not start treatment at all and thus there were 152 expected HRQOL forms at baseline assessment. Out of these, 146 patients returned the questionnaire yielding a baseline compliance of 96%. No statistically significant differences over time were found for any scale of the EORTC QLQ-C30. Figure 1 depicts mean scores over time for selected scales of: fatigue, physical functioning, pain and global HRQOL. No HRQOL differences were found between patients with serum ferritin levels lower or higher than 2000 μg/L (pretreatment median value) at baseline. Also, the possible impact of ferritin level on HRQoL over time was estimated via a linear mixed model with a one-step autoregressive covariance structure. Coefficients and p values are reported in table 1. The prognostic impact of baseline HRQOL on the probability of achieving transfusion independence (i.e., defined as freedom from transfusion for 3 consecutive months) was investigated. Higher severity of pain (P=0.007) was associated with a greater likelihood of achieving transfusion independence. Multivariate analysis, controlling for age, IPSS risk score, time from diagnosis, number of previous blood transfusions and baseline ferritin level confirmed the independent value of pain (P=0.003). Conclusion Current findings suggest that Deferasirox therapy does not decrease HRQOL in lower risk transfusion-dependent MDS patients. Patients with higher baseline pain severity seems more likely to achieve transfusion independence and further analysis is needed to understand underlying reasons. Disclosures: No relevant conflicts of interest to declare.
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Sakshi, Kausha, and Sharma R.K. "Modeling and Analysis of Adaptive Buffer Sharing Scheme for Consecutive Packet Loss Reduction in Broadband Networks." March 23, 2010. https://doi.org/10.5281/zenodo.1060068.
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High speed networks provide realtime variable bit rate service with diversified traffic flow characteristics and quality requirements. The variable bit rate traffic has stringent delay and packet loss requirements. The burstiness of the correlated traffic makes dynamic buffer management highly desirable to satisfy the Quality of Service (QoS) requirements. This paper presents an algorithm for optimization of adaptive buffer allocation scheme for traffic based on loss of consecutive packets in data-stream and buffer occupancy level. Buffer is designed to allow the input traffic to be partitioned into different priority classes and based on the input traffic behavior it controls the threshold dynamically. This algorithm allows input packets to enter into buffer if its occupancy level is less than the threshold value for priority of that packet. The threshold is dynamically varied in runtime based on packet loss behavior. The simulation is run for two priority classes of the input traffic – realtime and non-realtime classes. The simulation results show that Adaptive Partial Buffer Sharing (ADPBS) has better performance than Static Partial Buffer Sharing (SPBS) and First In First Out (FIFO) queue under the same traffic conditions.
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L., Estrada, Torres D., and Toral H. "Characterization and Modeling of Packet Loss of a VoIP Communication." June 28, 2010. https://doi.org/10.5281/zenodo.1081826.
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In this work, a characterization and modeling of packet loss of a Voice over Internet Protocol (VoIP) communication is developed. The distributions of the number of consecutive received and lost packets (namely gap and burst) are modeled from the transition probabilities of two-state and four-state model. Measurements show that both models describe adequately the burst distribution, but the decay of gap distribution for non-homogeneous losses is better fit by the four-state model. The respective probabilities of transition between states for each model were estimated with a proposed algorithm from a set of monitored VoIP calls in order to obtain representative minimum, maximum and average values for both models.
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Chen, Bing, Yangzhou Chen, and Jingyuan Zhan. "Consensus of discrete-time multi-agent systems with consecutive packet losses in directed communication topology." Transactions of the Institute of Measurement and Control, January 12, 2023, 014233122211388. http://dx.doi.org/10.1177/01423312221138892.
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In this paper, consensus analysis and design are investigated for discrete-time multi-agent systems (MASs) with consecutive packet losses in communication links of directed communication topology. It is assumed that at each transmitted instant, the packet loss is stochastic and described by Bernoulli distribution, but during a given time window, the data could be successfully transmitted to the agent from each of its neighbors. First, we utilize the incidence matrix of a directed spanning tree of the communication topology to construct a linear transformation matrix so that the consensus problem is equivalently transformed into a mean square asymptotic stability problem of a reduced-order system. Second, by using Lyapunov–Krasovskii functional approach, we derive some sufficient conditions of consensus criterion in terms of linear matrix inequalities (LMIs). These conditions express the relationship among the control gain matrix, packet loss rate, and the number of consecutive packet losses. Based on the conditions, gain matrix in the consensus protocol is designed to guarantee the MAS with stochastic packet losses to achieve mean square asymptotic consensus. Moreover, for the special case of undirected communication topology, by using the matrix decomposition method, the variables of LMIs are transformed into the low-order conditions independent of the network size. Finally, some numerical examples are given to show the effectiveness of the proposed method.
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Chydzinski, Andrzej, and Blazej Adamczyk. "Burst Ratio of Packet Losses in Individual Network Flows." Informatica, 2023, 1–18. http://dx.doi.org/10.15388/23-infor509.
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We study the burst ratio of packet loss processes in networking. This parameter characterizes the inclination of packet losses to form long, consecutive sequences. Such long sequences of losses may have a negative impact on multimedia streams, particularly those of real-time type. In packet networks, the burst ratio is often elevated due to overflows of packet buffers, which are present in all routers and switches. In the article, we investigate the burst ratio in the per-flow manner, i.e. individually for every flow of packets traversing a network node. We first confront all the per-flow burst ratios with each other, as well as with the burst ratio computed for the multiplexed traffic. Next, we study the influence of different features of the system on these burst ratios. In particular, the influence of rates of flows and their proportions, the standard deviation of interarrival times, the capacity of the buffer, the system load and the distribution of the service time, is studied. Special attention is paid to models with non-Poisson flows, which are not analytically tractable.
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Haider, Aun, and Richard Harris. "A Hybrid Random Early Detection Algorithm for Improving End-to-End Congestion Control in TCP/IP Networks." African Journal of Information & Communication Technology 4, no. 1 (2008). http://dx.doi.org/10.5130/ajict.v4i1.418.
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The successful operation of the present Internet depends mainly upon TCP/IP which employs end-to-end congestion
 control mechanisms built in the end hosts. In order to further enhance this paradigm of end-to-end control the
 Random Early Detection algorithm (RED) has been proposed, which starts to mark or drop packets at the onset of congestion. 
 The paper addresses issues related to the choice of queue length 
 indication parameters for packet marking/dropping decisions 
 in RED-type algorithms under varying traffic conditions. Two
 modifications to RED are proposed: (i) use of both instantaneous queue size and its Exponential Weighted Moving Average
 (EWMA) for packet marking/dropping and (ii) reducing the effect of the EWMA queue size value when the queue size is less than 
 $min_{th}$ for a certain number of consecutive packet arrivals. 
 
 The newly developed Hybrid RED algorithm can effectively improve the performance of TCP/IP based networks while working in a control loop formed by either dropping or marking of packets during congestion epochs. New guidelines are developed for better marking/dropping of packets to achieve a faster response of RED-type algorithms. The hybrid RED algorithm has been tested using ns-2 simulations, which show better utilization of network bandwidth and a lower packet loss rate.
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Zhang, Huihui, Lulu Li, and Jianquan Lu. "Stabilization of Networked Control Systems With Time Delays: An Observer‐Based Dynamic Quantized Control Approach." International Journal of Robust and Nonlinear Control, December 12, 2024. https://doi.org/10.1002/rnc.7770.
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ABSTRACTIn this article, we propose an observer‐based dynamic quantized control approach to stabilize networked control systems plagued by time delays. Our first step involves designing an observer‐based dynamic quantizer that effectively circumvents saturation, even in the presence of time delays. Notably, the zoom variable of this quantizer can be discretely adjusted. Specifically, the interval between two consecutive adjustments of the zoom variable has a positive lower bound, which contributes to reduced energy consumption. Next, we consider unbounded time delays that may lead to packet loss in networked control systems with limited bit rate. We prove that the system stabilization relies on a mild assumption on packet loss frequency. We then design a controller based on the quantized state of the observer to counteract time delays and maintain system performance. Finally, we provide three numerical examples to validate our theoretical results.
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Zhang, Tu, Guobao Zhang, and Yongming Huang. "Consensus control and initialization region optimization for leader‐following multi‐agent systems under time‐varying communication delay and consecutive packet dropouts." Optimal Control Applications and Methods, July 12, 2024. http://dx.doi.org/10.1002/oca.3180.
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AbstractThis article is to investigate the consensus control and initialization region optimization for leader‐following multi‐agent systems with time‐varying communication delay and nonidentical consecutive packet dropouts. By combining the Bernoulli distribution model of the data loss and the Hadamard product, the control protocols affected by both communication delay and packet dropouts are utilized to formulate the consensus problem into the mean‐square stability problem of the augmented error systems. Resorting to the Lyapunov function methodology and a structure separation method, a sufficient condition to ensure the consensus is built in the form of linear matrix inequality. Relying on the given Lyapunov function and set‐membership analysis, an optimization procedure is proposed to simultaneously ensure the consensus and enlarge the estimated ellipsoid of initial conditions. The validity of the provided method is illustrated through a comparative simulation.
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Guerra, Antonia Mirian Nogueira de Moura, Deyse Silva dos Santos, Maria Gabriela Magalhães Silva, et al. "PVC film coatings promote post-harvest conservation of Italian zucchini fruits (Cucurbita pepo L.)." Research, Society and Development 9, no. 8 (2020). http://dx.doi.org/10.33448/rsd-v9i8.5530.
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We evaluated the influence of storage conditions on the postharvest life of Italian zucchini fruits. Zucchinis with and without PVC coating film were evaluated at storage temperatures of 10 and 25 ºC. Evaluations were carried out at 0, 5, 10, 15 and 20 consecutive days. Zucchinis packed with PVC film at 10 ° C showed the lowest losses of fresh mass (0.84%), being the most efficient condition in reducing mass loss and maintaining the good aspects of the fruits. The treatments using 10ºC resulted in less loss of fruit firmness, regardless of packaging. Packaging with PVC at 25 ºC presented the lowest solids content at 20 days and increments up to 15 days of tritatable total acidity, with a subsequent decline at 20 days. Tritatable acidity increased until the end of the storage period in fruits without packaging. We found a variable pH in fruits without packing and a pH reduction in fruits with PCV packing regardless of temperature. Fruits stored at 10ºC with or without packing showed smaller biomass loss. Storing Italian zucchini fruits at low temperature or coated with PVC at low temperature decrease the activity of the enzymes of solubilization of the wall components, maintaining the turgor of the tissues and extending their useful life.
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Lapisatepun, Warangkana, Tanyong Pipanmekaporn, Prangmalee Leurcharusamee, Jiraporn Khonara, Jayanton Patumanond, and Worakitti Lapisatepun. "The risk factors for perioperative blood transfusion in open liver resection, a retrospective cohort study." International Journal of Surgery Open, February 15, 2024. http://dx.doi.org/10.1097/io9.0000000000000029.
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Purpose: Liver resection is the current treatment for hepatic neoplasms but may be associated with intraoperative hemorrhage and the need for blood transfusions. The aim of this study is to identify the risk factors for predicting the requirement of a perioperative blood transfusion in open liver resection. Methods: A total of 808 consecutive patients who had undergone elective open liver resection from 2006 to 2017 were retrospectively reviewed using the database. Baseline characteristics and intra-operative data were collected. Perioperative blood transfusion was defined as the transfusion of allogenic packed red cells during surgery and the 48 hours following surgery. An analysis of logistic regression was used to determine the independent risk factors for blood transfusion in open liver resection. Results: Three hundred and seventy-seven patients (46.7%) received perioperative packed red cell transfusions. The independent risk factors associated with perioperative blood transfusion included ASA classification>2, preoperative anemia (Hb<12 g/dL for women, Hb<13 g/dL for men), thrombocytopenia (platelet count<100×103/mm3), albumin<3.5 g/dL, largest tumor size>4 cm., major liver resection, and surgeon experience performing<50 cases of major open liver resection. Conclusion: Preoperative risk factors may be utilized to assess and predict patients who require perioperative blood transfusions following liver resection. Modifiable risk factors may also be treated prior to surgery. Furthermore, patient blood management and methods to minimize blood loss and blood transfusions during surgery should be implemented in patients who require high-risk transfusions.
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Cawich, Shamir, Greg Padmore, Sahle Griffith, Karisha LaCorbiniere, and Reena Patel. "Pancreaticoduodenectomies in a Low Volume, Small Island Eastern Caribbean State: A Retrospective Cohort Study." Medical Research Archives 11, no. 6 (2023). http://dx.doi.org/10.18103/mra.v11i6.3893.
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Background: Although pancreaticoduodenectomy (PD) is safe when performed in high-volume hospitals, many patients in low-income countries cannot access these hospitals. Barbados is a small island that does not have a high-volume pancreatic center. We sought to document peri-operative outcomes when PD was performed in Barbados. Methods: We carried out a retrospective cohort study of all consecutive patients who underwent PDs over from August 1, 2016 to October 30, 2022. Therapeutic outcomes, post-operative morbidity and mortality were evaluated. Statistical analyses were performed using SPSS ver 16.0. Results: Six patients at a mean age of 54.8 years underwent PD (mean annual case volume of 1). Two patients underwent planned vein resections and reconstruction. In this subset, the mean operating time was 325 minutes (Range 300-250; Median 325; SD ±35.4), mean estimated blood loss was 825mls (Range 750-900; Median 825; SD±106.1), and the mean transfusion requirement was 1 unit of packed cells (Range 0-2; Median 1; SD±1.41). In the four patients without vein resection, mean operating time was 308 minutes (Range 280-350; Median 300; SD±24.01), median blood loss was 575 ml (Range 150-900; Median 700; SD±320.6) and mean transfusion requirements were 0.5 units of packed cells (Range 0-2; Median 0; SD ±0.84). The mean ICU stay was 2.17 days (Range 1-3; Median 2.5; SD±0.98), and the mean duration of hospitalization was 9.3 days (Range 7-11; Median 9.5; SD±1.37). There were no recorded peri-operative deaths, but there was 1 (17%) minor complication (delayed gastric emptying) and 1 (17%) major complication (myocardial infarction). Conclusion: In Barbados, there are good peri-operative outcomes after PD despite the low volume and challenging healthcare environment. We believe that (1) surgeon experience (2) continuous adaptive hospital learning and (3) regular audit of hospital data are better indicators of PD quality than volume data alone.
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muhammad, yasir, sajjad muhammad, and batool maryam. "The Effectiveness of the B-Lynch Uterine Compression Sutures for Treating the Uncontrollable Postpartum Hemorrhage Following Cesarean Section." August 31, 2018. https://doi.org/10.5281/zenodo.4447133.
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<strong>Objective</strong><strong>: </strong>To find out the safety and efficacy of B-Lynch suturing technique in controlling of massive intractable postpartum hemorrhage.<strong>Study Design: </strong>A prospective case controlled study.<strong>Place and Duration of Study: </strong>Gynecology Department of Services Hospital Lahore and Bahawal Victoria Hospital Bahawalpur from June 2017 to June 2018.<strong>Methodology: </strong>Forty two patients were selected by nonprobability consecutive sampling technique. Age of the patient, gestational age, parity, cesarean section (elective/emergency) and preoperative Hb were compared between two groups as baseline data. Outcome data included blood lost, pints of packed red cells transfused, days of hospital stay and postoperative Hb. Data was put in SPSS v.23 and analyzed by applying Chi-square test, Mann Whitney U-test and student’s t-test, where appropriate. P-value more than 0.05 was considered insignificant.<strong>Results: </strong>The difference of age, gestational age, preoperative Hb, parity and the type of cesarean section was not statistically significant (p-value 0.270, 0.220, 0.184, 0.620 and 0.289, respectively). The difference in loss of blood, number of packed RBCs units transfused, number of days of hospital stay and hysterectomy was significantly more in Group O as compared to Group B (p-value being 0.037, 0.045, 0.018 and 0.030 respectively). Postoperative Hb was significantly lower in group O (p<0.001).<strong>Conclusion: </strong>The method of B-Lynch suture is simple, fast, effective and safe with no apparent adverse effects. This should be made available even in the settings of low resources and all the training centers around the country
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Henriquez, Dacia D. C. A., Ada Gillissen, Sharissa M. Smith, et al. "Clinical characteristics of women captured by extending the definition of severe postpartum haemorrhage with ‘refractoriness to treatment’: a cohort study." BMC Pregnancy and Childbirth 19, no. 1 (2019). http://dx.doi.org/10.1186/s12884-019-2499-9.
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Abstract Background The absence of a uniform and clinically relevant definition of severe postpartum haemorrhage hampers comparative studies and optimization of clinical management. The concept of persistent postpartum haemorrhage, based on refractoriness to initial first-line treatment, was proposed as an alternative to common definitions that are either based on estimations of blood loss or transfused units of packed red blood cells (RBC). We compared characteristics and outcomes of women with severe postpartum haemorrhage captured by these three types of definitions. Methods In this large retrospective cohort study in 61 hospitals in the Netherlands we included 1391 consecutive women with postpartum haemorrhage who received either ≥4 units of RBC or a multicomponent transfusion. Clinical characteristics and outcomes of women with severe postpartum haemorrhage defined as persistent postpartum haemorrhage were compared to definitions based on estimated blood loss or transfused units of RBC within 24 h following birth. Adverse maternal outcome was a composite of maternal mortality, hysterectomy, arterial embolisation and intensive care unit admission. Results One thousand two hundred sixty out of 1391 women (90.6%) with postpartum haemorrhage fulfilled the definition of persistent postpartum haemorrhage. The majority, 820/1260 (65.1%), fulfilled this definition within 1 h following birth, compared to 819/1391 (58.7%) applying the definition of ≥1 L blood loss and 37/845 (4.4%) applying the definition of ≥4 units of RBC. The definition persistent postpartum haemorrhage captured 430/471 adverse maternal outcomes (91.3%), compared to 471/471 (100%) for ≥1 L blood loss and 383/471 (81.3%) for ≥4 units of RBC. Persistent postpartum haemorrhage did not capture all adverse outcomes because of missing data on timing of initial, first-line treatment. Conclusion The definition persistent postpartum haemorrhage identified women with severe postpartum haemorrhage at an early stage of haemorrhage, unlike definitions based on blood transfusion. It also captured a large majority of adverse maternal outcomes, almost as large as the definition of ≥1 L blood loss, which is commonly applied as a definition of postpartum haemorrhage rather than severe haemorrhage.
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Conde, Osvaldo, Subaraman Ramchandran, Ergin Coskun, et al. "Role of Topical Tranexamic Acid on Blood Loss and Transfusion Requirements in Spinal Fusion for Neuromuscular and Syndromic Scoliosis." Global Spine Journal, February 15, 2024. http://dx.doi.org/10.1177/21925682241234016.
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Study Design Retrospective case control study. Objectives To determine the role of TXA when used as topical soaked sponges (tTXA) on peri-operative blood loss and changes in hemoglobin following posterior spinal fusion (PSF) for neuromuscular and syndromic scoliosis (NMS). Methods A single center review of NMS patients who underwent PSF was conducted. The initial set of patients where no tTXA (control) was used were compared to consecutive NMS patients in whom tTXA was used. In the tTXA group, sponges soaked in 1g TXA in 500 mL normal saline were packed in the wound instead of dry sponges. Estimated blood loss (EBL) was calculated intraoperatively using a standard way. Pre-operative, intra-operative and immediate post-operative variables were collected and compared between the 2 groups. Results 33 patients were included (mean age- 13.5 yrs., BMI- 21, 17 patients in tTXA and 16 patients in control group). Pre-op demographic and radiographic variables were similar between the 2 groups. EBL, EBL per level, EBVL, operative time and number of levels fused were similar in both groups. tTXA group received less intra-operative pRBC transfusion as compared to the control group (150 ± 214 vs 363 ± 186 cc, P = .004). No difference was noted in post-op blood transfusion and drain output for 3 days in both the groups. tTXA group had lesser hospital (5.1 vs 8.9 days) and ICU length of stay (2 vs 4.2 days) and fewer immediate post-operative complications (23.5 vs 52.9%) compared to the control group but not statistically significant ( P > .05). Conclusion Administration of tTXA-soaked sponges is an effective and safe method to reduce intraoperative blood transfusion requirements in the correction of spinal deformity in patients with NMS.