Older adults frequently attend the Emergency Department (ED) with poorly defined symptoms, often called nonspecific complaints (NSC). NSC such as 'weakness' and 'not feeling well', often lead to an ...extensive differential diagnosis. Patients with NSC experience a prolonged length of stay at the ED and are prone to adverse outcomes. Currently, a care pathway for patients with NSC does not exist. A special structured care pathway for patients with NSC was designed to improve the efficiency and quality of care at the ED. A multicenter parallel cohort study, organized in different hospitals in the Noord-Brabant area, the Netherlands, in which general practitioners (GP), elderly care physicians (ECP), Emergency Physicians (EP), geriatricians and internists will collaborate. Patients greater than or equal to 70 years presenting with NSC and in need of ED admission as indicated by their own GP or ECP are eligible for inclusion. Before implementation each hospital will retrospectively include their own control-group. After implementation, patients will prospectively be included. The care-pathway exists of risk stratification by the APOP-screener, in-depth history taking, i.e. limited comprehensive geriatric assessment (CGA) and a standard set of diagnostics, and a dedicated ED-nurse (if possible) present to ensure the care-pathway is followed. The primary outcome is length of stay at the ED (LOS-ED) and perceived quality of care. Secondary outcomes are hospital length of stay, revisits, readmissions and mortality at 30- and 90-day follow-up. This study proposes a structured care pathway for older patients presenting at the ED with NSCs and considering effectiveness and perceived quality this may improve acute care for these patients.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with thrombosis. We conducted a cohort study of consecutive patients, ...suspected of SARS-CoV-2 infection presented to the emergency department. We investigated haemostatic differences between SARS-CoV-2 PCR positive and negative patients, with dedicated coagulation analysis. The 519 included patients had a median age of 66 years, and 52.5% of the patients were male. Twenty-six percent of the patients were PCR-positive for SARS-CoV-2.PCR positive patients had increased levels of fibrinogen and (active) von Willebrand Factor (VWF) and decreased levels of protein C and α2-macroglobulin compared to the PCR negative patients. In addition, we found acquired activated protein C resistance in PCR positive patients. Furthermore, we found that elevated levels of factor VIII and VWF and decreased levels of ADAMTS-13 were associated with an increased incidence of thrombosis in PCR positive patients. In conclusion, we found that PCR positive patients had a pronounced prothrombotic phenotype, mainly due to an increase of endothelial activation upon admission to the hospital. These findings show that coagulation tests may be considered useful to discriminate severe cases of COVID-19 at risk for thrombosis.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
This study investigates retrospectively the incidence, risk factors and mortality of post‐transplant lymphoproliferative disorders (PTLD) in adult orthotopic liver transplant (OLT) recipients. Among ...1206 OLT recipients at a single institution, 37 developed a PTLD. The incidence of PTLD was highest during the first 18 months and relatively constant thereafter with cumulative incidence of 1.1% at 18 months and 4.7% at 15 years. The risk of PTLD was approximately 10% to 15% of the risk of death without PTLD. During the first 4 years following OLT, PTLD were predominantly related to EBV, while afterward most PTLD were EBV negative. Significant risk factors for PTLD in OLT recipients were transplantation for acute fulminant hepatitis during the first 18 months following OLT (HR = 2.6, p = 0.007), and rejection therapy with high‐dose steroids (HR = 4.5, p = 0.049) and OKT3 (HR = 3.9, p = 0.016) during the previous year. Therapy with high‐dose steroids or OKT3 (HR = 3.6, p = 0.0071) were also significant risk factors for PTLD‐associated mortality. OLT recipients remain at risk for PTLD years after transplantation. The strong association of PTLD with rejection therapy and the worse post‐PTLD prognosis among recipients of rejection therapy indicate the need to balance the risk of immunosuppression against the risk of PTLD following rejection treatment.
Abstract
To meet the demand for intense highly charged stable ion beams for medical and nuclear physics a traveling-wave-tube (TWT) based RF generator has been installed and is in commissioning at ...the Advanced Electron Cyclotron Resonance Upgrade (AECR-U) ion source at the UMCG-PAR-TREC facility. The generator comprises 2 x 750W in-phase combining TWT RF generators with an output frequency range of 12.75-14.5 GHz. Frequency scanning routines have been incorporated in the control software which makes it possible to identify intense and stable ion-beam regimes within the plasma-heating frequency domain. The new RF generator replaces a 14.1 GHz fixed frequency klystron. In this paper we present the setup, the scanning methodology, the first measurements, and discuss the frequency scans measured from a helium and a xenon beam. These results improve the stability and increase the beam intensity at the UMCG-PARTREC facility.
Abstract
The European Electron Cyclotron Resonance Ion Source (ECRIS) community has more than 20 years of experience working together in various EU-funded projects. In the recent project, called ...ERIBS (European Research Infrastructure – Beam Services), the community will focus on improving ion beam services for the EURO-LABS (European-Laboratories for Accelerator Based Sciences) research infrastructures. The EURO-LABS is a four-year project funded by the Horizon Europe program of the European Commission for years 2022 - 2026. In the ERIBS collaboration the best expertise, know-how and practices of the ECRIS community will be exploited and transferred between the partners to take full advantage of the European ion source infrastructure. The aim is to extend the beam variety available for the European user community by developing beam production methods and techniques. This development includes further improvement of technologies related to high temperature ovens, axial sputtering and MIVOC method for all the participating laboratories. We will also aim to improve both short- and long-term plasma and beam stability, as well as methods for online monitoring of these conditions. This can be realized, for example, by optical emission spectroscopy, identifying kinetic plasma instabilities by means of hard x-ray detection and using online beam current monitoring systems. An example of the recent developments is the new collaboration proposed by the CNRS-IPHC team to synthesize enriched MIVOC compounds for the other ERIBS partners. For example, the team successfully prepared an enriched chromocene compounds, which were needed to produce intensive
54
Cr and
50
Cr beams for the JYFL and GANIL nuclear physics programs, respectively.
A recent mandate emphasizes severity of liver disease to determine priorities in allocating organs for liver transplantation and necessitates a disease severity index based on generalizable, ...verifiable, and easily obtained variables. The aim of the study was to examine the generalizability of a model previously created to estimate survival of patients undergoing the transjugular intrahepatic portosystemic shunt (TIPS) procedure in patient groups with a broader range of disease severity and etiology. The Model for End-Stage Liver Disease (MELD) consists of serum bilirubin and creatinine levels, International Normalized Ratio (INR) for prothrombin time, and etiology of liver disease. The model's validity was tested in 4 independent data sets, including (1) patients hospitalized for hepatic decompensation (referred to as “hospitalized” patients), (2) ambulatory patients with noncholestatic cirrhosis, (3) patients with primary biliary cirrhosis (PBC), and (4) unselected patients from the 1980s with cirrhosis (referred to as “historical” patients). In these patients, the model's ability to classify patients according to their risk of death was examined using the concordance (c)-statistic. The MELD scale performed well in predicting death within 3 months with a c-statistic of (1) 0.87 for hospitalized patients, (2) 0.80 for noncholestatic ambulatory patients, (3) 0.87 for PBC patients, and (4) 0.78 for historical cirrhotic patients. Individual complications of portal hypertension had minimal impact on the model's prediction (range of improvement in c-statistic: <.01 for spontaneous bacterial peritonitis and variceal hemorrhage to ascites: 0.01-0.03). The MELD scale is a reliable measure of mortality risk in patients with end-stage liver disease and suitable for use as a disease severity index to determine organ allocation priorities. (HEPATOLOGY 2001;33:464-470.)
Abstract
The extraction system of the superconducting AGOR cyclotron consists of an electrostatic deflector and three electromagnetic channels. As the electrostatic deflector has only a moderate ...field strength (<100 kV/cm), the first electromagnetic channel (EMC1) has to generate a rather strong dipole component resulting in current densities up to 169 A/mm
2
in water-cooled copper coils. In the original design the coils consist of sections of hollow conductors, parallel to the beam path, vacuum-brazed to machined “bridges” over the beam aperture. Altogether there are over 200 brazed joints made in three subsequent cycles in the three coils (dipole, quadrupole and first harmonic corrector). In 25 years of operation two channels of this type have been “consumed”. The channels developed water leaks due to erosion of the copper by the high speed cooling water flow in the “bridge” regions that ultimately could not be repaired anymore. To remedy this problem the channel has been redesigned using bent conductors. A production technique for small radius bends and a new joining method to avoid vacuum brazing have been developed. The coil support taking up the 10 kN/m Lorentz forces on the windings are now made from isolating material instead of anodized aluminium to prevent grounding errors. The new channel (EMC1-U) has been in operation now for two years without any failure. A detailed comparison of the old and new design will be presented.
Recurrent hepatitis C virus (HCV) infection is a major cause of morbidity and mortality after liver transplantation for HCV‐related end stage liver disease. Although previous studies have shown a ...short‐term effect of interferon‐based treatment on fibrosis progression, it is unclear whether this translates to improved graft survival. We evaluated whether treatment of recurrent HCV leads to an improved graft survival. Cohort study included consecutive HCV patients who underwent liver transplantation between 1 January 1995 and 1 January 2005 in the Mayo Clinic, Rochester, MN. Two hundred and fifteen patients were included in the study. During a median follow‐up of 4.4 years (interquartile range 2.2–6.6), 165 patients (77%) had biopsy‐proven recurrent HCV infection confirmed by serum HCV RNA testing. Seventy‐eight patients were treated. There were no differences in MELD‐score, fibrosis stage or time towards HCV recurrence between treated and untreated patients at time of recurrence. There was a trend for greater frequency of acute cellular rejection among untreated patients. The incidence of graft failure was lower for patients treated within 6 months of recurrence compared to patients not treated within this time‐period (log rank p = 0.002). Time‐dependent multivariate Cox regression analysis showed that treatment of recurrent HCV infection was statistically significantly associated with a decreased risk of overall graft failure (hazard ratio 0.34; CI 0.15–0.77, p = 0.009) and a decreased risk of graft failure due to recurrent HCV (hazard ratio 0.24; CI 0.08–0.69, p = 0.008). In conclusion, although a cause and effect relationship cannot be established, treatment of recurrent HCV infection after liver transplantation is associated with a reduced risk of graft failure.
This paper examines the superior patient and graft survival experienced by patients with HCV infection who receive antiviral therapy following liver transplantation. See also editorial by Fortune and Trotter in this issue on page 2183
The aim of this randomized phase-II study was to evaluate the effect of substituting cytarabine by azacitidine in intensive induction therapy of patients with acute myeloid leukemia (AML). Patients ...were randomized to four induction schedules for two cycles: STANDARD (idarubicin, cytarabine, etoposide); and azacitidine given prior (PRIOR), concurrently (CONCURRENT), or after (AFTER) therapy with idarubicin and etoposide. Consolidation therapy consisted of allogeneic hematopoietic-cell transplantation or three courses of high-dose cytarabine followed by 2-year maintenance therapy with azacitidine in the azacitidine-arms. AML with CBFB-MYH11, RUNX1-RUNX1T1, mutated NPM1, and FLT3-ITD were excluded and accrued to genotype-specific trials. The primary end point was response to induction therapy. The statistical design was based on an optimal two-stage design applied for each arm separately. During the first stage, 104 patients (median age 62.6, range 18-82 years) were randomized; the study arms PRIOR and CONCURRENT were terminated early due to inefficacy. After randomization of 268 patients, all azacitidine-containing arms showed inferior response rates compared to STANDARD. Event-free and overall survival were significantly inferior in the azacitidine-containing arms compared to the standard arm (p < 0.001 and p = 0.03, respectively). The data from this trial do not support the substitution of cytarabine by azacitidine in intensive induction therapy.
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