Preoperative anemia is a common and potentially serious hematological problem in elective surgery and increases the risk for perioperative red blood cell (RBC) transfusion. Transfusion is associated ...with postoperative morbidity and mortality. Preoperative intravenous (IV) iron therapy has been proposed as an intervention to reduce perioperative transfusion; however, studies are generally small, limited, and inconclusive.
We propose performing a systematic review and meta-analysis. We will search MEDLINE, EMBASE, EBM Reviews, Cochrane-controlled trial registry, Scopus, registries of health technology assessment and clinical trials, Web of Science, ProQuest Dissertations and Theses, and conference proceedings in transfusion, hematology, and surgery. We will contact our study drug manufacturer for unpublished trials. Titles and abstracts will be identified and assessed by two reviewers for potential relevance. Eligible studies are: randomized or quasi-randomized clinical trials comparing preoperative administration of IV iron with placebo or standard of care to reduce perioperative blood transfusion in anemic patients undergoing major surgery. Screening, data extraction, and quality appraisal will be conducted independently by two authors. Data will be presented in evidence tables and in meta-analytic forest plots. Primary efficacy outcomes are change in hemoglobin concentration and proportion of patients requiring RBC transfusion. Secondary outcomes include number of units of blood or blood products transfused perioperatively, transfusion-related acute lung injury, neurologic complications, adverse events, postoperative infections, cardiopulmonary complications, intensive care unit (ICU) admission/readmission, length of hospital stay, acute kidney injury, and mortality. Dichotomous outcomes will be reported as pooled relative risks and 95% confidence intervals. Continuous outcomes will be reported using calculated weighted mean differences. Meta-regression will be performed to evaluate the impact of potential confounding variables on study effect estimates.
Reducing unnecessary RBC transfusions in perioperative medicine is a clinical priority. This involves the identification of patients at risk of receiving transfusions along with blood conservation strategies. Of potential pharmacological blood conservation strategies, IV iron is a compelling intervention to treat preoperative anemia; however, existing data are uncertain. We propose performing a systematic review and meta-analysis evaluating the efficacy and safety of IV iron administration to anemic patients undergoing major surgery to reduce transfusion and perioperative morbidity and mortality.
PROSPERO CRD42015016771.
Transcatheter aortic valve implantation (TAVI) is an effective alternative to surgical valve replacement in high-risk patients with severe aortic stenosis. Although measures of frailty have been used ...to attempt to predict outcomes in this population, few studies have demonstrated changes in these measures.
We performed a prospective, observational study of 171 patients undergoing TAVI, of whom 44 had maximal follow-up of 1 month and 50 had maximal follow-up of 1 year. Quality of life was assessed using the Minnesota Living With Heart Failure Questionnaire, Katz Index of Independence in Activities of Daily Living questionnaire, and patient perception of overall well-being. Frailty was measured using the 10-m walk test and handgrip strength testing.
In the overall cohort, participants demonstrated improvements in quality of life metrics, but deterioration in 10-m walk test and handgrip at 1 month. These trends continued at 1 year. However, patients in the lowest quintile of handgrip and 10-m walk test demonstrated a trend of improvements in these metrics during follow-up.
Despite improvements in quality of life after TAVI, no improvements in frailty were observed in patients at 1 year.
Le remplacement valvulaire aortique par cathéter (TAVI) est une solution de rechange efficace à la chirurgie de remplacement valvulaire chez les patients atteints de sténose aortique grave et présentant un risque élevé. Les mesures de la fragilité sont utilisées pour tenter de prévoir les résultats au sein de cette population. Néanmoins, peu d’études ont permis d’objectiver les variations de ces mesures.
Nous avons réalisé une étude observationnelle prospective portant sur 171 patients ayant subi un TAVI, dont 44 suivis pendant un mois ou moins, et 50 durant un an ou moins. La qualité de vie a été évaluée au moyen de questionnaires – Minnesota Living With Heart Failure Questionnaire et Katz Index of Independence in Activities of Daily Living Questionnaire – et en fonction de la perception du patient relativement à son bien-être général. La fragilité a été mesurée à l’aide d’un test de marche sur dix mètres et d’un test de force de préhension.
Dans l’ensemble de la cohorte, une amélioration des mesures de la qualité de vie a été observée parallèlement à une détérioration des résultats au test de marche sur dix mètres et au test de force de préhension après un mois. Les tendances à cet égard se sont poursuivies au bout d’un an. Cependant, les résultats des patients du quintile inférieur au test de marche sur 10 m et au test de force de préhension ont eu tendance à s’améliorer au cours de la période de suivi.
Malgré une amélioration de la qualité de vie après le TAVI, la fragilité des patients ne s’est nullement améliorée après un an.
The use of non-invasive macroscopic imaging techniques is becoming more prevalent in the field of cultural heritage, especially to avoid invasive procedures that damage valuable artworks. For this ...purpose, an X-ray powder diffraction scanner (MA-XRPD) capable of visualising crystalline compounds in a highly specific manner was recently developed. Many inorganic pigments present in paintings fall into this category of materials. In this study, the 17th century oil painting
Girl with a Pearl Earring
(c. 1665) by Johannes Vermeer was analysed with a combination of transmission and reflection mode MA-XRPD. By employing this scanner in reflection mode, the relative sensitivity for compounds that are present at the paint surface could be increased, establishing it as a highly relevant technique for investigating the degradation processes that are ongoing at paint surfaces. Many of the original pigments employed by Vermeer could be identified, along with four secondary alteration products: gypsum (CaSO
4
·2H
2
O), anglesite (PbSO
4
), palmierite (K
2
Pb(SO
4
)
2
) and weddellite (CaC
2
O
4
·2H
2
O). The formation of gypsum was linked to the presence of chalk in the upper glaze layer while the formation of palmierite and weddellite is driven by the presence of lake pigments (and their substrates). In this manner, MA-XRPD can also be used to pinpoint locations relevant for sampling and synchrotron µ-XRPD analysis, which provides information on the microscopic make-up of the paint. A paint cross-section taken from an area rich in palmierite was analysed with synchrotron µ-XRPD, which confirmed the presence of this secondary compound at the interface of the upper paint layer with the ground layer as well as the presence of anglesite in the ground layer. The capacity of MA-XRPD to identify and chart secondary alteration products in a non-invasive manner has only very recently been demonstrated and makes it a highly relevant technique for the assessment of the chemical condition of works of art.
This article reports on the discovery of pararealgar and semi-amorphous pararealgar in Rembrandt's masterpiece
The Night Watch
. A large-scale research project named
Operation Night Watch
was started ...in 2019
.
A variety of non-invasive analytical imaging techniques, together with paint sample research, has provided new information about Rembrandt's pigments, materials, and techniques as well as the current condition of the painting. Macroscopic X-ray fluorescence, macroscopic X-ray powder diffraction and reflectance imaging spectroscopy identified the presence of arsenic sulfide pigments and degradation products of these pigments in the doublet sleeves and embroidered buff coat worn by Lieutenant Willem van Ruytenburch (central figure to the right of Captain Frans Banninck Cocq). Examination by light microscopy of two paint samples taken from this area shows a mixture of large sharp-edged tabular yellow and orange to red pigment particles, and scanning electron microscopy-energy dispersive X-ray analysis identified these particles as containing arsenic and sulfur. Using micro-Raman spectroscopy, the yellow particles were identified as pararealgar, and the orange to red particles as semi-amorphous pararealgar. Synchrotron-based X-ray diffraction allowed visualization of the presence of multiple degradation products associated with arsenic sulfides throughout the paint layer. The discovery of pararealgar and semi-amorphous pararealgar is a new addition to Rembrandt's pigment palette. To contextualize our findings and to hypothesize why, how, and where Rembrandt obtained the pigments, we studied related historical sources. A comprehensive review of historical sources gives insight into the types of artificial arsenic sulfides that were available and suggests that a broader range of arsenic pigments could have been available in Amsterdam in the seventeenth century than previously thought. This is supported by the use of a very similar mixture of pigments by Willem Kalf (1619–1693), a contemporary artist based in Amsterdam. Together with the condition of the particles in the paint cross sections, this brings us to the conclusion that Rembrandt intentionally used pararealgar and semi-amorphous pararealgar, together with lead–tin yellow and vermilion, to create an orange paint.
The spontaneous chemical alteration of artists’ pigment materials may be caused by several degradation processes. Some of these are well known while others are still in need of more detailed ...investigation and documentation. These changes often become apparent as color modifications, either caused by a change in the oxidation state in the original material or the formation of degradation products or salts, via simple or more complex, multistep reactions. Arsenic-based pigments such as orpiment (As
2
S
3
) or realgar (α-As
4
S
4
) are prone to such alterations and are often described as easily oxidizing upon exposure to light. Macroscopic X-ray powder diffraction (MA-XRPD) imaging on a sub area of a still life painting by the 17th century Dutch painter Martinus Nellius was employed in combination with microscopic (μ-) XRPD imaging of a paint cross section taken in the area imaged by MA-XRPD. In this way, the in situ formation of secondary metal arsenate and sulfate species and their migration through the paint layer stack they originate from could be visualized. In the areas originally painted with orpiment, it could be shown that several secondary minerals such as schultenite (PbHAsO
4
), mimetite (Pb
5
(AsO
4
)
3
Cl), palmierite (K
2
Pb(SO
4
)
2
) and syngenite (K
2
Ca(SO
4
)
2
∙H
2
O) have formed. Closer inspection of the cross-sectioned paint layer stack with μ-XRPD illustrates that the arsenate minerals schultenite and mimetite have precipitated at the interface between the orpiment layer and the layer below that is rich in lead white, i.e. close to the depth of formation of the arsenate ions. The sulfate palmierite has mostly precipitated at the surface and upper layers of the painting.
The soft modelling of the skin tones in Vermeer’s
Girl with a Pearl Earring
(Mauritshuis) has been remarked upon by art historians, and is their main argument to date this painting to c. 1665. This ...paper describes the materials and techniques Vermeer used to accomplish the smooth flesh tones and facial features of the
Girl
, which were investigated as part of the 2018
Girl in the Spotlight
research project. It combines macroscopic X-ray fluorescence imaging (MA-XRF), reflectance imaging spectroscopy (RIS), and 3D digital microscopy. Vermeer built up the face, beginning with distinct areas of light and dark. He then smoothly blended the final layers to create almost seamless transitions. The combination of advanced imaging techniques highlighted that Vermeer built the soft contour around her face by leaving a ‘gap’ between the background and the skin. It also revealed details that were otherwise not visible with the naked eye, such as the eyelashes. Macroscopic imaging was complemented by the study of paint cross-sections using: light microscopy, SEM–EDX, FIB-STEM, synchrotron radiation µ-XRPD and FTIR–ATR. Vermeer intentionally used different qualities or grades of lead white in the flesh paints, showing different hydrocerussite/cerussite ratios and particle sizes. Lead isotope analysis showed that the geographic source of lead, from which the different types of lead white were manufactured, was the same: the region of Peak District of Derbyshire, UK. Finally, cross-section analysis identified the formation of new lead species in the paints: lead soaps and palmierite (K
2
Pb(SO
4
)
2
), associated with the red lake.
Vasopressin withdrawal associated with massive polyuria Peskey, Candy S., PharmD; Mauermann, William J., MD; Meyer, Steven R., MD, PhD ...
Journal of thoracic and cardiovascular surgery/The Journal of thoracic and cardiovascular surgery/The journal of thoracic and cardiovascular surgery,
08/2009, Letnik:
138, Številka:
2
Journal Article
Transcatheter aortic valve replacement has transitioned from an experimental procedure to an important alternative therapy for patients with symptomatic aortic stenosis and high surgical risk. We ...present a case outlining an approach to deal with the issue of "failure to cross" the aortic valve in transcatheter aortic valve replacement from the transfemoral retrograde approach.
The Dayton Accords, signed in 1995, aimed to do things: end hostilities in Bosnia and establish the framework for a working relationship among the three major ethnic groups that would lead to the ...establishment of a centralized, unified, multi-ethnic, democratic, free enterprise state in the Balkans.While the Accords did end the Bosnian iteration of the Balkan wars of the 1990s, it has been woefully inadequate as a vehicle to political success, at least as its authors and supporters intended it to be. Although all eleven annexes were supposed to play a role in establishing the political framework, Annex IV—as the constitution for the new state—was tasked with defining the primary structures and functions of the hoped for relationship. The stated objective of Western officials was that Bosnia would evolve quickly under the guiding hand of the “international community.”The difficulties in fashioning that state are now well documented. Indeed, no sooner had the Dayton Accords been signed, than there were calls to revise them and even abandon them for something better, something that would more permanently cement the constitutional order of Bosnia in place. Most of these calls came from Washington, from many of the same people who had authored the Dayton process in the first place, including Ambassador Richard Holbrooke, the chief architect. Ever since 1995 there has been no dearth of criticism and speculation about the Accords, especially the veracity and usefulness of Annex IV. Seemingly, we never tire of debating the future of Bosnia and what it will take to make it a truly modern, functioning European state.
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