Pegfilgrastim is a widely used long-acting granulocyte colony-stimulating factor (G-CSF) that prevents febrile neutropenia (FN) in patients with breast cancer receiving chemotherapy. This study aimed ...to evaluate the incidence of chemotherapy-related FN events and other adverse events (AEs) during chemotherapy in Korean patients with breast cancer treated with pegfilgrastim as secondary prophylactic support.
This was a multicenter, open-label, prospective, observational study. A total of 1255 patients were enrolled from 43 institutions. The incidence of FN was evaluated as the primary endpoint. The secondary endpoints included (1) incidence of bone pain, (2) proportion of patients with a relative dose intensity (RDI) of ≥85%, and (3) proportion of patients with AE.
Pegfilgrastim administration reduced FN by 11.8–1.6%. The highest incidence of bone pain was observed at the time point of the 1st day after the administration and mild bone pain was the most common of all bone pain severity. The mean RDI was 98.5 ± 7.3%, and the proportion of the patients with and RDI≥85% was 96.9% (1169/1233). AEs were reported in 52.6% of the patients, and serious drug reactions occurred in only 0.7%.
The use of pegfilgrastim as secondary prophylaxis was effective and safe for preventing FN in patients with breast cancer who were treated with chemotherapy.
•This is the first real-world study about pegfilgrastim for secondary prophylaxis in patients with breast cancer.•After pegfilgrastin administration the incident rate of FN was reduced to 1.6%.•The AEs, including bone pain, were tolerable in patients treated with pegfilgrastim.
This retrospective study aimed to evaluate the feasibility, safety, and efficacy of endovascular treatment (EVT) for M1 hilltop aneurysms, a specific M1 segment subtype located at the highest point ...of the middle cerebral artery (MCA).
The study included 54 patients with M1 hilltop aneurysms who underwent EVT between December 2017 and end date. Treatment decisions were based on angiographic findings and patient characteristics. Clinical and radiological data were reviewed, and outcomes were assessed using the Raymond-Roy classification (RRC) and modified Rankin Scale (mRS). Follow-up radiological examinations were conducted at specific intervals.
EVT was successful in all 54 cases. Immediate postprocedural angiograms showed favorable occlusion (RRC I or II) in 59.3% and aneurysm remnants (RRC III) in 40.7%. Procedure-related complications occurred in 7.4% of patients, including thromboembolism and ICA dissection, with no permanent neurological impairment. During a mean 18.2-month follow-up, no neurological deterioration or aneurysmal rupture occurred. Most patients showed stable/improved occlusion on follow-up imaging, with a 14% recurrence rate. Retreatment was required in 2% of cases.
EVT appears feasible, safe, and effective for treating M1 hilltop aneurysms. It resulted in favorable occlusion and low recurrence/retreatment rates. Neck diameter and stent usage influenced immediate outcomes and recurrence. Larger studies with longer follow-ups are needed to validate these findings further.
Objective
To evaluate the outcomes of flow-diverting device (FDD) treatment for large vertebral artery dissecting aneurysms (VADAs).
Methods
This retrospective study evaluated 12 patients with 12 ...VADAs who were treated using FDD between 2013 and 2020. Clinical and radiographic data, including procedure-related complications and clinical outcomes assessed using the modified Rankin Scale (mRS) at the time of the last follow-up, were collected and reviewed.
Results
All 12 patients had unruptured aneurysms. There were 3 (25%) female and 9 (75%) male patients, and the mean patient age was 54.6 years. The mean size of the aneurysm was 15.9 ± 4.8 mm. The mean follow-up duration was 15.8 months. Single FDD without additional coils was used in all patients. One patient underwent second-line treatment with FDD for recurrence of large VADA after stent-assisted coiling. Immediate follow-up angiography after placement of the FDD demonstrated intra-aneurysmal contrast stasis. There were 2 (17%) patients who had peri-procedural stroke. Angiography at the 6-month follow-up in 10 patients showed favorable occlusion (OKM grade C3 + D). A total of 11 (92%) patients had good clinical outcome (modified Rankin Scale ≤ 2) at the last follow-up. No re-treatment or delayed aneurysm rupture occurred during the follow-up period.
Conclusions
Reconstructive technique with FDD is a feasible and effective modality for the treatment of large VADAs, showing favorable occlusion rate and clinical outcome.
Risk factors of ventriculostomy-associated infection (VAI) reported in the literature are variable owing to heterogeneity of external ventricular drainage (EVD) procedures and management. This study ...aimed to assess the rate of VAI and its risk factors.
The medical records of patients >18 years old who received EVD catheterizations between January 2015 and December 2020 were retrospectively reviewed.
Among 243 patients with 355 catheters, 23 VAIs were identified, yielding VIA rates of 9.5% per patient and 6.5% per catheter. VAI was associated with a longer total EVD duration (29.2 days vs. 15.8 days, P < 0.001), a longer procedural time (72 minutes vs. 41 minutes, P < 0.001), intraoperative ventriculostomy (39.1% vs. 9.1%, P < 0.001), craniotomy (87.0% vs. 60.9%, P = 0.014), and other systemic infections (30.4% vs. 8.2%, P = 0.004). On multivariate analysis, a longer total EVD duration (odds ratio 1.086, P < 0.001), intraoperative ventriculostomy (odds ratio 6.119, P = 0.001), and other systemic infections (odds ratio 4.620, P = 0.015) were associated with VAI. There was no statistical difference between the VAI rates of patients with and without prophylactic EVD exchanges at a mean 12.6 days (7.1% vs. 2.2%, P = 0.401).
Intraoperative ventriculostomy was independently associated with VAI. Prophylactic EVD exchange at 12.6 days did not lower VAI rate.
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Traditional steel girder bridges are perceived to detract from the aesthetics of urban design because of the excessive volume of the bent cap. These bridges have additional construction and ...maintenance costs associated with the installation of supports. In this paper, a new bridge system is proposed to overcome these disadvantages. In this system, the composite behavior of the joint is key to ensuring proper structural performance. The main feature of the proposed bridge system is the construction of steel I-girders and inverted-T bent caps at the same elevation. Two methods for connecting steel girders and bent caps were investigated, namely, the introduction of pre-stressing forces and the installation of steel plates. To assess the composite performance of the proposed methods, up to two million fatigue test cycles were performed on full-scale test girders. The key parameters examined were the girder displacement; the relative joint displacement; the strain in the girder, steel plate, and reinforcement; and the crack patterns in the concrete. The test girders behaved stably, without a significant decline in performance at the joint, after elimination of the prestressing bar. However, use of a pre-stressing bar reduced tensile stress during fatigue testing and was highly effective in controlling cracks.
Universality of short-channel effects on saturation current of MOSFETs has been demonstrated. The modulations of carrier injection and transmission rate have been integrated into universal functions. ...The proposed form has been verified by a large set of quantum transport simulations, where relevant ranges of channel thickness, gate length, and scattering mechanisms are covered. As an application, nonlinear current scaling by channel width is presented for ultrascaled devices.
Background:
The relationship between the lateral femoral anatomic structures and femoral tunnel outlet according to changes in knee flexion and transverse drill angle during femoral tunnel creation ...in anterior cruciate ligament (ACL) reconstruction remains unclear.
Purpose:
To investigate the relationships between the lateral femoral anatomic structures and femoral tunnel outlet according to various knee flexion and transverse drill angles and to determine appropriate angles at which to minimize possible damage to the lateral femoral anatomic structures.
Study Design:
Controlled laboratory study.
Methods:
Simulation of ACL reconstruction was conducted using a 3-dimensional reconstructed knee model from the knees of 30 patients. Femoral tunnels were created using combinations of 4 knee flexion and 3 transverse drill angles. Distances between the femoral tunnel outlet and lateral femoral anatomic structures (minimum safe distance, 12 mm), tunnel length, and tunnel wall breakage were assessed.
Results:
Knee flexion and transverse drill angles independently affected distances between the femoral tunnel outlet and lateral femoral anatomic structures. As knee flexion angle increased, the distance to the lateral collateral ligament, lateral epicondyle, and popliteal tendon decreased, whereas the distance to the lateral head of the gastrocnemius increased (P < .001). As the transverse drill angle decreased, distances to all lateral femoral anatomic structures increased (P < .001). Considering safe distance, 120°, 130°, or 140° of knee flexion and maximum transverse drill angle (MTA) could damage the lateral collateral ligament; 130° or 140° of knee flexion and MTA could damage the lateral epicondyle; and 110° or 120° of knee flexion and MTA could damage the lateral head of the gastrocnemius. Tunnel wall breakage occurred under the conditions of MTA – 10° or MTA – 20° with 110° of knee flexion and MTA – 20° with 120° of knee flexion.
Conclusion:
Approximately 120° of knee flexion with MTA – 10° and 130° or 140° of knee flexion with MTA – 20° or MTA – 10° could be recommended to prevent damage to the lateral femoral anatomic structures, secure adequate tunnel length, and avoid tunnel wall breakage.
Clinical Relevance:
Knee flexion angle and transverse drill angle may affect femoral tunnel creation, but thorough studies are lacking. Our findings may help surgeons obtain a stable femoral tunnel while preventing damage to the lateral femoral anatomic structures.
The intrinsic limit on ballisticity of ultra-scaled transistors is investigated. A novel probing technique is presented, which locally resolves the loss of incident fluxes. This projection reveals ...the scalable and unscalable components of reflection. The poor ballisticity is explained by non-equilibrium distribution around the potential barrier, which triggers a substantial unscalable reflections.
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