In this paper, an insect brain-inspired computational structure was developed. The peculiarity of the core processing layer is the local connectivity among the spiking neurons, which allows for a ...representation under the cellular nonlinear network paradigm. Moreover, the processing layer works as a liquid state network with fixed internal connections and trainable output weights. Learning was accomplished by adopting a simple supervised, batch approach based on the calculation of the Moore–Penrose matrix. The architecture, taking inspiration from a specific neuropile of the insect brain, the mushroom bodies, is evaluated and compared with other standard and bio-inspired solutions present in the literature, referring to three different scenarios.
We analyzed the safety and efficacy of gemtuzumab ozogamicin (GO) combined with cytarabine and mitoxantrone in the treatment of 21 patients with acute myeloid leukemia (11 refractory and 10 in second ...relapse). Patients' median age was 52 years (range 36-68); all patients had previously been treated with anthracycline-containing regimens (daunorubicin and idarubicin). GO at a dosage of 3 mg/m2 was administered as a 2-h intravenous infusion on days 1 and 14, cytarabine at 100 mg/m2 on days 1-7, and mitoxantrone at 12 mg/m2 on days 1-3. Infusion-related events were observed in 15 of 21 (71.4%) patients. The incidence of grade 1 or 2 elevations of bilirubin and hepatic transaminases was 4 of 21 (19%) and 3 of 21 (14.2%). In response to chemotherapy, 2 of 21 (9.5%) achieved complete remission and 2 of 21 (9.5%) achieved complete remission with incomplete platelet recovery, with an overall remission rate of 4 of 21(19%); median survival of these 4 patients was 7 months. Four of 21 patients (19%) died during aplasia after chemotherapy; no veno-occlusive disease occurred. No treatment-related cardiotoxicity or cerebellar toxicity was observed. In our experience, the addition of GO to mitoxantrone and cytarabine is feasible in refractory or second relapse acute myeloid leukemia patients but yields a low response rate when used as a third-line treatment.
Impaired healing of the surgical incision represents a common complication after kidney transplantation. We led a retrospective study seeking to understand the factors linked to these complications ...and reasons for their reduction during the last year.
From January 2000 to April 2004, 170 consecutive kidney transplantations were performed in a homogenous patient population. We evaluated the influence of following factors to determine impaired healing of the incision: antirejection drugs, overweight/obesity, age, delayed graft function (DGF), diabetes, and abdominal wall reconstruction technique.
Among 165 patients we observed 26 (15.76%) cases of impaired healing of the surgical incision: 17 (65,38%) with first-level and nine with second-level wound complications.
Impaired healing of the surgical incision influences the outcome of kidney transplant patients. In our study we observed that cyclosporine and tacrolimus similary affected the incision’s healing. It was not possible to evaluate the role of basiliximab. A univariate analysis of the factors related to complications revealed overweight and DGF. However, all patients developing second-level complications showed more risk factors. Patients who had not had reconstruction of the muscle layers showed a greater incidence of surgical complications, whereas patients who had skin sutured with an intradermic technique did not show an increased risk.
Abstract Background A short right renal vein complicates transplantation causing traction and difficulties during anastomosis. When we perform a kidney transplantation from a cadaveric donor, this ...problem may be resolved by using the vena cava to create a venous duct. This elongation technique is proposed to be performed during bench surgery. We propose a small change in the technique: execution of an “elongation patch” during harvesting and under cold perfusion. Materials and Methods From January 2004 to June 2006, we performed 12 in situ (during the harvesting procedure) vena cava elongation patches. In these cases, the right renal vein was too short. The elongation patch was used in only 8 transplantations. In the other 4 cases we sacrificed the patch to perform a direct venous anastomosis due to favorable recipient anatomical characteristics. Results The 8 transplantations performed with the elongation patch did not show vascular complications and the venous anastomosis was easy to perform. Conclusions The “extension patch” was not associated with a greater incidence of vascular complications. Using the elongation patch during the harvest showed some advantages: performed during cold perfusion with a reduction in bench ischemia; the anatomical relationships are preserved so we can perform a calibrated suture; the perfusion of the organ allows us to observe the integrity of the anastomosis. This technique did not significantly increase the harvesting time.
Abstract Introduction The exponential increase in organ demand is not associated with a similar increase of available kidneys. This emergency led to expanded criteria to consider a kidney ...transplantable. The aim of this retrospective study was to explain our use of older donor kidneys without biopsy. Materials and Methods Between 2000 and 2005, 58 older kidneys were harvested: 27 were transplanted in our center; 13 were discarded; and 18 were transplanted in other centers. We considered 3 factors to define kidney quality: macroscopic anatomy, multiple factors linked to the donor, and clinical-laboratory data. After transplantation, we observed the patients for at least 1 year and up to 6 years. Discussion At 1 year, 24/27 (89%) patients had a functional kidney, 2 patients showed an initial renal failure and 1 patient lost the kidney. At maximum follow-up, 19 patients (70%) had functional kidneys, 4 with initial renal failure. These results compared with the kidneys harvested using Standard Donor Kidney Criteria are acceptable. Obviously we need long-term follow-up to increase, the amount of data and obtain a definitive outcome. Conclusion Biopsy is the gold standard for the definition of an older kidney’s quality. When a biopsy is not feasible, the study of the macroscopic anatomy the kidney’s donor and of some donor’s parameters represent an acceptable biopsy alternative, being able to rescue some organs that would be otherwise lost.
The new dialytic and medical therapies have improved the survival of uremic patients and their preservation of a efficacious clinical condition so as to warrant suitability for transplantation, even ...after a long period of dialysis. In addition, today the use of a “marginal donor” and “marginal kidney” are often used to increase the pool of available organs, so that the surgeon must face more technical difficulties than in the past; anomalies of the donor kidney, harvesting and bench surgery damages, as well as vascular pathologies in the recipient.
A review of our 151 renal transplantations from January 1999 to May 2003 showed that it was often possible to overcome these technical difficulties yielding good results.
This work sought to demonstrate that neither “marginal donor”/“marginal kidney” used to expand donor pool nor recipient vascular pathologies should be considered transplant contraindications. Knowledge of various technical options and the ability to put them rapidly into practice are necessary to use any organ.
Background:
Although Tyrosine Kinase Inhibitors (TKIs) have revolutionated the treatment of Chronic Myeloid Leukemia (CML), it is importat to focus the attention about the safety of this class of ...drugs specially for cardiovascular adverse events (CVE), their “off‐ target” effects encompass a wide range of cardio toxicities, including left ventricular disfunction, electrocardiographic abnormalities with dysrhythmias, hypertension, myocardial ischemia and thromboembolic events. The long‐term safety call for a multidisciplinary effort embracing hematologists, cadiologists, nurses.
Aims:
demonstrate the usefulness of a cardio‐oncology unit in primary and secondary cardiovascular risk prevention in patients with chronic myeloid leukemia in treatment with TKIs
Methods:
From February 2005 to September 2018, 61 consecutive patients (27 women and 34 men) affected by CML were treated with TKIs at our institution. The patients underwent to clinical, laboratory and instrumental evaluations. Several informations about cardiovascular risk factors, lifestyle and concomitant medications, were collected with the support of a nurse, who administered to patients specific questionnaires. Patients were assessed at baseline and during follow‐up.
Results:
50% of patients already had cardiovascular disease at diagnosis, 35% of patients developed cardiovascular events during treatment.
16.6 % of patients presented risk factors unchangeable, while 83.4 % of patients presented risk factors related to incorrect lifestyle habits.
Before the intervention by cardio‐oncology unit, 65% of patients thought they knew the risks associated with the wrong lifestyle habits. After the intervention, the percentage of patients aware of the risk factors was 90% (p value <0.05: significance index). The therapeutic education program was considered very useful for this purpose by 95% of patients. 75% of patients said that their quality of life has improved during the observation period.
Summary/Conclusion:
CONCLUSIONS: In our institution, the Cardio‐oncology Unit deals with primary prevention and the secondary treatmet of cardiovascular disease therapy‐related. Our results confirm that a cardio‐oncology program applied to patients with CML can represent unique oppotunities and challenges to preserve cardiovascular health, to allow the timely delivery of cancer therapy and achieve disease free remission. Managment of treatment with TKIs of CML patients is multifaced and involve lifestyle education, pharmacotherapy, enhanced cardiovascular surveillance and support services.The optimal composition of cardio‐oncology team should involve support from cardiologist, oncologist and nurses.
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