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Clinical Ophthalmology (Auckland, N.Z.) 2024This study investigates the efficacy of transitioning patients with neovascular age-related macular degeneration (nAMD) from aflibercept (T1) to biosimilar ranibizumab...
PURPOSE
This study investigates the efficacy of transitioning patients with neovascular age-related macular degeneration (nAMD) from aflibercept (T1) to biosimilar ranibizumab (T2), an approach not previously documented in literature.
METHODS
In this multicenter observational study, patients over 50 years of age with nAMD were shifted from intravitreal aflibercept (IVI AFL) to biosimilar ranibizumab (B-RBZ) due to financial constraints. This study employed standardized ophthalmological methods to assess visual acuity (VA), central macular thickness (CMT), and subretinal and intraretinal fluid. Statistical analyses included paired -tests, Wilcoxon signed-rank tests, and linear regression.
RESULTS
A total of 29 eyes (12 males and 17 females) were analyzed. Mean age was 72.55 ±6.43 years. VA improved significantly during T1, with a mean increase from 55.0 ± 10.2 to 70.0 ± 8.5 ETDRS letters at the switch time point ( < 0.01), then a slight decrease to 62.3 ± 8.9 at 12 months ( < 0.05) was noted during T2. The mean CMT decreased notably from 400 ± 50 to 290 ± 45 μm at the switch. The final CMT at 12 months after switching to B-RBZ was 280 ± 40 μm ( < 0.01). There was a significant decrease in the retinal and intra retinal fluid during T1, followed by a gradual increase during T2. A significant correlation ( < 0.05) was noted between the presence of intraretinal fluid and increased injection frequency of B-RBZ.
CONCLUSION
The switch from IVI AFL to IVI B-RBZ in patients with nAMD demonstrated efficacy in maintaining the VA and macular anatomy, with some challenges in fluid management.
PubMed: 38948341
DOI: 10.2147/OPTH.S459085 -
Clinical Ophthalmology (Auckland, N.Z.) 2024To compare the efficacy of intravitreal injections of Conbercept combined with dexamethasone (DEX) for macular edema (ME) following central retinal vein occlusion (CRVO).
BACKGROUND
To compare the efficacy of intravitreal injections of Conbercept combined with dexamethasone (DEX) for macular edema (ME) following central retinal vein occlusion (CRVO).
METHODS
This was a prospective, single-masked, randomised, controlled clinical trial. Patients with ME following CRVO were randomised into groups to receive intravitreal injections of 0.5 mg Conbercept plus 0.2 mg DEX or 0.5 mg Conbercept alone on day 0 followed by repeat injections as indicated. The primary outcome measure was the change in best-corrected visual acuity (BCVA) from baseline to month 12. Secondary outcome measures included decrease in central retinal thickness (CRT), injection frequency and interval and percentage of patients who gained more than 15 ETDRS letters or achieved a CRT of < 250 μm at month 12.
RESULTS
33 males (51%) and 32 females (49%) were initially recruited with an average age of 56.64 ± 13.88 years. Patients in the Conbercept and Conbercept + DEX groups gained an average of 14.55 ± 19.19 and 14.88 ± 17.68 ETDRS letters, respectively, at months 12 ( = 4.221, = 0.000; and = 4.834, = 0.000) with no significant difference between the two groups ( = 0.071, = 0.943). In the Conbercept group, the mean reduction in CRT from baseline to month 12 was 435.26 ± 293.37 μm ( = 8.261, = 0.000) compared to 431.36 ± 294.55 ( = 8.413, = 0.000) in the Conbercept + DEX group. There was no significant difference between the two groups ( = 0.053, = 0.958). The Conbercept + DEX group received fewer intravitreal injections. No major complications occurred.
CONCLUSION
Conbercept, alone or with DEX, can improve BCVA and reduce CRT in ME following CRVO without serious adverse events. The treatment interval was longer in the Conbercept + DEX group.
TRIAL REGISTRATION
The study was registered with the Chinese Clinical Trial Registry at 5 July 2017. (http://www.chictr.org.cn, 05/07/2017 Registration Number: ChiCTR-INR-17011877).
PubMed: 38948340
DOI: 10.2147/OPTH.S448671 -
Sichuan Da Xue Xue Bao. Yi Xue Ban =... May 2024To explore the effect and safety of calcium dibutyryl adenosine cyclophosphate (dbcAMP-Ca) combined with metoprolol in the treatment of older adults with heart failure...
OBJECTIVE
To explore the effect and safety of calcium dibutyryl adenosine cyclophosphate (dbcAMP-Ca) combined with metoprolol in the treatment of older adults with heart failure combined with arrhythmia.
METHODS
A total of 102 elderly patients with heart failure combined with arrhythmia were enrolled in our hospital between February 2021 and April 2023. The list of patients enrolled was entered into a random database by independent staffs not involved in the study and random assignment sequences were generated by the SAS9.4 software. Then, the 102 elderly patients were divided into a control group ( =51) and an experimental group ( =51). Patients in the control group were given metoprolol at an initial dose of 6.25 mg/d, which was gradually increased to the target dose of 25 mg/d. Patients in the experimental group were given 40 mg of dbcAMP-Ca once a day via intravenous drip in addition to the treatment given to the control group. Both groups were treated for 4 weeks. The rate of effective response to clinical treatment (the number of cases achieving significant effects and those achieving some effects divided by the total number of cases in the group) was defined as the main outcome index. Secondary indexes included cardiac function, heart rate variability, exercise ability, hemorheology, myocardial injury indexes, inflammatory indexes, and the occurrence of adverse reactions.
RESULTS
The rate of effective response to clinical treatment was higher in the experimental group than that in the control group (94.12% [48/51] vs. 78.43% [40/51], <0.05). After treatment, the left ventricular end-diastolic and end-systolic dimensions (LVEDD and LVESD) and the interventricular septal thickness (IVS) were lower in the experimental group than those in the control group, while the left ventricular ejection fraction (LVEF) and the stroke volume (SV) were higher in the experimental group than those in the control group ( <0.05). In terms of heart rate variability after treatment, the standard deviation of all the normal-to-normal intervals/the average of all the normal-to-normal intervals (SDNN/SDANN), the percentage of NN50 in the total number of normal-to-normal intervals (PNN50%), and the root mean square of the differences between adjacent normal-to-normal intervals/root mean square differences of successive R-R intervals (RMSSD) were higher in the experimental group than those in the control group ( <0.05). In terms of exercise capacity after treatment, the subjects in the experimental group covered more distance in the 6-min walk test than those in the control group did ( <0.05). In terms of the hemorheology indexes after treatment, the levels of platelet aggregation rate (PAgT), fibrinogen (FIB), erythrocyte sedimentation rate (ESR), and whole blood viscosity (ηb) were lower in the experimental group than those in the control group ( <0.05). In terms of the myocardial injury indexes after treatment, the levels of serum N-terminal pro-brain natriuretic peptide (NT-pro BNP) and cardiac troponin I (cTnI) were lower in the experimental group than those in the control group, while the levels of insulin-like growth factor 1 (IGF-1) and cardiotrophin 1 (CT-1) were higher in the experimental group than those in the control group ( <0.05). In terms of the inflammatory indexes after treatment, the levels of interleukin-6 (IL-6), high-sensitive C-reactive protein (hs-CRP), and tumor necrosis factor-α (TNF-α) were lower in the experimental group than those in the control group ( <0.05). The incidence of adverse reactions in the experimental group (9.80%) and that in the control group (7.84%) were comparable ( >0.05).
CONCLUSION
The use of dbcAMP-Ca in addition to metoprolol can effectively improve cardiac function, heart rate variability, and exercise tolerance, while inhibiting inflammatory response in elderly patients with heart failure combined with arrhythmia, with high medication safety. The combination medication shows better safety and therapeutic effects than those of metoprolol used alone.
PubMed: 38948272
DOI: 10.12182/20240560209 -
Frontiers in Physiology 2024The purpose of this study was to compare acute responses between manual and automated blood flow restriction (BFR) systems.
UNLABELLED
The purpose of this study was to compare acute responses between manual and automated blood flow restriction (BFR) systems.
METHODS
A total of 33 individuals completed this study. On visit 1, arterial occlusion pressure (AOP, mm Hg), cardiovascular responses, and discomfort (RPE-D) were measured with each BFR system at rest. On visit 2, unilateral bicep curls were completed [30% one-repetition maximum; 50% AOP] with one system per arm. Muscle thickness (MT, cm) and maximal force (N) were assessed before (pre), immediately (post-0), 5 min (post-5), and 10 min (post-10) post-exercise. Ratings of perceived exertion (RPE-E) and ratings of perceived discomfort (RPE-D) were assessed throughout the exercise. AOP and repetitions were compared with Bayesian paired t-tests. Other outcomes were compared with Bayesian RMANOVAs. BF represents the likelihood of the best model vs. the null. The results are presented as mean ± SD.
RESULTS
Supine cardiovascular responses and RPE-D were similar for manual and automated (all BF ≤ 0.2). Supine AOP for manual (157 ± 20) was higher than that of automated (142 ± 17; BF = 44496.0), but similar while standing (manual: 141 ± 17; automated: 141 ± 22; BF = 0.2). MT (time, BF = 6.047e + 40) increased from Pre (3.9 ± 0.7) to Post-0 (4.4 ± 0.8; BF = 2.969e + 28), with Post-0 higher than Post-5 (4.3 ± 0.8) and Post-10 (4.3 ± 0.8; both BF ≥ 275.2). Force (time, BF = 1.246e + 29) decreased from Pre (234.5 ± 79.2) to Post-0 (149.8 ± 52.3; BF = 2.720e + 22) and increased from Post-0 to Post-5 (193.3 ± 72.7; BF = 1.744e + 13), with Post-5 to Post-10 (194.0 ± 70.6; BF = 0.2) being similar. RPE-E increased over sets. RPE-D was lower for manual than automated. Repetitions per set were higher for manual (Set 1: 37 ± 18; Set 4: 9 ± 5) than automated (Set 1: 30 ± 7; Set 4: 7 ± 3; all BF ≥ 9.7).
CONCLUSION
Under the same relative pressure, responses are mostly similar between BFR systems, although a manual system led to lower exercise discomfort and more repetitions.
PubMed: 38948082
DOI: 10.3389/fphys.2024.1409702 -
Heliyon Jun 2024In this research, we delve into the fascinating dynamics of projectiles and their interactions with materials, with a keen focus on residual velocity - the speed a...
In this research, we delve into the fascinating dynamics of projectiles and their interactions with materials, with a keen focus on residual velocity - the speed a projectile retains after striking a target. This parameter is pivotal, especially when considering the design of protective barriers in various environments. Traditional methods of gauging residual velocity have been cumbersome, resource-intensive, and occasionally inconsistent. To address these challenges, we introduce an innovative approach using an Artificial Neural Network (ANN) model through MATLAB R2021a. This computerized tool, trained on a rich dataset from prior research, can predict residual velocities by considering multiple factors, including the initial speed of the projectile, its material and shape, and the thickness of the target. This paper meticulously details the development, training, and validation of the ANN model, highlighting its superior accuracy when compared to traditional methods like the Recht-Ipson model. The developed ANN model demonstrated remarkable performance compared to the Recht-Ipson model. During training, it exhibited a Mean Absolute Percentage Error (MAPE) of 0.0259 and a Root Mean Squared Error (RMSE) of 1.5993. For validation, MAPE was 0.0295, and RMSE was 2.2056. In contrast, the Recht-Ipson model displayed higher errors, with MAPE and RMSE values of 0.2349 and 14.1791, respectively. Furthermore, we discuss the potential of the ANN model in predicting not just residual velocities but also absorbed energy, showcasing its versatility. The practical implications of our findings are vast. From designing safer infrastructures in urban settings to enhancing armour systems in military applications, the ANN model's predictions can be a cornerstone for innovation.
PubMed: 38947463
DOI: 10.1016/j.heliyon.2024.e32149 -
Orthopaedic Surgery Jul 2024Clinical concerns exist regarding the quality of bony consolidation in the context of the induced membrane technique. This study evaluates the clinical process of bone...
OBJECTIVE
Clinical concerns exist regarding the quality of bony consolidation in the context of the induced membrane technique. This study evaluates the clinical process of bone grafting in the second stage of induced membrane bone union in patients with tibial bone defects to infer the possibility of non-union and establish a reliable and effective evaluation method combined with computed tomography (CT) to assess fracture healing.
METHODS
Patients with tibial bone defects who underwent the induced membrane technique at our hospital between February 2017 and February 2020 were retrospectively analyzed. The Hounsfield unit (HU) values of the patients were evaluated at different times during the second stage of bone grafting. Bone healing at the boundary value of the 120 HU output threshold (-1024 HU-3071 HU) was directionally selected, and the changes in the growth volume of union (new bone volume [selected according to HU value]/bone defect volume) were compared with analyzing individual class bone union. Method 1 involved X-rays revealing that at least three of the four cortices were continuous and at least 2 mm thick, with the patient being pain free. For Method 2, new bone volume (selected according to HU value/bone defect volume) at the stage was compared with analyzing individual class healing. Receiver operating characteristic curve analysis was used for Methods 1 and 2.
RESULTS
A total of 42 patients with a segmental bone defect with a mean age of 40.5 years (40.5 ± 8.3 years) were included. The relationship between bone graft volume and time variation was analyzed by single factor repeated variable analysis (F = 6.477, p = 0.016). Further, curve regression analysis showed that the change in bone graft volume over time presented a logarithmic curve pattern (Y = 0.563 + 0.086 × ln(X), Ra = 0.608, p = 0.041). ROC curve analysis showed that Method 2 is superior to Method 1 (AUC: 86.3% vs. 68.3%, p < 0.05).
CONCLUSION
The induced membrane technique could be used to treat traumatic long bone defects, with fewer complications and a higher healing rate. The proposed imaging grading of HU (new bone volume/bone defect volume) can be used as a reference for the quality of bony consolidation with the induced membrane technique.
PubMed: 38946673
DOI: 10.1111/os.14157 -
Analytical Methods : Advancing Methods... Jul 2024High-frequency pulse lasers, applied in the form of rapid scanning, act upon the surface of aircraft skin paint layers, thereby removing the paint layers, exhibiting...
High-frequency pulse lasers, applied in the form of rapid scanning, act upon the surface of aircraft skin paint layers, thereby removing the paint layers, exhibiting characteristics of efficiency and eco-friendliness. Real-time monitoring of the paint removal effect and prevention of substrate damage necessitates the continuous monitoring of paint removal thickness. Combining Laser-Induced Breakdown Spectroscopy (LIBS) online monitoring technology enables laser-controlled paint removal under multiple effects coupling, meeting the requirements of airworthiness maintenance. This paper, based on a high-frequency nanosecond infrared pulse laser paint removal LIBS monitoring platform, conducts research on laser paint removal thickness LIBS online monitoring of aluminum alloy plates coated with dual-layer paint. Spectra corresponding to the removal thickness of each group are collected and, respectively, paint removal thickness monitoring models based on LIBS spectra are established using the standard curve method and Principal Component Analysis-Support Vector Regression (PCA-SVR) algorithm. When monitoring paint removal thickness using the standard curve method, the intensity of five Ti element characteristic spectral lines selected is correlated with the paint removal thickness, and segmented curve fitting according to the paint layer structure satisfies the segmented curve fitting of topcoat and topcoat + primer. Among them, the average coefficient of the curve fitting of the Ti II 589.088 nm characteristic spectral line is 0.89, and the root mean square error (RMSE) is 12.28 μm. Its performance is superior in the five standard curves; thus, its fitting equation is used as the criterion for paint removal thickness monitoring. To further improve monitoring accuracy, research on paint removal thickness monitoring models based on PCA-SVR is conducted. Compared to the traditional univariate standard curve method, the PCA-SVR model does not require segmented monitoring. After parameter optimization, the average fitting coefficient reaches 0.97, and the RMSE is 2.92 μm. The results indicate that the PCA-SVR-based paint removal thickness monitoring model has higher accuracy, thereby forming the basis for paint removal thickness monitoring. Through comparative research on paint removal thickness monitoring models, two types of paint removal thickness monitoring criteria are obtained, providing model solutions for high-precision monitoring and automation of aircraft skin laser paint removal thickness.
PubMed: 38946640
DOI: 10.1039/d4ay00872c -
Circulation Journal : Official Journal... Jun 2024Identifying and understanding the microstructural changes within the wall of the pulmonary artery (PA) is crucial for elucidating disease mechanisms and guiding...
BACKGROUND
Identifying and understanding the microstructural changes within the wall of the pulmonary artery (PA) is crucial for elucidating disease mechanisms and guiding treatment strategies. We assessed the utility of optical coherence tomography (OCT) in identifying such changes within segmental/subsegmental PAs and compared the morphological variations in WHO group 4 pulmonary hypertension associated with Behcet Disease (BD), Takayasu arteritis (TA) and chronic thromboembolic pulmonary hypertension (CTEPH). Idiopathic pulmonary arterial hypertension (IPAH) patients served as controls.Methods and Results: A total of 197 cross-sectional images were analyzed from 20 consecutive patients. BD patients exhibited lower %wall area and mean wall thickness (MWT) compared with CTEPH, TA and, IPAH patients. TA patients showed a notably higher %wall area, which was significant in IPAH and BD patients. Variations in %wall area measurements were observed across distinct cross-sectional segments of the PA within individual patients (22% in CTEPH, 19% in BD, 16% in TA, 23% in IPAH patients). Intravascular webs, bands, and thrombi were observed in BD and CTEPH patients. OCT provided clear delineation of vascular wall calcifications and adventitial vasa vasorum. No procedure-related complications were observed.
CONCLUSIONS
PA involvement differs among the various etiologies of PH, with the PA being heterogeneously affected. OCT offers promise in elucidating microstructural vascular wall changes and providing insights into disease mechanisms and treatment effects.
PubMed: 38945862
DOI: 10.1253/circj.CJ-24-0254 -
The Journal of Maternal-fetal &... Dec 2024The resolution of factors linked to the recurrence of cesarean section defects can be accomplished through a comprehensive technique that effectively addresses the...
BACKGROUND
The resolution of factors linked to the recurrence of cesarean section defects can be accomplished through a comprehensive technique that effectively addresses the dehiscent area, eliminates associated intraluminal fibrosis, and establishes a vascularized anterior wall by creating a sliding myometrial flap.
OBJECTIVE
Propose a comprehensive surgical repair for recurrent and large low hysterotomy defects in women seeking pregnancy or recurrent spotting.
STUDY DESIGN
A retrospective cohort analysis included 54 patients aged 25-41 with recurrent large cesarean scar defects treated at Otamendi, CEMIC, and Valle de Lili hospitals. Comprehensive surgical repair was performed by suprapubic laparotomy, involving a wide opening of the vesicouterine space, removal of the dehiscent cesarean scar and all intrauterine abnormal fibrous tissues, using a glide myometrial flap, and intramyometrial injection of autologous platelet-rich plasma. Qualitative variables were determined, and descriptive statistics were employed to analyze the data in absolute frequencies or percentages. The data obtained were processed using the Infostat statistic program.
RESULTS
Following the repair, all women experienced normal menstrual cycles and demonstrated an adequate lower uterine segment thickness, with no evidence of healing defects. All patients experienced early ambulation and were discharged within 24 h. Uterine hemostasis was achieved at specific points, minimizing the use of electrocautery. The standard duration of the procedure was 60 min (skin-to-skin), and the average bleeding was 80-100 ml. No perioperative complications were recorded. A control T2-weighted MRI was performed six months after surgery. All patients displayed a clean, unobstructed endometrial cavity with a thick anterior wall (Median: 14.98 mm, IQR 13-17). Twelve patients became pregnant again, all delivered by cesarean between 36.1 and 38.0 weeks, with a mean of 37.17 weeks. The thickness of the uterine segment before cesarean ranged between 3 and 7 mm, with a mean of 3.91 mm. No cases of placenta previa, dehiscence, placenta accreta spectrum (PAS), or postpartum hemorrhage were reported.
CONCLUSIONS
The comprehensive repair of recurrent low-large defects offers a holistic solution for addressing recurrent hysterotomy defects. Innovative repair concepts effectively address the wound defect and associated fibrosis, ensuring an appropriate myometrial thickness through a gliding myometrial flap.
Topics: Humans; Female; Adult; Retrospective Studies; Hysterotomy; Pregnancy; Cicatrix; Surgical Flaps; Cesarean Section; Myometrium; Recurrence
PubMed: 38945839
DOI: 10.1080/14767058.2024.2365344 -
The Bone & Joint Journal Jul 2024Robotic arm-assisted surgery offers accurate and reproducible guidance in component positioning and assessment of soft-tissue tensioning during knee arthroplasty, but... (Comparative Study)
Comparative Study
AIMS
Robotic arm-assisted surgery offers accurate and reproducible guidance in component positioning and assessment of soft-tissue tensioning during knee arthroplasty, but the feasibility and early outcomes when using this technology for revision surgery remain unknown. The objective of this study was to compare the outcomes of robotic arm-assisted revision of unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA) versus primary robotic arm-assisted TKA at short-term follow-up.
METHODS
This prospective study included 16 patients undergoing robotic arm-assisted revision of UKA to TKA versus 35 matched patients receiving robotic arm-assisted primary TKA. In all study patients, the following data were recorded: operating time, polyethylene liner size, change in haemoglobin concentration (g/dl), length of inpatient stay, postoperative complications, and hip-knee-ankle (HKA) alignment. All procedures were performed using the principles of functional alignment. At most recent follow-up, range of motion (ROM), Forgotten Joint Score (FJS), and Oxford Knee Score (OKS) were collected. Mean follow-up time was 21 months (6 to 36).
RESULTS
There were no differences between the two treatment groups with regard to mean change in haemoglobin concentration (p = 0.477), length of stay (LOS, p = 0.172), mean polyethylene thickness (p = 0.065), or postoperative complication rates (p = 0.295). At the most recent follow-up, the primary robotic arm-assisted TKA group had a statistically significantly improved OKS compared with the revision UKA to TKA group (44.6 (SD 2.7) vs 42.3 (SD 2.5); p = 0.004) but there was no difference in the overall ROM (p = 0.056) or FJS between the two treatment groups (86.1 (SD 9.6) vs 84.1 (4.9); p = 0.439).
CONCLUSION
Robotic arm-assisted revision of UKA to TKA was associated with comparable intraoperative blood loss, early postoperative rehabilitation, functional outcomes, and complications to primary robotic TKA at short-term follow-up. Robotic arm-assisted surgery offers a safe and reproducible technique for revising failed UKA to TKA.
Topics: Humans; Arthroplasty, Replacement, Knee; Male; Female; Prospective Studies; Robotic Surgical Procedures; Aged; Middle Aged; Reoperation; Treatment Outcome; Range of Motion, Articular; Follow-Up Studies; Length of Stay; Postoperative Complications; Knee Prosthesis; Aged, 80 and over; Osteoarthritis, Knee
PubMed: 38945538
DOI: 10.1302/0301-620X.106B7.BJJ-2023-0943.R2