Search

Sinusoidal obstruction syndrome, also known as veno-occlusive disease (SOS/VOD), is a potentially life-threatening complication that can develop after hematopoietic cell transplantation (HCT). While SOS/VOD may resolve within a few weeks in the majority of patients with mild-to-moderate disease, the most severe forms result in multiorgan dysfunction and are associated with a high mortality rate (>80%). Therefore, careful surveillance may allow early detection of SOS/VOD, particularly as the licensed available drug is proven to be effective and reduce mortality. The aim of this work is to propose an international consensus guideline for the treatment and prevention of SOS/VOD in adult patients, on behalf of an international expert group, This work was made possible thanks to the support of the Association for Training, Education, Research, in Hematology, Immunology and Transplantation (ATHERIT), which received an unrestricted educational grant from JAZZ pharmaceuticals

Interstitial lung abnormalities (ILA) may represent undiagnosed early-stage or subclinical interstitial lung disease (ILD). ILA are often observed incidentally in patients who subsequently develop clinically overt ILD. There is limited information on consensus definitions for, and the appropriate evaluation of, ILA. Early recognition of patients with ILD remains challenging, yet critically important. Expert consensus could inform early recognition and referral.Can consensus-based expert recommendations be identified to guide clinicians in the recognition, referral, and follow-up of patients with or at risk of developing early ILDs?Pulmonologists and radiologists with expertise in ILD participated in two iterative rounds of surveys. The surveys aimed to establish consensus regarding ILA reporting, identification of patients with ILA, and identification of populations that might benefit from screening for ILD. Recommended referral criteria and follow-up processes were also addressed. Threshold for consensus was defined a priori as ≥ 75% agreement or disagreement.Fifty-five experts were invited and 44 participated; consensus was reached on 39 of 85 questions. The following clinically important statements achieved consensus: honeycombing and traction bronchiectasis or bronchiolectasis indicate potentially progressive ILD; honeycombing detected during lung cancer screening should be reported as potentially significant (eg, with the Lung CT Screening Reporting and Data System "S-modifier" [Lung-RADS; which indicates clinically significant or potentially significant noncancer findings]), recommending referral to a pulmonologist in the radiology report; high-resolution CT imaging and full pulmonary function tests should be ordered if nondependent subpleural reticulation, traction bronchiectasis, honeycombing, centrilobular ground-glass nodules, or patchy ground-glass opacity are observed on CT imaging; patients with honeycombing or traction bronchiectasis should be referred to a pulmonologist irrespective of diffusion capacity values; and patients with systemic sclerosis should be screened with pulmonary function tests for early-stage ILD.Guidance was established for identifying clinically relevant ILA, subsequent referral, and follow-up. These results lay the foundation for developing practical guidance on managing patients with ILA.

Topological optimization of plates, as well as shallow cylindrical and curved (spherical) shells, are attempted in the present study. For all structures examined, our objective is the minimization of the strain energy function under a volume constraint. An optimum distribution of thickness or microstructural density is sought under the hypothesis that the design variables can only be assigned their extreme allowable bounds, or values very near them, so that material can be removed from low density areas and thus, an optimum topology can be determined. The structural response is computed via a finite element analysis. The analytical formulation is based on a form of linear shallow shell theory with the effects of transverse shear deformation and bending-extensional coupling included. The method of feasible directions is used to perform the optimization task. Numerical examples for various boundary conditions showing similarities or differences of the two methods are presented and discussed. For all structures examined, it is found that the assumption of a repetitious microstructure based on homogenization theory resulted in stronger optima. For clamped plates and shells, both methods converged to nearly identical topologies, an indication of possible global optimal layouts.

The homogenization method together with mathematical optimization concepts were combined to perform two-dimensional shape and topology optimization of structures under volume constraint. Static, as well as single or multi-eigenvalue vibrational optimization of structures are considered. The basic assumption of the method is that the structure under consideration is formed by the spatial repetition of a non-homogeneous microstructure, composed of solid material and void regions. The method, upon convergence, allocates material or voids at different parts of the structure and thus, an optimum shape is achieved. A detailed study was made to assess the effect of various microstructural models on the final optimum shape. Good convergence characteristics were obtained for all examples considered. Comparison of the algorithm with published results using the optimality criteria method was attempted and similarities and differences are discussed. The results show that the proposed method can perform accurate static and vibrational optimization. Furthermore, its generality allows the implementation of more than one constraint in a straightforward manner, a very important feature for the design engineer.

The creation of optimum isotropic, single-layered orthotropic and multilayered anisotropic plate topologies was attempted in the present study. Our objective was the minimization of the structural strain energy under volume constraint. The concept of optimal material distribution based on homogenization of a unit microstructure together with sequential linear programming was used to perform the optimization task. The structural response, computed via a finite element analysis, was calculated using first order shear deformation theory in conjunction with a laminated plate finite element. Isotropic and single-layered orthotropic plates were treated as special cases of multilayered anisotropic laminates. The accuracy of the algorithm developed is demonstrated by means of numerical examples. The optimality of the results obtained was verified by performing structural analysis on different same-volume topologies created according to the algorithmic output and comparing the resulting displacement and stress fields.

A two-dimensional computational model is developed for nonlinear heat transfer in multilayered composite panels. The model is based on a first-order thermal lamination theory with a linear through-the-thickness variation of temperature. Both convection and nonlinear conduction modes of heat transfer are considered. A three-field mixed finite element model is used for the spatial discretization, with the fundamental unknowns consisting of temperature parameters, flux resultants, and generalized temperature gradients. The flux resultants and generalized temperature gradients are eliminated on the element level. A computational procedure is presented for generating the thermal response and the sensitivity derivatives with respect to material and lamination parameters. The effectiveness of the foregoing two-dimensional computational model is demonstrated by means of two numerical examples in which the solutions obtained by the model are compared with three-dimensional finite element solutions.

Simple analytic expressions are presented for the stiffness and thermoelastic coefficients of composite laminates in terms of the material properties of the individual layers. Expressions for the derivatives of the various coefficients with respect to each of the material properties and fiber orientation angles are also included. For typical high-performance composites, numerical values are given showing the effects of the stacking sequence and the fiber orientation angle of quasi-isotropic and angle-ply laminates on the values of the various coefficients and their sensitivity derivatives. The expressions for the thermoelastic coefficients and the sensitivity derivatives are given herein for the first time.

In the present study we discuss two thermal methods, namely vibrothermography and thermoelastic emission (SPATE), for NDE of composite materials. Both methods take advantage of 'local resonance', i.e., independent flaw dynamics, to detect and evaluate damage. Complementary information about the flaw position, size and depth can also be obtained. These methods are fast, practical, and can be performed 'in situ'. The SPATE system can also reveal delaminations in relatively thick structural components.

The number of HLA-haploidentical hematopoietic cell transplants continues to increase worldwide due to recent improvements in outcomes, allowing more patients with hematological malignancies and non-malignant disorders to benefit from this procedure and have a chance to cure their disease. Despite these encouraging results, questions remain as multiple donors are usually available for transplantation, and choosing the best HLA-haploidentical donor for transplantation remains a challenge. Several approaches to haploidentical transplantation havebeen developed over time and, based on the graft received, can be grouped as follows: T-cell depleted haploidentical transplants, either complete or partial, or withT-cell replete grafts, performed with post-transplant cyclophosphamide-based graft-versus-host disease (GVHD) prophylaxis, or G-CSF-primed bone marrow graft and enhanced GVHD prophylaxis. Carefully selecting the donor can help optimize transplant outcomes for recipients of haploidentical donor transplants. Variables usually considered in the donor selection include presence of donor-specific antibodies in the recipient, donor age, donor/recipient gender and ABO combinations, and immunogenic variables, such as natural killer cell alloreactivity or KIR haplotype. Here we provide a comprehensive review of available evidence for selecting haploidentical donors for transplantation, and summarize the recommendations from the European Society for Blood and Marrow Transplantation (EBMT) on donor selection for different transplant platforms.