Search

Current bridge assets management (BAM) is based on a site inspection–based condition rating methodology. Mitigation measures are adapted to assets' condition assessment results. The reaction approach of bridge infrastructure structural evaluation does not help in judicious planning for repair and rehabilitation in prioritization for bridge assets management. This research paper presents a risk assessment method (RAM) developed upon the statistical data analysis using analytical tools and techniques of the aging effect on the corrosion anomaly rate (CAR), as proposed by the authors. The proposed RAM methodology is developed in order to provide the bridge asset manager with an analytical tool for risk-based BAM optimization. A cluster of 92 New York City Department of Transportation (NYCDOT) steel girder with reinforced concrete deck bridges was selected. The main objectives of this research paper are to (1) develop a risk rating methodology (RAM) for preemptive bridge assets management, (2) compare the RAM-based risk rating (RR) with the primary member condition rating (CR) of 92 NYCDOT nonrehabilitated steel girder with reinforced concrete deck bridges, and (3) provide analytical tools for bridge life-cycle determination for different vulnerability levels and for forecasting the financial risk of prolonged delayed rehabilitation. This innovative paper illustrates the RAM application for predicting the aging process on the CAR and its disposition for a preemptive BAM planning and development. Practical Applications: Extending the useful service life of aging bridges is a critical issue of global interest. One problem faced globally by the transportation industry is the degradation of structural components of bridges. The purpose and practical application of this paper is to demonstrate a risk assessment approach for BAM relying on statistical data analysis for prioritizing the repair/rehabilitation of deteriorating bridge system. This research presents the deterioration rate concept in BAM framework consisting of estimating the useful service life expectancy of deteriorating bridge system through statistical data analysis, developing a deterioration rate model. The current BAM is based on a site inspection–based condition rating methodology, which depends upon structural evaluator's judgments. The outcomes of this research have demonstrated, through statistical data analysis, that the pattern of aging effects on the time-dependent CAR value may effectively serve as a substantial time-dependent early degradation indicator for life-cycle state evaluation and serviceability performance degradation. BAM provides valuable aid for bridge owner decision makers in forecasting the degradation rate of bridge system and making preemptive decisions for rehabilitation investment prioritization. One practical application of this research is forecasting the cost implications of deferred repair/rehabilitation along with associated financial risk. [ABSTRACT FROM AUTHOR]

Purpose: Transduodenal surgical ampullectomy (tAMP) with papillary reimplantation is a valid alternative to pancreaticoduodenectomy for lesions of the periampullary region not amenable to endoscopic resection. As tAMP is burdened by high rates of biliopancreatic-enteric anastomotic leak, we tested preventive endoluminal vacuum therapy (eVAC) combined with post-operative continuous perianastomotic irrigation (CPI) to reduce such anastomotic leak. Methods: Between 10/2013 and 09/2023, 37 patients undergoing laparotomic tAMP (with or without jejunal transposition) and papillary reimplantation at Hirslanden Klinik Zurich were retrospectively analysed; of these, 16 received prophylactic eVAC combined with CPI, while the remaining represented the historical cohort. Results: The eVAC-CPI-group and the historical-cohort were homogeneous in demographic characteristics. Surgery in the prophylactic eVAC-CPI-group lasted about 30 min longer due to eVAC application (p = 0.008). The biliopancreatico-enteric anastomotic leak rates were 6.2% in the eVAC-CIP-group vs. 19.0% in the historical-cohort (p = 0.266). Along, a strong trend of less severe post-operative complications in general (p = 0.073), and borderline-significantly less cases of acute pancreatitis (p = 0.057) and tAMP-related re-operations or re-interventions (p = 0.057) in particular, were observed in the eVAC-CPI-group. The only anastomotic leak in the eVAC-CPI-group was successfully managed through repeated cycles of eVAC. The device was well tolerated by all patients; no vacuum/irrigation-related complications or malfunctioning occurred. Conclusion: Our study is the first to provide some technical insights demonstrating the safety and feasibility of a prophylactic approach with eVAC and perianastomotic irrigation to reduce anastomotic leak after tAMP. Increasing the number of subjects will confirm the benefit of our promising results. [ABSTRACT FROM AUTHOR]

Blockchain is one of the leading technologies, and it has already begun to transform several industries and areas, including banking, business, healthcare, smart homes, and the Internet of Things. Its benefits include a decentralized network, robustness, availability, stability, anonymity, audibility, and accountability. As Blockchain applications proliferate, it becomes clear that most of the effort is focused on their engineering implementation. However, there has yet to be much focus on the theoretical side. This paper simulated the mining process in Blockchain-based systems using queuing theory. In order to simulate Bitcoin, one of the most well-known cryptocurrencies, we used actual data from Bitcoin and JSIMgraph's M/M/n/L queuing system. We used genuine Bitcoin data and JSIMgraph's M/M/n/L queuing system to replicate Bitcoin, one of the most well-known cryptocurrencies. We produced realistic results that are applicable and will pave the way for future theoretical research on Blockchain-based Queuing systems. Our study implemented both non-preemptive algorithms (such as First Come First Serve, Longest Job First, Shortest Job First, and Last Come First Serve) and preemptive algorithms (such as Round Robin). Further, the average queue waiting time of transactions under these algorithms is also compared. [ABSTRACT FROM AUTHOR]

Background and Aims: Gabapentin (GBP) has been found to decrease the pain scores and analgesic requirements following total abdominal hysterectomy, spinal surgery, and ear, nose, and throat surgery. It has been suggested that central neuronal sensitization may play an important role in postoperative pain. This study compares the effect of two different doses of preemptive GBP on morphine requirement and postoperative pain relief in patients undergoing mastectomy. Methods: This randomized comparative trial included 70 patients scheduled for unilateral mastectomy. They were divided into two groups. Group 1 received 800 mg oral GBP and Group 2 received 1200 mg oral GBP 2 h before surgery. After surgery, we recorded the pain score at different time points using the Visual Analog Scale (VAS) at rest. Patients were also asked about possible side effects of the premedication drug. Patients received morphine 0.1 mg/kg intravenous on demand. The time of first rescue analgesia was recorded along with the total rescue analgesic requirement in the first 24 h. Results: In our study, the mean VAS score, postoperatively at 2, 4, 12, 24 h in Group 2, was less than Group 1 but the difference was not statistically significant (P = 0.9, 0.1, 0.8, 0.4, respectively) Patients of Group 1 demanded rescue analgesia earlier (5.8 ± 3.4 h) than Group 2 (9.6 ± 5.9 h). The total 24 h morphine consumption in Group 1 (10.97 ± 4.01 mg) was higher than Group 2 (6.71 ± 5.02 mg). No significant side effects were observed during the perioperative period. Conclusion: We conclude that GBP in higher doses, when used preemptively, provides a greater degree of analgesia with opioid-sparing effect.

Aim: Peripheral nerve blocks, particularly femoral nerve blocks (FNBs), are a practical choice for relieving severe pain after total knee arthroplasty (TKA). We investigated the effectiveness of preemptive FNB on postoperative pain control and the reduction of opioid consumption. Methods: This was a single-center, prospective, randomized controlled trial conducted at a tertiary care health center, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Turkey. The study included 40 American Society of Anesthesiologists I-III patients scheduled for elective TKA surgery. Patients were studied in two groups. The FNB group (n=20) received preemptive single-injection FNB (15 mL of prilocaine 2% and 15 mL of 0.5% bupivacaine using a peripheral nerve stimulator) before general anesthesia (GA) as the study group and the control group (n=20) received standardized GA. The primary outcome measure was pain scores evaluated as numeric pain rating scale (0-10) at 2, 4, 8, 12, 16, 18, 20, and 24 h. Secondary outcome measures included opioid consumption with patient-controlled and perioperative hemodynamic changes. Results: Pain scores and opioid consumption in the FNB group were significantly lower than those in the control group at every measurement time (p

Background: Superior hypogastric plexus is a retroperitoneal plexus that receives visceral sensation from pelvic viscera. Superior hypogastric plexus block (SHPB) was used for chronic pelvic pain and recently studied for postoperative pain. We examined the safety and efficacy of preemptive anterior US-guided SHPB to reduce postoperative morphine consumption. Thirty-six patients undergoing pelvic cancer surgery were randomly divided into two equal groups; group S in which patients received anterior US-guided SHPB immediately after induction of general anesthesia and before skin incision using 20 ml bubivacaine 0.5%, group C control group in which 20 ml normal saline was given by the same technique. Patients of both groups received morphine via PCA postoperative and followed for 24 h. In both groups, we measured the total morphine consumption, VAS, vital signs, and side effects. Results: Demographic data, duration, and type of surgery were comparable in both groups. Total 24 h morphine consumption in mg was significantly lower in group S (43.8 ± 2) than in group C (54.83 ± 2) with P value < 0.001. VAS was significantly lower in group S in all time intervals from 2 till 24 h postoperative. Side effects were minimal with no significant difference between both groups. Conclusion: Preemptive US-guided SHPB is a relatively safe and effective method to reduce postoperative opioid demands after pelvic cancer surgeries. Trial registration: ClinicalTrials.gov NCT04732234 in 1–2-2021. [ABSTRACT FROM AUTHOR]

Aim: Peripheral nerve blocks, particularly femoral nerve blocks (FNBs), are a practical choice for relieving severe pain after total knee arthroplasty (TKA). We investigated the effectiveness of preemptive FNB on postoperative pain control and the reduction of opioid consumption. Methods: This was a single-center, prospective, randomized controlled trial conducted at a tertiary care health center, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Turkey. The study included 40 American Society of Anesthesiologists I-III patients scheduled for elective TKA surgery. Patients were studied in two groups. The FNB group (n=20) received preemptive single-injection FNB (15 mL of prilocaine 2% and 15 mL of 0.5% bupivacaine using a peripheral nerve stimulator) before general anesthesia (GA) as the study group and the control group (n=20) received standardized GA. The primary outcome measure was pain scores evaluated as numeric pain rating scale (0-10) at 2, 4, 8, 12, 16, 18, 20, and 24 h. Secondary outcome measures included opioid consumption with patient-controlled and perioperative hemodynamic changes. Results: Pain scores and opioid consumption in the FNB group were significantly lower than those in the control group at every measurement time (p<0.05). Total perioperative morphine use was also lower in the FNB group (p=0.023). Regarding hemodynamic variables, the heart rate values at the beginning of surgery and tourniquet insufflation in the FNB group were significantly lower than those in the control group. Conclusion: Using the FNB as part of any multimodal analgesia protocol to alleviate pain after TKA with less analgesic use would be beneficial. [ABSTRACT FROM AUTHOR]

Abstract Background Superior hypogastric plexus is a retroperitoneal plexus that receives visceral sensation from pelvic viscera. Superior hypogastric plexus block (SHPB) was used for chronic pelvic pain and recently studied for postoperative pain. We examined the safety and efficacy of preemptive anterior US-guided SHPB to reduce postoperative morphine consumption. Thirty-six patients undergoing pelvic cancer surgery were randomly divided into two equal groups; group S in which patients received anterior US-guided SHPB immediately after induction of general anesthesia and before skin incision using 20 ml bubivacaine 0.5%, group C control group in which 20 ml normal saline was given by the same technique. Patients of both groups received morphine via PCA postoperative and followed for 24 h. In both groups, we measured the total morphine consumption, VAS, vital signs, and side effects. Results Demographic data, duration, and type of surgery were comparable in both groups. Total 24 h morphine consumption in mg was significantly lower in group S (43.8 ± 2) than in group C (54.83 ± 2) with P value

Copyright of Journal of Political Sciences is the property of Republic of Iraq Ministry of Higher Education & Scientific Research (MOHESR) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background Empiric antifungal therapy is considered the standard of care for high-risk neutropenic patients with persistent fever. The impact of a preemptive, diagnostic-driven approach based on galactomannan screening and chest computed tomography scan on demand on survival and on the risk of invasive fungal disease (IFD) during the first weeks of high-risk neutropenia is unknown. Methods Patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) and allogeneic hematopoietic cell transplant recipients were randomly assigned to receive caspofungin empirically (arm A) or preemptively (arm B), while receiving fluconazole 400 mg daily prophylactically. The primary end point of this noninferiority study was overall survival (OS) 42 days after randomization. Results Of 556 patients recruited, 549 were eligible: 275 in arm A and 274 in arm B. Eighty percent of the patients had AML or MDS requiring high-dose chemotherapy, and 93% of them were in the first induction phase. At day 42, the OS was not inferior in arm B (96.7%; 95% confidence interval [CI], 93.8%–98.3%) when compared with arm A (93.1%; 95% CI, 89.3%–95.5%). The rates of IFDs at day 84 were not significantly different, 7.7% (95% CI, 4.5%–10.8%) in arm B vs 6.6% (95% CI, 3.6%–9.5%) in arm A. The rate of patients who received caspofungin was significantly lower in arm B (27%) than in arm A (63%; P <.001). Conclusions The preemptive antifungal strategy was safe for high-risk neutropenic patients given fluconazole as prophylaxis, halving the number of patients receiving antifungals without excess mortality or IFDs. Clinical Trials Registration. NCT01288378; EudraCT 2010-020814-27. [ABSTRACT FROM AUTHOR]

Introduction: Measurable residual disease (MRD)-directed interferon-a treatment (i.e. preemptive IFN-a treatment) can eliminate the MRD in patients with acute myeloid leukemia (AML) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Therefore, this study aimed to further assess its efficacy in a multicenter retrospective study in a real-world setting. Methods: A total of 247 patientswho received preemptive IFN-a treatment were recruited from 4 hospitals in China. The protocols for MRD monitoring mainly based on quantitative polymerase chain reaction [qPCR] and multiparameter flow cytometry [MFC]. Results: The median duration of IFN-a treatment was 56 days (range, 1-1211 days). The cumulative incidences of all grades acute graft-versus-host disease (aGVHD), all grades chronic graft-versus-host disease (cGVHD), and severe cGVHD at 3 years after IFN-a therapy were 2.0% (95% confidence interval [CI], 0.3-3.8%), 53.2% (95% CI, 46.8-59.7%), and 6.2% (95% CI, 3.1-9.2%), respectively. The cumulative incidence of achieving MRD negative state at 2 years after IFN-a treatment was 78.2% (95% CI, 72.6-83.7%). The 3-year cumulative incidences of relapse and non-relapse mortality following IFN-a therapy were 20.9% (95% CI, 15.5-26.3%) and 4.9% (95%CI, 2.0-7.7%), respectively. The probabilities of leukemia-free survival and overall survival at 3 years following IFN-a therapy were 76.9% (95% CI, 71.5-82.7%) and 84.2% (95% CI, 78.7-90.1%), respectively. Multivariable analysis showed that MRD positive state by qPCR and MFC before IFN-a treatment, high-risk disease risk index before allo-HSCT, and receiving identical sibling donor HSCT were associated with a higher risk of relapse and a poorer leukemia-free survival. Severe cGVHD was associated with an increased risk of non-relapse mortality. Discussion: Thus, real-world data suggest that preemptive IFN-a is effective for treating patients with AML with MRD after allo-HSCT. [ABSTRACT FROM AUTHOR]

Kidney donor allocation can occasionally be difficult in Australia given a small population spread over vast distances. Therefore, between 2017 and 2019 our service allowed transplantation from deceased donors into local (same‐state) preemptive recipients, only if no well‐matched dialysis‐dependent transplant waitlist recipient was available. Transplantation using this novel allocation pathway was associated with good clinical and immunological outcomes. [ABSTRACT FROM AUTHOR]

Background and Objectives: As an adjunct to postoperative multimodal analgesic regimens, pregabalin has been reported in reducing postoperative acute pain and opioid consumption. However, there is only a small amount of evidence for preemptive pregabalin in patients undergoing cancer-related surgery. This systematic review was conducted to integrate high-quality evidence to evaluate the preemptive analgesic effects of pregabalin in cancer-related surgery. Materials and Methods: Seven electronic databases were searched in a combination of subject terms and free words. Efficacy and safety of preemptive pregabalin on postoperative pain for cancer-related surgery were evaluated by assessing resting and dynamic pain scores postoperatively, cumulative morphine equivalent consumption, time to first analgesic request, hemodynamic parameters, and the safety indicators. Results: Thirteen trials were incorporated for quantitative synthesis. The pooled results showed administration of pregabalin preoperatively is clinically significant for improving resting (weighted mean difference (WMD), −1.53 cm; 95% CI, −2.30 to −0.77) and dynamic (WMD, −1.16 cm; 95% CI, −2.22 to −0.11) pain severity scores at 2 h postoperatively and prolonging time to first analgesic request (WMD, 2.28 h; 95% CI, 0.79 to 3.77) in cancer-related surgery. Preemptive pregabalin was also statistically effective in some other pain indicators but would increase the risk of pregabalin-related side effects after surgery. Conclusions: Our findings do not support the administration of pregabalin in doses larger than 300 mg when put in cancer-related surgery. Taken together, more high-quality research particularly focused on the optimal dosages and timing of pregabalin in cancer-related surgery is needed in the future to establish stronger evidence for therapeutic effects. [ABSTRACT FROM AUTHOR]

IntroductionMeasurable residual disease (MRD)-directed interferon-a treatment (i.e. preemptive IFN-α treatment) can eliminate the MRD in patients with acute myeloid leukemia (AML) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Therefore, this study aimed to further assess its efficacy in a multicenter retrospective study in a real-world setting.MethodsA total of 247 patientswho received preemptive IFN-α treatment were recruited from 4 hospitals in China. The protocols for MRD monitoring mainly based on quantitative polymerase chain reaction [qPCR] and multiparameter flow cytometry [MFC]. ResultsThe median duration of IFN-α treatment was 56 days (range, 1–1211 days). The cumulative incidences of all grades acute graft-versus-host disease (aGVHD), all grades chronic graft-versus-host disease (cGVHD), and severe cGVHD at 3 years after IFN-α therapy were 2.0% (95% confidence interval [CI], 0.3–3.8%), 53.2% (95% CI, 46.8–59.7%), and 6.2% (95% CI, 3.1–9.2%), respectively. The cumulative incidence of achieving MRD negative state at 2 years after IFN-α treatment was 78.2% (95% CI, 72.6–83.7%). The 3-year cumulative incidences of relapse and non-relapse mortality following IFN-α therapy were 20.9% (95% CI, 15.5–26.3%) and 4.9% (95%CI, 2.0–7.7%), respectively. The probabilities of leukemia-free survival and overall survival at 3 years following IFN-α therapy were 76.9% (95% CI, 71.5–82.7%) and 84.2% (95% CI, 78.7–90.1%), respectively. Multivariable analysis showed that MRD positive state by qPCR and MFC before IFN-α treatment, high-risk disease risk index before allo-HSCT, and receiving identical sibling donor HSCT were associated with a higher risk of relapse and a poorer leukemia-free survival. Severe cGVHD was associated with an increased risk of non-relapse mortality. DiscussionThus, real-world data suggest that preemptive IFN-α is effective for treating patients with AML with MRD after allo-HSCT.

Objective: The aim of this study is to investigate the effect of the preemptive use of plerixafor in patients with lymphoma and multiple myeloma which was administered as a preemptive single dose to the patients who were determined to have a CD34+ cell count of <15/pL in the peripheral blood (PB) on the 4th day of mobilization. Patients and Methods: Thirty-five patients who were administered plerixafor on the 4th day after granulocyte colony-stimulating factor (G-CSP) alone for stem cell mobilization between January 2020 and November 2021 were included. CD34+ stem cell counts in PB before and after plerixafor, the amount of CD34+ stem cells collected, and the outcome of transplantation was examined. Results: The median CD34+ cell count in PB on the 4th day was 5.2/µL (0.1-13.4), which was determined to increase 206.6-fold (31.57- 49347) to 924.80 /µL (295.00-5056) following the administration of plerixafor on the 5th day (Z=-5.160; r= - 872.2; p<0.0001). The number of apheresis sessions was 1 in all patients. The median collected CD34+ cell count was 5.90x106/kg (2.70x106-14.4x106). CONCLUSION: The use of preemptive plerixafor shows that it is an effective mobilization method by increasing the rate of stem cell collection at an effective dose and reducing the mobilization time/apheresis sessions. [ABSTRACT FROM AUTHOR]

Aim: Few studies have investigated pregabalin use as preemptive analgesia in the management of acute pain and anxiety following arthroscopic shoulder surgery. We hypothesized that the preemptive use of oral pregabalin might decrease pain and postoperative anxiety on arthroscopic shoulder surgery pain during the initial 48 hours. Patients and methods: In this prospective, randomized, double-blind, placebo-controlled study, 65 eligible patients were randomly divided into two groups, the preemptive pregabalin 150 mg (group P) and the control group (group C). The primary outcomes were pain levels measured both rest and during active motion based on a visual analog scale (VAS). Secondary outcomes were the level of anxiety (STAI-S and STAI-T), patient satisfaction, and complications. Results: Group P showed lower pain (p < 0.001), better opioid consumption (p < 0.001), longer time to first requirement of analgesia (p < 0.001), and lower rescue analgesic dose (p < 0.001) than the control group at postoperative 48 h follow-up. Also, group P showed less preoperative and postoperative anxiety (p < 0.001) and greater patient satisfaction (p < 0.001) than group C. The rate of postoperative adverse effects was similar between the groups (p > 0.05). Conclusion: The preemptive use of oral pregabalin received 150 mg daily for 2 days before surgery provided postoperative analgesia in both rest and active motion, and improved preoperative and postoperative anxiety levels and greater patient satisfaction in patients undergoing arthroscopic surgery.

Jingmin Zhang,1,2 Guangzhao Qi,1,2 Chao Han,1,2 Yubing Zhou,1,2 Yongjie Yang,1 Xinru Wang,1,2 Suna Liu,3 Xiaojian Zhang1,2 1Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China; 2Henan Key Laboratory for Precision Clinical Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China; 3Newborn Screening Center, Department of Pediatrics, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of ChinaCorrespondence: Guangzhao Qi; Xiaojian Zhang Tel +86-37166295269Email qiguangzhao1223@sina.com; zhangxiaojian15@126.comPurpose: Pharmacogenetic testing is recognized as the major method for the individualized pharmacotherapy in clinical pharmacy practice, but information about the clinical implementation of pharmacogenetic testing in China is limited. The present study aimed to determine the situation of clinical implementation for pharmacogenetic testing in central China.Methods: The study is conducted in the department of clinical pharmacy in The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China. We collected and analyzed pharmacogenetic testing results from November 1, 2013 to November 2, 2018 in our hospital, which were checked in the electronic medical record system. The main outcome measures were the number and type of pharmacogenetic testing across five years.Results: A total of 47,265 (56.9% male, mean age = 51.5 years) pharmacogenetic testing results were obtained with an average annual rate of growth of 63.0% across five years. A 50.2% (23,748/47,265) of all the pharmacogenetic testing results were for the determination of cytochrome P450 2C19 (CYP2C19) &ast;2, &ast;3 genotypes, and 41.7% were for the methylene tetrahydrofolate reductase (MTHFR) C677T genotype. The number of departments performing the pharmacogenetic testing was 35, 63, 55, 52, 52 and 39 for 2013– 2018, respectively, and the main top five departments were cardiology, psychiatry, ICU, cardiac surgery and intervention.Conclusion: Clinical implementation of pharmacogenetic testing in China is growing rapidly, but the types and implementing departments of pharmacogenetic testing were limited. Our present study reported the real-world implementation modality of pharmacogenomic tests in China. It will help us to understand the testing of pharmacogenetics in China in order to promote the rational development of pharmacogenetics.Keywords: clinical implementation, pharmacogenomics, pharmacogenetics, China, preemptive

The Covid-19 pandemic crisis has caused many difficulties worldwide. One of the most critical problems is that the emergency departments (EDs) have become overcrowded. Because this prob)lem can increase patients’ queue length and waiting times in EDs, this paper provides a mixed)integer non-linear mathematical model considering a preemptive M/M/C queueing system to solve the problem and optimize a benefit function concerning the number of servers and treatment rate. In this model, different patient priorities, which are modified according to Covid-19 patients, are considered. This model is then solved using an exact approach and a meta-heuristic algorithm, the grasshopper optimization algorithm, for two shifts of the ED of a hospital in order to consider non stationery arrival rate in Varamin, Iran. The results of both algorithms confirmed the effective)ness of the proposed model. Moreover, to justify using the preemptive model, a comparison between the preemptive and non-preemptive models is conducted. An extensive sensitivity ana)lysis is presented, and finally, a list of managerial insights is provided for managers to improve their service system further. [ABSTRACT FROM AUTHOR]

In the last decade, endoluminal vacuum therapy (eVAC) has emerged as an effective treatment for anastomotic leak (AL); however, little is known regarding its prophylactic use. In this systematic review we evaluated overall outcomes in patients undergoing major gastrointestinal surgery and treated with prophylactic eVAC. A systematic review of English articles on four electronic databases was performed according to the PRISMA statement up until January 2022. References of selected articles were manually screened to identify relevant missing papers. Primary endpoints were AL and mortality rates estimates. Secondary endpoints included analysis of eVAC-associated morbidity, treatment duration, long-term complications, and general indications for the eVAC management in the perioperative period. A total of 11 studies (5 case reports, 5 retrospective case series and a retrospective, case–control study) were included in the analysis. AL ranged from 0 to 25%. No major eVAC-associated complications were observed, except for sponge dislocation or obstruction. Overall mortality ranged between 0 and 12.5%; however, these fatalities were neither related to the use of eVAC, nor to AL-associated complications. The most frequent long-term complication was anastomotic stenosis responsive to endoscopic dilatation in most cases. The operating negative pressure ranged from −25 to −125 mmHg among different papers. In all studies but two, prophylactic eVAC was applied to anastomoses at high risk of dehiscence based on the subjective evaluation of the leading surgeon. In conclusion, prophylactic eVAC is safe and it could lead to potential benefit for prevention of AL, especially in high-risk anastomoses. [ABSTRACT FROM AUTHOR]

Background: Cytomegalovirus (CMV) is an important opportunistic pathogen after transplantation. Some virological variation in transplant recipients is explained by donor and recipient CMV serostatus, but not all. Circadian variability of herpesviruses has been described, so we investigated the effect of time of day of transplantation on posttransplant CMV viremia.Methods: We performed a retrospective analysis of 1517 patients receiving liver or kidney allografts at a single center from 2002 to 2018. All patients were given preemptive therapy with CMV viremia monitoring after transplantation. Circulatory arrest and reperfusion time of donor organ were categorized into 4 periods. Patients were divided into serostatus groups based on previous CMV infection in donor and recipient. CMV viremia parameters were compared between time categories for each group. Factor analysis of mixed data was used to interrogate this complex data set.Results: Live-donor transplant recipients were less likely to develop viremia than recipients of deceased-donor organs (48% vs 61%; P < .001). After controlling for this, there was no evidence of time of day of transplantation affecting CMV parameters in any serostatus group, by logistic regression or factor analysis of mixed data.Discussion: We found no evidence for a circadian effect of transplantation on CMV viremia, but these novel results warrant confirmation by other centers. [ABSTRACT FROM AUTHOR]

Objective: To study the effect of preemptive bronchodilator therapy in reducing postoperative pulmonary complications in smokers undergoing coronary artery bypass grafting. Study Design: Randomized Control Trial. Setting: Army Cardiac Centre CMH Lahore. Period: January to June 2021. Material & Methods: A total of 200 patients undergoing CABG in Army cardiac Centre CMH Lahore were included in this study. Patients were divided in to two groups i.e. case and interventional groups. All the procedures were performed by the consultant cardiac surgeon of experience of more than 5 years. In interventional group patients were administered with bronchodilator therapy i.e. salmicort inhaler preoperatively along with other necessary preoperative measures while in case group no bronchodilator therapy was introduced. Preoperatively, ASA status, FEV1, BMI, oxygen saturation, Ejection fraction (EF), and smoking status, COPD diagnosis, and PaCO2, FVC-L, PEFR, Hb and CRP levels was assessed. Postoperatively, different pulmonary function tests were performed in both groups i.e. need for prolonged oxygen therapy, prolonged ICU stay, re-intubation and antibiotic use. Results: The frequencies of prolonged oxygen therapy and ICU stay, re-intubation, antibiotics use, COPD diagnosis were same in both the groups. Therefore, the differences were statistically insignificant. But, PaCO2, in intervention group was higher than the control group with significant difference, (p=0.004). Conclusion: It can be concluded from the results of this study that administration of bronchodilator therapy preoperatively in patients with known history of smoking undergoing coronary artery bypass graft surgery has no significant effect in terms of outcome variables. [ABSTRACT FROM AUTHOR]

Objective: Adequate pain management is an essential key to success in endodontics. The present study aimed to evaluate the postoperative pain levels and analgesic intake on preemptive versus preventive oral administration of ibuprofen in single visit root canal treatment. Methods: A total of 100 participants presented with symptomatic irreversible pulpitis and with severe baseline pain scores were selected for the study. The participants were randomly allocated into two groups as follows: Group I: preemptive group (n=50), Group II: preventive group (n=50). Participants in group I were administered preoperatively with 600 mg of ibuprofen tablet 1 hour before the procedure, whereas in group II, participants were administered only with a placebo preoperatively. The treatment was finished in a single visit, and 200 mg ibuprofen tablet was administered every eight hours in both groups. The participants were asked to take tablets only when required and evaluated for pain scores and analgesic intake at 6, 24, 48, 72 hour intervals. Results: There was a statistically significant decrease (P<0.05) in both the pain levels and tablet intake in the preemptive group compared to the preventive group at 6, 24, 48 and 72 hours. Preemptive group was bene- ficial in reducing postoperative pain scores and analgesic intake at all time intervals. Conclusion: Preemptive analgesic administration seems beneficial in reducing postoperative pain levels and analgesic intake in single visit root canal treatment. [ABSTRACT FROM AUTHOR]

Because of the high incidence of cytomegalovirus (CMV) seropositivity in the population, CMV infection is a common and severe complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in Taiwan. Here we propose a CMV management strategy for patients undergoing allo-HSCT from the Taiwanese perspective, which focuses on the epidemiology, diagnosis, monitoring, prophylaxis, and treatment of CMV infection after allo-HSCT. In terms of CMV monitoring, weekly CMV monitoring with the COBAS® AmpliPrep system is the standard approach because the pp65 CMV antigenemia assay has a lower sensitivity than CMV monitoring with the COBAS® AmpliPrep system. However, pp65 CMV antigenemia assay has a better correlation with clinical symptoms in immunocompromised patients. A 14-week prophylactic course of letermovir is recommended for allo-HSCT recipients in Taiwan, especially for recipients of hematopoietic stem cells from mismatched unrelated and haploidentical donors. Preemptive ganciclovir therapy should be initiated when the CMV viral load exceeds 1000 copies/mL, and should not be discontinued until CMV DNA is no longer detected in the blood. For allo-HSCT recipients who have CMV-related diseases, ganciclovir with or without CMV-specific intravenous immunoglobulin is the standard of care. The limited availability of foscarnet, an alternative for patients who are not responsive to or cannot tolerate ganciclovir, is a crucial issue in Taiwan. For pediatric allo-HSCT recipients, more data are needed to propose a CMV management recommendation.

Abstract Purpose Abdominal myomectomy can be a challenging procedure, with elevated intraoperative blood loss and post-operative complications such as the need for blood transfusion and hemostasis with sometimes hysterectomy. Previous studies suggested that preemptive uterine artery embolization (PUAE) might reduce intraoperative blood loss. Materials and methods We reviewed all cases of abdominal myomectomy in our institution between January 2016 and June 2018. Out of 119 cases, 16 patients had PUAE and 103 did not. The objective of our study was to determine whereas PUAE reduced blood loss and post-operative complication rate. Results In our study, there was no difference between the two groups in regard to average blood loss (128 vs 192 mL, OR 1,00 [0.99;1,01], p = 0,73), difference between pre- and post-operative hemoglobin level (− 1,15 g/dL vs − 1,32 g/dL, OR 0,91 [0.47;1,73], p = 0,79), and post-operative complications (need for transfusion, surgical revision, post-operative embolization, hysterectomy). Conclusion Our findings could not conclude that PUAE is effective in reducing intraoperative blood loss during abdominal myomectomy, but it should still be considered an option for patients with large or multiple myomas, with a specific situation or previously operated, who wish to preserve their uterus.

As an emerging measure of data freshness, the age of information (AoI) is receiving extensive attention. Many methods using AoI have been proposed for communication scheduling in the Internet of Things (IoT). However, most of them are aimed at constant channel conditions in the ideal state, and the utilization of link resources is not sufficient. In addition, only the optimization of AoI is considered, without considering whether the sample is extruded. Sample extrusion refers to the scenario in which the transmission of the remaining untransmitted sample of the source node cannot be completed within the transmission time interval (TTI) before the arrival of the new sampling period of the source node. Thus, sample extrusion is a phenomenon that occurs when the new sample arrives while the old sample has not yet been completely transmitted. This scenario has a serious impact on delay-sensitive IoT applications. Therefore, under dynamic channel conditions and limited link resources, this paper establishes two mathematical models for AoI and sample extrusion. The influence of the scheduling algorithm on these two target values is analyzed and proven. Based on a greedy strategy, we propose a preemptive online algorithm for link resource allocation that considers two objectives: to give full play to the value of link resources and to minimize sample extrusion. The simulation results show that the proposed strategy can achieve better comprehensive performance in both scenarios where the sample variance between source nodes is small or large.

With the continuous development of intelligent manufacturing technology, the intelligent production line for the Industrial Internet of Things occupies an important position in the field of industrial intelligence. OPC UA is a standard for communication data exchange between intelligent production line devices. OPC UA can establish a unified information model for production line devices and improve the connectivity of heterogeneous networks. However, in industrial wireless network application scenarios, there are various types of sensing information and large amounts of data to be transmitted. Each type of data has different requirements for real-time. The traditional OPC UA communication method is difficult to achieve real-time and reliable transmission in intelligent production lines and can’t meet the transmission requirements of time-sensitive data. In this paper, we propose a real-time communication model of the OPC UA wireless network for intelligent production lines (UAMPDS). IEEE 802.15.4e TSCH is used as the wireless communication infrastructure, and OPC UA protocols are fused to this model. Meanwhile, we design a load-aware time-slot scheduling algorithm to dynamically allocate and schedule time slots according to the network topology and traffic load of each node. We also implement a dynamic preemptive resource scheduling strategy based on service differentiation to ensure real-time transmission of time-sensitive data. The experimental results show that this model achieves differentiated services based on data with different latency tolerance and effectively reduces the transmission latency of real-time service data under the constrained network resources. It can avoid the starvation phenomenon of low priority queues, and improves the overall quality of service of intelligent production line communication networks.

For allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients, preemptive interferon-α (IFN-α) therapy is considered as a useful method to eliminate the minimal residual disease (MRD). Our purpose is to assess the long-term efficacy of preemptive IFN-α therapy in acute myeloid leukemia (AML) patients following allo-HSCT based on two registry studies (#NCT02185261 and #NCT02027064). We would present the final data and unpublished results of long-term clinical outcomes with extended follow-up. We adopted polymerase chain reaction (PCR) and multiparameter flow cytometry (MFC) to monitor MRD, and a positive result of bone marrow specimen examined by either of them would be identified as the MRD-positive status. Subcutaneous injections of recombinant human IFN-α-2b were performed for 6 cycles, and prolonged IFN-α therapy could be permitted at the request of patients. The median cycles were 3.5 (range, 0.5–30.5) cycles. A total of 9 patients suffered from grade ≥3 toxicities (i.e., infectious: n = 6; hematologic: n = 3). The 6-year cumulative incidences of relapse and non-relapse mortality following IFN-α therapy were 13.0% (95% confidence interval [CI], 5.4–20.6%) and 3.9% (95%CI, 0.0–17.6%), respectively. The probability of disease-free survival at 6 years following IFN-α therapy was 83.1% (95%CI, 75.2–91.9%). The probability of overall survival at 6 years following IFN-α therapy was 88.3% (95%CI, 81.4–95.8%). The cumulative incidences of total chronic graft-versus-host disease (cGVHD) and severe cGVHD at 6 years following IFN-α therapy were 66.2% (95%CI, 55.5–77.0%) and 10.4% (95%CI, 3.6–17.2%), respectively. Multivariable analysis showed that an alternative donor was associated with a lower risk of relapse and the better disease-free survival. Thus, preemptive IFN-α therapy could clear MRD persistently, prevent relapse truly, and improve long-term survival in AML patients following allo-HSCT. [ABSTRACT FROM AUTHOR]

In patients with t(8;21) acute myeloid leukemia (AML), recurrent minimal residual disease (MRD) measured by RUNX1-RUNX1T1 transcript levels can predict relapse after allogeneic hematopoietic stem cell transplantation (allo-HSCT). This study aimed to compare the efficacy of preemptive interferon (IFN)-α therapy and donor lymphocyte infusion (DLI) in patients with t(8;21) AML following allo-HSCT. We also evaluated the appropriate method for patients with different levels of RUNX1-RUNX1T1 transcripts. In this retrospective study, consecutive patients who had high-risk t(8;21) AML and received allo-HSCT were enrolled. The inclusion criteria were as follows: (1) age ≤65 years; (2) regained MRD positive following allo-HSCT. MRD positive was defined as the loss of a ≥4.5-log reduction and/or <4.5-log reduction in the RUNX1-RUNX1T1 transcripts, and high-level, intermediate-level, and low-level MRDs were, respectively, defined as <2.5-log, 2.5−3.5-log, and 3.5−4.5-log reductions in the transcripts compared with the pretreatment baseline level. Patients with positive RUNX1-RUNX1T1 could receive preemptive IFN-α therapy or DLI, which was primarily based on donor availability and the intentions of physicians and patients. The patients received recombinant human IFN-α-2b therapy by subcutaneous injection twice a week every 4 weeks. IFN-α therapy was scheduled for six cycles or until the RUNX1-RUNX1T1 transcripts were negative for at least two consecutive tests. The rates of MRD turning negative for patients with low-level, intermediate-level, and high-level RUNX1-RUNX1T1 receiving IFN-α were 87.5%, 58.1%, and 22.2%, respectively; meanwhile, for patients with intermediate-level and high-level RUNX1-RUNX1T1 receiving DLI, the rates were 50.0% and 14.3%, respectively. For patients with low-level and intermediate-level RUNX1-RUNX1T1 , the probability of overall survival at 2 years was higher in the IFN-α group than in the DLI group (87.6% vs. 55.6%; p = 0.003). For patients with high levels of RUNX1-RUNX1T1 , the probability of overall survival was comparable between the IFN-α and DLI groups (53.3% vs. 83.3%; p = 0.780). Therefore, patients with low-level and intermediate-level RUNX1-RUNX1T1 could benefit more from preemptive IFN-α therapy compared with DLI. Clinical outcomes were comparable between preemptive IFN-α therapy and DLI in patients with high-level RUNX1-RUNX1T1 ; however, they should be further improved. [ABSTRACT FROM AUTHOR]

Aim: Few studies have investigated pregabalin use as preemptive analgesia in the management of acute pain and anxiety following arthroscopic shoulder surgery. We hypothesized that the preemptive use of oral pregabalin might decrease pain and postoperative anxiety on arthroscopic shoulder surgery pain during the initial 48 hours. Patients and methods: In this prospective, randomized, double-blind, placebo-controlled study, 65 eligible patients were randomly divided into two groups, the preemptive pregabalin 150 mg (group P) and the control group (group C). The primary outcomes were pain levels measured both rest and during active motion based on a visual analog scale (VAS). Secondary outcomes were the level of anxiety (STAI-S and STAI-T), patient satisfaction, and complications. Results: Group P showed lower pain (p < 0.001), lower opioid consumption (p < 0.001), longer time to first requirement of analgesia (p < 0.001), and lower rescue analgesic dose (p < 0.001) than the control group at postoperative 48 h follow-up. Also, group P showed less preoperative and postoperative anxiety (p < 0.001) and greater patient satisfaction (p < 0.001) than group C. The rate of postoperative adverse effects was similar between the groups (p > 0.05). Conclusion: The preemptive use of oral pregabalin received 150 mg daily for 2 days before surgery provided postoperative analgesia in both rest and active motion, and improved preoperative and postoperative anxiety levels and greater patient satisfaction in patients undergoing arthroscopic surgery. [ABSTRACT FROM AUTHOR]

The Civil Code of 1864 did not recognize the institution of the preemptive right. The current civil code includes an extensive regulation dedicated to the priority right to purchase a good. Its provisions are equally applicable when the source of the right is the law but also when the source is the will of the parties. These legal provisions outline the legal regime applicable whenever a special rule establishing a legal right of preemption does not also regulate a special procedure for exercising it or applicable whenever by their will, the parties who have generated a conventional preemptive right did not establish other contractual clauses. There is a preemptive right only when the owner decides to dispose of his good by sale. As a legal nature, the preemptive right seems to be a potestative right. [ABSTRACT FROM AUTHOR]

The ineffectiveness of punitive-based approaches after the occurrence of terrorist attacks in preventing this criminal phenomenon has led to the development of new strategies in order to control terrorism through preemptive mechanisms and the adoption of preventive measures before the occurrence of terrorist crimes. The present article by using descriptive-documentary research method seeks to answer the question that, in order to prevent the harmful risks of terrorism in the precrime stage, what Anticipatory measures have been presented in legal systems? Findings of this research demonstrate that today Anticipatory approaches to containment terrorism have a special station in legal systems. legislative systems by adopting Anticipatory mechanisms before the occurrence of terrorist threats, Have the future-based approach Against this dangerous phenomenon. The most important Anticipatory strategies to control terrorism to include the limitation or prohibition of ownership, financial transparency and prevention of terror financing, communication, training and employment restrictions, residence and monitoring obligations , control on travelling and inspect places. Safeguards for Anticipatory measures in the face of terrorism include administrative measures, Control orders and arrest.

In patients with t(8;21) acute myeloid leukemia (AML), recurrent minimal residual disease (MRD) measured by RUNX1-RUNX1T1 transcript levels can predict relapse after allogeneic hematopoietic stem cell transplantation (allo-HSCT). This study aimed to compare the efficacy of preemptive interferon (IFN)-α therapy and donor lymphocyte infusion (DLI) in patients with t(8;21) AML following allo-HSCT. We also evaluated the appropriate method for patients with different levels of RUNX1-RUNX1T1 transcripts. In this retrospective study, consecutive patients who had high-risk t(8;21) AML and received allo-HSCT were enrolled. The inclusion criteria were as follows: (1) age ≤65 years; (2) regained MRD positive following allo-HSCT. MRD positive was defined as the loss of a ≥4.5-log reduction and/or

For allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients, preemptive interferon-α (IFN-α) therapy is considered as a useful method to eliminate the minimal residual disease (MRD). Our purpose is to assess the long-term efficacy of preemptive IFN-α therapy in acute myeloid leukemia (AML) patients following allo-HSCT based on two registry studies (#NCT02185261 and #NCT02027064). We would present the final data and unpublished results of long-term clinical outcomes with extended follow-up. We adopted polymerase chain reaction (PCR) and multiparameter flow cytometry (MFC) to monitor MRD, and a positive result of bone marrow specimen examined by either of them would be identified as the MRD-positive status. Subcutaneous injections of recombinant human IFN-α-2b were performed for 6 cycles, and prolonged IFN-α therapy could be permitted at the request of patients. The median cycles were 3.5 (range, 0.5–30.5) cycles. A total of 9 patients suffered from grade ≥3 toxicities (i.e., infectious: n = 6; hematologic: n = 3). The 6-year cumulative incidences of relapse and non-relapse mortality following IFN-α therapy were 13.0% (95% confidence interval [CI], 5.4–20.6%) and 3.9% (95%CI, 0.0–17.6%), respectively. The probability of disease-free survival at 6 years following IFN-α therapy was 83.1% (95%CI, 75.2–91.9%). The probability of overall survival at 6 years following IFN-α therapy was 88.3% (95%CI, 81.4–95.8%). The cumulative incidences of total chronic graft-versus-host disease (cGVHD) and severe cGVHD at 6 years following IFN-α therapy were 66.2% (95%CI, 55.5–77.0%) and 10.4% (95%CI, 3.6–17.2%), respectively. Multivariable analysis showed that an alternative donor was associated with a lower risk of relapse and the better disease-free survival. Thus, preemptive IFN-α therapy could clear MRD persistently, prevent relapse truly, and improve long-term survival in AML patients following allo-HSCT.

BackgroundInvasive fungal infections (IFIs) are complications that lead to mortality and morbidity in hematologic malignancies. The time of starting antifungal therapy is vital. Preemptive antifungal therapy has appeared recently as a new policy for the management of IFIs based on noninvasive ways in neutropenic patients.MethodsWe enrolled leukemia patients with neutropenia after chemotherapy in Imam Khomeini Hospital Complex, Tehran, Iran. Patients who entered the neutropenic phase were divided into two categories (empirical and preemptive) for receiving antifungal agents. The patients were clinically examined in the preemptive group every day to find IFIs. As soon as clinical evidence of IFIs was observed, antifungal was prescribed. The empirical group patients received antifungals based on the ward protocol. Based on the data in each group, the diagnostic and therapeutic results of cases are followed-up to 3 months. To compare percentages between the two groups, the chi-squared test was used. And to compare two means between the two groups, the independent t-test was used. All the statistical analyses were done in the Statistical Package for the Social Sciences (SPSS) version 24 software (IBM Corporation, Armonk, New York, USA).ResultsWe assessed 132 leukemic patients with inclusion and exclusion criteria. Eventually, 80 patients were enrolled. The mean age was 35.52 years. Demographics data and distribution of leukemia type show no significant differences between the two groups. Despite a higher percentage of IFIs discovered in the preemptive group than the empirical group (25 vs. 18.75%, respectively), but data show no significant differences. The average days of IFIs diagnosis since the beginning of neutropenia in the empirical group were 9.5 days while in the preemptive group, the average days were 5.4 days (p < 0.05). Totally, there were 15 patients with a proven IFI in each group (40% in the empirical group and 60% in the preemptive group). Results significantly show an increase in surgical sinus debridement in the empirical groups (83.3%) vs. the preemptive groups (55.5%), (p < 0.05). The mortality rate differed significantly among the two groups; it was 7.5% in the preemptive group and 25% in the empirical group (p < 0.05).ConclusionDaily oral and nasal cavities examination to find the symptoms of IFIs and then start preemptive antifungal agents may be able to lead to accurate diagnosis, earlier treatment, and decreasing sinus surgery debridement in leukemia patients with neutropenia.

Background and Objectives: As an adjunct to postoperative multimodal analgesic regimens, pregabalin has been reported in reducing postoperative acute pain and opioid consumption. However, there is only a small amount of evidence for preemptive pregabalin in patients undergoing cancer-related surgery. This systematic review was conducted to integrate high-quality evidence to evaluate the preemptive analgesic effects of pregabalin in cancer-related surgery. Materials and Methods: Seven electronic databases were searched in a combination of subject terms and free words. Efficacy and safety of preemptive pregabalin on postoperative pain for cancer-related surgery were evaluated by assessing resting and dynamic pain scores postoperatively, cumulative morphine equivalent consumption, time to first analgesic request, hemodynamic parameters, and the safety indicators. Results: Thirteen trials were incorporated for quantitative synthesis. The pooled results showed administration of pregabalin preoperatively is clinically significant for improving resting (weighted mean difference (WMD), −1.53 cm; 95% CI, −2.30 to −0.77) and dynamic (WMD, −1.16 cm; 95% CI, −2.22 to −0.11) pain severity scores at 2 h postoperatively and prolonging time to first analgesic request (WMD, 2.28 h; 95% CI, 0.79 to 3.77) in cancer-related surgery. Preemptive pregabalin was also statistically effective in some other pain indicators but would increase the risk of pregabalin-related side effects after surgery. Conclusions: Our findings do not support the administration of pregabalin in doses larger than 300 mg when put in cancer-related surgery. Taken together, more high-quality research particularly focused on the optimal dosages and timing of pregabalin in cancer-related surgery is needed in the future to establish stronger evidence for therapeutic effects.

Many factors have been described to contribute to voriconazole (VCZ) interpatient variability in plasma concentrations, especially CYP2C19 genetic variability. In 2014, Hicks et al. presented data describing the correlation between VCZ plasma concentrations and CYP2C19 diplotypes in immunocompromised pediatric patients and utilized pharmacokinetic modeling to extrapolate a more suitable VCZ dose for each CYP2C19 diplotype. In 2017, in our hospital, a clinical protocol was developed for individualization of VCZ in immunocompromised patients based on preemptive genotyping of CYP2C19 and dosing proposed by Hicks et al., Clinical Pharmacogenetics Implementation Consortium (CPIC) clinical guidelines, and routine therapeutic drug monitoring (TDM). We made a retrospective review of a cohort of 28 immunocompromised pediatric patients receiving VCZ according to our protocol. CYP2C19 gene molecular analysis was preemptively performed using PharmArray®. Plasma trough concentrations were measured by immunoassay analysis until target concentrations (1–5.5 μg/ml) were reached. Sixteen patients (57.14%) achieved VCZ trough target concentrations in the first measure after the initial dose based on PGx. This figure is similar to estimations made by Hicks et al. in their simulation (60%). Subdividing by phenotype, our genotyping and TDM-combined strategy allow us to achieve target concentrations during treatment/prophylaxis in 90% of the CYP2C19 Normal Metabolizers (NM)/Intermediate Metabolizers (IM) and 100% of the Rapid Metabolizers (RM) and Ultrarapid Metabolizers (UM) of our cohort. We recommended modifications of the initial dose in 29% (n = 8) of the patients. In RM ≥12 years old, an increase of the initial dose resulted in 50% of these patients achieving target concentrations in the first measure after initial dose adjustment based only on PGx information. Our experience highlights the need to improve VCZ dose predictions in children and the potential of preemptive genotyping and TDM to this aim. We are conducting a multicenter, randomized clinical trial in patients with risk of aspergillosis in order to evaluate the effectiveness and efficiency of VCZ individualization: VORIGENIPHARM (EudraCT: 2019-000376-41). [ABSTRACT FROM AUTHOR]

Many factors have been described to contribute to voriconazole (VCZ) interpatient variability in plasma concentrations, especially CYP2C19 genetic variability. In 2014, Hicks et al. presented data describing the correlation between VCZ plasma concentrations and CYP2C19 diplotypes in immunocompromised pediatric patients and utilized pharmacokinetic modeling to extrapolate a more suitable VCZ dose for each CYP2C19 diplotype. In 2017, in our hospital, a clinical protocol was developed for individualization of VCZ in immunocompromised patients based on preemptive genotyping of CYP2C19 and dosing proposed by Hicks et al., Clinical Pharmacogenetics Implementation Consortium (CPIC) clinical guidelines, and routine therapeutic drug monitoring (TDM). We made a retrospective review of a cohort of 28 immunocompromised pediatric patients receiving VCZ according to our protocol. CYP2C19 gene molecular analysis was preemptively performed using PharmArray®. Plasma trough concentrations were measured by immunoassay analysis until target concentrations (1–5.5 μg/ml) were reached. Sixteen patients (57.14%) achieved VCZ trough target concentrations in the first measure after the initial dose based on PGx. This figure is similar to estimations made by Hicks et al. in their simulation (60%). Subdividing by phenotype, our genotyping and TDM-combined strategy allow us to achieve target concentrations during treatment/prophylaxis in 90% of the CYP2C19 Normal Metabolizers (NM)/Intermediate Metabolizers (IM) and 100% of the Rapid Metabolizers (RM) and Ultrarapid Metabolizers (UM) of our cohort. We recommended modifications of the initial dose in 29% (n = 8) of the patients. In RM ≥12 years old, an increase of the initial dose resulted in 50% of these patients achieving target concentrations in the first measure after initial dose adjustment based only on PGx information. Our experience highlights the need to improve VCZ dose predictions in children and the potential of preemptive genotyping and TDM to this aim. We are conducting a multicenter, randomized clinical trial in patients with risk of aspergillosis in order to evaluate the effectiveness and efficiency of VCZ individualization: VORIGENIPHARM (EudraCT: 2019-000376-41).

Background: Pregabalin provides good postoperative analgesia in nociceptive stimuli. Various studies show that preemptive oral pregabalin reduces acute postoperative pain. We conducted a study to evaluate the efficacy of two different doses of pregabalin and its effect on onset and duration of spinal anesthesia and postoperative pain. Methods: In prospective, double-blind and randomized study, 60 patients posted for vaginal hysterectomy under spinal anesthesia were randomly allocated to two groups recieving cap. Pregabalin 75 mg (group 1) and cap pregabalin 150 mg (group 2) orally, 90 min prior to surgery. Onset and duration of motor and sensory blockade were observed. Postoperative pain was assessed by VAS for 24 hrs. Injection paracetamol 1 gm. was given intravenously as rescue analgesic. Time of first rescue analgesic and total dose of rescue analgesics was noted. Results: Group 2 patients had better postoperative analgesia in terms of prolonged sensory and motor blockade which correlated well with the time of first request for rescue analgesia (504±123.2 min) as compared to group 1 patients (304.9±37.6 min). Also the total dose of rescue analgesic (paracetamol) was significantly less with 150mg pregabalin (p = 0.0001). Conclusion: Pregabalin 150 mg prolongs the duration of spinal anesthesia and has better analgesic profile without significant side effects. Thus we conclude that 150 mg pregabalin given preemptively optimizes spinal anesthesia well in patients for vaginal hysterectomy.

Purpose: Abdominal myomectomy can be a challenging procedure, with elevated intraoperative blood loss and post-operative complications such as the need for blood transfusion and hemostasis with sometimes hysterectomy. Previous studies suggested that preemptive uterine artery embolization (PUAE) might reduce intraoperative blood loss. Materials and methods: We reviewed all cases of abdominal myomectomy in our institution between January 2016 and June 2018. Out of 119 cases, 16 patients had PUAE and 103 did not. The objective of our study was to determine whereas PUAE reduced blood loss and post-operative complication rate. Results: In our study, there was no difference between the two groups in regard to average blood loss (128 vs 192 mL, OR 1,00 [0.99;1,01], p = 0,73), difference between pre- and post-operative hemoglobin level (− 1,15 g/dL vs − 1,32 g/dL, OR 0,91 [0.47;1,73], p = 0,79), and post-operative complications (need for transfusion, surgical revision, post-operative embolization, hysterectomy). Conclusion: Our findings could not conclude that PUAE is effective in reducing intraoperative blood loss during abdominal myomectomy, but it should still be considered an option for patients with large or multiple myomas, with a specific situation or previously operated, who wish to preserve their uterus. [ABSTRACT FROM AUTHOR]

Purpose: Non-opioid medications as a part of multimodal analgesia has been increasingly suggested in the management of acute post-surgical pain. The present study was planned to compare the efficacy of the combination of pregabalin plus ıv ibuprofen. Methods: 58 patients were included in this prospective, randomized, double-blinded study. The pregabalin group (Group P, n = 29) received 150 mg pregabalin, the pregabalin plus ibuprofen group (Gropu PI, n = 29) received 150 mg pregabalin and 400mg ıv ibuprofen before surgery. Postoperative fentanyl consumption, additional analgesia requirements and PACU stay were recorded. Postoperative analgesia was performed with patient-controlled IV fentanyl. Results: VAS scores in the group PI were statistically lower at PACU, 1and 2 hours at rest, at PACU, 1, 2, 4, 12 and 24 hours on movement compared to the group P (P < 0.05). Opioid consumption was statistically significantly higher in the group P compared to the group PI (130.17 ± 60.27 vs 78.45 ± 60.40 μq, respectively, P < 0.001) and reduced in the 4th 24 hours by 55% in group PI. Rescue analgesia usage was statistically significantly higher in the group P than in the group PI (16/29 vs 7/29, respectively, P < 0.001). Four patient in the group PI did not need any opioid drug. Besides, PACU stay was shorter in the group PI than the group P (10.62 ± 2.38 vs 15.59 ± 2.11 min, respectively, P < 0.001). Conclusion: Preemptive pregabalin plus ıv ibuprofen in laparoscopic cholecystectomy reduced postoperative opioid consumption. This multimodal analgesic aproach generated lower pain scores in the postoperative period.