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The therapeutic use of autologously prepared, platelet-leukocyte-enriched gel (PLG) is a relatively new technology for the stimulation and acceleration of soft tissue and bone healing. The effectiveness of this procedure lies in the delivery of a wide range of platelet growth factors mimicking the physiologic wound healing and reparative tissue processes. Despite an increase in PLG applications, the structures and kinetics of this autogenously derived biologic material have not been observed. A review of the most recent literature was performed to evaluate the use of PLG in various surgical disciplines. The review showed that the application of PLG has been extended to various surgical disciplines including orthopedics, cardiac surgery, plastic and maxillofacial surgery, and recently also endoscopic surgery. This review demonstrates the usefulness of PLG in a wide range of clinical applications for improvement of healing after surgical procedures.

The performance of the Sorin Xtra® Autotransfusion System (ATS) was studied in 62 patients undergoing coronary artery bypass grafting. Blood was collected intraoperatively and washed using three different wash sets in 4 groups. Both collected and washed blood were analysed for hemoglobin levels and hematocrit, concentrations of proteins, albumin, heparin and plasma free hemoglobin (PFH) were determined, erythrocytes, platelets and leukocytes were counted. Hematocrit measurements of the Xtra® were compared with laboratory measurements to study the accuracy of the Xtra® hematocrit sensor. In addition, the red blood cell recovery rate and elimination rates were calculated to evaluate the clinical performance of the Xtra®. The Xtra® ATS produced a volume of concentrated red blood cells with an average hematocrit from 58% to 63%, depending on the size of the bowl and the chosen default program. In all bowl sizes and programs, the Xtra® Hct-out measurement underestimated the CELL-DYN measurement by approximately 15%. The calculated recovery rates for red blood cells (RBC) in the 4 groups ranged from 86.7% to 91.6%. Elimination rates were calculated in each group for proteins (96.8-99.2%), albumin (96.4-98.7%), plasma free hemoglobin (83.6–91.2%), heparin (98.8-99.9%), platelets (82.4-94.3%) and white blood cells (28.6-42.3%). The Xtra® ATS can be appealing for its performance by producing high hematocrit levels in the washed RBC volume, while keeping RBC recovery rate at the same high level (≈ 90%) as in its predecessor, the Electa® Autotransfusion System.

ObjectiveRadiofrequency ablation (RFA)±endoscopic resection (ER) is the preferred treatment for early neoplasia in Barrett’s oesophagus (BE). We aimed to report short-term and long-term outcomes for all 1384 patients treated in the Netherlands (NL) from 2008 to 2018, with uniform treatment and follow-up (FU) in a centralised setting.DesignEndoscopic therapy for early BE neoplasia in NL is centralised in nine expert centres with specifically trained endoscopists and pathologists that adhere to a joint protocol. Prospectively collected data are registered in a uniform database. Patients with low/high-grade dysplasia or low-risk cancer, were treated by ER of visible lesions followed by trimonthly RFA sessions of any residual BE until complete eradication of BE (CE-BE). Patients with ER alone were not included.ResultsAfter ER (62% of cases; 43% low-risk cancers) and median 1 circumferential and 2 focal RFA (p25-p75 0–1; 1–2) per patient, CE-BE was achieved in 94% (1270/1348). Adverse events occurred in 21% (268/1386), most commonly oesophageal stenosis (15%), all were managed endoscopically. A total of 1154 patients with CE-BE were analysed for long-term outcomes. During median 43 months (22–69) and 4 endoscopies (1–5), 38 patients developed dysplastic recurrence (3%, annual recurrence risk 1%), all were detected as endoscopically visible abnormalities. Random biopsies from a normal appearing cardia showed intestinal metaplasia (IM) in 14% and neoplasia in 0%. A finding of IM in the cardia was reproduced during further FU in only 33%, none progressed to neoplasia. Frequent FU visits in the first year of FU were not associated with recurrence risk.ConclusionIn a setting of centralised care, RFA±ER is effective for eradication of Barrett’s related neoplasia and has remarkably low rates of dysplastic recurrence. Our data support more lenient FU intervals, with emphasis on careful endoscopic inspection. Random biopsies from neosquamous epithelium and cardia are of questionable value.Netherlands trial register numberNL7039.

Background: The introduction of new and more advanced technology in healthcare occurs with an increasing speed. Therefore, more attention is needed for safety evaluation of new devices or techniques from an end-user perspective, especially when (inter-) national perfusion safety standards are lacking. A recently increased awareness of the safety risks as a consequence of technical or human error has provoked interest in optimisation of perfusion methodology and devices. To prevent or reduce the severity or likelihood of failures of new technology, ‘failure mode effect analysis’ is a proven proactive technique. When it is used as a qualitative analysis for possible hazards in patient treatment associated with the use of medical devices, it’s called healthcare failure mode effect analysis (hFMEA). Methods: To evaluate the safety of the Extra Corporeal Circulation Optimized (ECCO, Sorin Group, Mirandola, Italy) miniaturized bypass circuit, hFMEA was used. A multi disciplinary team that consisted of two clinical perfusionists, a clinical physicist, a clinical physicist trainee and a technician has performed this analysis. Results: The hFMEA demonstrated that failure of the bubble sensor for the electric remote clamping system on the arterial line (Figure 1), activated by air passing the venous bubble trap, had the highest risk score of all failure modes. This has led to the implementation of an extra low-level sensor in the system to prevent air passing through into the centrifugal pump. The hFMEA has also indicated that extra individual simulation training is needed for handling critical failures during the use of the miniature bypass system. Conclusion: Early identification of possible technology failures in any process or device can avoid adverse patient outcomes. The technique of hFMEA is a valuable tool in evaluating the use of high-risk apparatus, such as an extracorporeal bypass system, in patient treatment in order to increase patient safety.

The increasing demand for optically pure compounds (enantiomers) stimulates the development of new enantiomer separation processes on an industrial scale. The separation of enantiomers by ultrafiltration of enantioselective micelles was studied in a cascaded system. The feasibility of this separation concept was proven by a cascade of five lab‐scale units and a bench‐scale system using an industrial membrane module. Model calculations show that the separation is not improved greatly at enantioselectivities (ratio of affinity constants) above 10 and the affinity of the enantioselective micelles for the substrate (enantiomers) plays a crucial role in the performance of the separation process. Modeling the separation as a function of the dimensionless affinity number (affinity constant · enantiomer feed concentration) shows that there is an operation window in which the separation satisfies its criterion of high yield and high enantiomeric excess. For countercurrent affinity systems, this implies that any research effort should focus on developing (microheterogeneous) media characterized by weak interactions with the substrate to allow for operation at high feed concentrations, not on high affinity systems.

The therapeutic use of autologously prepared platelet-leukocyte gel (PLG) is a relatively new technology which might stimulate and accelerate soft-tissue and bone healing. The effectiveness of this procedure lies in the exogenous delivery of a wide range of platelet growth factors, intentionally released from autologously prepared PLG. The rationale to employ this technique is to mimic physiological wound healing and reparative tissue processes. Despite an increase in clinical PLG applications, the structures and kinetics of this biological material have not been completely examined. Electron microscopic imaging was performed to evaluate platelet-leukocyte gel structures. Furthermore, directions for PLG application are presented, based on results from published articles in various surgical disciplines. In conclusion, PLG can be useful in a wide range of clinical applications to enhance healing following surgical procedures, since exogenous applied PLG releases instantly platelet growth factors, in the presence of leukocytic cells.

Background: Chronic pain is the main complication following inguinal hernia repair. A possible explanatory factor is the suture fixation of the mesh. Glue fixation might overcome this problem. Albeit at a very low frequency, human and bovine components of fibrin sealants currently available could contain blood-borne pathogens. Autologous platelet-rich fibrin sealant (P-RFS) eliminates this risk and has additional advantages such as hemostatic and antibacterial effects. Therefore, its feasibility was assessed in inguinal hernia repair, with a focus on pain. Methods: In 22 patients with primary inguinal hernia, the mesh was fixated with P-RFS. Data included operative variables, complications, pain scores and neurological examinations. Long-term follow-up was 22.2 months (SD 2.2) postoperatively. Results: After 2 weeks, visual analogue scale and disability pain scores were lower than they were preoperatively. Complications at 3 months were 1 recurrence, 1 chronic pain and 6 sensory disturbances. At the last clinical evaluation, the recurrence was planned for repair due to discomfort. No chronic pain, sensory disorders or discomfort was reported at long-term follow-up. Conclusion: Mesh fixation with autologous P-RFS is feasible. If there is a preference for autologous material, P-RFS is indicated. If glue fixation becomes standard, further randomized studies are warranted for this alternative.

Background. The worldwide prevalence of extended-spectrum β-lactamase (ESBL)—producing Enterobacteriaceae is increasing rapidly both in hospitals and in the community. A connection between ESBL-producing bacteria in food animals, retail meat, and humans has been suggested. We previously reported on the genetic composition of a collection of ESBL-producing Escherichia coli (ESBL-EC) from chicken meat and humans from a restricted geographic area. Now, we have extended the analysis with plasmid replicons, virulence factors, and highly discriminatory genomic profiling methods. Methods. One hundred forty-five ESBL-EC isolates from retail chicken meat, human rectal carriers, and blood cultures were analyzed using multilocus sequence typing, phylotyping, ESBL genes, plasmid replicons, virulence genes, amplified fragment length polymorphism (AFLP), and pulsed-field gel electrophoresis (PFGE). Results. Three source groups overlapped substantially when their genetic composition was compared. A combined analysis using all variables yielded the highest resolution (Wilks lambda [Λ]: 0.08). Still, a prediction model based on the combined data classified 40% of the human isolates as chicken meat isolates. AFLP and PFGE showed that the isolates from humans and chicken meat could not be segregated and identified 1 perfect match between humans and chicken meat. Conclusions. We found significant genetic similarities among ESBL-EC isolates from chicken meat and humans according to mobile resistance elements, virulence genes, and genomic backbone. Therefore, chicken meat is a likely contributor to the recent emergence of ESBL-EC in human infections in the study region. This raises serious food safety questions regarding the abundant presence of ESBL-EC in chicken meat.

COVID-19 induces both acute and chronic neurological changes. Existing evidence suggests that chemosensory changes, particularly olfactory loss, may reflect central neurological dysfunction in neurodegenerative diseases and mark progression from mild cognitive impairment to Alzheimer's. This scoping review summarizes the available literature to evaluate the relationship between neurocognition and olfaction in young to middle-aged adults with minimal comorbidities following COVID-19 infection. A literature search of PubMed, Ovid Embase, Web of Science, and Cochrane Library was conducted. Studies underwent title/abstract and full text screening by two reviewers, with a third reviewer resolving any conflicts. Remaining studies underwent data extraction. Seventeen studies were eligible for data extraction after the review process, where 12 studies found significantly poorer cognition in those suffering from olfactory dysfunction, four studies showed no association between cognition and olfaction, and one study reported lower anosmia prevalence among patients with cognitive impairment. The majority of studies in this review find that olfactory dysfunction is associated with poorer cognition. More rigorous studies are needed to further elucidate the relationship between olfaction and cognition after COVID-19.

Persistent COVID-19-associated olfactory dysfunction (C19OD), along with other neurologic and cognitive deficits are common features of long COVID. This study aims to evaluate longitudinal trends in neurocognitive performance within a cohort with C19OD. In individuals with perceived C19OD we performed serial psychophysical olfactory and neurocognitive assessments at baseline and follow-up one year later. At baseline evaluation, individuals with C19OD were found to have diminished cognitive functioning compared to normosmic counterparts across several domains, including attention, executive functioning, language, learning and memory, and psychomotor speed. At subsequent one-year follow-up assessment, C19OD participants demonstrated cognitive recovery, with performance comparable to normosmic counterparts. These findings suggest that early associations between C19OD and certain neurocognitive domains may dissipate upon repeated longitudinal evaluation, with partial resolution of cognitive deficits despite persistent C19OD.