Impact of postoperative complications on clinical and economic consequences in pancreatic surgery

Filip ?e?ka,Bohumil Jon,Eva ?ermakova,Zden?k ?ubrt,Alexander Ferko 대한외과학회 2015 Annals of Surgical Treatment and Research Vol.90 No.1

Purpose: Patients who develop complications consume a disproportionately large share of available resources in surgery; therefore the attention of healthcare funders focuses on the economic impact of complications. The main objective of this work was to assess the clinical and economic impact of postoperative complications in pancreatic surgery, and furthermore to assess risk factors for increased costs. Methods: In all, 161 consecutive patients underwent pancreatic resection. The costs of the treatment were determined and analyzed. Results: The overall morbidity rate was 53.4%, and the in-hospital mortality rate was 3.7%. The median of costs for all patients without complication was 3,963 Euro, whereas the median of costs for patients with at least one complication was significantly increased at 10,670 Euro (P < 0.001). In multivariate analysis American Society of Anesthesiologists ≥ 3 (P = 0.006), multivisceral resection (P < 0.001) and any complication (P < 0.001) were independently associated with increased costs. Conclusion: Postoperative complications are associated with an increase in mortality, length of hospital stay, and hospital costs. The treatment costs increase with the severity of the postoperative complications. Those factors that are known to increase the treatment costs in pancreatic resection should be considered when planning patients for surgery.

Poster Session : PS 0316 ; Hematology : A Case of Pancytopenia

( Filipe Filipe ),( Joana Martins ),( Catarina Espirito Santo ),( Ligia Peixoto ),( Ines Vendrell ),( Helena Luna Pais ),( Alba Acabado ),( Paulo Cantiga Duarte ),( Jose Braz Nogueira ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Megaloblastosis represents a wide group of disorders sharing a common pathophysiological pathway, due to defi cient intake or absorption of Vitamin B12 and folic acid. Major causes for this condition include alcoholism, achlorhydria, pernicious anemia or gastrectomy and celiac disease. It leads to abnormal DNA replication, impaired protein synthesis and nuclear maturation. It presents with macrocytosis, hypersegmented neutrophils, and elevated Lactate dehydrogenase (LDH) levels. It is more prevalent in underdeveloped countries and older populations, having similar gender distribution. Authors present the case of a 69-year-old man, with a previous known history of essential thrombocytosis, medicated with hydroxyurea (with irregular adherence to treatment), congestive heart failure and chronic alcoholism. He was admitted at the emergency room (ER) with symptoms of confusion, slurred speech and fatigue for a week. He presented mucosal palor, fever (38. 1ºC), splenomegaly, and a left lateral maleolar ulcer with a purulent exsudate. Blood values revealed pancytopenia (macrocytic anemia Hb 4. 1 g/dL and MCV 123 fi); Leukocytes 1110x106/L; Platelet count 30. 000x106/L), acute renal failure (blood urea nitrogen 97 mg/dL; creatinine 2. 5 mg/ dL) LDH 1545 U/L. He underwent blood transfusions at the ER, without previous iron tests screening. On subsequent evaluation, authors found levels of Vitamin B12 of 172 pg/mL and folate 0. 9 nmol/L. Patient underwent a bone marrow aspiration with bone biopsy, compatible with megaloblastic anemia. An endoscopy was performed, with histological fi ndings suggestive of atrophic gastritis, with no H. pylori bacilli found. Additional tests such as anti-gastric parietal cells antibodies and anti-intrinsic factor antibodies, were negative. The patient was medicated with Vitamin B12 injections and folic acid, with good reticulocitary response. At discharge he presented, blood values of Hb 8. 7 g/dL; Leukocytes 7110x106/L; and platelet count of 862. 000x106/L. This represents a case of severe pancytopenia, enhancing the relevance of megaloblastosis as differential diagnosis for this entity.

Redox Mediators in CO₂-assisted Li-O₂ Batteries: Performance Enhancement and Mechanistic Studies

( Filipe Marques Mota ),변혜령,김동하 한국공업화학회 2020 한국공업화학회 연구논문 초록집 Vol.2020 No.-

While replacing O₂ with air reflects a critical step towards the practical application of Li-air batteries, the present CO₂ alters the O₂ chemistry. In the tetraglyme-electrolyte, minor CO₂ reflected a swift shift towards the formation of Li₂CO₃, requiring impracticable recharge potentials (4.5 V). In our recent study, we revealed that a Br₃ ^-/Br₂ redox mediator could successfully suppress the overcharge potential. Hindered overcharges (~0.5 V) driven by electrochemically-generated Br₂ were found to be a function of the LiBr concentration and the insulating Li₂CO₃ structure. Coupled electrochemical and spectroscopic analyses shed light on the involved redox shuttling steps and unveiled the prominent presence of soluble Br₂···Br₃ ^- loosely-bound anionic complexes at progressive states-of-charge.

Assessing the Promise of CO₂-driven Li-air Batteries

( Filipe Marques Mota ),( Hye Ryung Byon ),김동하 한국공업화학회 2019 한국공업화학회 연구논문 초록집 Vol.2019 No.0

In recent years, an increasing number of perspectives have reflected the languished state of the Li-O₂ research field, and the need for a focus on exploratory works toward the development of energy storage devices with analogously high theoretical energy density. The incorporation of CO₂ up to 50% in Li-air cells in a TEGDME-based electrolyte was shown to result in a 1.9-fold increase in capacity. More interestingly, results also highlighted an analogous cyclability up to at least 30% of incorporated CO₂ upon comparison with conventional Li-O₂ cells (~400-500 h). The incorporation of CO₂ favors a preferable mechanistic pathway toward CO₄ - species with complete absence of Li₂O₂ formation, and increased electrolyte stability suggested by OEMS results and detailed product characterization. These O₂-assisted Li-CO₂ cells are presumed advantageous energy storage devices that may find its way to compete in an economical and environmental level with current Li-ion cells.

Two Messages out of One 2D Matrix Bar Code

( Filip Cvitic ),( Mario Osvin Pavcevic ),( Jesenka Pibernik ) 한국인터넷정보학회 2015 KSII Transactions on Internet and Information Syst Vol.9 No.3

With the proposed principle of two-dimensional matrix bar code design based on masks, the whole surface of a 2D bar code is used for creating graphic patterns. Masks are a method of overlaying certain information with complete preservation of encoded information. In order to ensure suitable mask performance, it is essential to create a set of masks (mask folder) which are similar to each other. This ultimately allows additional error correction on the whole code level which is proven mathematically through an academic example of a QR code with a matrix of size 9 × 9. In order to create a mask folder, this article will investigate parameters based on Weber`s law. With the parameters founded in the research, this principle shows how QR codes, or any other 2D bar code, can be designed to display two different messages. This ultimately enables a better description of a 2D bar code, which will improve users` visual recognition of 2D bar code purpose, and therefore users` greater enjoyment and involvement.

COVID-19–related acute respiratory distress syndrome treated with veno-venous extracorporeal membrane oxygenation and programmed multi-level ventilation: a case report

Filip Depta,Anton Turčan,Pavol Török,Petra Kapraľová,Michael A. Gentile 대한중환자의학회 2022 Acute and Critical Care Vol.37 No.3

We report a patient with severe coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) treated with veno-venous extracorporeal membrane oxygenation (VV ECMO) and programmed multi-level ventilation (PMLV). VV ECMO as a treatment modality for severe ARDS has been described multiple times as a rescue therapy for refractory hypoxemia. It is well known that conventional ventilation can cause ventilator-induced lung injury. Protective ventilation during VV ECMO seems to be beneficial, translating to using low tidal volumes, prone positioning with general concept of open lung approach. However, mechanical ventilation is still required as ECMO per se is usually not sufficient to maintain adequate gas exchange due to hyperdynamic state of the patient and limitation of blood flow via VV ECMO. This report describes ventilation strategy using PMLV during “resting” period of the lung. In short, PMLV is a strategy for ventilating non-homogenous lungs that incorporates expiratory time constants and multiple levels of positive end-expiratory pressure. Using this approach, most affected acute lung injury/ARDS areas can be recruited, while preventing overdistension in healthy areas. To our knowledge, case report using such ventilation strategy for lung resting period has not been previously published.

Plasmon and Upconversion Photoresponse in Decorated TiO₂ Inverse Opal Nanostructures with Enhanced Photoelectrochemical Water Splitting Performance

( Filipe Marques Mota ),( Ramireddy Boppella ),( Keiji Tanaka ),김동하 한국공업화학회 2020 한국공업화학회 연구논문 초록집 Vol.2020 No.-

To harvest low energy photons, we investigated a 3D composite photoanode integrating visible-responsive plasmonic Au nanoparticles and NIR-responsive upconversion nanocrystals (UCN) into 3D TiO₂ inverse-opals (Au/UCN/TiO₂) with extended solar energy utilization in the UV-vis-NIR range for photoelectrochemical (PEC) water splitting platforms. The NIR-responsive properties of NaYF₄:Yb³⁺ UCN nanocrystals doped with Er³⁺ or Tm³⁺ ions, and the effect of an alternating sequential introduction of UCN and Au were also investigated. Our Au/Er-UCN/TiO₂ hybrid revealed a 10-fold photocurrent density enhancement under UV-vis-NIR against the pristine TiO₂.

Assessing the effect of CO₂ in Li-O₂/CO₂ Batteries with Tetraglyme Electrolyte

( Filipe Marques Mota ),변혜령,김동하 한국공업화학회 2019 한국공업화학회 연구논문 초록집 Vol.2019 No.1

Reflecting the languished research state of Li-O₂, alternative devices operating under CO₂ or O₂/CO₂ with analogously high theoretical energy density have gained recent attraction. Here, we assess the effect of CO₂ within a 5 to 100% range in Li-O₂/CO₂. In the LiTFSI/tetraglyme electrolyte, the reaction mechanism is swiftly shifted toward the formation of Li₂CO₃ even at 5% CO₂. Conspicuous product and intermediate species identification and quantification are presented. Tuning the CO₂ content is shown to offer superior cyclability, deterred byproduct formation with enhanced electrolyte stability, and extended discharge capacity (1.5-fold), correlated with an induced stabilization of metastable CO₄^-/C₂O₆^2- intermediates in tetraglyme. These findings highlight the promise of a shift in the underlying mechanism of Li-air cells upon CO₂ incorporation on conventional O₂-based devices.

Determinants of neoadjuvant chemotherapy use in muscle-invasive bladder cancer

Filipe LF. Carvalho,Alexander Zeymo,Jillian Egan,Colleen H. Kelly,Chaoyi Zheng,John H. Lynch,Jonathan Hwang,Lambros Stamatakis,Ross E. Krasnow,Keith J. Kowalczyk 대한비뇨의학회 2020 Investigative and Clinical Urology Vol.61 No.4

Purpose: Cisplatin-based neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) is standard of care for muscle-invasive bladder cancer (MIBC). However, NAC is used in less than 20% of patients with MIBC. Our goal is to investigate factors that contribute to underutilization NAC to facilitate more routine incorporation into clinical practice. Materials and Methods: We identified 5,915 patients diagnosed with cT2-T3N0M0 MIBC who underwent RC between 2004 and 2014 from the National Cancer Database. Univariate and multivariable models were created to identify variables associated with NAC utilization. Results: Only 18.8% of patients received NAC during the study period. On univariate analyses, NAC utilization was more likely at academic hospitals, US South and Midwest (p<0.05). Higher Charlson score was associated with decrease use of NAC (p<0.05). On multivariate analysis, treatment in academic hospitals (odds ratio [OR], 1.367; 95% confidence interval [CI], 1.186–1.576), in the Midwest (OR, 1.538; 95% CI, 1.268–1.977) and South (OR, 1.424; 95% CI, 1.139–1.781) were independently associated with NAC utilization. Older age (75 to 84 years old; OR, 0.532; 95% CI, 0.427–0.664) and higher Charlson score (OR, 0.607; 95% CI, 0.439–0.839) were associated with decreased NAC utilization. Sixty-eight percent of patients did not receive NAC because it was not planned and only 2.5% of patients had contraindications for NAC treatment. Conclusions: Our study demonstrates that NAC is underutilized. Decreased utilization of NAC was associated with older patients and higher Charlson score. This underutilization may be related to practice patterns as very few patients have true contraindications.

Automated identification of the modal parameters of a cable-stayed bridge: Influence of the wind conditions

Filipe Magalhães,Álvaro Cunha 국제구조공학회 2016 Smart Structures and Systems, An International Jou Vol.17 No.3

This paper was written in the context of a benchmark study promoted by The Hong Kong Polytechnic University using data samples collected in an instrumented cable-stayed bridge. The main goal of the benchmark test was to study the identification of the bridge modes of vibration under different wind conditions. In this contribution, the tools developed at ViBest/FEUP for automated data processing of setups collected by dynamic monitoring systems are presented and applied to the data made available in the context of the benchmark study. The applied tools are based on parametric output only modal identification methods combined with clustering algorithms. The obtained results demonstrate that the proposed algorithms succeeded to automatically identify the modes with relevant contribution for the bridge response under different wind conditions.