Simulation of Mechanical Stresses in BaTiO Multilayer Ceramic Capacitors during Desoldering in the Rework of Electronic Assemblies Using a Framework of Computational Fluid Dynamics and Thermomechanical Models.

Multilayer ceramic capacitors (MLCCs) are critical components when thermal processes such as reflow desoldering are used during rework of electronic assemblies. The capacitor's ferroelectric BaTiO body is very brittle. Therefore, thermomechanical stresses can cause crack formation and create conductive paths that may short the capacitor.

Complement-Mediated Thrombotic Microangiopathy in Pregnancy: An Educational Case Report.

Rationale: Thrombotic microangiopathy (TMA) is a spectrum of rare diseases characterized by thrombocytopenia, microangiopathic hemolytic anemia, and organ damage. Differentiating pre-eclampsia, HELLP (Hemolysis, Elevated Liver enzymes, Low Platelets) syndrome and atypical hemolytic uremic syndrome (aHUS) during pregnancy may be diagnostically challenging yet important as the treatment pathways differ. Most cases of aHUS are associated with dysregulation of the complement alternative pathway, for which current guidelines recommend prompt treatment with complement C5 inhibitor to prevent chronic sequelae.

Impact of intraoperative therapeutic plasma exchange on bleeding in lung transplantation.

Background: Our program uses a desensitization protocol that includes intraoperative therapeutic plasma exchange (iTPE) for crossmatch-positive lung transplants, which improves access to lung transplant for sensitized candidates while mitigating immunologic risk. Although we have reported excellent outcomes for sensitized patients with the use of this protocol, concern for perioperative bleeding appears to have hindered broader adoption of it at other programs. We conducted a retrospective cohort study to quantify the impact of iTPE on perioperative bleeding in lung transplantation.

Propensity Score Matching Analysis Comparing the Efficacy and Steroid Tapering Benefit of Extracorporeal Photopheresis to Best Available Therapy in Third-Line or Beyond Treatment for Chronic GvHD.

Graft-versus host disease (GVHD) is one of the major limitations to allogeneic hematopoietic stem cell transplantation (HCT). Although corticosteroids with calcineurin inhibitors are established first line-therapy for chronic graft-versus-host disease (cGVHD), approximately one-half of cGVHD patients are refractory to corticosteroid therapy. The goal of the present study was to compare treatment outcomes of patients treated with extracorporeal photopheresis (ECP) and best available therapy (BAT) as third-line or beyond treatment for cGVHD.

Single centre retrospective analysis of extracorporeal photopheresis (ECP) therapy in patients heavily pre-treated for chronic graft-versus-host disease (cGvHD) with steroid failure.

Background: Extracorporeal photopheresis (ECP) is recommended as a second- or later-line therapy for chronic GvHD (cGvHD). Benefits include reasonable response with avoidance of intense systemic immunosuppression, which can translate into lowering the risk of systemic toxicity and opportunistic infection.

Methods: We evaluated 75 patients treated with ECP for cGvHD from 2007 to 2021 at Princess Margaret Cancer Centre, and analyzed overall response rate (ORR) and clinical benefit (CB) at 3, 6 and 12 months plus other long-term treatment outcomes.

Outcomes after flow cytometry crossmatch-positive lung transplants managed with perioperative desensitization.

Our program previously reported successful outcomes following virtual crossmatch (VXM)-positive lung transplants managed with perioperative desensitization, but our ability to stratify their immunologic risk was limited without flow cytometry crossmatch (FCXM) data before 2014. The aim of this study was to determine allograft and chronic lung allograft dysfunction (CLAD)-free survival following VXM-positive/FCXM-positive lung transplants, which are performed at a minority of programs due to the high immunologic risk and lack of data on outcomes. All first-time lung transplant recipients between January 2014 and December 2019 were divided into 3 cohorts: VXM-negative (n = 764), VXM-positive/FCXM-negative (n = 64), and VXM-positive/FCXM-positive (n = 74).

Blood-brain barrier permeability in survivors of immune-mediated thrombotic thrombocytopenic purpura: a pilot study.

Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is a rare, life-threatening disorder of systemic microthrombosis and organ ischemia. The etiology of chronic cerebrovascular outcomes in iTTP survivors is largely unknown. In this pilot study, we measured blood-brain barrier (BBB) permeability in patients with iTTP at the start of remission and 6 months later.

Long-term outcomes of sensitized lung transplant recipients after peri-operative desensitization.

The Toronto Lung Transplant Program has been using a peri-operative desensitization regimen of plasma exchange, intravenous immune globulin, and antithymocyte globulin in order to accept donor-specific antibody (DSA)-positive lung transplants safely since 2008. There are no long-term data on the impact of this practice on allograft survival or the development of chronic lung allograft dysfunction (CLAD). We extended our prior study to include long-term follow-up of 340 patients who received lung transplants between January 1, 2008 and December 31, 2011.

The practical integration of a hybrid model of ultrasound-guided peripheral venous access in a large apheresis center.

Background: Apheresis treatments require adequate venous access using peripheral intravenous (PIV) catheterization or central venous catheters (CVC). Ultrasound-guided PIV (USGPIV) can be used to decrease the need of CVC insertions for apheresis procedures.

Method: A hybrid model of USGPIV and standard of care (SOC) for PIV access was developed.

Peripheral vascular access for therapeutic plasma exchange: A practical approach to increased utilization and selecting the most appropriate vascular access.

Background: Therapeutic plasma exchange (TPE) is used in the treatment of many diseases. At present, peripheral vascular access (PVA) is an underutilized method of vascular access in TPE. It should be considered more frequently due its relatively low risk for adverse events, particularly infections.

Preoperative Extracorporeal Membrane Oxygenation and Plasmapheresis for Urgent Pulmonary Endarterectomy in Heparin-Induced Thrombocytopenia-Positive Patient.

Pulmonary endarterectomy is the treatment of choice for chronic thromboembolic pulmonary hypertension. This case report outlines the importance of venoarterial extracorporeal membrane oxygenation and plasmapheresis as two important options in the management of heparin-induced thrombocytopenia-positive patients requiring urgent pulmonary endarterectomy.

Asymmetric Free-Space Light Transport at Nonlinear Metasurfaces.

Asymmetric light transport has significantly contributed to fundamental science and revolutionized advanced technology in various aspects such as unidirectional photonic devices, optical diodes, and isolators. While metasurfaces mold wave fronts at will with an ultrathin flat optical element, asymmetric transport of light cannot be fundamentally achieved by any linear system including linear metasurfaces. We report asymmetric transport of free-space light at nonlinear metasurfaces upon transmission and reflection.

Results of a cross Canada survey of blood film review practice patterns by technologists and pathologists.

Introduction: No common or widely accepted criteria exist for physician review of blood films or for reported standards of physician rate of blood film review. Individual institutions generally have internal criteria for physician review of blood films. To better understand how and why blood film reviews are performed at different institutions across Canada, with a specific interest in physician blood film review, we undertook a survey to assess the current practise patterns of physician review of blood films across Canada.

Safety and feasibility of red cell exchange for sickle cell disease across Canada.

We outline a case whereby RBCX was successfully provided over disparate geographical areas and time zones in Canada and overcame the logistical challenges of coordinating care across four different health care systems with the application of modern telecommunication technologies. We present this case as a model for other SCD providers and patients.

Blastic plasmacytoid dendritic cell neoplasm with leukemic presentation: 10-Color flow cytometry diagnosis and HyperCVAD therapy.

Few studies describe the comprehensive immunophenotypic pattern of blastic plasmacytoid dendritic cell neoplasm (BPDCN) in the bone marrow and its treatment. This retrospective analysis evaluates the diagnostic flow cytometry (FCM) pattern and outcome of nine patients diagnosed with BPDCN. A four-tube 10-color FCM panel used for diagnosis of acute leukemia (AL), showed cells in the blast gate (CD45dim/low SSC) and were positive for CD4(bright), CD33(dim), CD56(heterogenous), CD123(bright), CD36, CD38, HLA-DR, CD71.

Cost-minimization analysis comparing intravenous immunoglobulin with plasma exchange in the management of patients with myasthenia gravis.

Introduction: Myasthenia gravis (MG) exacerbations may be treated with intravenous immunoglobulin (IVIg) or plasma exchange (PLEX), which have equivalent effectiveness. This cost-minimization analysis compared IVIg with PLEX for treatment of patients with MG exacerbation.

Methods: We combined the Ontario-based health cost data with clinical data from a randomized clinical trial.

Macroscale Transformation Optics Enabled by Photoelectrochemical Etching.

Photoelectrochemical etching of silicon can be used to form lateral refractive index gradients for transformation optical devices. This technique allows the fabrication of macroscale devices with large refractive index gradients. Patterned porous layers can also be lifted from the substrate and transferred to other materials, creating more possibilities for novel devices.

A phase-II sequential case-series study of all patients presenting to four plasma exchange centres with presumed relapsed/refractory thrombotic thrombocytopenic purpura treated with rituximab.

The primary objective of this phase II study was to evaluate the efficacy of rituximab in the management of adult patients with physician-diagnosed presumed thrombotic thrombocytopenic purpura (TTP); relapsed or refractory. We conducted a multicentre study in four Canadian hospital-based apheresis units. Forty patients with presumed TTP (20 refractory and 20 relapsing) were sequentially enrolled and all received rituximab in a standardized manner.

Safety of plasma exchange therapy in patients with myasthenia gravis.

Introduction: Plasma exchange (PLEX) is effective in myasthenia gravis (MG), but there are concerns about its safety.

Methods: We collected data prospectively from 42 patients randomized to PLEX treatment in a comparison study with intravenous immunoglobulin (IVIg). Detailed information on the PLEX treatment methodology and adverse events are reported.

IVIG and PLEX in the treatment of myasthenia gravis.

Intravenous immunoglobulin (IVIG) and plasma exchange (PLEX) are used to treat myasthenia gravis (MG) but with little trial evidence. While a class I study provided evidence for the efficacy of IVIG treatment, the empirical support for PLEX has been less convincing until recently. In a randomized controlled single-masked study of 84 MG patients with moderate to severe disease, IVIG and PLEX had comparable efficacy as demonstrated by reduction in the Quantitative Myasthenia Gravis Score (QMGS) for disease severity, percentage of responders, persistence of treatment effect, and tolerability, which were similar in both treatment arms.

Changes in quality of life scores with intravenous immunoglobulin or plasmapheresis in patients with myasthenia gravis.

Background: Intravenous immunoglobulin (IVIG) and plasmapheresis (plasma exchange (PLEX)) have comparable efficacy in reducing the Quantitative Myasthenia Gravis Score for disease severity (QMGS) in patients with moderate to severe myasthenia gravis (MG).

Objective: To determine if the improvement in the quality of life (QOL) after immunomodulation is comparable with either IVIG or PLEX.

Methods: 62 patients participated in the MG-QOL-60 study, completing the questionnaire at baseline and at day 14 after treatment.