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Sample records for atm-deficient mice refractory

  1. Low-dose irradiation prior to bone marrow transplantation results in ATM activation and increased lethality in Atm-deficient mice.

    Science.gov (United States)

    Pietzner, J; Merscher, B M; Baer, P C; Duecker, R P; Eickmeier, O; Fußbroich, D; Bader, P; Del Turco, D; Henschler, R; Zielen, S; Schubert, R

    2016-04-01

    Ataxia telangiectasia is a genetic instability syndrome characterized by neurodegeneration, immunodeficiency, severe bronchial complications, hypersensitivity to radiotherapy and an elevated risk of malignancies. Repopulation with ATM-competent bone marrow-derived cells (BMDCs) significantly prolonged the lifespan and improved the phenotype of Atm-deficient mice. The aim of the present study was to promote BMDC engraftment after bone marrow transplantation using low-dose irradiation (IR) as a co-conditioning strategy. Atm-deficient mice were transplanted with green fluorescent protein-expressing, ATM-positive BMDCs using a clinically relevant non-myeloablative host-conditioning regimen together with TBI (0.2-2.0 Gy). IR significantly improved the engraftment of BMDCs into the bone marrow, blood, spleen and lung in a dose-dependent manner, but not into the cerebellum. However, with increasing doses, IR lethality increased even after low-dose IR. Analysis of the bronchoalveolar lavage fluid and lung histochemistry revealed a significant enhancement in the number of inflammatory cells and oxidative damage. A delay in the resolution of γ-H2AX-expression points to an insufficient double-strand break repair capacity following IR with 0.5 Gy in Atm-deficient splenocytes. Our results demonstrate that even low-dose IR results in ATM activation. In the absence of ATM, low-dose IR leads to increased inflammation, oxidative stress and lethality in the Atm-deficient mouse model.

  2. Alteration in 5-hydroxymethylcytosine-mediated epigenetic regulation leads to Purkinje cell vulnerability in ATM deficiency.

    Science.gov (United States)

    Jiang, Dewei; Zhang, Ying; Hart, Ronald P; Chen, Jianmin; Herrup, Karl; Li, Jiali

    2015-12-01

    A long-standing mystery surrounding ataxia-telangiectasia is why it is mainly cerebellar neurons, Purkinje cells in particular, that appear vulnerable to ATM deficiency. Here we present data showing that 5-hydroxymethylcytosine (5hmC), a newly recognized epigenetic marker found at high levels in neurons, is substantially reduced in human ataxia-telangiectasia and Atm(-/-) mouse cerebellar Purkinje cells. We further show that TET1, an enzyme that converts 5-methylcytosine (5mC) to 5hmC, responds to DNA damage and manipulation of TET1 activity directly affects the DNA damage signalling and ATM-deficient neuronal cell cycle re-entry and death. Quantitative genome-wide analysis of 5hmC-containing sequences shows that in ATM deficiency there is a cerebellum- and Purkinje cell-specific shift in 5hmC enrichment in both regulatory elements and repeated sequences. Finally, we verify that TET1-mediated 5hmC production is linked to the degenerative process of Purkinje cells and behavioural deficits in Atm(-/-) mice. Taken together, the selective loss of 5hmC plays a critical role in driving Purkinje cell vulnerability in ATM deficiency.

  3. Nuclear accumulation of HDAC4 in ATM deficiency promotes neurodegeneration in ataxia telangiectasia.

    Science.gov (United States)

    Li, Jiali; Chen, Jianmin; Ricupero, Christopher L; Hart, Ronald P; Schwartz, Melanie S; Kusnecov, Alexander; Herrup, Karl

    2012-05-01

    Ataxia telangiectasia is a neurodegenerative disease caused by mutation of the Atm gene. Here we report that ataxia telangiectasia mutated (ATM) deficiency causes nuclear accumulation of histone deacetylase 4 (HDAC4) in neurons and promotes neurodegeneration. Nuclear HDAC4 binds to chromatin, as well as to myocyte enhancer factor 2A (MEF2A) and cAMP-responsive element binding protein (CREB), leading to histone deacetylation and altered neuronal gene expression. Blocking either HDAC4 activity or its nuclear accumulation blunts these neurodegenerative changes and rescues several behavioral abnormalities of ATM-deficient mice. Full rescue of the neurodegeneration, however, also requires the presence of HDAC4 in the cytoplasm, suggesting that the ataxia telangiectasia phenotype results both from a loss of cytoplasmic HDAC4 as well as its nuclear accumulation. To remain cytoplasmic, HDAC4 must be phosphorylated. The activity of the HDAC4 phosphatase, protein phosphatase 2A (PP2A), is downregulated by ATM-mediated phosphorylation. In ATM deficiency, enhanced PP2A activity leads to HDAC4 dephosphorylation and the nuclear accumulation of HDAC4. Our results define a crucial role of the cellular localization of HDAC4 in the events leading to ataxia telangiectasia neurodegeneration.

  4. Ataxia-telangiectasia mutated (ATM) deficiency decreases reprogramming efficiency and leads to genomic instability in iPS cells

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    Kinoshita, Taisuke [Department of Cell Differentiation, The Sakaguchi Laboratory, School of Medicine, Keio University, Tokyo 160-8582 (Japan); Nagamatsu, Go, E-mail: gonag@sc.itc.keio.ac.jp [Department of Cell Differentiation, The Sakaguchi Laboratory, School of Medicine, Keio University, Tokyo 160-8582 (Japan); Precursory Research for Embryonic Science and Technology, Japan Science and Technology Agency, Kawaguchi, Saitama 332-0012 (Japan); Kosaka, Takeo [Department of Urology, School of Medicine, Keio University, Tokyo 160-8582 (Japan); Takubo, Keiyo [Department of Cell Differentiation, The Sakaguchi Laboratory, School of Medicine, Keio University, Tokyo 160-8582 (Japan); Hotta, Akitsu [Precursory Research for Embryonic Science and Technology, Japan Science and Technology Agency, Kawaguchi, Saitama 332-0012 (Japan); Department of Reprogramming Science, Center for iPS Cell Research and Application (CiRA), Kyoto University, Kyoto (Japan); Ellis, James [Ontario Human iPS Cell Facility, Molecular Genetics, University of Toronto, Developmental and Stem Cell Biology, SickKids, Toronto, Canada MG1L7 (Canada); Suda, Toshio, E-mail: sudato@sc.itc.keio.ac.jp [Department of Cell Differentiation, The Sakaguchi Laboratory, School of Medicine, Keio University, Tokyo 160-8582 (Japan)

    2011-04-08

    Highlights: {yields} iPS cells were induced with a fluorescence monitoring system. {yields} ATM-deficient tail-tip fibroblasts exhibited quite a low reprogramming efficiency. {yields} iPS cells obtained from ATM-deficient cells had pluripotent cell characteristics. {yields} ATM-deficient iPS cells had abnormal chromosomes, which were accumulated in culture. -- Abstract: During cell division, one of the major features of somatic cell reprogramming by defined factors, cells are potentially exposed to DNA damage. Inactivation of the tumor suppressor gene p53 raised reprogramming efficiency but resulted in an increased number of abnormal chromosomes in established iPS cells. Ataxia-telangiectasia mutated (ATM), which is critical in the cellular response to DNA double-strand breaks, may also play an important role during reprogramming. To clarify the function of ATM in somatic cell reprogramming, we investigated reprogramming in ATM-deficient (ATM-KO) tail-tip fibroblasts (TTFs). Although reprogramming efficiency was greatly reduced in ATM-KO TTFs, ATM-KO iPS cells were successfully generated and showed the same proliferation activity as WT iPS cells. ATM-KO iPS cells had a gene expression profile similar to ES cells and WT iPS cells, and had the capacity to differentiate into all three germ layers. On the other hand, ATM-KO iPS cells accumulated abnormal genome structures upon continuous passages. Even with the abnormal karyotype, ATM-KO iPS cells retained pluripotent cell characteristics for at least 20 passages. These data indicate that ATM does participate in the reprogramming process, although its role is not essential.

  5. Endoplasmic Reticulum Stress and Unfolded Protein Response in Atm-Deficient Thymocytes and Thymic Lymphoma Cells Are Attributable to Oxidative Stress

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    Mingshan Yan

    2008-02-01

    Full Text Available Both oxidative stress and endoplasmic reticulum (ER stress have been implicated in carcinogenesis. It is well documented that cells deficient in the ataxia-telangiectasia mutated (ATM gene undergo oxidative stress, which is critically involved in thymic lymphomagenesis in Atm-/- mice. Here we demonstrate that undifferentiated Atm-/- thymocytes show signs of ER stress and of the unfolded protein response (UPR. Using two-dimensional (2-D gel electrophoresis and mass spectrometry (MS analysis, we identified 22 differentially expressed proteins, including the ER stress marker glucose-regulated protein 78 (GRP78, in Atm-/- thymocytes and in Atm-/- thymic lymphoma cells relative to Atm+/+ thymocytes. The phosphorylated α subunit of eukaryotic translation initiation factor 2 (p-eIF2α, a UPR marker, was also increased in Atm-/- thymocytes. Cells of the ATL-1 line, which were derived from an Atm-/- mouse thymic lymphoma, were more sensitive to the ER stress inducer tunicamycin than were Atm+/+ thymic leukemia ASL-1 cells. Notably, treatment with hydrogen peroxide duplicated the effects of ATM deficiency in cultured thymocytes, and treatment with the novel cell-permeable thiol antioxidant N-acetylcysteine amide (AD4 reduced elevated p-eIF2α levels in thymocytes of Atm-/- mice. Thus, we propose that ER stress and the UPR are secondary to oxidative stress in Atm-/- thymocytes.

  6. The orally active and bioavailable ATR kinase inhibitor AZD6738 potentiates the anti-tumor effects of cisplatin to resolve ATM-deficient non-small cell lung cancer in vivo.

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    Vendetti, Frank P; Lau, Alan; Schamus, Sandra; Conrads, Thomas P; O'Connor, Mark J; Bakkenist, Christopher J

    2015-12-29

    ATR and ATM are DNA damage signaling kinases that phosphorylate several thousand substrates. ATR kinase activity is increased at damaged replication forks and resected DNA double-strand breaks (DSBs). ATM kinase activity is increased at DSBs. ATM has been widely studied since ataxia telangiectasia individuals who express no ATM protein are the most radiosensitive patients identified. Since ATM is not an essential protein, it is widely believed that ATM kinase inhibitors will be well-tolerated in the clinic. ATR has been widely studied, but advances have been complicated by the finding that ATR is an essential protein and it is widely believed that ATR kinase inhibitors will be toxic in the clinic. We describe AZD6738, an orally active and bioavailable ATR kinase inhibitor. AZD6738 induces cell death and senescence in non-small cell lung cancer (NSCLC) cell lines. AZD6738 potentiates the cytotoxicity of cisplatin and gemcitabine in NSCLC cell lines with intact ATM kinase signaling, and potently synergizes with cisplatin in ATM-deficient NSCLC cells. In contrast to expectations, daily administration of AZD6738 and ATR kinase inhibition for 14 consecutive days is tolerated in mice and enhances the therapeutic efficacy of cisplatin in xenograft models. Remarkably, the combination of cisplatin and AZD6738 resolves ATM-deficient lung cancer xenografts.

  7. 53BP1 is limiting for NHEJ repair in ATM-deficient model systems that are subjected to oncogenic stress or radiation.

    Science.gov (United States)

    Rybanska-Spaeder, Ivana; Reynolds, Taylor L; Chou, Jeremy; Prakash, Mansi; Jefferson, Tameca; Huso, David L; Desiderio, Stephen; Franco, Sonia

    2013-10-01

    The DNA damage response (DDR) factors ataxia telangiectasia mutated (ATM) and p53 binding protein 1 (53BP1) function as tumor suppressors in humans and mice, but the significance of their mutual interaction to the suppression of oncogenic translocations in vivo has not been investigated. To address this question, the phenotypes of compound mutant mice lacking 53BP1 and ATM (Trp53bp1(-/-)/Atm(-/-)), relative to single mutants, were examined. These analyses revealed that loss of 53BP1 markedly decreased the latency of T-lineage lymphomas driven by RAG-dependent oncogenic translocations in Atm(-/-) mice (average survival, 14 and 23 weeks for Trp53bp1(-/-)/Atm(-/-) and Atm(-/-) mice, respectively). Mechanistically, 53BP1 deficiency aggravated the deleterious effect of ATM deficiency on nonhomologous end-joining (NHEJ)-mediated double-strand break repair. Analysis of V(D)J recombinase-mediated coding joints and signal joints in Trp53bp1(-/-)/Atm(-/-) primary thymocytes is, however, consistent with canonical NHEJ-mediated repair. Together, these findings indicate that the greater NHEJ defect in the double mutant mice resulted from decreased efficiency of rejoining rather than switching to an alternative NHEJ-mediated repair mechanism. Complementary analyses of irradiated primary cells indicated that defects in cell-cycle checkpoints subsequently function to amplify the NHEJ defect, resulting in more frequent chromosomal breaks and translocations in double mutant cells throughout the cell cycle. Finally, it was determined that 53BP1 is dispensable for the formation of RAG-mediated hybrid joints in Atm(-/-) thymocytes but is required to suppress large deletions in a subset of hybrid joints. The current study uncovers novel ATM-independent functions for 53BP1 in the suppression of oncogenic translocations and in radioprotection.

  8. AZD6738, a novel oral inhibitor of ATR, induces synthetic lethality with ATM-deficiency in gastric cancer cells.

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    Min, Ahrum; Im, Seock-Ah; Jang, Hyemin; Kim, Seongyeong; Lee, Miso; Kim, Debora Keunyoung; Yang, Yaewon; Kim, Hee-Jun; Lee, Kyung-Hun; Kim, Jin Won; Kim, Tae-Yong; Oh, Do-Youn; Brown, Jeff; Lau, Alan; O Connor, Mark J; Bang, Yung-Jue

    2017-01-30

    Ataxia telangiectasia and Rad3-related (ATR) can be considered an attractive target for cancer treatment due to its deleterious effect on cancer cells harboring a homologous recombination defect (HRD). The aim of this study was to investigate the potential use of the ATR inhibitor, AZD6738, to treat gastric cancer. In SNU-601 cells with dysfunctional ATM, AZD6738 treatment led to an accumulation of DNA damage due to dysfunctional RAD51 foci formation, S phase arrest, and caspase 3-dependent apoptosis. In contrast, SNU-484 cells with functional ATM were not sensitive to AZD6738. Inhibition of ATM in SNU-484 cells enhanced AZD6738 sensitivity to a level comparable with that observed in SNU-601 cells, showing that activation of the ATM-Chk2 signaling pathway attenuates AZD6738 sensitivity. In addition, decreased HDAC1 expression was found to be associated with ATM inactivation in SNU-601 cells, demonstrating the interaction between HDAC1 and ATM can affect sensitivity to AZD6738. Furthermore, in an in vivo tumor xenograft mouse model, AZD6738 significantly suppressed tumor growth and increased apoptosis. These findings suggest synthetic lethality between ATR inhibition and ATM-deficiency in gastric cancer cells. Further clinical studies on the interaction between AZD 6738 and ATM-deficiency are warranted to develop novel treatment strategies for gastric cancer.

  9. Interaction between ATM and PARP-1 in response to DNA damage and sensitization of ATM deficient cells through PARP inhibition

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    de Murcia Gilbert

    2007-04-01

    Full Text Available Abstract ATM and PARP-1 are two of the most important players in the cell's response to DNA damage. PARP-1 and ATM recognize and bound to both single and double strand DNA breaks in response to different triggers. Here we report that ATM and PARP-1 form a molecular complex in vivo in undamaged cells and this association increases after γ-irradiation. ATM is also modified by PARP-1 during DNA damage. We have also evaluated the impact of PARP-1 absence or inhibition on ATM-kinase activity and have found that while PARP-1 deficient cells display a defective ATM-kinase activity and reduced γ-H2AX foci formation in response to γ-irradiation, PARP inhibition on itself is able to activate ATM-kinase. PARP inhibition induced γ H2AX foci accumulation, in an ATM-dependent manner. Inhibition of PARP also induces DNA double strand breaks which were dependent on the presence of ATM. As consequence ATM deficient cells display an increased sensitivity to PARP inhibition. In summary our results show that while PARP-1 is needed in the response of ATM to gamma irradiation, the inhibition of PARP induces DNA double strand breaks (which are resolved in and ATM-dependent pathway and activates ATM kinase.

  10. Ataxia-telangiectasia mutated (ATM) deficiency decreases reprogramming efficiency and leads to genomic instability in iPS cells.

    Science.gov (United States)

    Kinoshita, Taisuke; Nagamatsu, Go; Kosaka, Takeo; Takubo, Keiyo; Hotta, Akitsu; Ellis, James; Suda, Toshio

    2011-04-08

    During cell division, one of the major features of somatic cell reprogramming by defined factors, cells are potentially exposed to DNA damage. Inactivation of the tumor suppressor gene p53 raised reprogramming efficiency but resulted in an increased number of abnormal chromosomes in established iPS cells. Ataxia-telangiectasia mutated (ATM), which is critical in the cellular response to DNA double-strand breaks, may also play an important role during reprogramming. To clarify the function of ATM in somatic cell reprogramming, we investigated reprogramming in ATM-deficient (ATM-KO) tail-tip fibroblasts (TTFs). Although reprogramming efficiency was greatly reduced in ATM-KO TTFs, ATM-KO iPS cells were successfully generated and showed the same proliferation activity as WT iPS cells. ATM-KO iPS cells had a gene expression profile similar to ES cells and WT iPS cells, and had the capacity to differentiate into all three germ layers. On the other hand, ATM-KO iPS cells accumulated abnormal genome structures upon continuous passages. Even with the abnormal karyotype, ATM-KO iPS cells retained pluripotent cell characteristics for at least 20 passages. These data indicate that ATM does participate in the reprogramming process, although its role is not essential.

  11. Interleukin-1 receptor is a target for adjunctive control of diazepam-refractory status epilepticus in mice.

    Science.gov (United States)

    Xu, Zheng-Hao; Wang, Yi; Tao, An-Feng; Yu, Jie; Wang, Xiao-Yu; Zu, Yun-Yun; Zhang, Shi-Hong; Chen, Zhong

    2016-07-22

    Proinflammatory cytokine interleukin-1 beta (IL-1β) may accumulate in the brain during status epilepticus, but whether it contributes to the progressive refractoriness of SE remains unclear. By using a kainic acid-induced SE mice model, we tested whether pharmacological blockade or knock-out of interleukin-1 receptor type 1 (IL-1R1) could influence the diazepam-refractory phenomenon of prolonged SE. We confirmed diazepam failed to terminate prolonged SE (allowed to continue for 40min before diazepam administration). The expression level of IL-1β in the hippocampus during prolonged SE was significantly higher than that of baseline. Interestingly, prolonged SE was not diazepam-refractory in IL-1R1 knock-out mice. Moreover, administration of interleukin-1 receptor antagonist (IL-1RA) combined with diazepam terminated established prolonged SE, while IL-1RA alone is not capable to terminate prolonged SE. On the contrary, administration of recombinant human IL-1β weakens the efficacy of diazepam by prolonging its latency to terminate non-prolonged SE. Thus, the present study provides direct evidence that accumulated IL-1β contributed to the diazepam refractoriness of prolonged SE, and suggests that interleukin-1 receptor is a target for adjunctive control of diazepam-refractory SE.

  12. Effects of Pre- and Post-Administration of Vitamin A on the Growth of Refractory Cancers in Xenograft Mice.

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    Li, Chuan; Imai, Masahiko; Yamasaki, Masahiro; Hasegawa, Shinya; Takahashi, Noriko

    2017-04-01

    Vitamin A is an essential nutrient that is obtained from the daily diet. The major forms of vitamin A in the body consist of retinol, retinal, retinoic acid (RA), and retinyl esters. Retinal is fundamental for vision and RA is used in clinical therapy of human acute promyelocytic leukemia. The actions of retinol and retinyl palmitate (RP) are not known well. Recently, we found that retinol is a potent anti-proliferative agent against human refractory cancers, including gallbladder cancer, being more effective than RA, while RP was inactive. In the current study, we determined serum retinol concentrations in xenograft mice bearing tumors derived from four refractory cancer cell lines. We also examined the effects of vitamin A on proliferation of human gallbladder cancer cells in vivo. Serum retinol concentrations were significantly lower in xenograft mice with tumors derived from various refractory cancer cell lines as compared with control mice. The growth of tumors was inhibited with increasing serum retinol concentrations obtained post-administration of RP. In addition, pre-administration of RP increased serum retinol concentrations and suppressed tumor growth. These results indicate that administration of RP can maintain retinol concentrations in the body and that this might suppress cancer cell growth and attachment. The regulation of vitamin A concentration in the body, which is critical biomarker of health, could be beneficial for cancer prevention and therapy.

  13. [The evaluation of carcinogenic effect in rats and mice after intraperitoneal administration of refractory ceramic fibers].

    Science.gov (United States)

    Krajnow, A; Lao, I; Stetkiewicz, J; Wiecek, E

    1998-01-01

    The carcinogenic effect of Langfaser and Thermowool ceramic fibres was assessed in Wistar rats and BALB/C mice. Fibres were administered into the animal peritoneal cavity in doses of 25 and 5 mg, and the animals were left for survival. Langfaser and Thermowool ceramic fibres were found carcinogenic. The carcinogenic properties of Thermowool ceramic fibre can be compared to those of Krokidoit UICC asbestos.

  14. T-cell-specific deletion of Mof blocks their differentiation and results in genomic instability in mice

    OpenAIRE

    Gupta, Arun; Hunt, Clayton R.; Pandita, Raj K.; Pae, Juhee; Komal, K.; Singh, Mayank; Shay, Jerry W; Kumar, Rakesh; Ariizumi, Kiyoshi; Horikoshi, Nobuo; Hittelman, Walter N.; Guha, Chandan; Ludwig, Thomas; Pandita, Tej K.

    2013-01-01

    Ataxia telangiectasia patients develop lymphoid malignancies of both B- and T-cell origin. Similarly, ataxia telangiectasia mutated (Atm)-deficient mice exhibit severe defects in T-cell maturation and eventually develop thymomas. The function of ATM is known to be influenced by the mammalian orthologue of the Drosophila MOF (males absent on the first) gene. Here, we report the effect of T-cell-specific ablation of the mouse Mof (Mof) gene on leucocyte trafficking and survival. Conditional Mof...

  15. Somatic inactivation of ATM in hematopoietic cells predisposes mice to cyclin D3 dependent T cell acute lymphoblastic leukemia.

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    Ehrlich, Lori A; Yang-Iott, Katherine; DeMicco, Amy; Bassing, Craig H

    2015-01-01

    T-cell acute lymphoblastic leukemia (T-ALL) is a cancer of immature T cells that exhibits heterogeneity of oncogenic lesions, providing an obstacle for development of more effective and less toxic therapies. Inherited deficiency of ATM, a regulator of the cellular DNA damage response, predisposes young humans and mice to T-ALLs with clonal chromosome translocations. While acquired ATM mutation or deletion occurs in pediatric T-ALLs, the role of somatic ATM alterations in T-ALL pathogenesis remains unknown. We demonstrate here that somatic Atm inactivation in haematopoietic cells starting as these cells differentiate in utero predisposes mice to T-ALL at similar young ages and harboring analogous translocations as germline Atm-deficient mice. However, some T-ALLs from haematopoietic cell specific deletion of Atm were of more mature thymocytes, revealing that the developmental timing and celluar origin of Atm inactivation influences the phenotype of ATM-deficient T-ALLs. Although it has been hypothesized that ATM suppresses cancer by preventing deletion and inactivation of TP53, we find that Atm inhibits T-ALL independent of Tp53 deletion. Finally, we demonstrate that the Cyclin D3 protein that drives immature T cell proliferation is essential for transformation of Atm-deficient thymocytes. Our study establishes a pre-clinical model for pediatric T-ALLs with acquired ATM inactivation and identifies the cell cycle machinery as a therapeutic target for this aggressive childhood T-ALL subtype.

  16. Refractory vasculitis

    NARCIS (Netherlands)

    Rutgers, Bram; Kallenberg, Cees G. M.

    2011-01-01

    Refractory vasculitis occurs in 4-5% of patients with anti-neutrophil cytoplasmic antibody associated vasculitis (AAV). Differences between therapies used for refractory disease are mostly reflected in the percentages of complete and partial remissions, but also in the number of serious side effects

  17. Refractory vasculitis

    NARCIS (Netherlands)

    Rutgers, Bram; Kallenberg, Cees G. M.

    Refractory vasculitis occurs in 4-5% of patients with anti-neutrophil cytoplasmic antibody associated vasculitis (AAV). Differences between therapies used for refractory disease are mostly reflected in the percentages of complete and partial remissions, but also in the number of serious side

  18. Old Mice Accumulate Activated Effector CD4 T Cells Refractory to Regulatory T Cell-Induced Immunosuppression.

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    Harpaz, Idan; Bhattacharya, Udayan; Elyahu, Yehezqel; Strominger, Itai; Monsonego, Alon

    2017-01-01

    Chronic low-grade inflammation and reduced lymphocyte potency are implicated in the pathogenesis of major illnesses associated with aging. Whether this immune phenotype results from a loss of cell-mediated regulation or intrinsic dysregulated function of effector T cells (Teffs) requires further research. Here, we report that, as compared with young C57BL6 mice, old mice show an increased frequency of CD4+CD62L- Teffs with a dysregulated activated phenotype and markedly increased effector functions. Analysis of the frequency and suppressive function of CD4+FoxP3+ regulatory T cells (Tregs) indicates an increase in the frequency of FoxP3+ T cells with aging which, however, occurs within the CD4+CD25- T cells. Furthermore, whereas Tregs from young and old mice similarly suppress Teffs from young mice, both have a compromised suppressive capacity of Teffs from old mice, a phenomenon which is partially recovered in the presence of IL-2-producing CD4+CD62L+ non-Teffs. Finally, we observed that Teff subsets from old mice are enriched with IL-17A-producing T cells and exhibit intrinsically dysregulated expression of genes encoding cell-surface molecules and transcription factors, which play a key role in T-cell activation and regulation. We, thus, demonstrate an age-related impairment in the regulation of effector CD4 T cells, which may underlie the higher risk for destructive inflammation associated with aging.

  19. Severe Developmental B Lymphopoietic Defects in Foxp3-Deficient Mice are Refractory to Adoptive Regulatory T Cell Therapy.

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    Riewaldt, Julia; Düber, Sandra; Boernert, Marie; Krey, Martina; Dembinski, Marcin; Weiss, Siegfried; Garbe, Annette I; Kretschmer, Karsten

    2012-01-01

    The role of Foxp3-expressing regulatory T (T(reg)) cells in tolerance and autoimmunity is well-established. However, although of considerable clinical interest, the role of T(reg) cells in the regulation of hematopoietic homeostasis remains poorly understood. Thus, we analysed B and T lymphopoiesis in the scurfy (Sf) mouse model of T(reg) cell deficiency. In these experiments, the near-complete block of B lymphopoiesis in the BM of adolescent Sf mice was attributed to autoimmune T cells. We could exclude a constitutive lympho-hematopoietic defect or a B cell-intrinsic function of Foxp3. Efficient B cell development in the BM early in ontogeny and pronounced extramedullary B lymphopoietic activity resulted in a peripheral pool of mature B cells in adolescent Sf mice. However, marginal zone B and B-1a cells were absent throughout ontogeny. Developmental B lymphopoietic defects largely correlated with defective thymopoiesis. Importantly, neonatal adoptive T(reg) cell therapy suppressed exacerbated production of inflammatory cytokines and restored thymopoiesis but was ineffective in recovering defective B lymphopoiesis, probably due to a failure to compensate production of stroma cell-derived IL-7 and CXCL12. Our observations on autoimmune-mediated incapacitation of the BM environment in Foxp3-deficient mice will have direct implications for the rational design of BM transplantation protocols for patients with severe genetic deficiencies in functional Foxp3(+) T(reg) cells.

  20. CD47 agonist peptides induce programmed cell death in refractory chronic lymphocytic leukemia B cells via PLCγ1 activation: evidence from mice and humans.

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    Ana-Carolina Martinez-Torres

    2015-03-01

    Full Text Available Chronic lymphocytic leukemia (CLL, the most common adulthood leukemia, is characterized by the accumulation of abnormal CD5+ B lymphocytes, which results in a progressive failure of the immune system. Despite intense research efforts, drug resistance remains a major cause of treatment failure in CLL, particularly in patients with dysfunctional TP53. The objective of our work was to identify potential approaches that might overcome CLL drug refractoriness by examining the pro-apoptotic potential of targeting the cell surface receptor CD47 with serum-stable agonist peptides.In peripheral blood samples collected from 80 patients with CLL with positive and adverse prognostic features, we performed in vitro genetic and molecular analyses that demonstrate that the targeting of CD47 with peptides derived from the C-terminal domain of thrombospondin-1 efficiently kills the malignant CLL B cells, including those from high-risk individuals with a dysfunctional TP53 gene, while sparing the normal T and B lymphocytes from the CLL patients. Further studies reveal that the differential response of normal B lymphocytes, collected from 20 healthy donors, and leukemic B cells to CD47 peptide targeting results from the sustained activation in CLL B cells of phospholipase C gamma-1 (PLCγ1, a protein that is significantly over-expressed in CLL. Once phosphorylated at tyrosine 783, PLCγ1 enables a Ca2+-mediated, caspase-independent programmed cell death (PCD pathway that is not down-modulated by the lymphocyte microenvironment. Accordingly, down-regulation of PLCγ1 or pharmacological inhibition of PLCγ1 phosphorylation abolishes CD47-mediated killing. Additionally, in a CLL-xenograft model developed in NOD/scid gamma mice, we demonstrate that the injection of CD47 agonist peptides reduces tumor burden without inducing anemia or toxicity in blood, liver, or kidney. The limitations of our study are mainly linked to the affinity of the peptides targeting CD47

  1. Developing Refractories for Exporting

    Institute of Scientific and Technical Information of China (English)

    PANShang-xin

    1996-01-01

    The total output of China refractory products and export volume of China refractory raw materials rank the first in the world,In future the task is to improve the quality of the products to enlarge the variety and to expand export.

  2. Silica Refractory Bricks

    Institute of Scientific and Technical Information of China (English)

    Yu Lingyan; Peng Xigao

    2011-01-01

    @@ 1.Scope This standard specifies the classification,technical requirements,test methods,quality appraisal procedures,packing,marking,transportation,storage,and quality certificate of silica refractory bricks.This standard is applicable to silica refractory bricks with single weight≤40 kg.

  3. Development of improved refractories

    Energy Technology Data Exchange (ETDEWEB)

    Wereszczak, A.A.; Ferber, M.K.; Liu, K.C. [Oak Ridge National Lab., TN (United States); Moore, R.E. [Univ. of Missouri, Rolla, MO (United States)

    1997-04-01

    The goal of the proposed project is to provide expertise and facilities for the high temperature mechanical properties characterization of refractory materials which are of interest to the US DOE`s Office of Industrial Technologies Advanced Industrial Materials Project. Initially the project would establish dedicated refractory testing facilities which would be capable of generating representative engineering creep and high temperature modulus of elasticity (MOE) data to a temperature of 3300{degrees}F (1815{degrees}C) in ambient air. The generated engineering creep and MOE data would serve R&D requirements of refractories-manufacturers and its glass-manufacturer end-users and designers. The relevance of this effort to the refractory and glass-making industries would be ensured by coordinating the research activities through a membership with Alfred University`s Center for Glass Research (CGR) Satellite Center at the University of Missouri-Rolla (UMR), an NSF Center. Valid engineering creep and high temperature MOE data currently do not exist for almost all commercial refractories. Refractory end-users such as glass-manufacturers require such data for efficient and economical design of their various glass-melting furnace superstructures (e.g., furnace crowns). Refractories in glass production furnaces may be subjected to extreme temperatures as high as 3200{degrees}F (1760{degrees}C). With the simultaneous imposition of mechanical and thermal stresses, creep deformation of the refractory material will assuredly occur as a consequence. Designers must ensure that the structural integrity is maintained, so these high temperature deformations must be considered for successful glass furnace superstructure design. These criteria can only be satisfied with the utilization of representative engineering creep and high temperature MOE data for the refractory materials that are chosen for the design of the refractory superstructures.

  4. Fireclay Refractory Bricks

    Institute of Scientific and Technical Information of China (English)

    Zhang Xiaohui

    2010-01-01

    @@ 1 Scope This standard specifies the classification,brand,shape,dimension,technical requirements,test methods,quality appraisal procedures,packing,marking,transportation,storage,and quality certificate of fireclay refractory bricks.

  5. Refractory duodenal ulcer

    Directory of Open Access Journals (Sweden)

    Al Freihi Hussein

    1995-01-01

    Full Text Available Refractory or intractable ulcer is defined as an ulcer that fails to heal completely after eight to twelve weeks, despite appropriate treatment with a modern antiulcer therapy in a compliant patient. Refractory ulcer should be suspected in individuals diagnosed to have peptic ulcer if their symptoms persist longer than usual: occurrence of complications or simply their ulcers fail to heal, since up to 25% of such patients remain asymptomatic. Conditions associated with refractory ulcer include noncompliance, continuous consumption of nonsteroidal anti-inflam-matory drugs, acid hypersecretion, smoking. male gender and other factors with questionable role like advanced age, large ulcer size, prolonged duration of symptoms and the presence of complication like bleeding. Nonpeptic ulcers like tuberculosis, malignancy, Crohn′s disease and primary intestinal lymphoma should always be considered in the differential diagnosis. Colonization with H. pylori which is well-known as a cause of frequent recurrences, has not been linked with refractoriness. Patients with refractory ulcers must undergo thorough re-evaluation including repeated endoscopies, obtaining biopsies for microbiology and histology and determination of serum-gastrin level. Once diseases with identifiable etiologies have been ruled out, aggressive medical management with single or multiple antiulcer drugs should be instituted. Such treatments will virtually heal all refractory ulcers. Surgery should be reserved for patients whose ulcers fail to respond to optimal medical therapy or those who develop com-plications necessitating surgical intervention.

  6. Early B-cell-specific inactivation of ATM synergizes with ectopic CyclinD1 expression to promote pre-germinal center B-cell lymphomas in mice.

    Science.gov (United States)

    Yamamoto, K; Lee, B J; Li, C; Dubois, R L; Hobeika, E; Bhagat, G; Zha, S

    2015-06-01

    Ataxia telangiectasia-mutated (ATM) kinase is a master regulator of the DNA damage response. ATM is frequently inactivated in human B-cell non-Hodgkin lymphomas, including ~50% of mantle cell lymphomas (MCLs) characterized by ectopic expression of CyclinD1. Here we report that early and robust deletion of ATM in precursor/progenitor B cells causes cell autonomous, clonal mature B-cell lymphomas of both pre- and post-germinal center (GC) origins. Unexpectedly, naive B-cell-specific deletion of ATM is not sufficient to induce lymphomas in mice, highlighting the important tumor suppressor function of ATM in immature B cells. Although EμCyclinD1 is not sufficient to induce lymphomas, EμCyclinD1 accelerates the kinetics and increases the incidence of clonal lymphomas in ATM-deficient B-cells and skews the lymphomas toward pre-GC-derived small lymphocytic neoplasms, sharing morphological features of human MCL. This is in part due to CyclinD1-driven expansion of ATM-deficient naive B cells with genomic instability, which promotes the deletions of additional tumor suppressor genes (i.e. Trp53, Mll2, Rb1 and Cdkn2a). Together these findings define a synergistic function of ATM and CyclinD1 in pre-GC B-cell proliferation and lymphomagenesis and provide a prototypic animal model to study the pathogenesis of human MCL.

  7. Early B-cell Specific Inactivation of ATM Synergizes with Ectopic CyclinD1 Expression to Promote Pre-germinal center B-cell Lymphomas in Mice

    Science.gov (United States)

    Yamamoto, Kenta; Lee, Brian J.; Li, Chen; Dubois, Richard L.; Hobeika, Elias; Bhagat, Govind; Zha, Shan

    2017-01-01

    Ataxia Telangiectasia Mutated (ATM) kinase is a master regulator of the DNA damage response. ATM is frequently inactivated in human B-cell non-Hodgkin Lymphomas (B-NHL), including ~50% of mantle cell lymphomas (MCLs) characterized by ectopic expression of CyclinD1. Here we report that early and robust deletion of ATM in precursor/progenitor B-cells causes cell-autonomous, clonal mature B cell lymphomas of both pre- and post-germinal center (GC) origins. Unexpectedly naïve B cell specific deletion of ATM is not sufficient to induce lymphomas in mice, highlighting the important tumor suppressor function of ATM in immature B cells. While EμCyclinD1 is not sufficient to induce lymphomas, EμCyclinD1 accelerates the kinetics and increased the incidence of clonal lymphomas in ATM-deficient B-cells and skews the lymphomas towards pre-GC derived small lymphocytic neoplasms sharing morphological features of human MCL. This is in part due to CyclinD1-driven expansion of ATM-deficient naïve B cells with genomic instability, which promotes the deletions of additional tumor suppressor genes (i.g. Trp53, Mll2, Rb1 and Cdkn2a). Together these findings define a synergistic function of ATM and CyclinD1 in pre-germinal center B-cell proliferation and lymphomagenesis and provide a prototypic animal model to study the pathogenesis of human MCL. PMID:25676421

  8. RHI Refractories Opens Dalian Plant

    Institute of Scientific and Technical Information of China (English)

    Stefan Pirker

    2004-01-01

    @@ End of November the opening ceremony of the RHI Refractories Dalian plant took place in the presence of 250 guests from China and Europe. RHI Refractories welcomed highly official guests from the Dalian City and the Dalian Development Area, the Supervisory Board of RHI, the company's biggest shareholder, the Board of Management, representatives of customers in China as well as Professors of China's refractory academic field. The ceremony' s highlight was the speech of Professor Zhong Xiangchong from Zhengzhou University, member of the China Academy of Science, who pointed out RHI Refractories' long and successful history of refractory innovations during the last decades and the future possibilities of collaboration with RHI Refractories.

  9. Refractory peptic ulcer disease.

    Science.gov (United States)

    Napolitano, Lena

    2009-06-01

    Refractory PUD is a diagnostic and therapeutic challenge. Optimal management of severe or refractory PUD requires a multidisciplinary team approach, using primary care providers, gastroenterologists, and general surgeons. Medical management has become the cornerstone of therapy. Identification and eradication of H pylori infection combined with acid reduction regimens can heal ulceration and also prevent recurrence. Severe, intractable or recurrent PUD and associated complications mandates a careful and methodical evaluation and management strategy to determine the potential etiologies and necessary treatment (medical or surgical) required.

  10. Dynamic Testing of Gasifier Refractory

    Energy Technology Data Exchange (ETDEWEB)

    Michael D. Mann; Wayne S. Seames; Devdutt Shukla; Xi Hong; John P. Hurley

    2005-12-01

    The University of North Dakota (UND) Chemical Engineering Department in conjunction with the UND Energy & Environmental Research Center (EERC) have initiated a program to examine the combined chemical (reaction and phase change) and physical (erosion) effects experienced by refractory materials under slagging coal gasification conditions. The goal of this work is to devise a mechanism of refractory loss under these conditions. The controlled-atmospheric dynamic corrodent application furnace (CADCAF) was utilized to simulate refractory/slag interactions under dynamic conditions that more realistically simulate the environment in a slagging coal gasifier than any of the static tests used previously by refractory manufacturers and researchers. High-alumina and high-chromia refractory bricks were tested using slags obtained from two solid fuel gasifiers. Testing was performed at 1475 C in a reducing atmosphere (2% H{sub 2} in N{sub 2}) The CADCAF tests show that high-chrome refractories have greater corrosion resistance than high-aluminum refractories; coal slag readily diffuses into the refractory through its grain boundaries; the refractory grains are more stable than the matrix in the tests, and the grains are the first line of defense against corrosion; calcium and alkali in the slag are more corrosive than iron; and silicon and calcium penetrate the deepest into the refractory. The results obtained from this study are preliminary and should be combined with result from other research programs. In particular, the refractory corrosion results from this study should be compared with refractories removed from commercial gasifiers.

  11. Refractory Minerals in Henan Province

    Institute of Scientific and Technical Information of China (English)

    JIN Qinguo; LI Jing; LIU Jiehua; LIU Yanjun

    2004-01-01

    Henan province is very rich in refractory minerals of many varieties including silica, dolomite, graphite,pearlite, sepiolite, olivine, and sillimanite group minerals, besides the abundant reserves of fireclay and bauxite,which lay a good foundation for the development of the refractories industry of the province. The paper introduces the reserves, distribution and character of the refractory minerals in Henan province.

  12. Status epilepticus: Refractory and super-refractory.

    Science.gov (United States)

    Dubey, Deepanshu; Kalita, Jayantee; Misra, Usha K

    2017-01-01

    Status epilepticus (SE) is an important neurological emergency. It is defined as seizures lasting for 5 minutes or more or recurrent seizures without recovery of consciousness to baseline between the attacks. Refractory SE (RSE) is defined as SE persisting despite sufficient dose of benzodiazepines and at least one antiepileptic drug (AED), irrespective of time. Super refractory SE (SRSE) is defined as SE that continues for 24 hours or more after the use of anesthetic therapy, including cases that recur on weaning of the anesthestic agent. RSE occurs in 23%-48% of the patients and SRSE in approximately 22% of the patients with SE. In general, RSE occurs in patients with new-onset seizures rather than in patients with chronic epilepsy. The etiology of RSE in developing countries is dominated by central nervous system (CNS) infections and head injury compared to stroke and drug withdrawal in the developed countries. The treatment of RSE and SRSE is not evidence based. Following benzodiazepines, the second line antiepileptic drugs include sodium valproate, phenytoin, levetiracetam, and anesthetic drugs such as midazolam, phenobarbital, and propofol. Most intravenous anesthetic drugs produce hypotension and respiratory suppression; therefore, patients with RSE are managed in intensive care units (ICUs). In RSE patients, electroencephalogram (EEG) burst suppression with interburst interval of 2-20 s or even flat EEG has been tried. Recently, concerns have been raised on the safety of burst suppression in RSE and SRSE. The paucity of ICUs in developing countries limits the use of these management protocols. There is a need to explore intravenous AEDs with safer cardiovascular and respiratory profile for the management of SE.

  13. Refractory headache: classification and nomenclature.

    Science.gov (United States)

    Levin, Morris

    2008-06-01

    There are a number of reasons to attempt to define and classify refractory headache disorders. Particularly important are the potential benefits in the areas of research, treatment, and medical cost reimbursement. There are challenges in attempting to classify refractory forms of headaches, including the lack of biological or other objective markers and a lack of consensus among practitioners as to what qualifies as refractoriness, or even if a separate category for refractory migraine and other refractory headaches needs to be established. A definition of refractory migraine has been proposed by Schulman et al in this issue ("Defining Refractory Migraine [RM] and Refractory Chronic Migraine [RCM]: Proposed Criteria for the Refractory Headache Special Interests Section of the American Headache Society"), which should be tested for validity and usefulness. It seems reasonable to consider adding this defined syndrome to the International Classification of Headache Disorders, second edition (ICHD-II). In this article, options for adding refractory headache syndromes to the ICHD are discussed with pros and cons for each. Two "best" options for adding the disorder "refractory migraine" to the ICHD are presented along with an illustrative case example.

  14. Refractory gastroesophageal reflux disease

    OpenAIRE

    Joaquim Prado P. Moraes-Filho

    2012-01-01

    CONTEXT: Gastroesophageal reflux disease (GERD) is a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications. Its pathophysiology, diagnosis and treatment have frequently been analyzed but it is interesting to review some aspects of the GERD refractory patients to the proton pump inhibitors treatment. The treatment encompasses behavioral measures and pharmacological therapy. The majority of the patients respond well to proton pump inhibito...

  15. Colectomy for refractory constipation

    DEFF Research Database (Denmark)

    Raahave, Dennis; Loud, Franck Bjørn; Christensen, Elsebeth;

    2010-01-01

    OBJECTIVE: This study evaluated the type of colectomy, postoperative complications, functional results, and satisfaction in patients with constipation refractory to conservative therapy. Further, colonic transit time (CTT), faecal load (coprostasis), and colon length (redundancies) were compared...... had at hemicolectomy, 11 patients a subtotal colectomy and 3 patients an ileostomy. Two patients had an anastomotic leak and one died. In 11 patients, further surgery was necessary, because of recurrent constipation. Abdominal pain disappeared and defecation patterns improved significantly to 1-4 per...

  16. Refractory status epilepticus

    Directory of Open Access Journals (Sweden)

    Sanjay P Singh

    2014-01-01

    Full Text Available Refractory status epilepticus is a potentially life-threatening medical emergency. It requires early diagnosis and treatment. There is a lack of consensus upon its semantic definition of whether it is status epilepticus that continues despite treatment with benzodiazepine and one antiepileptic medication (AED, i.e., Lorazepam + phenytoin. Others regard refractory status epilepticus as failure of benzodiazepine and 2 antiepileptic medications, i.e., Lorazepam + phenytoin + phenobarb. Up to 30% patients in SE fail to respond to two antiepileptic drugs (AEDs and 15% continue to have seizure activity despite use of three drugs. Mechanisms that have made the treatment even more challenging are GABA-R that is internalized during status epilepticus and upregulation of multidrug transporter proteins. All patients of refractory status epilepticus require continuous EEG monitoring. There are three main agents used in the treatment of RSE. These include pentobarbital or thiopental, midazolam and propofol. RSE was shown to result in mortality in 35% cases, 39.13% of patients were left with severe neurological deficits, while another 13% had mild neurological deficits.

  17. Refractories Utilizability for Slagging Gasifiers

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Slagging coal gasification process became a highlight of coal chemical industry in China during the last decade. Refractory lining's life of slagging gasifiers is one of the most critical factors for a cost -effective operation. The paper introduces current status of coal gasification in China, lining structure of slagging gasifiers and performance of refractory lining. It also summarizes the major factors impacting on refractory wear in slagging coal gasifiers in four Chinese chemical plants, based on ten years of industrial experience. The utilizability is discussed in terms of cost -effectiveness of high chromia refractories and possibility of the alternatives.

  18. Orind Refractories Limited

    Institute of Scientific and Technical Information of China (English)

    Mr R. Mishra; Group Manging Director

    2005-01-01

    @@ "Sight can be acquired, Vision cannot". Orind Refractories Limited (ORIND), China was formed with this rare vision. At a time when the world was testing the tepid waters of China; Mr. Ravin Jhunjhunwala, Chairman of ORIND and the management of ORIND India had looked over the Great Wall to begin a journey of success. Incorported on 18th August 1994 with an initial investment of USD 5 million, ORL caters to the ever-demanding needs of the steel industry and beyond. Incidentally ORIND was the first wholly owned India company to set up base in China. Pesently, ORIND China has a 616 strong work force including 23 expatriates.

  19. Refractoriness in human atria

    DEFF Research Database (Denmark)

    Skibsbye, Lasse; Jespersen, Thomas; Christ, Torsten

    2016-01-01

    drugs. Cardiomyocyte excitability depends on availability of sodium channels, which involves both time- and voltage-dependent recovery from inactivation. This study therefore aims to characterise how sodium channel inactivation affects refractoriness in human atria. METHODS AND RESULTS: Steady......-state activation and inactivation parameters of sodium channels measured in vitro in isolated human atrial cardiomyocytes were used to parameterise a mathematical human atrial cell model. Action potential data were acquired from human atrial trabeculae of patients in either sinus rhythm or chronic atrial...... in pharmacological management of chronic atrial fibrillation....

  20. Development of Refractories for Continuous Casting

    Institute of Scientific and Technical Information of China (English)

    TIAN Shouxin; JIN Congjin; YAO Jinfu; LI Zeya

    2004-01-01

    The paper introduces refractories for continuous casting, especially, refractories for continuous casting for clean steel in baosteel. Developing direction of refractories for continuous casting has been pointed out to satisfy the new metallurgical operating practice.

  1. Approaches to refractory epilepsy

    Directory of Open Access Journals (Sweden)

    Jerome Engel

    2014-01-01

    Full Text Available Epilepsy is one of the most common serious neurological conditions, and 30 to 40% of people with epilepsy have seizures that are not controlled by medication. Patients are considered to have refractory epilepsy if disabling seizures continue despite appropriate trials of two antiseizure drugs, either alone or in combination. At this point, patients should be referred to multidisciplinary epilepsy centers that perform specialized diagnostic testing to first determine whether they are, in fact, pharmacoresistant, and then, if so, offer alternative treatments. Apparent pharmacoresistance can result from a variety of situations, including noncompliance, seizures that are not epileptic, misdiagnosis of the seizure type or epilepsy syndrome, inappropriate use of medication, and lifestyle issues. For patients who are pharmacoresistant, surgical treatment offers the best opportunity for complete freedom from seizures. Surgically remediable epilepsy syndromes have been identified, but patients with more complicated epilepsy can also benefit from surgical treatment and require more specialized evaluation, including intracranial EEG monitoring. For patients who are not surgical candidates, or who are unwilling to consider surgery, a variety of other alternative treatments can be considered, including peripheral or central neurostimulation, ketogenic diet, and complementary and alternative approaches. When such alternative treatments are not appropriate or effective, quality of life can still be greatly improved by the psychological and social support services offered by multidisciplinary epilepsy centers. A major obstacle remains the fact that only a small proportion of patients with refractory epilepsy are referred for expert evaluation and treatment.

  2. Refractory Celiac Disease

    Directory of Open Access Journals (Sweden)

    K Khatami

    2014-04-01

    Full Text Available Refractory celiac disease (RCD is when malabsorption symptoms and villous atrophy persist despite strict adherence to a gluten free diet (GFD for more than 12 months and other causes of villous atrophy have been ruled out.  RCD is considered a rare disease and almost exclusively occurs in adults. Persistent diarrhea, abdominal pain, weight loss are the most common symptoms in RCD. Also, anemia, fatigue, malaise, thromboembolic events and coexisting autoimmune disorders are frequent. Diagnosis of RCD is based on other causes of unresponsiveness to the GFD, particularly collagenous sprue, ulcerative jejunitis, and enteropathy-associated T-cell lymphoma. Many disorders such as autoimmune enteropathy, tropical sprue, common variable immunodeficiency, and intolerance to non-gluten dietary proteins may have similar histological findings but not necessarily identical with CD and therefore should be excluded. Repeat intestinal biopsy may help to differentiate causes of non-responsive CD associated with ongoing villous atrophy (e.g., gluten contamination, small-bowel bacterial overgrowth, RCD. There are 2 subtypes of RCD according to absence (type I or presence (type II of an abnormal intraepithelial lymphocyte population. RCD type 1 usually becomes better with a combination of aggressive nutritional support, adherence to GFD, and pharmacologic therapies such as prednisone, budesonide and azathioprine. For RCD type 2, more aggressive therapeutic approach is needed since clinical response to therapies is less certain and may evolve into aggressive enteropathy associated T-cell lymphoma and the prognosis is poor.   Key words: Celiac Disease, Refractory.  

  3. Refractory chronic migraine

    DEFF Research Database (Denmark)

    Martelletti, Paolo; Katsarava, Zaza; Lampl, Christian

    2014-01-01

    and in the uncontrolled application of therapeutic techniques not yet validated.The European Headache Federation Expert Group on rCM presents hereby the updated definition criteria for this harmful subset of headache disorders. This attempt wants to be the first impulse towards the correct identification......The debate on the clinical definition of refractory Chronic Migraine (rCM) is still far to be concluded. The importance to create a clinical framing of these rCM patients resides in the complete disability they show, in the high risk of serious adverse events from acute and preventative drugs...... of these patients, the correct application of innovative therapeutic techniques and lastly aim to be acknowledged as clinical entity in the next definitive version of the International Classification of Headache Disorders 3 (ICHD-3 beta)....

  4. Refractory status epilepticus.

    Science.gov (United States)

    Fernandez, Andres; Claassen, Jan

    2012-04-01

    Refractory status epilepticus (RSE) has a high morbidity and mortality. There are currently no definitive data to guide both the optimal choice of therapy and treatment goals. This review focuses on RSE diagnosis and outcome and discusses both commonly used and anecdotal therapies for RSE. The challenges in performing randomized controlled trials (RCTs) in neurocritical care and more specifically for the treatment of RSE are illustrated by the early termination of the first RCT of RSE due to low recruitment that compared propofol to barbiturates. Recent case series include the successful treatment of recurrent RSE with ketamine, intravenous lacosamide as an add-on treatment, the use of combination antiepileptics (phenytoin, levetiracetam, and pregabalin), and surgical treatments (vagal nerve and deep brain stimulation) for the control of RSE. A number of different therapeutic options are available for the treatment of RSE but none have been shown to be superior to others at this point.

  5. Refractory chronic cluster headache

    DEFF Research Database (Denmark)

    Mitsikostas, Dimos D; Edvinsson, Lars; Jensen, Rigmor H

    2014-01-01

    Chronic cluster headache (CCH) often resists to prophylactic pharmaceutical treatments resulting in patients' life damage. In this rare but pragmatic situation escalation to invasive management is needed but framing criteria are lacking. We aimed to reach a consensus for refractory CCH definition...... for clinical and research use. The preparation of the final consensus followed three stages. Internal between authors, a larger between all European Headache Federation members and finally an international one among all investigators that have published clinical studies on cluster headache the last five years....... Eighty-five investigators reached by email. Proposed criteria were in the format of the International Classification of Headache Disorders III-beta (description, criteria, notes, comments and references). Following this evaluation eight drafts were prepared before the final. Twenty-four (28...

  6. Sample Preparation for Monolithic Refractories Part 1: Refractory Castables

    Institute of Scientific and Technical Information of China (English)

    Zhang Xiaohui; Peng Xigao

    2010-01-01

    @@ 1 Scope This standard specifies the definition and test methods of flowability of dense and insulating refractory castables,and moulding equipment,moulding methods,curing and drying conditions of castables samples.

  7. Present Situation of Refractories for Baosteel

    Institute of Scientific and Technical Information of China (English)

    TAI Li; SHEN Keyin

    2004-01-01

    The paper reviews the present situation of refractories for Baosteel, including refractories for iron-making system, converters, ladles and tundishes. Descriptions have been also conducted on the environment protection and reutilization of refractories in Baosteel, together with somesuggestions for refractories suppliers to meet the advancement in iron and steel making technology of Baosteel.

  8. Self-flow Refractory Castables

    Institute of Scientific and Technical Information of China (English)

    Zhang Xiaohui; Peng Xigao

    2010-01-01

    @@ 1 Scope This standard specifies the term and definition,classification, technical requirements, test methods,quality appraisal procedures, packing, marking, transportation, storage, and quality certificate of self-flow refractory castables.

  9. Alumina-magnesia Refractory Castables

    Institute of Scientific and Technical Information of China (English)

    Wang Jing

    2010-01-01

    @@ 1 Scope This standard specifies the classification,technical requirements,test methods,quality appraisal procedures,packing,marking,transportation,storage,and quality certificate of alumina-magnesia refractory castables.

  10. Impact of alternate fuels on industrial refractories and refractory insulation applications. An Assessment

    Energy Technology Data Exchange (ETDEWEB)

    Wei, G.C.; Tennery, V.J.

    1976-09-01

    The effects of use of alternate fuels such as distillate oils, residual oils, coal, producer gas, and electricity on refractory insulation are evaluated. Sections are included on alternate fuels for 1976 to 1980, assessment by industry of fuel conversion impact on industrial refractories in the period 1976 to 1980, interactions of alternate fuel combustion products with refractories and refractory insulation, and analysis of degradation mechanisms in refractories and refractory materials. (JRD)

  11. Radiation Effects in Refractory Alloys

    Science.gov (United States)

    Zinkle, Steven J.; Wiffen, F. W.

    2004-02-01

    In order to achieve the required low reactor mass per unit electrical power for space reactors, refractory alloys are essential due to their high operating temperature capability that in turn enables high thermal conversion efficiencies. One of the key issues associated with refractory alloys is their performance in a neutron irradiation environment. The available radiation effects data are reviewed for alloys based on Mo, W, Re, Nb and Ta. The largest database is associated with Mo alloys, whereas Re, W and Ta alloys have the least available information. Particular attention is focused on Nb-1Zr, which is a proposed cladding and structural material for the reactor in the Jupiter Icy Moons Orbiter (JIMO) project. All of the refractory alloys exhibit qualitatively similar temperature-dependent behavior. At low temperatures up to ~0.3TM, where TM is the melting temperature, the dominant effect of radiation is to produce pronounced radiation hardening and concomitant loss of ductility. The radiation hardening also causes a dramatic decrease in the fracture toughness of the refractory alloys. These low temperature radiation effects occur at relatively low damage levels of ~0.1 displacement per atom, dpa (~2×1024 n/m2, E>0.1 MeV). As a consequence, operation at low temperatures in the presence of neutron irradiation must be avoided for all refractory alloys. At intermediate temperatures (0.3 to 0.6 TM), void swelling and irradiation creep are the dominant effects of irradiation. The amount of volumetric swelling associated with void formation in refractory alloys is generally within engineering design limits (>10 dpa). Very little experimental data exist on irradiation creep of refractory alloys, but data for other body centered cubic alloys suggest that the irradiation creep will produce negligible deformation for near-term space reactor applications.

  12. Effects of lactoferrin in 6 patients with refractory bacterial vaginosis.

    Science.gov (United States)

    Otsuki, Katsufumi; Imai, Noriaki

    2017-02-01

    We previously reported that lactoferrin (LF) could be effective for preventing preterm delivery and intrauterine infections, based on data derived from mice and rabbits. Here we describe 6 women with a history of multiple pregnancy losses or preterm delivery and refractory bacterial vaginosis, who received prebiotic LF therapy and delivered an infant normally. Five of the women were pregnant and one was not at the time of this study. The Ethics Committee at Showa University Hospital and Showa University Koto Toyosu Hospital approved the therapeutic protocol. Vaginal suppositories and oral prebiotic LF were administered to patients who were refractory to conventional treatment for vaginosis and had a history of late miscarriages and very early preterm delivery due to refractory vaginitis and chorioamnionitis. LF significantly improved the vaginal bacterial flora. Lactobacillus, which was detectable in the vaginas of all patients after one month of LF therapy, gradually became dominant. The findings from these 6 patients suggest that administering LF to humans could help prevent refractory vaginitis, cervical inflammation, and preterm delivery.

  13. Company Profile Dengfeng Chunsheng Refractories Co., Ltd.

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    @@ Dengfeng Chunsheng Refractories Co., Ltd. is an industrial enterprise integrating refractories research, design, manufacturing and engineering service into one and was entitled as one of China's high-quality silica bricks production and export bases.

  14. SINTERED REFRACTORY TUNGSTEN ALLOYS. Gesinterte hochschmelzende wolframlegierungen

    Energy Technology Data Exchange (ETDEWEB)

    Kieffer, R.; Sedlatschek, K.; Braun, H.

    1971-12-15

    Dependence of the melting point of the refractory metals on their positions in the periodic system - alloys of tungsten with other refractory metals - sintering of the alloys - processing of the alloys - technological properties.

  15. Magnesia-Chrome Refractories for Flash Furnace

    Institute of Scientific and Technical Information of China (English)

    LI Yong; CHEN Kaixian; LU Xinghua; LIU Jianlong; SUN Jialin; HONG Yanruo

    2002-01-01

    The rapid development of our country's heavy nonferrous metallurgical technology and the revolution in new type of heavynon-ferrous metallurgical furnace have imposed more critical demand on the refractory materials ,i. e. high quality and long service life. This paper presents the domestic status of the refractories for flash furnace , briefly describes the wear of the refractory used , and it is considered that the domestic in refractories for flashfurnace can be surely realized.

  16. Reuse and Reproduction of Used Refractories

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    The paper analyzed the recycle condition and developing trend of used refractories China and other countries, including research achievements of recycles of used refractories such as MgO-C bricks, Al2O3-MgO-C bricks, Al2O3-SiC-C castable and MgO-Cr2O3 bricks. Recycled refractories exhibit the same or even better properties as compared with the original. In addition, prospects for recycle of used refractories are also discusseded.

  17. Management of chronic refractory cough.

    Science.gov (United States)

    Gibson, Peter G; Vertigan, Anne E

    2015-12-14

    Chronic refractory cough (CRC) is defined as a cough that persists despite guideline based treatment. It is seen in 20-46% of patients presenting to specialist cough clinics and it has a substantial impact on quality of life and healthcare utilization. Several terms have been used to describe this condition, including the recently introduced term cough hypersensitivity syndrome. Key symptoms include a dry irritated cough localized around the laryngeal region. Symptoms are not restricted to cough and can include globus, dyspnea, and dysphonia. Chronic refractory cough has factors in common with laryngeal hypersensitivity syndromes and chronic pain syndromes, and these similarities help to shed light on the pathophysiology of the condition. Its pathophysiology is complex and includes cough reflex sensitivity, central sensitization, peripheral sensitization, and paradoxical vocal fold movement. Chronic refractory cough often occurs after a viral infection. The diagnosis is made once the main diseases that cause chronic cough have been excluded (or treated) and cough remains refractory to medical treatment. Several treatments have been developed over the past decade. These include speech pathology interventions using techniques adapted from the treatment of hyperfunctional voice disorders, as well as the use of centrally acting neuromodulators such as gabapentin and pregabalin. Potential new treatments in development also show promise.

  18. Refractory disease in autoimmune diseases

    NARCIS (Netherlands)

    Vasconcelos, Carlos; Kallenberg, Cees; Shoenfeld, Yehuda

    2011-01-01

    Refractory disease (RD) definition has different meanings but it is dynamic, according to knowledge and the availability of new drugs. It should be differentiated from severe disease and damage definitions and it must take into account duration of adequate therapy and compliance of the patient. It c

  19. Deregulation of mTOR signaling is involved in thymic lymphoma development in Atm-/- mice

    Energy Technology Data Exchange (ETDEWEB)

    Kuang, Xianghong; Shen, Jianjun; Wong, Paul K.Y. [Department of Carcinogenesis, The University of Texas, MD Anderson Cancer Center, Science Park-Research Division, Park Road 1C, Smithville, TX 78957 (United States); Yan, Mingshan, E-mail: mingyan@mdanderson.org [Department of Carcinogenesis, The University of Texas, MD Anderson Cancer Center, Science Park-Research Division, Park Road 1C, Smithville, TX 78957 (United States)

    2009-06-05

    Abnormal thymocyte development with thymic lymphomagenesis inevitably occurs in Atm-/- mice, indicating that ATM plays a pivotal role in regulating postnatal thymocyte development and preventing thymic lymphomagenesis. The mechanism for ATM controls these processes is unclear. We have shown previously that c-Myc, an oncoprotein regulated by the mammalian target of rapamycin (mTOR), is overexpressed in Atm-/- thymocytes. Here, we show that inhibition of mTOR signaling with its specific inhibitor, rapamycin, suppresses normal thymocyte DNA synthesis by downregulating 4EBP1, but not S6K, and that 4EBP1 phosphorylation and cyclin D1 expression are coordinately increased in Atm-/- thymocytes. Administration of rapamycin to Atm-/- mice attenuates elevated phospho-4EBP1, c-Myc and cyclin D1 in their thymocytes, and delays thymic lymphoma development. These results indicate that mTOR downstream effector 4EBP1 is essential for normal thymocyte proliferation, but deregulation of 4EBP1 in Atm deficiency is a major factor driving thymic lymphomagenesis in the animals.

  20. Chromia refractory brick with carbon treatment

    Energy Technology Data Exchange (ETDEWEB)

    Bennett, James P.; Kwong, Kyei-Sing

    2017-03-21

    The disclosure provides a refractory brick system comprising a chromia refractory brick for operation in the slagging environment of an air-cooled gasifier. The chromia refractory brick comprises a ceramically-bonded porous chromia refractory having a porosity greater than 9% and having carbon deposits residing within the pores. The brick may be further comprised of Al.sub.2O.sub.3. The air-cooled gasifier generates a liquefied slag in contact with the refractory brick and generally operates at temperatures between 1250.degree. C. and 1575.degree. C. and pressures between 300 psi to 1000 psi, with oxygen partial pressures generally between 10.sup.-4 and 10.sup.-10 atm. The refractory brick performs without substantial chromium carbide or chromium metal formation in the low oxygen partial pressure environment. The inclusion of carbon without chromium carbide formation provides for significant mitigation of slag penetration and significantly reduced refractory wear.

  1. Alloimmune refractoriness to platelet transfusions.

    Science.gov (United States)

    Sandler, S G

    1997-11-01

    Patients who are transfused on multiple occasions with red cells or platelets may develop platelet-reactive alloantibodies and experience decreased clinical responsiveness to platelet transfusion. This situation, conventionally described as "refractoriness to platelet transfusions," is defined by an unsatisfactory low post-transfusion platelet count increment. If antibodies to HLAs are detected, improved clinical outcomes may result from transfusions of HLA-matched or donor-recipient cross-matched platelets. Because refractoriness is an expected, frequently occurring phenomenon, prevention of HLA alloimmunization is an important management strategy. Prevention strategies include efforts to decrease the number of transfusions, filtration of cellular components to reduce the number of HLA-bearing leukocytes, or pretransfusion ultraviolet B irradiation of cellular components to decrease their immunogenicity. Other investigational approaches include reducing the expression of HLAs on transfused platelets, inducing a transient reticuloendothelial system blockade by infusions of specialized immunoglobulin products, or transfusing semisynthetic platelet substitutes (thromboerythrocytes, thrombospheres) or modified platelets (infusible platelet membranes, lyophilized platelets).

  2. Iron refractory iron deficiency anemia

    OpenAIRE

    De Falco, Luigia; Sanchez, Mayka; Silvestri, Laura; Kannengiesser, Caroline; Muckenthaler, Martina U; Iolascon, Achille; Gouya, Laurent; Camaschella, Clara; Beaumont, Carole

    2013-01-01

    Iron refractory iron deficiency anemia is a hereditary recessive anemia due to a defect in the TMPRSS6 gene encoding Matriptase-2. This protein is a transmembrane serine protease that plays an essential role in down-regulating hepcidin, the key regulator of iron homeostasis. Hallmarks of this disease are microcytic hypochromic anemia, low transferrin saturation and normal/high serum hepcidin values. The anemia appears in the post-natal period, although in some cases it is only diagnosed in ad...

  3. Understanding and treating refractory constipation

    Institute of Scientific and Technical Information of China (English)

    Gabrio; Bassotti; Corrado; Blandizzi

    2014-01-01

    Chronic constipation is a frequently encountered disorder in clinical practice. Most constipated patients benefit from standard medical approaches. However, current therapies may fail in a proportion of patients. These patients deserve better evaluation and thorough investigations before their labeling as refractory to treatment. Indeed, several cases of apparent refractoriness are actually due to misconceptions about constipation, poor basal evaluation (inability to recognize secondary causes of constipation, use of constipating drugs) or inadequate therapeutic regimens. After a careful reevaluation that takes into account the above factors, a certain percentage of patients can be defined as being actually resistant to first-line medical treatments. These subjects should firstly undergo specific diagnostic examination to ascertain the subtype of constipation. The subsequent therapeutic approach should be then tailored according to their underlying dysfunction. Slow transit patients could benefit from a more robust medical treatment, based on stimulant laxatives (or their combination with osmotic laxatives, particularly over the short-term), enterokinetics (such as prucalopride) or secretagogues (such as lubiprostone or linaclotide). Patients complaining of obstructed defecation are less likely to show a response to medical treatment and might benefit from biofeedback, when available. When all medical treatments prove to be unsatisfactory, other approaches may be attempted in selected patients (sacral neuromodulation, local injection of botulinum toxin, anterograde continence enemas), although with largely unpredictable outcomes. A further although irreversible step is surgery (subtotal colectomy with ileorectal anastomosis or stapled transanal rectal resection), which may confer some benefit to a few patients with refractoriness to medical treatments.

  4. Refractories Quality Improvement for Glass Industry Upgrading

    Institute of Scientific and Technical Information of China (English)

    ZENG Dafan

    2009-01-01

    @@ 1 Glass Industry and Refractories Industry Closely Connect 1.1 Glass Development Drives Refractories Progress Refractories are indispensable to glass industry; the rapid development of glass industry drives the growth of refractories industry. China's glass industry developed slowly before the mid 1980s. The kilns and furnaces were backward and small-scale with furnace life of only 2-3 years; glass was produced with extremely low efficiency and poor quality. During that period, refractories for glass melting furnaces had very limited varieties and inferior quality. The fused cast refractories for advanced glass melting furnaces were imported, for the materials made in China could not meet the requirements, which seriously restrained the technical progress of China's glass industry.

  5. Refractory, Abrasive and Other Industrial Mineral Operations

    Data.gov (United States)

    Department of Homeland Security — This map layer includes refractory, abrasive, and other industrial minerals operations in the United States. The data represent commodities covered by the Minerals...

  6. ATM-Deficient Colorectal Cancer Cells Are Sensitive to the PARP Inhibitor Olaparib.

    Science.gov (United States)

    Wang, Chen; Jette, Nicholas; Moussienko, Daniel; Bebb, D Gwyn; Lees-Miller, Susan P

    2017-02-06

    The ataxia telangiectasia mutated (ATM) protein kinase plays a central role in the cellular response to DNA damage. Loss or inactivation of both copies of the ATM gene (ATM) leads to ataxia telangiectasia, a devastating childhood condition characterized by neurodegeneration, immune deficiencies, and cancer predisposition. ATM is also absent in approximately 40% of mantle cell lymphomas (MCLs), and we previously showed that MCL cell lines with loss of ATM are sensitive to poly-ADP ribose polymerase (PARP) inhibitors. Next-generation sequencing of patient tumors has revealed that ATM is altered in many human cancers including colorectal, lung, prostate, and breast. Here, we show that the colorectal cancer cell line SK-CO-1 lacks detectable ATM protein expression and is sensitive to the PARP inhibitor olaparib. Similarly, HCT116 colorectal cancer cells with shRNA depletion of ATM are sensitive to olaparib, and depletion of p53 enhances this sensitivity. Moreover, HCT116 cells are sensitive to olaparib in combination with the ATM inhibitor KU55933, and sensitivity is enhanced by deletion of p53. Together our studies suggest that PARP inhibitors may have potential for treating colorectal cancer with ATM dysfunction and/or colorectal cancer with mutation of p53 when combined with an ATM kinase inhibitor.

  7. Genetics Home Reference: iron-refractory iron deficiency anemia

    Science.gov (United States)

    ... refractory iron deficiency anemia iron-refractory iron deficiency anemia Enable Javascript to view the expand/collapse boxes. ... All Close All Description Iron-refractory iron deficiency anemia is one of many types of anemia , which ...

  8. Management of refractory cardiogenic shock.

    Science.gov (United States)

    Reyentovich, Alex; Barghash, Maya H; Hochman, Judith S

    2016-08-01

    Cardiogenic shock is a life-threatening condition that occurs in response to reduced cardiac output in the presence of adequate intravascular volume and results in tissue hypoxia. Cardiogenic shock has several underlying aetiologies, with the most common being acute myocardial infarction (AMI). Refractory cardiogenic shock presents as persistent tissue hypoperfusion despite administration of adequate doses of two vasoactive medications and treatment of the underlying aetiology. Investigators of the SHOCK trial reported a long-term mortality benefit of emergency revascularization for shock complicating AMI. Since the publication of the SHOCK trial and subsequent guideline recommendations, the increase in community-based use of percutaneous coronary intervention for this condition has resulted in a significant decline in mortality. Despite these successes in the past 15 years, mortality still remains exceptionally high, particularly in patients with refractory cardiogenic shock. In this Review, we discuss the aetiology and pathophysiology of cardiogenic shock and summarize the data on the available therapeutics and their limitations. Although new mechanical circulatory support devices have been shown to improve haemodynamic variables in patients with shock complicating AMI, they did not improve clinical outcomes and are associated with high costs and complications.

  9. Refractory Pellet for Hot Blast Stove

    Institute of Scientific and Technical Information of China (English)

    Wang Jing; Peng Xigao

    2011-01-01

    1 Scope This standard specifies the term,definition,classification,specification,technical requirements,test methods,quality appraisal procedures,packing,marking,transportation,storage,and quality certificate of refractory pellet for hot blast stove.This standard is applicable to refractory pellet for hot blast stove.

  10. Spectral reflecting characteristics of dinas refractory

    Energy Technology Data Exchange (ETDEWEB)

    Zapechnikov, V.N.; Pushkin, V.T.; Zen' kovskii, A.G.

    1987-09-01

    This article outlines a nondestructive testing format which uses spectral reflectance to assess the remaining service life, the thermal degradation, and the insulating effectiveness of refractories used as insulating liners in glass melters. Thermal as well as mechanical influences on the reflectance behavior of several refractories are discussed.

  11. Modern technologies of refractory glaucoma treatment. Review

    Directory of Open Access Journals (Sweden)

    A. Yu. Rascheskov

    2014-07-01

    Full Text Available this article presents a review of available literature concerning basic directions of refractory glaucoma treatment. the surgical management of refractory glaucoma is presented by two main groups of surgical techniques: filtering surgery (including surgery with the use of antimetabolites and implants and cyclodestructive procederes. types of glaucoma drainages are described, modern valve drainage system is presented.

  12. Research on High Performance New Refractories

    Institute of Scientific and Technical Information of China (English)

    Zhong Xiangchong

    2007-01-01

    @@ At the age of 86,Prof.Zhong Xiangchong has his new book-"Research on High Performance New Refractories" published by Henan Science and Technology Publishing House to commemorate his 65 years service in the refractories science and technology including the recent 6 years at High Temperature Ceramics Institute which he founded in Zhengzhou University in 2001.

  13. Case 40. Misdiagnosis of refractory macrocytic anemia.

    Science.gov (United States)

    Stringaris, Kate; Bain, Barbara

    2008-11-01

    A diagnosis of myelodysplastic syndrome, refractory anemia subtype, was made in an elderly Indian woman on the basis of a refractory macrocytic anemia with normal vitamin B(12) and folate assays, normal thyroid function, essentially normal liver function and normal cytogenetic analysis. Disease evolution revealed that the diagnosis was erroneous.

  14. How Social and Refractory Is the Social Psychological Refractory Period?

    Science.gov (United States)

    Wühr, Peter; Heuer, Herbert

    2017-07-01

    The social psychological refractory period (PRP) effect refers to an increase in RT to the second of two successive stimuli when another person responds to the first stimulus (shared dual-task condition) rather than when a single person responds to both stimuli (individual dual-task condition). We investigated (a) whether a social PRP effect would occur without explicit instruction concerning task priority and (b) whether there are crosstalk effects in the shared dual-task situation. We observed a strong PRP effect together with a small crosstalk effect in the individual dual-task condition, but in the shared dual-task condition both effects were absent. These findings suggest that the explicit instruction to perform responses in a fixed order is necessary to obtain the social PRP effect. In the individual dual-task condition, sequential processing can be seen as a means to reduce or prevent crosstalk effects, which is not necessary in the shared dual-task condition.

  15. REFRACTORY FOR BLACK LIQUOR GASIFIERS

    Energy Technology Data Exchange (ETDEWEB)

    William L. Headrick Jr; Musa Karakus; Jun Wei

    2005-03-01

    The University of Missouri-Rolla will identify materials that will permit the safe, reliable and economical operation of combined cycle gasifiers by the pulp and paper industry. The primary emphasis of this project will be to resolve the material problems encountered during the operation of low-pressure high-temperature (LPHT) and low-pressure low-temperature (LPLT) gasifiers while simultaneously understanding the materials barriers to the successful demonstration of high-pressure high-temperature (HPHT) black liquor gasifiers. This study will define the chemical, thermal and physical conditions in current and proposed gasifier designs and then modify existing materials and develop new materials to successfully meet the formidable material challenges. Resolving the material challenges of black liquor gasification combined cycle technology will provide energy, environmental, and economic benefits that include higher thermal efficiencies, up to three times greater electrical output per unit of fuel, and lower emissions. In the near term, adoption of this technology will allow the pulp and paper industry greater capital effectiveness and flexibility, as gasifiers are added to increase mill capacity. In the long term, combined-cycle gasification will lessen the industry's environmental impact while increasing its potential for energy production, allowing the production of all the mill's heat and power needs along with surplus electricity being returned to the grid. An added benefit will be the potential elimination of the possibility of smelt-water explosions, which constitute an important safety concern wherever conventional Tomlinson recovery boilers are operated. Developing cost-effective materials with improved performance in gasifier environments may be the best answer to the material challenges presented by black liquor gasification. Refractory materials may be selected/developed that either react with the gasifier environment to form protective

  16. Refractory for Black Liquor Gasifiers

    Energy Technology Data Exchange (ETDEWEB)

    William L. Headrick Jr; Musa Karakus; Xiaoting Laing

    2005-10-01

    The University of Missouri-Rolla will identify materials that will permit the safe, reliable and economical operation of combined cycle gasifiers by the pulp and paper industry. The primary emphasis of this project will be to resolve the material problems encountered during the operation of low-pressure high-temperature (LPHT) and low-pressure low-temperature (LPLT) gasifiers while simultaneously understanding the materials barriers to the successful demonstration of high-pressure high-temperature (HPHT) black liquor gasifiers. This study will define the chemical, thermal and physical conditions in current and proposed gasifier designs and then modify existing materials and develop new materials to successfully meet the formidable material challenges. Resolving the material challenges of black liquor gasification combined cycle technology will provide energy, environmental, and economic benefits that include higher thermal efficiencies, up to three times greater electrical output per unit of fuel, and lower emissions. In the near term, adoption of this technology will allow the pulp and paper industry greater capital effectiveness and flexibility, as gasifiers are added to increase mill capacity. In the long term, combined-cycle gasification will lessen the industry's environmental impact while increasing its potential for energy production, allowing the production of all the mill's heat and power needs along with surplus electricity being returned to the grid. An added benefit will be the potential elimination of the possibility of smelt-water explosions, which constitute an important safety concern wherever conventional Tomlinson recovery boilers are operated. Developing cost-effective materials with improved performance in gasifier environments may be the best answer to the material challenges presented by black liquor gasification. Refractory materials may be selected/developed that either react with the gasifier environment to form protective

  17. REFRACTORY FOR BLACK LIQUOR GASIFIERS

    Energy Technology Data Exchange (ETDEWEB)

    William L. Headrick Jr; Musa Karakus; Xiaoting Liang; Alireza Rezaie

    2004-10-01

    The University of Missouri-Rolla will identify materials that will permit the safe, reliable and economical operation of combined cycle gasifiers by the pulp and paper industry. The primary emphasis of this project will be to resolve the material problems encountered during the operation of low-pressure high-temperature (LPHT) and low-pressure low-temperature (LPLT) gasifiers while simultaneously understanding the materials barriers to the successful demonstration of high-pressure high-temperature (HPHT) black liquor gasifiers. This study will define the chemical, thermal and physical conditions in current and proposed gasifier designs and then modify existing materials and develop new materials to successfully meet the formidable material challenges. Resolving the material challenges of black liquor gasification combined cycle technology will provide energy, environmental, and economic benefits that include higher thermal efficiencies, up to three times greater electrical output per unit of fuel, and lower emissions. In the near term, adoption of this technology will allow the pulp and paper industry greater capital effectiveness and flexibility, as gasifiers are added to increase mill capacity. In the long term, combined-cycle gasification will lessen the industry's environmental impact while increasing its potential for energy production, allowing the production of all the mill's heat and power needs along with surplus electricity being returned to the grid. An added benefit will be the potential elimination of the possibility of smelt-water explosions, which constitute an important safety concern wherever conventional Tomlinson recovery boilers are operated. Developing cost-effective materials with improved performance in gasifier environments may be the best answer to the material challenges presented by black liquor gasification. Refractory materials may be selected/developed that either react with the gasifier environment to form protective

  18. REFRACTORY FOR BLACK LIQUOR GASIFIERS

    Energy Technology Data Exchange (ETDEWEB)

    William L. Headrick Jr; Musa Karakus; Xiaoting Liang; Jun Wei

    2005-04-01

    The University of Missouri-Rolla will identify materials that will permit the safe, reliable and economical operation of combined cycle gasifiers by the pulp and paper industry. The primary emphasis of this project will be to resolve the material problems encountered during the operation of low-pressure high-temperature (LPHT) and low-pressure low-temperature (LPLT) gasifiers while simultaneously understanding the materials barriers to the successful demonstration of high-pressure high-temperature (HPHT) black liquor gasifiers. This study will define the chemical, thermal and physical conditions in current and proposed gasifier designs and then modify existing materials and develop new materials to successfully meet the formidable material challenges. Resolving the material challenges of black liquor gasification combined cycle technology will provide energy, environmental, and economic benefits that include higher thermal efficiencies, up to three times greater electrical output per unit of fuel, and lower emissions. In the near term, adoption of this technology will allow the pulp and paper industry greater capital effectiveness and flexibility, as gasifiers are added to increase mill capacity. In the long term, combined-cycle gasification will lessen the industry's environmental impact while increasing its potential for energy production, allowing the production of all the mill's heat and power needs along with surplus electricity being returned to the grid. An added benefit will be the potential elimination of the possibility of smelt-water explosions, which constitute an important safety concern wherever conventional Tomlinson recovery boilers are operated. Developing cost-effective materials with improved performance in gasifier environments may be the best answer to the material challenges presented by black liquor gasification. Refractory materials may be selected/developed that either react with the gasifier environment to form protective

  19. REFRACTORY FOR BLACK LIQUOR GASIFIERS

    Energy Technology Data Exchange (ETDEWEB)

    William L. Headrick Jr; Musa Karakus; Xiaoting Liang; Jun Wei

    2005-01-01

    The University of Missouri-Rolla will identify materials that will permit the safe, reliable and economical operation of combined cycle gasifiers by the pulp and paper industry. The primary emphasis of this project will be to resolve the material problems encountered during the operation of low-pressure high-temperature (LPHT) and low-pressure low-temperature (LPLT) gasifiers while simultaneously understanding the materials barriers to the successful demonstration of high-pressure high-temperature (HPHT) black liquor gasifiers. This study will define the chemical, thermal and physical conditions in current and proposed gasifier designs and then modify existing materials and develop new materials to successfully meet the formidable material challenges. Resolving the material challenges of black liquor gasification combined cycle technology will provide energy, environmental, and economic benefits that include higher thermal efficiencies, up to three times greater electrical output per unit of fuel, and lower emissions. In the near term, adoption of this technology will allow the pulp and paper industry greater capital effectiveness and flexibility, as gasifiers are added to increase mill capacity. In the long term, combined-cycle gasification will lessen the industry's environmental impact while increasing its potential for energy production, allowing the production of all the mill's heat and power needs along with surplus electricity being returned to the grid. An added benefit will be the potential elimination of the possibility of smelt-water explosions, which constitute an important safety concern wherever conventional Tomlinson recovery boilers are operated. Developing cost-effective materials with improved performance in gasifier environments may be the best answer to the material challenges presented by black liquor gasification. Refractory materials may be selected/developed that either react with the gasifier environment to form protective

  20. Refractory for Black Liquor Gasifiers

    Energy Technology Data Exchange (ETDEWEB)

    William L. Headrick Jr; Musa Karakus; Xiaoting Liang

    2005-10-01

    The University of Missouri-Rolla identified materials that permit the safe, reliable and economical operation of combined cycle gasifiers by the pulp and paper industry. The primary emphasis of this project was to resolve the material problems encountered during the operation of low-pressure high-temperature (LPHT) and low-pressure low-temperature (LPLT) gasifiers while simultaneously understanding the materials barriers to the successful demonstration of high-pressure high-temperature (HPHT) black liquor gasifiers. This study attempted to define the chemical, thermal and physical conditions in current and proposed gasifier designs and then modify existing materials and develop new materials to successfully meet the formidable material challenges. Resolving the material challenges of black liquor gasification combined cycle technology will provide energy, environmental, and economic benefits that include higher thermal efficiencies, up to three times greater electrical output per unit of fuel, and lower emissions. In the near term, adoption of this technology will allow the pulp and paper industry greater capital effectiveness and flexibility, as gasifiers are added to increase mill capacity. In the long term, combined-cycle gasification will lessen the industry's environmental impact while increasing its potential for energy production, allowing the production of all the mill's heat and power needs along with surplus electricity being returned to the grid. An added benefit will be the potential elimination of the possibility of smelt-water explosions, which constitute an important safety concern wherever conventional Tomlinson recovery boilers are operated. Developing cost-effective materials with improved performance in gasifier environments may be the best answer to the material challenges presented by black liquor gasification. Refractory materials were selected/developed that either react with the gasifier environment to form protective surfaces in

  1. REFRACTORY FOR BLACK LIQUOR GASIFIERS

    Energy Technology Data Exchange (ETDEWEB)

    William L. Headrick Jr; Musa Karakus; Xiaoting Liang

    2005-07-01

    The University of Missouri-Rolla will identify materials that will permit the safe, reliable and economical operation of combined cycle gasifiers by the pulp and paper industry. The primary emphasis of this project will be to resolve the material problems encountered during the operation of low-pressure high-temperature (LPHT) and low-pressure low-temperature (LPLT) gasifiers while simultaneously understanding the materials barriers to the successful demonstration of high-pressure high-temperature (HPHT) black liquor gasifiers. This study will define the chemical, thermal and physical conditions in current and proposed gasifier designs and then modify existing materials and develop new materials to successfully meet the formidable material challenges. Resolving the material challenges of black liquor gasification combined cycle technology will provide energy, environmental, and economic benefits that include higher thermal efficiencies, up to three times greater electrical output per unit of fuel, and lower emissions. In the near term, adoption of this technology will allow the pulp and paper industry greater capital effectiveness and flexibility, as gasifiers are added to increase mill capacity. In the long term, combined-cycle gasification will lessen the industry's environmental impact while increasing its potential for energy production, allowing the production of all the mill's heat and power needs along with surplus electricity being returned to the grid. An added benefit will be the potential elimination of the possibility of smelt-water explosions, which constitute an important safety concern wherever conventional Tomlinson recovery boilers are operated. Developing cost-effective materials with improved performance in gasifier environments may be the best answer to the material challenges presented by black liquor gasification. Refractory materials may be selected/developed that either react with the gasifier environment to form protective

  2. Refractory for Black Liquor Gasifiers

    Energy Technology Data Exchange (ETDEWEB)

    William L. Headrick Jr; Alireza Rezaie; Xiaoting Liang; Musa Karakus; Jun Wei

    2005-12-01

    The University of Missouri-Rolla identified materials that permit the safe, reliable and economical operation of combined cycle gasifiers by the pulp and paper industry. The primary emphasis of this project was to resolve the material problems encountered during the operation of low-pressure high-temperature (LPHT) and low-pressure low-temperature (LPLT) gasifiers while simultaneously understanding the materials barriers to the successful demonstration of high-pressure high-temperature (HPHT) black liquor gasifiers. This study attempted to define the chemical, thermal and physical conditions in current and proposed gasifier designs and then modify existing materials and develop new materials to successfully meet the formidable material challenges. Resolving the material challenges of black liquor gasification combined cycle technology will provide energy, environmental, and economic benefits that include higher thermal efficiencies, up to three times greater electrical output per unit of fuel, and lower emissions. In the near term, adoption of this technology will allow the pulp and paper industry greater capital effectiveness and flexibility, as gasifiers are added to increase mill capacity. In the long term, combined-cycle gasification will lessen the industry's environmental impact while increasing its potential for energy production, allowing the production of all the mill's heat and power needs along with surplus electricity being returned to the grid. An added benefit will be the potential elimination of the possibility of smelt-water explosions, which constitute an important safety concern wherever conventional Tomlinson recovery boilers are operated. Developing cost-effective materials with improved performance in gasifier environments may be the best answer to the material challenges presented by black liquor gasification. Refractory materials were selected or developed that reacted with the gasifier environment to form protective surfaces in

  3. Refractory for Black Liquor Gasifiers

    Energy Technology Data Exchange (ETDEWEB)

    William L. Headrick; Musa Karakus; Alireza Rezaie

    2004-03-30

    The University of Missouri-Rolla will identify materials that will permit the safe, reliable and economical operation of combined cycle gasifiers by the pulp and paper industry. The primary emphasis of this project will be to resolve the material problems encountered during the operation of low-pressure high-temperature (LPHT) and low-pressure low-temperature (LPLT) gasifiers while simultaneously understanding the materials barriers to the successful demonstration of high-pressure high-temperature (HPHT) black liquor gasifiers. This study will define the chemical, thermal and physical conditions in current and proposed gasifier designs and then modify existing materials and develop new materials to successfully meet the formidable material challenges. Resolving the material challenges of black liquor gasification combined cycle technology will provide energy, environmental, and economic benefits that include higher thermal efficiencies, up to three times greater electrical output per unit of fuel, and lower emissions. In the near term, adoption of this technology will allow the pulp and paper industry greater capital effectiveness and flexibility, as gasifiers are added to increase mill capacity. In the long term, combined-cycle gasification will lessen the industry's environmental impact while increasing its potential for energy production, allowing the production of all the mill's heat and power needs along with surplus electricity being returned to the grid. An added benefit will be the potential elimination of the possibility of smelt-water explosions, which constitute an important safety concern wherever conventional Tomlinson recovery boilers are operated. Developing cost-effective materials with improved performance in gasifier environments may be the best answer to the material challenges presented by black liquor gasification. Refractory materials may be selected/developed that either react with the gasifier environment to form protective

  4. Refractory for Black Liquor Gasifiers

    Energy Technology Data Exchange (ETDEWEB)

    William L. Headrick Jr; Alireza Rezaie

    2003-08-01

    The University of Missouri-Rolla will identify materials that will permit the safe, reliable and economical operation of combined cycle gasifiers by the pulp and paper industry. The primary emphasis of this project will be to resolve the materials problems encountered during the operation of low-pressure high-temperature (LFHT) and low-pressure low-temperature (LPLT) gasifiers while simultaneously understanding the materials barriers to the successful demonstration of high-pressure high-temperature (HPHT) black liquor gasifiers. This study will define the chemical, thermal and physical conditions in current and proposed gasifier designs and then modify existing materials and develop new materials to successfully meet the formidable material challenges. Resolving the material challenges of black liquor gasification combined cycle technology will provide energy, environmental, and economic benefits that include higher thermal efficiencies, up to three times greater electrical output per unit of fuel, and lower emissions. In the near term, adoption of this technology will allow the pulp and paper industry greater capital effectiveness and flexibility, as gasifiers are added to increase mill capacity. In the long term, combined-cycle gasification will lessen the industry's environmental impact while increasing its potential for energy production, allowing the production of all the mill's heat and power needs along with surplus electricity being returned to the grid. An added benefit will be the potential elimination of the possibility of smelt-water explosions, which constitute an important safety concern wherever conventional Tomlinson recovery boilers are operated. Developing cost-effective materials with improved performance in gasifier environments may be the best answer to the material challenges presented by black liquor gasification. Refractory materials may be selected/developed that either react with the gasifier environment to form protective

  5. Refractory for Black Liquor Gasifiers

    Energy Technology Data Exchange (ETDEWEB)

    William L. Headrick Jr; Alireza Rezaie

    2003-12-01

    The University of Missouri-Rolla will identify materials that will permit the safe, reliable and economical operation of combined cycle gasifiers by the pulp and paper industry. The primary emphasis of this project will be to resolve the materials problems encountered during the operation of low-pressure high-temperature (LFHT) and low-pressure low-temperature (LPLT) gasifiers while simultaneously understanding the materials barriers to the successful demonstration of high-pressure high-temperature (HPHT) black liquor gasifiers. This study will define the chemical, thermal and physical conditions in current and proposed gasifier designs and then modify existing materials and develop new materials to successfully meet the formidable material challenges. Resolving the material challenges of black liquor gasification combined cycle technology will provide energy, environmental, and economic benefits that include higher thermal efficiencies, up to three times greater electrical output per unit of fuel, and lower emissions. In the near term, adoption of this technology will allow the pulp and paper industry greater capital effectiveness and flexibility, as gasifiers are added to increase mill capacity. In the long term, combined-cycle gasification will lessen the industry's environmental impact while increasing its potential for energy production, allowing the production of all the mill's heat and power needs along with surplus electricity being returned to the grid. An added benefit will be the potential elimination of the possibility of smelt-water explosions, which constitute an important safety concern wherever conventional Tomlinson recovery boilers are operated. Developing cost-effective materials with improved performance in gasifier environments may be the best answer to the material challenges presented by black liquor gasification. Refractory materials may be selected/developed that either react with the gasifier environment to form protective

  6. REFRACTORY FOR BLACK LIQUOR GASIFIERS

    Energy Technology Data Exchange (ETDEWEB)

    William L. Headrick Jr; Musa Karakus; Xiaoting Liang; Alireza Rezaie

    2004-07-01

    The University of Missouri-Rolla will identify materials that will permit the safe, reliable and economical operation of combined cycle gasifiers by the pulp and paper industry. The primary emphasis of this project will be to resolve the material problems encountered during the operation of low-pressure high-temperature (LPHT) and low-pressure low-temperature (LPLT) gasifiers while simultaneously understanding the materials barriers to the successful demonstration of high-pressure high-temperature (HPHT) black liquor gasifiers. This study will define the chemical, thermal and physical conditions in current and proposed gasifier designs and then modify existing materials and develop new materials to successfully meet the formidable material challenges. Resolving the material challenges of black liquor gasification combined cycle technology will provide energy, environmental, and economic benefits that include higher thermal efficiencies, up to three times greater electrical output per unit of fuel, and lower emissions. In the near term, adoption of this technology will allow the pulp and paper industry greater capital effectiveness and flexibility, as gasifiers are added to increase mill capacity. In the long term, combined-cycle gasification will lessen the industry's environmental impact while increasing its potential for energy production, allowing the production of all the mill's heat and power needs along with surplus electricity being returned to the grid. An added benefit will be the potential elimination of the possibility of smelt-water explosions, which constitute an important safety concern wherever conventional Tomlinson recovery boilers are operated. Developing cost-effective materials with improved performance in gasifier environments may be the best answer to the material challenges presented by black liquor gasification. Refractory materials may be selected/developed that either react with the gasifier environment to form protective

  7. REFRACTORY FOR BLACK LIQUOR GASIFIERS

    Energy Technology Data Exchange (ETDEWEB)

    William L. Headrick Jr.; Alireza Rezaie

    2004-04-01

    The University of Missouri-Rolla will identify materials that will permit the safe, reliable and economical operation of combined cycle gasifiers by the pulp and paper industry. The primary emphasis of this project will be to resolve the materials problems encountered during the operation of low-pressure high-temperature (LPHT) and low-pressure low-temperature (LPLT) gasifiers while simultaneously understanding the materials barriers to the successful demonstration of high-pressure high-temperature (HPHT) black liquor gasifiers. This study will define the chemical, thermal and physical conditions in current and proposed gasifier designs and then modify existing materials and develop new materials to successfully meet the formidable material challenges. Resolving the material challenges of black liquor gasification combined cycle technology will provide energy, environmental, and economic benefits that include higher thermal efficiencies, up to three times greater electrical output per unit of fuel, and lower emissions. In the near term, adoption of this technology will allow the pulp and paper industry greater capital effectiveness and flexibility, as gasifiers are added to increase mill capacity. In the long term, combined-cycle gasification will lessen the industry's environmental impact while increasing its potential for energy production, allowing the production of all the mill's heat and power needs along with surplus electricity being returned to the grid. An added benefit will be the potential elimination of the possibility of smelt-water explosions, which constitute an important safety concern wherever conventional Tomlinson recovery boilers are operated. Developing cost-effective materials with improved performance in gasifier environments may be the best answer to the material challenges presented by black liquor gasification. Refractory materials may be selected/developed that either react with the gasifier environment to form protective

  8. Refractory for Black Liquor Gasifiers

    Energy Technology Data Exchange (ETDEWEB)

    Robert E. Moore; William L. Headrick; Alireza Rezaie

    2003-03-31

    The University of Missouri-Rolla will identify materials that will permit the safe, reliable and economical operation of combined cycle gasifiers by the pulp and paper industry. The primary emphasis of this project will be to resolve the materials problems encountered during the operation of low-pressure high-temperature (LFHT) and low-pressure low-temperature (LPLT) gasifiers while simultaneously understanding the materials barriers to the successful demonstration of high-pressure high-temperature (HPHT) black liquor gasifiers. This study will define the chemical, thermal and physical conditions in current and proposed gasifier designs and then modify existing materials and develop new materials to successfully meet the formidable material challenges. Resolving the material challenges of black liquor gasification combined cycle technology will provide energy, environmental, and economic benefits that include higher thermal efficiencies, up to three times greater electrical output per unit of fuel, and lower emissions. In the near term, adoption of this technology will allow the pulp and paper industry greater capital effectiveness and flexibility, as gasifiers are added to increase mill capacity. In the long term, combined-cycle gasification will lessen the industry's environmental impact while increasing its potential for energy production, allowing the production of all the mill's heat and power needs along with surplus electricity being returned to the grid. An added benefit will be the potential elimination of the possibility of smelt-water explosions, which constitute an important safety concern wherever conventional Tomlinson recovery boilers are operated. Developing cost-effective materials with improved performance in gasifier environments may be the best answer to the material challenges presented by black liquor gasification. Refractory materials may be selected/developed that either react with the gasifier environment to form protective

  9. REFRACTORY FOR BLACK LIQUOR GASIFIERS

    Energy Technology Data Exchange (ETDEWEB)

    William L. Headrick Jr.; Alireza Rezaie

    2003-12-01

    The University of Missouri-Rolla will identify materials that will permit the safe, reliable and economical operation of combined cycle gasifiers by the pulp and paper industry. The primary emphasis of this project will be to resolve the materials problems encountered during the operation of low-pressure high-temperature (LFHT) and low-pressure low-temperature (LPLT) gasifiers while simultaneously understanding the materials barriers to the successful demonstration of high-pressure high-temperature (HPHT) black liquor gasifiers. This study will define the chemical, thermal and physical conditions in current and proposed gasifier designs and then modify existing materials and develop new materials to successfully meet the formidable material challenges. Resolving the material challenges of black liquor gasification combined cycle technology will provide energy, environmental, and economic benefits that include higher thermal efficiencies, up to three times greater electrical output per unit of fuel, and lower emissions. In the near term, adoption of this technology will allow the pulp and paper industry greater capital effectiveness and flexibility, as gasifiers are added to increase mill capacity. In the long term, combined-cycle gasification will lessen the industry's environmental impact while increasing its potential for energy production, allowing the production of all the mill's heat and power needs along with surplus electricity being returned to the grid. An added benefit will be the potential elimination of the possibility of smelt-water explosions, which constitute an important safety concern wherever conventional Tomlinson recovery boilers are operated. Developing cost-effective materials with improved performance in gasifier environments may be the best answer to the material challenges presented by black liquor gasification. Refractory materials may be selected/developed that either react with the gasifier environment to form protective

  10. Primordial Compositions of Refractory Inclusions

    Energy Technology Data Exchange (ETDEWEB)

    Grossman, L; Simon, S B; Rai, V K; Thiemens, M H; Hutcheon, I D; Williams, R W; Galy, A; Ding, T; Fedkin, A V; Clayton, R N; Mayeda, T K

    2008-02-20

    Bulk chemical and oxygen, magnesium and silicon isotopic compositions were measured for each of 17 Types A and B refractory inclusions from CV3 chondrites. After bulk chemical compositions were corrected for non-representative sampling in the laboratory, the Mg and Si isotopic compositions of each inclusion were used to calculate its original chemical composition assuming that the heavy-isotope enrichments of these elements are due to Rayleigh fractionation that accompanied their evaporation from CMAS liquids. The resulting pre-evaporation chemical compositions are consistent with those predicted by equilibrium thermodynamic calculations for high-temperature nebular condensates but only if different inclusions condensed from nebular regions that ranged in total pressure from 10{sup -6} to 10{sup -1} bar, regardless of whether they formed in a system of solar composition or in one enriched in OC dust relative to gas by a factor of ten relative to solar composition. This is similar to the range of total pressures predicted by dynamic models of the solar nebula for regions whose temperatures are in the range of silicate condensation temperatures. Alternatively, if departure from equilibrium condensation and/or non-representative sampling of condensates in the nebula occurred, the inferred range of total pressure could be smaller. Simple kinetic modeling of evaporation successfully reproduces observed chemical compositions of most inclusions from their inferred pre-evaporation compositions, suggesting that closed-system isotopic exchange processes did not have a significant effect on their isotopic compositions. Comparison of pre-evaporation compositions with observed ones indicates that 80% of the enrichment in refractory CaO + Al{sub 2}O{sub 3} relative to more volatile MgO + SiO{sub 2} is due to initial condensation and 20% due to subsequent evaporation for both Type A and Type B inclusions.

  11. Refractories for Industrial Processing. Opportunities for Improved Energy Efficiency

    Energy Technology Data Exchange (ETDEWEB)

    Hemrick, James G. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Hayden, H. Wayne [Metals Manufacture Process and Controls Technology, Inc., Oak Ridge, TN (United States); Angelini, Peter [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Moore, Robert E. [R.E. Moore Associates, Maricopa, AZ (United States); Headrick, William L. [R.E. Moore Associates, Maricopa, AZ (United States)

    2005-01-01

    Refractories are a class of materials of critical importance to manufacturing industries with high-temperature unit processes. This study describes industrial refractory applications and identifies refractory performance barriers to energy efficiency for processing. The report provides recommendations for R&D pathways leading to improved refractories for energy-efficient manufacturing and processing.

  12. Fireclay Refractory Bricks for Hot Blast Stove

    Institute of Scientific and Technical Information of China (English)

    Wang Jing; Zhang Yongfang; Chai Junlan

    2008-01-01

    @@ 1 Scope This standard specifies the classification, shape, dimension, technical requirements, test method,inspection rules, packing, marking,transportation,storage and quality certification of fireclay refractory bricks for hot blast stove.

  13. Spalling Resistance Fast-drying Refractory Castables

    Institute of Scientific and Technical Information of China (English)

    Wang Jing; Peng Xigao

    2010-01-01

    @@ 1 Scope This standard specifies the term and definition,classification, technical requirements, test methods,quality appraisal procedures, packing, marking, transportation, storage, and quality certificate of spalling resistance fast-drying refractory castables.

  14. Ultra High Temperature Refractory Materials Project

    Data.gov (United States)

    National Aeronautics and Space Administration — Legacy refractory materials that have origins dating to the original Saturn program are commonly used in current launch facilities. Although they failure to meet the...

  15. Ultra High Temperature Refractory Materials Project

    Data.gov (United States)

    National Aeronautics and Space Administration — Legacy refractory materials that have origins dating to the original Saturn program are commonly used in current launch facilities. Although they fail to meet the...

  16. Alumina Carbon Refractory Products for Continuous Casting

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    @@ 1 Scope This standard specifies the classification.techni-cal requirements,test methods,inspection rules,packing,marking,transportation,storage and quality certificate of alumina carbon refractory products for continuous casting.

  17. Testing Consent Order on Refractory Ceramic Fibers

    Science.gov (United States)

    This notice announces that EPA has signed signed an enforceable testing consent order under the Toxic Substances Control Act (TSCA), 15 U.S.C. section 2601 at seq., with three of the primary producers of refractory ceramic fibers (RCF).

  18. Emergency coronary angioplasty in refractory unstable angina

    NARCIS (Netherlands)

    P.J. de Feyter (Pim); P.W.J.C. Serruys (Patrick); M.J.B.M. van den Brand (Marcel); K. Balakumaran (Kulasekaram); A.L. Soward; P.G. Hugenholtz (Paul); A.E.R. Arnold (Alfred); B. Mochtar (Bas)

    1985-01-01

    textabstractWe performed percutaneous transluminal coronary angioplasty as an emergency procedure in 60 patients with unstable angina pectoris that was refractory to treatment with maximally tolerated doses of beta-blockers, calcium antagonists, and intravenous nitroglycerin. The initial success

  19. Prognostic Factors for Refractory Status Epilepticus

    Directory of Open Access Journals (Sweden)

    J. Gordon Millichap

    2013-03-01

    Full Text Available Researchers at the Mayo Clinic, Rochester, MN studied the outcome and identified prognostic factors for refractory status epilepticus (RSE in 54 adult patients, median age 52 years [range 18-93].

  20. Situation of China's Refractories Industry in Last Sixty Years

    Institute of Scientific and Technical Information of China (English)

    HUO Jiangping; PAN Shangxin; LI Chaowen

    2009-01-01

    The annual output of China's refractories in 1949 was 74 thousand tons, and was 29.11 million tons in 2007, which was 65% of the world total refractories output. The export of China's refractory products and raw materials in 2008 was 6.18 million tons, which were exported to hundreds of countries and regions in the world. China is a big country in the field of refractories production and refractories export, which has devoted a lot to relative high temperature industry.

  1. Method of making a composite refractory material

    Science.gov (United States)

    Morrow, Marvin S.; Holcombe, Cressie E.

    1995-01-01

    A composite refractory material is prepared by combining boron carbide with furan resin to form a mixture containing about 8 wt. % furan resin. The mixture is formed into a pellet which is placed into a grit pack comprising an oxide of an element such as yttrium to form a sinterable body. The sinterable body is sintered under vacuum with microwave energy at a temperature no greater than 2000.degree. C. to form a composite refractory material.

  2. The modified atkins diet in refractory epilepsy.

    Science.gov (United States)

    Sharma, Suvasini; Jain, Puneet

    2014-01-01

    The modified Atkins diet is a less restrictive variation of the ketogenic diet. This diet is started on an outpatient basis without a fast, allows unlimited protein and fat, and does not restrict calories or fluids. Recent studies have shown good efficacy and tolerability of this diet in refractory epilepsy. In this review, we discuss the use of the modified Atkins diet in refractory epilepsy.

  3. Neuromodulation in refractory epilepsy: Brazilian specialists consensus

    Directory of Open Access Journals (Sweden)

    Vera Cristina Terra

    Full Text Available ABSTRACT Epilepsy is a potentially devastating brain disorder characterized by a predisposition to spontaneous epileptic seizures. In patients with medically refractory epilepsy, new non-pharmacological therapeutic approaches may be considered. In this scenario, palliative surgery such as vagus nerve stimulation (VNS or deep brain stimulation (DBS may be indicated in a subset of patients. In this paper we make recommendations for the use of VNS and DBS in patients in Brazil with refractory epilepsy.

  4. The Modified Atkins Diet in Refractory Epilepsy

    Directory of Open Access Journals (Sweden)

    Suvasini Sharma

    2014-01-01

    Full Text Available The modified Atkins diet is a less restrictive variation of the ketogenic diet. This diet is started on an outpatient basis without a fast, allows unlimited protein and fat, and does not restrict calories or fluids. Recent studies have shown good efficacy and tolerability of this diet in refractory epilepsy. In this review, we discuss the use of the modified Atkins diet in refractory epilepsy.

  5. Refractory migraine in a headache clinic population

    Directory of Open Access Journals (Sweden)

    Fernandez-Torron Roberto

    2011-08-01

    Full Text Available Abstract Background Many migraineurs who seek care in headache clinics are refractory to treatment, despite advances in headache therapies. Epidemiology is poorly characterized, because diagnostic criteria for refractory migraine were not available until recently. We aimed to determine the frequency of refractory migraine in patients attended in the Headache Unit in a tertiary care center, according to recently proposed criteria. Methods The study population consisted of a consecutive sample of 370 patients (60.8% females with a mean age of 43 years (range 14-86 evaluated for the first time in our headache unit over a one-year period (between October 2008 and October 2009. We recorded information on clinical features, previous treatments, Migraine Disability Assessment Score (MIDAS, and final diagnosis. Results Overall migraine and tension-type headache were found in 46.4% and 20.5% of patients, respectively. Refractory migraine was found in 5.1% of patients. In refractory migraineurs, the mean MIDAS score was 96, and 36.8% were medication-overusers. Conclusions Refractory migraine is a relatively common and very disabling condition between the patients attended in a headache unit. The proposed operational criteria may be useful in identifying those patients who require care in headache units, the selection of candidates for combinations of prophylactic drugs or invasive treatments such as neurostimulation, but also to facilitate clinical studies in this patient group.

  6. REFRACTORY THROMBOCYTOPENIA AND NEUTROPENIA: A DIAGNOSTIC CHALLENGE

    Directory of Open Access Journals (Sweden)

    Emmanuel Gyan

    2015-02-01

    Full Text Available Background. The 2008 WHO classification identified refractory cytopenia with unilineage dysplasia (RCUD as a composite entity encompassing refractory anemia, refractory thrombocytopenia (RT, and refractory neutropenia (RN, characterized by 10% or more dysplastic cells in the bone marrow respective lineage. The diagnosis of RT and RN is complicated by several factors.  Diagnosing RT first requires exclusion of familial thrombocytopenia, chronic auto-immune thrombocytopenia, concomitant medications, viral infections, or hypersplenism. Diagnosis of RN should also be made after ruling out differential diagnoses such as ethnic or familial neutropenia, as well as acquired, drug-induced, infection-related or malignancy-related neutropenia. An accurate quantification of dysplasia should be performed in order to distinguish RT or RN from the provisional entity named idiopathic cytopenia of unknown significance (ICUS. Cytogenetic analysis, and possibly in the future somatic mutation analysis (of genes most frequently mutated in MDS, and flow cytometry analysis aberrant antigen expression on myeloid cells may help in this differential diagnosis. Importantly, we and others found that, while isolated neutropenia and thrombocytopenia are not rare in MDS, those patients can generally be classified (according to WHO 2008 classification as refractory cytopenia with multilineage dysplasia or refractory anemia with excess blasts, while RT and RN (according to WHO 2008 are quite rare.These results suggest in particular that identification of RT and RN as distinct entities could be reconsidered in future WHO classification updates.

  7. Advances in Modern Refractory Castables

    Institute of Scientific and Technical Information of China (English)

    ZHOU Ningsheng; HU Shuhe; ZHANG Sanhua

    2004-01-01

    Recent developments in terms of binding system, new material system, installation method and pre-cast shapes of refractory castables are introduced and discussed. In authors view, binding system is advancing on the one hand towards "purification" to minimize impurity components from binder materials, and on the other hand "stabilization" to minimize the structure destroy by volatility and decomposition of binder materials. Challenges of higher service temperature, slag resistance, clean steel production and better thermal shock resistance have promoted the booming of new varieties of castables including MgObased, natural flake graphite containing and non-oxides like Si3 N4, AlON and SiAlON containing castables. Installation technique is developing towards convenience,simplification and high efficiency. Advancement in installation and dry-out is of an incentive to the boost of selfflow castables, shotcreting castables, infiltration casting,quick dry-out castables and pre-cast shapes. Along with the increased adoption of pre-cast shapes of castables, the boundary between "shaped" and "unshaped" is becoming vague.

  8. Advances in Modern Refractory Castables

    Institute of Scientific and Technical Information of China (English)

    ZHOUNingsheng; HUShuhe; ZHANGSanhua

    2004-01-01

    Recent developments in terms of binding system, new material system, installation method and pre-cast shapes of refractory castables are introduced and discussed. In authors' view, binding system is advancing on the one hand towards "purification" to minimize impurity components from binder materials, and on the other hand "stabilization" to minimize the structure destroy by volatility and decomposition of binder materials. Challenges of higher service temperature, slag resistance, clean steel production and better thermal shock resistance have promoted the booming of new varieties of castables including MgO based, natural flake graphite containing and non-oxides like Sis N4, AION and SIMON containing castables. Installation technique is developing towards convenience, simplification and high efficiency. Advancement in installation and dry-out is of an incentive to the boost of selfflow castables, shotcreting castables, infiltration casting, quick dry-out castables and pre-cast shapes. Along wit hthe increased adoption of pre-cast shapes of castables, the boundary between "shaped" and " unshaped " is becoming vague.

  9. VNS for refractory status epilepticus.

    Science.gov (United States)

    Zeiler, F A; Zeiler, K J; Teitelbaum, J; Gillman, L M; West, M

    2015-05-01

    Our goal was to perform a systematic review of the literature on the insertion of vagal nerve stimulators (VNS) for refractory status epilepticus (RSE) and its impact on the control of RSE. All articles from MEDLINE, BIOSIS, EMBASE, Global Health, HealthStar, Scopus, Cochrane Library, the International Clinical Trials Registry Platform, clinicaltrials.gov (inception to June 2014), reference lists of relevant articles, and gray literature were searched. The strength of evidence was adjudicated using both the Oxford and GRADE methodology by two independent reviewers (FZ and MW). Overall, 17 studies were identified, with 7 manuscripts and 10 meeting abstracts. A total of 28 patients were treated. In those with generalized RSE, 76% displayed cessation of RSE with VNS insertion. In cases of focal RSE, 25% responded to VNS insertion. Few adverse effects related to VNS insertion were described. We currently cannot recommend the use of VNS for RSE. Oxford level 4, GRADE D evidence exists to suggest improvement in seizure control with the use of urgent VNS in generalized RSE. No comments can be made on the utility of VNS in focal RSE. Further prospective study is warranted. Copyright © 2015 Elsevier B.V. All rights reserved.

  10. T-cell-specific deletion of Mof blocks their differentiation and results in genomic instability in mice.

    Science.gov (United States)

    Gupta, Arun; Hunt, Clayton R; Pandita, Raj K; Pae, Juhee; Komal, K; Singh, Mayank; Shay, Jerry W; Kumar, Rakesh; Ariizumi, Kiyoshi; Horikoshi, Nobuo; Hittelman, Walter N; Guha, Chandan; Ludwig, Thomas; Pandita, Tej K

    2013-05-01

    Ataxia telangiectasia patients develop lymphoid malignancies of both B- and T-cell origin. Similarly, ataxia telangiectasia mutated (Atm)-deficient mice exhibit severe defects in T-cell maturation and eventually develop thymomas. The function of ATM is known to be influenced by the mammalian orthologue of the Drosophila MOF (males absent on the first) gene. Here, we report the effect of T-cell-specific ablation of the mouse Mof (Mof) gene on leucocyte trafficking and survival. Conditional Mof(Flox/Flox) (Mof (F/F)) mice expressing Cre recombinase under control of the T-cell-specific Lck proximal promoter (Mof(F/F)/Lck-Cre(+)) display a marked reduction in thymus size compared with Mof(F/F)/Lck-Cre(-) mice. In contrast, the spleen size of Mof(F/F)/Lck-Cre(+) mice was increased compared with control Mof(F/F)/Lck-Cre(-) mice. The thymus of Mof(F/F)/Lck-Cre(+) mice contained significantly reduced T cells, whereas thymic B cells were elevated. Within the T-cell population, CD4(+)CD8(+) double-positive T-cell levels were reduced, whereas the immature CD4(-)CD8(-) double-negative (DN) population was elevated. Defective T-cell differentiation is also evident as an increased DN3 (CD44(-)CD25(+)) population, the cell stage during which T-cell receptor rearrangement takes place. The differentiation defect in T cells and reduced thymus size were not rescued in a p53-deficient background. Splenic B-cell distributions were similar between Mof(F/F)/Lck-Cre(+) and Mof(F/F)/Lck-Cre(-) mice except for an elevation of the κ light-chain population, suggestive of an abnormal clonal expansion. T cells from Mof(F/F)/Lck-Cre(+) mice did not respond to phytohaemagglutinin (PHA) stimulation, whereas LPS-stimulated B cells from Mof(F/F)/Lck-Cre(+) mice demonstrated spontaneous genomic instability. Mice with T-cell-specific loss of MOF had shorter lifespans and decreased survival following irradiation than did Mof(F/F)/Lck-Cre(-) mice. These observations suggest that Mof plays a critical

  11. Analysis on the Causes for Refractory GERD

    Institute of Scientific and Technical Information of China (English)

    陈婕; 许军英; 徐勇; 谢小平; 易粹琼; 侯晓华

    2002-01-01

    To analyze the causes of failure in conventional treatment to refractory gastroesophageal reflux diseases (GERD) patients, 16 refractory GERD patients (group R) and 16 eases of GERD primarily diagnosed (group P) were studied. Endoscopy, pathologic examination and 14C urea breath test were conducted in every patient. 24 h ambulatory pH and bilirubin monitoring were performed with Digitrapper MI Ⅲ and Synetics Bilitec 2000. It was found that esophagitis in group R was more severe than in group P. The rate of Helicobacter pylori infection in group R was significantly lower than in group P. Fraction time pH below 4. 00 was not longer while the bile reflux represented by fraction time abs above 0. 14 was greater for patients in the group R as compared with those in the group P. The mixed refluxes and pure bile refluxes between the two groups had significant difference. The reflux episodes in the group R mainly occurred during nights. These results indicated that severe esophagitis, especially Barrett's esophagus with complications makes it difficult to control GERD. Severe duodenogastroesophageal refluxes (DGER) are often accompanied by refractory GERD. Mixed refluxes aggravate the esophageal injuries. Pure bile refluxes and nocturnal refluxes may cause failure of administration of proton pump inhibitors (PPI) in the morning. Helicobacter pylori infection and acid refluxes may not be the direct cause of refractoriness. Individual refractory GERD patient without abnormal results on pH or bile reflux recently should be diagnosed again.

  12. Identification of platelet refractoriness in oncohematologic patients

    Directory of Open Access Journals (Sweden)

    Aline Aparecida Ferreira

    2011-01-01

    Full Text Available OBJECTIVES: To identify the occurrence and the causes of platelet refractoriness in oncohematologic patients. INTRODUCTION: Platelet refractoriness (unsatisfactory post-transfusion platelet increment is a severe problem that impairs the treatment of oncohematologic patients and is not routinely investigated in most Brazilian services. METHODS: Forty-four episodes of platelet concentrate transfusion were evaluated in 16 patients according to the following parameters: corrected count increment, clinical conditions and detection of anti-platelet antibodies by the platelet immunofluorescence test (PIFT and panel reactive antibodies against human leukocyte antigen class I (PRA-HLA. RESULTS: Of the 16 patients evaluated (median age: 53 years, nine (56% were women, seven of them with a history of pregnancy. An unsatisfactory increment was observed in 43% of the transfusion events, being more frequent in transfusions of random platelet concentrates (54%. Platelet refractoriness was confirmed in three patients (19%, who presented immunologic and non-immunologic causes. Alloantibodies were identified in eight patients (50% by the PIFT and in three (19% by the PRA-HLA. Among alloimmunized patients, nine (64% had a history of transfusion, and three as a result of pregnancy (43%. Of the former, two were refractory (29%. No significant differences were observed, probably as a result of the small sample size. CONCLUSION: The high rate of unsatisfactory platelet increment, refractoriness and alloimmunization observed support the need to set up protocols for the investigation of this complication in all chronically transfused patients, a fundamental requirement for the guarantee of adequate management.

  13. Refractory Behaviors of Magnetite-Kaolin Bricks

    Science.gov (United States)

    Adeosun, S. O.; Akpan, E. I.; Gbenebor, O. P.; Taiwo, O. O.; Eke, I. J.

    2016-11-01

    In this work, the suitability of using kaolin-magnetite-plastic clay to produce refractory bricks has been experimentally explored. Thirty bricks of different compositions were produced and fired at 1200°C. The density, shrinkage moisture content, loss on ignition, porosity and permeability of the bricks were examined. Results show that the bricks remained stable during firing and thus possess good insulating characteristics. The highest (2.23 g/cm3) and lowest (2.00 g/cm3) bulk densities obtained in this study are higher than the highest bulk density reported for Al dross-filled refractories (1.23 g/cm3). The bricks also possessed very low effective moisture content (10-23%) and very high compression modulus (16-100 MPa) desirable in insulating refractory bricks with high resistance to abrasion.

  14. Dramatic response to infliximab in refractory neurosarcoidosis

    Directory of Open Access Journals (Sweden)

    Chintamaneni Sreekanth

    2010-01-01

    Full Text Available Sarcoidosis is a systemic disease characterized by noncaseating granulomas in the involved organs. Neurologic manifestations involving the central and/or peripheral nervous system occur in about 5% of patients. Neurosarcoidosis is often refractory to conventional treatment and therefore more effective treatment options are needed. While the etiology of the disease is still unknown, there is now a better understanding of its pathogenesis on a molecular level. It is clear that tumor necrosis factor-α (TNFα plays a pivotal role in the development of the granulomas and it is believed to be a key cytokine involved in the pathogenesis of the disease. Taking advantage of this better understanding of disease pathogenesis, anti-TNFα agents are being increasingly used to treat refractory sarcoidosis. We report a patient with refractory neurosarcoidosis who showed dramatic improvement in the clinical and radiological manifestations following treatment with infliximab; he suffered a relapse upon discontinuation of the medication.

  15. Topical cidofovir for refractory verrucae in children.

    Science.gov (United States)

    Gupta, Monique; Bayliss, Susan J; Berk, David R

    2013-01-01

    Warts are common and are a challenge to treat in some children, especially immunocompromised children and those who fail or cannot tolerate salicylic acid preparations and cryotherapy. Cidofovir, a nucleotide analogue with antiviral activity, has demonstrated promising results when compounded into a topical form to treat refractory warts. We present a retrospective institutional review of 12 children with refractory verrucae treated with 1% to 3% topical cidofovir compounded in an unscented moisturizing cream, applied every other day to daily. In our institutional series, only three patients (25%) demonstrated complete clearance of their verrucae. An additional four patients (33%) demonstrated partial clearance. Our experience using topical cidofovir has been less successful than previous institutional reviews, possibly because we used a lower concentration and less-frequent dosing. More studies are needed to better characterize the efficacy, safety, and dosing of topical cidofovir for the treatment of refractory warts.

  16. Office Procedures in Refractory Chronic Rhinosinusitis.

    Science.gov (United States)

    Thamboo, Andrew; Patel, Zara M

    2017-02-01

    Office procedures in chronic rhinosinusitis (CRS) can be considered before and after medical management, as well as before and after surgical management. This article focuses specifically on refractory CRS, meaning those patients who have failed medical and surgical management already. The options available in the management of refractory CRS depend on the personnel, equipment, and instrumentation available in the office setting; surgeon experience; and patient suitability and tolerability. This article provides readers with possible procedural options that can be done in their clinics with indications, patient selection, potential complications, and postoperative considerations.

  17. Refractory Materials for Flame Deflector Protection System Corrosion Control: Refractory Ceramics Literature Survey

    Science.gov (United States)

    Calle, Luz Marina; Hintze, Paul E.; Parlier, Christopher R.; Curran, Jerome P.; Kolody, Mark; Perusich, Stephen; Whitten, Mary C.; Trejo, David; Zidek, Jason; Sampson, Jeffrey W.; Coffman, Brekke E.

    2009-01-01

    Ceramics can be defmed as a material consisting of hard brittle properties produced from inorganic and nonmetallic minerals made by firing at high temperatures. These materials are compounds between metallic and nonmetallic elements and are either totally ionic, or predominately ionic but having some covalent character. This definition allows for a large range of materials, not all applicable to refractory applications. As this report is focused on potential ceramic materials for high temperature, aggressive exposure applications, the ceramics reviewed as part of this report will focus on refractory ceramics specifically designed and used for these applications. Ceramic materials consist of a wide variety of products. Callister (2000) 1 characterized ceramic materials into six classifications: glasses, clay products, refractories, cements, abrasives, and advanced ceramics. Figure 1 shows this classification system. This review will focus mainly on refractory ceramics and cements as in general, the other classifications are neither applicable nor economical for use in large structures such as the flame trench. Although much work has been done in advanced ceramics over the past decade or so, these materials are likely cost prohibitive and would have to be fabricated off-site, transported to the NASA facilities, and installed, which make these even less feasible. Although the authors reviewed the literature on advanced ceramic refractories 2 center dot 3 center dot 4 center dot 5 center dot 6 center dot 7 center dot 8 center dot 9 center dot 10 center dot 11 center dot 12 after the review it was concluded that these materials should not be ' the focus of this report. A review is in progress on materials and systems for prefabricated refractory ceramic panels, but this review is focusing more on typical refractory materials for prefabricated systems, which could make the system more economically feasible. Refractory ceramics are used for a wide variety of applications

  18. Refractory disease in antineutrophil cytoplasmic antibodies associated vasculitis

    NARCIS (Netherlands)

    Rutgers, Abraham; Kallenberg, Cornelis

    2012-01-01

    Purpose of review Induction treatment of antineutrophil cytoplasmic antibodies (ANCA) associated vasculitis (AAV) is not always successful and nonresponding patients are considered refractory. Recent findings Refractory disease should be subdefined to the treatment that was received. Cyclophosphamid

  19. Recent advances in silica-alumina refractory: A review

    Directory of Open Access Journals (Sweden)

    Chaouki Sadik

    2014-06-01

    Full Text Available In this article, the elaboration and the characterization of silica-alumina refractory have been reviewed. Refractory oxides encompass a broad range of unary, binary, and ternary ceramic compounds that can be used in structural, insulating, and other applications. This paper provides a historical perspective on the elaboration and the use of silica-alumina refractory, reviews applications for refractory oxides, describes typical processing routes, overviews fundamental structure–property relations, and summarizes the properties of these materials.

  20. Tungsten and other refractory metals for VLSI applications II

    Energy Technology Data Exchange (ETDEWEB)

    Broadbent, E.K.

    1987-01-01

    This book presents papers on tungsten and other refractory metals for VLSI applications. Topics include the following: Selectivity loss and nucleation on insulators, fundamental reaction and growth studies, chemical vapor deposition of tungsten, chemical vapor deposition of molybdenum, reactive ion etching of refractory metal films; and properties of refractory metals deposited by sputtering.

  1. An Overview on China's Refractories-Market and New Demands

    Institute of Scientific and Technical Information of China (English)

    LIU Jiehua; ZHOU Ningsheng

    2004-01-01

    Based on the authors' information sources and personal viewpoints, this paper provides updated information on China s refractories situation in terms of output, consumption in main refractory using sectors, exportation and importation of refractory products and raw materials,structural change, future prosperity and new demands .From authors understanding, some analyses have also been given.

  2. Export and Import Situation of Refractories in China

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    China has been the biggest country in production and exporting of refractories. The article describes the problems in the export and import and suggestions on development of refractories. In the future, China will expand its cooperation with world refractories community in science, technology, economy and trade to play a more important role in the international and domestic markets.

  3. Management of refractory ischemic priapism: current perspectives.

    Science.gov (United States)

    Capece, Marco; Gillo, Arianna; Cocci, Andrea; Garaffa, Giulio; Timpano, Massimiliano; Falcone, Marco

    2017-01-01

    The aim of the present manuscript is to review the current literature on priapism, focusing on the state-of-the-art knowledge of both the diagnosis and the treatment of the refractory ischemic priapism (IP). Pubmed and EMBASE search engines were used to search for words "priapism", "refractory priapism", "penile prosthesis", "diagnosis priapism", "priapism treatment", "penile fibrosis", "priapism therapy". All the studies were carefully examined by the authors and then included in the review. First-line treatment involves ejaculation, physical exercise and cold shower followed by corporal blood aspiration and injection of α-adrenoceptor agonists. Subsequently, a distal or proximal shunt may be considered. If none of the treatment is effective or the priapism episode lasts >48 hours penile prosthesis implantation could be the only option to solve the priapism and treat the ongoing erectile dysfunction. The management of IP is to achieve detumescence of persistent penile erection and to preserve erectile function after resolution of the priapic episode. On the other hand, penile fibrosis and following shortening should be prevented. Early penile prosthesis implantation in patients with refractory IP is able to solve both the priapic episode and prevent the otherwise certain penile shortening. Penile prosthesis implantation is the actual gold standard of care in cases of refractory IP.

  4. Synthetic Raw Materials for Refractories in China

    Institute of Scientific and Technical Information of China (English)

    SHIGan; YUEWeidong

    2001-01-01

    The development and status of synthetic raw materials for refractories in China are reviewed,including magne-site-based materials,alumina ,ullite,calcium alumi-nate cement ,ultrafine powder,spinel,silicon carbide and cordierite.The research work on calcium zirconate and sialon materials are also introduced.

  5. 2011 China's Refractories Raw Materials Symposium Held in Zhengzhou

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    @@ On April 20-22,2011,China's Refractories Raw Materials Symposium,co-sponsored by Refractories Branch of The Chinese Society for Metals and China Henan Refractory Industry Association,was held successfully in Zhengzhou,Henan Province.Over 150 delegates from 100 refractory raw materials and products enterprises,testing equipment manufacturers,raw materials trade companies,institutes,universities,testing institutions,and industrial organizations attended the symposium.Wang Shouye,secretary-general of Refractories Branch of The Chinese Society for Metals and vice president of Sinosteel Luoyang Institute of Refractories Research Co.,Ltd.,made the address of welcome.Zhang Yazhong,vice chairman of Henan Committee of the Chinese People's Political Consultative Conference and honorary chairman of China Henan Refractory Industry Association,gave a speech.

  6. Atm heterozygous mice are more sensitive to radiation-induced cataracts than are their wild-type counterparts

    Science.gov (United States)

    Worgul, Basil V.; Smilenov, Lubomir; Brenner, David J.; Junk, Anna; Zhou, Wei; Hall, Eric J.

    2002-01-01

    It is important to know whether the human population includes genetically predisposed radiosensitive subsets. In vitro studies have shown that cells from individuals homozygous for ataxia telangiectasia (A-T) are much more radiosensitive than cells from unaffected individuals. Although cells heterozygous for the ATM gene (ATM(+/-)) may be slightly more radiosensitive in vitro, it remained to be determined whether the greater susceptibility of ATM(+/-) cells translates into an increased sensitivity for late effects in vivo, though there is a suggestion that radiotherapy patients that are heterozygous for the ATM gene may be more at risk of developing late normal tissue damage. We chose cataractogenesis in the lens as a means to assay for the effects of ATM deficiency in a late-responding tissue. One eye of wild-type, Atm heterozygous and homozygous knockout mice was exposed to 0.5-, 1.0-, 2.0-, or 4.0-Gy x rays. The animals were followed weekly for cataract development by conventional slit-lamp biomicroscopy. Cataract development in the animals of all three groups was strongly dependent on dose. The lenses of homozygous mice were the first to opacify at any given dose. Most important in the present context is that cataracts appeared earlier in the heterozygous versus wild-type animals. The data suggest that ATM heterozygotes in the human population may also be radiosensitive. This may influence the choice of individuals destined to be exposed to higher than normal doses of radiation, such as astronauts, and may also suggest that radiotherapy patients who are ATM heterozygotes could be predisposed to increased late normal tissue damage.

  7. Improved Refractories for IGCC Power Systems

    Energy Technology Data Exchange (ETDEWEB)

    Dogan, Cynthia P.; Kwong, Kyei-Sing; Bennett, James P.; Chinn, Richard E.; Dahlin, Cheryl L.

    2002-01-01

    The gasification of coal, petroleum residuals, and biomass provides the opportunity to produce energy more efficiently, and with significantly less environmental impact, than more-conventional combustion-based processes. In addition, the synthesis gas that is the product of the gasification process offers the gasifier operator the option of ''polygeneration'', i.e., the production of alternative products instead of power should it be economically favorable to do so. Because of these advantages, gasification is a key element in the U.S. Department of Energy?s Vision 21 power system. However, issues with both the reliability and the economics of gasifier operation will have to be resolved before gasification will be widely adopted by the power industry. Central to both increased reliability and economics is the development of materials with longer service lives in gasifier systems that can provide extended periods of continuous gasifier operation. The focus of the Advanced Refractories for Gasification project at the Albany Research Center is to develop improved materials capable of withstanding the harsh, high-temperature environment created by the gasification reaction, and includes both the refractory lining that insulates the slagging gasifier, as well as the thermocouple assemblies that are utilized to monitor gasifier operating temperatures. Current generation refractory liners in slagging gasifiers are typically replaced every 10 to 18 months, at costs ranging up to $2,000,000. Compounding materials and installation costs are the lost-opportunity costs for the three to four weeks that the gasifier is off-line for the refractory exchange. Current generation thermocouple devices rarely survive the gasifier start-up process, leaving the operator with no real means of temperature measurement during gasifier operation. As a result, the goals of this project include the development of a refractory liner with a service life at least double that of

  8. Midazolam and pentobarbital for refractory status epilepticus.

    Science.gov (United States)

    Holmes, G L; Riviello, J J

    1999-04-01

    Status epilepticus, a serious, life-threatening emergency characterized by prolonged seizure activity, occurs most commonly in pediatric patients. Although initial therapies with agents such as diazepam, phenytoin, or phenobarbital generally terminate seizure activity within 30-60 minutes, patients with refractory status epilepticus (RSE) lasting longer require additional intervention. High-dose pentobarbital has been the most commonly prescribed agent for the management of RSE in children; however, midazolam has emerged as a new treatment option. This review compares the use of midazolam with pentobarbital in published reports of pediatric RSE. Both drugs effectively terminated refractory seizure activity, although pentobarbital use was complicated by hypotension, delayed recovery, pneumonia, and other adverse effects. Midazolam use was effective and well tolerated, affirming its value in pediatric RSE management.

  9. EXTRASOLAR REFRACTORY-DOMINATED PLANETESIMALS: AN ASSESSMENT

    Energy Technology Data Exchange (ETDEWEB)

    Jura, M.; Xu, S., E-mail: jura@astro.ucla.edu, E-mail: sxu@astro.ucla.edu [Department of Physics and Astronomy, University of California, Los Angeles, CA 90095-1562 (United States)

    2013-02-01

    Previously published observations of 60 externally polluted white dwarfs show that none of the stars have accreted from intact refractory-dominated parent bodies composed mainly of Al, Ca, and O, although planetesimals with such a distinctive composition have been predicted to form. We propose that such remarkable objects are not detected by themselves because, unless they are scattered outward from their initial orbit, they are engulfed and destroyed during the star's asymptotic giant branch evolution. As yet, there is at most only weak evidence supporting a scenario where the composition of any extrasolar minor planet can be explained by blending of an outwardly scattered refractory-dominated planetesimal with an ambient asteroid.

  10. [Liposteroid therapy for refractory epileptic spasms].

    Science.gov (United States)

    Shimono, Kuriko Kagitani; Imai, Katsumi; Idoguchi, Rie; Kamio, Noriko; Okinaga, Takeshi; Ozono, Keiichi

    2003-11-01

    Liposteroid was administered intravenously to 6 patients with refractory epileptic spasms. In one case, the spasms initially disappeared but then reappeared after three months. Another case had a transient and slight decrease of epileptic spasms. In the only patient in whom spasms disappeared, EEG abnormalities were greatly improved with diffuse spikes and waves changing into focal spikes. Two cases displayed hyperexcitability, insomnia and acting out behavior, and the therapy was discontinued in one of them. One case had appetite loss and another showed an increase in tonic seizures. No patient had serious adverse effects such as infection, edema, subdural hematoma and brain shrinkage. Although liposteroid therapy has been recommended as an easy, useful and safe alternative for ACTH, we found considerable adverse effects and only a small effect on refractory spasms, and conclude that the regimen should be modified.

  11. Arrhythmogenic channelopathy syndromes presenting as refractory epilepsy.

    Science.gov (United States)

    Hazle, Matthew A; Shellhaas, Renée A; Bradley, David J; Dick, Macdonald; Lapage, Martin J

    2013-08-01

    Children and young adults with potentially lethal cardiac channelopathies often present to medical care with a history of syncope or seizures due to episodic ventricular arrhythmias and associated cerebral hypoperfusion. Two important types of genetic arrhythmia syndromes-long QT syndrome and catecholaminergic polymorphic ventricular tachycardia-are discussed using relevant case examples. The pathophysiology and distinguishing clinical features of these conditions are reviewed. The patients in each case were ultimately diagnosed with a cardiac channelopathy as the cause for their syncope and refractory seizures. With appropriate medical management, no further events have occurred to date. Cardiac channelopathies can be misdiagnosed as refractory epilepsy when in fact these events represent convulsive syncopes. Knowledge of and suspicion for these arrhythmogenic conditions may expedite diagnosis and improve outcomes. Copyright © 2013 Elsevier Inc. All rights reserved.

  12. Molecular sidebands of refractory elements for ISOL

    Energy Technology Data Exchange (ETDEWEB)

    Kronenberg, A. [Oak Ridge Associated Universities, Oak Ridge (United States)], E-mail: kronenberga@ornl.gov; Spejewski, E.H.; Carter, H.K.; Mervin, B.; Jost, C. [Oak Ridge Associated Universities, Oak Ridge (United States); Stracener, D.W. [Oak Ridge National Laboratory, TN 37831 (United States); Lapi, S. [TRIUMF (Canada); Bray, T. [Auburn University (United States)

    2008-10-15

    The formation of molecular sidebands of refractory elements, such as V, Re, Zr, Mo, Tc, is discussed. The focus is on in situ sideband formation and its advantage for the release process. An atomic {sup 48}V beam has been produced in a two step process, forming the oxide in situ, transporting it through the target-ion source as a chloride and destroying the chlorine sideband in the ion source. The sideband formation of Re, Zr, Mo, Tc is discussed.

  13. Molecular Sidebands of Refractory Elements for ISOL

    Energy Technology Data Exchange (ETDEWEB)

    Kronenberg, Andreas [Oak Ridge Associated Universities (ORAU); Spejewski, Eugene H. [Oak Ridge Associated Universities (ORAU); Carter, H Kennon [Oak Ridge Associated Universities (ORAU); Mervin, Brenden T. [Oak Ridge Associated Universities (ORAU); Jost, Cara [Oak Ridge Associated Universities (ORAU); Stracener, Daniel W [ORNL; Lapi, Suzanne [TRIUMF, Canada; Bray, T. H. [Auburn University, Auburn, Alabama

    2008-01-01

    The formation of molecular sidebands of refractory elements, such as V, Re, Zr, Mo, Tc, is discussed. The focus is on in situ sideband formation and its advantage for the release process. An atomic 48V beam has been produced in a two step process, forming the oxide in situ, transporting it through the target-ion source as a chloride and destroying the chlorine sideband in the ion source. The sideband formation of Re, Zr, Mo, Tc is discussed.

  14. Extracorporeal life support for refractory ventricular tachycardia

    Science.gov (United States)

    Joseph, Nicholas; Hofmann, James P.; Saranteas, Theodosios; Papadimos, Thomas J.

    2017-01-01

    Extracorporeal life support (ECLS) is a very effective bridging therapy in patients with refractory ventricular tachycardia (VT) associated with cardiogenic shock. A moribund patient in extremis, is not amenable to optimization by standard ACC/AHA guidelines. New approaches and novel salvage techniques are necessary to improve outcomes in patients with refractory clinical settings such as malignant ventricular arrhythmias, cardiac arrest, cardiogenic shock and/or pulmonary failure until further management options are explored. Data base searches were done using key words such as ECLS, VT, cardiac arrest, VT ablation, venoarterial extra-corporeal membrane oxygenation (VA-ECMO). The use of ECLS has been described in a few case reports to facilitate VT ablation for incessant VT refractory to medical therapy. For patients with, out-of- hospital ventricular fibrillation (VF) and VT, Minnesota Resuscitation Consortium has implemented emergent advanced perfusion and reperfusion strategy, followed by coronary angiography and primary coronary intervention to improve outcome. The major indications for ECLS are cardiogenic shock related to acute myocardial infarction, myocarditis, post embolic acute cor pulmonale, drug intoxication and post cardiac arrest syndrome with the threat of multi-organ failure. ECLS permits the use of negative inotropic antiarrhythmic drug therapy, facilitates the weaning of catecholamine administration, thereby ending the vicious cycle of catecholamine driven electric storm. ECLS provides hemodynamic support during ablation procedure, while mapping and induction of VT is undertaken. ECLS provides early access to cardiac catheterization laboratory in patients with cardiac arrest due to shockable rhythm. The current evidence from literature, supports the use of ECLS to ensure adequate vital organ perfusion in patients with refractory VT. ECLS is a safe, feasible and effective therapeutic option when conventional therapies are insufficient to support

  15. Management of refractory ischemic priapism: current perspectives

    Directory of Open Access Journals (Sweden)

    Capece M

    2017-08-01

    Full Text Available Marco Capece,1 Arianna Gillo,2 Andrea Cocci,3 Giulio Garaffa,1 Massimiliano Timpano,4 Marco Falcone4 1The Institute of Urology, University College of London Hospital (UCLH, London, UK; 2Department of Urology, “Umberto Parini” Hospital, Aosta, 3Department of Urology, Careggi Hospital, Firenze, 4Department of Urology, University of Turin, Città della Salute e della Scienza, Turin, Italy Objectives: The aim of the present manuscript is to review the current literature on priapism, focusing on the state-of-the-art knowledge of both the diagnosis and the treatment of the refractory ischemic priapism (IP.Methods: Pubmed and EMBASE search engines were used to search for words “priapism”, “refractory priapism”, “penile prosthesis”, “diagnosis priapism”, “priapism treatment”, “penile fibrosis”, “priapism therapy”. All the studies were carefully examined by the authors and then included in the review.Results: First-line treatment involves ejaculation, physical exercise and cold shower followed by corporal blood aspiration and injection of α-adrenoceptor agonists. Subsequently, a distal or proximal shunt may be considered. If none of the treatment is effective or the priapism episode lasts >48 hours penile prosthesis implantation could be the only option to solve the priapism and treat the ongoing erectile dysfunction.Conclusion: The management of IP is to achieve detumescence of persistent penile erection and to preserve erectile function after resolution of the priapic episode. On the other hand, penile fibrosis and following shortening should be prevented. Early penile prosthesis implantation in patients with refractory IP is able to solve both the priapic episode and prevent the otherwise certain penile shortening. Penile prosthesis implantation is the actual gold standard of care in cases of refractory IP. Keywords: priapism, ischemic priapism, penile fibrosis, penile prosthesis, shunt 

  16. Propofol infusion syndrome in refractory status epilepticus.

    Science.gov (United States)

    Hwang, Woo Sub; Gwak, Hye Min; Seo, Dae-Won

    2013-06-01

    Propofol is used for treating refractory status epilepticus, which has high rate of mortality. Propofol infusion syndrome is a rare but often fatal syndrome, characterized by lactic acidosis, lipidemia, and cardiac failure, associated with propofol infusion over prolonged periods of time. We investigated the clinical factors that characterize propofol infusion syndrome to know the risk of them in refractory status epilepticus. This retrospective observation study was conducted in Samsung medical center from Jan. 2005 to Dec. 2009. Thirty two patients (19 males, 13 females, aged between 16 and 64 years), with refractory status epilepsy were included. Their clinical findings and treatment outcomes were evaluated retrospectively. We divided our patients into established status epilepticus (ESE) and refractory status epilepticus (RSE). And then the patients with RSE was further subdivided into propofol treatment group (RSE-P) and the other anesthetics treatment group (RSE-O). We analyzed the clinical characteristics by comparison of the groups. There were significant differences of hypotension and lipid change between ESE and RSE (pRSE-P and RSE-O groups. The hospital days were longer in RSE than in ESE (p=0.012) and treatment outcome was also worse in RSE than in ESE (p=0.007) but there were no significant differences of hospital stays and treatment outcome between RSE-P and RSE-O. RSE is very critical disease with high mortality, which may show as many clinical changes as propofol infusion syndrome. Therefore propofol infusion syndrome might be considered as one of the clinical manifestations of RSE.

  17. Review of the United States Refractories Industry

    Institute of Scientific and Technical Information of China (English)

    Charles E.Semler

    2003-01-01

    Factors affecting the U. S. Refractories industry,such us decreasing demand, mergers, and decreased education are discussed, along with manufacturing statistics (I. E., annual value and product trends ), indicating that the U. S. Market has declined for five straight years.Research activities have changed, with more emphasis on practical, applied projects, which have continued to produce important advances. Many challenges and opportunities remain, based on the current and future business requirements.

  18. Barrier Coatings for Refractory Metals and Superalloys

    Energy Technology Data Exchange (ETDEWEB)

    SM Sabol; BT Randall; JD Edington; CJ Larkin; BJ Close

    2006-02-23

    In the closed working fluid loop of the proposed Prometheus space nuclear power plant (SNPP), there is the potential for reaction of core and plant structural materials with gas phase impurities and gas phase transport of interstitial elements between superalloy and refractory metal alloy components during service. Primary concerns are surface oxidation, interstitial embrittlement of refractory metals and decarburization of superalloys. In parallel with kinetic investigations, this letter evaluates the ability of potential coatings to prevent or impede communication between reactor and plant components. Key coating requirements are identified and current technology coating materials are reviewed relative to these requirements. Candidate coatings are identified for future evaluation based on current knowledge of design parameters and anticipated environment. Coatings were identified for superalloys and refractory metals to provide diffusion barriers to interstitial transport and act as reactive barriers to potential oxidation. Due to their high stability at low oxygen potential, alumina formers are most promising for oxidation protection given the anticipated coolant gas chemistry. A sublayer of iridium is recommended to provide inherent diffusion resistance to interstitials. Based on specific base metal selection, a thin film substrate--coating interdiffusion barrier layer may be necessary to meet mission life.

  19. Predicting factors for refractory kawasaki disease.

    Science.gov (United States)

    Do, Young-Sun; Kim, Ki-Won; Chun, Jin-Kyong; Cha, Byung Ho; Namgoong, Mee Kyung; Lee, Hae Yong

    2010-05-01

    About 10-15% of Kawasaki disease (KD) is refractory to intravenous immunoglobulin (IVIG) therapy. This study was designed to investigate the predicting factors for refractory KD. We reviewed retrospectively the clinical records of 77 patients with typical KD admitted at Wonju Christian Hospital from January, 2005, to December, 2008. The variance of laboratory and demographic parameters between the IVIG-responsive group and IVIG-resistant group were analyzed. Thirteen patients with urinary tract infections were randomly collected as a febrile control group. Among 77 patients diagnosed with complete KD, 13 patients (16.9%) were IVIG-resistant. The febrile period and hospital days were significantly longer in the IVIG-resistant group than IVIG-responsive group (pIVIG-resistant group (p=0.025). The Kobayashi score could differentiate these two groups (p=0.015). Fewer lymphocytes was observed during the subacute phase in the IVIG-resistant group (p=0.032). Coronary arterial dilatations (CADs) were observed in 10.9% (7/64) of IVIG-responders and 38.5% (5/13) of IVIG-resistant patients (p=0.038). The percentage of neutrophils and lymphocytes in patients with KD, in addition to known risk factors for refractory KD, may help predict IVIG-resistance in patients with KD.

  20. New-onset refractory status epilepticus

    Science.gov (United States)

    Foreman, Brandon P.; Alvarez, Vincent; Cabrera Kang, Christian; Probasco, John C.; Jongeling, Amy C.; Meyers, Emma; Espinera, Alyssa; Haas, Kevin F.; Schmitt, Sarah E.; Gerard, Elizabeth E.; Gofton, Teneille; Kaplan, Peter W.; Lee, Jong W.; Legros, Benjamin; Szaflarski, Jerzy P.; Westover, Brandon M.; LaRoche, Suzette M.; Hirsch, Lawrence J.

    2015-01-01

    Objectives: The aims of this study were to determine the etiology, clinical features, and predictors of outcome of new-onset refractory status epilepticus. Methods: Retrospective review of patients with refractory status epilepticus without etiology identified within 48 hours of admission between January 1, 2008, and December 31, 2013, in 13 academic medical centers. The primary outcome measure was poor functional outcome at discharge (defined as a score >3 on the modified Rankin Scale). Results: Of 130 cases, 67 (52%) remained cryptogenic. The most common identified etiologies were autoimmune (19%) and paraneoplastic (18%) encephalitis. Full data were available in 125 cases (62 cryptogenic). Poor outcome occurred in 77 of 125 cases (62%), and 28 (22%) died. Predictors of poor outcome included duration of status epilepticus, use of anesthetics, and medical complications. Among the 63 patients with available follow-up data (median 9 months), functional status improved in 36 (57%); 79% had good or fair outcome at last follow-up, but epilepsy developed in 37% with most survivors (92%) remaining on antiseizure medications. Immune therapies were used less frequently in cryptogenic cases, despite a comparable prevalence of inflammatory CSF changes. Conclusions: Autoimmune encephalitis is the most commonly identified cause of new-onset refractory status epilepticus, but half remain cryptogenic. Outcome at discharge is poor but improves during follow-up. Epilepsy develops in most cases. The role of anesthetics and immune therapies warrants further investigation. PMID:26296517

  1. Posaconazole treatment of refractory eumycetoma and chromoblastomycosis.

    Science.gov (United States)

    Negroni, Ricardo; Tobón, Angela; Bustamante, Beatriz; Shikanai-Yasuda, Maria Aparecida; Patino, Hernando; Restrepo, Angela

    2005-01-01

    Eumycetoma and chromoblastomycosis are chronic, disfiguring fungal infections of the subcutaneous tissue that rarely resolve spontaneously. Most patients do not achieve sustained long-term benefits from available treatments; therefore, new therapeutic options are needed. We evaluated the efficacy of posaconazole, a new extended-spectrum triazole antifungal agent, in 12 patients with eumycetoma or chromoblastomycosis refractory to existing antifungal therapies. Posaconazole 800 mg/d was given in divided doses for a maximum of 34 months. Complete or partial clinical response was considered a success; stable disease or failure was considered a nonsuccess. All 12 patients had proven infections refractory to standard therapy. Clinical success was reported for five of six patients with eumycetoma and five of six patients with chromoblastomycosis. Two patients were reported to have stable disease. As part of a treatment-use extension protocol, two patients with eumycetoma who initially had successful outcome were successfully retreated with posaconazole after a treatment hiatus of > 10 months. Posaconazole was well tolerated during long-term administration (up to 1015 d). Posaconazole therapy resulted in successful outcome in most patients with eumycetoma or chromoblastomycosis refractory to standard therapies, suggesting that posaconazole may be an important treatment option for these diseases.

  2. Angiotensin II in Refractory Septic Shock.

    Science.gov (United States)

    Antonucci, Elio; Gleeson, Patrick J; Annoni, Filippo; Agosta, Sara; Orlando, Sergio; Taccone, Fabio Silvio; Velissaris, Dimitrios; Scolletta, Sabino

    2017-05-01

    Refractory septic shock is defined as persistently low mean arterial blood pressure despite volume resuscitation and titrated vasopressors/inotropes in patients with a proven or suspected infection and concomitant organ dysfunction. Its management typically requires high doses of catecholamines, which can induce significant adverse effects such as ischemia and arrhythmias. Angiotensin II (Ang II), a key product of the renin-angiotensin-aldosterone system, is a vasopressor agent that could be used in conjunction with other vasopressors to stabilize critically ill patients during refractory septic shock, and reduce catecholamine requirements. However, very few clinical data are available to support Ang II administration in this setting. Here, we review the current literature on this topic to better understand the role of Ang II administration during refractory septic shock, differentiating experimental from clinical studies. We also consider the potential role of exogenous Ang II administration in specific organ dysfunction and possible pitfalls with Ang II in sepsis. Various issues remain unresolved and future studies should investigate important topics such as: the optimal dose and timing of Ang II administration, a comparison between Ang II and the other vasopressors (epinephrine; vasopressin), and Ang II effects on microcirculation.

  3. Refractory status epilepticus: a prospective observational study.

    Science.gov (United States)

    Novy, Jan; Logroscino, Giancarlo; Rossetti, Andrea O

    2010-02-01

    Status epilepticus (SE) that is resistant to two antiepileptic compounds is defined as refractory status epilepticus (RSE). In the few available retrospective studies, estimated RSE frequency is between 31% and 43% of patients presenting an SE episode; almost all seem to require a coma induction for treatment. We prospectively assessed RSE frequency, clinical predictors, and outcome in a tertiary clinical setting. Over 2 years we collected 128 consecutive SE episodes (118 patients) in adults. Clinical data and their relationship to outcome (mortality and return to baseline clinical conditions) were analyzed. Twenty-nine of 128 SE episodes (22.6%) were refractory to first- and second-line antiepileptic treatments. Severity of consciousness impairment and de novo episodes were independent predictors of RSE. RSE showed a worse outcome than non-RSE (39% vs. 11% for mortality; 21% vs. 63% for return to baseline clinical conditions). Only 12 patients with RSE (41%) required coma induction for treatment. This prospective study identifies clinical factors predicting the onset of SE refractoriness. RSE appears to be less frequent than previously reported in retrospective studies; furthermore, most RSE episodes were treated outside the intensive care unit (ICU). Nonetheless, we confirm that RSE is characterized by high mortality and morbidity.

  4. IMPROVED CORROSION RESISTANCE OF ALUMINA REFRACTORIES

    Energy Technology Data Exchange (ETDEWEB)

    John P. Hurley; Patty L. Kleven

    2001-09-30

    The initial objective of this project was to do a literature search to define the problems of refractory selection in the metals and glass industries. The problems fall into three categories: Economic--What do the major problems cost the industries financially? Operational--How do the major problems affect production efficiency and impact the environment? and Scientific--What are the chemical and physical mechanisms that cause the problems to occur? This report presents a summary of these problems. It was used to determine the areas in which the EERC can provide the most assistance through bench-scale and laboratory testing. The final objective of this project was to design and build a bench-scale high-temperature controlled atmosphere dynamic corrosion application furnace (CADCAF). The furnace will be used to evaluate refractory test samples in the presence of flowing corrodents for extended periods, to temperatures of 1600 C under controlled atmospheres. Corrodents will include molten slag, steel, and glass. This test should prove useful for the glass and steel industries when faced with the decision of choosing the best refractory for flowing corrodent conditions.

  5. [Renal replacement therapy for refractory heart failure].

    Science.gov (United States)

    Schwenger, V; Remppis, A B

    2012-07-01

    After broad cardiological and nephrological evaluation and consideration of optimal conservative options according to national and international guidelines, renal replacement therapy might be helpful in patients with refractory heart failure even if they are not dialysis-dependent. This is even more important as renal failure is a strong predictor for mortality in patients with severe congestive heart failure (CHF) and CHF is one of the fastest growing morbidities in western countries. Although peritoneal dialysis (PD) is frequently used in patients with CHF its role remains unclear. Acute chronic volume overload in refractory CHF is still an unresolved clinical problem. In patients with acute heart and renal failure with need of management in an intensive care unit, extracorporeal ultrafiltration or a dialysis modality should be preferred. In patients with chronic refractory CHF, volume overload and renal failure, peritoneal dialysis should be the therapy of choice. Due to the limited data available, treatment and outcome parameters should be recorded in the registry of the German Society of Nephrology (http://www.herz-niere.de).

  6. Tacrolimus Ointment for Refractory Posterior Blepharitis.

    Science.gov (United States)

    Sakassegawa-Naves, Fernando Eiji; Ricci, Helena Maria Moraes; Moscovici, Bernardo Kaplan; Miyamoto, Daniela Akemi; Chiacchio, Brenda Biagio; Holzchuh, Ricardo; Santo, Ruth Muyuki; Hida, Richard Yudi

    2017-09-18

    This prospective, randomized, double-blind interventional case series was designed to evaluate the short-term efficacy of 0.03% tacrolimus ointment as a new therapeutic approach for refractory cases of posterior blepharitis. Forty eyes (20 patients) with posterior blepharitis refractory to previous treatment were randomized. Eighteen eyes (9 patients) were treated with 0.03% tacrolimus ointment and 20 eyes (10 patients) with placebo ointment twice daily. Patients were evaluated with a questionnaire and slit-lamp examination 14 days and 28 days after treatment, and symptoms and signs of blepharitis were compared to those observed at baseline. We could observe statistical difference in the outcome measurements of meibomian gland secretion, conjunctival hyperemia, telangiectasia of inferior lid, Rose Bengal, and fluorescein scoring for the study group. As for the symptoms score, we observed statistical difference in the symptoms scoring for pruritus and dry eye sensation in the tacrolimus group. This study suggests that topical administration of 0.03% tacrolimus ointment can improve some symptoms and some ocular surface status in patients with refractory posterior blepharitis.

  7. Comprehensive Creep and Thermophysical Performance of Refractory Materials

    Energy Technology Data Exchange (ETDEWEB)

    Ferber, M.K.; Wereszczak, A.; Hemrick, J.A.

    2006-06-29

    Furnace designers and refractory engineers recognize that optimized furnace superstructure design and refractory selection are needed as glass production furnaces are continually striving toward greater output and efficiencies. Harsher operating conditions test refractories to the limit, while changing production technology (such as the conversion to oxy-fuel from traditional air-fuel firing) can alter the way the materials perform [1-3]. Refractories for both oxy- and air-fuel fired furnace superstructures (see Fig. 1) are subjected to high temperatures that may cause them to creep excessively or subside during service if the refractory material is not creep resistant, or if it is subjected to high stress, or both. Furnace designers can ensure that superstructure structural integrity is maintained if the creep behavior of the refractory material is well understood and well represented by appropriate engineering creep models. Several issues limit the abilities of furnace designers to (1) choose the optimum refractory for their applications, (2) optimize the engineering design, or (3) predict the service mechanical integrity of their furnace superstructures. Published engineering creep data are essentially nonexistent for almost all commercially available refractories used for glass furnace superstructures. The limited data that do exist are supplied by the various refractory suppliers. Unfortunately, the suppliers generally have different ways of conducting their mechanical testing, and they interpret and report their data differently. This inconsistency makes it hard for furnace designers to draw fair comparisons between competing grades of candidate refractories. Furthermore, the refractory suppliers' data are often not available in a form that can be readily used for furnace design or for the prediction and design of long-term structural integrity of furnace superstructures. As a consequence, the U.S. Department of Energy (DOE) Industrial Technology Program

  8. Export and Import Situation of Refractories and Refractory Raw Materials in China

    Institute of Scientific and Technical Information of China (English)

    PANShangxin; ZHANGZhongqi; 等

    2000-01-01

    The article states China is a great nation in producing and exporting refractories and refractory raw materials,which, has earned much foreign exchange for our country ,only a few advanced refactory material, zircon and chrome ore are needed to be imported.The ar-ticle points out the problems in the export and import,and raises suggestions on development.After the entry of WTO,China will expand its co-operations with other countries in science,technology,economy and trade to play a more important role in the world market.

  9. Development and Application of Refractory Materials for Molten Aluminum Applications

    Energy Technology Data Exchange (ETDEWEB)

    Hemrick, James Gordon [ORNL; Headrick, William [University of Missouri, Rolla; Peters, Klaus-Markus [ORNL

    2008-01-01

    Two new refractory materials have been developed for use in molten aluminum contact applications which exhibit improved corrosion and wear resistance, along with improved thermal management through reduced heat losses. The development of these materials was based on understanding of the corrosion and wear mechanisms associated with currently used aluminum contact refractories through physical, chemical, and mechanical characterization and analysis performed by Oak Ridge National Laboratory (ORNL) and the University of Missouri, Rolla (UMR) along with their industrial partners, under the ITP Materials project "Multifunctional Metallic and Refractory Materials for Energy Efficient Handling of Molten Metals". Spent castable refractories obtained from a natural gas fired reverberatory aluminum alloy melting furnace were analyzed leading to identification of several refractory degradation mechanisms and strategies to produce improved materials. The newly developed materials have been validated through both R&D industrial trials and independent commercial trials by the refractory manufacturers.

  10. Technology Progress of Refractories for Iron Making in China

    Institute of Scientific and Technical Information of China (English)

    CHAI Junlan; CHENG Qingxian; SHEN Keyin

    2005-01-01

    This paper reviews the present development situation of refractories for iron making system in China, which includes blast furnace, hot blast stove and coke dry quenching, etc. Varieties and performances of refractories used by the top steel and iron groups such as Baosteel, Wuhan I&S Group and Anshan I&S Group for iron making were exemplified and concerned problems were analyzed,together with solutions and suggestions for future refractories R&D work.

  11. Properties of Refractory Concrete in Tension and Compression

    Science.gov (United States)

    Sampson, Jeffrey

    2009-01-01

    Refractory concrete on the LC-39A Flame Deflector has been damaged during multiple Space Shuttle launches (e.g. STS-124, STS-126, STS-119, and STS-125, STS-127). These events have prompted a better understanding of the system via an analytical model of the Flame Deflector assembly to include the Fondu Fyre refractory concrete. This model requires test data inputs of the refractory concrete's mechanical properties, which include stress versus strain curves in tension and compression, modulus of elasticity, and Poisson's ratio. Sections of Fondu Fyre refractory concrete removed from the LC-39A Flame Deflector were provided for this testing.

  12. Bendamustine Plus Alemtuzumab for Refractory Chronic Lymphocytic Leukemia (CLL)

    Science.gov (United States)

    2013-08-20

    Recurrent Small Lymphocytic Lymphoma; Refractory Chronic Lymphocytic Leukemia; Stage III Chronic Lymphocytic Leukemia; Stage III Small Lymphocytic Lymphoma; Stage IV Chronic Lymphocytic Leukemia; Stage IV Small Lymphocytic Lymphoma

  13. Ketogenic diet therapy is effective in encephalitis with refractory seizures.

    Science.gov (United States)

    Matsuzono, Kosuke; Kurata, Tomoko; Deguchi, Shoko; Yamashita, Toru; Deguchi, Kentaro; Abe, Koji

    2014-10-01

    Although ketogenic diet therapy is effective in refractory seizures in childhood, its effect on adult encephalitis with similar refractory seizures and prolonged encephalopathy has not been well reported. We report here a case of a 22-year-old man with acute encephalitis with refractory repetitive partial seizures (AERRPS). Partial seizures of the face developed to repeated generalized convulsions, which were refractory against anti-epileptic drugs and a high dose of propofol. After struggling for 9 months, he dramatically recovered after ketogenic diet therapy. Ketogenic diet therapy may be an important tool to help cure AERRPS.

  14. Refractory Coated/Lined Low Density Structures Project

    Data.gov (United States)

    National Aeronautics and Space Administration — This project addresses the development of refractory coated or lined low density structures applicable for advanced future propulsion system technologies. The...

  15. Handbook of industrial refractories technology principles, types, properties and applications

    CERN Document Server

    Caniglia, Stephen

    1989-01-01

    Encompasses the entire range of industrial refractory materials and forms: properties and their measurement, applications, manufacturing, installation and maintenance techniques, quality assurance, and statistical process control.

  16. Launch Pad Flame Trench Refractory Materials

    Science.gov (United States)

    Calle, Luz M.; Hintze, Paul E.; Parlier, Christopher R.; Bucherl, Cori; Sampson, Jeffrey W.; Curran, Jerome P.; Kolody, Mark; Perusich, Steve; Whitten, Mary

    2010-01-01

    The launch complexes at NASA's John F. Kennedy Space Center (KSC) are critical support facilities for the successful launch of space-based vehicles. These facilities include a flame trench that bisects the pad at ground level. This trench includes a flame deflector system that consists of an inverted, V-shaped steel structure covered with a high temperature concrete material five inches thick that extends across the center of the flame trench. One side of the "V11 receives and deflects the flames from the orbiter main engines; the opposite side deflects the flames from the solid rocket boosters. There are also two movable deflectors at the top of the trench to provide additional protection to shuttle hardware from the solid rocket booster flames. These facilities are over 40 years old and are experiencing constant deterioration from launch heat/blast effects and environmental exposure. The refractory material currently used in launch pad flame deflectors has become susceptible to failure, resulting in large sections of the material breaking away from the steel base structure and creating high-speed projectiles during launch. These projectiles jeopardize the safety of the launch complex, crew, and vehicle. Post launch inspections have revealed that the number and frequency of repairs, as well as the area and size of the damage, is increasing with the number of launches. The Space Shuttle Program has accepted the extensive ground processing costs for post launch repair of damaged areas and investigations of future launch related failures for the remainder of the program. There currently are no long term solutions available for Constellation Program ground operations to address the poor performance and subsequent failures of the refractory materials. Over the last three years, significant liberation of refractory material in the flame trench and fire bricks along the adjacent trench walls following Space Shuttle launches have resulted in extensive investigations of

  17. Bulk Vitrification Castable Refractory Block Protection Study

    Energy Technology Data Exchange (ETDEWEB)

    Hrma, Pavel R.; Bagaasen, Larry M.; Beck, Andrew E.; Brouns, Thomas M.; Caldwell, Dustin D.; Elliott, Michael L.; Matyas, Josef; Minister, Kevin BC; Schweiger, Michael J.; Strachan, Denis M.; Tinsley, Bronnie P.; Hollenberg, Glenn W.

    2005-05-01

    Bulk vitrification (BV) was selected for a pilot-scale test and demonstration facility for supplemental treatment to accelerate the cleanup of low-activity waste (LAW) at the Hanford U.S. DOE Site. During engineering-scale (ES) tests, a small fraction of radioactive Tc (and Re, its nonradioactive surrogate) were transferred out of the LAW glass feed and molten LAW glass, and deposited on the surface and within the pores of the castable refractory block (CRB). Laboratory experiments were undertaken to understand the mechanisms of the transport Tc/Re into the CRB during vitrification and to evaluate various means of CRB protection against the deposition of leachable Tc/Re. The tests used Re as a chemical surrogate for Tc. The tests with the baseline CRB showed that the molten LAW penetrates into CRB pores before it converts to glass, leaving deposits of sulfates and chlorides when the nitrate components decompose. Na2O from the LAW reacts with the CRB to create a durable glass phase that may contain Tc/Re. Limited data from a single CRB sample taken from an ES experiment indicate that, while a fraction of Tc/Re is present in the CRB in a readily leachable form, most of the Tc/Re deposited in the refractory is retained in the form of a durable glass phase. In addition, the molten salts from the LAW, mainly sulfates, chlorides, and nitrates, begin to evaporate from BV feeds at temperatures below 800 C and condense on solid surfaces at temperatures below 530 C. Three approaches aimed at reducing or preventing the deposition of soluble Tc/Re within the CRB were proposed: metal lining, sealing the CRB surface with a glaze, and lining the CRB with ceramic tiles. Metal liners were deemed unsuitable because evaluations showed that they can cause unacceptable distortions of the electric field in the BV system. Sodium silicate and a low-alkali borosilicate glaze were selected for testing. The glazes slowed down molten salt condensate penetration, but did little to reduce the

  18. Arthroscopic capsular release for refractory shoulder stiffness.

    Science.gov (United States)

    Fernandes, Marcos Rassi

    2013-01-01

    To evaluate the results of the arthroscopic treatment of refractory adhesive capsulitis of the shoulder with two to nine years of follow-up, comparing the pre- and postoperative range of motion. This was an observational study (case series) of 18 patients who underwent arthroscopic capsular release for refractory shoulder stiffness. The mean age was of 53.6 years (range: 39 to 68), with female predominance (77.77%) and nine cases left shoulders. There were 6 primary (33.33%) and 12 secondary cases (66.67%). Arthroscopic capsular release was performed in all patients after a mean of 9.33 months of physical therapy (range: 6 to 20 months) with a minimum follow-up of two years (range: 26 to 110 months). The mean active and passive forward flexion, external rotation and internal rotation increased from 94.4°/103.3°, 11.9°/21.9°, and S1/L5 vertebral level, respectively, to 151.1°/153.8°, 57.2°/64.4°, and T12/T10 vertebral level, respectively. There was a significant difference between the pre- and postoperative range of motion (p < 0.001). According to the Constant-Murley functional score (ROM), the value increased from 14 (preoperative mean) to 30 points (postoperative mean). Postoperatively, all patients showed diminished shoulder pain (none or mild/15 or 10 points in the Constant-Murley score). Arthroscopic treatment is an effective treatment for refractory shoulder stiffness. Copyright © 2013 Elsevier Editora Ltda. All rights reserved.

  19. Gastroesophageal Reflux in Children with Refractory Asthma

    Directory of Open Access Journals (Sweden)

    Alaa S. Deeb

    2010-07-01

    Full Text Available Objectives: To investigate the association between clinical and macroscopic findings of GER and severity of refractory asthma (statistical study.Methods: A prospective study in a university-based practice of 75 children who were diagnosed with refractory asthma because they exhibited no satisfactory response for at least three months of treatment. Medical history, physical examination, spirometrical measurements and prick skin test were conducted on all patients. Endoscopic and macroscopic evaluations for esophagitis were performed on all patients regardless of the presence of GER symptoms.Results: Endoscopy was done for 75 children with refractory asthma. GER was symptomatic in 65% of all patients with no statistical significance (p>0.05 and the most frequent symptom was abdominal pain (67%. The frequency of these symptoms was 50% in mild asthma, 58% in moderate asthma and 72% in severe asthma with no statistical significance (p>0.05. The frequency of macroscopic esophagitis was 71%, distributed in three asthmatic groups as in order of 75% in mild asthma, 58.3% in moderate asthma and 76.6% in severe asthma (p>0.05. Regarding the relationship between GER and nocturnal attacks or spasmodic cough, the frequency of the latest was 66.7%. The differences have no statistical significance regarding GER symptoms (p>0.05, but they are statistically significant regarding the reflux esophagitis (p<0.05. Also endoscopic reflux was as frequent as76.3% in non allergic patients, and this result is statistically significant (p<0.05.Conclusion: In spite of the fact that there was no relationship between the severity of asthma and the symptoms of GER, or its endoscopic findings, the frequency of GER in asthmatic children was higher than its frequency in other children.

  20. Refractory thrombotic thrombocytopenic purpura following acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Ebisa Bekele; Bethel Shiferaw; Alexandra Sokolova; Arpan Shah; Phillip Saunders; Alida Podrumar; Javed Iqbal

    2016-01-01

    Thrombotic thrombocytopenic purpura (TTP) is a rare blood disorder with an estimated incidence of 4–5 cases per million people per year. It is characterized by small-vessel platelet-rich thrombi that cause thrombocytopenia, microangiopathic hemolytic anemia and organ damage. There are reports in literature that TTP and acute pancreatitis are associated, indicating each can be the cause of the other. However, acute pancreatitis triggering TTP is very rare. A 71 years old female presented with abdominal pain of 3 days, followed by dark urine. She had icteric sclera, petechial rash and mild epigastric tenderness. Lab findings were significant for hemolytic anemia, thrombocytopenia and elevated lipase. CT of abdomen showed evidence of pancreatitis and cholelithiasis. After admission, patient developed symptoms of stroke. Further investigation showed elevated lactate dehydrogenase and normal coagulation studied with peripheral blood smear showed 5–6 schistocytes/high power field. Disintegrin and metalloproteinase with thrombospondin motifs-13 (ADAMTS13) activity showed less than 3% with high ADAMTS13 inhibitor 2.2. Patient required 6–7 weeks of daily plasmapheresis until she showed complete response. Our patient presented with clinical features of pancreatitis prior to having dark urine and petechial rash. Therefore, we strongly believe that our patient had pancreatitis which was followed by TTP. Patient's ADMTS13 activity was 6%after 10 plasma exchanges, signifying refractory TTP and higher risk for morbidity and mortality. There are limited data and consensus on the management of refractory TTP. TTP and acute pancreatitis are associated. However, refractory TTP following acute pancreatitis is rarely mentioned in the literature. We would like to emphasize the importance of having higher clinical suspicion of the association of both disease entities.

  1. Refractory leg ulcers associated with Klinefelter syndrome.

    Science.gov (United States)

    Yabuno, Yuto; Tosa, Mamiko; Iwakiri, Itaru; Nomoto, Shunichi; Kaneko, Mayuko; Kuwahara, Kousuke; Hyakusoku, Hiko; Murakami, Masahiro

    2015-01-01

    We present a man with refractory leg ulcers, bilateral varicosis of the lower extremities, and Buerger disease. Autoimmune work-up was negative. However, chromosome analysis showed Klinefelter syndrome (48 XXY). Ulcerative lesions of the lower extremities are a complication of Klinefelter syndrome. To date, the pathogenesis of ulcers in Klinefelter syndrome has not been clarified, but several factors, such as abnormalities of fibrinolysis and prothrombotic states, might be involved. Our present case emphasizes the importance of considering Klinefelter syndrome in the differential diagnosis of a male patient with nonhealing ulcers of the lower extremities.

  2. Refractory overactive bladder: Beyond oral anticholinergic therapy

    Directory of Open Access Journals (Sweden)

    Ronald W Glinski

    2007-01-01

    Full Text Available Objectives: In this review, we discuss the treatment of refractory overactive bladder (OAB that has not adequately responded to medication therapy and we propose an appropriate care pathway to the treatment of OAB. We also attempt to address the cost of OAB treatments. Materials and Methods: A selective expert review of the current literature on the subject of refractory OAB using MEDLINE was performed and the data is summarized. We also review our experience in treating refractory OAB. The role and outcomes of various treatment options for refractory OAB are discussed and combined therapy with oral anticholinergics is explored. Emerging remedies including intravesical botulinum toxin injection and pudendal neuromodulation are also reviewed, along with conventional surgical options. Results: In general behavioral therapy, pelvic floor electrical stimulation, magnetic therapy and posterior tibial nerve stimulation (PTNS, have shown symptom decreases in 50-80% of patients with OAB. Depending on the study, combination therapy with oral anticholinergics seems to improve efficacy of behavioral therapy and PTNS in approximately 10-30%. In multicenter, long-term randomized controlled trials, sacral neuromodulation has been shown to improve symptoms of OAB and OAB incontinence in up to 80% of the patients treated. Studies involving emerging therapies such as pudendal serve stimulation suggest that there may be a 15-20% increase in efficacy over sacral neuromodulation, but long-term studies are not yet available. Another emerging therapy, botulinum toxin, is also showing similar success in reducing OAB symptoms in 80-90% of patients. Surgical approaches, such as bladder augmentation, are a last resort in the treatment of OAB and are rarely used at this point unless upper tract damage is a concern and all other treatment options have been exhausted. Conclusion: The vast majority of OAB patients can be managed successfully by behavioral options with or

  3. Management in refractory epilepsy: Beyond epilepsy surgery...

    Directory of Open Access Journals (Sweden)

    Roop Gursahani

    2008-01-01

    Full Text Available Although definititions of refractory epilepsy vary, about 40% of prevalent cases of epilepsy are not controlled by anti-epileptic drugs. A substantial proportion of this population requires palliative therapy since only a minority are candidates for epilepsy surgery. Drug therapy can be optimised after accurate classification of the epilepsy. Monotherapy is often as effective as polytherapy with fewer adverse effects. Depression and CNS adverse effects significantly impact quality of life and must be systematically screened for and treated. The ketogenic diet and vagal nerve stimulation provide substantial seizure control in a significant number of cases and may be used synergistically. Deep brain stimulation is another promising modality.

  4. Deoxyspergualin in relapsing and refractory Wegener's granulomatosis

    DEFF Research Database (Denmark)

    Flossmann, O; Baslund, B; Bruchfeld, A

    2008-01-01

    at entry and prednisolone doses adjusted according to clinical status. Deoxyspergualin, 0.5 mg/kg per day, was self-administered by subcutaneous injection in six cycles of 21 days with a 7-day washout between cycles. Cycles were stopped early for white blood count less than 4000 cells/mm(3). The primary......-threatening (> or = grade 3) treatment-related adverse events occurred in 24 (53%) patients mostly due to leucopaenias. CONCLUSIONS: Deoxyspergualin achieved a high rate of disease remission and permitted prednisolone reduction in refractory or relapsing Wegener's granulomatosis. Adverse events were common but rarely led...

  5. Flow and Flow Decay of Refractory Castables

    Institute of Scientific and Technical Information of China (English)

    CHEN Zhiqiang; Bjom Myhre; Bjorn Sandberg

    2003-01-01

    Installation of refractoty castables depend not only on flow, but also on how soon the flow is lost because of setting. The loss of flow (flow decay) has always been one of the main problems of refractory castable manufacturers,a problem that has not been too well described in literature. The flow decay has been studied for a castable system based on alumina, pointing out some general trends. The flow decay was found very temperature sensitive, being strongly accelerated by termperature increases. To compensate for excessive flow loss, a retarder like citric acid may be used. Thus flow decay was measured as a function of citric acid (retarder) addition at 35 ℃ .

  6. Status epilepticus: Analysis of refractory cases

    Directory of Open Access Journals (Sweden)

    B. P. Gladov

    2016-01-01

    Full Text Available Objective: to analyze refractory status epilepticus (SE cases.Patients and methods. Fifteen female patients aged 21 to 62 years with refractory SE were comprehensively examined using long-term electroencephalography monitoring. The investigators evaluated the efficiency of treatment regimens with intravenous antiepileptic drugs (AEDs, such as diazepam (DZP; valproic acid (VPA; levetiracetam; and lacosamide and their combinations, at the prehospital and hospital stages, as well as SE therapy complications noted only in the intravenous administration of narcotics (propofol, sodium thiopental.Results and discussion. A fetal outcome due to multiple organ dysfunction indirectly related to SE was recorded in 2 (13.3% patients with acute symptomatic status. SE was abolished in the other 13 cases. The preliminary findings may suggest that it is appropriate to prescribe VPA just at the prehospital stage. The co-administration of VPA and DZP substantially enhances the efficiency of SE therapy. The maximum acceptable doses of AEDs using the whole available therapeutic arsenal should be administered within the first hours of acute symptomatic SE.

  7. Liposteroid therapy for refractory seizures in children.

    Science.gov (United States)

    Yoshikawa, H; Yamazaki, S; Abe, T; Oda, Y

    2000-10-01

    Liposteroid is dexamethasone palmitate incorporated into liposomes and was developed as an anti-inflammatory drug for targeting therapy mainly for rheumatoid arthritis. Recently, it was reported that liposteroid might be effective for the treatment of West syndrome, with fewer side effects than those of corticotropin therapy. We describe three patients, a 2-month-old boy with early infantile epileptic encephalopathy, a 4-month-old girl with symptomatic West syndrome, and a 2-year-old girl with symptomatic localization-related epilepsy, whose refractory seizures were treated with liposteroid according to the original method reported by Yamamoto and colleagues in 1998. Uncontrollable seizures ceased completely in two patients and the seizure frequency decreased markedly in the other patient. Electroencephalograms revealed marked improvement in all patients. They showed no relapse of the seizures, and all showed no adverse effects except for mild brain shrinkage in one patient. Our experience with these three patients suggests that liposteroid therapy might be a new option for the treatment of refractory seizures in children, as well as for West syndrome.

  8. Development of a Refractory High Entropy Superalloy

    Directory of Open Access Journals (Sweden)

    Oleg N. Senkov

    2016-03-01

    Full Text Available Microstructure, phase composition and mechanical properties of a refractory high entropy superalloy, AlMo0.5NbTa0.5TiZr, are reported in this work. The alloy consists of a nano-scale mixture of two phases produced by the decomposition from a high temperature body-centered cubic (BCC phase. The first phase is present in the form of cuboidal-shaped nano-precipitates aligned in rows along <100>-type directions, has a disordered BCC crystal structure with the lattice parameter a1 = 326.9 ± 0.5 pm and is rich in Mo, Nb and Ta. The second phase is present in the form of channels between the cuboidal nano-precipitates, has an ordered B2 crystal structure with the lattice parameter a2 = 330.4 ± 0.5 pm and is rich in Al, Ti and Zr. Both phases are coherent and have the same crystallographic orientation within the former grains. The formation of this modulated nano-phase structure is discussed in the framework of nucleation-and-growth and spinodal decomposition mechanisms. The yield strength of this refractory high entropy superalloy is superior to the yield strength of Ni-based superalloys in the temperature range of 20 °C to 1200 °C.

  9. [Iron-refractory iron deficiency anemia].

    Science.gov (United States)

    Kawabata, Hiroshi

    2016-02-01

    The major causes of iron deficiency anemia (IDA) include iron loss due to bleeding, increased iron requirements, and decreased iron absorption by the intestine. The most common cause of IDA in Japanese women is iron loss during menstruation. Autoimmune atrophic gastritis and Helicobacter pylori infection can also cause IDA by reducing intestinal iron absorption. In addition to these common etiologies, germline mutations of TMPRSS6 can cause iron-refractory IDA (IRIDA). TMPRSS6 encodes matriptase-2, a membrane-bound serine protease primarily expressed in the liver. Functional loss of matriptase-2 due to homozygous mutations results in an increase in the expression of hepcidin, which is the key regulator of systemic iron homeostasis. The serum hepcidin increase in turn leads to a decrease in iron supply from the intestine and macrophages to erythropoietic cells. IRIDA is microcytic and hypochromic, but decreased serum ferritin is not observed as in IDA. IRIDA is refractory to oral iron supplementation, but does respond to intravenous iron supplementation to some extent. Because genetic testing is required for the diagnoses of IRIDA, a considerable number of cases may go undiagnosed and may thus be overlooked.

  10. Refractory Degradation by Slag Attack in Coal Gasification

    Science.gov (United States)

    2009-02-01

    REFRACTORY DEGRADATION BY SLAG ATTACK IN COAL GASIFICATION Jinichiro Nakano 1,2 , Sridhar Seetharaman 1,2 , James Bennett 3 , Kyei-Sing...00-2009 4. TITLE AND SUBTITLE Refractory Degradation by Slag Attack in Coal Gasification 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM

  11. ZrO2-Containing Refractories for Cement Rotary Kilns

    Institute of Scientific and Technical Information of China (English)

    YE Guotian; XU Yanqing

    2002-01-01

    ZrO2-containing refractories have been increasingly used for cement rotary kilns. This paper discusses how the properties and performance of ZrO2-containing. Refractories are inwroved in terms of chemical attack resistance, thermal shock resistance, thermal conductivity and mechanical stress.

  12. Abrasion Resistant Refractory Materials GB/T 23294-2009

    Institute of Scientific and Technical Information of China (English)

    Yu Lingyuan

    2009-01-01

    @@ 1 Scope This standard specifies the definition, classification, technical requirements, test methods, quality appraisal procedure, packing, marking, transportation, storage, and quality certificate of abrasion resistant refractory materials. This standard is applicable to abrasion resistant refractory materials for circulating fluidized bed boilers, daily waste incinerator, industrial waste incinerator, medical waste incinerator, ordinary solid waste incinerator, hazardous waste incinerator, etc.

  13. Bortezomib for refractory antibody-mediated cardiac allograft rejection.

    Science.gov (United States)

    Eckman, Peter M; Thorsgard, Marit; Maurer, David; Kim, Youngki; Alloway, Rita R; Woodle, E Steve

    2009-01-01

    This experience demonstrates that a bortezomib-based regimen provided effective therapy for late, refractory AMR in an adult heart transplant recipient and was well tolerated. This remarkably positive experience despite the refractory nature of the AMR episode argues strongly for continued evaluation of bortezomib use in this patient population.

  14. Thirty Years' Reform and Development in China's Refractories Industry

    Institute of Scientific and Technical Information of China (English)

    XU Dianli; CHEN Jianxiong

    2009-01-01

    @@ 1 Development of Refractories Industry Since the People's Republic of China Founded Refractories is mainly used in high temperature industries,such as metallurgy,building materials,nonferrous,chemical,mechanical,electric power industries,which is the important fundamental material for high temperature industries.

  15. Intraepithelial lymphocytes in refractory celiac disease : lost in transition

    NARCIS (Netherlands)

    Schmitz, Frederike

    2014-01-01

    Refractory coeliac disease type II (RCDII) is a severe complication of coeliac disease. Whereas celiac disease can successfully be treated by the strict avoidance of gluten, refractory celiac patients show no remission despite a gluten-free diet. The pathology of RCDII is only partially understood,

  16. Intraepithelial lymphocytes in refractory celiac disease : lost in transition

    NARCIS (Netherlands)

    Schmitz, Frederike

    2014-01-01

    Refractory coeliac disease type II (RCDII) is a severe complication of coeliac disease. Whereas celiac disease can successfully be treated by the strict avoidance of gluten, refractory celiac patients show no remission despite a gluten-free diet. The pathology of RCDII is only partially understood,

  17. From stellar nebula to planets: the refractory components

    CERN Document Server

    Thiabaud, Amaury; Alibert, Yann; Cabral, Nahuel; Leya, Ingo; Mezger, Klaus

    2013-01-01

    We computed the abundance of refractory elements in planetary bodies formed in stellar systems with solar chemical composition by combining models for chemical composition and planet formation. We also consider the formation of refractory organic compounds, which have been ignored in previous studies on this topic. We used the commercial software package HSC Chemistry in order to compute the condensation sequence and chemical composition of refractory minerals incorporated into planets. The problem of refractory organic material is approached with two distinct model calculations: the first considers that the fraction of atoms used in the formation of organic compounds is removed from the system (i.e. organic compounds are formed in the gas phase and are nonreactive); and the second assumes that organic compounds are formed by the reaction between different compounds that had previously condensed from the gas phase. Results show that refractory material represents more than 50 wt % of the mass of solids accret...

  18. Diagnosis and Treatment of Refractory Gastroesophageal Reflux Disease (GERD

    Directory of Open Access Journals (Sweden)

    Selfie

    2015-12-01

    Full Text Available Gastroesophageal reflux disease (GERD was a damage in mucosal layer caused by gastric acid reflux. GERD was found about 10-20% in Western Countries and less in Asia, about 2,6-6,7%. Among different type of GERD, refractory GERD was a problem found in daily clinical practice. This terminology was used in patients with regurgitation and heartburn symptoms which is not responsive to 8 weeks proton pump inhibitor (PPI therapy. There were several mechanisms underlying the etiology and pathophysiology of refractory GERD. In general, refractory GERD diagnosis was based on clinical findings, objective endoscopic examination, ambulatory reflux monitoring, and response to antiacid-secretion therapy. Reevaluation of patients compliance should be the first step in refractory GERD management. A further treatment strategies could be started, consist of medical and surgical therapies. A basic clinical knowledge of refractory GERD would help clinician in deciding the best approach for diagnosis and therapy.

  19. Refractory alloy technology for space nuclear power applications

    Energy Technology Data Exchange (ETDEWEB)

    Cooper, R.H. Jr.; Hoffman, E.E. (eds.)

    1984-01-01

    Purpose of this symposium is twofold: (1) to review and document the status of refractory alloy technology for structural and fuel-cladding applications in space nuclear power systems, and (2) to identify and document the refractory alloy research and development needs for the SP-100 Program in both the short and the long term. In this symposium, an effort was made to recapture the space reactor refractory alloy technology that was cut off in midstream around 1973 when the national space nuclear reactor program began in the early 1960s, was terminated. The six technical areas covered in the program are compatibility, processing and production, welding and component fabrication, mechanical and physical properties, effects of irradiation, and machinability. The refractory alloys considered are niobium, molybdenum, tantalum, and tungsten. Thirteen of the 14 pages have been abstracted separately. The remaining paper summarizes key needs for further R and D on refractory alloys. (DLC)

  20. Endothelium-specific GTP cyclohydrolase I overexpression accelerates refractory wound healing by suppressing oxidative stress in diabetes.

    Science.gov (United States)

    Tie, Lu; Li, Xue-Jun; Wang, Xian; Channon, Keith M; Chen, Alex F

    2009-06-01

    Refractory wound is a severe complication that leads to limb amputation in diabetes. Endothelial nitric oxide synthase (eNOS) plays a key role in normal wound repair but is uncoupled in streptozotocin (STZ)-induced type 1 diabetes because of reduced cofactor tetrahydrobiopterin (BH(4)). We tested the hypothesis that overexpression of GTP cyclohydrolase I (GTPCH I), the rate-limiting enzyme for de novo BH(4) synthesis, retards NOS uncoupling and accelerates wound healing in STZ mice. Blood glucose levels were significantly increased in both male endothelium-specific GTPCH I transgenic mice (Tg-GCH; via a tie-2 promoter) and wild-type (WT) littermates 5 days after STZ regimen. A full-thickness excisional wound was created on mouse dorsal skin by a 4-mm punch biopsy. Wound closure was delayed in STZ mice, which was rescued in STZ Tg-GCH mice. Cutaneous BH(4) level was significantly reduced in STZ mice vs. WT mice, which was maintained in STZ Tg-GCH mice. In STZ mice, constitutive NOS (cNOS) activity and nitrite levels were decreased compared with WT mice, paralleled by increased superoxide anion (O(2)(-)) level and inducible NOS (iNOS) activity. In STZ Tg-GCH mice, nitrite level and cNOS activity were potentiated and O(2)(-) level and iNOS activity were suppressed compared with STZ mice. Thus endothelium-specific BH(4) overexpression accelerates wound healing in type 1 diabetic mice by enhancing cNOS activity and suppressing oxidative stress.

  1. Stimulus-dependent refractoriness in the Frankenhaeuser-Huxley model.

    Science.gov (United States)

    Morse, R P; Allingham, D; Stocks, N G

    2015-10-07

    Phenomenological neural models, such as the leaky integrate-and-fire model, normally have a fixed refractory time-course that is independent of the stimulus. The recovery of threshold following an action potential is typically based on physiological experiments that use a two-pulse paradigm in which the first pulse is suprathreshold and causes excitation and the second pulse is used to determine the threshold at various intervals following the first. In such experiments, the nerve is completely unstimulated between the two pulses. This contrasts the receptor stimuli in normal physiological systems and the electrical stimuli used by cochlear implants and other neural prostheses. A numerical study of the Frankenhaeuser-Huxley conductance-based model of nerve fibre was therefore undertaken to investigate the effect of stimulation on refractoriness. We found that the application of a depolarizing stimulus during the later part of what is classically regarded as the absolute refractory period could effectively prolong the absolute refractory period, while leaving the refractory time-constants and other refractory parameters largely unaffected. Indeed, long depolarizing pulses, which would have been suprathreshold if presented to a resting nerve fibre, appeared to block excitation indefinitely. Stimulation during what is classically regarded as the absolute refractory period can therefore greatly affect the temporal response of a nerve. We conclude that the classical definition of absolute refractory period should be refined to include only the initial period following an action potential when an ongoing stimulus would not affect threshold; this period was found to be about half as long as the classical absolute refractory period. We further conclude that the stimulus-dependent nature of the relative refractory period must be considered when developing a phenomenological nerve model for complex stimuli.

  2. NOvel Refractory Materials for High Alkali, High Temperature Environments

    Energy Technology Data Exchange (ETDEWEB)

    Hemrick, J.G.; Griffin, R. (MINTEQ International, Inc.)

    2011-08-30

    Refractory materials can be limited in their application by many factors including chemical reactions between the service environment and the refractory material, mechanical degradation of the refractory material by the service environment, temperature limitations on the use of a particular refractory material, and the inability to install or repair the refractory material in a cost effective manner or while the vessel was in service. The objective of this project was to address the need for new innovative refractory compositions by developing a family of novel MgO-Al2O3 spinel or other similar magnesia/alumina containing unshaped refractory composition (castables, gunnables, shotcretes, etc) utilizing new aggregate materials, bond systems, protective coatings, and phase formation techniques (in-situ phase formation, altered conversion temperatures, accelerated reactions, etc). This family of refractory compositions would then be tailored for use in high-temperature, highalkaline industrial environments like those found in the aluminum, chemical, forest products, glass, and steel industries. A research team was formed to carry out the proposed work led by Oak Ridge National Laboratory (ORNL) and was comprised of the academic institution Missouri University of Science and Technology (MS&T), and the industrial company MINTEQ International, Inc. (MINTEQ), along with representatives from the aluminum, chemical, glass, and forest products industries. The two goals of this project were to produce novel refractory compositions which will allow for improved energy efficiency and to develop new refractory application techniques which would improve the speed of installation. Also methods of hot installation were sought which would allow for hot repairs and on-line maintenance leading to reduced process downtimes and eliminating the need to cool and reheat process vessels.

  3. Talimogene Laherparepvec and Nivolumab in Treating Patients With Refractory Lymphomas or Advanced or Refractory Non-melanoma Skin Cancers

    Science.gov (United States)

    2017-06-30

    Adenoid Cystic Carcinoma; Adnexal Carcinoma; Apocrine Carcinoma; Eccrine Porocarcinoma; Extraocular Cutaneous Sebaceous Carcinoma; Hidradenocarcinoma; Keratoacanthoma; Malignant Sweat Gland Neoplasm; Merkel Cell Carcinoma; Microcystic Adnexal Carcinoma; NK-Cell Lymphoma, Unclassifiable; Non-Melanomatous Lesion; Paget Disease; Papillary Adenocarcinoma; Primary Cutaneous Mucinous Carcinoma; Refractory Anaplastic Large Cell Lymphoma; Refractory Cutaneous T-Cell Non-Hodgkin Lymphoma; Refractory Mature T-Cell and NK-Cell Non-Hodgkin Lymphoma; Refractory Mycosis Fungoides; Refractory T-Cell Non-Hodgkin Lymphoma; Sezary Syndrome; Signet Ring Cell Carcinoma; Skin Basal Cell Carcinoma; Skin Basosquamous Cell Carcinoma; Skin Squamous Cell Carcinoma; Spiradenocarcinoma; Squamous Cell Carcinoma of Unknown Primary Origin; Stage III Skin Cancer; Stage IV Skin Cancer; Sweat Gland Carcinoma; Trichilemmocarcinoma; Vulvar Squamous Cell Carcinoma

  4. Monitoring of Refractory wall recession using radar technique

    Energy Technology Data Exchange (ETDEWEB)

    University of missouri

    2003-12-30

    Furnaces are the most crucial components in the glass and metallurgical industry. Like any other components in an industry, furnaces require periodic maintenance and repair. Today, furnaces are being operated at higher temperatures and for longer periods of time thus increasing the rate of wear and tear on the furnace refractory lining. As a result of the competitive market facing these industries, longer furnace lifetime with shorter maintenance downtime are increasingly required. Higher fuel consumption, low production and safety are issues that accompany delayed maintenance. Consequently, there is a need to know the state of a refractory wall to prevent premature or unnecessary maintenance shutdowns. For many years the observation skills of an experienced operator has been the primary source of evaluating the wear associated with a refractory wall. The rate of regression of a refractory lining depends on the type of the refractory lining, the materials Monitoring of Refractory Wall Recession Using Frequency-Modulated Continuous-Wave (FM-CW) Radar Techniques: A Proof-of-Concept Study, Final Report, Submitted to the Department of Energy (DOE), September 2003. being melted, seepage, mechanical stresses, and temperature. Moreover, the regression of a refractory lining is also not uniform throughout a furnace and it is more prominent at the metal line along the sidewalls as this region is exposed to hot gaseous byproducts and flowing molten material. Hence, more accurate measurement techniques are required to determine the local residual thickness of a refractory lining so as to utilize the refractory lining to the maximum extent possible. The use of isotope radiators, thermocouples and endoscopes has also been investigated for monitoring regression. These techniques are capable of providing scanned thermal images showing the profile of the refractory wall. However, these techniques can only provide relative profile information and cannot provide absolute thickness

  5. Refractoriness in sustained visuo-manual control: is the refractory duration intrinsic or does it depend on external system properties?

    Science.gov (United States)

    van de Kamp, Cornelis; Gawthrop, Peter J; Gollee, Henrik; Loram, Ian D

    2013-01-01

    Researchers have previously adopted the double stimulus paradigm to study refractoriness in human neuromotor control. Currently, refractoriness, such as the Psychological Refractory Period (PRP) has only been quantified in discrete movement conditions. Whether refractoriness and the associated serial ballistic hypothesis generalises to sustained control tasks has remained open for more than sixty years. Recently, a method of analysis has been presented that quantifies refractoriness in sustained control tasks and discriminates intermittent (serial ballistic) from continuous control. Following our recent demonstration that continuous control of an unstable second order system (i.e. balancing a 'virtual' inverted pendulum through a joystick interface) is unnecessary, we ask whether refractoriness of substantial duration (~200 ms) is evident in sustained visual-manual control of external systems. We ask whether the refractory duration (i) is physiologically intrinsic, (ii) depends upon system properties like the order (0, 1(st), and 2(nd)) or stability, (iii) depends upon target jump direction (reversal, same direction). Thirteen participants used discrete movements (zero order system) as well as more sustained control activity (1(st) and 2(nd) order systems) to track unpredictable step-sequence targets. Results show a substantial refractory duration that depends upon system order (250, 350 and 550 ms for 0, 1(st) and 2(nd) order respectively, n=13, p<0.05), but not stability. In sustained control refractoriness was only found when the target reverses direction. In the presence of time varying actuators, systems and constraints, we propose that central refractoriness is an appropriate control mechanism for accommodating online optimization delays within the neural circuitry including the more variable processing times of higher order (complex) input-output relations.

  6. Refractoriness in sustained visuo-manual control: is the refractory duration intrinsic or does it depend on external system properties?

    Directory of Open Access Journals (Sweden)

    Cornelis van de Kamp

    Full Text Available Researchers have previously adopted the double stimulus paradigm to study refractoriness in human neuromotor control. Currently, refractoriness, such as the Psychological Refractory Period (PRP has only been quantified in discrete movement conditions. Whether refractoriness and the associated serial ballistic hypothesis generalises to sustained control tasks has remained open for more than sixty years. Recently, a method of analysis has been presented that quantifies refractoriness in sustained control tasks and discriminates intermittent (serial ballistic from continuous control. Following our recent demonstration that continuous control of an unstable second order system (i.e. balancing a 'virtual' inverted pendulum through a joystick interface is unnecessary, we ask whether refractoriness of substantial duration (~200 ms is evident in sustained visual-manual control of external systems. We ask whether the refractory duration (i is physiologically intrinsic, (ii depends upon system properties like the order (0, 1(st, and 2(nd or stability, (iii depends upon target jump direction (reversal, same direction. Thirteen participants used discrete movements (zero order system as well as more sustained control activity (1(st and 2(nd order systems to track unpredictable step-sequence targets. Results show a substantial refractory duration that depends upon system order (250, 350 and 550 ms for 0, 1(st and 2(nd order respectively, n=13, p<0.05, but not stability. In sustained control refractoriness was only found when the target reverses direction. In the presence of time varying actuators, systems and constraints, we propose that central refractoriness is an appropriate control mechanism for accommodating online optimization delays within the neural circuitry including the more variable processing times of higher order (complex input-output relations.

  7. Refractory and super-refractory status epilepticus in adults: a 9-year cohort study.

    Science.gov (United States)

    Delaj, L; Novy, J; Ryvlin, P; Marchi, N A; Rossetti, A O

    2017-01-01

    While status epilepticus (SE) persisting after two antiseizure agents is called refractory (RSE), super-refractory status epilepticus (SRSE) defines SE continuing after general anaesthesia. Its prevalence and related clinical profiles have received limited attention, and most studies were restricted to intensive care facilities. We therefore aimed at describing RSE and SRSE frequencies and identifying associated clinical variables. Between 2006 and 2015, consecutive adult SE episodes were prospectively recorded in a registry. Occurrence of RSE and SRSE and their relationship to clinical variables of interest, including outcome, were analysed. Of 804 SE episodes, 268 (33.3%) were RSE and 33 (4%) SRSE. Coma induction for SE treatment occurred in 79 (9.8%) episodes. Severe consciousness impairment (OR 1.67; 95% CI 1.24-2.46; P = 0.001), increasing age (OR 1.01, 95% CI 1.01-1.02), and lack of remote symptomatic SE aetiology (OR 0.48; 95% CI 0.32-0.72) were independently associated with RSE, while severe consciousness impairment (OR 4.26; 95% CI 1.44-12.60) and younger age (OR 0.96; 95% CI 0.95-0.99) correlated with SRSE; however, most SRSE episodes were not predicted by these variables. Mortality was 15.5% overall, higher in RSE (24.5%) and SRSE (37.9%) than in non-refractory SE (9.8%) (P < 0.001). Super-refractory status epilepticus appears clearly less prevalent in this cohort than previously reported, probably as it is not restricted to intensive care unit. SRSE emerges in younger patients with marked consciousness impairment, pointing to the underlying severe clinical background, but these variables do not predict most SRSE developments. There is currently a knowledge gap for prediction of SRSE occurrence that needs to be filled. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  8. Alemtuzumab in refractory Sézary syndrome*

    Science.gov (United States)

    Reifs, Carmen María Alcántara; Salido-Vallejo, Rafael; Garnacho-Saucedo, Gloria María; la Corte-Sánchez, Sofía De; González-Menchen, Alberto; García-Nieto, Antonio Vélez

    2016-01-01

    Sézary syndrome is a primary cutaneous T-cell lymphoma characterized by the triad of erythroderma, lymphadenopathy and circulating atypical cells. The emergence of new molecular targets has enabled the development of drugs such as alemtuzumab, an anti-CD52 monoclonal antibody, which has shown promising results in the treatment of this entity. We report the case of a 70-year-old male with refractory Sézary syndrome in whom treatment with alemtuzumab achieved an 80% skin lesion clearance with complete haematologic and radiologic response. The treatment was discontinued after 4 months due to adverse effects, with the patient showing a sustained response without disease progression after 13 months of follow-up. PMID:27828640

  9. Hypothermia for pediatric refractory status epilepticus.

    Science.gov (United States)

    Guilliams, Kristin; Rosen, Max; Buttram, Sandra; Zempel, John; Pineda, Jose; Miller, Barbara; Shoykhet, Michael

    2013-09-01

    Refractory status epilepticus (RSE) is a life-threatening emergency, demonstrating, by definition, significant pharmacoresistance. We describe five cases of pediatric RSE treated with mild hypothermia. Retrospective chart review was performed of records of children who received hypothermia for RSE at two tertiary-care pediatric hospitals between 2009 and 2012. Five children with RSE received mild hypothermia (32-35°C). Hypothermia reduced seizure burden during and after treatment in all cases. Prior to initiation of hypothermia, four children (80%) received pentobarbital infusions to treat RSE, but relapsed after pentobarbital discontinuation. No child relapsed after treatment with hypothermia. One child died after redirection of care. Remaining four children were discharged. This is the largest pediatric case series reporting treatment of RSE with mild hypothermia. Hypothermia decreased seizure burden during and after pediatric RSE and may prevent RSE relapse. Wiley Periodicals, Inc. © 2013 International League Against Epilepsy.

  10. Iron-Refractory Iron Deficiency Anemia

    OpenAIRE

    Ebru Yılmaz Keskin; İdil Yenicesu

    2015-01-01

    Demir, oksijenin taşınması, DNA sentezi ve hücre çoğalması gibi çeşitli biyolojik reaksiyonlar için vazgeçilmez olduğundan, yaşam için zorunludur. Demir metabolizması ve bu elementin düzenlenmesiyle ilgili bilgilerimiz, son yıllarda belirgin şekilde değişmiştir. Demir metabolizması ile ilgili yeni bozukluklar tanımlanmış ve demirin başka bozuklukların kofaktörü olduğu anlaşılmaya başlamıştır. Hemokromatozis ve demir tedavisine dirençli demir eksikliği anemisi (IRIDA; “iron-refractory iron def...

  11. Ketamine Infusions for Treatment Refractory Headache.

    Science.gov (United States)

    Pomeroy, Jared L; Marmura, Michael J; Nahas, Stephanie J; Viscusi, Eugene R

    2017-02-01

    Management of chronic migraine (CM) or new daily persistent headache (NDPH) in those who require aggressive outpatient and inpatient treatment is challenging. Ketamine has been suggested as a new treatment for this intractable population. This is a retrospective review of 77 patients who underwent administration of intravenous, subanesthetic ketamine for CM or NDPH. All patients had previously failed aggressive outpatient and inpatient treatments. Records were reviewed for patients treated between January 2006 and December 2014. The mean headache pain rating using a 0-10 pain scale was an average of 7.1 at admission and 3.8 on discharge (P ketamine well. A number of adverse events were observed, but very few were serious. Subanesthetic ketamine infusions may be beneficial in individuals with CM or NDPH who have failed other aggressive treatments. Controlled trials may confirm this, and further studies may be useful in elucidating more robust benefit in a less refractory patient population. © 2016 American Headache Society.

  12. Electrochemical Corrosion of Carbon—Containing Refractories

    Institute of Scientific and Technical Information of China (English)

    CHENZhao-you

    1994-01-01

    The electrochemical examination on the cor-rosion of carbon or carbon containing refractiories at molten slag-liquid interface has been carried out.The electromotive force(E.M.F)of cells with different molten slags:C|molten slag | Fe at elevated temperatures has been measured by means of potentiometer and it is in the range from 250 to 450mV .It is found that the carbon electrode in these cells is anode and whn a counter E.M.F.is applied externally to the cel,the corrosion of carbon electrode will be sup-pressed entirely.Test results show that the local corrosion of carbon containing refractories at slag-metal interface is mainly caused by the mechanism of electrochemical corrosion.

  13. Greater omentum in reconstruction of refractory wounds

    Institute of Scientific and Technical Information of China (English)

    沈余明; 沈祖尧

    2003-01-01

    Objective: To evaluate the clinical efficacy of greater omentum in reconstruction of refractory wounds. Methods: From August 1988 to May 2001, 20 patients with refractory wound underwent pedicle or microvascular free transfer of the greater omentum. Indications of surgery were electrical injury of the wrist and hand in 9 patients, electrical injury of the scalp and cranial bones in 3, avulsion injury of the scalp in 2, radiation-related ulcer of the chest wall in 2, ulcer and osteomyelitis following resection of the sternum sarcoma in 1, electrical injury of the abdomen in 1, bone and soft tissue defects following compound fracture of the leg in 1, and extensive scar and ulcer of the leg and footdrop following trauma in 1. Severe infection and extensive tissue necrosis were present prior to surgical operation in 12 patients. Eleven patients were treated with pedicled omental flaps, and 9 patients with free omental flaps. The size of the omental flaps ranged from 20 cm×12 cm to 38 cm×23 cm. Results: All the omental flaps survived. Healing at the first intention of the wounds was achieved in 17 cases. The on-top skin grafts resulted in partial necrosis of lipid liquefaction developed in the omentum and healed with dressing change in 2 cases. A sinus tract of osteomyelitis occurred in one case and healed after delayed excision of the necrosed bone. Follow-up study of all cases from 3 to 24 months showed no recurrent wounds and post-operative abdominal complication. Recovery with acceptable appearance and restoration of function was satisfactory. Conclusions: Greater omentum provides a well-vascularized tissue with lymphatic ducts for wound coverage. It has strong resistance against infection. It is very malleable and can be molded easily. Therefore it is an ideal tissue in filling cavities and repairing defects, especially in covering large and irregular defects that can not be treated with skin or muscle flaps.

  14. Pegloticase: in treatment-refractory chronic gout.

    Science.gov (United States)

    Lyseng-Williamson, Katherine A

    2011-11-12

    Intravenous pegloticase offers a novel approach to treating chronic gout refractory to conventional therapy. Pegloticase is a recombinant polyethylene glycol-conjugated form of uricase (a uric acid-specific enzyme lacking in humans) that catalyses the oxidation of uric acid to allantoin. In randomized, placebo-controlled, double-blind, 6-month, phase III trials, intravenous pegloticase 8 mg every 2 or 4 weeks provided sustained reductions in plasma uric acid levels to less than the therapeutic target of 6 mg/dL in a substantial proportion of patients with chronic gout who were refractory to, or intolerant of, conventional urate-lowering therapy. Pegloticase 8 mg every 2 weeks was associated with disease-modifying benefits relative to placebo, as shown by significant improvements from baseline in tophi resolution, frequency of gout flares and tender joint count, and clinically relevant and statistically significant improvements from baseline in health-related quality-of-life parameters related to disability, pain and physical function. Pegloticase 8 mg every 4 weeks was also significantly more effective than placebo with regard to most, but not all, of these endpoints. Preliminary data from an open-label extension of the phase III trials indicate that long-term treatment with pegloticase 8 mg every 2 or 4 weeks may maintain plasma uric acid normalization in patients who experienced a sustained uric acid response during the phase III trials. The most common serious adverse events associated with pegloticase are gout flares, infusion reactions and anaphylaxis. In addition, exacerbation of pre-existing congestive heart failure was reported in 2% of patients receiving pegloticase 8 mg every 2 weeks in the phase III trials.

  15. Esquizofrenia refratária Refractory schizophrenia

    Directory of Open Access Journals (Sweden)

    Helio Elkis

    2007-10-01

    Full Text Available OBJETIVO: O propósito deste artigo é o de revisar vários aspectos da esquizofrenia refratária levando em conta questões relacionadas à definição, aspectos clínicos, correlatos psicobiológicos, tratamentos farmacológicos e não farmacológicos, assim como preditores de resposta terapêutica. MÉTODO: Pesquisa no Medline, assim como artigos dos autores. RESULTADOS E CONCLUSÕES: Pelo menos um terço dos pacientes com esquizofrenia são refratários a tratamento com antipsicóticos e as evidências apontam a clozapina em monoterapia como a principal opção nesses casos. A politerapia com antipsicóticos não tem apoio em evidências. Ensaios clínicos recentes mostraram que a potencialização da clozapina com outros antipsicóticos não é superior ao placebo.OBJECTIVE: The aim of the present paper is to review the various aspects of refractory schizophrenia regarding issues such as definitions, clinical aspects, psychobiological correlates, pharmacological and non-pharmacological treatment options and predictors of treatment response. METHOD: Medline search as well as articles of the authors. RESULTS AND CONCLUSIONS: Refractory schizophrenia affects at least one third of patients with schizophrenia and the best evidence shows that is monotherapy with clozapine remains the mainstay for the treatment of such condition. Antipsychotic polipharmacy is not supported by current evidence and recent clinical trials have shown that clozapine augmentation with antipsychotics has no benefit over placebo.

  16. Brain stimulation for treatment of refractory epilepsy

    Institute of Scientific and Technical Information of China (English)

    GE Yan; HU Wei; LIU Chong; ZHANG Jian-guo; MENG Fan-gang

    2013-01-01

    Objective We review the targets of the deep brain and the responsive neurostimulation system (RNS) to identify the best optimal stimulation parameters and the best mode of stimulation,whether cyclical,continuous,or smarter.Data sources This review is based on data obtained from published articles from 1950 to 2013.To perform the PubMed literature search,the following keywords were input:deep brain stimulation (DBS),RNS,and refractory epilepsy.Study selection Articles containing information related to brain stimulation or RNS for the treatment of refractory epilepsy were selected.Results The currently available treatment options for those patients who resist multiple antiepileptic medications and surgical procedures include electric stimulation,both direct and indirect,of brain nuclei thought to be involved in epileptogenesis.The number of potential targets has increased over the years to include the anterior nucleus of the thalamus,the centromedian nucleus of the thalamus,the hippocampus,the subthalamic nucleus,the caudate nucleus,and the cerebellum,among others.The results of a randomized controlled trial and the RNS trial were published to reveal the effectiveness.Conclusions Although statistically significant reductions in seizures have been observed using several different stimulation techniques,including vagus nerve stimulation,DBS,and RNS,these effects are currently only palliative and do not approach the efficacy comparable with that seen in resection in appropriately selected patients.More research is needed to determine optimal stimulation targets and techniques as well as to determine which epilepsy patients will benefit most from this technology.

  17. High-Density Infrared Surface Treatments of Refractories

    Energy Technology Data Exchange (ETDEWEB)

    Tiegs, T.N.

    2005-03-31

    Refractory materials play a crucial role in all energy-intensive industries and are truly a crosscutting technology for the Industries of the Future (IOF). One of the major mechanisms for the degradation of refractories and a general decrease in their performance has been the penetration and corrosion by molten metals or glass. Methods and materials that would reduce the penetration, wetting, and corrosive chemistry would significantly improve refractory performance and also maintain the quality of the processed liquid, be it metal or glass. This report presents the results of an R&D project aimed at investigating the use of high-density infrared (HDI) heating to surface treat refractories to improve their performance. The project was a joint effort between Oak Ridge National Laboratory (ORNL) and the University of Missouri-Rolla (UMR). HDI is capable of heating the near-surface region of materials to very high temperatures where sintering, diffusion, and melting can occur. The intended benefits of HDI processing of refractories were to (1) reduce surface porosity (by essentially sealing the surface to prevent liquid penetration), (2) allow surface chemistry changes to be performed by bonding an adherent coating onto the underlying refractory (in order to inhibit wetting and/or improve corrosion resistance), and (3) produce noncontact refractories with high-emissivity surface coatings.

  18. [Fever-induced refractory epileptic encephalopathy of children].

    Science.gov (United States)

    Sivkova, S N; Bogdanov, E I; Zaĭkova, F M; Morozova, E A; Aiupova, V A; Zabbarova, A T; Shaĭmardanova, R M

    2013-01-01

    Fever-induced refractory epileptic encephalopathy of school-age children is a rare epileptic syndrome that causes difficulties in diagnosis at the initial stage of disease. It is characterized by sudden onset with multifocal refractory status epilepticus in previously healthy children with normal development. Later, children suffer from resistant focal epilepsy in the combination with cognitive deficit and behavioral difficulties. Authors describe a clinical case of fever-induced refractory epileptic encephalopathy of school-age children in a child of 7 years old. Aspects of etiology, pathogenesis, clinical manifestation, differential diagnosis, treatment and prognosis of the disease are discussed.

  19. RESEARCH ON REFRACTORY SUPERALLOYS IN THE HTM 21 PROJECT

    Institute of Scientific and Technical Information of China (English)

    Y.F.Gu; Y.Yamabe-Mitarai; C.Huang; H.Harada

    2005-01-01

    It was proposed that a new class of alloys based on platinum group metals (PGMs) were called refractory superalloys.These refractory superalloys have an fcc and LI2 coherent two-phase structure (similar to that of Ni-based superalloys), high melting temperatures and good potential as structural materials used at temperatures up to 1800℃.Our recent results on the microstructure evolution, deformation and fracture behavior of some of these refracotry superalloys, especial Ir- and Rh-base refractory superalloys were reported.

  20. Successful treatment of severe refractory lupus hepatitis with mycophenolate mofetil.

    Science.gov (United States)

    Tagawa, Y; Saito, T; Takada, K; Kawahata, K; Kohsaka, H

    2016-04-01

    Systemic lupus erythematosus-related hepatitis, known as lupus hepatitis, is a rare manifestation of systemic lupus erythematosus, and is usually subclinical with mild abnormalities of serum liver enzymes. While cases with clinically significant and refractory lupus hepatitis are uncommon, treatment options for lupus hepatitis are to be established. Here, we report the case of a 45-year-old man with progressive lupus hepatitis accompanied by autoimmune haemolytic anaemia. Lupus hepatitis of this patient was refractory to tacrolimus, azathioprine and cyclophosphamide, but was successfully treated by mycophenolate mofetil. Mycophenolate mofetil might be an effective therapeutic option for refractory lupus hepatitis.

  1. Compressive Creep and Thermophysical Performance of Mullite Refractories

    Energy Technology Data Exchange (ETDEWEB)

    Hemrick, JG

    2002-04-01

    Compressive creep testing of ten commercially available mullite refractories was performed at 1300-1450 C and at static stresses between 0.2-0.6 MPa. These refractories were examined because they are used in borosilicate glass furnace crowns and superstructures along with in sidewall applications. Additionally, despite their high cost ({approx}$500/ft{sup 3}) they are cheaper than other refractories such as chrome alumina ({approx}$3000/ft{sup 3}) or fusion-cast alumina ({approx}900/ft{sup 3}) which are used as replacements for traditional silica refractories in harsh oxy-fuel environments. The corrosion resistances of these ten materials were also evaluated. In addition, measurements were made that tracked their dimensional stability, phase content, microstructure, and composition as a function of temperature and time. The techniques used for these characterizations and their respective analyses are described. An intent of this study was to provide objective and factual results whose interpretations were left to the reader.

  2. Refractory Coated/Lined Low Density Structures Project

    Data.gov (United States)

    National Aeronautics and Space Administration — The innovation in this proposed effort is the development of refractory coated or lined low density structures. Lightweight structures are desirable for space...

  3. Fireclay Refractory Mortars GB/T 14982-2008

    Institute of Scientific and Technical Information of China (English)

    Zhang Xiaohui; Chai Junlan

    2009-01-01

    @@ 1 Scope This standard specifies the classification, techni-cal requirements, test methods, quality appraisal pro-cedure, packing, marking, transportation, storage and quality certificate of fireclay refractory mortars.

  4. High Alumina Refractory Mortars GB/T 2994-2008

    Institute of Scientific and Technical Information of China (English)

    Wang Jing; Chai Junlan

    2009-01-01

    @@ 1 Scope This standard specifies the classification, techni-cal requirements, test methods, quality appraisal pro-cedure, packing, marking, transportation, storage and quality certificate of high alumina refractory mortars.

  5. Refractory, Abrasive, and Other Industrial Minerals Operations - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer includes refractory, abrasive, and other industrial minerals operations in the United States. The data represent commodities covered by the Minerals...

  6. Refractory Gunning Material for Inner Lining Maintenance of Blast Furnace

    Institute of Scientific and Technical Information of China (English)

    Yu Lingyan; Peng Xigao

    2010-01-01

    @@ 1 Scope This standard specifies the term and definition,classification, technical requirements, test methods,quality appraisal procedures, packing, marking, transportation, storage, and quality certificate of refractory gunning material for inner lining maintenance of blast furnace .

  7. Fused Cast Alumina Refractory Products for Glass Tank Furnace

    Institute of Scientific and Technical Information of China (English)

    SHEN Keyin

    2006-01-01

    @@ 1 Subject and Scope The standard specifies the requirement, testing method, inspection rule and requirements for the labeling, packing, shipping and storing of the fused cast alumina refractory products for glass tanks.

  8. Effectiveness of botulinum toxin A in treatment of refractory erythromelalgia

    Directory of Open Access Journals (Sweden)

    Kuan-Hsiang Lin

    2013-05-01

    Full Text Available Erythromelalgia is characterized by intense burning pain, erythema, and heat in affected areas after precipitating factors such as warm temperature or stress. It is refractory to treatment in some situations. We describe a woman with adenosquamous cell carcinoma of the lung and medically refractory erythromelalgia. The symptoms of erythromelalgia presented as refractory to any medical treatment. Due to the unresponsive nature of her condition, botulinum toxin type A (onabotulinumtoxin A was injected over both of her cheeks, periodically for six cycles. Her symptoms responded dramatically to subcutaneous and intradermal injection of botulinum toxin type A. Repetitive injection demonstrated consistent and reproducible responses, and the efficacy was maintained for approximately 1 month. No adverse effects or complications were noted. Botulinum toxin type A might be safe and effective as an alternative treatment for refractory erythromelalgia, but further large-scale studies are required.

  9. High Alumina Refractory Bricks for Electric Arc Furnace Roofs

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    @@ 1 Scope This standard specifies the sort, technical requirement, test method, inspection rules, marking, packing, transportation, storage and quality certification of high alumina refractory bricks for electric arc furnace roofs.

  10. Elderly woman with cerebrovascular accident and refractory arrhythmias.

    Science.gov (United States)

    Sethi, S K; Sarm, P S A

    2009-11-01

    Fatal bilateral cerebro-vascular accident with variable atrio-ventricular blocks, atrial fibrillation and refractory tachy-arrhythmias in a previously healthy 75-years-old hypertensive female is presented.

  11. Rituximab Efficacy during a Refractory Polyarteritis Nodosa Flare

    Directory of Open Access Journals (Sweden)

    Emmanuel Ribeiro

    2009-01-01

    Full Text Available Polyarteritis nodosa (PAN is a systemic vasculitis whose severe forms are treated with glucocorticoids and cyclophosphamide. Refractory patients are exposed to many complications, notably accelerated atherosclerosis. We report a case report of 71-year-old man followed for polyarteritis nodosa refractory to glucocorticoids and cyclosphosphamide. Systemic vasculitis relapses are followed to accelerated atherosclerosis: severe ischemic lesions led to amputation of lower limbs. Remission of refractory PAN is obtained with rituximab. Disappearance of biological inflammatory is allowed to regression of ischemic lesions in upper limbs. In this situation, we recommend a systematic vascular work-up for patients suffered from refractory vasculitis. On the other hand, therapeutic trials are needed to determine the real efficacy and place of rituximab in the treatment of polyarteritis nodosa.

  12. Recycling MgO-C refractory in electric arc furnaces

    Energy Technology Data Exchange (ETDEWEB)

    Conejo, A.N. [Metallurgy Department, Morelia Technological Institute, Morelia (Mexico); Lule, R.G.; Lopez, F. [Process Engineering Department-Steelmaking Shop, Lazaro Cardenas City (Mexico); Rodriguez, R. [Refractories Department, Lazaro Cardenas City (Mexico)

    2006-11-15

    MgO-C refractory recycling from electric arc furnaces and ladle furnaces has been carried out during the melting of direct reduced iron (DRI). Metallurgical trials to define the effects of refractory recycling on energy consumption, melting time, flux consumption and refractory consumption are reported in this work. The method of preparation as well as the method of injection is also included in this study. Based on current results, the practice of recycling spent refractory is highly recommended. Visual inspection indicates the potential benefits in slag foaming which starts to form at the beginning of the heat thus allowing the use of full power transformer and in turn results in faster melting rates. (author)

  13. Coatability of cement clinker on basic refractories

    Science.gov (United States)

    Guo, Zongqi

    The aim of this work is to develop an effective and practicable method to evaluate the coatability of cement clinker on basic refractory bricks, susceptible to be translated in numbers. Determinations of the dominant influential factors, and assessment of reliability, as well as of coating mechanisms on different basic bricks, are to be tackled. Raw meal has been investigated in terms of chemical and phase compositions, particle size distribution, using DTA and TGA, as well as x-ray diffraction and microstructural analysis after heating at different temperatures. Raw meal calcinated at 1000°C for 4 hours contains plenty of free lime. Over 1350°C, most of liquid phases and belite C2S have formed. At 1450°C, there are still some clusters of free lime in clinker. Alite C 3S becomes dominant phase in clinker fired at temperature of 1550°C, with reduction of belite C2S and depletion of free lime. Samples of 50 x 50 x 60 mm are directly cut dry from available bricks (without water-cooling) and the sandwich is prepared using the cut surfaces. At least six pieces are needed to have three sandwiches for all tested brands of basic refractories. Mean value of the modulus of rupture obtained from three replicates is considered as representative of the adherence strength of the coating. Statistical process analysis was also used to plan and carry out experiments carefully so as to confirm repeatability and reproducibility of the sandwich protocol. Variability of +/-0.5 MPa is considered to be acceptable on a 5 MPa measured value. The following conclusions can be derived from the results: (1) The most significant effects on adherence strength are the compressive loads, the nature of the raw meal, the heating temperature and the holding time, ranked in the order of importance. (2) A ruggedness test indicates that the sandwich test is insensitive to minor changes, in holding time, paste thickness and mixing mode of the paste. (3) Adherence mechanism of cement clinker on doloma

  14. Refractory absence epilepsy associated with GLUT-1 deficiency syndrome.

    LENUS (Irish Health Repository)

    Byrne, Susan

    2011-05-01

    GLUT-1 deficiency syndrome (GLUT-1 DS) is a disorder of cerebral glucose transport associated with early infantile epilepsy and microcephaly. We report two boys who presented with refractory absence epilepsy associated with hypoglycorrhachia, both of whom have genetically confirmed GLUT-1 DS. We propose that these children serve to expand the phenotype of GLUT-1 DS and suggest that this condition should be considered as a cause of refractory absence seizures in childhood.

  15. Thoughts on Strategic Development of China's Refractories Industry

    Institute of Scientific and Technical Information of China (English)

    ZHONG Xiangchong

    2003-01-01

    For China' s refractories industry, the first two decades in the new century would be a period of structural optimization with reorganization of refractories enterprises,reconstruction of manufacturing plants and restructuring of product varieties. An important strategic measure should be to develop high quality synthetic raw materials and high performance functional products mainly based on our rich natural resources to cope with new demands of advanced high temperature technologies.

  16. New Applications of Some High Technologies i Refractories

    Institute of Scientific and Technical Information of China (English)

    WUYiquan; ZHANGYufeng; 等

    2001-01-01

    The potential applications of some high tenologies in refractories,such as,nanotechnology,in-situ synthesis,self-propagating high-temperature synthesis,functional gradient materials,computer assisted design and some new advanced refactories in Si-Al-O-N system are briefly described.The characteristics and preparation processes of these new refractories areintroduced,and the remaining problems awaiting effective solutions are pointed out .Some suggesions on future diection of research and development are fitly made.

  17. Salvage abdominal irradiation for refractory non-Hodgkin′s lymphoma

    Directory of Open Access Journals (Sweden)

    Akoum Riad

    2007-01-01

    Full Text Available Background: Abdominal irradiation, as a part of treatment, is often ignored in the management of refractory non-Hodgkin′s lymphoma (NHL. Objective: To evaluate the efficacy and the toxicity of this approach after failure of chemotherapy. Materials and Methods: 27 patients with intraabdominal lymphoma underwent salvage irradiation between 1982 and 2001. All patients were treated with a Cobalt-60 machine. The total dose administered to the abdomen was 18-20 Gy at the rate of 1.5-1.8 Gy per daily fraction, followed by a boost to gross disease up to 20 Gy. All patients had previously been heavily pretreated with chemotherapy. Fourteen patients, nine with follicular and five with diffuse lymphomas, had primary refractory tumors that had never achieved remission. Thirteen patients, six with follicular and seven with aggressive tumors, had refractory relapsed tumors after achieving one or more complete remissions. Results: The response rate was 77%. The median follow-up was 53 months. The 5-year and 10-year survival rates were 25 and 17%, respectively. The in-field and out-of-field recurrence rates were 22 and 33%, respectively. Survival rates were significantly better for patients with refractory relapse compared to those with primary refractory lymphoma (P < 0.01. There was no significant difference in terms of response, recurrence, or survival rates between follicular and aggressive types. Out-of-field recurrence occurred more frequently in initial stage III and IV disease. Toxic deaths occurred in three patients (11%. Conclusion: Salvage radiotherapy for refractory abdominal NHL is a feasible alternative for both follicular and diffuse subtypes and may provide significant palliation and prolongation of survival. It is less effective in patients with primary refractory NHL than in those with refractory relapsed NHL.

  18. Ketogenic diet in 3 cases of childhood refractory status epilepticus

    DEFF Research Database (Denmark)

    Sort, Rune; Born, Alfred P; Pedersen, Karen N.;

    2013-01-01

    Refractory status epilepticus (RSE) in children is associated with a significant risk of death or neurological morbidity. Recently attention has been drawn to the ketogenic diet (KD) as an acute treatment, as it has shown promise in controlling seizures in otherwise refractory status epilepticus...... in several cases. We have listed these and reviewed all cases of KD used in RSE at our centre. KD was given as 4:1 fat:carbohydrate-protein solution....

  19. Severe aortic coarctation in a patient with refractory hypertension

    OpenAIRE

    Hiram Tápanes Daumy

    2015-01-01

    Idiopathic hypertension is common in adults, and some patients are considered resistant or refractory to treatment. In such cases it is often associated with a patho-logical process which hinders its control, in spite of changes in lifestyle and the proper use of drugs. This article is about an adult female patient with refractory hypertension due to aortic coarctation. CT scan and angiographic images are shown.Key words: Hypertension, Treatment, Aortic coarctation

  20. Chronic lymphocytic leukemia: treatment options for patients with refractory disease.

    Science.gov (United States)

    Motta, Marina; Wierda, William G; Ferrajoli, Alessandra

    2009-09-01

    Patients with purine analogue-refractory chronic lymphocytic leukemia (CLL) have short survival and limited treatment options. Defining the best salvage strategies for this population is challenging, because limited data are available from clinical trials, and because studies have enrolled mixed populations (patients with recurrent and refractory disease or patients with refractory disease and Richter transformation). Moreover, patients with refractory CLL have a high incidence of unfavorable molecular and clinical features, such as high-risk genomic profiles, unmutated immunoglobulin heavy-chain genes, expression of zeta-chain-associated protein kinase 70, and bulky lymphadenopathies. These patients are also severely immunosuppressed because of the underlying disease and the treatments received, and experience a high rate of infectious complications that pose an additional difficulty in selecting treatment. Despite these challenges, in parallel with better characterizations of the biologic features of refractory CLL, the number of available treatment modalities for this population has increased. Several chemoimmunotherapy combinations have been developed, and novel agents with a different mechanism of action are being investigated in clinical trials. Furthermore, allogeneic stem cell transplantation with nonmyeloablative conditioning regimens is a therapeutic strategy that is increasingly offered to patients with refractory CLL.

  1. Refractory ceramic fibers activate alveolar macrophage eicosanoid and cytokine release.

    Science.gov (United States)

    Leikauf, G D; Fink, S P; Miller, M L; Lockey, J E; Driscoll, K E

    1995-01-01

    Refractory ceramic fiber has been developed for industrial processes requiring materials with high thermal and mechanical stability. To evaluate the biological activity of this fiber, rat alveolar macrophages were exposed for < or = 24 h to 0-1,000 micrograms/ml of refractory ceramic fiber, crocidolite asbestos, silica (fibrogenic particles), or titanium dioxide (a nonfibrogenic particle), and eicosanoid, tumor necrosis factor-alpha (TNF), and lactate dehydrogenase release were measured. Particle dimensions were determined by electron microscopy. Radioactivity coeluting with leukotriene B4 (LTB4) and immunoreactive LTB4 and TNF release increased after refractory ceramic fiber and were similar in magnitude after asbestos but less than after silica. For example, the total [3H]eicosanoid release increased 3.9-fold after refractory ceramic fiber, 4.6-fold after asbestos, and 8.7-fold after silica. Refractory ceramic fiber and asbestos also have similar particle dimensions (diameter, length, and surface area). Inasmuch as macrophage-derived LTB4 and TNF are potent mediators in inflammatory events, including migration and activation of neutrophils, these findings suggest that refractory ceramic fiber can activate macrophages in vitro to release mediators relevant to in vivo findings of inflammation and fibrotic lung disease in laboratory animals.

  2. Refractory diarrhea: A paraneoplastic syndrome of neuroblastoma.

    Science.gov (United States)

    Han, Wei; Wang, Huan-Min

    2015-07-01

    Neuroblastoma (NB) is the most common extracranial solid tumor in children. Diarrheal NB is quite rare and is not easy to diagnose in the early stage. Six cases of diarrheal NB in our hospital treated from 1996 to 2006 were retrospectively analyzed, including characteristics such as electrolyte imbalance, pathologic features, vasoactive intestinal peptide (VIP) immunohistochemical staining results, treatment, and prognosis. All patients were boys with 3-8 loose or watery stools each day and routine fecal tests were normal. Abdominal tumors were identified by B-ultrasound. Drugs were ineffective. Three patients underwent surgery, and the remaining three patients received surgery and chemotherapy. Diarrhea stopped after treatment in five patients. Two patients died due to intractable hypokalemia. The tumor was located in the adrenal gland in four patients, in the upper retroperitoneum in one patient, and in the presacral area in one patient. Pathologic findings were NB and ganglioneuroblastoma. Five patients were at clinical stage I-II, and one was at stage III. Four patients survived (followed-up for 6 mo to 4 years). Immunohistochemical staining for VIP was positive. Refractory diarrhea is a paraneoplastic syndrome of NB and is rare. Patients aged 1-3 years who present with chronic intractable diarrhea should be followed closely. Intractable diarrhea, hypokalemia, and dysplasia are the initial clinical manifestations. Increased VIP is characteristic of this disease. Potassium supplementation plays a vital role in the treatment procedure, especially preoperatively. The prognosis of diarrheal NB is good following appropriate treatment.

  3. Nonlinear Refractory Plasmonics with Titanium Nitride Nanoantennas.

    Science.gov (United States)

    Gui, Lili; Bagheri, Shahin; Strohfeldt, Nikolai; Hentschel, Mario; Zgrabik, Christine M; Metzger, Bernd; Linnenbank, Heiko; Hu, Evelyn L; Giessen, Harald

    2016-09-14

    Titanium nitride (TiN) is a novel refractory plasmonic material which can sustain high temperatures and exhibits large optical nonlinearities, potentially opening the door for high-power nonlinear plasmonic applications. We fabricate TiN nanoantenna arrays with plasmonic resonances tunable in the range of about 950-1050 nm by changing the antenna length. We present second-harmonic (SH) spectroscopy of TiN nanoantenna arrays, which is analyzed using a nonlinear oscillator model with a wavelength-dependent second-order response from the material itself. Furthermore, characterization of the robustness upon strong laser illumination confirms that the TiN antennas are able to endure laser irradiation with high peak intensity up to 15 GW/cm(2) without changing their optical properties and their physical appearance. They outperform gold antennas by one order of magnitude regarding laser power sustainability. Thus, TiN nanoantennas could serve as promising candidates for high-power/high-temperature applications such as coherent nonlinear converters and local heat sources on the nanoscale.

  4. Iron-refractory iron deficiency anemia.

    Science.gov (United States)

    Yılmaz Keskin, Ebru; Yenicesu, İdil

    2015-03-05

    Iron is essential for life because it is indispensable for several biological reactions, such as oxygen transport, DNA synthesis, and cell proliferation. Over the past few years, our understanding of iron metabolism and its regulation has changed dramatically. New disorders of iron metabolism have emerged, and the role of iron as a cofactor in other disorders has begun to be recognized. The study of genetic conditions such as hemochromatosis and iron-refractory iron deficiency anemia (IRIDA) has provided crucial insights into the molecular mechanisms controlling iron homeostasis. In the future, these advances may be exploited to improve treatment of both genetic and acquired iron disorders. IRIDA is caused by mutations in TMPRSS6, the gene encoding matriptase-2, which downregulates hepcidin expression under conditions of iron deficiency. The typical features of this disorder are hypochromic, microcytic anemia with a very low mean corpuscular volume of erythrocytes, low transferrin saturation, no (or inadequate) response to oral iron, and only a partial response to parenteral iron. In contrast to classic iron deficiency anemia, serum ferritin levels are usually low-normal, and serum or urinary hepcidin levels are inappropriately high for the degree of anemia. Although the number of cases reported thus far in the literature does not exceed 100, this disorder is considered the most common of the "atypical" microcytic anemias. The aim of this review is to share the current knowledge on IRIDA and increase awareness in this field.

  5. Electron microscopy study of refractory ceramic fibers.

    Science.gov (United States)

    MacKinnon, P A; Lentz, T J; Rice, C H; Lockey, J E; Lemasters, G K; Gartside, P S

    2001-10-01

    In epidemiological studies designed to identify potential health risks of exposures to synthetic vitreous fibers, the characterization of airborne fiber dimensions may be essential for assessing mechanisms of fiber toxicity. Toward this end, air sampling was conducted as part of an industry-wide study of workers potentially exposed to airborne fibrous dusts during the manufacture of refractory ceramic fibers (RCF) and RCF products. Analyses of a subset of samples obtained on the sample filter as well as on the conductive sampling cowl were performed using both scanning electron microscopy (SEM) and transmission electron microscopy (TEM) to characterize dimensions of airborne fibers. Comparison was made of bivariate fiber size distributions (length and diameter) from air samples analyzed by SEM and by TEM techniques. Results of the analyses indicate that RCF size distributions include fibers small enough in diameter ( 60 microm) may go undetected by TEM, as evidenced by the proportion of fibers in this category for TEM and SEM analyses (1% and 5%, respectively). Limitations of the microscopic techniques and differences in fiber-sizing rules for each method are believed to have contributed to the variation among fiber-sizing results. It was concluded from these data that further attempts to characterize RCF exposure in manufacturing and related operations should include analysis by TEM and SEM, since the smallest diameter fibers are not resolved with SEM and the fibers of longer length are not sized by TEM.

  6. Iron-Refractory Iron Deficiency Anemia

    Science.gov (United States)

    Yılmaz Keskin, Ebru; Yenicesu, İdil

    2015-01-01

    Iron is essential for life because it is indispensable for several biological reactions, such as oxygen transport, DNA synthesis, and cell proliferation. Over the past few years, our understanding of iron metabolism and its regulation has changed dramatically. New disorders of iron metabolism have emerged, and the role of iron as a cofactor in other disorders has begun to be recognized. The study of genetic conditions such as hemochromatosis and iron-refractory iron deficiency anemia (IRIDA) has provided crucial insights into the molecular mechanisms controlling iron homeostasis. In the future, these advances may be exploited to improve treatment of both genetic and acquired iron disorders. IRIDA is caused by mutations in TMPRSS6, the gene encoding matriptase-2, which downregulates hepcidin expression under conditions of iron deficiency. The typical features of this disorder are hypochromic, microcytic anemia with a very low mean corpuscular volume of erythrocytes, low transferrin saturation, no (or inadequate) response to oral iron, and only a partial response to parenteral iron. In contrast to classic iron deficiency anemia, serum ferritin levels are usually low-normal, and serum or urinary hepcidin levels are inappropriately high for the degree of anemia. Although the number of cases reported thus far in the literature does not exceed 100, this disorder is considered the most common of the “atypical” microcytic anemias. The aim of this review is to share the current knowledge on IRIDA and increase awareness in this field. PMID:25805669

  7. Mobilization of refractory chronic schizophrenics with haloperidol.

    Science.gov (United States)

    Psaras, M; Zissis, N P; Mouzakis, D; Lyketsos, G

    1980-01-01

    Adequate high doses of haloperidol have been administered to 24 chronic, refractory to standard antipsychotic treatment, schizophrenics (16 male, 8 female, mean age 32.9 years) to investigate the possibility of mobilizing and releasing these patients from the hospital. Treatment was started with 20 mg haloperidol and optimal doses were determined for each patient. The median daily optimal dose at the end of the trial was 100mg. All patients were followed up for 16 weeks. Evaluating criteria were the BPRS, the Discharge Readiness Questionnaire, a side-effect rating scale, a CGI scale and the number of patients able to leave the hospital. 3 patients were evaluated as able to leave the hospital. 87.4% of the patients were subjectively evaluated as improved. High doses of haloperidol did not correlate with a higher incidence of unwanted effects. On the contrary antiparkinson treatment was discontinued or decreased in 14 patients. It is concluded that nonresponsive chronic schizophrenics can profit from adequate high doses of haloperidol.

  8. Lenalidomide for relapsed or refractory multiple myeloma

    Directory of Open Access Journals (Sweden)

    S. S. Bessmeltsev1

    2012-01-01

    Full Text Available We report the activity of lenalidomide (revlimide – R, lenalidomide plus dexamethasone (Rd, lenalidomide plus bortezomib plus dexamethasone (RVd in 34 patients with relapsed and refractory myeloma. For patients who received lenalidomide the overall response rate was 70.5 %. 38 % patients achieved very good partial response (VGPR + complete response (CR. Median overall survival (OS was 48 months. Lenalidomide may overcome the poor prognostic impact of various factors, particularly elevated beta (2-microglobulin. Lenalidomide is highly active in elderly patients (> 65 years. Significantly increased OS with a lenalidomide-based induction and lenalidomide maintenance therapy was revealed. The median duration of the overall response without lenalidomide maintenance therapy was 10 months. The median duration of the overall response with lenalidomide maintenance therapy was 20 months (р < 0,05. Median OS with lenalidomide maintenance therapy was not reached. Median OS without lenalidomide maintenance therapy was 36 months (р < 0.05. Side effects were predictable and manageable. The most common adverse events reported were neutropenia (38.3 % and thrombocytopenia (23.7 %. Serious adverse events were rare.

  9. Levetiracetam in children with refractory status epilepticus.

    Science.gov (United States)

    Gallentine, William B; Hunnicutt, Addie S; Husain, Aatif M

    2009-01-01

    The objective of this study was to investigate the utility of levetiracetam (LEV) in children with refractory status epilepticus (RSE). Records of children with RSE who received LEV as adjunctive therapy were reviewed. Over a 7-year period, 11 children had received LEV for RSE. Age ranged from 2 days to 9 years (median = 2.5 months). Prior to administration of LEV, the number of anticonvulsants used to treat RSE ranged from 2 to 7 (median = 3). Starting doses of LEV ranged from 15 to 70 mg/kg (median = 30 mg/kg). LEV was felt to be of benefit in 45% (5/11) of cases, resulting in either resolution of RSE or successful weaning of patients off continuous infusions of other anticonvulsants. In 27% (3/11), response to LEV was unclear as other medications were either added or increased concomitantly with LEV use. The median latency to cessation of RSE following LEV initiation was 1.5 days (range = 1-8 days). All responding patients were on LEV doses >or= 30 mg/kg/day (median 40 mg/kg/day). No significant adverse effects of LEV were reported. LEV may be an effective and safe adjuvant therapy in children with RSE.

  10. Autologous Stem Cell Transplant Followed by Donor Stem Cell Transplant in Treating Patients With Relapsed or Refractory Lymphoma

    Science.gov (United States)

    2016-02-23

    Prolymphocytic Leukemia; Recurrent Adult Hodgkin Lymphoma; Recurrent Childhood Hodgkin Lymphoma; Recurrent Childhood Non-Hodgkin Lymphoma; Recurrent Chronic Lymphocytic Leukemia; Recurrent Non-Hodgkin Lymphoma; Recurrent Small Lymphocytic Lymphoma; Refractory Childhood Hodgkin Lymphoma; Refractory Chronic Lymphocytic Leukemia; Refractory Hodgkin Lymphoma; Refractory Non-Hodgkin Lymphoma; Refractory Small Lymphocytic Lymphoma; T-Cell Chronic Lymphocytic Leukemia; T-Cell Prolymphocytic Leukemia

  11. Directed Light Fabrication of Refractory Metals and Alloys

    Energy Technology Data Exchange (ETDEWEB)

    Fonseca, J.C.; Lewis, G.K.; Dickerson, P.G.; Nemec, R.B.

    1999-05-14

    This report covers work performed under Order No. FA0000020 AN Contract DE-AC12-76SN00052 for deposition of refractory pure metals and alloys using the Directed Light Fabrication (DLF) process and represents the progress in depositing these materials through September 1998. In extending the DLF process technology to refractory metals for producing fully dense, structurally sound deposits, several problems have become evident. 1. Control of porosity in DLF-deposited refractory metal is difficult because of gases, apparently present in commercially purchased refractory metal powder starting materials. 2. The radiant heat from the molten pool during deposition melts the DLF powder feed nozzle. 3. The high reflectivity of molten refractory metals, at the Nd-YAG laser wavelength (1.06{micro}m), produces damaging back reflections to the optical train and fiber optic delivery system that can terminate DLF processing. 4. The current limits on the maximum available laser power to prevent back reflection damage limit the parameter range available for densification of refractory metals. The work to date concentrated on niobium, W-25Re, and spherodized tungsten. Niobium samples, made from hydride-dehydride powder, had minimal gas porosity and the deposition parameters were optimized; however, test plates were not made at this time. W-25Re samples, containing sodium and potassium from a precipitation process, were made and porosity was a problem for all samples although minimized with some process parameters. Deposits made from potassium reduced tungsten that was plasma spherodized were made with minimized porosity. Results of this work indicate that further gas analysis of starting powders and de-gassing of starting powders and/or gas removal during deposition of refractory metals is required.

  12. Directed light fabrication of refractory metals and alloys

    Energy Technology Data Exchange (ETDEWEB)

    Fonseca, J.C.; Lewis, G.K.; Dickerson, P.G.; Nemec, R.B.

    1999-05-30

    This report covers deposition of refractory pure metals and alloys using the Directed Light Fabrication (DLF) process and represents progress in depositing these materials through September 1998. In extending the DLF process technology to refractory metals for producing fully dense, structurally sound deposits, several problems have become evident. (1) Control of porosity in DLF-deposited refractory metal is difficult because of gases, apparently present in commercially purchased refractory metal powder starting materials. (2) The radiant heat from the molten pool during deposition melts the DLF powder feed nozzle. (3) The high reflectivity of molten refractory metals, at the Nd-YAG laser wavelength (1.06{micro}m), produces damaging back reflections to the optical train and fiber optic delivery system that can terminate DLF processing. (4) The current limits on the maximum available laser power to prevent back reflection damage limit the parameter range available for densification of refractory metals. The work to date concentrated on niobium, W-25Re, and spherodized tungsten. Niobium samples, made from hydride-dehydride powder, had minimal gas porosity and the deposition parameters were optimized; however, test plates were not made at this time. W-25Re samples, containing sodium and potassium from a precipitation process, were made and porosity was a problem for all samples although minimized with some process parameters. Deposits made from potassium reduced tungsten that was plasma spherodized were made with minimized porosity. Results of this work indicate that further gas analysis of starting powders and de-gassing of starting powders and/or gas removal during deposition of refractory metals is required.

  13. The management of refractory coeliac disease

    Science.gov (United States)

    2013-01-01

    A significant proportion of patients with coeliac disease are ‘nonresponsive’ to gluten withdrawal. Most cases of nonresponsive coeliac disease are due to persisting gluten ingestion. Refractory coeliac disease (RCD) is currently defined by persistent symptoms and signs of malabsorption after gluten exclusion for 12 months with ongoing intestinal villous atrophy. Primary (without initial response to diet) and secondary (relapse following response to diet) RCD is recognized. RCD is further classified as type I or type II based on the absence or presence of a population of aberrant intestinal lymphocytes. Quality of dietetic advice and support is fundamental, and lack of objective corroboration of gluten exclusion may result in over-identification of RCD I, particularly in those cases with persisting antibody responses. Over-reliance on lymphocyte clonality similarly may result in over-diagnosis of RCD II which requires careful quantification of aberrant lymphocyte populations. Management of RCD should be undertaken in specialist centres. It requires initial intensive dietary supervision, strict gluten exclusion and subsequent re-evaluation. There is currently insufficient evidence to recommend specific treatments. Steroids are often used in both RCD I and II (albeit with little objective evidence of benefit in RCD II), and azathioprine as steroid-sparing therapy in RCD I. There is growing evidence for the use of cladribine in RCD II with autologous stem cell transplantation in nonresponders, but this requires further multicentre evaluation. There remains considerable controversy regarding the diagnosis, treatment and surveillance of RCD: international consensus in these areas is urgently required to facilitate future therapeutic advances. PMID:23556127

  14. Surgical treatment for medically refractory myasthenic blepharoptosis

    Directory of Open Access Journals (Sweden)

    Shimizu Y

    2014-09-01

    Full Text Available Yusuke Shimizu,1 Shigeaki Suzuki,2 Tomohisa Nagasao,1 Hisao Ogata,1 Masaki Yazawa,1 Norihiro Suzuki,2 Kazuo Kishi1 1Department of Plastic and Reconstructive Surgery, 2Department of Neurology, Keio University School of Medicine, Tokyo, JapanPurpose: Currently, only a few reports have recommended surgery as a suitable treatment for blepharoptosis associated with myasthenia gravis. The present study aims to introduce our surgical criteria, surgical options, outcomes, and precautions for medically refractory myasthenic blepharoptosis. Patients and methods: Eight patients who failed to respond to at least 2 years of medical treatment and who underwent blepharoptosis surgery, from January 2008 to December 2011, were enrolled in this study. Medical records, photographs, and questionnaire results regarding postoperative status were evaluated. Of the eleven procedures performed, four involved frontal suspension, four involved external levator advancement, one involved nonincisional transconjunctival levator advancement, and two involved subbrow blepharoplasty with orbicularis oculi muscle tucking. The margin reflex distance improved postoperatively in seven patients. Results: Seven patients had very minimal scarring, and one had minimal scarring. Five patients showed no eyelid asymmetry, one had subtle asymmetry, and two had obvious asymmetry. Seven patients were very satisfied, and one patient was satisfied with the overall result. Postoperative complications included mild lid lag with incomplete eyelid closure, prolonged scar redness, and worsened heterophoria. No patient experienced postoperative exposure keratitis or recurrent blepharoptosis during the study period. Conclusion: Our results indicate that blepharoptosis surgery is effective for patients with myasthenia gravis, especially those with residual blepharoptosis despite multiple sessions of medical treatments. We recommend that neurologists and surgeons collaborate more systematically and

  15. Probiotics and refractory chronic spontaneous urticaria.

    Science.gov (United States)

    Nettis, E; Di Leo, E; Pastore, A; Distaso, M; Zaza, I; Vacca, M; Macchia, L; Vacca, A

    2016-09-01

    Background. In chronic spontaneous urticaria (CSU) first-line therapy with an antihistamine-based regimen may not achieve satisfactory control in patients. Thus, a continuing need exists for effective and safe treatments for refractory CSU. Aim. To evaluate the clinical efficacy and safety of an intake of a combination of 2 probiotics (Lactobacillus salivarius LS01 and Bifidobacterium breve BR03) in patients with CSU who remain symptomatic despite concomitant H1-antihistamine therapy. Methods. This report analyzes the effects of therapy with two probiotic strains on the clinical progress of 52 unselected patients with difficulty to treat CSU underwent to medical examination in two Italian specialist urticaria Clinics between September 2013 and September 2014. A mixture of Lactobacillus LS01 and Bifidobacterium BR03 were administered in each patient twice daily for 8 weeks. To evaluate patients' improvement with probiotics, urticaria activity score over 7 days (UAS7) was used at baseline and at week 8 in addition to a 5-question urticaria quality of life questionnaire. Results. Fifty-two patients with CSU were included in this study (10 male and 42 female, age range 19-72 years). Mean disease duration was 1.5 years. Fourteen patients discontinued treatment, so evaluable population consisted of 38 patients. Nine of the 38 patients experienced mild clinical improvement during probiotic treatment (23.7%); one patient reported significant clinical improvement (2.6%) and one patient had complete remission of urticaria (2.6%). Twenty-seven patients did not have improvement in symptoms (71.1%). No side effects during the course of therapy were reported. Conclusions. A combination of Lactobacillus salivarius LS01 and Bifidobacterium breve BR03 administered twice daily for 8 weeks might reduce the symptoms scores and improve quality of life scores in a part of patients with CSU who remained symptomatic despite treatment with H1 antihistamine mostly in subjects with allergic

  16. Managing refractory Crohn's disease: challenges and solutions

    Directory of Open Access Journals (Sweden)

    Tanida S

    2015-04-01

    Full Text Available Satoshi Tanida, Keiji Ozeki, Tsutomu Mizoshita, Hironobu Tsukamoto, Takahito Katano, Hiromi Kataoka, Takeshi Kamiya, Takashi Joh Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Aichi Prefecture, Japan Abstract: The goals of treatment for active Crohn's disease (CD are to achieve clinical remission and improve quality of life. Conventional therapeutics for moderate-to-severe CD include 5-aminosalicylic acid, corticosteroids, purine analogs, azathioprine, and 6-mercaptopurine. Patients who fail to respond to conventional therapy are treated with tumor necrosis factor (TNF-α inhibitors such as infliximab and adalimumab, but their efficacy is limited due to primary nonresponse or loss of response. It is suggested that this requires switch to another TNF-α inhibitor, a combination therapy with TNF-α blockade plus azathioprine, or granulocyte and monocyte adsorptive apheresis, and that other therapeutic options having different mechanisms of action, such as blockade of inflammatory cytokines or adhesion molecules, are needed. Natalizumab and vedolizumab are neutralizing antibodies directed against integrin a4 and a4ß7, respectively. Ustekinumab is a neutralizing antibody directed against the receptors for interleukin-12 and interleukin-23. Here, we provide an overview of therapeutic treatments that are effective and currently available for CD patients, as well as some that likely will be available in the near future. We also discuss the advantages of managing patients with refractory CD using a combination of TNF-α inhibitors plus azathioprine or intensive monocyte adsorptive apheresis. Keywords: adalimumab, granulocyte and monocyte adsorptive apheresis, combination therapy, complete remission

  17. Managing refractory cryoglobulinemic vasculitis: challenges and solutions

    Directory of Open Access Journals (Sweden)

    Ostojic P

    2017-05-01

    Full Text Available Predrag Ostojic, Ivan R Jeremic Institute of Rheumatology, School of Medicine, University of Belgrade, Belgrade, Serbia Abstract: Cryoglobulinemia is thought to be a rare condition. It may be an isolated disorder or secondary to a particular disease. According to immunoglobulin composition, cryoglobulinemia is classified into three types. In mixed cryoglobulinemia (types II and III, vascular deposition of cryoglobulin-containing immune complexes and complement may induce a clinical syndrome, characterized by systemic vasculitis and inflammation – cryoglobulinemic vasculitis (CryoVas. Most common clinical manifestations in CryoVas are skin lesions (orthostatic purpura and ulcers, weakness, peripheral neuropathy, Raynaud’s phenomenon, sicca syndrome, membranoproliferative glomerulonephritis, and arthralgia and seldom arthritis. In patients with mixed cryoglobulinemia, prevalence of anti-hepatitis C virus (HCV antibodies and/or HCV RNA, detected by polymerase chain reaction (PCR, is reported to be up to 90%, indicating a significant role of HCV in the development of this condition. The goals of therapy for mixed cryoglobulinemia include immunoglobulin level reduction and antigen elimination. CryoVas not associated with HCV infection should be treated according to treatment recommendations for small-vessel vasculitides. CryoVas associated with chronic HCV infection should be treated with antivirals along with immunosuppressive drugs, with or without plasmapheresis, depending on disease severity and organ involvement. Patients who do not respond to first-line therapy may achieve remission when treatment with rituximab is started as second-line therapy. In HCV-related CryoVas, antiviral therapy should be given along with rituximab in order to achieve complete or partial remission. Moreover, rituximab has proven to be a glucocorticoid-sparing medication. Other potential therapies for refractory CryoVas include mycophenolate mofetil and belimumab

  18. Commercial off-the-Shelf (COTS) Refractory Material Evaluation

    Science.gov (United States)

    Calle, Luz Marina; Kolody, Mark R.; Curran, Jerome P.; Back, Teddy; Hintze, Paul E.; Parlier, Christopher R.; Sampson, Jeffrey W.; Perusich, Stephen; Bucherl, Cori

    2009-01-01

    Fondu Fyre (FF) is currently the only refractory material qualified for use in the flame trench at KSC's Shuttle Launch Pads 39A and 39B. However, the material is not used as it was qualified and has undergone increasingly frequent and severe degradation due to the launch blasts. This degradation is costly as well as dangerous for launch infrastructure, crew and vehicle. FF is applied at the pad via the gunnite process, where wetted refractory material is sprayed onto a steel grid mounted on a support structure. The water content in this process can be manually adjusted by operators, causing distinct visual and physical discrepancies among repair areas. Since the application process is unlikely to change for new refractory materials, it is important to understand the effects of water content on commercial off-the-shelf (COTS) refractory materials. The purpose of this study was to evaluate the performance of the FF with respect to various water contents as well as heat treatments, to simulate aging and exposure to the blast. Initial results indicated that different water contents and heat treatments result in distinct differences in crushing strength, apparent porosity and bulk density. However, water content became an insignificant factor in both crush strength and porosity when FF was cured to at least 1500 deg. Additionally, inspection of the material's surface microstructure by scanning electron microscopy indicated distinguishable characteristics for different heat treatment levels. Results from this study will help guide future studies on the development and identification of new refractory materials.

  19. Radiosurgery for the management of refractory trigeminal neuralgia

    Directory of Open Access Journals (Sweden)

    Ajay Niranjan

    2016-01-01

    Full Text Available Gamma Knife stereotactic radiosurgery (SRS is a minimally invasive surgical approach for managing medically refractory trigeminal neuralgia (TN. The goal of trigeminal neuralgia SRS is to eliminate or reduce the facial pain in order to improve the quality of life. Over the past 28 years, 1250 patients have undergone gamma knife SRS for TN at our institution. In our retrospective review of 503 patients who underwent SRS for management of refractory TN, 449 patients (89% experienced initial pain relief at a median latency of 1 month. At the one year mark, 73% patients were pain free (with or without medications and 80% had pain control. Repeat radiosurgery was performed for 193 patients (43%. At the one year mark, 26% of these patients were completely pain free and 78% were pain free with or without medications. The role of gamma Knife SRS in the management of medically refractory trigeminal neuralgia has evolved over the past two decades. SRS is a minimally invasive procedure and is associated with 60-90% rate of pain relief in patents with medical refractory trigeminal neuralgia. Early intervention with SRS as the initial surgical procedure for management of refractory trigeminal neuralgia is associated with faster, better, and longer pain relief. As SRS is the least invasive procedure for TN, it is a good treatment option for patients with other high-risk medical conditions. SRS is an attractive alternative especially to those who do not want to accept the greater risk associated with other surgical procedures.

  20. Resistant and Refractory Hypertension: Antihypertensive Treatment Resistance vs Treatment Failure.

    Science.gov (United States)

    Siddiqui, Mohammed; Dudenbostel, Tanja; Calhoun, David A

    2016-05-01

    Resistant or difficult to treat hypertension is defined as high blood pressure that remains uncontrolled with 3 or more different antihypertensive medications, including a diuretic. Recent definitions also include controlled blood pressure with use of 4 or more medications as also being resistant to treatment. Recently, refractory hypertension, an extreme phenotype of antihypertensive treatment failure has been defined as hypertension uncontrolled with use of 5 or more antihypertensive agents, including a long-acting thiazide diuretic and a mineralocorticoid receptor antagonist. Patients with resistant vs refractory hypertension share similar characteristics and comorbidities, including obesity, African American race, female sex, diabetes, coronary heart disease, chronic kidney disease, and obstructive sleep apnea. Patients with refractory vs resistant hypertension tend to be younger and are more likely to have been diagnosed with congestive heart failure. Refractory hypertension might also differ from resistant hypertension in terms of underlying cause. Preliminary evidence suggests that refractory hypertension is more likely to be neurogenic in etiology (ie, heightened sympathetic tone), vs a volume-dependent hypertension that is more characteristic of resistant hypertension in general. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  1. DIFFERENCES IN INTERICTAL PERFUSION PATTERNS BETWEEN REFRACTORY AND NON-REFRACTORY TEMPORAL LOBE EPILEPSIES EVALUATED WITH FAIR AT 3.0T

    Institute of Scientific and Technical Information of China (English)

    Hui You; Jing-jing Lu; Lian-kun Ren; Xiao-zhen Li; Feng Feng; Chun-ling Meng; Zheng-yu Jin

    2006-01-01

    Objective To investigate the difference in interictal perfusion patterns between refractory and non-refractory temporal lobe epilepsies evaluated with flow-sensitive alternating inversion recovery (FAIR) magnetic resonance (MR) sequence.Methods Nine patients with refractory temporal lobe epilepsy,21 patients with non-refractory temporal lobe epilepsy,and 13 normal volunteers underwent FAIR MR scanning.The relative cerebral blood flow (rCBF) in bilateral hemispheres and mesial temporal lobes were measured.And we also calculated the asymmetry index (AI) values.Results The AI values of bilateral hemispheres in refractory and non-refractory epilepsy patients were both significantly different from those of volunteers (P=0.012 and 0.029,respectively).There was significant difference in AI values of bilateral mesial temporal lobes between non-refractory epilepsy patients and volunteers (P=0.049),while no significant difference between refractory epilepsy patients and volunteers.Conclusions The hypoperfusion pattern of interictal refractory temporal lobe epilepsy patients is different from that of non-refractory patients.Although the hypoperfusion tends to extend out of temporal lobes in all patients,the refractory epilepsy patients have a preference of bilateral mesial temporal hypoperfusion,which may be valuable for evaluating prognosis.

  2. Beta-blockers in cirrhosis and refractory ascites

    DEFF Research Database (Denmark)

    Kimer, Nina; Feineis, Martin; Møller, Søren

    2015-01-01

    OBJECTIVE: It is currently discussed if beta-blockers exert harmful effects and increase mortality in patients with cirrhosis and refractory ascites. In this study, we provide an overview of the available literature in this field in combination with a retrospective analysis of 61 patients...... trials (9 trials on propranolol, 1 case-control study and 4 retrospective analyses) were identified. One trial suggested an increased mortality in patients treated with beta-blockers and refractory ascites. The results of the remaining trials were inconclusive. No increase in mortality among beta-blocker......-treated patients was found in the present retrospective analysis. CONCLUSIONS: Treatment with beta-blockers may increase mortality in patients with cirrhosis and refractory ascites. However, the current evidence is sparse and high-quality studies are warranted to clarify the matter....

  3. Prolonged treatment of refractory status epilepticus in a child.

    Science.gov (United States)

    Sahin, M; Riviello, J J

    2001-02-01

    Barbiturate anesthesia, which is commonly used for refractory status epilepticus, is an effective treatment, but with many significant complications. The relationship between the duration of this extreme therapy and the ultimate outcome of refractory status epilepticus has not been well studied. We report a 7-year-old girl who presented with refractory status epilepticus secondary to presumed encephalitis with a focal lesion on cranial magnetic resonance imaging. She was treated for 70 days with high-dose antiepileptic drugs and recovered with a residual seizure disorder. This case suggests that, if the status epilepticus is due to a reversible cause such as encephalitis, neurologic recovery may occur despite this very prolonged course of extreme therapy.

  4. Alloy design for intrinsically ductile refractory high-entropy alloys

    Science.gov (United States)

    Sheikh, Saad; Shafeie, Samrand; Hu, Qiang; Ahlström, Johan; Persson, Christer; Veselý, Jaroslav; Zýka, Jiří; Klement, Uta; Guo, Sheng

    2016-10-01

    Refractory high-entropy alloys (RHEAs), comprising group IV (Ti, Zr, Hf), V (V, Nb, Ta), and VI (Cr, Mo, W) refractory elements, can be potentially new generation high-temperature materials. However, most existing RHEAs lack room-temperature ductility, similar to conventional refractory metals and alloys. Here, we propose an alloy design strategy to intrinsically ductilize RHEAs based on the electron theory and more specifically to decrease the number of valence electrons through controlled alloying. A new ductile RHEA, Hf0.5Nb0.5Ta0.5Ti1.5Zr, was developed as a proof of concept, with a fracture stress of close to 1 GPa and an elongation of near 20%. The findings here will shed light on the development of ductile RHEAs for ultrahigh-temperature applications in aerospace and power-generation industries.

  5. Neuroimaging in refractory epilepsy. Current practice and evolving trends

    Energy Technology Data Exchange (ETDEWEB)

    Ramli, N. [Department of Biomedical Imaging, University Malaya Research Imaging Centre (Malaysia); Rahmat, K., E-mail: katt_xr2000@yahoo.com [Department of Biomedical Imaging, University Malaya Research Imaging Centre (Malaysia); Lim, K.S.; Tan, C.T. [Neurology Unit, Department of Medicine, University Malaya, Kuala Lumpur (Malaysia)

    2015-09-15

    Highlights: • Neuroimaging is imperative in diagnostic work up and therapeutic assessment of refractory epilepsy. • Identification of epileptogenic zone on EEG, MRI and functional imaging improves the success of surgery. • High performance MRI greatly enhanced metabolic information and elucidate brain functions. • Optimisation of epilepsy protocols in structural and functional MRI are presented in this article. - Abstract: Identification of the epileptogenic zone is of paramount importance in refractory epilepsy as the success of surgical treatment depends on complete resection of the epileptogenic zone. Imaging plays an important role in the locating and defining anatomic epileptogenic abnormalities in patients with medically refractory epilepsy. The aim of this article is to present an overview of the current MRI sequences used in epilepsy imaging with special emphasis of lesion seen in our practices. Optimisation of epilepsy imaging protocols are addressed and current trends in functional MRI sequences including MR spectroscopy, diffusion tensor imaging and fusion MR with PET and SPECT are discussed.

  6. Felbamate in an adult population with severe refractory epilepsy.

    LENUS (Irish Health Repository)

    Kearney, H

    2011-04-05

    Felbamate (FBM) is efficacious in treating patients with refractory epilepsy but was withdrawn due to cases of aplastic anaemia, hepatic failure and five reported deaths. FBM is currently used in specialist centres and is only being used in one Irish centre to date. This papers aim is to review the efficacy and safety experience of FBM in Irish adult patients with refractory epilepsy. A retrospective chart review was done on patients\\' medical records. Patients were subdivided into responders and non responders based on change in seizure frequency and side effects were recorded for all. Of the 13 patients on FBM nine patients responded to FBM, four patients did not. FBM is a safe and efficacious alternative in an Irish adult population with refractory epilepsy. However close monitoring is still required given the potential fatal side effects that are possible with this anticonvulsant.

  7. Thermal Insulation and Strength Characteristics of Refractory Incorporating Natural Silica

    Directory of Open Access Journals (Sweden)

    Namboonruang Weerapol

    2016-01-01

    Full Text Available This work emphasizes on the studying of using silica to develop for the production of refractory materials. Materials are tested at the cured times of 7, 14 and 28 days. Results show that the cold crushing strength, flexural strength and bulk density increase with increasing cured times. On the other hand, the permanent linear change (PLC decreases with increasing cured times. It is also found that adding more silica contents can increase the durability of cracking property due to temperature changing. This study concludes that the silica refractory materials (SRM shows the enough quality to produce as the refractory material, type of the Conventional Cast/Pound (815 °C for the agroindustry using the thermal energy of Thailand.

  8. IMPROVED FURNACE EFFICIENCY THROUGH THE USE OF REFRACTORY MATERIALS

    Energy Technology Data Exchange (ETDEWEB)

    Hemrick, James Gordon [ORNL; Rodrigues-Schroer, Angela [Minteq International, Inc.; Colavito, [Minteq International, Inc.; Smith, Jeffrey D [ORNL

    2011-01-01

    This paper describes efforts performed at Oak Ridge National Laboratory (ORNL), in collaboration with industrial refractory manufacturers, refractory users, and academic institutions, to improve energy efficiency of U.S. industry through increased furnace efficiency brought about by the employment of novel refractory systems and techniques. Work in furnace applications related to aluminum, gasification, and lime are discussed. The energy savings strategies discussed are achieved through reduction of chemical reactions, elimination of mechanical degradation caused by the service environment, reduction of temperature limitations of materials, and elimination of costly installation and repair needs. Key results of several case studies resulting from a US Department of Energy (DOE) funded research program are discussed with emphasis on applicability of these results to high temperature furnace applications.

  9. Depression in patients with refractory temporal lobe epilepsy

    Directory of Open Access Journals (Sweden)

    Eleonora Borges Gonçalves

    2011-10-01

    Full Text Available OBJECTIVE: To evaluate the comorbidity of depressive disorders in patients with refractory temporal lobe epilepsy (TLE. METHOD: We evaluated 25 consecutive patients with refractory TLE (16 women and 9 men, using semi-structured psychiatric interviews, according to the International Classification of Diseases (ICD-10, and the Beck Depression Inventory. RESULTS: Seventeen of 25 patients (68% had depressive disorder: 6 with dysthymia, three with major depressive episodes and 8 with recurrent depressive disorders. Two (8% were diagnosed with mixed anxiety and depression. Only 5 of 17 patients (29.4% were previously diagnosed with depressive disorder and received prior antidepressant treatment. Duration of epilepsy was significantly higher in patients with depressive disorder (p=0.016, but there was no relationship between depression and seizure frequency. CONCLUSION: This study confirmed that depressive disorders are common and underdiagnosed in patients with TLE refractory to AEDs. Patients with longer duration of epilepsy are at higher risk of having depression.

  10. Refractory Characteristics of Aluminum Dross-Kaolin Composite

    Science.gov (United States)

    Adeosun, S. O.; Akpan, E. I.; Dada, M. O.

    2014-11-01

    The suitability of using aluminum dross waste and kaolin to produce refractory bricks is experimentally studied. Thirty brick samples of different blends are produced, dried at 30°C, dried further at 110°C, and fired at 1200°C. The firing temperature point, bulk density, apparent porosity, thermal conductivity, thermal shock, loss on ignition, permeability, shatter index, and shrinkage of the bricks blends are determined. The results show that some blend samples have good refractory characteristics with mixing ratio 4:1:2 (representing weight in grams of aluminum dross, plastic clay, and kaolin, respectively). The evaluations of studied properties reveal the possibility for aluminum dross waste to be used as matrix in refractory bricks.

  11. Investigation of Appropriate Refractory Material for Laboratory Electritic Resistrance Furnance

    Directory of Open Access Journals (Sweden)

    J.B Agboola

    2009-07-01

    Full Text Available There have been numerous efforts to increase the local content of furnaces; hence the choice of appropriate refractory material for lining of locally manufactured furnaces has remained a major concern. This research work investigates the choice of appropriate local refractory material for the lining of laboratory electric resistance furnace.Electric resistance furnaces are extensively used in the laboratory for heat treatment of metals and alloys. Refractory binders such as silicon carbide were experimented upon for strength and resistance to high temperature.The results obtained showed that Kankara fireclay containing 15% SiC ( 5.70 % linear shrinkage , 46.2% apparent porosity, 1.77gkm³ Bulk density, 18 cycles of spalling tests at 1300°C, 5.253KN/m² of cold strength has appropriate properties for producing grooved bricks for lining of laboratory electric resistance Furnace.

  12. A new hypothesis of drug refractory epilepsy: neural network hypothesis.

    Science.gov (United States)

    Fang, Min; Xi, Zhi-Qin; Wu, Yuan; Wang, Xue-Feng

    2011-06-01

    Drug refractory is an important clinical problem in epilepsy, affecting a substantial number of patients globally. Mechanisms underlying drug refractory need to be understood to develop rational therapies. Current two prevailing theories on drug refractory epilepsy (DRE) include the target hypothesis and the transporter hypothesis. However, those hypotheses could not be adequate to explain the mechanisms of all the DRE. Thus, we propose another possible mechanism of DRE, which is neural network hypothesis. It is hypothesized that seizure-induced alterations of brain plasticity including axonal sprouting, synaptic reorganization, neurogenesis and gliosis could contribute to the formation of abnormal neural network, which has not only avoided the inhibitory effect of endogenous antiepileptic system but also prevented the traditional antiepileptic drugs from entering their targets, eventually leading to DRE. We will illustrate this hypothesis at molecular and structural level based on our recent studies and other related researches.

  13. Failure Mechanisms in High Chrome Oxide Gasifier Refractories

    Science.gov (United States)

    Bennett, James P.; Kwong, Kyei-Sing

    2011-04-01

    Gasification is a high-temperature, high-pressure chemical process used to convert a carbon feedstock into CO and H2 (syngas) for use in power generation and the production of chemicals. It is also a leading candidate as a source of hydrogen in a hydrogen economy and is one of several technologies expected to see increased use in advanced fossil fuel power systems in the future. Gasification is being evaluated because of its high efficiency, its ability to capture CO2 for sequestration or reuse in other applications, and its potential for carbon feedstock fuel flexibility. At the heart of the gasification process is a gasifier, a high pressure chemical reaction vessel used to contain the interactions between carbon and water in a shortage of oxygen, producing syngas. The gasifier is lined with high chrome oxide materials to protect the containment vessel. Gasifiers are complex systems, and failure of the refractories used to line them was identified by industry as a limitation to their reliability and availability and to their increased use. NETL researchers have examined spent high-Cr2O3 (over 90 pct Cr2O3) refractories from numerous gasifiers to determine in-service failure mechanisms. This analysis revealed that premature failure of the high chrome oxide refractories was related to ash in the carbon feedstock, which liquefies during gasification and interacts with the refractories, leading to wear by chemical dissolution or spalling (structural and chemical). A discussion of this postmortem wear of spent refractory materials and of thermodynamic modeling used to explain microstructural changes leading to wear are explained in this article. This information will serve the basis to develop improved performance refractory materials.

  14. Refractory strictures despite steroid injection after esophageal endoscopic resection

    Science.gov (United States)

    Hanaoka, Noboru; Ishihara, Ryu; Uedo, Noriya; Takeuchi, Yoji; Higashino, Koji; Akasaka, Tomofumi; Kanesaka, Takashi; Matsuura, Noriko; Yamasaki, Yasushi; Hamada, Kenta; Iishi, Hiroyasu

    2016-01-01

    Background: Although steroid injection prevents stricture after esophageal endoscopic submucosal dissection (ESD), some patients require repeated sessions of endoscopic balloon dilation (EBD). We investigated the risk for refractory stricture despite the administration of steroid injections to prevent stricture in patients undergoing esophageal ESD. Refractory stricture was defined as the requirement for more than three sessions of EBD to resolve the stricture. In addition, the safety of steroid injections was assessed based on the rate of complications. Patients and methods: We analyzed data from 127 consecutive patients who underwent esophageal ESD and had mucosal defects with a circumferential extent greater than three-quarters of the esophagus. To prevent stricture, steroid injection was performed. EBD was performed whenever a patient had symptoms of dysphagia. Results: The percentage of patients with a tumor circumferential extent greater than 75 % was significantly higher in those with refractory stricture than in those without stricture (P = 0.001). Multivariate analysis adjusted for age, sex, history of radiation therapy, tumor location, and tumor diameter showed that a tumor circumferential extent greater than 75 % was an independent risk factor for refractory stricture (adjusted odds ratio [OR] 5.49 [95 %CI 1.91 – 15.84], P = 0.002). Major adverse events occurred in 3 patients (2.4 %): perforation during EBD in 2 patients and delayed perforation after EBD in 1 patient. The patient with delayed perforation underwent esophagectomy because of mediastinitis. Conclusions: A tumor circumferential extent greater than 75 % is an independent risk factor for refractory stricture despite steroid injections. The development of more extensive interventions is warranted to prevent refractory stricture. PMID:27004256

  15. Dependency of calcium alternans on ryanodine receptor refractoriness.

    Directory of Open Access Journals (Sweden)

    Enric Alvarez-Lacalle

    Full Text Available BACKGROUND: Rapid pacing rates induce alternations in the cytosolic calcium concentration caused by fluctuations in calcium released from the sarcoplasmic reticulum (SR. However, the relationship between calcium alternans and refractoriness of the SR calcium release channel (RyR2 remains elusive. METHODOLOGY/PRINCIPAL FINDINGS: To investigate how ryanodine receptor (RyR2 refractoriness modulates calcium handling on a beat-to-beat basis using a numerical rabbit cardiomyocyte model. We used a mathematical rabbit cardiomyocyte model to study the beat-to-beat calcium response as a function of RyR2 activation and inactivation. Bi-dimensional maps were constructed depicting the beat-to-beat response. When alternans was observed, a novel numerical clamping protocol was used to determine whether alternans was caused by oscillations in SR calcium loading or by RyR2 refractoriness. Using this protocol, we identified regions of RyR2 gating parameters where SR calcium loading or RyR2 refractoriness underlie the induction of calcium alternans, and we found that at the onset of alternans both mechanisms contribute. At low inactivation rates of the RyR2, calcium alternans was caused by alternation in SR calcium loading, while at low activation rates it was caused by alternation in the level of available RyR2s. CONCLUSIONS/SIGNIFICANCE: We have mapped cardiomyocyte beat-to-beat responses as a function of RyR2 activation and inactivation, identifying domains where SR calcium load or RyR2 refractoriness underlie the induction of calcium alternans. A corollary of this work is that RyR2 refractoriness due to slow recovery from inactivation can be the cause of calcium alternans even when alternation in SR calcium load is present.

  16. Ketogenic diet treatment for pediatric super-refractory status epilepticus.

    Science.gov (United States)

    Appavu, Brian; Vanatta, Lisa; Condie, John; Kerrigan, John F; Jarrar, Randa

    2016-10-01

    We aimed to study whether ketogenic diet (KD) therapy leads to resolution of super-refractory status epilepticus in pediatric patients without significant harm. A retrospective review was performed at Phoenix Children's Hospital on patients with super-refractory status epilepticus undergoing ketogenic diet therapy from 2011 to 2015. Ten children with super-refractory status epilepticus, ages 2-16 years, were identified. 4/10 patients had immune mediated encephalitis, including Rasmussen encephalitis, anti-N-methyl-d-aspartate receptor encephalitis, and post-infectious mycoplasma encephalitis. Other etiologies included Lennox Gastaut Syndrome, non-ketotic hyperglycinemia, PCDH19 and GABRG2 genetic epilepsy, New Onset Refractory Status Epilepticus, and Febrile Infection-Related Epilepsy Syndrome. 4/10 patients' EEG features suggested focal with status epilepticus, and 6/10 suggested generalized with status epilepticus. Median hospital length was 61days and median ICU length was 27days. The median number of antiepileptic medications prior to diet initiation was 3.0 drugs, and the median after ketogenic diet treatment was 3.5 drugs. Median duration of status epilepticus prior to KD was 18days. 9/10 patients had resolution of super-refractory status epilepticus in a median of 7days after diet initiation. 8/9 patients were weaned off anesthesia within 15days of diet initiation, and within 1day of achieving ketonuria. 1/10 patients experienced side effects on the diet requiring supplementation. Most patients achieved resolution of status epilepticus on KD therapy, suggesting it could be an effective therapy that can be utilized early in the treatment of children with super refractory status epilepticus. Copyright © 2016. Published by Elsevier Ltd.

  17. Research progress of gene target therapy for refractory epilepsy

    Directory of Open Access Journals (Sweden)

    Xing-hua TANG

    2014-12-01

    Full Text Available Nowadays, the strategies of gene therapy for the treatment of refractory epilepsy (RE mainly include modulating neurotransmitter systems, neuropeptide Y (NPY and neurotrophic factors. Among them, the hot target spots include γ-aminobutyric acid (GABA and its receptor, N-methyl-D-aspartate (NMDA and its receptor, galanin, NPY and neurotrophic factors. This paper reviews the chief research results, and advantages and disadvantages of studies, and provides evidence for the treatment of refractory epilepsy. doi: 10.3969/j.issn.1672-6731.2014.12.004

  18. Refractory carcinoid syndrome: a review of treatment options

    Science.gov (United States)

    Riechelmann, Rachel P.; Pereira, Allan A.; Rego, Juliana F. M.; Costa, Frederico P.

    2016-01-01

    Carcinoid syndrome (CSy) is a constellation of symptoms that may commonly present in patients with well differentiated neuroendocrine tumors (NETs), with somatostatin analogs (SSAs) being the first-line option for symptom management. However, symptomatic progression eventually occurs and in this scenario of a refractory CSy; several treatment options have been studied such as dose escalation of SSA, interferon and liver-directed therapies. Nevertheless, recent phase III trials have contributed to the understanding and management of this condition. We performed a comprehensive review of interventional studies examining refractory CSy to provide the evidence for current treatment options and propose a treatment sequence. PMID:28203303

  19. EVALUATION OF THE REFRACTORY CHARACTERISTICS OF DUKKU CLAY DEPOSIT

    OpenAIRE

    A.M. Yami; M. A. B. Hassan; Umaru, S.

    2007-01-01

    Dukku clay was investigated to determine its refractory characteristics. The result shows that it has a bulk modulus of 9.27g/cm2, porosity of 27.84%, linear shrinkage of 1.27% and cold crushing strength of 80.20kg/cm3.A thermal shock resistance of 25 cycles was obtained with specific gravity of 2.69g and refractoriness of 1300oC.The sample was also analyzed to determine its chemical composition by atomic absorption spectra photometry method (AAS969). The result of the chemical analysis shows...

  20. The Key Technique of Manufacture of Dense Chromium Sesquioxide Refractories

    Institute of Scientific and Technical Information of China (English)

    LIMaoqiang; ZHANGShuying; 等

    1998-01-01

    Dense chromium sesquioxide refractories have widely been used in the kilns for making alkai-free and anti-alkali glass fibers due to their excellent re-sistance to molten glasses.Densifications of chromium sesquioxide during sintering can be blocked by evaporation of chromium trioxide derived from oxidation at high temperature,In this paper the mech-anism of sintering chromium oxide and the process-ing technique for making dense chromium sesquiox-ide refractories are discussed .A process in laboratory scale for making dense chromium sesquioxide bricks is demonstrated.

  1. Uterine artery embolisation for management of refractory postpartal haemmorhage.

    Science.gov (United States)

    Urundady, Vishalakshi; Shetty, Vrinda

    2012-12-01

    Management of Postpartal Haemorrhage (PPH) refractory to medical management continues to be a formidable condition, further compounded by unstable haemodynamic condition and associated coagulopathy, usually associated with this condition. Though surgical exploration is the usual therapeutic option for such patients, selective pelvic arterial embolisation is gaining the popularity in view of its safety and efficacy profile. Uterine preservation further adds to its advantages.We present our experience of managing 5 such patients with Uterine Artery Embolisation (UAE). The current status of UAE as therapeutic modality for management of refractory PPH is discussed.

  2. The Utility of Cannabidiol in the Treatment of Refractory Epilepsy.

    Science.gov (United States)

    Reddy, D S

    2017-02-01

    Cannabis-derived cannabinoids such as cannabidiol (CBD) have anticonvulsant properties. Recently, there has been an emerging interest in the use of CBD-enriched products for treatment of drug-resistant epilepsy. Some pilot trials of CBD have proved beneficial for refractory epilepsy, but its efficacy is yet to be confirmed by standard placebo-controlled trials. However, the mechanisms underlying the seizure protection efficacy claims of CBD remain unclear. This review briefly describes the clinical utility of CBD in the treatment of refractory epilepsy. © 2016 American Society for Clinical Pharmacology and Therapeutics.

  3. The Future of the Refractory Industry, with a Chinese Perspective

    Institute of Scientific and Technical Information of China (English)

    Michel Rigaud; ZHOU Ningsheng; YE Fangbao

    2005-01-01

    Globalization is a reality resulting in many changes in the refractory industry. In this paper some of the threats and opportunities, which are influencing the future prosperity of the refractory industry on a worldwide basis, are being evoked. Some key technical and management issues are underlined, in terms of adjusting the productivity-quality-cost to the customers requirements; producing unshapes versus shapes; innovations supported by research; international profile for the import-export game; training and education. Consequences for China, who does play a dominant role due to the size of its internal market (customers demand) and the magnitude of its production capability (including raw materials availability) , are being drawn.

  4. Refractory pancytopenia and megaloblastic anemia due to falciparum malaria.

    Science.gov (United States)

    Aggarwal, Varun; Maheshwari, Anu; Rath, Bimbadhar; Kumar, Praveen; Basu, Srikanta

    2011-08-01

    Anemia is a common complication in malarial infection. Direct destruction and ineffective erythropoesis does not adequately explain the cause of anemia in malaria. We present a case with refractory megaloblastic anemia with asymptomatic falciparum malaria. We hypothesize that promoter variants in the inducible nitric oxide synthase gene might be the cause of severe refractory megaloblastic anemia and pancytopenia in our patient. Malaria should always be kept in mind as a cause of anemia especially in endemic areas even if the child is asymptomatic or there is no demonstrable parasite on routine smear examination.

  5. Emissivity Results on High Temperature Coatings for Refractory Composite Materials

    Science.gov (United States)

    Ohlhorst, Craig W.; Vaughn, Wallace L.; Daryabeigi, Kamran; Lewis, Ronald K.; Rodriguez, Alvaro C.; Milhoan, James D.; Koenig, John R.

    2007-01-01

    The directional emissivity of various refractory composite materials considered for application for reentry and hypersonic vehicles was investigated. The directional emissivity was measured at elevated temperatures of up to 3400 F using a directional spectral radiometric technique during arc-jet test runs. A laboratory-based relative total radiance method was also used to measure total normal emissivity of some of the refractory composite materials. The data from the two techniques are compared. The paper will also compare the historical database of Reinforced Carbon-Carbon emissivity measurements with emissivity values generated recently on the material using the two techniques described in the paper.

  6. Improved Refractories for Slagging Gasifiers in IGCC Power Systems

    Energy Technology Data Exchange (ETDEWEB)

    Dogan, Cynthia P.; Kwong, Kyei-Sing; Bennett, James P.; Chinn, Richard E.

    2003-04-24

    The gasification of coal and other carbon-containing fuels provides the opportunity to produce energy more efficiently, and with significantly less environmental impact, than more-conventional combustion-based processes. In addition, the synthesis gas that is the product of the gasification process offers the option of ''polygeneration,'' i.e., the production of alternative products instead of power should it be economically favorable to do so. Because of these advantages, gasification is viewed as one of the key processes in the U.S. Department of Energy's Vision 21 power system. However, issues with both the reliability and the economics of gasifier operation will have to be resolved before gasification will be widely adopted by the power industry. Central to both enhanced reliability and economics is the development of materials with longer service lives in gasifier systems that can provide extended periods of continuous, trouble-free gasifier operation. The focus of the Advanced Refractories for Gasification project at the Albany Research Center is to develop improved refractory materials capable of withstanding the harsh, high-temperature environment created by the gasification reaction, and includes both the refractory lining that protects and insulates the slagging gasifier, as well as the thermocouple assemblies that are utilized to monitor gasifier operating temperatures. Current generation refractory liners in slagging gasifiers are typically replaced every four to 18 months, at costs ranging up to $2,000,000, depending upon the size of the gasification vessel. Compounding materials and installation costs are the lost-opportunity costs for the time that the gasifier is off-line for the refractory exchange. Current generation thermocouple devices rarely survive the gasifier start-up process, leaving the operator with no real means of temperature measurement during routine operation. Reliable, efficient, and economical gasifier

  7. Refractory experience in circulating fluidized bed combustors, Task 7

    Energy Technology Data Exchange (ETDEWEB)

    Vincent, R.Q.

    1989-11-01

    This report describes the results of an investigation into the status of the design and selection of refractory materials for coal-fueled circulating fluidized-bed combustors. The survey concentrated on operating units in the United States manufactured by six different boiler vendors: Babcock and Wilcox, Combustion Engineering, Foster Wheeler, Keeler Dorr-Oliver, Pyropower, and Riley Stoker. Information was obtained from the boiler vendors, refractory suppliers and installers, and the owners/operators of over forty units. This work is in support of DOE's Clean Coal Technology program, which includes circulating fluidized-bed technology as one of the selected concepts being evaluated.

  8. Efficacy and Safety of Rituximab in Children with Refractory Nephrotic Syndrome; A Multicenter Clinical Trial

    Directory of Open Access Journals (Sweden)

    Yo Han Ahn

    2014-06-01

    Conclusions: In this interim analysis of clinical trial to evaluate the efficacy and safety of RTX in children with refractory NS, RTX treatment for refractory NS was safe and effective, especially in patients with DNS.

  9. Nivolumab and Dasatinib in Treating Patients With Relapsed or Refractory Philadelphia Chromosome Positive Acute Lymphoblastic Leukemia

    Science.gov (United States)

    2016-08-25

    B Acute Lymphoblastic Leukemia With t(9;22)(q34;q11.2); BCR-ABL1; Recurrent Adult Acute Lymphoblastic Leukemia; Recurrent Childhood Acute Lymphoblastic Leukemia; Refractory Adult Acute Lymphoblastic Leukemia; Refractory Childhood Acute Lymphoblastic Leukemia

  10. Reactions Between MgO-C Refractory, Molten Slag and Metal

    National Research Council Canada - National Science Library

    Li, Zushu; Mukai, Kusuhiro; Tao, Zainan

    2000-01-01

    The behavior of MgO-C refractory-slag-metal system, which is caused by the reactions such as the dissolution of MgO and graphite in the refractory into slag and metal respectively and the generation...

  11. Treatment Options for Primary Refractory/Recurrent Hodgkin Lymphoma in Children and Adolescents

    Science.gov (United States)

    ... Primary Refractory/Recurrent Hodgkin Lymphoma in Children and Adolescents Primary refractory Hodgkin lymphoma is lymphoma that continues ... treated with an adult treatment regimen . Children and adolescents may have treatment-related side effects that appear ...

  12. Relapsed/Refractory acute myeloid leukemia patients | EU Clinical Trials Register [EU Clinical Trials Register

    Lifescience Database Archive (English)

    Full Text Available Treatment of relapsed/refractory leukemia with intravenous administration of Dacarbazine Trattamento della leucemia...tment of relapsed/refractory leukemia with intravenous administration of Dacarbazine Trattamento della leucemia...on(s) being investigated Relapsed/Refractory acute myeloid leukemia patients Pazienti affetti da leucemia... language Relapsed/Refractory acute myeloid leukemia patients Pazienti affetti da leucemia acuta mieloide re...arbazina nei pazienti affetti da leucemia acuta mieloide recidivata/refrattaria i cui blasti esprimono bassi

  13. Abstracts from Naihuo Cailiao(Refractories)——A Chinese-Language Bimonthly

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    @@ Volume 43,Number 6,2009 Dissolution behaviors of refractory fiber powders in simulated lung fluid.Wang Xitang,Liu Hao,Zhang Baoguo,et al.(401-404).-Bio-soluble refractory fi-ber,Simulated lung fluid,Dissolution behavior--The dissolution behaviors in Gamble solution (simulated lung fluid)of bio-soluble refractory fiber and alumino-silicate refractory fiber were analyzed and compared using ICP-AES,FTIR,and FESEM.

  14. Erosion Effect of Molten Steel on Carbon Containing Refractories for Continuous Casting

    Institute of Scientific and Technical Information of China (English)

    LI Hongxia; YANG Bin; LIU Guoqi; CHENG Hepeng

    2007-01-01

    The erosion resistance of carbon containing refractories for continuous casting to molten steel was investigated by means of simulative erosion test and examining used refractories.Decolonization and reaction between molten steel and decolonization layer are main erosion process of carbon containing refractories by1 molten steel.The reactions between molten steel and oxide in refractories determine the thickness of decarbonization layer A dense layer formation on the working surface contacting with molten steel during casting will suppress decarbonization and erosion process.

  15. Iron-Refractory Iron Deficiency Anemia

    Directory of Open Access Journals (Sweden)

    Ebru Yılmaz Keskin

    2015-03-01

    Full Text Available Demir, oksijenin taşınması, DNA sentezi ve hücre çoğalması gibi çeşitli biyolojik reaksiyonlar için vazgeçilmez olduğundan, yaşam için zorunludur. Demir metabolizması ve bu elementin düzenlenmesiyle ilgili bilgilerimiz, son yıllarda belirgin şekilde değişmiştir. Demir metabolizması ile ilgili yeni bozukluklar tanımlanmış ve demirin başka bozuklukların kofaktörü olduğu anlaşılmaya başlamıştır. Hemokromatozis ve demir tedavisine dirençli demir eksikliği anemisi (IRIDA; “iron-refractory iron deficiency anemia” gibi genetik durumlar üzerinde yapılan çalışmalar, vücuttaki demir dengesini kontrol eden moleküler mekanizmalar ile ilgili önemli ipuçları sunmuştur. Bu ilerlemeler, gelecekte, hem genetik hem de kazanılmış demir bozukluklarının daha etkili şekilde tedavi edilmesi amacıyla kullanılabilir. IRIDA, demir eksikliği ile giden durumlarda, hepsidin üretimini baskılayan matriptaz-2’yi kodlayan TMPRSS6 genindeki mutasyonlardan kaynaklanmaktadır. Hastalığın tipik özellikleri, hipokrom, mikrositer anemi, çok düşük ortalama eritrosit hacmi, oral demir tedavisine yanıtsızlık (veya yetersiz yanıt ve parenteral demire kısmi yanıttır. Klasik demir eksikliği anemisinin aksine, serum ferritin değeri genellikle hafif düşük ya da normal aralıkta; serum ve idrar hepsidin değerleri ise, aneminin derecesi ile orantısız şekilde yüksek bulunur. Şimdiye kadar literatürde bildirilmiş olguların sayısı 100’ü geçmediği halde, IRIDA’nın, “atipik” mikrositik anemilerin en sık nedeni olduğu düşünülmektedir. Bu derlemenin amacı, IRIDA hakkındaki güncel bilgileri araştırıcılar ile paylaşmak ve bu alandaki farkındalıklarını arttırmaktır.

  16. Cometary Refractory Grains: Interstellar and Nebular Sources

    Science.gov (United States)

    Wooden, D. H.

    2008-07-01

    with asteroids, the Stardust Fe-bearing and Fe-rich crystalline silicates suggests partial aqueous alteration in comet nuclei. However, aqueous alteration transforms Fe-rich olivine to phyllosilicates before Mg-rich olivine, and Stardust has Mg-rich and Fe-rich olivine and no phyllosilicates. Hence, we look to a nebular source for the moderately Fe-rich to nearly pure-Fe crystalline silicates. Primitive matrices have Mg-Fe silicates but no phyllosilicates, supporting the idea that Mg-Fe silicates but not phyllosilicates are products of water-rich shocks. Chondrule-formation is a late stage process in our protoplanetary disk. Stardust samples show comet 81P/Wild 2 formed at least as late to incorporate a few chondrules, requiring radial transport of chondrules out to perhaps >20 AU. By similar radial transport mechanisms, collisional fragments of aqueously altered asteroids, in particular achondrites that formed earlier than chondrules, might reach the comet-forming zones. However, Stardust samples do not have phyllosilicates and chondrules are rare. Hence, the nebular refractory grains in comet 81P/Wild 2, as well as other comets, appear to be pre-accretionary with respect to asteroid parent bodies. By discussing nebular pathways for the formation of Fe-rich crystalline silicates, and also phyllosilicates and carbonates, we put forth the view that comets contain both the interstellar ingredients for and the products of nebular transmutation.

  17. Kinetics and Structure of Refractory Compounds and AlloysObtained by Mechanical Alloying

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Refractory compounds are material with interesting properties for structural applications. However, the processing of such material is a great challenge because of their high melting temperature and limited ductility. Mechanical alloying is a novel technique of producing refractory compounds with specific properties. Kinetical and structural peculiarities of refractory compounds and alloys obtained by mechanical alloying are discussed.

  18. The Role of Refractory Dissolved Organic Matter in Ocean Carbon Sequestration

    DEFF Research Database (Denmark)

    Jørgensen, Linda

    that prokaryotes can produce refractory compounds from simple substrates such as glucose. Microbial deg-radation of glucose itself only produces small amounts of refractory DOM. However, degradation of prokaryote cell remains (grown from the glucose) produces a considera-ble amount of refractory DOM. In addition...

  19. Dissecting the inflammatory twitch in allergically inflamed mice.

    Science.gov (United States)

    Pothen, Joshua J; Poynter, Matthew E; Lundblad, Lennart K A; Bates, Jason H T

    2016-05-15

    We have previously advanced the hypothesis that the allergic inflammatory response in the lungs occurs as a self-limited sequence of events that begins with the onset of inflammation and then resolves back to baseline over a predetermined time course (Pothen JJ, Poynter ME, Bates JH. J Immunol 190: 3510-3516, 2013). In the present study we tested a key prediction of this hypothesis, which is that the instigation of the allergic inflammatory response should be accompanied by a later refractory period during which the response cannot be reinitiated. We challenged groups of ovalbumin-sensitized BALB/c mice for 3, 14, 21 and 31 consecutive days with aerosolized ovalbumin. We measured airways responsiveness as well as cell counts and cytokines in bronchoalveolar lavage fluid after the final challenge in subgroups from each group. In other subgroups we performed the same measurements following rest periods and after a final single recall challenge with antigen. We determined that the refractory periods for GM-CSF, KC, and IL-5 are no longer than 10 days, while those for IFNγ and IL-10 are no longer than 28 days. The refractory periods for total leukocytes and neutrophils were no greater than 28 days, while that for eosinophils was more than 28 days. The refractory period for airways resistance was less than 17, while for lung elastance it was longer than 28 days. Our results thus demonstrate that the components of the allergic inflammatory response in the lung have finite refractory periods, with the refractory period of the entire response being in the order of a month.

  20. A refractory case of erythromelalgia involving the ears.

    Science.gov (United States)

    Ramirez, Claudia C; Kirsner, Robert S

    2004-01-01

    Erythromelalgia is a rare syndrome that is characterized by episodic attacks of burning pain, erythema, and increased temperature usually affecting the extremities, which is aggravated by warmth or exercise. We describe a patient with a 3-year history of refractory burning pain and red ears. A review of clinical features, disease classification, associated diseases, and treatment of this disease is presented.

  1. REFRACTORY HYPERTENSION – MODERN APPROACHES TO DIAGNOSTICS AND TREATMENT

    Directory of Open Access Journals (Sweden)

    A. N. Britov

    2010-01-01

    Full Text Available The refractory arterial hypertension (HT is diagnosed, if therapy with three antihypertensive drugs from different classes (including a diuretic in optimal doses did not provide target blood pressure (BP level. Prevalence of a refractory HT is high and reaches up 10-30% among hypertensive patients. However, poor BP control is often caused by patient non-compliance with the medical recommendations, an inadequate estimation of BP level, and "white coat" HT. It is classified as a pseudo resistance. Obesity, salt and alcohol overconsumption, taking some drugs worsen BP control. Secondary HT causes (sleep apnea syndrome, kidney diseases, renal artery stenosis, and primary hyperaldosteronism are more possible in patients with refractory HT. Specific treatment of these diseases improves BP control and long-term prognosis. Successful treatment of refractory HT includes detection and correction of reversible risk factors and reasons of the secondary HT, use of the effective combined therapy with the aldosterone antagonist. Improvement of patient compliance is one of key factors of effective treatment.

  2. Ictal PET in presurgical workup of refractory extratemporal epilepsy

    Directory of Open Access Journals (Sweden)

    Javeria Nooraine

    2013-01-01

    Full Text Available Ictal Pet in presurgical workup of refractory epilepsy is seldom performed and limited due to technical difficulties. In carefully selected patient subset with frequent extratemporal seizures, ictal PET depicts ′seizure onset zone′ with high spatial resolution even within a widespread pathology. We here depict a four year old with posterior quadrant dysplasia evaluated with ictal PET.

  3. Microscopic colitis: A review of etiology, treatment and refractory disease.

    Science.gov (United States)

    Park, Tina; Cave, David; Marshall, Christopher

    2015-08-07

    Microscopic colitis is a common cause of chronic, nonbloody diarrhea. Microscopic colitis is more common in women than men and usually affects patients in their sixth and seventh decade. This article reviews the etiology and medical management of microscopic colitis. The etiology of microscopic colitis is unknown, but it is associated with autoimmune disorders, such as celiac disease, polyarthritis, and thyroid disorders. Smoking has been identified as a risk factor of microscopic colitis. Exposure to medications, such as non-steroidal anti-inflammatory drugs, proton pump inhibitors, and selective serotonin reuptake inhibitors, is suspected to play a role in microscopic colitis, although their direct causal relationship has not been proven. Multiple medications, including corticosteroids, anti-diarrheals, cholestyramine, bismuth, 5-aminosalicylates, and immunomodulators, have been used to treat microscopic colitis with variable response rates. Budesonide is effective in inducing and maintaining clinical remission but relapse rate is as high as 82% when budesonide is discontinued. There is limited data on management of steroid-dependent microscopic colitis or refractory microscopic colitis. Immunomodulators seem to have low response rate 0%-56% for patients with refractory microscopic colitis. Response rate 66%-100% was observed for use of anti-tumor necrosis factor (TNF) therapy for refractory microscopic colitis. Anti-TNF and diverting ileostomy may be an option in severe or refractory microscopic colitis.

  4. Azathioprine and prednisone combination therapy in refractory coeliac disease.

    NARCIS (Netherlands)

    Goerres, MS; Meijer, JW; Wahab, PJ; Kerckhaert, JA; Groenen, PJ; Krieken, JH Van; Mulder, C.J.J.

    2003-01-01

    INTRODUCTION: Refractory coeliac disease (RCD) is a rare syndrome with a poor prognosis, defined by malabsorption due to gluten-related enteropathy after initial or subsequent failure of a strict gluten-free diet and after exclusion of any disorder mimicking coeliac disease. PATIENTS AND METHODS:

  5. ROSA DAMASCENA OIL: AN ADJUNCTIVE THERAPY FOR PEDIATRIC REFRACTORY SEIZURES

    Directory of Open Access Journals (Sweden)

    F. Ashrafzadeh MD

    2009-01-01

    Full Text Available ObjectiveSeveral investigations have demonstrated that Rosa damascena has an inhibitory effect on the hypothalamus and on pituitary system reactivity in the rat; it has also been shown that the essential oil of Rosa damascena has significant antiepileptic effects on pentylentetrazole (PTZ induced seizures in rats. We aimed at assessing the effects of the essential oil of Rosa damascena when used as an adjunct treatment to treat children with refractory seizuresMaterials and MethodsIn this double-blind clinical trial, conducted as a pilot study between April 2004 and March 2005, we administered essential oil of Rosa damascena to sixteen children with refractory epilepsy as an adjunct therapy, and evaluated its effects.Results16 patients, age range 3-13 years, were enrolled; 56.3% (n=9 girls and 43.8% (n=7 boys. All has been under treatment for 3-6 weeks (baseline phase. They received either the essential oil or placebo for a period of 4 weeks and in between these periods, they took only their pre-existing antiepileptic drugs for two weeks (washout phase.The mean frequency of seizures in those using essential oil, showed significant decrease as compared to the controls using placeboes (p=0.00.ConclusionIt can be concluded that the essential oil of Rosa Damascena has beneficial antiepileptic effect in children with refractory seizures.Keywords:Rosa damascena, refractory epilepsy, children, oil.

  6. Methods to Characterize Oxidation Resistance for Magnesia—carbon Refractories

    Institute of Scientific and Technical Information of China (English)

    LIXiang-min; MichelReigaud

    1996-01-01

    The parameters influencing the process of carbon oxidation in magnesia-carbon refracto-ries are reviewed.A typology of their oxidation resistance measurements is then presented;four different method are discussed in details.No agreement has been reached yet on a standard-ized test method.So far,oxidation resistance describes a process more than a property.

  7. Queuing Network Modeling of the Psychological Refractory Period (PRP)

    Science.gov (United States)

    Wu, Changxu; Liu, Yili

    2008-01-01

    The psychological refractory period (PRP) is a basic but important form of dual-task information processing. Existing serial or parallel processing models of PRP have successfully accounted for a variety of PRP phenomena; however, each also encounters at least 1 experimental counterexample to its predictions or modeling mechanisms. This article…

  8. Evaluation and management of patients with refractory ascites

    Institute of Scientific and Technical Information of China (English)

    Bahaa Eldeen Senousy; Peter V Draganov

    2009-01-01

    Some patients with ascites due to liver cirrhosis become no longer responsive to diuretics. Once other causes of ascites such as portal vein thrombosis,malignancy or infection and non-compliance with medications and low sodium diet have been excluded,the diagnosis of refractory ascites can be made based on strict criteria. Patients with refractory ascites have very poor prognosis and therefore referral for consideration for liver transplantation should be initiated. Search for reversible components of the underlying liver pathology should be undertaken and targeted therapy, when available, should be considered. Currently, serial large volume paracentesis (LVP) and transjugular intrahepatic portasystemic stent-shunt (TIPS) are the two mainstay treatment options for refractory ascites. Other treatment options are available but not widely used either because they carry high morbidity and mortality (most surgical options) rates, or are new interventions that have shown promise but still need further evaluation. In this comprehensive review, we describe the evaluation and management of patients with refractory ascites from the prospective of the practicing physician.

  9. Dr. Lai Xinsheng's Experience in Acupuncture Treatment of Refractory Diseases

    Institute of Scientific and Technical Information of China (English)

    Lin Shaozhen; Lai Xinsheng; Duan Shumin

    2006-01-01

    @@ Having been engaged in teaching, clinical practice and research for many years, Dr. Lai Xinsheng is good at acupuncture and the combined acupuncture and medication therapy to treat refractory diseases with satisfactory therapeutic effect. Sample cases treated by Dr. Lai are selected as follows.

  10. Aborted and refractory status epilepticus in children : A comparative analysis

    NARCIS (Netherlands)

    Lambrechtsen, Florise A. C. P.; Buchhalter, Jeffrey R.

    Purpose: The aims of this retrospective study were: (1) to compare the demographics, clinical characteristics, etiology, and EEG findings of status epilepticus aborted with medication (ASE) and refractory status epilepticus (RSE), (2) to describe the treatment response of status epilepticus (SE),

  11. USE OF STRUCTURAL MRI IN PATIENTS WITH MEDICALLY REFRACTORY SEIZURES

    Directory of Open Access Journals (Sweden)

    Ara G. Kaprelyan

    2012-12-01

    Full Text Available Introduction: Refractory epilepsy is common in patients with structural brain lesions including acquired disorders and genetic abnormalities. Recently, MRI is a precise diagnostic tool for recognition of different structural causes underlying medically intractable seizures.Objective: To evaluate the usefulness of MRI for detection of brain lesions associated with refractory epilepsy.Material and methods: 49 patients (20M and 29F; aged 48.6±24.7 years with refractory epilepsy were included in the study. They presented with partial (46.0%, secondary (31.0% or primary (23.0% generalized tonic-clonic seizures. Clinical diagnosis was based on the revised criteria of ILAE. Structural neuroimaging (MRI, EEG recording, and neurological examination were performed.Results: MRI detected different structural brain abnormalities totally in 36 (73.5% patients, including cerebral tumors (21p, cerebrovascular accidents (5p, hyppocampal sclerosis (3p, developmental malformations (2p, postencephalitic lesions (2p, arachnoid cysts (2p, and tuberous sclerosis (1p. Neuroimaging revealed normal findings in 13 (27.5% cases. EEG recordings showed focal epileptic activity in 38 (77.6% patients, including 33 cases with and 5 without structural brain abnormalities.Conclusion: This study revealed that structural brain lesions are commonly associated with refractory epilepsy. We suggested that MRI is a useful diagnostic method for assessment of patients with uncontrolled seizures or altered epileptic pattern.

  12. Penetration and Effectiveness of Micronized Copper in Refractory Wood Species

    Science.gov (United States)

    Civardi, Chiara; Van den Bulcke, Jan; Schubert, Mark; Michel, Elisabeth; Butron, Maria Isabel; Boone, Matthieu N.; Dierick, Manuel; Van Acker, Joris; Wick, Peter; Schwarze, Francis W. M. R.

    2016-01-01

    The North American wood decking market mostly relies on easily treatable Southern yellow pine (SYP), which is being impregnated with micronized copper (MC) wood preservatives since 2006. These formulations are composed of copper (Cu) carbonate particles (CuCO3·Cu(OH)2), with sizes ranging from 1 nm to 250 μm, according to manufacturers. MC-treated SYP wood is protected against decay by solubilized Cu2+ ions and unreacted CuCO3·Cu(OH)2 particles that successively release Cu2+ ions (reservoir effect). The wood species used for the European wood decking market differ from the North American SYP. One of the most common species is Norway spruce wood, which is poorly treatable i.e. refractory due to the anatomical properties, like pore size and structure, and chemical composition, like pit membrane components or presence of wood extractives. Therefore, MC formulations may not suitable for refractory wood species common in the European market, despite their good performance in SYP. We evaluated the penetration effectiveness of MC azole (MCA) in easily treatable Scots pine and in refractory Norway spruce wood. We assessed the effectiveness against the Cu-tolerant wood-destroying fungus Rhodonia placenta. Our findings show that MCA cannot easily penetrate refractory wood species and could not confirm the presence of a reservoir effect. PMID:27649315

  13. Azathioprine and prednisone combination therapy in refractory coeliac disease.

    NARCIS (Netherlands)

    Goerres, MS; Meijer, JW; Wahab, PJ; Kerckhaert, JA; Groenen, PJ; Krieken, JH Van; Mulder, C.J.J.

    2003-01-01

    INTRODUCTION: Refractory coeliac disease (RCD) is a rare syndrome with a poor prognosis, defined by malabsorption due to gluten-related enteropathy after initial or subsequent failure of a strict gluten-free diet and after exclusion of any disorder mimicking coeliac disease. PATIENTS AND METHODS: Ni

  14. Current Status and Suggestions of China's Refractories Industry

    Institute of Scientific and Technical Information of China (English)

    XU Dianli

    2009-01-01

    @@ China' s economy has developed rapidly since joined WTO in 2000.Influenced by the rapid development of high temperature industries such as metallurgy,building material,nonferrous metal,etc.,China's refractories industry has its production and sales boomed,benefit enhanced and industrial structure adjusted.

  15. Rituximab treatment in patients with refractory inflammatory myopathies

    NARCIS (Netherlands)

    Mahler, E.A.; Blom, M.; Voermans, N.C.; Engelen, B.G. van; Riel, P.L. van; Vonk, M.C.

    2011-01-01

    Objective. To assess the efficacy of rituximab on disease activity and muscle strength in patients with inflammatory myopathies refractory to conventional therapy. Methods. Thirteen patients were treated with rituximab 1000 mg i.v., twice, with a 2-week interval and followed for a median of 27 month

  16. Issues Impacting Refractory Service Life in Biomass/Waste Gasification

    Energy Technology Data Exchange (ETDEWEB)

    Bennett, J.P.; Kwong, K.-S.; Powell, C.A.

    2007-03-01

    Different carbon sources are used, or are being considered, as feedstock for gasifiers; including natural gas, coal, petroleum coke, and biomass. Biomass has been used with limited success because of issues such as ash impurity interactions with the refractory liner, which will be discussed in this paper.

  17. Penetration and Effectiveness of Micronized Copper in Refractory Wood Species.

    Science.gov (United States)

    Civardi, Chiara; Van den Bulcke, Jan; Schubert, Mark; Michel, Elisabeth; Butron, Maria Isabel; Boone, Matthieu N; Dierick, Manuel; Van Acker, Joris; Wick, Peter; Schwarze, Francis W M R

    2016-01-01

    The North American wood decking market mostly relies on easily treatable Southern yellow pine (SYP), which is being impregnated with micronized copper (MC) wood preservatives since 2006. These formulations are composed of copper (Cu) carbonate particles (CuCO3·Cu(OH)2), with sizes ranging from 1 nm to 250 μm, according to manufacturers. MC-treated SYP wood is protected against decay by solubilized Cu2+ ions and unreacted CuCO3·Cu(OH)2 particles that successively release Cu2+ ions (reservoir effect). The wood species used for the European wood decking market differ from the North American SYP. One of the most common species is Norway spruce wood, which is poorly treatable i.e. refractory due to the anatomical properties, like pore size and structure, and chemical composition, like pit membrane components or presence of wood extractives. Therefore, MC formulations may not suitable for refractory wood species common in the European market, despite their good performance in SYP. We evaluated the penetration effectiveness of MC azole (MCA) in easily treatable Scots pine and in refractory Norway spruce wood. We assessed the effectiveness against the Cu-tolerant wood-destroying fungus Rhodonia placenta. Our findings show that MCA cannot easily penetrate refractory wood species and could not confirm the presence of a reservoir effect.

  18. Aborted and refractory status epilepticus in children : A comparative analysis

    NARCIS (Netherlands)

    Lambrechtsen, Florise A. C. P.; Buchhalter, Jeffrey R.

    2008-01-01

    Purpose: The aims of this retrospective study were: (1) to compare the demographics, clinical characteristics, etiology, and EEG findings of status epilepticus aborted with medication (ASE) and refractory status epilepticus (RSE), (2) to describe the treatment response of status epilepticus (SE), an

  19. Refractory metals fabrication technology as applied to fusion reactors

    Energy Technology Data Exchange (ETDEWEB)

    1976-07-01

    Activities are reported in research programs on inspection and fabricion of refractory metals and alloys including those of Mo, Nb, Ta, and V. Progress is summarized in sections on blanking, edge preparation, machining, forming, joining, cleaning, thermal processing, and coating. (JRD)

  20. Transient refractory material dissolution by a volumetrically-heated melt

    Energy Technology Data Exchange (ETDEWEB)

    Seiler, Jean Marie, E-mail: jean-marie.seiler@cea.fr [CEA, DEN, DTN, 17 Rue des Martyrs, 38054 Grenoble Cedex 9 (France); Ratel, Gilles [CEA, DEN, DTN, 17 Rue des Martyrs, 38054 Grenoble Cedex 9 (France); Combeau, Hervé [Institut Jean Lamour, UMR 7198, Lorraine University, Ecole des Mines de Nancy, Parc de Saurupt, 54042 Nancy Cedex (France); Gaus-Liu, Xiaoyang; Kretzschmar, Frank; Miassoedov, Alexei [Karlsruhe Institut of Technology, Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen (Germany)

    2014-12-15

    Highlights: • We describe a test investigating ceramic dissolution by a molten non-eutectic melt. • The evolution of the interface temperature between melt and refractory is measured. • A theoretical model describing dissolution kinetics is proposed. • When dissolution stops, interface temperature is the liquidus temperature of the melt. - Abstract: The present work addresses the question of corium–ceramic interaction in a core catcher during a core-melt accident in a nuclear power plant. It provides an original insight into transient aspects concerning dissolution of refractory material by a volumetrically heated pool. An experiment with simulant material (LIVECERAM) is presented. Test results clearly show that dissolution of solid refractory material can occur in a non-eutectic melt at a temperature which is lower than the melting temperature of the refractory material. During the dissolution transient, the interface temperature rises above the liquidus temperature, corresponding to the instantaneous average composition of the melt pool. With constant power dissipation in the melt and external cooling of the core-catcher, a final steady-state situation is reached. Dissolution stops when the heat flux (delivered by the melt to the refractory) can be removed by conduction through the residual thickness of the ceramic, with T{sub interface} = T{sub liquidus} (calculated for the average composition of the final liquid pool). The final steady state corresponds to a uniform pool composition and uniform interface temperature distribution. Convection in the pool is governed by natural thermal convection and the heat flux distribution is therefore similar to what would be obtained for a single component pool. An interpretation of the experiment with two model-based approaches (0D and 1D) is presented. The mass transfer kinetics between the interface and the bulk is controlled by a diffusion sublayer within the boundary layer. During the dissolution transient

  1. Refractory generalised convulsive status epilepticus : a guide to treatment.

    Science.gov (United States)

    Kälviäinen, Reetta; Eriksson, Kai; Parviainen, Ilkka

    2005-01-01

    The patient with status epilepticus has continuous or rapidly repeating seizures. Generalised convulsive status epilepticus (GCSE) is the most common form of the disorder and is a life-threatening condition that requires prompt medical management. Status epilepticus that does not respond to first-line benzodiazepines (lorazepam or diazepam) or to second-line antiepileptic drugs (phenytoin/fosphenytoin, phenobarbital or valproate) is usually considered refractory and requires more aggressive treatment. The optimal treatment of refractory GCSE has not been defined, but patients should be treated in an intensive care unit, as artificial ventilation and haemodynamic support are required. Invasive haemodynamic monitoring is often necessary and EEG monitoring is essential. The drug treatment of refractory GCSE involves general anaesthesia with continuous intravenous anaesthetics given in doses that abolish all clinical and electrographic epileptic activity, often requiring sedation to the point of burst suppression on the EEG. Barbiturate anaesthetics, pentobarbital in the US and thiopental sodium in Europe and Australia, are the most frequently used agents and are highly effective for refractory GCSE both in children and adults. Indeed, they remain the only way to stop seizure activity with certainty in severely refractory cases. Other options are midazolam for adults and children and propofol for adults only.Regardless of the drug selected, intravenous fluids and vasopressors are usually required to treat hypotension. Once seizures have been controlled for 12-24 hours, continuous intravenous therapy should be gradually tapered off if the drug being administered is midazolam or propofol. Gradual tapering is probably not necessary with pentobarbital or thiopental sodium. Continuous EEG monitoring is required during high-dose treatment and while therapy is gradually withdrawn. During withdrawal of anaesthetic therapy, intravenous phenytoin/fosphenytoin or valproate should

  2. Refractoriness of interferon-beta signaling through NOD1 pathway in mouse respiratory epithelial cells using the anticancer xanthone compound

    Institute of Scientific and Technical Information of China (English)

    Zaifang; Yu; Jarrod; D; Predina; Guanjun; Cheng

    2013-01-01

    AIM:To explore the possibility that nucleotide oligomerization domain 1(NOD1) pathway involved in refractoriness of interferon-β signaling in mouse respiratory epithelial cells induced by the anticancer xanthone compound,5,6-dimethylxanthenone-4-acetic acid(DMXAA).METHODS:C10 mouse bronchial epithelial cells were grown in Dulbecco’s modified Eagle’s medium supplemented with 10% fetal bovine serum,2 mmol/L glutamine,100 units/mL penicillin,100 g/mL streptomycin.Pathogen-free female BALB/c mice were used to explore the mechanisms of refractoriness of interferon-signaling.Mouse thioglycollate-elicited peritoneal macrophages,bone marrow derived macrophages and bone marrow derived dendritic cells were collected and cultured.The amount of interferon(IFN)-inducible protein-10(IP10/CXCL10),macrophage chemotactic protein(MCP1/CCL2) and interleukin(IL)-6 secreted by cells activated by DMXAA was quantified using enzyme-linked immunosorbent assay kits according to the instructions of the manufacturers.Total RNA was isolated from cells or nasal epithelium with RNeasy Plus Mini Kit,and cDNA was synthesized.Gene expression was checked using Applied Biosystems StepOne Real-Time Polymerase Chain Reaction System.Transfection of small interfering RNA(siRNA) control,NOD1 duplexed RNA oligonucleotides,and high-mobility group box 1/2/3(HMGB1/2/3) siRNA was performed using siRNA transfection reagent.RESULTS:DMXAA activates IFN-β pathway with high level of IFN-β dependent antiviral genes including 2’,5’-oligoadenylate synthetase 1 and myxovirus resistance 1 in mouse thioglycollate-elicited peritoneal macrophages,bone marrow derived macrophages and bone marrow derived dendritic cells.Activation of IFN-β by DMXAA involved in NOD1,but not HMGB1/2/3 signal pathway demonstrated by siRNA.NOD1 pathway plays an important role in refractoriness of IFN-β signaling induced by DMXAA in mouse C10 respiratory epithelial cells and BALB/c mice nasal epithelia.These data indicate that DMXAA

  3. Refractory anemia with severe dysplasia: clinical significance of morphological features in refractory anemia.

    Science.gov (United States)

    Matsuda, A; Jinnai, I; Yagasaki, F; Kusumoto, S; Minamihisamatsu, M; Honda, S; Murohashi, I; Bessho, M; Hirashima, K

    1998-04-01

    Refractory anemia (RA) in myelodysplastic syndromes (MDS) are very heterogeneous diseases regarding their morphology, clinical features and survival. We proposed the new designations 'RA with severe dysplasia (RASD)' and 'RA with minimal dysplasia (RAminiD)'. In our criteria, RASD is considered present if a bone marrow (BM) examination shows Pseudo-Pelger-Huet anomalies of mature neutrophils > or =3% and/or micromegakaryocytes (mMgk) of megakaryocytes > or =10% in RA patients. RAminiD is defined as RA cases other than RASD. After the reclassification of 58 primary RA patients, the group was composed of 45 RAminiD and 13 RASD patients. The blast percentage in the BM and the frequency of cytogenetic abnormalities observed in the RASD patients were intermediate between those in the RAminiD and RAEB patients. The analysis of survival curves revealed differences among the three groups; the RASD patients had lower survival probabilities than those of the RAminiD group, and significantly higher probabilities than those of the RAEB group. (RAminiD vs RASD, P=0.06; RASD vs RAEB, P=0.004.) Our data indicate that in RA patients, RASD is a distinct subset of RA with an unfavorable clinical outcome.

  4. Bioleaching of refractory gold ore (Ⅲ)--Fluid leaching Jinya refractory gold concentrate by Thiobacillus ferrooxidans

    Institute of Scientific and Technical Information of China (English)

    闵小波; 柴立元; 陈为亮; 于霞; 张传福; 邝中

    2002-01-01

    A novel fluidized-bed reactor was designed and installed for bioleaching in a semi-continuous way,by which a process for bioleaching-cyanidation of Jinya refractory gold arsenical concentrate was studied.The arsenic extraction rate reaches 82.5% after 4-day batch biooxidation of the concentrate under the optimized condition of pH 2.0,ferric ion concentration 6.5 g/L and pulp concentration 10%.And leached rate of gold in the following cyanidation is over 90%.The parameters of three series fluidized-bed reactors exhibit stability during the semi-continuous bioleaching of the concentrate.Arsenic in the concentrate can be got rid of 91% after 6-day leaching.Even after 4 days,82% of arsenic extraction rate was still obtained.The recovery rates of gold are 92% and 87.5% respectively in cyaniding the above bioleached residues.The results will provide a base for further commercial production of gold development.

  5. Development of Refractory Technology in China‘s Iron and Steel Industry

    Institute of Scientific and Technical Information of China (English)

    LITingshou; PENGXigao

    2000-01-01

    Review on the development of refractories technology in China's iron and steel industry during the period of "the ninth five-year plan" has been made.Some sugges-tions and opinions on the future development of refractories science and technology in China has been put forward ,including full utilization of domestic rich resources of refrac-tory raw materials to develop sophisticated synthetic refrac-tory raw materials with Chinese characteristics and the R & D on high-tech refractory products for meeting the require-ment of the development of new metallurgical technology.

  6. Experimental Research for Refractories Used in High-Turbulent-Mixer (HTM)-Reactor

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    The high turbulent mixer (HTM) process is benefit for improving the quality of iron and steel, but the refractory of the reactor is easy to be eroded by slag and liquid metal at high temperature. Especially for the violent mixing in HTM, refractory can also be impacted by molten metal (iron or steel), so it is very important to study and find out new refractory to meet the demand of HTM. Suitable refractory not only can stand the eroding of slag and liquid metal, but also can reduce the loss of electromagnetic energy. According to the experimental results, the influence of different refractory on electromagnetic force is unconspicuous, the refractory with Al2O3-base is better than that with MgO-base for standing the erosion by slag and iron. Al2O3-base refractory is more suitable for HTM process.

  7. NOVEL REFRACTORY MATERIALS FOR HIGH ALKALI, HIGH TEMPERATURE ENVIRONMENTS

    Energy Technology Data Exchange (ETDEWEB)

    Hemrick, James Gordon [ORNL; Smith, Jeffrey D [ORNL; O' Hara, Kelley [University of Missouri, Rolla; Rodrigues-Schroer, Angela [Minteq International, Inc.; Colavito, [Minteq International, Inc.

    2012-08-01

    A project was led by Oak Ridge National Laboratory (ORNL) in collaboration with a research team comprised of the academic institution Missouri University of Science and Technology (MS&T), and the industrial company MINTEQ International, Inc. (MINTEQ), along with representatives from the aluminum, chemical, glass, and forest products industries. The project was to address the need for new innovative refractory compositions by developing a family of novel MgO-Al 2O3, MgAl2O4, or other similar spinel structured or alumina-based unshaped refractory compositions (castables, gunnables, shotcretes, etc.) utilizing new aggregate materials, bond systems, protective coatings, and phase formation techniques (in-situ phase formation, altered conversion temperatures, accelerated reactions, etc). This family of refractory compositions would then be tailored for use in high-temperature, high-alkaline industrial environments like those found in the aluminum, chemical, forest products, glass, and steel industries. Both practical refractory development experience and computer modeling techniques were used to aid in the design of this new family of materials. The newly developed materials were expected to offer alternative material choices for high-temperature, high-alkali environments that were capable of operating at higher temperatures (goal of increasing operating temperature by 100-200oC depending on process) or for longer periods of time (goal of twice the life span of current materials or next process determined service increment). This would lead to less process down time, greater energy efficiency for associated manufacturing processes (more heat kept in process), and materials that could be installed/repaired in a more efficient manner. The overall project goal was a 5% improvement in energy efficiency (brought about through a 20% improvement in thermal efficiency) resulting in a savings of 3.7 TBtu/yr (7.2 billion ft3 natural gas) by the year 2030. Additionally, new

  8. Repair works at coke ovens lined with refractory mixtures

    Energy Technology Data Exchange (ETDEWEB)

    Beckmann, R.; Friebe, G.

    1981-06-01

    The wear characteristics of the usual refractory mixtures are strongly dependent upon the prevailing operating conditions, the location of use within the oven and the temperature range to be expected. As exemplified by typical deteriorations, the suitability of refractory mixtures of aluminium sulphate, water glass, clay, aluminous cement and phosphate basis for various applications is discussed. Structure and bonding mechanisms of the repair mixtures are decisive for application, service time and temperature behaviour. Also pretreatment of the base and proper selection of the application method are important for the success of the repair. The application methods: dusting, spraying, pressure spraying, casting and ramming, are compared based on operating experience. Pressure spraying proved to be a simple and less expensive method for repairing large deteriorations. With sufficient care good success is ensured.

  9. Epidural blood patch for refractory low CSF pressure headache

    DEFF Research Database (Denmark)

    Madsen, Søren Aalbæk; Fomsgaard, Jonna Storm; Jensen, Rigmor

    2011-01-01

    of non-invasive/conservative measures and invasive measures with epidural blood patch providing the cornerstone of the invasive measures. In the present pilot study we therefore aimed to evaluate the treatment efficacy of epidural blood patch (EBP) in treatment-refractory low-pressure headache. Our...... reduction in frequency. An increase in days with use of medication was found. Increased awareness of low CSF pressure headache is emphasized and a controlled larger randomized study is needed to confirm the results. However the present results, allows us to conclude that EBP in treatment-refractory low CSF......Once believed an exceedingly rare disorder, recent evidence suggests that low cerebrospinal fluid (CSF) pressure headache has to be considered an important cause of new daily persistent headaches, particularly among young and middle-aged individuals. Treatment of low CSF pressure headache consists...

  10. New-onset refractory status epilepticus mimicking herpes virus encephalitis.

    Science.gov (United States)

    Puoti, Gianfranco; Elefante, Andrea; Saracino, Dario; Capasso, Antonella; Cotrufo, Roberto; Anello, Clara Belluomo

    2013-01-01

    New-onset refractory status epilepticus (NORSE) is a recently defined clinical entity that describes patients who present with status epilepticus of unclear etiology that is highly refractory to therapy. Magnetic resonance imaging (MRI) of NORSE usually discloses no specific abnormalities except for an occasional mild T2/FLAIR hyperintense signal of the mesial temporal lobe. Here, we report a peculiar case of NORSE in which brain MRI showed massive alteration of both temporal lobes, with features strongly supporting the diagnosis of herpes virus encephalitis, but lacking any laboratory evidence of viral infection in the blood and cerebrospinal fluid. It showed also striking signal alterations in the thalamus, which got worse in the course of the disease. This report emphasizes the possibility that seizure activity alone plays a critical role in both determining the disease and whether it will be self-sustaining.

  11. New-Onset Refractory Status Epilepticus Mimicking Herpes Virus Encephalitis

    Directory of Open Access Journals (Sweden)

    Gianfranco Puoti

    2013-09-01

    Full Text Available New-onset refractory status epilepticus (NORSE is a recently defined clinical entity that describes patients who present with status epilepticus of unclear etiology that is highly refractory to therapy. Magnetic resonance imaging (MRI of NORSE usually discloses no specific abnormalities except for an occasional mild T2/FLAIR hyperintense signal of the mesial temporal lobe. Here, we report a peculiar case of NORSE in which brain MRI showed massive alteration of both temporal lobes, with features strongly supporting the diagnosis of herpes virus encephalitis, but lacking any laboratory evidence of viral infection in the blood and cerebrospinal fluid. It showed also striking signal alterations in the thalamus, which got worse in the course of the disease. This report emphasizes the possibility that seizure activity alone plays a critical role in both determining the disease and whether it will be self-sustaining.

  12. Chemotherapy Plus Sargramostim in Treating Patients With Refractory Myeloid Cancer

    Science.gov (United States)

    2013-01-08

    Accelerated Phase Chronic Myelogenous Leukemia; Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities; Adult Acute Myeloid Leukemia With Del(5q); Adult Acute Myeloid Leukemia With Inv(16)(p13;q22); Adult Acute Myeloid Leukemia With t(15;17)(q22;q12); Adult Acute Myeloid Leukemia With t(16;16)(p13;q22); Adult Acute Myeloid Leukemia With t(8;21)(q22;q22); Blastic Phase Chronic Myelogenous Leukemia; Chronic Myelomonocytic Leukemia; Chronic Phase Chronic Myelogenous Leukemia; Paroxysmal Nocturnal Hemoglobinuria; Previously Treated Myelodysplastic Syndromes; Recurrent Adult Acute Myeloid Leukemia; Refractory Anemia; Refractory Anemia With Ringed Sideroblasts; Relapsing Chronic Myelogenous Leukemia; Thrombocytopenia; Untreated Adult Acute Myeloid Leukemia

  13. Treatment of pediatric refractory Crohn's disease with thalidomide

    Institute of Scientific and Technical Information of China (English)

    Cui-Fang Zheng; Jia-Hua Xu; Ying Huang; Ying-Kit Leung

    2011-01-01

    AIM: To assess the efficacy and tolerability of thalidomide in pediatric Crohn's disease (CD). METHODS: Six patients with refractory CD received thalidomide at an initial dose of 2 mg/kg per day for one month, then increased to 3 mg/kg per day or decreased to 1 mg/kg per day, and again further reduced to 0.5 mg/kg per day, according to the individual patient's response to the drug. RESULTS: Remission was achieved within three months. Dramatic clinical improvement was demonstrated after thalidomide treatment. Endoscopic and pathological improvements were also observed after thalidomide treatment, which was well tolerated by all patients. CONCLUSION: Thalidomide is a useful drug for pediatric refractory CD.

  14. Refractory Cardiogenic Shock During Tramadol Poisoning: A Case Report.

    Science.gov (United States)

    Belin, Nicolas; Clairet, Anne-Laure; Chocron, Sidney; Capellier, Gilles; Piton, Gaël

    2017-04-01

    Tramadol is a weak opioid analgesic indicated for the treatment of moderate to severe pain. Tramadol intoxication can be lethal, and this drug is frequently involved in voluntary overdose. Classically, tramadol intoxication is associated with neurological and respiratory side effects. In contrast, cardiac effects are poorly documented in the literature. We report a case of severe tramadol intoxication, with plasma concentration 20 times the toxic threshold, complicated by refractory cardiogenic shock, successfully treated by extra corporeal life support (ECLS) with a favorable cardiac outcome and ECLS weaning at day 10. Seizure, clonus, and nonreactive mydriasis were present during 4 days, and complete awakening was delayed to day 15. Poisoning caused by high doses of tramadol can lead to refractory cardiogenic shock, and ECLS can be considered as effective rescue therapy in this context.

  15. Oral methylphenidate for the treatment of refractory facial dystonias.

    Science.gov (United States)

    Eftekhari, Kian; Choe, Christina H; Vagefi, M Reza; Gausas, Roberta E; Eckstein, Lauren A

    2015-01-01

    Oral methylphenidate (Ritalin, Novartis) has been reported to alleviate symptoms of benign essential blepharospasm in an off-label application. This series presents 3 patients with refractory periorbital and facial dystonias, including blepharospasm, apraxia of eyelid opening, and oromandibular dystonia unresponsive to standard treatments who experienced a response to oral methylphenidate therapy. While the mechanisms for facial dystonias have not been elucidated, there is evidence to suggest that they are on the spectrum with Parkinson disease. Given the role of dopamine loss in the pathogenesis of Parkinson, the authors' speculate that methylphenidate may be acting on the pathway directly involved in facial dystonias. To the authors' knowledge, this is the first report of a case of successful treatment of blepharospasm refractory to upper eyelid myectomy with methylphenidate monotherapy.

  16. A new extraction process of refractory gold arsenosulfide concentrates

    Institute of Scientific and Technical Information of China (English)

    Yuqun Meng; Tao Jin; Minjie Wu; Shaoling Su; Longbao Wang

    2003-01-01

    A new hydrometallurgical process for the refractory gold arsenosulfide concentrates under normal temperature and pressure was presented. The experimental results of a refractory gold concentrate show that the total consumption of NaOH in alkaline leaching is only 40% of those theoretically calculated under the conditions of full oxidization at the same oxidation of arsenic to arsenate and sulfur to sulfate. After alkaline leaching, cyanidation and adsorption were carried out for 24 h. The dissolution of gold by NaCN is increased to 95.3% from 12.8% before pretreatment, and meanwhile 99.3% of the adsorption of gold by activated charcoal.The consumption of NaCN for one ton ore is 10 kg, which is 1.2 times less than that before pretreatment. As it is carried out under normal temperature and pressure, the investment of installations is also decreased.

  17. Mechanisms of Drug Resistance in Relapse and Refractory Multiple Myeloma

    Science.gov (United States)

    Yang, Wen-Chi; Lin, Sheng-Fung

    2015-01-01

    Multiple myeloma (MM) is a hematological malignancy that remains incurable because most patients eventually relapse or become refractory to current treatments. Although the treatments have improved, the major problem in MM is resistance to therapy. Clonal evolution of MM cells and bone marrow microenvironment changes contribute to drug resistance. Some mechanisms affect both MM cells and microenvironment, including the up- and downregulation of microRNAs and programmed death factor 1 (PD-1)/PD-L1 interaction. Here, we review the pathogenesis of MM cells and bone marrow microenvironment and highlight possible drug resistance mechanisms. We also review a potential molecular targeting treatment and immunotherapy for patients with refractory or relapse MM. PMID:26649299

  18. Brentuximab vedotin desensitization in a patient with refractory Hodgkin's lymphoma.

    Science.gov (United States)

    Arora, Anubha; Bhatt, Vijaya Raj; Liewer, Susanne; Armitage, James O; Bociek, R Gregory

    2015-10-01

    Brentuximab vedotin has emerged as a useful treatment option for relapsed or refractory Hodgkin's lymphoma; however, uncommon cases of anaphylactic reactions may require its permanent discontinuation. We report a 29-yr-old woman with refractory Hodgkin's lymphoma, who developed an anaphylactic reaction during the second dose of brentuximab vedotin. A 12-step desensitization protocol was followed; after premedicating with antihistaminic agents, methylprednisolone and montelukast, a total dose of 156 mg of brentuximab vedotin (1.8 mg/kg) was given as three infusions with increasing rate and concentration. Such desensitization protocol can allow safe administration of brentuximab vedotin and may have a broader applicability in managing hypersensitivity reactions with other monoclonal antibodies. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  19. Omeprazole for Refractory Gastroesophageal Reflux Disease during Pregnancy and Lactation

    Directory of Open Access Journals (Sweden)

    John K Marshall

    1998-01-01

    Full Text Available Symptomatic gastroesophageal reflux is a common complication of pregnancy and lactation. However, the safety of many effective medical therapies, including oral proton pump inhibitors, has not been well defined. The administration of oral omeprazole to a 41-year-old female during the third trimester of pregnancy, after ranitidine and cisapride failed to control her refractory gastroesophageal reflux, is reported. No adverse fetal effects were apparent, and the patient elected to continue omeprazole therapy (20 mg/day while breastfeeding. Peak omeprazole concentrations in breast milk (58 nM, 3 h after ingestion were less than 7% of the peak serum concentration (950 nM at 4 h, indicating minimal secretion. Although omeprazole is a potentially useful therapy for refractory gastroesophageal reflux during pregnancy and lactation, further data are needed to define better its safety and efficacy.

  20. Creep in refractory materials; Fluencia en materiales refractarios

    Energy Technology Data Exchange (ETDEWEB)

    Tomba Martinez, A. G.; Luz, A. P.; Pandolfelli, V. C.

    2013-10-01

    Refractory materials are widely used in various industrial fields due to their outstanding properties and performance in aggressive environments. However, although creep resistance is one of the most important properties for the selection of these materials, few researches were carried out focused on the fundamentals and technological understanding of their performance at high temperatures. In this context, this work addresses: 1) the creep mechanisms, 2) the mathematical models proposed for the analysis and to forecast the creep deformation at high temperature, 3) technical procedures and experimental testing, and 4) a critical analysis of some basic and practical aspects considering the literature available on this issue. Based on the collected information, mathematical models (such as the Projection concept) were considered as a powerful tool for the prediction of the refractories creep behavior, helping to identify the main creep mechanisms in these materials and to induce the development of optimized compositions able to attend the end-users requirements. (Author)

  1. Interleukin-1 blockade in refractory giant cell arteritis.

    Science.gov (United States)

    Ly, Kim-Heang; Stirnemann, Jérôme; Liozon, Eric; Michel, Marc; Fain, Olivier; Fauchais, Anne-Laure

    2014-01-01

    Giant cell arteritis is a primary large-vessel vasculitis characterized by an arterial wall inflammation associated with intimal hyperplasia leading to arterial occlusion. Glucocorticoids remain the mainstay of giant cell arteritis treatment. However, relapses and glucocorticoid-related complications are frequent and therapeutic options for refractory giant cell arteritis are quite limited. Like tumor necrosis factor-α and interleukin-6, interleukin-1β is also highly expressed in inflamed arterial walls of patients with giant cell arteritis and may contribute in the pathogenesis of this disease. We report treatment of three cases of refractory giant cell arteritis successfully treated with anakinra, an interleukin-1 blockade therapy. Anakinra was effective for all patients, yielding improvement in their inflammation biomarkers and/or in their symptoms, as well as a disappearance of arterial inflammation in PET/CT for two of them. Copyright © 2013. Published by Elsevier SAS.

  2. Epidural blood patch for refractory low CSF pressure headache

    DEFF Research Database (Denmark)

    Madsen, Søren Aalbæk; Fomsgaard, Jonna Storm; Jensen, Rigmor

    2011-01-01

    of non-invasive/conservative measures and invasive measures with epidural blood patch providing the cornerstone of the invasive measures. In the present pilot study we therefore aimed to evaluate the treatment efficacy of epidural blood patch (EBP) in treatment-refractory low-pressure headache. Our......Once believed an exceedingly rare disorder, recent evidence suggests that low cerebrospinal fluid (CSF) pressure headache has to be considered an important cause of new daily persistent headaches, particularly among young and middle-aged individuals. Treatment of low CSF pressure headache consists...... reduction in frequency. An increase in days with use of medication was found. Increased awareness of low CSF pressure headache is emphasized and a controlled larger randomized study is needed to confirm the results. However the present results, allows us to conclude that EBP in treatment-refractory low CSF...

  3. Unusual cause of respiratory distress misdiagnosed as refractory asthma

    Directory of Open Access Journals (Sweden)

    Al-Otair Hadil

    2006-01-01

    Full Text Available We report a young lady, who was labeled as a case of refractory asthma for a few years, based on history of shortness of breath on minimal exertion, noisy breathing and normal chest radiograph. Repeated upper airway exam by an otolaryngologist and computerized tomography scan, were normal. On presentation to our hospital, she was diagnosed to have fixed upper airway obstruction, based on classical flow-volume loop findings. Fibroptic bronchoscopy revealed a web-shaped subglottic stenosis. The histopathology of a biopsy taken from that area, showed non-specific inflammation. No cause for this stenosis could be identified. The patient was managed with rigid bronchoscopy dilatation, without recurrence. We report this case as idiopathic subglottic stenosis, that was misdiagnosed as refractory bronchial asthma, stressing the importance of performing spirometry in the clinic.

  4. Refractory hypotension in a patient with Wernicke's encephalopathy.

    Science.gov (United States)

    Wang, Shi; Hou, Xiaojun; Ding, Suju; Guan, Yangtai; Zhen, Huimin; Tu, Laihui; Qiu, Yiqing

    2012-01-01

    A 57-year-old male patient with gastric carcinoma underwent radical distal gastrectomy type II + Braun anastomosis, and received total parenteral nutrition for 10 days after surgery, followed by small amounts of semi-liquid nutrition for 3 days and liquid nutrition for 2 days. The patient developed refractory hypotension for more than 1 week in the early course of disease, and on Day 15 after surgery presented with characteristic signs of Wernicke's encephalopathy, including diplopia and mental confusion. The hypotension did not improve despite appropriate fluid replacement soon after admission. Treatment with moderate dose of thiamine for 3 months partly relieved ophthalmoplegia and confusion, but not Korsakoff syndrome. This extraordinary presentation with refractory hypotension and the unusual course of the disease encouraged us to present this case.

  5. Feasibility Study for Casting of High Temperature Refractory Superalloy Composites

    Science.gov (United States)

    Lee, Jonathan A.

    1998-01-01

    Abstract This study investigated the feasibility of using conventional casting technique to fabricate refractory wires reinforced superalloy composites. These composites were being developed for advanced rocket engine turbine blades and other high temperature applications operating up to 2000 F. Several types of refractory metal wires such as W- Th, W-Re, Mo-Hf-C and W-HF-C reinforced waspaloy were experimentally cast and heat treated at 2000 F up to 48 hrs. Scanning electron microscope analysis was conducted in regions adjacent to the wire-matrix interface to determine the reaction zone and chemical compatibility resulting from material interdiffusion. It was concluded that fabrication using conventional casting may be feasible because the wire-matrix reaction zone thickness was comparable to similar composites produced by arc-sprayed monotape with hot isostatic pressing technique, Moreover, it was also found that the chemical compatibility could be improved significantly through a slight modification of the superalloy matrix compositions.

  6. Androgen receptor gene mutations in hormone-refractory prostate cancer.

    Science.gov (United States)

    Wallén, M J; Linja, M; Kaartinen, K; Schleutker, J; Visakorpi, T

    1999-12-01

    Prostate cancer is considered to be one of the most hormone-dependent human malignancies. As a key mediator of hormonal response, the androgen receptor (AR) is believed to have an important role in the progression of prostate cancer. Mutations in the coding region of the AR gene have been found in both untreated and hormone-refractory prostate cancer, but the frequency of such mutations at different stages of the disease is poorly documented and even contradictory results have been published. In the present study, the frequency of AR gene mutations was determined in 30 locally recurrent and two metastatic hormone-refractory prostate tumours using the polymerase chain reaction (PCR), non-radioactive single strand conformation polymorphism (SSCP), and sequencing. The length of the polymorphic CAG repeat, which is inversely correlated with the ability of the AR to activate transcription, was also analysed as well as the GGC repeat. Twelve samples were known to contain an AR gene amplification. Altogether, one point mutation (Gly(674)-->Ala) and one microsatellite mutation (CAG(20)-->CAG(18)) were found, both in cancers containing the AR gene amplification. The mean lengths of the polymorphic CAG and GGC repeats were similar to those observed in the normal population. These results favour the view that mutations in the AR gene are rare in hormone-refractory prostate cancer and do not play an important role, at least, in local relapse. Instead, the amplification and consequent overexpression of the wild-type AR gene seem to be the most common alteration involving the AR in hormone-refractory prostate cancer.

  7. Evaluation of nutritional status in children with refractory epilepsy

    OpenAIRE

    Testolin G; Trentani C; Veggiotti P; Cardinali S; Bertoli S; Tagliabue A

    2006-01-01

    Abstract Background children affected by refractory epilepsy could be at risk of malnutrition because of feeding difficulties (anorexia, chewing, swallowing difficulties or vomiting) and chronic use of anticonvulsants, which may affect food intake and energy metabolism. Moreover, their energy requirement may be changed as their disabilities would impede normal daily activities. The aim of the present study was to evaluate nutritional status, energy metabolism and food intake in children with ...

  8. Individual differences effects on the psychological refractory period

    OpenAIRE

    Laguë-Beauvais, Maude; Gagnon, Christine; Castonguay, Nathalie; Bherer, Louis

    2013-01-01

    The goal of this study was to assess the impact of individual neuropsychological differences on the ability to share attention between concurrent tasks. Participants (n = 20) were trained on six single task practice sessions and dual-task was assessed with reaction time performance on a psychological refractory period (PRP) paradigm. Neuropsychological test scores were also acquired. Furthermore, one of the known variables that can influence performances on neuropsychological tests is gender,...

  9. Wettability of Silicon with Refractory Materials: A Review

    OpenAIRE

    Ciftja, Arjan

    2008-01-01

    The wettability of ceramics by liquid metals is a key fac¬tor in many fields of high temperature materials science and engineering. The wetting behavior of liquid-silicon/refractory-materials system is especially important in refining and crystallization of silicon with respect to production of low cost solar cells but also in the production of silicon carbide based materials for advanced applications. This paper is a review on the wetting properties of molten silicon with various carbon, sil...

  10. Clean Production of Steel and Refractories in China's Steel Industry

    Institute of Scientific and Technical Information of China (English)

    SU Tiansen

    2002-01-01

    The paper describes the importance of clean production of steel and the relationships amongst sustaining development of steel industry, environment protection and the role of refractories in the clean production of steel. The main achievements and main shortcomings in the clean production of China' s steel industry have been reviewed together with the introduction of the policy supporting system and the future development of clean production in China' s steel industry.

  11. Wettability of Silicon with Refractory Materials: A Review

    OpenAIRE

    Ciftja, Arjan

    2008-01-01

    The wettability of ceramics by liquid metals is a key fac¬tor in many fields of high temperature materials science and engineering. The wetting behavior of liquid-silicon/refractory-materials system is especially important in refining and crystallization of silicon with respect to production of low cost solar cells but also in the production of silicon carbide based materials for advanced applications. This paper is a review on the wetting properties of molten silicon with various carbon, sil...

  12. Low-Chrome/Chrome Free Refractories for Slagging Gasifiers

    Energy Technology Data Exchange (ETDEWEB)

    Bennett, J.P.; Kwong, K.-S.; Powell, C.P.; Thomas, H.; Petty, A.V., Jr.

    2007-01-01

    Gasifiers are containment vessels used to react carbon-containing materials with oxygen and water, producing syngas (CO and H2) that is used in chemical and power production. It is also a potential source of H2 in a future hydrogen economy. Air cooled slagging gasifiers are one type of gasifier, operating at temperatures from 1275-1575º C and at pressures of 400 psi or higher. They typically use coal or petroleum coke as the carbon source, materials which contain ash impurities that liquefy at the gasification temperatures, producing liquid slag in quantities of 100 or more tons/day, depending on the carbon fed rate and the percent ash present in the feedstock. The molten slag is corrosive to refractory linings, causing chemical dissolution and spalling. The refractory lining is composed of chrome oxide, alumina, and zirconia; and is replaced every 3-24 months. Gasifier users would like greater on-line availability and reliability of gasifier liners, something that has impacted gasifier acceptance by industry. Research is underway at NETL to improve refractory service life and to develop a no-chrome or low-chrome oxide alternative refractory liner. Over 250 samples of no- or low-chrome oxide compositions have been evaluated for slag interactions by cup testing; with potential candidates for further studies including those with ZrO2, Al2O3, and MgO materials. The development of improved liner materials is necessary if technologies such as IGCC and DOE’s Near Zero Emissions Advanced Fossil Fuel Power Plant are to be successful and move forward in the marketplace.

  13. Morbidity and mortality after peritoneovenous shunt surgery for refractory ascites.

    OpenAIRE

    Rubinstein, D; McInnes, I; Dudley, F

    1985-01-01

    A prospective analysis of the morbidity and mortality after peritoneovenous shunting was carried out in 25 patients who had a total of 27 shunts for refractory ascites. Major complications were limited to the patients in whom ascites was secondary to hepatic rather than peritoneal disease. Immediate postoperative complications followed 17 out of the 23 shunts carried out in patients with liver disease and included septicaemia (two), profound hypotension (two), pulmonary oedema (one), and clin...

  14. Airway refractoriness to inhaled mannitol after repeated challenge.

    Science.gov (United States)

    Suh, Dong In; Lee, Ju Kyung; Kim, Jin-Tack; Koh, Young Yull

    2011-10-01

    Exercise and inhaled mannitol are thought to cause bronchoconstriction through a similar mechanism in asthma. The response to exercise becomes refractory with repeated challenges. This study aimed to investigate whether repeated challenge with mannitol induces refractoriness, as with exercise. Forty-one children with asthma underwent two consecutive dose-response mannitol challenges (Phase 1); the second challenge proceeded after recovery (FEV(1) : 95% or more of baseline value) from the first. The response to mannitol was expressed as a provocative dose causing a 15% fall in FEV(1) (PD(15) ) and the response-dose ratio (RDR) (% fall in FEV(1) /cumulative dose). In 18 subjects who were deemed to have mannitol refractoriness in Phase 1, a mannitol challenge was performed before and after a methacholine challenge (Phase 2). In Phase 1, the time taken for the FEV(1) to recover after the first mannitol challenge ranged from 20 to 100 min with a median of 50 min. In the 23 subjects with a measurable mannitol PD(15) in both challenges, the geometric mean (95%CI) PD(15) in the second challenge (163 mg [114-232]) was significantly higher than that in the first challenge (66 mg [50-88], P value of 0.083%/mg (0.055-0.125) in the first challenge to 0.029%/mg (0.017-0.048) in the second challenge (P challenge with methacholine or mannitol did not significantly alter subsequent bronchoconstriction to the opposite challenge. Repeated challenge with mannitol resulted in less bronchoconstriction when compared with the initial challenge. This refractoriness seems not to be attributable to functional loss of responsiveness or non-specific effect of prior bronchoconstriction.

  15. Research and Development of Bauxite—based Refractories

    Institute of Scientific and Technical Information of China (English)

    ZHONGXiang-chong

    1996-01-01

    The research work on the microstructure and high temperature mehanical properties of sintered Chinses bauxite(DK type) and the ef-fects of foreign oxide additions (K2O,CaO,TiO,Fe2O3,MgO,ZrO2·SiO2) carried out at our laboratories have been reviewed.Based on these basic research results,bauxite-based high performance refractories have been develped for high temperature applications with success-ful achievements.

  16. Recent Development of High Alumina Refractories in China

    Institute of Scientific and Technical Information of China (English)

    WANGJin-xiang; LIUJie-hua

    1994-01-01

    The paper reviews the achievements which have been attained recently in China in high alumina refractories raw materials and their products,including 1) homogenization ,urification and electric fusion of high alumina raw materials and synthesizing of spinel from natural raw materials;2) processing principle and characteristics and microstructural features of creep-resistance high alu-mina brick ,alumina-magnesia-carbon brick and thermal shock resistanced high alumina brikc and their application in practice.

  17. The surgical management of the refractory overactive bladder

    Directory of Open Access Journals (Sweden)

    Nikhil Vasdev

    2010-01-01

    Full Text Available The refractory overactive bladder is a clinically challenging entity to manage and affects millions of people worldwide. Current surgical treatment options include botulinum toxin type A, sacral neuromodulation, and bladder reconstruction surgery all of which require careful attention to the individual patients needs and circumstances. In our paper we present a detailed up-to-date review on all the above mentioned surgical techniques from current literature and briefly describe our units experience with sacral neuromodulation.

  18. Updates on Treatment of Gemcitabine-Refractory Pancreatic Adenocarcinoma

    Directory of Open Access Journals (Sweden)

    Nektaria Makrilia

    2011-07-01

    Full Text Available Gemcitabine monotherapy and gemcitabine-based regimens are the current standard of care for locally advanced or metastatic pancreatic adenocarcinoma. However, there is still great controversy over the role of salvage chemotherapy after failure of gemcitabine. This review is an update on the 2011 American Society of Clinical Oncology (ASCO Annual Meeting regarding the most important developments in the treatment of refractory pancreatic cancer, as they were reported in Abstracts #e14542 and #e14588.

  19. Oral cyclosporine therapy for refractory severe vernal keratoconjunctivitis

    Directory of Open Access Journals (Sweden)

    Nikhil S Gokhale

    2012-01-01

    Full Text Available We report the success of oral cyclosporine therapy in a patient with severe vision-threatening vernal keratoconjunctivitis. A child presented with severe allergy which was not controlled with topical steroids, cyclosporine and mast cell stabilizers. Oral steroids were required repeatedly to suppress inflammation. Child showed a dramatic improvement and stabilization with oral cyclosporine therapy. Oral cyclosporine therapy can be tried in severe vision-threatening allergy refractory to conventional therapy.

  20. Corticosteroid refractory radiation pneumonitis that remarkably responded to cyclosporin A

    Energy Technology Data Exchange (ETDEWEB)

    Muraoka, Tomie; Bandoh, Shuji; Fujita, Jiro; Horiike, Atsushi; Ishii, Tomoya; Tojo, Yasunori; Kubo, Akihito; Ishida, Toshihiko [Kagawa Medical Univ., Miki (Japan)

    2002-09-01

    Radiation therapy is commonly used for the treatment of lung cancer. However, radiation pneumonitis frequently occurs as a complication of the radiation therapy. Although corticosteroids are widely used for the treatment of radiation pneumonitis, they are not always effective. In this report, we used cycosporin A in the treatment of a patient suffering from steroid-refractory radiation pneumonitis. To our knowledge, this is the first report in which cyclosporin A was successfully used in the treatment of radiation pneumonitis. (author)

  1. Etanercept in the treatment of refractory SAPHO syndrome

    OpenAIRE

    Zhang, Lei; Gao, Zhaomeng

    2016-01-01

    Objective: To explore the application and efficacy of TNF-α inhibitors in the treatment of SAPHO syndrome. Methods: Two cases of refractory SAPHO syndrome were successfully treated with etanercept. And pain scores, laboratory parameters and functional index were used to judge the efficacies. Literature was also systemically reviewed. Results: Both patients achieved marked clinical remission. There was no obvious toxic or adverse response. Conclusion: Etanercept has rapid and definite efficaci...

  2. Refractory period of an excitable semiconductor laser with optical injection

    CERN Document Server

    Garbin, Bruno; Prati, Franco; Javaloyes, Julien; Tissoni, Giovanna; Barland, Stéphane

    2016-01-01

    Injection-locked semiconductor lasers can be brought to a neuron-like excitable regime when parameters are set close to the unlocking transition. Here we study experimentally the response of this system to repeated optical perturbations and observe the existence of a refractory period during which perturbations are not able to elicit an excitable response. The results are analyzed via simulations of a set of dynamical equations which reproduced adequately the experimental results.

  3. XK469R in Treating Patients With Refractory Hematologic Cancer

    Science.gov (United States)

    2013-02-07

    Adult Acute Basophilic Leukemia; Adult Acute Eosinophilic Leukemia; Adult Acute Megakaryoblastic Leukemia (M7); Adult Acute Minimally Differentiated Myeloid Leukemia (M0); Adult Acute Monoblastic Leukemia (M5a); Adult Acute Monocytic Leukemia (M5b); Adult Acute Myeloblastic Leukemia With Maturation (M2); Adult Acute Myeloblastic Leukemia Without Maturation (M1); Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities; Adult Acute Myeloid Leukemia With Inv(16)(p13;q22); Adult Acute Myeloid Leukemia With t(16;16)(p13;q22); Adult Acute Myeloid Leukemia With t(8;21)(q22;q22); Adult Acute Myelomonocytic Leukemia (M4); Adult Erythroleukemia (M6a); Adult Pure Erythroid Leukemia (M6b); Blastic Phase Chronic Myelogenous Leukemia; Chronic Myelomonocytic Leukemia; de Novo Myelodysplastic Syndromes; Previously Treated Myelodysplastic Syndromes; Recurrent Adult Acute Lymphoblastic Leukemia; Recurrent Adult Acute Myeloid Leukemia; Refractory Anemia With Excess Blasts; Refractory Anemia With Excess Blasts in Transformation; Refractory Chronic Lymphocytic Leukemia; Relapsing Chronic Myelogenous Leukemia; Secondary Myelodysplastic Syndromes; Stage III Chronic Lymphocytic Leukemia; Stage IV Chronic Lymphocytic Leukemia; Untreated Adult Acute Myeloid Leukemia

  4. Synthesis process of forsterite refractory by iron ore tailings.

    Science.gov (United States)

    Li, Jing; Wang, Qi; Liu, Jihui; Li, Peng

    2009-01-01

    With mineral resources becoming gradually more deficient, as well as the issue of mine tailings causing environmental pollution, more and more people have realized the great significance of tailings utilization. Iron ore tailings, as a kind of secondary resource, have been developed in recycling industries. The feasibility to produce forsterite refractory from high-silicon iron tailings and high-magnesium raw materials were discussed. Also, the synthesis reaction processes were studied from the results of the laboratory experiments. The experiments showed that the synthesis processes can be separated into three steps when using iron tailings to synthesize forsterite: (1) produce magnesium iron sosoloid (Mg(1-X)Fe(X)O) and magnesium metasilicate (MgSiO3), (2) form the fayalite, and (3) create the forsterite. The synthetic productions are primarily forsterite, hortonolite, and small amounts of magnesium metasilicate (MgSiO3). The hortonolite is wrapped around the surface of the forsterite particles and formed the cementing phase. In addition, the method to produce forsterite refractory and lightweight forsterite refractory from iron tailings were offered.

  5. Effect of refractory agent on ash fusibility temperatures of briquette

    Institute of Scientific and Technical Information of China (English)

    Guo-xing CUI; Kui HUANG; Ming-sui LIN

    2013-01-01

    To solve the problem of the low ash fusion point of briquette,this paper reported that the ash fusibility temperatures can be elevated by changing ash ingredients through blending refractory agents in briquette ash,which will create favorable conditions for moving bed continuous gasification of briquette with oxygen-rich air.The effects of Al2O3,SiO2,kaolin,dry powder and bentonite on ash fusibility temperatures were studied,based upon the relationship between briquette ash components and ash fusibility.The results show that the increasing of ash fusibility temperatures by adding the same amount (11%,w)of refractory agents follows the sequence of SiO2,bentonite,dry powder,kaolin,Al2O3,with the softening temperatures beingelevated by 37.2,57.6,60.4,82.6 and 104.4 ℃.With the same ratio of SiO2/Al2O3 in briquette,adding the Al2O3 component is more effective than SiO2 for raising ash fusibility temperatures.In this paper,inexpensive kaolin and bentonite rich in Al2O3 are found to be better refractory agents,and the suitable adding quantities are 9% and 11%,respectively.

  6. Recommendation for optimal management of severe refractory asthma

    Directory of Open Access Journals (Sweden)

    Jaymin B Morjaria

    2010-07-01

    Full Text Available Jaymin B Morjaria1, Riccardo Polosa21Department of IIR, University of Southampton, Southampton, UK; 2Dipartimento di Medicina Interna e Specialistica, University of Catania, Catania, ItalyAbstract: Patients whose asthma is not adequately controlled despite treatment with a ­combination of high dose inhaled corticosteroids and long-acting bronchodilators pose a major clinical challenge and an important health care problem. Patients with severe refractory disease often require regular oral corticosteroid use with an increased risk of steroid-related adverse events. Alternatively, immunomodulatory and biologic therapies may be considered, but they show wide variation in efficacy across studies thus limiting their generalizability. Managing asthma that is refractory to standard treatment requires a systematic approach to evaluate ­adherence, ensure a correct diagnosis, and identify coexisting disorders and trigger factors. In future, ­phenotyping of patients with severe refractory asthma will also become an ­important element of this systematic approach, because it could be of help in guiding and tailoring ­treatments. Here, we propose a pragmatic management approach in diagnosing and treating this challenging subset of asthmatic patients.Keywords: severe asthma, corticosteroids, immunological modifiers, steroid-sparing, ­anti-TNF-a drugs, omalizumab, mepolizumab, daclizumab, bronchial thermoplasty

  7. Performance Evaluation of Refractory Composite Coatings in Potassium Rich Environment

    Directory of Open Access Journals (Sweden)

    Kristina BRINKIENĖ

    2016-09-01

    Full Text Available A laboratory scale method was used to study the performance of reinforced cement composites in potassium rich environment of biomass combustion. Buckwheat husk (BH was used as potential source of unexploited biomass product applicable as biomass derived fuel. In order to enhance the alkali effect on the properties of the investigated materials, the solution of potassium carbonate (K2CO3 was selected as potassium rich aggressive environment. Two reinforced cement composites as potential repair coatings for restoration of damaged refractory surfaces with different composition of aggregate were used in corrosion tests. Performance of refractory coatings was evaluated by analysing the microstructure of the treated composites as well as mechanical properties. Energy-dispersive X-ray spectroscopy (SEM/EDS and optical microscopy were used to study the microstructure in the corroded region of the refractory coatings. Long term studies in the solution of 1M K2CO3 for 56 months have demonstrated that composite with the additive of fluid cracking catalyst of oil refinery and petrochemical industries is more durable in the potassium rich environment.DOI: http://dx.doi.org/10.5755/j01.ms.22.3.8348

  8. Successful rescue of refractory, severe antibody mediated rejection with splenectomy.

    Science.gov (United States)

    Kaplan, Bruce; Gangemi, Antonio; Thielke, James; Oberholzer, José; Sankary, Howard; Benedetti, Enrico

    2007-01-15

    Antibody-mediated rejection (AMR) commonly occurs after transplantation of ABO-incompatible and sensitized renal transplant. Treatment regimens commonly include a combination of plasmapheresis (PL) and intravenous immunoglobulin (IVIG). However, some cases of AMR remain refractory to treatment. We report a case series of four patients with AMR refractory to standard therapy (ST) who resolved after splenectomy. Four living donor kidney transplant recipients were diagnosed with AMR. Two patients were ABO incompatible, one was cross-match positive and one had no obvious predisposing factors. After failure of therapy with corticosteroids, PL, IVIG, Thymoglobulin, and Rituximab (three patients) or Campath (one patient), AMR was treated with laparoscopic splenectomy. After an average of 11 days of ST, laparoscopic splenectomy was performed for rescue. The urinary output improved immediately in all patients, serum creatinine levels decreased within 48 hr, and ABO titers fell in the ABO-incompatible patient and the cross-match became negative in the two sensitized patients. Splenectomy may play a role in the treatment of AMR refractory to ST.

  9. Dietary therapy is the best option for refractory nonsurgical epilepsy.

    Science.gov (United States)

    Felton, Elizabeth A; Cervenka, Mackenzie C

    2015-09-01

    Ketogenic diet therapies for epilepsy have been described since the fifth century and published in scientific literature since the early 1900s. Since that time, the diet's popularity has waxed and waned as newer drugs and other treatments have been introduced. However, in recent years, dietary therapy for epilepsy has been increasingly accepted by physicians and desired by patients as an alternative to new drugs and neurostimulation. The introduction of less restrictive versions of the classic ketogenic diet, such as the modified Atkins diet (MAD), have led to increased numbers of adult patients with refractory epilepsy who are initiating dietary treatment. Approximately half of adults and children who start a ketogenic diet have a >50% seizure reduction, which is impressive given that these patients typically have medically refractory epilepsy. We believe that ketogenic dietary treatment is the best option for children and adults with refractory nonsurgical epilepsy due to its efficacy, rapid seizure reduction, synergistic effects with other antiseizure treatments, known and treatable side effects, potential to treat comorbid medical conditions, and worldwide availability.

  10. Synthesis of Refractory Materials by Skull Melting Technique

    Science.gov (United States)

    Osiko, Vyacheslav V.; Borik, Mikhail A.; Lomonova, Elena E.

    This chapter discusses methods of growing refractory oxide single crystals and synthesis of refractory glasses by skull melting technique in a cold crucible. It shows the advantages of radiofrequency (RF) heating of dielectric materials in a cold crucible and points out some specific problems regarding the process of growing crystals by directional crystallization from the melt and by pulling on a seed from the melt. The distinctive features of the method of directional crystallization from the melt are discussed in detail on the example of technology of materials based on zirconia, i.e., cubic single crystals and partly stabilized single crystals. It is shown that the size and quality of crystals are functions of the process conditions, such as thermal conditions under crystallization, growth rate, and chemical composition. We provide an overview of research on the structure, phase composition, and physicochemical properties of crystals based on zirconia. The optical, mechanical, and electric properties of these crystals make them suitable for a number of technical and industrial applications in optics, electronics, materials processing, and medicine. In this chapter, we also consider some problems regarding the synthesis of refractory glasses by skull melting technique. The physicochemical and optical properties of glasses are given and their practical applications in technology are discussed. We note that one of the better developed and most promising applications of skull melting technique is the immobilization of liquid and solid waste (also radioactive waste) into solid-state materials by vitrification.

  11. Posaconazole in the management of refractory invasive fungal infections

    Directory of Open Access Journals (Sweden)

    Stefan Langner

    2008-09-01

    Full Text Available Stefan Langner, Philipp B Staber, Peter NeumeisterDivision of Hematology, Department of Internal Medicine, Medical University of Graz, AustriaAbstract: The rising incidence of invasive fungal infections due to the expanding population of immunocompromised hosts and the increasing prevalence of fungal resistance has led to the need for novel antifungal agents. Posaconazole, a new member of the triazole class has demonstrated in vitro activity against a broad spectrum of fungi and clinical activity against various fungal pathogens, including Aspergillus spp., Candida spp., zygomycetes, and Fusarium spp. To date, posaconazole has been approved for prophylaxis of invasive fungal infections in stem cell transplant recipients with acute graft versus host disease (GVHD and neutropenic patients receiving intensive induction chemotherapy for acute myelogenous leukemia and myelodysplastic syndrome. In addition, it has been licensed for use in oropharyngeal candidiasis and for salvage therapy in invasive aspergillosis, fusariosis, coccidioidomycosis, chromoblastomycosis, and mycetoma. Posaconazole is the only azole with activity against zygomycetes and other difficult-to-treat fungi, representing a potential treatment option for refractory invasive mycosis. This article reviews available preclinical and clinical data of posaconazole, focusing on its role in the teatment of refractory invasive fungal infections.Keywords: posaconazole, refractory invasive fungal infections, salvage therapy

  12. Characterization of Abaji clay deposits for refractory applications

    Directory of Open Access Journals (Sweden)

    Grace Olufunke MATHEW

    2016-12-01

    Full Text Available In this research work, Abaji clay deposit in Abuja, Nigeria was investigated to determine its suitability for refractory applications. The clay was sourced froom three different locations having Red clay, Pink clay, and White clay; and was labeled samples A, B, and C respectively. The chemical analysis was carried out by X-ray Fluorescence Spectrometry complemented with thermogravimetry while the mineralogical analysis was conducted using X-ray Diffractometer and property test such as sieve analysis, loss on ignition, shrinkage, porosity, bulk density plastic index, thermal shock resistance, permanent linear change on re-heating, and refractoriness were carried out using standard techniques. The chemical analysis shows that samples A, B, and C were composed of Silica: 49.98%, 36.89%, and 44.38% respectively; Alumina (Al2O3: 16.39%, 20.12%, and 18.33% respectively. The mineralogical analysis shows the clays are mainly kaolinite and free quartz. The result of the physical tests show that samples A, B, and C have: an apparent porosity of 25.90%, 20.78%, 13.82% respectively; shrinkage of 1.90%, 2.04%, 0.95%; bulk density of 1.58g/cm3, 1.63g/cm3, 1.78g/cm3; thermal shock resistance of 11 cycles, 15cycles, 17cycles respectively; while the three samples A, B, and C have the same refractoriness of 1100 °C.

  13. Efficacy and tolerability of levetiracetam for pediatric refractory epilepsy.

    Science.gov (United States)

    Muramatsu, Kazuhiro; Sawaura, Noriko; Ogata, Tomomi; Makioka, Nishiki; Tomita, Keiko; Motojima, Toshino; Ida, Kuniko; Hazama, Kyoko; Arakawa, Hirokazu

    2017-03-01

    Levetiracetam has a high tolerability and is effective against various seizure types and epilepsy syndromes. However, no study has specifically evaluated the efficacy of levetiracetam in children with refractory epilepsy based on magnetic resonance imaging (MRI) findings and the presence of intellectual disability (ID). We retrospectively evaluated levetiracetam efficacy and safety in 49 pediatric patients who met the following inclusion criteria: (1) diagnosis of refractory epilepsy with first-line antiepileptic (AED) treatment ⩾2years, (2) younger than 20years old, and (3) received oral levetiracetam treatment for ⩾6months. We assessed the relationships of these outcomes with MRI findings and ID status. Eighteen (37%) patients achieved a ⩾50% reduction in seizure frequency, and the majority (78%) had no remarkable side effects. Twenty-two (45%) patients had previously been treated with more than seven antiepileptic drugs prior to levetiracetam. Among 18 patients who achieved a ⩾50% reduction in seizure frequency, 13 and 5 had negative and positive MRI findings, and 9 and 9 had and did not have ID, respectively. Our findings suggest that even for intractable pediatric cases with symptomatic etiology (i.e., MRI lesion and ID), levetiracetam has favorable efficacy for refractory epilepsy with tolerable adverse effects. Copyright © 2016 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  14. Obinutuzumab for relapsed or refractory indolent non-Hodgkin's lymphomas.

    Science.gov (United States)

    Gabellier, Ludovic; Cartron, Guillaume

    2016-04-01

    The use of anti-CD20 monoclonal antibodies (mAbs), such as rituximab, in CD20-positive B-cell malignancies has dramatically improved the outcome of chronic lymphoid leukemia and non-Hodgkin's lymphomas (NHL). However, the occurrence of relapse and development of rituximab-refractory disease highlight the need to develop novel anti-CD20 mAbs, with improved mechanisms of action. Obinutuzumab is the first humanized type II glycoengineered anti-CD20 mAb. In vitro and in vivo data suggested several differences compared with rituximab, including a low level of complement-dependent cytotoxicity and an increased direct nonapoptotic cell death. Moreover, the glycoengineered Fc-linked nonfucosylated oligosaccharide enhanced the Fc-Fcγ receptor (FcγR) IIIa interaction, resulting in improved antibody-dependent cellular cytotoxicity and phagocytosis. Preclinical models suggested that these differences translate into superior survival in murine lymphoma models. Phase I/II trials in monotherapy in relapsed or refractory B-cell NHL demonstrated that obinutuzumab has an acceptable safety profile, infusion-related reactions being the most common adverse event. In rituximab-refractory indolent NHL, the recent randomized phase III GADOLIN study demonstrated an improved median progression-free survival for patients treated with obinutuzumab plus bendamustine rather than bendamustine alone. Further trials are ongoing to determine the role of obinutuzumab as a first-line agent in the treatment of follicular lymphoma.

  15. INVESTIGATION OF THERMAL SHOCK BEHAVIOUR IN ALUMINA BASED REFRACTORY BRICKS

    Directory of Open Access Journals (Sweden)

    N. Sinan KÖKSAL

    2003-02-01

    Full Text Available cUnderstanding of mechanical and thermal properties of refractory bricks used in industry is an important aspect to determine appropriate operating conditions. In this study, commercial refractory materials used in the sector of iron steel 45 % and 80 % alumina (Al2O3 of content refractory bricks were investigated. To determinate thermal shock behavior and mechanical properties of samples, thermal shock tests were applied by quenching in the water at the temperature differences of 500, 700, 900 and 1000 0 C. Three point bending test was examined for changes occured in the microstructure of materials. The critical temperature difference, modulus of rupture (MOR, changes of elastic modulus (E, thermal shock parameters such as resistance to crack initiation (R and resistance to crack propagation (R''' were calculated. Not with thermal treatment samples was examined same properties in the room temperature and to compare results of tests. The critical temperature difference of materials was found to be about 600 0 C. Crack start from samples of edges, space of spilling grains and microcracks occured around grains and they cause a damage by connecting to each other.

  16. Advances in multidisciplinary individualized treatment of refractory hepatic alveolar echinococcosis

    Directory of Open Access Journals (Sweden)

    ABUDUAINI Abulizi

    2015-04-01

    Full Text Available Hepatic alveolar echinococcosis (HAE is a zoonotic parasitic disease that seriously threatens the population in western China and compromises patients′ quality of life. With the continuous improvement in radical resection rate in recent years, late-stage HAE patients that were incurable in the past now have the opportunity for radical resection. However, patients who are not suitable candidates for radical resection still suffer from various complications and poor quality of life. Therefore, HAE is still considered a refractory and complex disease. The simple empirical treatment model provided by traditional professional discussion is unable to satisfy the treatment of advanced refractory HAE as it is unable to integrate specialized, standardized clinical skills for diagnosis and treatment. Multidisciplinary individualized treatment (MDT organically integrates the advantages of the available treatment into a reasonable individualized comprehensive treatment regimen. This review summarizes the advances in MDT for HAE as the best option to increase long-term survival, and suggests MDT as the first-line treatment for late-stage refractory hepatic alveolar echinococcosis.

  17. Prognosis of refractory neurosarcoidosis altered by thalidomide: a case report

    Directory of Open Access Journals (Sweden)

    Hoyle J Chad

    2008-01-01

    Full Text Available Abstract Introduction Sarcoidosis is a multisystem disease characterized by noncaseating granulomas in the lungs, skin, lymph nodes, and, rarely, the nervous system. Granuloma formation in sarcoidosis is mediated by increased secretion of interferon-gamma, interleukin-2, and tumor necrosis factor-alpha. 25% of patients with neurosarcoidosis are steroid resistant and another 20–40% are resistant to any conventional immunosuppression, but the typical agents suppress the immune system in a non-specific fashion. Thalidomide has been shown to have activity specific to the inflammatory mediators of sarcoidosis, has been shown to be beneficial in cutaneous sarcoidosis, and provides an interesting observation in our patient with refractory neurosarcoidosis. Case presentation A 40 year old African-american female presented with refractory neurosarcoidosis. Over the course of several years, the patient was treated with high dose steroids, imuran, cytoxan, and cyclosporine without benefit. Then, the patient received thalidomide, slowly escalating to 650 mg. After 2 months radiologic improvement was noted and after 6 months clinical stabilization and improvement became apparent. Conclusion Our case report presents a difficult, refractory case of neurosarcoidosis that demonstrates an altered prognosis based on the addition of thalidomide.

  18. Interaction mechanism between refractory and melts in iron bath smelting reduction process

    Directory of Open Access Journals (Sweden)

    Qiu G.B.

    2010-01-01

    Full Text Available The corrosion behavior of three sorts of refractories based on alumina-graphite were studied by immersion tests. The melts included smelting reduction molten slag and corresponding carbon saturated molten iron. The influence of test temperature, FeO content in slag and specimen rotative velocity on the corrosion rate of refractories was examined. By means of SEM and EDS, the microstructure change of the refractories after immersion test in kinds of melts was studied. The morphology of the deteriorated layer showed the corrosion extent of refractories. With the addition of zirconia and titania into the refractories, the corrosion rate changed to some extent. The corrosion rate of three sorts of refractories increased dramatically with the increasing FeO content in smelting reduction slag. Compared with alumina-graphite refractory and alumina-graphite-zirconia refractory, alumina-graphite-titania refractory had stronger corrosion resistance in the smelting reduction conditions. By the results of SEM and EDS, the corrosion mechanism of refractories was developed.

  19. The outcome of therapies in refractory and super-refractory convulsive status epilepticus and recommendations for therapy.

    Science.gov (United States)

    Ferlisi, Monica; Shorvon, Simon

    2012-08-01

    In a previous paper, we reviewed the range of therapies available for the treatment of super-refractory status epilepticus. Here we report a review of the outcome of therapies in refractory and super-refractory status epilepticus. Patients (n = 1168) are reported who had therapy with: thiopental, pentobarbital, midazolam, propofol, ketamine, inhalational anaesthetics (isoflurane, desflurane), antiepileptic drugs (topiramate, lacosamide, pregabalin, levetiracetam), hypothermia, magnesium, pyridoxine, immunotherapy, ketogenic diet, emergency neurosurgery, electroconvulsive therapy, cerebrospinal fluid drainage, vagal nerve stimulation and deep brain stimulation. The outcome parameters reported include control of status epilepticus, relapse on withdrawal, breakthrough seizures and mortality. Where reported (596 cases), the long-term outcome was found to be death (35%), severe neurological deficit (13%), mild neurological deficit (13%), undefined deficit (4%) and recovery to baseline (35%). The quality of reported outcome data is generally poor and the number of cases reported for all non-anaesthetic therapies is low. Outcome assessment is complicated by changes in co-medication, delay in response and publication bias. Given these deficits, only broad recommendations can be made regarding optimal therapy. An approach to therapy, divided into first-line, second-line and third-line therapy, is suggested on the basis of this outcome evaluation. The importance of treatments directed at the cause of the status epilepticus, and of supportive ITU care is also emphasized.

  20. Optimization of protocols for derivation of mouse embryonic stem cell lines from refractory strains, including the non obese diabetic mouse.

    Science.gov (United States)

    Davies, Timothy J; Fairchild, Paul J

    2012-07-01

    The derivation of pluripotent embryonic stem cells (ESCs) from a variety of genetic backgrounds remains a desirable objective in the generation of mice functionally deficient in genes of interest and the modeling of human disease. Nevertheless, disparity in the ease with which different strains of mice yield ESC lines has long been acknowledged. Indeed, the generation of bona fide ESCs from the non obese diabetic (NOD) mouse, a well-characterized model of human type I diabetes, has historically proved especially difficult to achieve. Here, we report the development of protocols for the derivation of novel ESC lines from C57Bl/6 mice based on the combined use of high concentrations of leukemia inhibitory factor and serum-replacement, which is equally applicable to fresh and cryo-preserved embryos. Further, we demonstrate the success of this approach using Balb/K and CBA/Ca mice, widely considered to be refractory strains. CBA/Ca ESCs contributed to the somatic germ layers of chimeras and displayed a very high competence at germline transmission. Importantly, we were able to use the same protocol for the derivation of ESC lines from nonpermissive NOD mice. These ESCs displayed a normal karyotype that was robustly stable during long-term culture, were capable of forming teratomas in vivo and germline competent chimeras after injection into recipient blastocysts. Further, these novel ESC lines efficiently formed embryoid bodies in vitro and could be directed in their differentiation along the dendritic cell lineage, thus illustrating their potential application to the generation of cell types of relevance to the pathogenesis of type I diabetes.

  1. FGF21 promotes metabolic homeostasis via white adipose and leptin in mice.

    Science.gov (United States)

    Véniant, Murielle M; Hale, Clarence; Helmering, Joan; Chen, Michelle M; Stanislaus, Shanaka; Busby, Jim; Vonderfecht, Steven; Xu, Jing; Lloyd, David J

    2012-01-01

    Fibroblast growth factor 21 (FGF21) is a potent metabolic regulator, and pharmacological administration elicits glucose and lipid lowering responses in mammals. To delineate if adipose tissue is the predominant organ responsible for anti-diabetic effects of FGF21, we treated mice with reduced body fat (lipodystrophy mice with adipose specific expression of active sterol regulatory element binding protein 1c; Tg) with recombinant murine FGF21 (rmuFGF21). Unlike wildtype (WT) mice, Tg mice were refractory to the beneficial effects of rmuFGF21 on body weight, adipose mass, plasma insulin and glucose tolerance. To determine if adipose mass was critical for these effects, we transplanted WT white adipose tissue (WAT) into Tg mice and treated the mice with rmuFGF21. After transplantation, FGF21 responsiveness was completely restored in WAT transplanted Tg mice compared to sham Tg mice. Further, leptin treatment alone was sufficient to restore the anti-diabetic effects of rmuFGF21 in Tg mice. Molecular analyses of Tg mice revealed normal adipose expression of Fgfr1, Klb and an 8-fold over-expression of Fgf21. Impaired FGF21-induced signaling indicated that residual adipose tissue of Tg mice was resistant to FGF21, whilst normal FGF21 signaling was observed in Tg livers. Together these data suggest that adipose tissue is required for the triglyceride and glucose, but not the cholesterol lowering efficacy of FGF21, and that leptin and FGF21 exert additive anti-diabetic effects in Tg mice.

  2. Reaction-Forming Method for Producing Near Net-Shape Refractory Metal Carbides

    Energy Technology Data Exchange (ETDEWEB)

    Palmisiano, Marc N.; Jakubenas, Kevin J.; Baranwal, Rita

    2004-07-20

    A method for reaction forming refractory metal carbides. The method involves the fabrication of a glassy carbon preform by casting an organic, resin-based liquid mixture into a mold and subsequently heat treating it in two steps, which cures and pyrolizes the resin resulting in a porous carbon preform. By varying the amounts of the constituents in the organic, resin-based liquid mixture, control over the density of the carbon preform is obtained. Control of the density and microstructure of the carbon preform allows for determination of the microstructure and properties of the refractory metal carbide material produced. The glassy carbon preform is placed on a bed of refractory metal or refractory metal--silicon alloy. The pieces are heated above the melting point of the metal or alloy. The molten metal wicks inside the porous carbon preform and reacts, forming the refractory metal carbide or refractory metal carbide plus a minor secondary phase.

  3. Reuse of ultrafine mineral wool production waste in the manufacture of refractory concrete.

    Science.gov (United States)

    Stonys, R; Kuznetsov, D; Krasnikovs, A; Škamat, J; Baltakys, K; Antonovič, V; Černašėjus, O

    2016-07-01

    The paper deals with the mineral wool production waste (cupola dust - CD), presents CD characterization and aims to reuse CD in production of refractory concrete with calcium aluminate cement. The study of CD covers its chemical, phase and thermal analyses along with the morphological study and determination of particles size distribution. Zeta-potential, electrical conductivity and pH values of CD suspension are presented in the paper as well. Commercial microsilica additive in refractory concrete has been replaced with cupola dust. Compositions of refractory concrete have been prepared by incorporating 1%, 2% and 3% of CD. The bulk density, ultrasonic wave velocity, cold crushing strength and thermal shock resistance of the created refractory concrete have been determined. Based on experimental results, it has been found that cupola dust may be used for the production of refractory concrete. The environmental impact related to the CD reuse in refractory concrete production has been evaluated as well.

  4. Laboratory Treated T Cells in Treating Patients With Relapsed or Refractory Chronic Lymphocytic Leukemia, Non-Hodgkin Lymphoma, or Acute Lymphoblastic Leukemia

    Science.gov (United States)

    2017-07-06

    CD19-Positive Neoplastic Cells Present; Recurrent Adult Acute Lymphoblastic Leukemia; Recurrent Chronic Lymphocytic Leukemia; Recurrent Diffuse Large B-Cell Lymphoma; Recurrent Mantle Cell Lymphoma; Recurrent Non-Hodgkin Lymphoma; Recurrent Small Lymphocytic Lymphoma; Refractory Chronic Lymphocytic Leukemia; Refractory Diffuse Large B-Cell Lymphoma; Refractory Mantle Cell Lymphoma; Refractory Non-Hodgkin Lymphoma; Refractory Small Lymphocytic Lymphoma

  5. The efficacy and safety of methotrexate in refractory Crohn’s disease

    Institute of Scientific and Technical Information of China (English)

    徐萍萍

    2014-01-01

    Objective To assess the efficacy and safety of methotrexate(MTX)on refractory Crohn’s disease(CD).Methods A total of 35 consecutive refractory CD patients in the First Affiliated Hospital of Sun Yat-Sen University treated with MTX were retrospectively analyzed.Clinical data from June 2004 to December 2012 were collected from the database of inflammatory bowel disease(IBD)center.Clinical responses and drug side effects were recorded and analyzed.Results Thirty-five refractory CD

  6. Successful Treatment of Refractory Hypoxemia Secondary to Disseminated Histoplasmosis Using Extracorporeal Membrane Oxygenation Support.

    Science.gov (United States)

    Wanta, Brendan T; Tyner, Harmony L; Bohman, John K; Baddour, Larry M

    2016-10-15

    Refractory hypoxemia secondary to acute respiratory distress syndrome (ARDS) is associated with high mortality. Extracorporeal membraneoxygenation (ECMO) is an accepted strategy for treating refractory hypoxemia in patients with ARDS but is relatively contraindicated in the setting of systemic infections. We present a case of successful ECMO use in a host with refractory hypoxemia secondary to disseminated histoplasmosis with fungemia and discuss our management approach to this difficult patient.

  7. Reaction of chromalumozirconium refractory with alkali-free borosilicate glass melt

    Energy Technology Data Exchange (ETDEWEB)

    Popov, O.N.; Frolova, V.P.

    1985-03-01

    The corrosion mechanism of chromalumozirconium refractory synthesized on the base of the Cr/sub 2/O/sub 3/-Al/sub 2/O/sub 3/-ZrO/sub 2/-SiO/sub 2/ system by the alkali-free borosilicate ''E'' glass melt is investigated. It is estalished that in the process of refractory destruction the diffusion zonality is formed in it being a reflection of comparative migration activity of refractory components.

  8. Factors predicting mortality after tips for refractory ascites: a single center experience

    OpenAIRE

    2010-01-01

    Introduction: Transjugular intrahepatic porto-systemic shunt (TIPS) is an accepted indication for treating refractory ascites. Different models have been proposed for the prediction of survival after TIPS; aim of present study was to evaluate the factors associated with mortality after TIPS for refractory ascites. Methods: Seventy-three consecutive patients undergoing a TIPS for refractory ascites in our centre between 2003 and 2008, were prospectively recorded in a database ad were the s...

  9. Effective treatment of refractory pulmonary hemorrhage with monoclonal anti-CD20 antibody (rituximab).

    Science.gov (United States)

    Pinto, Luis Fernando; Candia, Liliana; Garcia, Patricia; Marín, Juan Ignacio; Pachón, Ines; Espinoza, Luis R; Marquez, Javier

    2009-01-01

    We report a 19-year-old female with systemic lupus erythematosus and lupus nephritis who developed pulmonary hemorrhage (PH) refractory to conventional immunosuppressive treatment. She was initially treated with intravenous methylprednisolone and cyclophosphamide pulses. She required mechanical ventilation due to a lack of responsiveness and her disease was considered refractory to conventional treatment. Rituximab was administered and this was followed by clinical improvement in both PH and nephritis. Rituximab may be a useful therapeutic option for the treatment of refractory PH.

  10. NOVEL REFRACTORY MATERIALS FOR HIGH ALKALI, HIGH TEMPERATURE ENVIRONMENTS

    Energy Technology Data Exchange (ETDEWEB)

    Hemrick, James Gordon [ORNL; Smith, Jeffrey D [ORNL; O' Hara, Kelley [University of Missouri, Rolla; Rodrigues-Schroer, Angela [Minteq International, Inc.; Colavito, [Minteq International, Inc.

    2012-08-01

    A project was led by Oak Ridge National Laboratory (ORNL) in collaboration with a research team comprised of the academic institution Missouri University of Science and Technology (MS&T), and the industrial company MINTEQ International, Inc. (MINTEQ), along with representatives from the aluminum, chemical, glass, and forest products industries. The project was to address the need for new innovative refractory compositions by developing a family of novel MgO-Al 2O3, MgAl2O4, or other similar spinel structured or alumina-based unshaped refractory compositions (castables, gunnables, shotcretes, etc.) utilizing new aggregate materials, bond systems, protective coatings, and phase formation techniques (in-situ phase formation, altered conversion temperatures, accelerated reactions, etc). This family of refractory compositions would then be tailored for use in high-temperature, high-alkaline industrial environments like those found in the aluminum, chemical, forest products, glass, and steel industries. Both practical refractory development experience and computer modeling techniques were used to aid in the design of this new family of materials. The newly developed materials were expected to offer alternative material choices for high-temperature, high-alkali environments that were capable of operating at higher temperatures (goal of increasing operating temperature by 100-200oC depending on process) or for longer periods of time (goal of twice the life span of current materials or next process determined service increment). This would lead to less process down time, greater energy efficiency for associated manufacturing processes (more heat kept in process), and materials that could be installed/repaired in a more efficient manner. The overall project goal was a 5% improvement in energy efficiency (brought about through a 20% improvement in thermal efficiency) resulting in a savings of 3.7 TBtu/yr (7.2 billion ft3 natural gas) by the year 2030. Additionally, new

  11. Characteristics and Application of Andalusite Material and Andalusite-Based Refractory

    Institute of Scientific and Technical Information of China (English)

    DONG Hongqin; SHEN Jianping; WANG Li; JIANG Mingxue

    2005-01-01

    Andalusite material and Andalusite-based refractory are very popular in Europe and Japan, but its applications are restrained because of its low quality and misunderstanding in China. The paper introduced in detail the characteristics of andalusite material and andalusite-based refractory based on the authors' research work in recent years and on some references. Some information is illustrated clearly by figures and microstructure photographs. It is concluded the property of raw material and refractory is not determined by alumina content but by type and quantity of the impurities and microstructure. Mullitisation provide andalusite-based refractories more excellent macro and micro properties that guarantee its popular application.

  12. Silica Refractory Bricks for Glass Melting Furnace YB/T 147-1998

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    @@ 1 Scope This standard specifies the classification, technical requirements, test method, inspection rules, marking, packing, transportation, storage and quality certification of silica refractory bricks for glass melting furnaces.

  13. Bauxite Based Refractory Bricks for Hot Blast Stove YB/T 5016-2000

    Institute of Scientific and Technical Information of China (English)

    Wang Jing; Chai Junlan

    2008-01-01

    @@ 1Scope This standard specifies the technical requirements, test method, inspection rules, packing, marking, transportation, storage and quality certificate of bauxite based refractory bricks for hot blast stove.

  14. Study of Wetting Feature on Refractories for Smelting Reuction Melts With Iron Bath

    Institute of Scientific and Technical Information of China (English)

    LIUQingcai

    1997-01-01

    The wetting feature of smelting reduction melts on the different kinds of refractories is studied in this paper.The results indicate that the activity or concentration of FeO in slag and content of carbon existing in refractory are the important factors affecting on the wetting character,The higher the activity of FeO,the stronger the wetting capacity of slag on refrac-tories ,On the other hand,the higher the crbon content in refrctories,the lower the wetting capacity of melts ,wetting feature of smelting reduction melts is th key factor that affects the corrrosion capacity of melts of smelting reduction on refractory.

  15. Development Tendency of the Refractories for Iron & Steel Industry in China

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    This paper introduces the developing tendency of refractories for iron and steel industry combined with the new metallurgical techniques applied in iron and steel industry in China. Refractories for blast furnace long service life, smelting reduction iron-making process, secondary refining metallurgies and clean steel making, near net shape continuous casting are described respectively. To meet the requirement of iron and steel industry, the high quality, multi-functions and environment-friendly refractories with long service life will be focused and developed in the future. In addition, high grade refractories in China have great developing space and potential market.

  16. Super-Refractory Status Epilepticus: Report of a Case and Review of the Literature.

    Science.gov (United States)

    Lapenta, Leonardo; Frisullo, Giovanni; Vollono, Catello; Brunetti, Valerio; Giannantoni, Nadia Mariagrazia; Sandroni, Claudio; Di Lella, Giuseppe; Della Marca, Giacomo

    2015-10-01

    Super-refractory status epilepticus (SE; ie, SE continuing or recurring despite 24 hours of general anesthesia) is a severe condition with high percentage of mortality and morbidity. Usually, this condition occurs because of serious brain damage; nevertheless, some patients develop super-refractory SE without identifiable etiology. Although not uncommonly encountered in neurointensive care, scientific data on this condition are still lacking in terms of treatment and prognosis. Herein, we report a case of super-refractory SE with recovery after 50 days, despite electroencephalographic (EEG) and magnetic resonance imaging (MRI) signs traditionally related to poor prognosis. A review of the literature on super-refractory SE is also presented.

  17. Entinostat in Treating Pediatric Patients With Recurrent or Refractory Solid Tumors

    Science.gov (United States)

    2017-03-16

    Childhood Brain Stem Neoplasm; Childhood Lymphoma; Childhood Solid Neoplasm; Pineal Region Neoplasm; Recurrent Childhood Central Nervous System Neoplasm; Recurrent Childhood Visual Pathway Glioma; Refractory Central Nervous System Neoplasm

  18. Handbook of refractory carbides and nitrides properties, characteristics, processing and applications

    CERN Document Server

    Pierson, Hugh O

    1996-01-01

    Refractory carbides and nitrides are useful materials with numerous industrial applications and a promising future, in addition to being materials of great interest to the scientific community. Although most of their applications are recent, the refractory carbides and nitrides have been known for over one hundred years. The industrial importance of the refractory carbides and nitrides is growing rapidly, not only in the traditional and well-established applications based on the strength and refractory nature of these materials such as cutting tools and abrasives, but also in new and promising fields such as electronics and optoelectronics.

  19. Compressive Creep Performance and High Temperature Dimensional Stability of Conventional Silica Refractories

    Energy Technology Data Exchange (ETDEWEB)

    Karakus, M.; Kirkland, T.P.; Liu, K.C.; Moore, R.E.; Pint, B.A.; Wereszczak, A.A.

    1999-03-01

    Furnace designers and refractory engineers recognize that optimized furnace superstructure design and refractory selection are needed as glass production furnaces are continually striving toward greater output and efficiencies. Harsher operating conditions test refractories to the limit, while changing production technology (such as the conversion to oxy-fuel from traditional air-fuel firing) can alter the way the materials perform. Refractories for both oxy- and air-fuel fired furnace superstructures are subjected to high temperatures during service that may cause them to excessively creep or subside if the refractory material is not creep resistant, or if it is subjected to high stress, or both. Furnace designers can ensure that superstructure structural integrity is maintained if the creep behavior of the refractory material is well understood and well represented by appropriate engineering creep models. Several issues limit the abilities of furnace designers to (1) choose the optimum refractory for their applications, (2) optimize the engineering design, or (3) predict the service mechanical integrity of their furnace superstructures. Published engineering creep data are essentially non-existent for almost all commercially available refractories used for glass furnace superstructures. The limited data that do exist are supplied by the various refractory suppliers. Unfortunately, these suppliers generally have different ways of conducting their mechanical testing and they also interpret and report their data differently; this makes it hard for furnace designers to draw fair comparisons between competing grades of candidate refractories. Furthermore, the refractory supplier's data are often not available in a form that can be readily used for furnace design and for the prediction and design of long-term structural integrity of furnace superstructures. With the aim of providing such comparable data, the US DOE's Office of Industrial Technology and its

  20. Defining refractory migraine and refractory chronic migraine: proposed criteria from the Refractory Headache Special Interest Section of the American Headache Society.

    Science.gov (United States)

    Schulman, Elliott A; Lake, Alvin E; Goadsby, Peter J; Peterlin, B Lee; Siegel, Sherry E; Markley, Herbert G; Lipton, Richard B

    2008-06-01

    Certain migraines are labeled as refractory, but the entity lacks a well-accepted operational definition. This article summarizes the results of a survey sent to American Headache Society members to evaluate interest in a definition for RM and what were considered necessary criteria. Review of the literature, collaborative discussions and results of the survey contributed to the proposed definition for RM. We also comment on our considerations in formulating the criteria and any issues in making the criteria operational. For the proposed definition for RM and refractory chronic migraine, patients must meet the International Classification of Headache Disorders, Second Edition criteria for migraine or chronic migraine, respectively. Headaches need to cause significant interference with function or quality of life despite modification of triggers, lifestyle factors, and adequate trials of acute and preventive medicines with established efficacy. The definition requires that patients fail adequate trials of preventive medicines, alone or in combination, from at least 2 of 4 drug classes including: beta-blockers, anticonvulsants, tricyclics, and calcium channel blockers. Patients must also fail adequate trials of abortive medicines, including both a triptan and dihydroergotamine (DHE) intranasal or injectable formulation and either nonsteroidal anti-inflammatory drugs (NSAIDs) or combination analgesic, unless contraindicated. An adequate trial is defined as a period of time during which an appropriate dose of medication is administered, typically at least 2 months at optimal or maximum-tolerated dose, unless terminated early due to adverse effects. The definition also employs modifiers for the presence or absence of medication overuse, and with or without significant disability.

  1. Extremely refractory Kawasaki disease with disseminated intravascular coagulation.

    Science.gov (United States)

    Koh, Young Kwon; Lee, Jae Hee; Park, Yeong Bong

    2017-07-01

    Disseminated intravascular coagulation is a rare complication of Kawasaki disease and appears in Kawasaki disease patients. We report a case of refractory Kawasaki disease complicated with disseminated intravascular coagulation and giant coronary aneurysm. A 5-month-old boy presented with Kawasaki disease with coagulopathy. Although the coagulopathy improved after fresh-frozen plasma and antithrombin-III administration, the fever persisted despite two rounds of intravenous immunoglobulin, along with intravenous methylprednisolone pulse therapy and infliximab administration. Despite all efforts to treatment, the patient had giant coronary aneurysms and died suddenly.

  2. Glatiramer Acetate-associated Refractory Immune Thrombocytopenic Purpura

    Directory of Open Access Journals (Sweden)

    Iftach Sagy

    2016-04-01

    Full Text Available We present a case of glatiramer acetate-associated refractory immune thrombocytopenic purpura (ITP in a female patient with multiple sclerosis. A search of MEDLINE/PubMed did not find any connection between glatiramer acetate and thrombocytopenia, specifically ITP. The autoimmune reaction was resistant to conservative ITP treatment, and was eventually managed only by splenectomy. To the best of our knowledge, this is the first report of glatiramer acetate-associated ITP. Physicians should be aware of this condition, and consider performing routine blood counts at the beginning of glatiramer acetate treatment.

  3. Development of a Refractory High Entropy Superalloy (Postprint)

    Science.gov (United States)

    2016-03-17

    primary phase . RHEAs with a low density and high strength are among the most promising recent achievements in this field [19–23]. In particular, the...after annealing at 1400 °C for 24 h. Second- phase precipitates (which are dark) are present at grain boundaries. (a) (b) Figure 4. High magnification...Microstructure, phase composition and mechanical properties of a refractory high entropy super alloy, AlMo0.5NbTa0.5TiZr, are reported in this work. The

  4. Pomalidomide in heavily pretreated refractory multiple myeloma: a case report.

    Science.gov (United States)

    Palmas, Angelo; Piras, Giovanna; Uras, Antonella; Asproni, Rosanna; Murineddu, Marco; Monne, Maria; Stradoni, Roberta; Latte, Giancarlo

    2017-02-01

    We present the case of a 70-year-old man diagnosed with multiple myeloma in 2008, who after four therapy lines initiated a fifth-line treatment with pomalidomide (4 mg orally, days 1-21 of a 28-day cycle) and low-dose dexamethasone (40 mg weekly orally). The patient was treated with pomalidomide for almost 2 years achieving a complete remission after 12 cycles. Complete remission was maintained for 9 months. This case illustrates the potential of pomalidomide plus low-dose dexamethasone to overcome multiple myeloma refractoriness inducing a quick and very prolonged remission.

  5. First Ti-XANES analyses of refractory inclusions from Murchison

    Energy Technology Data Exchange (ETDEWEB)

    Simon, S.B.; Sutton, S.R.; Grossman, L. (UC)

    2009-03-23

    Ti valence in refractory phases is an important recorder of redox conditions in the early solar nebula. We report the valence of Ti in pyroxene, spinel and hibonite in spinel-hibonite and spinel-pyroxene inclusions and in a coarse hibonite grain. A system of solar composition is so reducing that Ti{sup 3+} and Ti{sup 4+} can coexist, making the valence of Ti a valuable indicator of f{sub O2} conditions during formation of nebular materials. The Ti{sup 3+}/Ti{sup 4+} ratios observed in the Ti-rich phases fassaite and rhoenite in coarse-grained refractory inclusions from CV3 chondrites have been shown to be quantitatively consistent with formation in a gas of solar composition (log f{sub O2} = IW-6.8), but these are the only objects in chondrites for which this is the case. Here, we report the valence of Ti in various phases in refractory inclusions from the Murchison CM2 chondrite. The second-highest temperature, major-element-bearing phase predicted to condense from a gas of solar composition, hibonite (ideally CaAl{sub 12}O{sub 19}), can contain significant amounts of Ti, but the hibonite structure can have oxygen vacancies, so calculation of Ti valence from stoichiometry of electron probe analyses is not recommended for hibonite. To date, the only reported measurement of Ti valence in meteoritic hibonite was done by electron spin resonance, on coarse crystals from a Murchison hibonite-perovskite-melilite inclusion. Spinel and most of the pyroxene in CM inclusions contain too little Ti for derivation of Ti{sup 3+}/Ti{sup 4+} ratios from electron probe analyses. X-ray absorption near edge spectroscopy (XANES), however, allows determination of Ti valence in relatively Ti-poor phases. In the present work, we apply synchrotron microXANES to a large hibonite grain from Murchison and to spinel-hibonite (sp-hib) and spinel-pyroxene (sp-pyx) inclusions from Murchison, refractory materials whose Ti{sup 3+}/Ti{sup 4+} ratios have not been previously measured. Analysis of

  6. Treatment of refractory ulcerative necrobiosis lipoidica diabeticorum with oral thalidomide

    Directory of Open Access Journals (Sweden)

    Swapnil D Shah

    2016-01-01

    Full Text Available Ulcerative necrobiosis lipoidica (NL in diabetic patients is a rare, painful condition. It is a difficult-to-treat condition, impairing quality of life of patients. Although various drugs have been tried, none of them is consistently effective. Biologics in the form of TNF-alpha inhibitors show promising results in the treatment. But because of their high cost we chose thalidomide, which also has TNF-alpha inhibiting properties to successfully treat a long-standing case of ulcerative NL, which was refractory to various treatment modalities.

  7. Treatment of refractory ulcerative necrobiosis lipoidica diabeticorum with oral thalidomide

    Science.gov (United States)

    Shah, Swapnil D.; Kale, Girish V.

    2016-01-01

    Ulcerative necrobiosis lipoidica (NL) in diabetic patients is a rare, painful condition. It is a difficult-to-treat condition, impairing quality of life of patients. Although various drugs have been tried, none of them is consistently effective. Biologics in the form of TNF-alpha inhibitors show promising results in the treatment. But because of their high cost we chose thalidomide, which also has TNF-alpha inhibiting properties to successfully treat a long-standing case of ulcerative NL, which was refractory to various treatment modalities. PMID:26951036

  8. Novel Engineered Refractory Materials for Advanced Reactor Applications

    Energy Technology Data Exchange (ETDEWEB)

    Shannon, Steven [North Carolina State Univ., Raleigh, NC (United States); Eapen, Jacob [North Carolina State Univ., Raleigh, NC (United States); Maria, Jon-Paul [North Carolina State Univ., Raleigh, NC (United States); Weber, William [Univ. of Tennessee, Knoxville, TN (United States)

    2016-03-14

    This report summarizes the results of DOE-NEUP grant 10-853. The project spanned 48 months (36 months under the original grant plus a 12 month no cost extension). The overarching goal of this work was to fabricate and characterize refractory materials engineered at the atomic scale with emphasis on their tolerance to accumulated radiation damage. With an emphasis on nano-scale structure, this work included atomic scale simulation to study the underlying mechanisms for modified radiation tolerance at these atomic scales.

  9. Refractory ceramic fibers (RCFs) induce germline aneuploidy in Drosophila oocytes.

    Science.gov (United States)

    Osgood, C J

    1994-06-01

    Mineral fibers are ubiquitous in the natural environment and are widely used in industry in such applications as insulators. We have previously shown that asbestos fibers induce aneuploidy in oocytes of Drosophila melanogaster; here we extend those studies by testing refractory ceramic fibers (RCFs) for their mutagenicity to germ cells. The results establish that the tested RCFs are inducers of aneuploidy following feeding of adult females. A subset of the RCFs were also effective following larval feeding. Our results suggest that RCFs, like certain asbestos fibers, may pose a hazard to germ cells.

  10. Retention modeling of refractory ceramic fibers (RCF) in humans.

    Science.gov (United States)

    Yu, C P; Ding, Y J; Zhang, L; Oberdörster, G; Mast, R W; Maxim, L D; Utell, M J

    1997-02-01

    A mathematical retention model has been developed to predict the lung burden and size distribution of kaolin refractory ceramic fibers (RCF) in the pulmonary region of the human lung during exposure. Fiber dissolution, breakage, and differential clearance are considered in this model; rates for these processes are obtained by extrapolation from available data on laboratory rats. The lung burden predicted by this model is in general agreement with fiber counts from three factory workers. An important prediction from this study is that clearance of RCF is not significantly impaired at a fiber concentration beneath 10 f/cm3 during occupational exposure.

  11. Development of wire drawing processes for refractory metal fibers

    Science.gov (United States)

    King, G. W.

    1972-01-01

    Fabrication schedules were developed for producing wire, 0.25 mm to 0.51 mm diameter, from the refractory metal alloys ASTAR-811C, B-88 and W-Hf-C. Tensile properties were evaluated at room temperature and up to 1204 C. Also, the stress rupture properties of the alloys at 1093 C were determined. W-Hf-C and B-88 were found to have the best mechanical properties on a strength to density basis. The fabrication schedules for producing wire from these two alloys were further improved with regards to the wire quality and material yield under the optimization of fabrication schedule.

  12. Resolution of chronic severe refractory thrombocytopenia after treatment of hypothyroidism

    Science.gov (United States)

    Bowles, K M; Turner, G E; Wimperis, J Z

    2004-01-01

    The case of a 52 year old woman with chronic severe refractory thrombocytopenia is presented. Over a three year period, her platelet count was persistently less than 20 × 109/litre (normal range, 150–400). She required repeated hospital admission for management of bleeding and received multiple blood transfusions. She was given repeated courses of steroids, immunosuppression, immunoglobulin, and splenectomy, without success, in an attempt to stop the chronic blood loss. Eventually, she was found to be profoundly hypothyroid. On correction of her thyroid deficiency the platelet count returned to the normal range and all bleeding stopped. The platelet count remains in the normal range three years later. PMID:15333667

  13. Volatile anesthetic for the control of posthypoxic refractory myoclonic status

    Directory of Open Access Journals (Sweden)

    Vivek Rayadurg

    2016-01-01

    Full Text Available Posthypoxic myoclonus (Lance-Adams syndrome is characterized by myoclonus involving multiple muscle groups which is resistant to most conventional antiepileptic drugs. We present a case of hypoxic brain injury-induced myoclonic status epilepticus successfully controlled with isoflurane. The antimyoclonic effects of isoflurane are likely due to potentiation of inhibitory postsynaptic GABA A receptor-mediated currents and its effects on thalamocortical pathways. It is effective even when intravenous agents fail to control myoclonus. It may be a useful alternative to intravenous anesthetics as a third tier therapy in patients with refractory status myoclonus.

  14. Combined arteriovenous thrombolytic infusion for refractory renal vein thrombosis.

    Science.gov (United States)

    Heafner, Thomas A; Scott, Daniel; Watson, J Devin; Propper, Brandon; Johnson, Chatt; Arthurs, Zachary M

    2014-08-01

    Acute renal vein thrombosis can rapidly lead to significant impairment and eventual loss of renal function. Classically presenting with flank pain, hematuria, and laboratory markers consistent with acute kidney injury, therapeutic anticoagulation is the mainstay of treatment. However, endovascular surgery offers a safe and effective alternative for renal salvage in the setting of acute renal vein thrombosis. Described is the use of combined arteriovenous thrombolytic infusion for refractory renal vein thromboses to quickly and effectively decrease clot burden in the micro- and macrovenous circulations while limiting systemic exposure.

  15. Use of lenalidomide in treating refractory prurigo nodularis.

    Science.gov (United States)

    Liu, Hannah; Gaspari, Anthony A; Schleichert, Rachel

    2013-03-01

    Prurigo nodularis is a chronic, relapsing neurodermatitis that is often resistant to standard therapies with topical corticosteroids and oral antihistamines. Thalidomide, while efficacious in treating recalcitrant cases of prurigo nodularis, causes significant toxicity. Thalidomide-induced peripheral neuropathy frequently results in drug discontinuation. Lenalidomide (Revlimid; Celgene Corporation, Summit, NJ) is a derivative of thalidomide with less neurotoxicity approved for the treatment of multiple myeloma and myelodysplastic syndromes that has not been widely studied in dermatologic disorders. Here, we report a case of refractory prurigo nodularis effectively treated with lenalidomide. Given its favorable side-effect profile, lenalidomide may offer a superior alternative to thalidomide in the treatment of this condition.

  16. [Refractory ceramic fibers, kinds, health effects after exposure, TLVs].

    Science.gov (United States)

    Woźniak, H; Wiecek, E

    1996-01-01

    Ceramic fibres are amorphous or crystalline synthetic mineral fibres which are characterised by refractory properties (i.c. stability in temperature above 1000 degrees C). In general, ceramic fibres are produced from aluminium oxide, silicon oxide and other metal oxides and less frequently from non-oxide materials such as silicon carbide, silicon nitride and boron nitride. In Poland, the production of ceramic fibres was begun in the Refractory Materials Plant, Skawina, during mid-eighties. The production capacity accounts for about 600 tons annually. It is estimated that approximately 3000 persons are exposed to the effect of ceramic fibres in Poland. During the production of ceramic fibres, concentrations of respiral fibres in the air at work places range from 0.07 to 0.27 f/cm3; during the manufacture of ceramic fibre products from 0.23 to 0.71 f/cm3 and during the application of ceramic fibre products from 0.07 to 1.67 f/cm3. As published data depict, fibres longer than 5 microns are most common in the work environment, and the proportion of fibres with diameters below 1 micron accounts for 40-50%. Bearing in mind the present situation in Poland, namely combined exposure to asbestos (during removal of worn out heat-insulating materials) and ceramic fibres (during installation of new insulation), as well as in view of own investigations and literature data which evidence a strong carcinogenic effect of certain fibres, the following MAC values have been adopted: Dusts of refractory ceramic fibres: total dust-2 mg/m3; respirable fibres-1 f/cm3 (L > 5 microns; D fibres mixed with asbestos: total dust-1 mg/m3; respirable fibres-1 f/m3. Dusts of refractory ceramic fibres mixed with other man-made mineral fibres (MMMF): total dust-2 mg/m3; respirable fibres-1 f/m3. According to the IARC, ceramic fibres have been included into group 2B-suspected human carcinogen.

  17. Trace Element Abundances in Refractory Inclusions from Antarctic Micrometeorites

    Science.gov (United States)

    Greshake, A.; Hoppe, P.; Bischoff, A.

    1995-09-01

    Refractory inclusions are charcteristic components in carbonaceous chondrites. Therefore, refractory inclusions found in micrometeorites can give important hints about the relationship between micrometeorites and carbonaceous chondrites. So far, only a few inclusions were found in micrometeorites [1-4]. In this study we report the first trace element analysis of perovskite and fassaite found in micrometeorites. We studied two Antarctic micrometeorites by ASEM, EMP, and SIMS. The first particle is 120 micrometers in size mainly consisting of a fine-grained matrix of dehydrated former phyllosilikates that enclose a 5 micrometers sized perovskite [5]. The perovskite is surrounded by a 1 micrometers thick rim of ilmenite and contains up to 1.3 wt% FeO as determined by EMP. The trace element abundances were determined by SIMS following the procedure described by [6]. The REE pattern of the perovskite is shown in Fig. 1. The pattern is closely related to the Group II pattern with its typical depletion of the more refractory REEs [7]. It is also very similar to the REE abundances of perovskite from Murchison (CM) [8] and CH-chondrites [9]. This may indicate a relationship between this micrometeorite and components in carbonaceous chondrites. The second micrometeorite is 100 micrometers in size consisting of a fine-grained (20 micrometers across) and a coarse-grained (80 micrometers across) area. Both areas contain fassaite with different chemical compositions. The particle was previously analyzed by Lindstrom and Kloeck [1] without knowing the mineralogy. We carried out SIMS analysis of each area of the micrometeorite separately. The TEE patterns of these two areas are similar and show in general a Group III pattern (20-30x CI) in which the more refractory REEs are not fractionated. The negative Eu anomaly is much more apparent in the coarse-grained area and no Yb anomaly is apparent in one of the areas. This is the first CAI of a micrometeorite showing a Group III REE

  18. Dexamethasone partially rescues ataxia telangiectasia-mutated (ATM) deficiency in ataxia telangiectasia by promoting a shortened protein variant retaining kinase activity.

    Science.gov (United States)

    Menotta, Michele; Biagiotti, Sara; Bianchi, Marzia; Chessa, Luciana; Magnani, Mauro

    2012-11-30

    Ataxia telangiectasia (AT) is a rare genetic disease, still incurable, resulting from biallelic mutations in the ataxia telangiectasia-mutated (ATM) gene. Recently, short term treatment with glucocorticoid analogues improved neurological symptoms characteristic of this syndrome. Nevertheless, the molecular mechanism involved in glucocorticoid action in AT patients is not yet known. Here we describe, for the first time in mammalian cells, a short direct repeat-mediated noncanonical splicing event induced by dexamethasone, which leads to the skipping of mutations upstream of nucleotide residue 8450 of ATM coding sequence. The resulting transcript provides an alternative ORF translated in a new ATM variant with the complete kinase domain. This miniATM variant was also highlighted in lymphoblastoid cell lines from AT patients and was shown to be likely active. In conclusion, dexamethasone treatment may partly restore ATM activity in ataxia telangiectasia cells by a new molecular mechanism that overcomes most of the mutations so far described within this gene.

  19. p38 MAPK-Mediated Bmi-1 down-regulation and defective proliferation in ATM-deficient neural stem cells can be restored by Akt activation.

    Directory of Open Access Journals (Sweden)

    Jeesun Kim

    Full Text Available A-T (ataxia telangiectasia is a genetic disease caused by a mutation in the Atm (A-T mutated gene that leads to neurodegeneration. Despite an increase in the numbers of studies in this area in recent years, the mechanisms underlying neurodegeneration in human A-T are still poorly understood. Previous studies demonstrated that neural stem cells (NSCs isolated from the subventricular zone (SVZ of Atm(-/- mouse brains show defective self-renewal and proliferation, which is accompanied by activation of chronic p38 mitogen-activated protein kinase (MAPK and a lower level of the polycomb protein Bmi-1. However, the mechanism underlying Bmi-1 down-regulation and its relevance to defective proliferation in Atm(-/- NSCs remained unclear. Here, we show that over-expression of Bmi-1 increases self-renewal and proliferation of Atm(-/- NSCs to normal, indicating that defective proliferation in Atm(-/- NSCs is a consequence of down-regulation of Bmi-1. We also demonstrate that epidermal growth factor (EGF-induced Akt phosphorylation renders Bmi-1 resistant to the proteasomal degradation, leading to its stabilization and accumulation in the nucleus. However, inhibition of the Akt-dependent Bmi-1 stabilizing process by p38 MAPK signaling reduces the levels of Bmi-1. Treatment of the Atm(-/- NSCs with a specific p38 MAPK inhibitor SB203580 extended Bmi-1 posttranscriptional turnover and H2A ubiquitination in Atm(-/- NSCs. Our observations demonstrate the molecular basis underlying the impairment of self-renewal and proliferation in Atm(-/- NSCs through the p38 MAPK-Akt-Bmi-1-p21 signaling pathway.

  20. ATM-deficient human fibroblast cells are resistant to low levels of DNA double-strand break induced apoptosis and subsequently undergo drug-induced premature senescence

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jun; Jo, Yong Hwa; Cho, Chang Hoon; Choe, Wonchae; Kang, Insug; Baik, Hyung Hwan [Department of Biochemistry and Molecular Biology, School of Medicine, Kyung Hee University, 26 Kyunghee-daero, Dongdaemun-gu, Seoul 130-701 (Korea, Republic of); Yoon, Kyung-Sik, E-mail: sky9999@khu.ac.kr [Department of Biochemistry and Molecular Biology, School of Medicine, Kyung Hee University, 26 Kyunghee-daero, Dongdaemun-gu, Seoul 130-701 (Korea, Republic of)

    2013-01-04

    Highlights: Black-Right-Pointing-Pointer A-T cells were not hypersensitive to low levels of DNA DSBs. Black-Right-Pointing-Pointer A-T cells have enhanced Akt but defect in activation of p53 and apoptotic proteins. Black-Right-Pointing-Pointer A-T cells underwent premature senescence after DNA damage accumulated. Black-Right-Pointing-Pointer Chemotherapeutic effect in cancer therapy may be associated with premature senescence. -- Abstract: DNA DSBs are induced by IR or radiomimetic drugs such as doxorubicin. It has been indicated that cells from ataxia-telangiectasia patients are highly sensitive to radiation due to defects in DNA repair, but whether they have impairment in apoptosis has not been fully elucidated. A-T cells showed increased sensitivity to high levels of DNA damage, however, they were more resistant to low doses. Normal cells treated with combination of KU55933, a specific ATM kinase inhibitor, and doxorubicin showed increased resistance as they do in a similar manner to A-T cells. A-T cells have higher viability but more DNA breaks, in addition, the activations of p53 and apoptotic proteins (Bax and caspase-3) were deficient, but Akt expression was enhanced. A-T cells subsequently underwent premature senescence after treatment with a low dose of doxorubicin, which was confirmed by G2 accumulation, senescent morphology, and SA-{beta}-gal positive until 15 days repair incubation. Finally, A-T cells are radio-resistant at low doses due to its defectiveness in detecting DNA damage and apoptosis, but the accumulation of DNA damage leads cells to premature senescence.

  1. Iodine I 131 Monoclonal Antibody BC8 Before Autologous Stem Cell Transplant in Treating Patients With Relapsed or Refractory Hodgkin Lymphoma or Non-Hodgkin Lymphoma

    Science.gov (United States)

    2016-06-10

    Recurrent B-Cell Non-Hodgkin Lymphoma; Recurrent Hodgkin Lymphoma; Recurrent T-Cell Non-Hodgkin Lymphoma; Refractory B-Cell Non-Hodgkin Lymphoma; Refractory Hodgkin Lymphoma; Refractory T-Cell Non-Hodgkin Lymphoma

  2. High-Dose Y-90-Ibritumomab Tiuxetan Added to Reduced-Intensity Allogeneic Stem Cell Transplant Regimen for Relapsed or Refractory Aggressive B-Cell Lymphoma

    Science.gov (United States)

    2016-07-08

    Post-Transplant Lymphoproliferative Disorder; Recurrent Adult Diffuse Large Cell Lymphoma; Recurrent B-Cell Non-Hodgkin Lymphoma; Recurrent Burkitt Lymphoma; Refractory B-Cell Non-Hodgkin Lymphoma; Refractory Burkitt Lymphoma; Refractory Diffuse Large B-Cell Lymphoma

  3. Processing of Refractory Metal Alloys for JOYO Irradiations

    Energy Technology Data Exchange (ETDEWEB)

    RF Luther; ME Petrichek

    2006-02-21

    This is a summary of the refractory metal processing experienced by candidate Prometheus materiats as they were fabricated into specimens destined for testing within the JOYO test reactor, ex-reactor testing at Oak Ridge National Laboratory (ORNL), or testing within the NRPCT. The processing is described for each alloy from the point of inception to the point where processing was terminated due to the cancellation of Naval Reactor's involvement in the Prometheus Project. The alloys included three tantalum-base alloys (T-111, Ta-10W, and ASTAR-811C), a niobium-base alloy, (FS-85), and two molybdenum-rhenium alloys, one containing 44.5 w/o rhenium, and the other 47.5 w/o rhenium. Each of these alloys was either a primary candidate or back-up candidate for cladding and structural applications within the space reactor. Their production was intended to serve as a forerunner for large scale production ingots that were to be procured from commercial refractory metal vendors such as Wah Chang.

  4. Vagus nerve stimulation for the treatment of refractory epilepsy

    Directory of Open Access Journals (Sweden)

    Gorgan M.R.

    2015-06-01

    Full Text Available Vagus nerve stimulation (VNS represents one of the main surgical options for the treatment of the refractory epilepsy in pediatric and adult patients. There are several mechanism involved in vagal nerve stimulation which could influence the pathophysiology of seizures like neuromodulation of the thalamic and subthalamic nuclei involved in seizure initiation and the modulation of the neurotransmitters pattern norepinefrin, GABA, and serotonin. The VNS system is composed of the implanted components (the generator, the lead with the electrodes attached and the programming system components (programming wand and handheld computer. The authors present their experience with 81 patients diagnosed with refractory epilepsy, investigated, selected and implanted with vagal neurostimulators between December 2012 and January 2015 in Neurosurgery Clinic, "Bagdasar-Arseni" Emergency Hospital. The surgical technique and the potential pitfalls are described in detail. There were 20 children (24,7% and 61 (75,3% adults in this series. There was no death in this series and no intraoperative incidence. One patient presented dysphagia postoperatively which completely remitted after two months of follow-up. The outcome in term of seizure frequency and severity was better for patients under 30 years compared with patients older than 30 years. VNS represents now a safe, quick and efficient surgical procedure with a minimum period of hospitalization and a short recovery period. The good results on long term improve the quality of life of the patients and facilitate the social and professional reinsertion

  5. Effectiveness of infliximab in refractory FDG PET-positive sarcoidosis.

    Science.gov (United States)

    Vorselaars, Adriane D M; Crommelin, Heleen A; Deneer, Vera H M; Meek, Bob; Claessen, Anke M E; Keijsers, Ruth G M; van Moorsel, Coline H M; Grutters, Jan C

    2015-07-01

    Inconclusive evidence for the efficacy of infliximab in sarcoidosis hinders the global use of this potentially beneficial drug. To study infliximab efficacy in a clinical setting, we performed a prospective open-label trial in patients refractory to conventional treatment. Patients (n=56) received eight infusions of 5 mg·kg(-1) infliximab. Pulmonary function, disease activity measured by (18)F-fluorodeoxyglucose (FDG) by positron emission tomography (PET) and quality of life were part of the clinical work-up. Infliximab levels were measured before every infusion. After 26 weeks of infliximab treatment, mean improvement in forced vital capacity (FVC) was 6.6% predicted (p=0.0007), whereas in the 6 months before start of treatment, lung function decreased. Maximum standardised uptake value (SUVmax) of pulmonary parenchyma on (18)F-FDG PET decreased by 3.93 (pinfliximab trough level (mean 18.0 µg·mL(-1)) and initial response was found. In conclusion, infliximab causes significant improvement in FVC in refractory (18)F-FDG PET positive sarcoidosis. Especially in pulmonary disease, high (18)F-FDG PET SUVmax values at treatment initiation predict clinically relevant lung function improvement. These results suggest that inclusion of (18)F-FDG PET is useful in therapeutic decision-making in complex sarcoidosis.

  6. ROSA DAMASCENA OIL: AN ADJUNCTIVE THERAPY FOR PEDIATRIC REFRACTORY SEIZURES

    Directory of Open Access Journals (Sweden)

    H. Rakhshandeh

    2007-08-01

    Full Text Available ObjectiveSeveral investigations have demonstrated that Rosa damascena has aninhibitory effect on the hypothalamus and on pituitary system reactivityin the rat; it has also been shown that the essential oil of Rosa damascenahas significant antiepileptic effects on pentylentetrazole (PTZ inducedseizures in rats. We aimed at assessing the effects of the essential oil ofRosa damascena when used as an adjunct treatment to treat children withrefractory seizuresMaterials and MethodsIn this double-blind clinical trial, conducted as a pilot study between April2004 and March 2005, we administered essential oil of Rosa damascenato sixteen children with refractory epilepsy as an adjunct therapy, andevaluated its effects.Results16 patients, age range 3-13 years, were enrolled; 56.3% (n=9 girls and43.8% (n=7 boys.All has been under treatment for 3-6 weeks (baseline phase. They receivedeither the essential oil or placebo for a period of 4 weeks and in betweenthese periods, they took only their pre-existing antiepileptic drugs for twoweeks (washout phase.The mean frequency of seizures in those using essential oil, showedsignificant decrease as compared to the controls using placeboes (p=0.00.ConclusionIt can be concluded that the essential oil of Rosa Damascena has beneficialantiepileptic effect in children with refractory seizures.

  7. Outcomes of CAG Regimen for Refractory Biphenotypic Acute Leukemia Patients

    Institute of Scientific and Technical Information of China (English)

    Guang-sheng He; Xiang Zhang; De-pei Wu; Ai-ning Sun; Zheng-ming Jin; Hui-ying Qiu; Miao Miao; Xiao-wen Tang; Zheng-zheng Fu; Yue Han

    2009-01-01

    Objective To evaluated the efficiency of low-dose cytosine arabinoside plus aclarubicin with concurrent administration of granulocyte colony-stimulating factor(CAG)regimen for refractory biphenotypic acute leukemia(BAL).Methods We treated 5 refractory BAL patients by CAG regimen(10 mg·m 2 cytosine arabinoside subcutaneously administrated every 12 hours,day 1-14;5-7 mg·m2 aclarubicin intravenously administrated daily,day 1-8;and concurrently used 200 μg.m-2·d-1 granulocyte colony-stimulating factor subcutaneously)from November 2002 to April 2007.The efficacy of the regimen was evaluated by response rate,and the side effects were also measured.Results The complete remission rate was 80% ,median duration of absolute neutrophil count<5.0×108/L and platelet count<2.0×1010/L was day 13 and day 1,respectively;and the infection rate was low(Ⅲ-Ⅳ infection rate,20.00% ).Conclusion CAG regimen as remission induction chemotherapy for BAL patients is effective with a high remission rate and low toxicity.

  8. Treatment of refractory complex partial seizures: role of vigabatrin

    Directory of Open Access Journals (Sweden)

    Elizabeth J Waterhouse

    2009-10-01

    Full Text Available Elizabeth J Waterhouse, Kimberly N Mims, Soundarya N GowdaDepartment of Neurology, Virginia Commonwealth University School of Medicine, Richmond, VA, USAAbstract: Vigabatrin (VGB is an antiepileptic drug that was designed to inhibit GABA-transaminase, and increase levels of γ-amino-butyric acid (GABA, a major inhibitory neurotransmitter in the brain. VGB has demonstrated efficacy as an adjunctive antiepileptic drug for refractory complex partial seizures (CPS and for infantile spasms (IS. This review focuses on its use for complex partial seizures. Although VGB is well tolerated, there have been significant safety concerns about intramyelinic edema and visual field defects. VGB is associated with a risk of developing bilateral concentric visual field defects. Therefore, the use of VGB for complex partial seizures should be limited to those patients with seizures refractory to other treatments. Patients must have baseline and follow-up monitoring of visual fields, early assessment of its efficacy, and ongoing evaluation of the benefits and risks of VGB therapy.Keywords: vigabatrin, epilepsy, complex partial seizures, review

  9. Predicting Refractory Detrusor Overactivity: Are There any Clues at Diagnosis

    Directory of Open Access Journals (Sweden)

    Kylie J Mansfield

    2013-12-01

    Full Text Available Approximately one-third of patients diagnosed with detrusor overactivity (DO will be refractory to treatment with antimuscarinic drugs. In this study, we examined baseline clinical details and history of urinary tract infection (UTI, urodynamics parameters, urinary pH and ATP in voided urodynamic fluid for any prognostic factors that would allow prediction of the refractory state at the time of diagnosis. At follow-up (2 to 5 years, patients were characterised as responders or non-responders based on a >50% decrease in urge leaks and voids per 24 hours. Of the 61 patients who met the inclusion criteria, follow-up revealed that 25% of these did not respond to antimuscarinic therapy. There were no significant differences in urodynamic parameters in responders compared to non-responders. Patients with a greater number of leaks/week at baseline and a history of UTI were more likely to be non-responsive to antimuscarinic therapy. There was no difference in urinary pH or ATP concentration in voided urodynamic fluid in the two groups. The results indicate that severity of leakage at baseline history and a history of recurrent UTI appears to be poor prognostic features in patients with DO. These may be associated with the development of the ‘refractory’ state.

  10. Ketogenic diet in 3 cases of childhood refractory status epilepticus.

    Science.gov (United States)

    Sort, Rune; Born, Alfred P; Pedersen, Karen N; Fonsmark, Lise; Uldall, Peter

    2013-11-01

    Refractory status epilepticus (RSE) in children is associated with a significant risk of death or neurological morbidity. Recently attention has been drawn to the ketogenic diet (KD) as an acute treatment, as it has shown promise in controlling seizures in otherwise refractory status epilepticus in several cases. We have listed these and reviewed all cases of KD used in RSE at our centre. KD was given as 4:1 fat:carbohydrate-protein solution. A 3-year-old girl with RSE due to Hemiconvulsion-Hemiplegia Epilepsy syndrome. KD was instigated on day 6. Seizures stopped with ketosis on day 7. A 10-year-old boy rapidly developing RSE. After months a mitochondrial disorder was discovered. KD was tried twice with severe side-effects but no seizure control. 11-year-old healthy boy with RSE as FIRES. On KD seizures stopped for 24 h one day after reaching ketosis. He improved over 3-4 weeks. KD was efficient in two of three cases of RSE. The non-responder had severe side-effects and proved to have a mitochondrial disorder which is arguably a contraindication for KD. More studies are needed to prove efficacy of KD in RSE, to define optimal timing of KD and possible contraindications for KD in RSE. Copyright © 2013 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

  11. Centromedian thalamic nuclei deep brain stimulation in refractory status epilepticus.

    Science.gov (United States)

    Valentín, Antonio; Nguyen, Huy Q; Skupenova, Alena M; Agirre-Arrizubieta, Zaloa; Jewell, Sharon; Mullatti, Nandini; Moran, Nicholas F; Richardson, Mark P; Selway, Richard P; Alarcón, Gonzalo

    2012-10-01

    Refractory status epilepticus (RSE) is associated with high mortality. We report a potential treatment alternative. Deep brain stimulation (DBS) of the centromedian thalamic nuclei (CMN) can be effective in the treatment of RSE. Report of the evolution of RSE after DBS of the CMN in a 27-year-old man. In the course of an encephalopathy of unknown origin, and after a cardiac arrest, the patient developed RSE with myoclonic jerks and generalized tonic-clonic seizures. The EEG showed continuous generalized periodic epileptiform discharges (GPEDS). Five weeks after RSE onset, bilateral DBS of the CMN was started. This treatment was immediately followed by disappearance of tonic-clonic seizures and GPEDS, suggesting a resolution of RSE. The patient continued having multifocal myoclonic jerks, probably subcortical in origin, which resolved after 4 weeks. The patient remained clinically stable for 2 months in a persistent vegetative state. The remission of RSE, the abolition of GPEDS, and the patient survival suggest that DBS of the CMN may be efficacious in the treatment of refractory, generalized status epilepticus. Copyright © 2012 Elsevier Inc. All rights reserved.

  12. Effects of Mg/Si on Exoplanetary Refractory Oxygen Budget

    CERN Document Server

    Unterborn, Cayman T

    2016-01-01

    Solar photospheric abundances of refractory elements mirror the Earth's to within ~10 mol% when normalized to the dominant terrestrial planet-forming elements Mg, Si and Fe. This allows for the adoption of Solar composition as an order-of-magnitude proxy for Earth's. It is not known, however, the degree to which this mirroring of stellar and terrestrial planet abundances holds true for other star-planet systems without determination of the composition of initial planetesimals via condensation sequence calculations and post condensation processes. We present the open-source Arbitrary Composition Condensation Sequence calculator (ArCCoS) to assess how the elemental composition of a parent star affects that of the planet-building material, including the extent of oxidation within the planetesimals. We demonstrate the utility of ArCCoS by showing how variations in stellar refractory elements Mg and Si affect the condensation of oxygen, which directly lead to the resulting core to silicate ratio in exoplanets. Thi...

  13. Brazing Refractory Metals Used In High-Temperature Nuclear Instrumentation

    Energy Technology Data Exchange (ETDEWEB)

    A. J. Palmer; C. J. Woolstenhulme

    2009-06-01

    As part of the U. S. Department of Energy (DOE) sponsored Next Generation Nuclear Project (NGNP) currently ongoing at Idaho National Laboratory (INL), the irradiation performance of candidate high-temperature gas reactor fuels and materials is being evaluated at INL’s Advanced Test Reactor (ATR). The design of the first Advanced Gas Reactor (AGR 1) experiment, currently being irradiated in the ATR, required development of special techniques for brazing niobium and molybdenum. Brazing is one technique used to join refractory metals to each other and to stainless steel alloys. Although brazing processes are well established, it is difficult to braze niobium, molybdenum, and most other refractory metals because they quickly develop adherent oxides when exposed to room-temperature air. Specialized techniques and methods were developed by INL to overcome these obstacles. This paper describes the techniques developed for removing these oxides, as well as the ASME Section IX-qualified braze procedures that were developed as part of the AGR-1 project. All brazes were made using an induction coil with an inert or reducing atmosphere at low pressure. Other parameters, such as filler metals, fluxes used, and general setup procedures, are also discussed.

  14. Modeling of high entropy alloys of refractory elements

    Energy Technology Data Exchange (ETDEWEB)

    Grosso, M.F. del, E-mail: delgrosso@tandar.cnea.gov.ar [Gcia. Investigacion y Aplicaciones, CNEA, Av. Gral Paz 1499, (B1650KNA), San Martin (Argentina); GCMM, UTN, FRG Pacheco, Av. H. Yrigoyen 288, Gral. Pacheco (Argentina); Consejo Nacional de Investigaciones Cientificas y Tecnicas, CONICET (Argentina); Bozzolo, G. [Loyola University Maryland, 4501 N. Charles St., Baltimore, MD 21210 (United States); Mosca, H.O. [Gcia. Investigacion y Aplicaciones, CNEA, Av. Gral Paz 1499, (B1650KNA), San Martin (Argentina); GCMM, UTN, FRG Pacheco, Av. H. Yrigoyen 288, Gral. Pacheco (Argentina)

    2012-08-15

    Reverting the traditional process of developing new alloys based on one or two single elements with minority additions, the study of high entropy alloys (HEA) (equimolar combinations of many elements) has become a relevant and interesting new field of research due to their tendency to form solid solutions with particular properties in the absence of intermetallic phases. Theoretical or modeling studies at the atomic level on specific HEA, describing the formation, structure, and properties of these alloys are limited due to the large number of constituents involved. In this work we focus on HEA with refractory elements showing atomistic modeling results for W-Nb-Mo-Ta and W-Nb-Mo-Ta-V HEA, for which experimental background exists. An atomistic modeling approach is applied for the determination of the role of each element and identification of the interactions and features responsible for the transition to the high entropy regime. Results for equimolar alloys of 4 and 5 refractory elements, for which experimental results exist, are shown. A straightforward algorithm is introduced to interpret the transition to the high entropy regime.

  15. New-Onset Refractory Status Epilepticus: More Investigations, More Questions

    Directory of Open Access Journals (Sweden)

    Philippe Dillien

    2016-06-01

    Full Text Available A 27-year-old previously healthy woman was admitted to the hospital with recurrent seizures. Status epilepticus developed that became refractory to third-line therapy with propofol and barbiturates. The patient had a very extensive diagnostic workup including autoimmune, viral and genetic investigations. A tentative immune therapy was proposed with high doses of steroids and plasma exchanges. Our patient had an inherited heterozygous single nucleotide variant in the sequence c.1280A>G [p.Lys427Arg] of the SMC3 gene that was insufficient to explain the seizures. Surprisingly, IgM antibodies against Japanese encephalitis virus were positive on the serum drawn 11 days after symptom onset, as detected by ELISA and the immunofluorescence antibody (IFA technique. IgG antibodies were also positive using the IFA technique, but not with ELISA. The same investigations as well as the detection of the viral genome by the q-RT-PCR technique were negative on cerebrospinal fluid. Despite the suspicion of a viral infection, we concluded that our patient had a new-onset refractory status epilepticus of cryptogenic origin. Termination of the status epilepticus was obtained after 47 days, with a possible benefit from the introduction of ketamine.

  16. A multiyear workplace-monitoring program for refractory ceramic fibers.

    Science.gov (United States)

    Maxim, L D; Kelly, W P; Walters, T; Waugh, R

    1994-12-01

    This paper summarizes interim results of a 5-year workplace monitoring program conducted by firms belonging to the Refractory Ceramic Fibers Coalition (RCFC) pursuant to a Consent Agreement with the U.S. EPA. The exposure monitoring program is part of a model Product Stewardship Program (PSP) developed by RCFC. This paper reviews the refractory ceramic fiber (RCF) industry, findings of animal bioassay and epidemiological investigations, and the regulatory approach used by EPA. The scope, protocols, sample collection budgets, and experimental design of the monitoring program are summarized. In brief, the program will gather 720 time-weighted average (TWA) workplace concentration measurements annually, partitioned among 8 functional job classifications, both from plants that manufacture and from those that process or use RCF. Statistical analyses reveal that: workplace airborne RCF concentration data are approximately log-normally distributed, 93% of workplace TWAs are beneath the industry's recommended exposure guideline of 1 fiber per cubic centimeter (f/cc), there are significant differences in average workplace RCF concentrations among job types, and PSP activities are effective in lowering workplace exposure. Results of this effort provide an interesting illustration of a successful cooperative effort between a responsible industry and regulatory agencies.

  17. A plasmapheresis protocol for refractory pulmonary alveolar proteinosis.

    Science.gov (United States)

    Garber, Bryan; Albores, Jeffrey; Wang, Tisha; Neville, Thanh H

    2015-04-01

    Pulmonary alveolar proteinosis (PAP) is a rare lung disease characterized by the accumulation of proteinaceous material within the lungs. While typically managed with whole lung lavage (WLL), more recent PAP therapies aimed at reducing granulocyte-macrophage colony stimulating factor autoantibodies (anti-GM-CSF) have reduced symptoms and improved lung function. We present a patient with PAP refractory to WLL, exogenous GM-CSF and rituximab who underwent a novel plasmapheresis protocol as a therapeutic trial. While previously reported regimens have utilized plasmapheresis sessions distributed over months, our patient underwent five consecutive days of plasmapheresis, followed by rituximab. Anti-GM-CSF levels decreased from 24.8 to 2.7 mcg/mL post-plasmapheresis. This reduction of autoantibody correlated with reduction in WLL frequency, increase in diffusing capacity for carbon monoxide, and subjective improvement in dyspnea. Our case suggests that five consecutive days of plasmapharesis results in increased clearance of anti-GM-CSF and may be potentially efficacious in cases of refractory PAP.

  18. Silica crown refractory corrosion in glass melting furnaces

    Directory of Open Access Journals (Sweden)

    Balandis A.

    2011-01-01

    Full Text Available The critical parameters of silica refractories, such as compressive strength, bulk, density, quantity of silica, microstructure and porosity were evaluated of unused and used bricks to line the crowns of glass furnaces, when the rate of corrosion of crowns were about 2 times greater. The change of these parameters, the chemical composition and formation of the microcracks in the used silica refractories material were studied. It was established that the short time at service of container glass furnace crown can be related to low quality of silica brick: high quantity of CaO and impurities, low quantity of silica, low quantity of silica, transferred to tridymite and cristobalite and formation of 5-10 μm and more than 100 μm cracks in the crown material. The main reason of corrosion high quality silica bricks used to line the crown of electrovacuum glass furnace is the multiple cyclic change of crown temperature at 1405 - 1430°C range in the initial zone of crown and at 1575 - 1605°C range in the zone of highest temperatures.

  19. Cometary dust: the diversity of primitive refractory grains

    Science.gov (United States)

    Wooden, D. H.; Ishii, H. A.; Zolensky, M. E.

    2017-05-01

    Comet dust is primitive and shows significant diversity. Our knowledge of the properties of primitive cometary particles has expanded significantly through microscale investigations of cosmic dust samples (anhydrous interplanetary dust particles (IDPs), chondritic porous (CP) IDPs and UltraCarbonaceous Antarctic micrometeorites, Stardust and Rosetta), as well as through remote sensing (Spitzer IR spectroscopy). Comet dust are aggregate particles of materials unequilibrated at submicrometre scales. We discuss the properties and processes experienced by primitive matter in comets. Primitive particles exhibit a diverse range of: structure and typology; distribution of constituents; concentration and form of carbonaceous and refractory organic matter; Mg- and Fe-contents of the silicate minerals; sulfides; existence/abundance of type II chondrule fragments; high-temperature calcium-aluminium inclusions and ameboid-olivine aggregates; and rarely occurring Mg-carbonates and magnetite, whose explanation requires aqueous alteration on parent bodies. The properties of refractory materials imply there were disc processes that resulted in different comets having particular selections of primitive materials. The diversity of primitive particles has implications for the diversity of materials in the protoplanetary disc present at the time and in the region where the comets formed. This article is part of the themed issue 'Cometary science after Rosetta'.

  20. Growth hormone for optimization of refractory heart failure treatment

    Directory of Open Access Journals (Sweden)

    Bocchi Edimar Alcides

    1999-01-01

    Full Text Available It has been reported that growth hormone may benefit selected patients with congestive heart failure. A 63-year-old man with refractory congestive heart failure waiting for heart transplantation, depending on intravenous drugs (dobutamine and presenting with progressive worsening of the clinical status and cachexia, despite standard treatment, received growth hormone replacement (8 units per day for optimization of congestive heart failure management. Increase in both serum growth hormone levels (from 0.3 to 0.8 mg/l and serum IGF-1 levels (from 130 to 300ng/ml was noted, in association with clinical status improvement, better optimization of heart failure treatment and discontinuation of dobutamine infusion. Left ventricular ejection fraction (by MUGA increased from 13 % to 18 % and to 28 % later, in association with reduction of pulmonary pressures and increase in exercise capacity (rise in peak VO2 to 13.4 and to 16.2ml/kg/min later. The patient was "de-listed" for heart transplantation. Growth hormone may benefit selected patients with refractory heart failure.

  1. Clobazam therapy of refractory epilepsy in tuberous sclerosis complex.

    Science.gov (United States)

    Jennesson, Melanie; van Eeghen, Agnies M; Caruso, Paul A; Paolini, Jan L; Thiele, Elizabeth A

    2013-05-01

    Clobazam (CLB) was recently approved by the FDA, but has not been evaluated in tuberous sclerosis complex (TSC). We retrospectively reviewed a cohort of patients with TSC and refractory epilepsy who started CLB over a 5-year period. Clinical characteristics and number of tubers on MRI were assessed. Duration of therapy, therapeutic response and adverse events were recorded. CLB was prescribed in 29 adults and children of whom 72% were cognitively impaired, with a median age at seizure onset of 5 months. Mean duration of CLB therapy was 17.3 months with a 12 and 24-month estimated retention rate of 82% and 68%, respectively. Twenty patients (69%) reported a good response (>50% seizure reduction) at the end of the titration, and six patients (21%) remained good responders after 12 months of CLB therapy. Adverse events occurred in 13 patients, predominantly somnolence and behavioral disorders. One quarter of the responders reported improvement in behavior. No predictive factor for a good response could be identified. CLB appears to be a well-tolerated and valuable option for treatment of refractory epilepsy in TSC.

  2. Radiation induced decomposition of a refractory cefathiamidine intermediate

    Institute of Scientific and Technical Information of China (English)

    Qiburi Bao; Lujun Chen; Jianlong Wang

    2014-01-01

    Diisopropylthiourea (DPT),an intermediate of a widely used cephalosporin,has been found to be one of the most refractory components in cephalosporin synthesis wastewater.This compound cannot be completely removed by conventional biological processes due to its antimicrobial property.Ionizing radiation has been applied in the decomposition of refractory pollutants in recent years and has proved effective.Therefore,the decomposition of DPT by γ-irradiation was studied.The compound was irradiated at the dose of 150-2000 Gy before a change of concentration and UV absorption of the solutions was detected.Furthermore,the decomposition kinetics and radiation yield (G-value) of DPT was investigated.The results of radiation experiments on DPT-containing aqueous showed that the DPT can be effectively degraded by γ-radiation.DPT concentration decreased with increasing absorbed doses.G-values of radiolytic decomposition for DPT (20 mg/L) were 1.04 and 0.47 for absorbed doses of 150 and 2000 Gy,respectively.The initial concentration and pH of the solutions affected the degradation.As the concentration of substrate increased,the decomposition was reduced.The decrease of removal rate and radiation efficacy under alkaline condition suggested that lower pH values benefit the γ-induced degradation.UV absorption from 190 to 250 nm decreased after radiation while that from 250 to 300 nm increased,indicating the formation of by-products.

  3. Design and development of advanced castable refractory materials

    Science.gov (United States)

    Davis, Robert Bruce

    New formulations of castable refractory composite materials were studied. This technology is used to produce low cost composite concrete structures designed for high temperature stability, superior wear resistance and improved strength. An in situ fired, castable cement installation is a heterogeneous structure divided into three zones according to the temperature history and microstructure. The properties of each zone depend on the predominant bonding mode between constituents. Each zone has a characteristic microstructure that influences the integrity of the monolith. The hot side may have a highly dense and developed network of ceramic bonds between constituent particles while the cold side may never reach temperatures sufficient to drive off free water. The thermal, structural and tribological properties depend on the microstructure and the type of bonding that holds the monolith together. The phase distributions are defined by sets of metastable phase conditions driven by the local hydrated chemistry, nearest neighbor oxide compounds, impurities and sintering temperature. Equilibrium phase diagrams were used to select optimum compositions based on higher melting point phases. The phase diagrams were also used to target high temperature phase fields that are stable over wide temperature and stoichiometric ranges. Materials selection of candidate hydraulic clinkers, high temperature oxides, and reinforcement phases were based on requirements for high temperature stability. The calcium aluminate (CaO-Al2O3) and calcium dialuminate (CaO-(Al2O3)2) are common refractory clinkers used in castable refractory cements. The thermodynamics and kinetics of cement hydrate formation are well studied and suited to become the building block of a design for a superior refractory castable cement. The inert oxides mixed with the calcium aluminate clinkers are magnesia (MgO), alumina (Al 2O3), spinel (MgAl2O4) and chromic (Cr2O3). The bulk of the experiments concentrated in the Al

  4. Fusion Techniques for the Oxidation of Refractory Actinide Oxides

    Energy Technology Data Exchange (ETDEWEB)

    Rudisill, T.S.

    1999-04-15

    Small-scale experiments were performed to demonstrate the feasibility of fusing refractory actinide oxides with a series of materials commonly used to decompose minerals, glasses, and other refractories as a pretreatment to dissolution and subsequent recovery operations. In these experiments, 1-2 g of plutonium or neptunium oxide (PuO2 or NpO2) were calcined at 900 degrees Celsius, mixed and heated with the fusing reagent(s), and dissolved. For refractory PuO2, the most effective material tested was a lithium carbonate (Li2CO3)/sodium tetraborate (Na2B4O7) mixture which aided in the recovery of 90 percent of the plutonium. The fused product was identified as a lithium plutonate (Li3PuO4) by x-ray diffraction. The use of a Li2CO3/Na2B4O7 mixture to solubilize high-fired NpO2 was not as effective as demonstrated for refractory PuO2. In a small-scale experiment, 25 percent of the NpO2 was oxidized to a neptunium (VI) species that dissolved in nitric acid. The remaining neptunium was then easily recovered from the residue by fusing with sodium peroxide (Na2O2). Approximately 70 percent of the neptunium dissolved in water to yield a basic solution of neptunium (VII). The remainder was recovered as a neptunium (VI) solution by dissolving the residue in 8M nitric acid. In subsequent experiments with Na2O2, the ratio of neptunium (VII) to (VI) was shown to be a function of the fusion temperature, with higher temperatures (greater than approximately 400 degrees C) favoring the formation of neptunium (VII). The fusion of an actual plutonium-containing residue with Na2O2 and subsequent dissolution was performed to demonstrate the feasibility of a pretreatment process on a larger scale. Sodium peroxide was chosen due

  5. Effectiveness and tolerability of perampanel in children and adolescents with refractory epilepsies

    DEFF Research Database (Denmark)

    Biró, Anna; Stephani, Ulrich; Tarallo, Tiziana;

    2015-01-01

    OBJECTIVE: This article aims to report the first clinical experiences concerning effectiveness and tolerability of perampanel (PER) in a pediatric population with refractory epilepsies. PATIENTS AND METHODS: This nonsponsored, observational, retrospective survey was conducted through collaboratio...... (n = 14). DISCUSSION: PER seems to be effective also in children and adolescents with pharmaco-refractory epilepsies. Tolerability was acceptable....

  6. Rapid pacing results in changes in atrial but not in ventricular refractoriness

    NARCIS (Netherlands)

    Schoonderwoerd, BA; Van Gelder, IC; Tieleman, RG; Bel, KJ; Crijns, HJGM

    2002-01-01

    It is well known that atrial tachycardia causes atrial electrical remodeling, characterized by shortening of atrial effective refractory periods (AERPs) and loss of physiological adaptation of AERP to rate. However, the nature and time course of changes in ventricular effective refractory periods (V

  7. Brief Introduction of The Refractories Branch of The Chinese Society for Metals

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    @@ The Refractories Branch,a specialized branch of The Chinese Society for Metals(CSM,a nonprofit academic organization concemed with the advancement of science and technology in metallurgical industry and materials science and engineering in China and is also an organization ofChinese scientists and engineersin these field.),is a nationwide academic organization for researchers or engineers in China'S refractories field.

  8. Treatment of plasmapheresis refractory thrombotic thrombocytopenic purpura with double-filtration membrane plasmapheresis.

    Science.gov (United States)

    Karakus, Volkan; Deveci, Burak; Kurtoğlu, Erdal

    2013-06-01

    Thrombotic thrombocytic purpura (TTP) is a life-threatening disorder. Without plasma exchange treatment (PET) the mortality rate is quite high. Double-filtration plasmapheresis is an alternative opportunity for TTP patients refractory to PET. Here we report our experience in a refractory TTP patient who was successfully treated by means of double-filtration plasmapheresis therapy.

  9. ZrO2—Containing Refractories for Cement Rotary Kilns

    Institute of Scientific and Technical Information of China (English)

    YEGuotian; XUYanqing

    2002-01-01

    ZrO2-Containing Refractories have been increasingly used for cement rotary kilns,This paper discusses how the properties and performance of ZrO2-Containing Refractories are improved in terms of chemical attack resistance,thermal shock resistance,thermal conductivity and mechanical stress.

  10. Antipsychotic Polypharmacy in a Treatment-Refractory Schizophrenia Population Receiving Adjunctive Treatment With Electroconvulsive Therapy

    DEFF Research Database (Denmark)

    Kristensen, Diana; Hageman, Ida; Bauer, Jeanett

    2013-01-01

    Antipsychotic polypharmacy (APP) is frequent, but its pattern is unknown in treatment-refractory schizophrenia-spectrum patients receiving electroconvulsive therapy (ECT).......Antipsychotic polypharmacy (APP) is frequent, but its pattern is unknown in treatment-refractory schizophrenia-spectrum patients receiving electroconvulsive therapy (ECT)....

  11. Ten patients with refractory status epilepticus in an intensive care department

    NARCIS (Netherlands)

    ter Maaten, JC; van Schijndel, RJM; Heimans, JJ; Schreuder, WO

    1998-01-01

    Status epilepticus (SE) is a serious disease, associated with a high morbidity and mortality, particularly if refractory to initial therapy. We describe the clinical manifestations and outcome in ten cases with refractory SE admitted to our medical intensive care unit. Three of these selected group

  12. Refractory Materials based on Magnesia-Alumina Spinel for Improved Performance in Coal Gasification Environments

    Energy Technology Data Exchange (ETDEWEB)

    Hemrick, James Gordon [ORNL; Armstrong, Beth L [ORNL; Rodrigues-Schroer, Angela [Minteq International, Inc.; Colavito, [Minteq International, Inc.; Smith, Jeffrey D [ORNL; O' Hara, Kelley [University of Missouri, Rolla

    2013-01-01

    As part of a larger project to develop novel refractory systems and techniques to reduce energy consumption of refractory lined vessels, a team composed of Oak Ridge National Laboratory, refractory manufacturer Minteq International, Inc., and academic partner Missouri University of Science and Technology have developed new refractory materials and coating systems specifically for application in coal gasification environments. Materials were developed under this U.S. DOE funded project to address the need for innovative refractory compositions by developing MgO-Al2O3 spinel gunnable refractory compositions utilizing new aggregate materials, bond systems, protective coatings, and phase formation techniques. Work was conducted to develop and deploy these new materials and to develop and apply low cost coatings using a colloidal approach for protection against attack of the refractory brick by the serviced environment. Additionally, a light-weight back-up refractory system was developed to help offset the high thermal conductivity inherent in spinel materials. This paper discusses the efforts involved in the development of these materials, along with the laboratory testing and evaluation of these materials leading to relevant results achieved toward the reduction of chemical reactions and mechanical degradation by the service environment though compositional and processing modifications.

  13. SPINEL-BASED REFRACTORIES FOR IMPROVED PERFORMANCE IN COAL GASIFICATION ENVIRONMENTS

    Energy Technology Data Exchange (ETDEWEB)

    Hemrick, James Gordon [ORNL; Armstrong, Beth L [ORNL; Rodrigues-Schroer, Angela [Minteq International, Inc.; Colavito, [Minteq International, Inc.; Smith, Jeffrey D [ORNL; O' Hara, Kelley [University of Missouri, Rolla

    2013-01-01

    Oak Ridge National Laboratory, in collaboration with refractory manufacturer Minteq International, Inc., academic partner Missouri University of Science and Technology and refractory end users have developed novel refractory systems and techniques to reduce energy consumption of refractory lined vessels. The objective of this U.S. DOE funded project was to address the need for innovative refractory compositions by developing MgO-Al 2O3 spinel gunnable refractory compositions utilizing new aggregate materials, bond systems, protective coatings, and phase formation techniques. Materials have been developed specifically for coal gasification environments and work has been performed to develop and apply low cost coatings using a colloidal approach for protection against attack of the refractory brick by the service environment and to develop a light-weight back-up refractory system to help offset the high thermal conductivity inherent in spinel materials. This paper discusses the systematic development of these materials, laboratory testing and evaluation of these materials, and relevant results achieved toward the reduction of chemical reactions and mechanical degradation by the service environment though compositional and processing modifications.

  14. Therapy refractory angioimmunoblastic T-cell lymphoma in complete remission with lenalidomide.

    NARCIS (Netherlands)

    Beckers, M.M.; Huls, G.A.

    2013-01-01

    The prognosis of therapy refractory angioimmunoblastic lymphoma (AITL) is very poor. In this report we describe a patient with AITL refractory to 2 lines of chemotherapy. He was treated with lenalidomide 15 mg continuously and prednisone. After 2 yr follow-up, the patient has no detectable disease.

  15. Therapy refractory angioimmunoblastic T-cell lymphoma in complete remission with lenalidomide

    NARCIS (Netherlands)

    Beckers, Marielle M.; Huls, Gerwin

    2013-01-01

    The prognosis of therapy refractory angioimmunoblastic lymphoma (AITL) is very poor. In this report we describe a patient with AITL refractory to 2 lines of chemotherapy. He was treated with lenalidomide 15 mg continuously and prednisone. After 2 yr follow-up, the patient has no detectable disease.

  16. Genetics of refractoriness to Plasmodium falciparum in the mosquito Anopheles stephensi

    NARCIS (Netherlands)

    Feldmann, A.M.; Gemert, Geert-Jan van; Vegte-Bolmer, Marga G. van de; Jansen, Ritsert C.

    1998-01-01

    We previously selected a line of the malaria vector mosquito Anopheles stephensi refractory (resistant) to the human malaria parasite Plasmodium falciparum, using in vitro infections with P. falciparum gametocytes. This report presents data on the genetic background of refractoriness. The results of

  17. RESULTS OF OUTPATIENT PROGRAM ON EFFECTIVE THERAPY OF REFRACTORY ARTERIAL HYPERTENSION

    Directory of Open Access Journals (Sweden)

    M. M. Batyushin

    2015-12-01

    Full Text Available Aim. To increase in efficacy of antihypertensive therapy in patients with refractory arterial hypertension (HT.Material and methods. Patients with refractory HT were revealed during first month of program. The causes of refractory HT were analyzed. Combined antihypertensive therapy was prescribed to reach target level of blood pressure (BP. This therapy lasted 24 weeks and included angiotensin converting enzyme (ACE inhibitor, thiazid diuretic (indapamide and dihydropyridine calcium antagonist (nifedipine XL.Results. 200 patients with refractory HT were revealed. True refractory HT took place in 59,9% of patients and pseudo refractory HT – in 40,1% of patients. Lack of diuretics or combined antihypertensive therapy were the main reason of insufficient BP control. Proposed 3-drugs therapy resulted in reduction of systolic BP from 190 to 132 Hg mm and diastolic BP from 104 to 81 Hg mm. Target level of BP was reached in 94% patients. There were no side effects which demanded to stop therapy.Conclusion. High incidence of pseudorefractory HT (40,1% is revealed. Significant prevalence of renal disturbances especially chronic interstitial inflammatory could be responsible for refractory HT development. Use of 3-drugs therapy (ACE inhibitor, indapamide and nifedipine XL provides effective control of BP in refractory and pseudorefractory HT.

  18. Cytogenetics and long-term survival of patients with refractory or relapsed and refractory multiple myeloma treated with pomalidomide and low-dose dexamethasone

    OpenAIRE

    Dimopoulos, Meletios A.; Weisel, Katja C.; Song, Kevin W.; Delforge, Michel; Karlin, Lionel; Goldschmidt, Hartmut; Moreau, Philippe; Banos, Anne; Oriol, Albert; Garderet, Laurent; Cavo, Michele; Ivanova, Valentina; Alegre, Adrian; Martinez-Lopez, Joaquin; Chen, Christine

    2016-01-01

    Patients with refractory or relapsed and refractory multiple myeloma who no longer receive benefit from novel agents have limited treatment options and short expected survival. del(17p) and t(4;14) are correlated with shortened survival. The phase 3 MM-003 trial demonstrated significant progression-free and overall survival benefits from treatment with pomalidomide plus low-dose dexamethasone compared to high-dose dexamethasone among patients in whom bortezomib and lenalidomide treatment had ...

  19. Analysis of renal impairment in MM-003, a phase III study of pomalidomide + low - dose dexamethasone versus high - dose dexamethasone in refractory or relapsed and refractory multiple myeloma

    OpenAIRE

    Weisel, Katja C.; Dimopoulos, Meletios A.; Moreau, Philippe; Lacy, Martha Q.; Song, Kevin W.; Delforge, Michel; Karlin, Lionel; Goldschmidt, Hartmut; Banos, Anne; Oriol, Albert; Alegre, Adrian; Chen, Christine; Cavo, Michele; Garderet, Laurent; Ivanova, Valentina

    2016-01-01

    Pomalidomide + low-dose dexamethasone is effective and well tolerated for refractory or relapsed and refractory multiple myeloma after bortezomib and lenalidomide failure. The phase III trial MM-003 compared pomalidomide + low-dose dexamethasone with high-dose dexamethasone. This subanalysis grouped patients by baseline creatinine clearance ≥ 30 − < 60 mL/min (n=93, pomalidomide + low-dose dexamethasone; n=56, high-dose dexamethasone) or ≥ 60 mL/min (n=205, pomalidomide + low-dose dexamethaso...

  20. High Throughput Drug Sensitivity Assay and Genomics- Guided Treatment of Patients With Relapsed or Refractory Acute Leukemia

    Science.gov (United States)

    2016-11-14

    Acute Leukemia of Ambiguous Lineage; Recurrent Adult Acute Lymphoblastic Leukemia; Recurrent Adult Acute Myeloid Leukemia; Recurrent Childhood Acute Lymphoblastic Leukemia; Recurrent Childhood Acute Myeloid Leukemia; Refractory Adult Acute Lymphoblastic Leukemia; Refractory Childhood Acute Lymphoblastic Leukemia

  1. Microstructure and nano-mechanical property of cold spray Co-base refractory alloy coating

    Institute of Scientific and Technical Information of China (English)

    Yongli LIANG; Bi SHI; Xiaoping YANG; Junbao ZHANG; Xianming MENG

    2011-01-01

    Co-base refractory alloy coating was prepared on carbon steel substrate by cold spray technology; microstructure and nano-mechenical property were examined by scanning electron microscope (SEM) and nano indenter individually. The results showed that about 250 μm Co-base refractory alloy coating could be deposited on steel substrate by cold spray technique, interface between coating and substrate was combined well, and the refractory alloy particle had a significant plastic deformation during deposition process; mixing Ni powders into Co-base refractory alloy powders could increase the density and decrease the nano-hardness of coating, the nano-hardness and elastic modulus of refractory alloy coating was higher than 6 GPa and 160 GPa, respectively.

  2. Petrography and origin of refractory inclusions from the Murray and Murchison C2 chondrites

    Science.gov (United States)

    Simon, S. B.; Grossman, L.; Hsu, A.

    1993-01-01

    By freeze-thaw disaggregation, we have recovered a total of 47 refractory inclusions. New discoveries include the following: a hibonite-pyroxene spherule from Murray; a CaAl4O7-bearing spherule from Murchison; and a Sc-fassaite-bearing ultrarefractory inclusion from Murchison. Freeze-thaw disaggregation, combined with density separation and hand-picking as described is a proven method for recovering rare objects from carbonaceous chondrites. This method is especially effective on C2's due to their porosity and typically results in the discovery of new types of refractory inclusions. Because few refractory inclusions from Murray have been described, we studied this meteorite, although only a small amount of material (730 mg) was available for disaggregation. Many refractory inclusions from Murchison have been described, and we disaggregated a larger amount (approximately 18 g) of Murchison in an attempt to find new types of refractory inclusions, especially corundum-bearing ones.

  3. Paediatric refractory rhinosinusitis secondary to hypertrophied adenoids: management and review of literature.

    Directory of Open Access Journals (Sweden)

    Gautham MK

    2014-06-01

    Full Text Available Background /Objectives: Hypertrophied adenoids are the most common cause of refractory sinusitis in paediatric age. We study 42 cases of patients of chronic adenoiditis with adenoid facies and refractory chronic rhinosinusitis managed by endoscopic assisted adenoidectomy (EAA and conventional adenoidectomy (CA. Materials and method: 42 cases of chronic refractory sinusitis with adenoid facies secondary to hypertrophied adenoids were randomized into 2 groups during the study period of 12 months from August 2012 to July 2013. Group A (n=21 underwent endoscope assisted adenoidectomy and Group B(n=21 underwent conventional adenoidectomy. Result: Endoscopic assisted adenoidectomy proves to be more effective in managing adenoid facies and chronic refractory rhinosinusitis with adenoid hyperplasia. Conclusion: Visualization of the adenoid mass using endoscope helps complete removal of the diseased adenoids. Endoscopic assisted adenoidectomy is treatment of choice in adenoid facies and chronic refractory rhinosinusitis with adenoid hyperplasia and more effective than conventional adenoidectomy.

  4. Effect of Refractory on Nonmetallic Inclusions in Al-Killed Steel

    Science.gov (United States)

    Deng, Zhiyin; Zhu, Miaoyong; Sichen, Du

    2016-10-01

    To understand the effect of refractory on the evolution of inclusions in the secondary steelmaking, steel samples were taken at different stages of the process train. Laboratory experiments were carried out using different refractories (alumina, spinel, and MgO). In the laboratory study, the types of inclusions considered were alumina, spinel, and calcium aluminate. The focus was given to Al-killed steel. The results showed that alumina refractory and spinel refractory had little effect on all the three types of inclusions, while the effect of MgO refractory depended on the activity of dissolved oxygen in liquid steel. With lower oxygen activity, alumina inclusions could transform into spinel inclusions. No evident change could be found for spinel and calcium aluminate inclusions. When the oxygen activity was high enough, spinel inclusions could not be generated from alumina inclusions. The laboratory results helped in understanding the evolution of the inclusions in the industrial process.

  5. Corrosion Resistance of MgO-C Based Refractory to Slag Containing Titania

    Institute of Scientific and Technical Information of China (English)

    LIU Qing-cai; SUN Ya-li; DU Yun-gui; CHEN Deng-fu

    2004-01-01

    The interaction between the slag containing titanium oxides (TiO2 of 2.0 %-20.0 %) and a MgO-C based refractory was investigated by immersion test. The relationship between TiO2 content in slag and corrosion rate of the refractory was studied. The microstructure and compositions of the corroded refractory were analyzed by SEM and X-ray diffraction. The corrosion mechanism of MgO-C based refractory in the slag containing titanium was proposed, and the effects of TiO2 content, slag basicity (ωCaO/ωSiO2) and temperature in molten bath on the corrosion rate of the refractory were obtained.

  6. NOVEL SPINEL-FAMILY REFRACTORIES FOR HIGH-TEMPERATURE, HIGH-ALKALINE ENVIRONMENTS

    Energy Technology Data Exchange (ETDEWEB)

    Hemrick, James Gordon [ORNL; Armstrong, Beth L [ORNL; Smith, Jeffrey D [ORNL; O' Hara, Kelley [University of Missouri, Rolla; Rodrigues-Schroer, Angela [Minteq International, Inc.; Colavito, [Minteq International, Inc.

    2012-01-01

    Work was performed by Oak Ridge National Laboratory (ORNL), in collaboration with the industrial refractory manufacturer Minteq International, Inc. (MINTEQ), academic research partner Missouri University of Science and Technology (MS&T) and end users to employ novel refractory systems and techniques to reduce energy consumption of refractory lined vessels found in industries such as aluminum, chemical, glass, and pulp and paper. The project aim was to address factors which limit the applicability of currently available refractory materials such as chemical attack, mechanical degradation, use temperature, and installation or repair issues. To this end, new innovative unshaped refractory compositions (gunnables) were developed based on MgO-Al 2O3 spinel and alumino-silicate based structures utilizing new aggregate materials, bond systems, protective coatings, and phase formation techniques. Development efforts, materials validation, and results to date of current industrial validation trials a discussed.

  7. DEVELOPMENT AND DEPLOYMENT OF SHOTCRETE REFRACTORIES FOR ALUMINUM ROTARY FURNACE APPLICATION

    Energy Technology Data Exchange (ETDEWEB)

    Hemrick, James Gordon [ORNL; Rodrigues-Schroer, Angela [Minteq International, Inc.; Colavito, [Minteq International, Inc.; Smith, Jeffrey D [ORNL; O' Hara, Kelley [University of Missouri, Rolla

    2013-01-01

    Work was performed by Oak Ridge National Laboratory (ORNL) in the United States, in collaboration with the industrial refractory manufacturer Minteq International, Inc. (MINTEQ), academic research partner Missouri University of Science and Technology (MS&T) and end users to employ novel refractory systems and techniques to reduce energy consumption of refractory lined vessels found in the aluminum industry. The project aim was to address factors that limit the applicability of currently available refractory materials such as chemical attack, mechanical degradation, use temperature, and installation or repair issues. To this end, as part of the overall project, shotcretable refractory compositions were developed based on alumino-silicate based structures utilizing new aggregate materials, bond systems, protective coatings, and phase formation techniques for use in rotary dross furnaces. Additionally a shotcretable high strength insulating back-up lining material was also developed for use in this and other applications. Development efforts, materials validation, and results from industrial validation trials are discussed.

  8. Zonisamide Efficacy as Adjunctive Therapy in Children With Refractory Epilepsy

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    Parvaneh KARIMZADEH

    2013-06-01

    Full Text Available How to Cite This Article: Karimzadeh P, Ashrafi MR, Bakhshandeh Bali MK, Nasehi MM, Taheri Otaghsara SM, Taghdiri MM, Ghofrani M. ZonisamideEfficacy as Adjunctive Therapy in Children With Refractory Epilepsy. Iran J Child Neurol. 2013 Spring; 7(2:37-42.ObjectiveApproximately one third of epileptic children do not achieve complete seizure improvement. Zonisamide is a new antiepileptic drug which is effective as adjunctive therapy in treatment of intractable partial seizures.The purpose of the current study was to evaluate the effectiveness, safety, and tolerability of Zonisamide in epileptic children.Materials & MethodsFrom November 2011 until October 2012, 68 children who referred to Children’s Medical Center and Mofid Children Hospital due to refractory epilepsy (failure of seizure control with the use of two or more anticonvulsant drugs entered the study. The patients were treated with Zonisamide by dose of 2- 12 mg/kg daily in addition to the previous medication. We followed the children every three to four-weeks intervals based on daily frequency, severity and duration of seizures. During the follow-up equal and more than fifty percent reduction in seizurefrequency or severity known as response to the drug.ResultsIn this study 68 patients were examined that 61 children reached the last stage.35 (57.4% were male and 26 (42.6% patients were female.After first and six months of Zonisamide administration daily seizure frequency decreased to 2.95±3.54 and 3.73±3.5 respectively. There was significant difference between seizure frequency in first and six month after Zonisamide toward initial attacks. After six months ZNS therapy a little side effects were created in 10 patients (16.4% including stuttering(4.9%, decreased appetite (4.9%, hallucination (1.6%, dizziness(1.6%, blurred vision(1.6% and suspiring(1.6% as all of them eliminated later dosage reduction.ConclusionThis study confirms the short term efficacy and safety of Zonisamide in

  9. Molecular Determinants of Hormone-Refractory Prostate Cancer

    Science.gov (United States)

    2015-07-01

    isolated from tumors from the day 2 and day 5 time points and subjected to gene expression analysis using RNASeq . Gene expression changes with NEK6...expression was measured in different contexts (tumors vs. culture) and using different assays ( RNASeq vs. Affymetrix microarray) in both comparisons...a doxycycline-inducible promoter in tumors formed in male mice, which were harvested for RNASeq five days after castration from mice with continued

  10. [TREATMENT OF REFRACTORY RHINOSINUSITIS IN PATIENTS WITH IGE-DEFICIENCY].

    Science.gov (United States)

    Tsaryk, V V

    2014-12-01

    The most significant:clinical manifestation of isolated IgE-deficiency is chronic and recurrent sinopulmonary diseases. A few papers about treatment of IgE-deficiency, which shows the effect of intravenous immunoglobulin (IVIG) at a dose of 300-400 mg/kg was found. The results of such studies has level of evidence D. In our study we included IgE-deficient patients with refractory rhinosinusitis, which confirmed the diagnosis on the basis of at least two-fold examination with an interval of 1 month in the absence of obvious causes of secondary immunosuppression. In the study group included 82 patients (49 female, 34 male) aged 18 to 61, with the refractory rhinosinusitis combined with deficient IgE, total--33 (group 1) and partial--4 patients (group 2). In 22 patients (26.8%) immunoglobulin E deficiency combined with decreased serum concentrations of IgG sub-classes and other classes. The control group are 33 patients with refractory rhinosinusitis who refused IVIG. Immunoglobulinl intramuscularly administered at a dose of 0.3-0.4 ml/kg body weight for 3 days in a row 2-3 courses at intervals of 2-3 weeks. In the absence of clinical effect of said treatment for 2-3 months, we used IVIG at a dose of 200-400 mg/kg 1 month 1-3 courses with the consent of the patient. The clinical ohserved in 49 patients (87%), which was to reduce the number, severity and duration of exacerhations course rhinosinusitis. After IVIG were marked with significantly higher serum concentrations of total IgE in patients with total and partial deficiency compared with the results of intramuscular immunoglobulin. During treatment significantly increased serum concentration not only IgE (from 3.05 IU/ml ± 1.21 IU/ml to 12.5/IU/ml ± 1.86 IU/ml in total deficit; P rhinosinusitis deficient IgE. This clinical and immunological effects we regarded as the influence of small doses of immunoglobulin to Fc-receptors on B lymphocytes mediated by regulatory mechanism of antibody production (Bayry J. et al).

  11. Meta-analysis of adjunctive levetiracetam in refractory partial sei

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    ZHANG Ying

    2012-10-01

    Full Text Available Objective To evaluate the effects and tolerability of adjunctive levetiracetam (LEV in refractory partial seizures. Methods Relevant research articles about randomized controlled trials of adjunctive LEV in refractory partial seizures from January 1998 to December 2010 were retrieved from Cochrane Library, MEDLINE, EMbase, Social Sciences Citation Index (SSCI, VIP, Chinese National Knowledge Infrastructure (CNKI database, China Biology Medicine (CBM. Two reviewers independently evaluated the quality of the included articles and abstracted the data. A Meta-analysis was conducted by using RevMan 5.0 software. Results According to the enrollment criteria, eleven prospective, randomized controlled clinical trials with a total of 1192 in LEV group and 789 in placebo group were finally selected. The reduction in three endpoints (a 50% or greater reduction of partial seizure frequency per week, a 75% or greater reduction of partial seizure frequency per week and seizure free was significant in LEV group than placebo group. There was no significance between LEV group and placebo group in the withdrawl rate (1000 mg/d: OR = 1.180, 95%CI: 0.690-2.010, P = 0.540; 2000 mg/d: OR = 1.530, 95%CI: 0.770-3.030, P = 0.230; 3000 mg/d: OR = 1.000, 95% CI: 0.620-1.600, P = 1.000. The following adverse events were associated with LEV: somnolence (OR = 1.720, 95%CI: 1.280-2.310, P = 0.000, dizziness (OR = 1.490, 95%CI: 1.000-2.220, P = 0.050, asthenia (OR = 1.670, 95%CI: 1.140-2.240, P = 0.008, nasopharyngitis (OR = 1.120, 95% CI: 0.710-1.760, P = 0.630, psychiatric and behavioral abnormalities (OR = 2.120, 95% CI: 1.370-3.280, P = 0.000. Conclusion LEV is effective and well tolerated when added to existing therapy in patients with refractory partial seizures compared with control drugs. Further studies are needed to identify the effects of monotherapy of LEV in partial seizures.

  12. Refractory Epistaxis due to Severe Factor V Deficiency with Inhibitor

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    Elizabeth S. John

    2015-01-01

    Full Text Available Factor V deficiency secondary to inhibitors is extremely rare and can be caused by a wide collection of exposures such as bovine thrombin and beta lactamase antibiotics. The management of factor V deficiency with inhibitor is a condition treated based on case reports due to the rarity of this condition. We describe a complicated case of an elderly patient with severe factor V deficiency with high inhibitor titer refractory to FEIBA (anti-inhibitor coagulation complex treated with NovoSeven concurrently with cyclosporine immunosuppression and Rituxan. Given that there are no consensus guidelines on treatment, this case offers important insight into the therapeutic approaches that can be used to treat such patients.

  13. Treatment of refractory hemodialysis ascites with maintenance peritoneal dialysis.

    Science.gov (United States)

    Ing, T S; Daugirdas, J T; Popli, S; Kheirbek, A O; Humayun, H M; Gandhi, V C; Chapa, S M

    1981-04-01

    In 5 patients who were receiving maintenance hemodialysis, ascites developed that was refractory to treatment by ultrafiltration during hemodialysis. Use of sequential isolated ultrafiltration and hemodialysis therapy either precipitated side effects or else required prolongation of total treatment time which the patients declined to accept. In 4 of the patients, ascites was believed to be primarily responsible for severe, progressive cachexia. Maintenance peritoneal dialysis was instituted in all patients, and abdominal fluid was removed gradually, over a period of 2 to 3 days. Ascites resolved promptly in each case. Three patients noted a dramatic improvement in appetite after relief of abdominal distension. Follow-up periods ranged from 6 to 4 1/2 years. Our results suggest that maintenance peritoneal dialysis can successfully control hemodialysis ascites.

  14. Refractory pediatric cardiogenic shock: A case for mechanical support

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    Anil Sachdev

    2016-01-01

    Full Text Available Acute left ventricular dysfunction in children justifies aggressive treatment because of the high potential for complete recovery. The options for providing mechanical support to the failing heart in a child include extracorporeal membrane oxygenation, left ventricular assist devices, and the use of the intra-aortic balloon pump (IABP. The IABP is a commonly used method of temporary circulatory support in adults. However, despite the availability of pediatric size balloons, the usage of IABP for temporary circulatory support in children has not been widespread. Current case report, first from India in pediatric age group, aims to aware the pediatric intensivist about the role of IABP in providing temporary mechanical cardiovascular support in managing patients with refractory low cardiac output state.

  15. Update on the Diagnosis and Management of Refractory Coeliac Disease

    Directory of Open Access Journals (Sweden)

    Petula Nijeboer

    2013-01-01

    Full Text Available A small subset of coeliac disease (CD patients experiences persisting or recurring symptoms despite strict adherence to a gluten-free diet (GFD. When other causes of villous atrophy have been excluded, these patients are referred to as refractory celiac disease (RCD patients. RCD can be divided in two types based on the absence (type I or presence (type II of an, usually clonal, intraepithelial lymphocyte population with aberrant phenotype. RCDI usually runs a benign course and may be difficult to be differentiated from uncomplicated, slow responding CD. In contrast, RCDII can be defined as low-grade intraepithelial lymphoma and frequently transforms into an aggressive enteropathy associated T-cell lymphoma with dismal prognosis. This paper describes the clinical characteristics of RCDI and RCDII, diagnostic approach, and the latest insights in treatment options.

  16. [Molecular-targeted therapy for hormone-refractory prostate cancer].

    Science.gov (United States)

    Nishimura, Kazuo; Takayama, Hitoshi; Nakayama, Masashi; Nonomura, Norio; Okuyama, Akihiko

    2006-06-01

    Molecular-targeted therapy is to treat pathologic pathways specifically in tumor cell or tumor microenvironment. Specific molecular-targeted therapeutic agents for hormone-refractory prostate cancer (HRPC) include endothelin-A receptor antagonist, EGF receptor (EGFR) inhibitor, platelet derived growth factor receptor (PDGFR) inhibitor, nuclear factor of kappaB (NF-kappaB) inhibitor, cyclooxygenase-2 (COX2) inhibitor, and active form of Vitamin D. These agents have been investigated in clinical trials. So far, none of the above-mentioned agent has shown a sufficient clinical efficacy alone. However, docetaxel-based combinations with thalidomide or calcitriol have promising clinical activities. Further investigations are needed to optimize the molecular-targeted agents in the combinations with chemotherapeutic agents for the treatment of HRPC.

  17. Neurobiochemical mechanisms of a ketogenic diet in refractory epilepsy

    Directory of Open Access Journals (Sweden)

    Patricia Azevedo de Lima

    2014-12-01

    Full Text Available A ketogenic diet is an important therapy used in the control of drug-refractory seizures. Many studies have shown that children and adolescents following ketogenic diets exhibit an over 50% reduction in seizure frequency, which is considered to be clinically relevant. These benefits are based on a diet containing high fat (approximately 90% fat for 24 months. This dietary model was proposed in the 1920s and has produced variable clinical responses. Previous studies have shown that the mechanisms underlying seizure control involve ketone bodies, which are produced by fatty acid oxidation. Although the pathways involved in the ketogenic diet are not entirely clear, the main effects of the production of ketone bodies appear to be neurotransmitter modulation and antioxidant effects on the brain. This review highlights the impacts of the ketogenic diet on the modulation of neurotransmitters, levels of biogenic monoamines and protective antioxidant mechanisms of neurons. In addition, future perspectives are proposed.

  18. Relative Refractory Period in an Excitable Semiconductor Laser

    Science.gov (United States)

    Selmi, F.; Braive, R.; Beaudoin, G.; Sagnes, I.; Kuszelewicz, R.; Barbay, S.

    2014-05-01

    We report on experimental evidence of neuronlike excitable behavior in a micropillar laser with saturable absorber. We show that under a single pulsed perturbation the system exhibits subnanosecond response pulses and analyze the role of the laser bias pumping. Under a double pulsed excitation we study the absolute and relative refractory periods, similarly to what can be found in neural excitability, and interpret the results in terms of a dynamical inhibition mediated by the carrier dynamics. These measurements shed light on the analogy between optical and biological neurons and pave the way to fast spike-time coding based optical systems with a speed several orders of magnitude faster than their biological or electronic counterparts.

  19. Structural and microstructural characterisation of refractory oxides synthesised by laser

    Energy Technology Data Exchange (ETDEWEB)

    Bakali, J.; Fortanet, E. [Esmaltes S. A., Alcora (Spain); Fuente, X. de la; Lahoz, R.; Estepa, L.C. [Inst. de Ciencia de Materiales de Aragon (CSIC), Zaragoza (Spain); Peris, G. [Servei Central d' Instrumentacio Cientifica, Univ. Jaume I, Castellon (Spain); Marinova, I.; Pavlov, R.; Pedra, J.M.; Carda, J. [Dept. de Quimica Inorganica y Organica, Univ. Jaume I, Castellon (Spain)

    2004-07-01

    Several ceramic materials have been chosen and synthesized by selective fusion by laser (SFL). These materials have been selected because their refractory condition, high hardness and good colouring power, that make them useful to be used as ceramic pigments. In the present work it is shown the structural and microstructural characterisation of these materials prepared by laser assisted synthesis, individually and into a vitreous matrix (glaze) and subjected to a firing cycle with a maximum (highest) temperature of 1200 C. The techniques used in the characterisation have been scanning electron microscopy (SEM), X-ray diffraction (XRD), thermal analysis as differential thermal analysis (DTA) and thermogravimetry (TG) and UV-Vis spectroscopy to obtain their CIE-Lab chromatic coordinates. (orig.)

  20. Neurobiochemical mechanisms of a ketogenic diet in refractory epilepsy.

    Science.gov (United States)

    Lima, Patricia Azevedo de; Sampaio, Leticia Pereira de Brito; Damasceno, Nágila Raquel Teixeira

    2014-12-01

    A ketogenic diet is an important therapy used in the control of drug-refractory seizures. Many studies have shown that children and adolescents following ketogenic diets exhibit an over 50% reduction in seizure frequency, which is considered to be clinically relevant. These benefits are based on a diet containing high fat (approximately 90% fat) for 24 months. This dietary model was proposed in the 1920s and has produced variable clinical responses. Previous studies have shown that the mechanisms underlying seizure control involve ketone bodies, which are produced by fatty acid oxidation. Although the pathways involved in the ketogenic diet are not entirely clear, the main effects of the production of ketone bodies appear to be neurotransmitter modulation and antioxidant effects on the brain. This review highlights the impacts of the ketogenic diet on the modulation of neurotransmitters, levels of biogenic monoamines and protective antioxidant mechanisms of neurons. In addition, future perspectives are proposed.

  1. Refractory absorber/emitter using monolayer of ceramic microparticles

    Science.gov (United States)

    Dyachenko, P. N.; do Rosário, J. J.; Leib, E. W.; Petrov, A. Y.; Störmer, M.; Weller, H.; Vossmeyer, T.; Schneider, G. A.; Eich, M.

    2016-04-01

    We present a self-assembled refractory absorber/emitter without the necessity to structure the metallic surface itself, still retaining the feature of tailored optical properties for visible light emission and thermophotovoltaic (TPV) applications. We have demonstrated theoretically and experimentally that monolayers of zirconium dioxide (ZrO2) microparticles on a tungsten layer can be used as large area, efficient and thermally stable selective absorbers/emitters. The band edge of the absorption is based on critically coupled microsphere resonances. It can be tuned from visible to near-infrared range by varying the diameter of the microparticles. We demonstrated the optical functionality of the structure after annealing up to temperatures of 1000°C under vacuum conditions. In particular it opens up the route towards high efficiency TPV systems with emission matched to the photovoltaic cell.

  2. Propylene Glycol Toxicity in Adolescent with Refractory Myoclonic Status Epilepticus

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    Kara A. Bjur

    2017-01-01

    Full Text Available Propylene glycol (PG is a solvent commonly used in medications that, while benign at low doses, may cause toxicity in adults and children at high doses. We describe a case and the physiologic sequelae of propylene glycol toxicity manifested in a critically ill adolescent male with refractory myoclonic status epilepticus aggressively treated with multiple PG-containing medications (lorazepam, phenobarbital, and pentobarbital—all within accepted dosing guidelines and a total daily PG exposure previously recognized to be safe. Hemodynamic measurements by bedside echocardiography during clinical toxicity are also reported. Clinicians should have a high index of suspicion for propylene glycol toxicity in patients treated with PG-containing medications even when the total PG exposure is lower than currently accepted limits.

  3. Exophiala oligosperma involved in a refractory chronic rhinosinusitis.

    Science.gov (United States)

    Badali, H; Hedayati, M T; Bahoosh, M; Kasir, A; Ghasemi, M; Motahari, J; Meis, J F; De Hoog, G S

    2011-03-01

    Fungal rhinosinusitis refers to a wide variety of conditions caused by fungal infections of the paranasal sinuses. Allergic fungal rhinosinusitis and sinus fungus balls are mostly noted in healthy individuals. Aspergillus species are supposed to be the most common etiologic agents of the disorder, but melanized fungi also occur, and these potentially are able to lead to fatal dissemination into brain parenchyma. We report on a case of fungus ball in a 20-year-old female with refractory chronic rhinosinusitis (RCRS) and bronchial asthma due to the black yeast Exophiala oligosperma which was confirmed by mycological and molecular (sequences of ITS rDNA) investigations. Exophiala oligosperma has previously not been reported to cause fungus balls or invasive fungal rhinosinusitis. Patient underwent functional endoscopic sinusitis surgery and the hypertrophic mucosa was removed completely. Without antifungal therapy, successful cure was achieved after spray therapy with corticosteroids for 1 month, without any relapse after a 6 month-follow up.

  4. Treatment-refractory anxiety; definition, risk factors, and treatment challenges.

    Science.gov (United States)

    Roy-Byrne, Peter

    2015-06-01

    A sizable proportion of psychiatric patients will seek clinical evaluation and treatment for anxiety symptoms reportedly refractory to treatment. This apparent lack of response is either due to "pseudo-resistance" (a failure to have received and adhered to a recognized and effective treatment or treatments for their condition) or to true "treatment resistance." Pseudo-resistance can be due to clinician errors in selecting and delivering an appropriate treatment effectively, or to patient nonadherence to a course of treatment. True treatment resistance can be due to unrecognized exogenous anxiogenic factors (eg, caffeine overuse, sleep deprivation, use of alcohol or marijuana) or an incorrect diagnosis (eg, atypical bipolar illness, occult substance abuse, attention deficit-hyperactivity disorder). Once the above factors are eliminated, treatment should focus on combining effective medications and cognitive behavioral therapy, combining several medications (augmentation), or employing novel medications or psychotherapies not typically indicated as first-line evidence-based anxiety treatments.

  5. Thoracoscopy for diagnosis and management of refractory hepatic hydrothorax

    Institute of Scientific and Technical Information of China (English)

    LIN Dian-jie; ZHANG Min; GAO Gui-xin; LI Bin; WANG Mao-fen; ZHU Ling; XUE Li-fu

    2006-01-01

    @@ The prevalence of pleural effusion caused by hepatocirrhosis ranges from 0.4% to 30%. Some patients with hepatic hydrothorax (HH) fail to respond to aggressive medical management such as albumin application, diuretics, and thoracentesis,and remain refractory massive pleural fluid.1 The repeated suctions to relieve the symptoms such as respiratory distress are associated with significant hyponatremia and hypoalbuminemia caused by the large volumes of fluid loss. Review of the literature has revealed that, to date, no therapy is ideal. This report describes our experiments in treating HH of patients with cirrhosis and ascites by thoracoscopy and talc poudrage, to offer our efforts to approach the pathogenesis of HH and to explore the new therapeutic strategy.

  6. Treatment of refractory epilepsy with the modified Atkins diet.

    Science.gov (United States)

    Vaccarezza, María Magdalena; Toma, Marisol Vanesa; Ramos Guevara, Juan David; Diez, Cecilia Griselda; Agosta, Guillermo Eduardo

    2014-08-01

    The modified Atkins diet (MAD) is an alternative therapeutic diet for the treatment of drug-resistant epilepsy. It consists of a diet with 60% energy from fat, 30% from protein, and 10% from carbohydrates. The objective of this article is to present a series of nine patients diagnosed with refractory epilepsy of different etiologies treated with the MAD at our hospital. In our group of nine patients, results obtained were similar to those published by other authors, with adequate adherence, tolerance and response. Of all patients, two achieved a reduction of more than 90% in the number of seizures; four experienced a reduction of 50-90%; two had a reduction of less than 50% in seizure control; and only one patient did not respond to the MAD. No patient had an increase in the number of seizures, and the diet was well-tolerated in all cases.

  7. Fracture characteristics of refractory composites containing metakaolin and ceramic fibers

    Directory of Open Access Journals (Sweden)

    Ondřej Holčapek

    2015-03-01

    Full Text Available The aim of present article is to describe influence of composition of refractory composites on its response to gradual thermal loading. Attention was focused on the impact of ceramic fibers and application of metakaolin as an aluminous cement supplementary material. Studied aluminate binder system in combination with natural basalt fine aggregates ensures sufficient resistance to high-temperature exposure. Influence of composition changes was evaluated by the results of physical and mechanical testing—compressive and flexural strength, bulk density, and fracture energy were determined on the different levels of temperature loading. Application of ceramic fibers brought expected linear increase of ductility in studied composites. Metakaolin replacement showed the optimal dose to be just about 20% of aluminous cement weight.

  8. Cannabidiol as potential treatment in refractory pediatric epilepsy.

    Science.gov (United States)

    Paolino, Maria Chiara; Ferretti, Alessandro; Papetti, Laura; Villa, Maria Pia; Parisi, Pasquale

    2016-01-01

    In recent years there has been great scientific and public interest focused on the therapeutic potential of compounds derived from cannabis for the treatment of refractory epilepsy in children. From in vitro and in vivo studies on animal models, cannabidiol (CBD) appears to be a promising anticonvulsant drug with a favorable side-effect profile. In humans, CBD efficacy and safety is not supported by well-designed trials and its use has been described by anecdotal reports. It will be necessary to investigate CBD safety, pharmacokinetics and interaction with other anti-epileptic drugs (AEDs) alongside performing double-blinded placebo-controlled trials in order to obtain conclusive data on its efficacy and safety in children.

  9. Biodesulfurization of refractory organic sulfur compounds in fossil fuels.

    Science.gov (United States)

    Soleimani, Mehran; Bassi, Amarjeet; Margaritis, Argyrios

    2007-01-01

    The stringent new regulations to lower sulfur content in fossil fuels require new economic and efficient methods for desulfurization of recalcitrant organic sulfur. Hydrodesulfurization of such compounds is very costly and requires high operating temperature and pressure. Biodesulfurization is a non-invasive approach that can specifically remove sulfur from refractory hydrocarbons under mild conditions and it can be potentially used in industrial desulfurization. Intensive research has been conducted in microbiology and molecular biology of the competent strains to increase their desulfurization activity; however, even the highest activity obtained is still insufficient to fulfill the industrial requirements. To improve the biodesulfurization efficiency, more work is needed in areas such as increasing specific desulfurization activity, hydrocarbon phase tolerance, sulfur removal at higher temperature, and isolating new strains for desulfurizing a broader range of sulfur compounds. This article comprehensively reviews and discusses key issues, advances and challenges for a competitive biodesulfurization process.

  10. Westphal variant Huntington disease and refractory catatonia: a case report.

    Science.gov (United States)

    Merida-Puga, Jorge; Ramirez-Bermudez, Jesus; Aguilar-Venegas, Luis Carlos; Fricchione, Gregory L; Espinola-Nadurille, Mariana

    2011-12-01

    A young woman with Westphal variant (juvenile) Huntington disease (HD) also developed catatonia. Catatonia is an underdiagnosed psychomotor syndrome often associated with neurological and psychiatric disorders, but it has rarely been documented in patients with HD. Catatonia usually responds to standard treatment with benzodiazepines and electroconvulsive therapy; however, this patient's catatonic syndrome did not improve until we augmented the standard treatment with amantadine and levodopa. The underlying pathophysiology and a neurochemical hypothesis of HD and catatonia can explain their comorbidity and the refractoriness of catatonia to treatment. Both conditions are linked to dysregulation of neurotransmitters in the striatocortical and corticocortical pathways. This understanding may serve as a guide for the use of nonstandard treatments. Our evidence also suggests that electroconvulsive therapy can be useful and safe in the treatment of HD.

  11. Successful treatment of refractory Trichomonas vaginalis infection using intravenous metronidazole.

    Science.gov (United States)

    Hawkins, Isobel; Carne, Christopher; Sonnex, Christopher; Carmichael, Andrew

    2015-08-01

    Trichomonas vaginalis is a sexually transmitted protozoan infection resulting in a vulvo-vaginitis and altered vaginal discharge in symptomatic women. Since its introduction in the 1960 s, metronidazole has been the first-line drug for trichomonal infection. Other nitroimidazoles, such as tinidazole, are used as alternative regimens with similar activity but at a greater expense. Treatment failure usually represents patient non-compliance or reinfection, although metronidazole resistance has previously been documented. Sensitivity testing is currently not available in the UK. Patients with disease unresponsive to first-line treatments pose a major challenge, as therapeutic options are limited. This case looks at a patient with refractory disease over an 18-month period, where intravenous infusion of metronidazole resulted in cure after multiple previous therapy failures. There is limited evidence to endorse the use of intravenous metronidazole, and this case report provides further support for its efficacy.

  12. Refractory anemia with ring sideroblasts and RARS with thrombocytosis.

    Science.gov (United States)

    Patnaik, Mrinal M; Tefferi, Ayalew

    2015-06-01

    Ring sideroblasts (RS) are erythroid precursors with abnormal perinuclear mitochondrial iron accumulation. Two myeloid neoplasms defined by the presence of RS, include refractory anemia with ring sideroblasts (RARS) and RARS with thrombocytosis (RARS-T). RARS is a lower risk myelodysplastic syndrome (MDS) with dysplasia limited to the erythroid lineage, thrombocytosis. Both RARS and RARS-T have a low risk of leukemic transformation. Anemia and iron overload are complications in both diseases and are managed similar to lower risk MDS. Aspirin therapy is reasonable in RARS-T, especially in the presence of JAK2V617F, but the value of platelet-lowering drugs is uncertain. Case reports of RARS-T therapy with lenalidomide warrant additional studies. © 2015 Wiley Periodicals, Inc.

  13. The evaluation and management of refractory neurogenic overactive bladder.

    Science.gov (United States)

    Kurpad, Raj; Kennelly, Michael J

    2014-10-01

    Patients with neurologic disease commonly develop overactive bladder (OAB) symptoms of urgency, frequency, and/or urge incontinence that remain bothersome despite oral pharmacologic therapy. Management of refractory OAB in the neurogenic population is a complex issue with no uniform treatment strategy. When treatment fails or patients generally are dissatisfied with the adverse effects of oral therapy, available options include sacral neuromodulation, percutaneous tibial nerve stimulation (PTNS), botulinum toxin injections, and lower urinary tract reconstruction such as augmentation cystoplasty. A thorough knowledge and understanding of available and emerging treatment options for neurogenic detrusor overactivity is paramount to assisting clinicians in choosing an appropriate treatment. This article reviews the non-pharmacologic treatment options for neurogenic OAB, mainly botulinum toxin, neuromodulation, and lower urinary tract reconstruction, and discusses important relevant studies.

  14. Refractory cardiopulmonary failure after glyphosate surfactant intoxication: a case report

    Directory of Open Access Journals (Sweden)

    Chang Chia-Chu

    2009-01-01

    Full Text Available Abstract Background Glyphosate is an herbicide considered to be of low toxicity to humans because its effects are specific to plants. However, fatal reactions to glyphosate have been reported after the ingestion of large amounts. Pulmonary edema, shock, and arrhythmia were the reported causes of mortality. Case presentation We present the case of a 57-year-old woman who was admitted to the emergency department unconsciousness after ingestion of glyphosate surfactant in a suicide attempt. Metabolic acidosis, refractory respiratory failure, and shock developed during hospitalization. Despite aggressive supportive care, the patient died in the hospital. Conclusion The toxicokinetics of glyphosate surfactant is complicated. Respiratory failure, metabolic acidosis, tachycardia, elevated creatinine, and hyperkalemia are poor prognostic factors if presented. Physicians should consider using hemodialysis early to improve the outcome of patients with glyphosate surfactant intoxication.

  15. Pica and refractory iron deficiency anaemia: a case report

    Directory of Open Access Journals (Sweden)

    von Garnier Christophe

    2008-10-01

    Full Text Available Abstract Introduction Iron deficiency is the most common cause of anaemia worldwide. Pica, the ingestion of substances that are inappropriate for consumption, is associated with iron deficiency and may be under-diagnosed. Case presentation A 34-year-old woman presented with iron deficiency anaemia refractory to treatment for more than a decade. The clinical presentation, endoscopic findings and laboratory investigations were consistent with pica. Subsequent geophysical analysis confirmed that the ingested material was kaolin, a negatively charged silicate. Conclusion Prolonged unexplained iron deficiency anaemia should prompt clinicians to remember and inquire about pica. In our patient, this would have averted numerous unnecessary investigations and prevented a decade-long suffering.

  16. [Refractory ascites and dilutional hyponatremia: current management and new aquaretics].

    Science.gov (United States)

    Torre Delgadillo, Aldo

    2005-01-01

    Ascites is the most common complication of cirrhosis and is associated with 50% mortality at 2 years if patients do not receive orthotopic liver transplantation. Recently the International Ascites Club defined ascites into three groups: In grade I ascites fluid is detected only by ultrasound; in grade II, ascites is moderate with symmetrical distention of the abdomen; and in Grade 3 ascites is large or tense with marked abdominal distention. About 10% of patients with ascites are refractory to treatment with diuretics. In refractory ascites, patients do not respond to highest doses of diuretics (spironolactone 400 mg/day and furosemide 160 mg/ day) or develop side effects (hyperkalemia, hyponatremia, hepatic encephalopathy, or renal failure) that prohibit their use. Patients may be treated either by repeated large volume paracentesis plus albumin or transjugular intrahepatic portosystemic shunts (TIPS). Dilutional hyponatremia in cirrhotic patients is defined as serum sodium < or = 130 mEq/L in the presence of an expanded extracellular fluid volume, as indicated by the presence of ascites and/or edema. This complication of cirrhotic patients with ascites has recently gained attention given that several reports indicate that when serum sodium concentration is combined with the Model for End-Stage liver disease (MELD) it improves the prognostic accuracy of MELD score in patients awaiting orthotopic liver transplant (OLT). The first step in the management of dilutional hyponatremia is fluid restriction and discontinuation of diuretics. Water restriction at 1,000 mL/day helps prevent the progressive decrease in serum sodium concentration but usually does not correct hyponatremia in most cases. Actually are developing drugs that are active orally and act by selectively antagonizing the specific receptors (V2 receptor) of arginine vasopressin. These agents act in the distal collecting ducts of the kidneys, by increasing solute free water excretion and, thus, improving

  17. Cross-sectional imaging in refractory celiac disease.

    Science.gov (United States)

    Al-Bawardy, Badr; Barlow, John M; Vasconcelos, Rogerio N; Kim, Sarasa T; Bruining, David H; Hansel, Stephanie L; Sheedy, Shannon P; Murray, Joseph A; Rubio-Tapia, Alberto; Rajan, Elizabeth; Fidler, Jeff L; Fletcher, Joel G

    2017-02-01

    The purpose of this study is to identify unique imaging findings of refractory celiac disease (RCD) including Type I RCD, Type II RCD versus healed celiac disease (CD). A retrospective study of patients with known CD and refractory symptoms with cross-sectional imaging was performed. We included patients who underwent T cell receptor rearrangement or T-cell immunophenotyping studies on small bowel (SB) biopsies to classify patients into: healed CD, Type I RCD, or Type II RCD. GI radiologists performed a blinded review of the imaging studies. One-hundred eighteen patients (32 healed; 67 Type I RCD; 19 Type II RCD) were included (mean age 53 ± 6 years; 62% female). The presence of any fold pattern abnormality was more likely to be found in Type II and Type I RCD than healed CD (53% vs. 43% vs.16%; p = 0.009). Type II RCD patients were more likely than Type I RCD and healed CD to have imaging findings of ulcerative jejunitis (26% vs. 6% vs. 3%; p = 0.009), SB wall thickening (37% vs. 16% vs. 0%; p = 0.002) and SB dilation (26% vs. 7% vs. 6%; p = 0.04). Type II RCD demonstrated non-significant trends for decreased number of jejunal folds only, SB mass, mesenteric lymphadenopathy, localized peri-mural edema, and intramural duodenal edema. Fold pattern abnormalities, ulcerative jejunitis, SB wall thickening, and SB dilation are more likely to be identified in cross-sectional imaging of RCD than healed CD. SB dilatation and ulcerative jejunitis are more likely to be found in Type II than Type I RCD.

  18. Phenobarbital for Neonatal Seizures: Response Rate and Predictors of Refractoriness.

    Science.gov (United States)

    Spagnoli, Carlotta; Seri, Stefano; Pavlidis, Elena; Mazzotta, Silvia; Pelosi, Annalisa; Pisani, Francesco

    2016-10-01

    Background Phenobarbital is the first-line choice for neonatal seizures treatment, despite a response rate of approximately 45%. Failure to respond to acute anticonvulsants is associated with poor neurodevelopmental outcome, but knowledge on predictors of refractoriness is limited. Objective To quantify response rate to phenobarbital and to establish variables predictive of its lack of efficacy. Methods We retrospectively evaluated newborns with electrographically confirmed neonatal seizures admitted between January 1999 and December 2012 to the neonatal intensive care unit of Parma University Hospital (Italy), excluding neonates with status epilepticus. Response was categorized as complete (cessation of clinical and electrographic seizures after phenobarbital administration), partial (reduction but not cessation of electrographic seizures with the first bolus, response to the second bolus), or absent (no response after the second bolus). Multivariate analysis was used to identify independent predictors of refractoriness. Results Out of 91 newborns receiving phenobarbital, 57 (62.6%) responded completely, 15 (16.5%) partially, and 19 (20.9%) did not respond. Seizure type (p = 0.02), background electroencephalogram (EEG; p ≤ 0.005), and neurologic examination (p  ≤  0.005) correlated with response to phenobarbital. However, EEG (p  ≤  0.02) and seizure type (p  ≤  0.001) were the only independent predictors. Conclusion Our results suggest a prominent role of neurophysiological variables (background EEG and electrographic-only seizure type) in predicting the absence of response to phenobarbital in high-risk newborns. Georg Thieme Verlag KG Stuttgart · New York.

  19. Refractory epilepsy and basal ganglia: the role of seizure frequency

    Energy Technology Data Exchange (ETDEWEB)

    Bouilleret, V.; Trebossen, R.; Mantzerides, M.; Semah, F.; Ribeiro, M.J. [Service Hospitalier Frederic Joliot, I2BM/DSV, CEA, 91 - Orsay (France); Bouilleret, V. [CHU Bicetre, Unite de Neurophysiologie et d' Epileptologie, AP-HP, 75 - Paris (France); Chassoux, F. [Hopital Saint Anne, Service de Neurochirurgie, 75 - Paris (France); Biraben, A. [CHU, Service de Neurologie, Hopital Pontchaillou, 35 - Rennes (France)

    2008-02-15

    Objectives. - A decrease of [{sup 18}F]Fluoro-L-DOPA uptake in basal ganglia (B.G.) was recently reported in medically refractory epilepsy. The purpose of this study was to assess the involvement of dopaminergic neurotransmission in refractory Temporal Lobe Epilepsy (T.L.E.) and its relationship to glucose metabolism and morphological changes. Methods. - Twelve T.L.E. patients were studied using [{sup 18}F]FDG PET, [{sup 18}F]Fluoro-L-DOPA PET and MRI and compared with healthy control volunteers. Morphological cerebral changes were assessed using Voxel-Based Morphometry (V.B.M.). Student t test statistical maps of functional and morphological differences between patients and controls were obtained using a general linear model. Results. - In T.L.E. patients, [{sup 18}F]Fluoro-L-DOPA uptake was reduced to the same extent in caudate and putamen in both cerebral hemispheres as well as in the substantia nigra (S.N.). These dopaminergic functional alterations occurred without any glucose metabolism changes in these areas. The only mild morphological abnormality was found in striatal regions without any changes in the S.N.. Conclusion. - The present study provides support for dopaminergic neurotransmission involvement in T.L.E.. The discrepancies between G.M.V. atrophy and the pattern of [{sup 18}F]Fluoro-L-DOPA suggest that B.G. involvement is not related to structural subcortical abnormalities. A functional decrease can be ruled out as there was no change of the glycolytic pathway metabolism in these areas. (authors)

  20. Emerging role of multikinase inhibitors for refractory thyroid cancer

    Directory of Open Access Journals (Sweden)

    Perez CA

    2012-08-01

    Full Text Available Cesar A Perez,1 Belisario A Arango,1 Michel Velez,1 Luis E Raez,2 Edgardo S Santos11University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, USA; 2Memorial Cancer Institute, Memorial Health Care System, Hollywood, FL, USAAbstract: Thyroid cancer incidence continues to increase, remaining the most common endocrine malignancy. The need for effective systemic therapies combined with high incidence of driver mutations and overexpression of molecular pathways make refractory thyroid cancer an ideal candidate for treatment with novel agents. Multikinase inhibitors have caused a paradigm shift in the treatment of patients with advanced iodine-refractory thyroid cancer. These agents have shown to be the most effective systemic therapy for this disease not only causing prolonged responses but also improving survival. The activity of these agents inhibiting several pathways simultaneously, such as rearranged during transfection protooncogene, mitogen-activated protein kinase, and angiogenesis, can probably explain the effectiveness in controlling the progression of this malignancy. Several of these agents are currently on clinical studies in patients with differentiated and medullary thyroid cancer and most of them are showing promising clinical activity. With the approval of vandetanib for the treatment of medullary thyroid cancer, a new era in the management of this disease has begun. The molecular rationale for the use of these drugs for thyroid cancer is discussed as well as their promising clinical results.Keywords: axitinib, cabozantinib, lenvatinib, mitogen-activated protein kinase (MAPK, motesanib, pazopanib, thyroid cancer, vandetanib, vascular endothelial growth factor receptor-2 (VEGFR2

  1. Disrupting Disordered Neurocircuitry: Treating Refractory Psychiatric Illness With Neuromodulation

    Science.gov (United States)

    Tye, Susannah J.; Frye, Mark A.; Lee, Kendall H.

    2009-01-01

    Despite the premature and somewhat infamous rise and fall of psychosurgery in the mid-20th century, the current era of functional neuromodulation proffers immense opportunity for surgical intervention in treatment-resistant psychiatric disorders. On the basis of recent successes with novel, focused, less invasive, and reversible treatment strategies for movement disorders, several therapeutic trials have been conducted to investigate the effectiveness of deep brain stimulation (DBS) in treatment-resistant depression, obsessive-compulsive disorder (OCD), and Tourette syndrome. The many anatomic targets for these psychiatric disorders are indicative of both the system-wide effects of DBS and the network-level dysfunction mediating the emotional and cognitive disturbances. To gain insight into the application of neuromodulation therapies and their further advancement, we must elucidate neuroanatomic networks involved in refractory psychiatric illness, the neurophysiological anomalies that contribute to disordered information processing therein, and the local and system-wide modulatory effects of DBS. This review discusses the history of psychosurgical procedures, recent DBS clinical data, current anatomic models of psychopathology, and possible therapeutic mechanisms of action of DBS neuromodulation. Our search criteria for PubMed included combinations of the following terms: neuromodulation, DBS, depression, OCD, Tourette syndrome, mechanism of action, and history. Dates were not restricted. As clinical and basic scientific investigations probe the neuromodulatory effects of DBS in the treatment of refractory neuropsychiatric illness, our knowledge of these disorders and our potential to treat them are rapidly expanding. Indeed, this modern era of neuromodulation may provide the key that unlocks many of the mysteries pertaining to the biological basis of disordered emotional neurocircuitry. PMID:19483169

  2. Arthroscopic treatment of refractory adhesive capsulitis of the shoulder

    Directory of Open Access Journals (Sweden)

    Marcos Rassi Fernandes

    Full Text Available OBJECTIVE: to evaluate the results of arthroscopic treatment of refractory adhesive capsulitis of the shoulder associated as for improved range of motion after a minimum follow up of six years. METHODS: from August 2002 to December 2004, ten patients with adhesive capsulitis of the shoulder resistant to conservative treatment underwent arthroscopic surgery. One interscalene catheter was placed for postoperative analgesia before the procedure. All were in Phase II, with a minimum follow up of two years. The mean age was 52.9 years (39-66, predominantly female (90%, six on the left shoulder. The time between onset of symptoms and surgical treatment ranged from six to 20 months. Four adhesive capsulitis were found to be primary (40% and six secondary (60%. RESULTS: the preoperative mean of active anterior elevation was 92°, of external rotation was 10.5° of the L5 level internal rotation; the postoperative ones were 149°, 40° and T12 level, respectively. Therefore, the average gain was 57° for the anterior elevation, 29.5° for external rotation in six spinous processes. There was a significant difference in movements' gains between the pre and post-operative periods (p<0.001. By the Constant Score (range of motion, there was an increase of 13.8 (average pre to 32 points (average post. CONCLUSION: the arthroscopic treatment proved effective in refractory adhesive capsulitis of the shoulder resistant to conservative treatment, improving the range of joint movements of patients evaluated after a minimum follow up of six years.

  3. Efficacy of Anakinra in Refractory Adult-Onset Still's Disease

    Science.gov (United States)

    Ortiz-Sanjuán, Francisco; Blanco, Ricardo; Riancho-Zarrabeitia, Leyre; Castañeda, Santos; Olivé, Alejandro; Riveros, Anne; Velloso-Feijoo, María.L.; Narváez, Javier; Jiménez-Moleón, Inmaculada; Maiz-Alonso, Olga; Ordóñez, Carmen; Bernal, José A.; Hernández, María V.; Sifuentes-Giraldo, Walter A.; Gómez-Arango, Catalina; Galíndez-Agirregoikoa, Eva; Blanco-Madrigal, Juan; Ortiz-Santamaria, Vera; del Blanco-Barnusell, Jordi; De Dios, Juan R.; Moreno, Mireia; Fiter, Jordi; Riscos, Marina de los; Carreira, Patricia; Rodriguez-Valls, María J.; González-Vela, M. Carmen; Calvo-Río, Vanesa; Loricera, Javier; Palmou-Fontana, Natalia; Pina, Trinitario; Llorca, Javier; González-Gay, Miguel A.

    2015-01-01

    Abstract Adult-onset Still's disease (AOSD) is often refractory to standard therapy. Anakinra (ANK), an interleukin-1 receptor antagonist, has demonstrated efficacy in single cases and small series of AOSD. We assessed the efficacy of ANK in a series of AOSD patients. Multicenter retrospective open-label study. ANK was used due to lack of efficacy to standard synthetic immunosuppressive drugs and in some cases also to at least 1 biologic agent. Forty-one patients (26 women/15 men) were recruited. They had a mean age of 34.4 ± 14 years and a median [interquartile range (IQR)] AOSD duration of 3.5 [2–6] years before ANK onset. At that time the most common clinical features were joint manifestations 87.8%, fever 78%, and cutaneous rash 58.5%. ANK yielded rapid and maintained clinical and laboratory improvement. After 1 year of therapy, the frequency of joint and cutaneous manifestations had decreased to 41.5% and to 7.3% respectively, fever from 78% to 14.6%, anemia from 56.1% to 9.8%, and lymphadenopathy from 26.8% to 4.9%. A dramatic improvement of laboratory parameters was also achieved. The median [IQR] prednisone dose was also reduced from 20 [11.3–47.5] mg/day at ANK onset to 5 [0–10] at 12 months. After a median [IQR] follow-up of 16 [5–50] months, the most important side effects were cutaneous manifestations (n = 8), mild leukopenia (n = 3), myopathy (n = 1), and infections (n = 5). ANK is associated with rapid and maintained clinical and laboratory improvement, even in nonresponders to other biologic agents. However, joint manifestations are more refractory than the systemic manifestations. PMID:26426623

  4. Oxcarbazepine for refractory epilepsy: systematic review of the literature

    Directory of Open Access Journals (Sweden)

    Humberto Saconato

    Full Text Available CONTEXT AND OBJECTIVE: It has been estimated that 50 million people worldwide suffer from epilepsy and around 30% will not achieve adequate control over the disease. The aim was to evaluate the effectiveness of oxcarbazepine for refractory partial or generalized epilepsy. METHODS: Systematic review. A search was conducted in the PubMed, Lilacs, EMBASE and CENTRAL databases. Studies were analyzed using the Cochrane Collaboration methodology. RESULTS: Four randomized clinical trials of medium to poor methodological quality were included. Among the adult patients, the chances that they would obtain a 50% reduction in seizure frequency were greater after using oxcarbazepine at doses of 600 mg (relative risk, RR 2.11; 95% confidence interval, CI 1.32 to 3.35, 1,200 mg (RR 3.24; 95% CI 2.11 to 4.98 and 2,400 mg (RR 3.83; 95% CI 2.59 to 5.97. Among the children, the response in the group using oxcarbazepine was also greater (RR 2.11; 95% CI 1.32 to 3.35. The oxcarbazepine doses of 1,200 mg (RR 17.59; 95% CI 2.37 to 130.35 and 2,400 mg (RR 25.41; 95% CI 6.26 to 103.10 were effective for keeping patients probably free from seizures, but the dose of 600 mg was not. There was no significant difference between oxcarbazepine and carbamazepine for controlling the crises. CONCLUSIONS: There is moderate evidence indicating that oxcarbazepine is effective as an alternative treatment for partial or generalized epilepsy in children and adults who were refractory to previous treatment

  5. 90Y-edotreotide for metastatic carcinoid refractory to octreotide.

    Science.gov (United States)

    Bushnell, David L; O'Dorisio, Thomas M; O'Dorisio, M Sue; Menda, Yusuf; Hicks, Rodney J; Van Cutsem, Eric; Baulieu, Jean-Louis; Borson-Chazot, Francoise; Anthony, Lowell; Benson, Al B; Oberg, Kjell; Grossman, Ashley B; Connolly, Mary; Bouterfa, Hakim; Li, Yong; Kacena, Katherine A; LaFrance, Norman; Pauwels, Stanislas A

    2010-04-01

    Metastatic carcinoid is an incurable malignancy whose symptoms, such as diarrhea and flushing, can be debilitating and occasionally life-threatening. Although symptom relief is available with octreotide, the disease eventually becomes refractory to octreotide, leaving no proven treatment options. The goal of this study was to evaluate the clinical effect of using (90)Y-edotreotide to treat symptomatic patients with carcinoid tumors. Patients enrolled had metastatic carcinoid, at least one sign/symptom refractory to octreotide, and at least one measurable lesion. Study treatment consisted of three cycles of 4.4 GBq (120 mCi) (90)Y-edotreotide each, once every 6 weeks. Ninety patients were enrolled in the study. Using Southwest Oncology Group tumor response criteria, 67 (74.%) of 90 patients (95% CI, 65.4% to 83.4%) were objectively stable or responded. A statistically significant linear trend toward improvement was demonstrated across all 12 symptoms assessed. Median progression-free survival was significantly greater (P = .03) for the 38 patients who had durable diarrhea improvement than the 18 patients who did not (18.2 v 7.9 months, respectively). Adverse events (AEs) were reported in 96.7% (87 of 90) of patients. These AEs consisted primarily of reversible GI events (76 of 90), which could be caused in part by concomitant administration of amino acid solution given to reduce radiation exposure to the kidneys. There was one case each of grade 3 oliguria and grade 4 renal failure, each lasting 6 days. (90)Y-edotreotide treatment improved symptoms associated with malignant carcinoid among subjects with no treatment alternatives. Treatment was well-tolerated and had an acceptable expected AE profile.

  6. Refractory Lesional Parietal Lobe Epilepsy: Clinical, Electroencephalographic and Neurodiagnostic Findings.

    Science.gov (United States)

    Kurşun, Oğuzhan; Karataş, Hülya; Dericioğlu, Neşe; Saygi, Serap

    2016-09-01

    Specialized centers, in the management and surgical treatment of medically refractory epilepsy, emphasize the importance of differentiating the varieties of localization related epilepsies. There has been considerable recent interest in temporal and frontal lobe epileptic syndromes and less attention has been paid to parietal and occipital lobe epilepsies. Here we report the clinical, electroencephalographic and neuroimaging characteristics of 46 patients with medically refractory lesional parietal lobe epilepsy who have been followed up for 1-10 years. In this study auras were reported in 78.3% of the patients and included sensory symptoms (72.2%), headache (36.1%), nausea and vomiting (36.1%), psychic symptoms (36.1%) and visual symptoms (16.6%). The most common ictal behavioral changes were paresthesia (69.6%) and focal clonic activity (39.1%). Tonic posture, various automatisms, head deviation, staring, sensation of pain and speech disturbances occurred to a lesser extent. Simple partial seizures were present in 69.6%. Complex partial seizures occurred in 43.5% and secondary generalized tonic clonic seizures were reported in 58.7% of the patients. Interictal routine EEG disclosed abnormal background activity in 1/3 of the patients. Nonlocalising epileptiform abnormalities were found in 34.8% of the patients. EEG findings were normal in 34.8% of the patients. The most common presumed etiologic factors were as follows: posttraumatic encephalomalacia, stroke, tumor, malformation of cortical development, atrophy, and arteriovenous malformation. Clinical, electrophysiological and neuroimaging features of the lesional symptomatic partial epilepsy patients may help us to localize the seizure focus in some patients with cryptogenic partial epilepsy. So that, the timing decision of the parietal lobe sampling with more invasive techniques like intracranial electrodes prior to epilepsy surgery would be easier.

  7. Randomized trial of TAS-102 for refractory metastatic colorectal cancer.

    Science.gov (United States)

    Mayer, Robert J; Van Cutsem, Eric; Falcone, Alfredo; Yoshino, Takayuki; Garcia-Carbonero, Rocio; Mizunuma, Nobuyuki; Yamazaki, Kentaro; Shimada, Yasuhiro; Tabernero, Josep; Komatsu, Yoshito; Sobrero, Alberto; Boucher, Eveline; Peeters, Marc; Tran, Ben; Lenz, Heinz-Josef; Zaniboni, Alberto; Hochster, Howard; Cleary, James M; Prenen, Hans; Benedetti, Fabio; Mizuguchi, Hirokazu; Makris, Lukas; Ito, Masanobu; Ohtsu, Atsushi

    2015-05-14

    Early clinical trials conducted primarily in Japan have shown that TAS-102, an oral agent that combines trifluridine and tipiracil hydrochloride, was effective in the treatment of refractory colorectal cancer. We conducted a phase 3 trial to further assess the efficacy and safety of TAS-102 in a global population of such patients. In this double-blind study, we randomly assigned 800 patients, in a 2:1 ratio, to receive TAS-102 or placebo. The primary end point was overall survival. The median overall survival improved from 5.3 months with placebo to 7.1 months with TAS-102, and the hazard ratio for death in the TAS-102 group versus the placebo group was 0.68 (95% confidence interval [CI], 0.58 to 0.81; P<0.001). The most frequently observed clinically significant adverse events associated with TAS-102 were neutropenia, which occurred in 38% of those treated, and leukopenia, which occurred in 21%; 4% of the patients who received TAS-102 had febrile neutropenia, and one death related to TAS-102 was reported. The median time to worsening performance status (a change in Eastern Cooperative Oncology Group performance status [on a scale of 0 to 5, with 0 indicating no symptoms and higher numbers indicating increasing degrees of disability] from 0 or 1 to 2 or more) was 5.7 months with TAS-102 versus 4.0 months with placebo (hazard ratio, 0.66; 95% CI, 0.56 to 0.78; P<0.001). In patients with refractory colorectal cancer, TAS-102, as compared with placebo, was associated with a significant improvement in overall survival. (Funded by Taiho Oncology-Taiho Pharmaceutical; RECOURSE ClinicalTrials.gov number, NCT01607957.).

  8. Endocytic pathway mediates refractoriness of insect Bactrocera dorsalis to RNA interference.

    Science.gov (United States)

    Li, Xiaoxue; Dong, Xiaolong; Zou, Cong; Zhang, Hongyu

    2015-03-03

    RNA interference (RNAi) is a powerful and convenient tool for sequence-specific gene silencing, and it is triggered by double-stranded RNA (dsRNA). RNAi can be easily achieved in many eukaryotes by either injecting or feeding dsRNAs. This mechanism has demonstrated its potential in fundamental research on genetics, medicine and agriculture. However, the possibility that insects might develop refractoriness to RNAi remains unexplored. In this study, we report that the oriental fruit fly, Bactrocera dorsalis, became refractory to RNAi using orally administered dsRNA targeting endogenous genes. Furthermore, refractoriness to RNAi is not gene-specific, and its duration depends on the dsRNA concentration. RNAi blockage requires the endocytic pathway. Fluorescence microscopy indicated that in RNAi refractory flies, dsRNA uptake is blocked. Genes involved in the entry of dsRNAs into cells, including chc, cog3, light and others, are down-regulated in RNAi refractory flies. Increasing the endocytic capacity by improving F-actin polymerization disrupts RNAi refractoriness after both primary and secondary dsRNA exposures. Our results demonstrate that an insect can become refractory to RNAi by preventing the entry of dsRNA into its cells.

  9. DEVELOPMENT OF NOVEL SPINEL REFRACTORIES FOR USE IN COAL GASIFICATION ENVIRONMENTS

    Energy Technology Data Exchange (ETDEWEB)

    Hemrick, James Gordon [ORNL; Armstrong, Beth L [ORNL; Rodrigues-Schroer, Angela [Minteq International, Inc.; Colavito, [Minteq International, Inc.; Smith, Jeffrey D [ORNL; O' Hara, Kelley [University of Missouri, Rolla

    2011-01-01

    Work has been performed by Oak Ridge National Laboratory (ORNL), in collaboration with industrial refractory manufacturer (Minteq International, Inc.), academic research partner (Missouri University of Science and Technology) and end users to employ novel refractory systems and techniques to reduce energy consumption of refractory lined vessels found in industries such as aluminum, chemical, glass, and pulp and paper. The objective of the project was to address the need for new innovative refractory compositions by developing a family of novel MgO-Al 2O3 spinel structured unshaped refractory compositions (castables, gunnables, shotcretes, etc) utilizing new aggregate materials, bond systems, protective coatings, and phase formation techniques. As part of the four-year project funded by the U.S. Department of Energy (DOE), materials have been developed specifically for coal gasification environments. Additionally, work has been performed to develop and apply low cost coatings using a colloidal approach for protection against corrosion attack of the refractory brick and to develop a light-weight back-up refractory system to help offset the high thermal conductivity inherent in spinel materials. This paper discusses the development of these materials, along with preliminary results achieved toward the reduction of chemical reactions and mechanical degradation by the service environment.

  10. DEVELOPMENT AND APPLICATION OF IMPROVED SHOTCTRETE REFRACTORY FOR ALUMINUM ROTARY FURNACE APPLICATIONS

    Energy Technology Data Exchange (ETDEWEB)

    Hemrick, James Gordon [ORNL; Rodrigues-Schroer, Angela [Minteq International, Inc.; Colavito, [Minteq International, Inc.; Smith, Jeffrey D [ORNL; O' Hara, Kelley [University of Missouri, Rolla

    2013-01-01

    Oak Ridge National Laboratory, in collaboration with refractory manufacturer Minteq International, Inc., academic partner Missouri University of Science and Technology and refractory end users have developed novel refractory systems and techniques to reduce energy consumption of refractory lined vessels. The objective of this U.S. DOE funded project was to address the need for innovative refractory compositions by developing novel gunnable refractory compositions for use in high temperature and high alkali environments. Developed materials utilized new aggregate materials, bond systems, protective coatings, and phase formation techniques. Under this project, materials were developed specifically for aluminum rotary dross furnace applications and a light-weight back-up refractory system was also developed to improve the thermal efficiency of the installed lining system. This paper discusses the systematic development of these materials, laboratory testing and evaluation of these materials, and the performance of several industrial trials performed using these newly developed materials. The success of the industrial trials will be highlighted and future areas of application of these materials discussed.

  11. Progression-free survival of two cases of high-risk neuroblastoma with refractory/relapsed disease following surgery alone.

    Science.gov (United States)

    Sokol, Elizabeth; Haut, Paul R; Gosiengfiao, Yasmin; Feinstein, Kate; Pytel, Peter; Cohn, Susan L

    2013-03-01

    Outcome for the vast majority of high-risk neuroblastoma patients with refractory or relapsed disease is dismal. We report two high-risk patients who remain progression-free for more than 113 and 18 months following the diagnosis of refractory/relapsed disease who were treated with surgery alone. Complete resolution of a refractory thoracic mass and relapsed liver nodules was observed in one patient. The refractory/relapsed disease in the second patient has remained stable. In both cases, the tumor showed histologic evidence of neuroblastoma maturation. These cases demonstrate that refractory/relapsed neuroblastoma is clinically heterogeneous and highlight the need for better biomarkers to optimize patient care.

  12. The Best of Both Worlds: Supply and Demand China's Role as a Source of Refractory Minerals for Global Markets

    Institute of Scientific and Technical Information of China (English)

    Mike O' Driscoll

    2003-01-01

    China has long been recognised as an important source of refractory raw materials for refractory markets worldwide.Bauxite,magnesia,fused alumina, and refractory clays in particular, have maintained China's strong position as the world's leading supplier of these minerals .However , important changes have taken place ir the structure of Chinese and global supply of these minerals. Moreover, the world refractory market and the minerals trading sector have also undergone a radical transformation that has influenced mineral supply , and shifted end product manufacture to China . This paper highlights these changes and sees how they have impacted on China as a world source of refractory minerals.

  13. Occupational exposure to natural radiation in zirconium refractory plants in Japan.

    Science.gov (United States)

    Iwaoka, Kazuki; Tabe, Hiroyuki; Suzuki, Toshikazu; Yonehara, Hidenori

    2013-02-01

    The authors measured the ambient dose rate and activity concentration of natural radionuclides in raw materials, products, and aerosols on worksites, as well as the (222)Rn and (220)Rn concentrations in an unshaped refractory, a shaped refractory, and an electrocast refractory plant processing zirconium ore in Japan. Estimations were made of the effective doses to plant workers. The activity concentration of the (238)U series in raw materials and products in the refractory plants was higher than the critical values (10 Bq g(-1) for (40)K and 1 Bq g(-1) for all other radionuclides of natural origin) specified in the International Atomic Energy Agency Safety Guide. The ambient dose rate in the raw material warehouse of the electrocast refractory plant was 0.75 μSv h(-1), which was the highest among all the worksites at all the refractory plants studied. The activity concentrations of aerosols in the product-output site of the unshaped refractory plant was 0.0015 Bq m for U and 0.00078 Bq m(-3) for (232)Th, which were the highest of all the worksites for all refractory plants. The indoor (222)Rn and (220)Rn concentrations in all worksites of all the refractory plants were almost the same levels as those in everyday indoor places in Japan. The maximum value of the effective dose to workers was 430 μSv y(-1), which was lower than the intervention exemption level (1,000 μSv y(-1)) specified in ICRP Publication 82.

  14. Clinical features and course of refractory anemia with ring sideroblasts associated with marked thrombocytosis

    Science.gov (United States)

    Broseus, Julien; Florensa, Lourdes; Zipperer, Esther; Schnittger, Susanne; Malcovati, Luca; Richebourg, Steven; Lippert, Eric; Cermak, Jaroslav; Evans, Jyoti; Mounier, Morgane; Raya, José Maria; Bailly, François; Gattermann, Norbert; Haferlach, Torsten; Garand, Richard; Allou, Kaoutar; Besses, Carlos; Germing, Ulrich; Haferlach, Claudia; Travaglino, Erica; Luno, Elisa; Pinan, Maria Angeles; Arenillas, Leonor; Rozman, Maria; Perez Sirvent, Maria Luz; Favre, Bernardine; Guy, Julien; Alonso, Esther; Ahwij, Nuhri; Jerez, Andrés; Hermouet, Sylvie; Maynadié, Marc; Cazzola, Mario; Girodon, François

    2012-01-01

    Background Refractory anemia with ring sideroblasts associated with marked thrombocytosis was proposed as a provisional entity in the 2001 World Health Organization classification of myeloid neoplasms and also in the 2008 version, but its existence as a single entity is contested. We wish to define the clinical features of this rare myelodysplastic/myeloproliferative neoplasm and to compare its clinical outcome with that of refractory anemia with ring sideroblasts and essential thrombocythemia. Design and Methods We conducted a collaborative retrospective study across Europe. Our database included 200 patients diagnosed with refractory anemia with ring sideroblasts and marked thrombocytosis. For each of these patients, each patient diagnosed with refractory anemia with ring sideroblasts was matched for age and sex. At the same time, a cohort of 454 patients with essential thrombocythemia was used to compare outcomes of the two diseases. Results In patients with refractory anemia with ring sideroblasts and marked thrombocytosis, depending on the Janus Kinase 2 V617F mutational status (positive or negative) or platelet threshold (over or below 600×109/L), no difference in survival was noted. However, these patients had shorter overall survival and leukemia-free survival with a lower risk of thrombotic complications than did patients with essential thrombocythemia (P<0.001) but better survival (P<0.001) and a higher risk of thrombosis (P=0.039) than patients with refractory anemia with ring sideroblasts. Conclusions The clinical course of refractory anemia with ring sideroblasts and marked thrombocytosis is better than that of refractory anemia with ring sideroblasts and worse than that of essential thrombocythemia. The higher risk of thrombotic events in this disorder suggests that anti-platelet therapy might be considered in this subset of patients. From a clinical point of view, it appears to be important to consider refractory anemia with ring sideroblasts and

  15. Refractory myasthenia gravis – clinical profile, comorbidities and response to rituximab

    Science.gov (United States)

    Sudulagunta, Sreenivasa Rao; Sepehrar, Mona; Sodalagunta, Mahesh Babu; Settikere Nataraju, Aravinda; Bangalore Raja, Shiva Kumar; Sathyanarayana, Deepak; Gummadi, Siddharth; Burra, Hemanth Kumar

    2016-01-01

    Introduction: Myasthenia gravis (MG) is an antibody mediated autoimmune neuromuscular disorder characterized by fatigable muscle weakness. A proportion of myasthenia gravis patients are classified as refractory due to non responsiveness to conventional treatment. This retrospective study was done to evaluate clinical profile, epidemiological, laboratory, and features of patients with MG and mode of management using rituximab and complications. Methods: Data of myasthenia gravis patients admitted or presented to outpatient department (previous medical records) with MG between January 2008 and January 2016 were included. A total of 512 patients fulfilled the clinical and diagnostic criteria of myasthenia gravis of which 76 patients met the diagnostic certainty for refractory myasthenia gravis and were evaluated. Results: Out of 76 refractory MG patients, 53 (69.73%) patients fulfilled all the three defined criteria. The median age of onset of the refractory MG group was 36 years with a range of 27–53 years. In our study 25 patients (32.89%) belonged to the age group of 21–30 years. Anti-MuSK antibodies were positive in 8 non-refractory MG patients (2.06%) and 36 refractory MG patients (47.36%). Mean HbA1C was found to be 8.6±2.33. The dose of administered prednisone decreased by a mean of 59.7% (p=3.3x10–8) to 94.6% (p=2.2x10–14) after the third cycle of rituximab treatment. Conclusion: The refractory MG patients are most commonly female with an early age of onset, anti-MuSK antibodies, and thymomas. Refractory MG patients have higher prevalence and poor control (HbA1C >8%) of diabetes mellitus and dyslipidemia probably due to increased steroid usage. Rituximab is very efficient in treatment of refractory MG with adverse effects being low. PMID:27790079

  16. Separating refractory and non-refractory particulate chloride and estimating chloride depletion by aerosol mass spectrometry in a marine environment

    Directory of Open Access Journals (Sweden)

    I. Nuaaman

    2015-01-01

    Full Text Available Aerosol composition and concentration measurements along the coast of California were obtained using an Aerodyne high-resolution time-of-flight aerosol mass spectrometer (HR-AMS onboard the research vessel Atlantis during the CalNex study in 2010. This paper focuses on the measurement of aerosol chloride using the HR-AMS that can be ambiguous in regions with significant quantities of sea salt aerosols. This ambiguity arises due to large differences in the sensitivity of the HR-AMS to refractory chloride species (i.e., NaCl and non refractory chloride species (i.e., NH4Cl, HCl, etc.. Using the HR-AMS, the aerosol chloride signal is typically quantified using ion signals for 35Cl+, H35Cl+, 37Cl+ and H37Cl+ (HxCl+. During this study, the highest aerosol chloride signal was observed during sea sweep experiments when the source of the aerosol chloride was NaCl present in artificially generated sea salt aerosols even though the HR-AMS has significantly lower sensitivity to such refractory species. Other prominent ion signals that arise from NaCl salt were also observed at m/z 22.99 for Na+ and m/z 57.96 for Na35Cl+ during both sea sweep experiments and during periods of ambient measurements. Thus, refractory NaCl contributes significantly to the HxCl+ signal, interfering with attempts to quantify non sea salt chloride (nssCl. It was found that during ambient aerosol measurements, the interference in the HxCl+ signal from sea salt chloride (ssCl was as high as 89%, but with a study wide average of 10%. The Na35Cl+ ion signal was found to be a good tracer for NaCl. We outline a method to establish nssCl in the ambient aerosols by subtracting the sea salt chloride (ssCl signal from the HxCl+ signal. The ssCl signal is derived from the Na35Cl+ ion tracer signal and the HxCl+ to Na35Cl+ ratio established from the sea sweep experiments. Ambient submicron concentrations of ssCl were also established using the

  17. Neostigmine in the treatment of refractory constipation in critically ill children.

    Science.gov (United States)

    González, Rafael; López-Herce, Jesús; García, Ana; Botrán, Marta; Solana, Maria Jose; Urbano, Javier

    2011-08-01

    Constipation is a common complication in critically ill children and it is occasionally resistant to the drugs typically used in treatment. Neostigmine has been used in some cases of refractory constipation in critically ill adults. There is no reference to its use in critically ill children. We describe 3 cases of refractory constipation in critically ill children treated with intravenous neostigmine by continuous infusion. Two patients responded well. There were no adverse effects. We conclude that continuous intravenous neostigmine can be effective in critically ill children with refractory constipation. Further studies are necessary to determine the dose and safety of the treatment.

  18. Prevalence of serum N-methyl-D-aspartate receptor autoantibodies in refractory psychosis.

    Science.gov (United States)

    Beck, Katherine; Lally, John; Shergill, Sukhwinder S; Bloomfield, Michael A P; MacCabe, James H; Gaughran, Fiona; Howes, Oliver D

    2015-02-01

    N-methyl-d-aspartate receptor (NMDA-R) autoantibodies have been reported in people with acute psychosis. We hypothesised that their presence may be implicated in the aetiology of treatment-refractory psychosis. We sought to ascertain the point prevalence of NMDA-R antibody positivity in patients referred to services for treatment-refractory psychosis. We found that 3 (7.0%) of 43 individuals had low positive NMDA-R antibody titres. This suggests that NMDA-R autoantibodies are unlikely to account for a large proportion of treatment-refractory psychosis.

  19. Environmental Problems Related to Refractories --Some Discussions Based on Historical Surveys mainly in Japan

    Institute of Scientific and Technical Information of China (English)

    Kiyoshi Sugita

    2005-01-01

    Major environmental problems related to refractories are discussed based on their historical studies mostly in Japan. Those issues have been experienced in a wide range of industrial scenes, from processing raw materials, making refractories to relining furnaces, handling after-use refractories.The key substances dealt with in this paper include, for example, suspended particulate, SOx and other exhaust gaseous emissions, hexa-valent chromium, and dioxin. The measures so far taken to avoid or reduce their influences upon environments are described with some future problems to be tackled.

  20. Improvement of castable refractories for RH snorkel; RH shinshitsukanyo futeikeizai no kaizen

    Energy Technology Data Exchange (ETDEWEB)

    Nishi, K.; Obana, T.; Fijii, T.; Shimizu, I. [Harima Ceramics Corp., Hyogo (Japan)

    1999-11-01

    Relating to corrosion of RH submerged nozzle, resistance against iron oxide of monolithic refractories was examined. Corrosion and seepage of refractories were measured by rotating corrosion, refractories include alumina-spinel castable, which is applied to RH under tank, and alumina-magnesia castable, which is generally used for RH, submerged nozzle. Alumina-spinel castable is superior in resistance against iron oxide than alumina-magnesia castable, and the resistance decreased with increase of stainless fiber addition to castable. Alumina-spinel castable without stainless fiber was suitable for bottom end of the dipping pipe. (NEDO)